Naveed Saleh, MD, MS, for MDLinx | November 15, 2019
The Cleveland Clinic recently announced its annual list of the top 10 medical innovations for 2019 at the 2018 Medical Innovation Summit, held in Cleveland, OH. The advances, which are expected to enhance health care, were selected by a panel of Cleveland Clinic physicians and scientists.
Let’s take a closer look at these innovations with a focus on how they could change your practice of medicine.
1. Pharmacogenomic testing
Pharmacogenomic testing determines patients’ genetic makeup to tailor prescribed medical treatments based on individual drug metabolism. Pharmacogenomic testing, for example, can determine how patients will respond to opioid therapy, potentially decreasing opioid abuse.
Outside clinical consensus on the benefits of pharmacogenomic testing is split, with some experts optimistic about the technology and others pessimistic. Clinicians have been slow to implement pharmacogenomics, despite technological advances in the field and greater access to genetic testing. Stakeholders in the United States and Europe are examining the clinical utility of pharmacogenomics and establishment of appropriate guidelines.
2. Artificial intelligence
The Encyclopedia Britannica defines artificial intelligence (AI) as “the ability of a digital computer or computer-controlled robot to perform tasks commonly associated with intelligent beings. The term is frequently applied to the project of developing systems endowed with the intellectual processes characteristic of humans, such as the ability to reason, discover meaning, generalize, or learn from past experience.”
Although AI technologies have matched human performance of tasks, such as mathematical calculations or playing chess, they have yet to match human adeptness at covering wide domains of information.
With respect to health care, AI can assist medical diagnosis and aid physicians in identifying pathology on diagnostic scans. Furthermore, AI can help interpret mounds of electronic health data.
3. Treatment of acute stroke
In 2018, the American Heart Association (AHA) and the American Stroke Association (ASA) released new guidelines for patients with acute stroke. One big revision was the recommendation for an extended window for the treatment of stroke.
Here is a summary of the change, according to the American Heart Association Stroke Council:
“These 2018 guidelines are an update to the 2013 guidelines, which were published prior to the six positive ‘early window’ mechanical thrombectomy trials (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT, SWIFT PRIME, THRACE) that emerged in 2015 and 2016. In addition, in the last 3 months, two trials (DAWN and DEFUSE 3) showed a clear benefit of ‘extended window’ mechanical thrombectomy for certain patients with large vessel occlusion who could be treated out to 16-24 hours.”
Immunotherapy has revolutionized cancer treatment by leveraging the immune system to fight tumors. In particular, immune checkpoint inhibitors have demonstrated great potential in the treatment of solid-tumor types, such as melanoma and non-small cell lung cancer. The hope is that someday immunotherapy options will exist for all types of tumors.
5. 3-D printing
3-D printing allows the user to create health products specific to the patient, including prosthetics, implants, and airway stents. These customized creations enhance comfort and performance because they are modeled after the patient’s body measurements, while offering minimal risk of postoperative complications. 3-D printing also has applications in surgical planning, such as with heart surgery or even face transplant.
6. Virtual reality/mixed reality
Virtual reality/mixed reality (VR/MR) applications have become popular in medical education. With its immersive approach, VR/MR is good for all kinds of learners: audio, visual, and kinesthetic.
VR is a completely computer-generated version of the world and requires the use of VR goggles. MR, or augmented reality, superimposes computer-generated images or sounds onto real-world settings and needs only be displayed on a screen.
VR/MR permits medical students to experience and learn from life-and-death scenarios in a low-stakes environment. Other applications of VR/MR include surgical simulation and diagnostic imaging.
7. Stroke visor
In 2018, the FDA cleared the Cerebrotech Visor, which is a noninvasive spectroscopy device that measures changes in the distribution of cerebral fluids and couples these findings with machine-learning to enhance algorithms and detect certain brain pathologies, such as stroke, trauma, and swelling.
In particular, this technology helps detect hemorrhagic stroke, which—although less common than ischemic stroke—accounts for 40% of stroke deaths.
8. Robotic surgery
Robotic approaches to surgery are less invasive and faster, and are often associated with improved clinical outcomes, such as decreased recovery time and reduced pain. Robotic approaches to surgery also guide surgeons in the operating room. Currently, robotic surgery is used in a gamut of procedures from spine to endovascular.
For instance, the da Vinci Surgical System, which is probably the best-known robotic surgery platform, translates the surgeon’s hand movements to smaller movements made by the robot inside the body, all visualized via laparoscopy. The da Vinci System has been used on more than 3 million patients globally.
9. Heart valve replacement
Advances in technology now allow for the performance of heart surgery percutaneously. Replacement of the aortic, mitral, or tricuspid valves via catheter obviate the need for open-heart surgery and improves surgery results.
10. RNA therapeutics
RNA therapeutics stymie RNA genetic abnormalities before these abnormalities are translated into functioning or nonfunctioning proteins. Examples of this technology include antisense nucleotides and RNA interference, and are applicable to rare genetic diseases, cancer, and neurologic illness.