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Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus

A portion of a simplified entity-relationship diagram for a relational database is shown displaying the 1st-, 2nd- and 3rd-order information entities of a generic patient-specific model and a 4th-order entity: hepatocellular carcinoma. INT integer; VARCHAR includes text [characters, numbers and punctuation].
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Figure 5: A portion of a simplified entity-relationship diagram for a relational database is shown displaying the 1st-, 2nd- and 3rd-order information entities of a generic patient-specific model and a 4th-order entity: hepatocellular carcinoma. INT integer; VARCHAR includes text [characters, numbers and punctuation].

Mentions: In the preceding sections, we have defined the current state of knowledge, as well as the limits of our knowledge, with respect to HCC. To advance PPPM, we will be examining HCC from a more integrated point of view, combining epidemiology, risk factors, infectious etiologies, pathology, microenvironment and biomarkers, screening and diagnostic technologies and treatment modalities (single, combined and/or sequential). The IEs identified will be used in organizing and populating the databases required for the development of the DPMs and MEBNs for an ITS-PM, as described above.First- and second-order IEs for the generic PSM for HCC are identified in the first two columns in Figure 5. The attributes of these entities may be obtained through links with the appropriate databases, spreadsheets, electronic medical records (EMRs) and repositories, for example, by means of the functionalities of a TIMMS. These first- and second-order IEs are broken down into third-order IEs and further subdivisions that include the vast, and continually expanding, list of patient-related information.Fourth- and fifth-order IEs for HCC, as identified in ‘Review of HCC and its current management’ section of this article, are identified in Figure 6. The attributes of these entities may also be determined through links with the appropriate databases, spreadsheets, electronic medical records (EMRs) and repositories by means of TIMMS functionalities.Figure 7 identifies fourth- and fifth-order IEs for HCC relating to potential biomarkers and targeted therapies. It is postulated that a comprehensive DPM incorporating the combined IEs will provide insights facilitating and enhancing diagnosis and treatment of HCC, as well as providing a means of handling research data relating to epidemiology, virology and pathology at the anatomic, molecular and genetic levels.


Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine.

Berliner L, Lemke HU, vanSonnenberg E, Ashamalla H, Mattes MD, Dosik D, Hazin H, Shah S, Mohanty S, Verma S, Esposito G, Bargellini I, Battaglia V, Caramella D, Bartolozzi C, Morrison P - EPMA J (2014)

A portion of a simplified entity-relationship diagram for a relational database is shown displaying the 1st-, 2nd- and 3rd-order information entities of a generic patient-specific model and a 4th-order entity: hepatocellular carcinoma. INT integer; VARCHAR includes text [characters, numbers and punctuation].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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getmorefigures.php?uid=PMC4274760&req=5

Figure 5: A portion of a simplified entity-relationship diagram for a relational database is shown displaying the 1st-, 2nd- and 3rd-order information entities of a generic patient-specific model and a 4th-order entity: hepatocellular carcinoma. INT integer; VARCHAR includes text [characters, numbers and punctuation].
Mentions: In the preceding sections, we have defined the current state of knowledge, as well as the limits of our knowledge, with respect to HCC. To advance PPPM, we will be examining HCC from a more integrated point of view, combining epidemiology, risk factors, infectious etiologies, pathology, microenvironment and biomarkers, screening and diagnostic technologies and treatment modalities (single, combined and/or sequential). The IEs identified will be used in organizing and populating the databases required for the development of the DPMs and MEBNs for an ITS-PM, as described above.First- and second-order IEs for the generic PSM for HCC are identified in the first two columns in Figure 5. The attributes of these entities may be obtained through links with the appropriate databases, spreadsheets, electronic medical records (EMRs) and repositories, for example, by means of the functionalities of a TIMMS. These first- and second-order IEs are broken down into third-order IEs and further subdivisions that include the vast, and continually expanding, list of patient-related information.Fourth- and fifth-order IEs for HCC, as identified in ‘Review of HCC and its current management’ section of this article, are identified in Figure 6. The attributes of these entities may also be determined through links with the appropriate databases, spreadsheets, electronic medical records (EMRs) and repositories by means of TIMMS functionalities.Figure 7 identifies fourth- and fifth-order IEs for HCC relating to potential biomarkers and targeted therapies. It is postulated that a comprehensive DPM incorporating the combined IEs will provide insights facilitating and enhancing diagnosis and treatment of HCC, as well as providing a means of handling research data relating to epidemiology, virology and pathology at the anatomic, molecular and genetic levels.

Bottom Line: We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient.An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists.The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

View Article: PubMed Central - HTML - PubMed

Affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.

ABSTRACT
Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

No MeSH data available.


Related in: MedlinePlus