Patients' perspectives related to ethical issues and risks in precision medicine: a systematic review

Mechanistic study of cancer drug delivery: Current techniques, limitations, and future prospects

Cancer drug delivery remains a critical challenge with systemic toxicity, poor drug bioavailability, and a lack of effective targeting. Overcoming these barriers is essential for improving treatment efficacy and patient outcomes. This review discusses current drug delivery techniques that reshape cancer therapy by offering precise, controlled-release tailored to tumor-specific features. Innovations in nanotechnology, immunotherapy, and gene therapy enable interventions at molecular and cellular levels. Radiomics and pathomics integrate high-dimensional data to optimize diagnostics and treatment planning. Combination therapy addresses the complexities of tumor heterogeneity by synergizing multiple agents within a single therapeutic framework, while peptide-drug conjugates enhance specificity and potency. Hydrogel-based systems and microneedle arrays offer localized, sustained release, significantly improving therapeutic outcomes. However, clinical translation of these advancements faces significant barriers such as drug resistance, off-target effects, scalability, cost, and ethical concerns. Moreover, regulatory complexities and the economic feasibility of these therapies highlight the need for innovative frameworks to make them accessible globally. Therefore, there is a need for innovation in gene and cell therapy, next-generation drug delivery platforms, and personalized medicine. This review focuses on recent advancements in drug delivery techniques over the past decade, evaluating their limitations and exploring potential future directions for transforming cancer treatment.

Barriers to and facilitators of clinician acceptance and use of artificial intelligence in healthcare settings: a scoping review

OBJECTIVES

This study aimed to systematically map the evidence and identify patterns of barriers and facilitators to clinician artificial intelligence (AI) acceptance and use across the types of AI healthcare application and levels of income of geographic distribution of clinician practice.

DESIGN

This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.

DATA SOURCES

PubMed and Embase were searched from 2010 to 21 August 2023.

ELIGIBILITY CRITERIA

This scoping review included both empirical and conceptual studies published in peer-reviewed journals that focused on barriers to and facilitators of clinician acceptance and use of AI in healthcare facilities. Studies that involved either hypothetical or real-life applications of AI in healthcare settings were included. Studies not written in English and focused on digital devices or robots not supported by an AI system were excluded.

DATA EXTRACTION AND SYNTHESIS

Three independent investigators conducted data extraction using a pre-tested tool meticulously designed based on eligibility criteria and constructs of the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to systematically summarise data. Subsequently, two independent investigators applied the framework analysis method to identify additional barriers to and facilitators of clinician acceptance and use in healthcare settings, extending beyond those captured by UTAUT.

RESULTS

The search identified 328 unique articles, of which 46 met the eligibility criteria, including 44 empirical studies and 2 conceptual studies. Among these, 32 studies (69.6%) were conducted in high-income countries and 9 studies (19.6%) in low-income and middle-income countries (LMICs). In terms of the types of healthcare settings, 21 studies examined primary care, 26 focused on secondary care and 21 reported on tertiary care. Overall, drivers of clinician AI acceptance and use were ambivalent, functioning as either barriers or facilitators depending on context. Performance expectancy and facilitating conditions emerged as the most frequent and consistent drivers across healthcare contexts. Notably, there were significant gaps in evidence examining the moderator effect of clinician demographics on the relationship between drivers and AI acceptance and use. Key themes not encompassed by the UTAUT framework included physician involvement as a facilitator and clinician hesitancy and legal and ethical considerations as barriers. Other factors, such as conclusiveness, relational dynamics, and technical features, were identified as ambivalent drivers. While clinicians' perceptions and experiences of these drivers varied across primary, secondary and tertiary care, there was a notable lack of evidence exclusively examining drivers of clinician AI acceptance in LMIC clinical practice.

CONCLUSIONS

This scoping review highlights key gaps in understanding clinician acceptance and use of AI in healthcare, including the limited examination of individual moderators and context-specific factors in LMICs. While universal determinants such as performance expectancy and facilitating conditions were consistently identified across settings, factors not covered by the UTAUT framework such as clinician hesitancy, relational dynamics, legal and ethical considerations, technical features and clinician involvement emerged with varying impact depending on the level of healthcare context. These findings underscore the need to refine frameworks like UTAUT to incorporate context-specific drivers of AI acceptance and use. Future research should address these gaps by investigating both universal and context-specific barriers and expanding existing frameworks to better reflect the complexities of AI adoption in diverse healthcare settings.

Implementing Personalized Cancer Medicine: Insights from a Qualitative Interview Study

Background: Personalized cancer medicine (PCM) tailors cancer treatments based on individual genetic profiles, enabling more precise and effective therapies. Despite its potential, integrating PCM into clinical practice remains challenging because of organizational and systemic barriers. This study examined the factors influencing PCM implementation at a major cancer center in Stockholm, Sweden. Methods: We conducted semi-structured interviews with 16 medical professionals and management staff from Karolinska University Hospital and Karolinska Institutet. Content analysis was used to identify key themes related to PCM implementation. This study followed the established Consolidated Criteria for Reporting Qualitative Research guidelines to ensure methodological rigor and transparency. Results: Informants framed PCM as both a technological innovation and a patient-centered approach. However, significant barriers to implementation were identified, including organizational inertia, fragmented funding models, and ethical challenges related to access and equity. Structural silos between academic and healthcare institutions complicate integration. Key facilitators include leadership commitment, cross-sectoral collaboration, and a supportive policy environment. Participants emphasized the need for integrated infrastructure, real-time data-sharing mechanisms, and interdisciplinary training programs to support PCM. Conclusions: Successful PCM implementation requires overcoming entrenched organizational and systemic barriers through a multi-stakeholder approach involving healthcare providers, researchers, policymakers, and patient advocates. The findings underscore the necessity of a "third-form organization" to mediate between academia and clinical care. Addressing these challenges requires adaptive governance models, evidence-based policy reforms, and sustainable funding frameworks. Future research should explore comparative contexts to enhance the scalability and generalizability of PCM integration strategies.

Trusted partners, community priorities, and data protections: requirements for precision medicine research with Alaska Native peoples

Precision medicine holds promise for improving health care by tailoring disease treatment and prevention efforts to the needs of individual patients. It also raises ethical questions related to equitable distribution of the benefits of precision medicine; data management, including the terms of data ownership, sharing, and security; and, the nature and extent of community engagement in and oversight of research. These questions are particularly salient for minoritized communities that have been harmed by unethical research practices and often deprived the full benefit of advances in medical science. Understanding the perspectives of these communities is essential to the design and conduct of ethical and effective precision medicine research. This study explored perspectives on the acceptability, feasibility, value, and benefits and harms of precision medicine research among Alaska Native and American Indian (ANAI) peoples. We conducted four focus groups with ANAI individuals who receive primary care from a Tribal health organization in Anchorage, Alaska. Participants were willing to engage in precision medicine research provided specific requirements were met. Research must be conducted by the Tribal health organization or another trusted partner, community health priorities must drive the research agenda, and researchers must employ robust data protections to guard against loss of data security and maintain control over data use and access. These requirements work collectively to ensure research benefits and respects Tribal sovereignty. These findings could help inform efforts to design and implement precision medicine research programs tailored to concerns of ANAI peoples.

Digital Health Technologies in Pediatric Infectious Disease and the Perspective of Patients and Healthcare Professionals: A Review

BACKGROUND AND AIMS

Pediatric infectious diseases pose a global health challenge, causing 13.7 million deaths in 2019 and three million in children under four. Early recognition and management are vital, and challenges in effectively addressing this persist, particularly in resource-limited areas. Digital health tools, such as telemedicine and mHealth, offer promising solutions. In this review, we aim to evaluate digital health applications in managing pediatric infectious diseases from patient and healthcare perspectives.

METHODS

A literature search was conducted using PubMed, Google Scholar, and Scopus with keywords including "digital health," "telemedicine," and "pediatric infectious disease." Studies published up to January 2024 were included and critically reviewed.

RESULTS

Digital health technologies aid in real-time monitoring and early diagnosis of infectious diseases, improving access to specialized care for pediatric populations. Tools like telemedicine and mHealth enhance communication between patients, caregivers, and physicians, facilitating shared decision-making. Wearable devices and mobile applications enable proactive health management and timely interventions. Despite access challenges in resource-limited settings, caregivers report benefits such as improved healthcare coordination, reduced delays in care, and better health outcomes for children.

CONCLUSION

Digital health shows promise in addressing pediatric infectious disease management, particularly in resource-limited settings, enhancing outcomes through timely interventions and better communication.

Prenatal gene editing for neurodevelopmental diseases: Ethical considerations

Neurodevelopmental diseases (NDDs) are notoriously difficult to treat because clinical symptoms stem from developmental processes that begin before birth. Prenatal gene editing could fill the treatment gap for NDDs by targeting and permanently correcting the genetic variants that underlie these pathogenic developmental processes. At the same time, there is a risk of unintended edits to the fetus or the pregnant person that could result in serious adverse consequences that are difficult, if not impossible, to undo. This raises ethical concerns that make the development of prenatal gene editing especially challenging. To date, there are no frameworks for considering the steps necessary for an ethical path forward for prenatal gene editing specifically. The 60-year history of in utero therapy has included the development of frameworks for other therapies that can provide starting points for addressing the unique issues of prenatal gene editing. We identified 12 themes from 17 ethical frameworks, literature, consensus statements, and government reports on prenatal interventions that could set precedents for prenatal gene editing interventions. In considering these alongside current criteria for postnatal gene therapies for NDDs, we discuss a path forward for prenatal gene editing interventions of NDDs.

Exploiting omic-based approaches to decipher Traditional Chinese Medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese Medicine (TCM), an ancient health system, faces significant research challenges due to the complexity of its active components and targets, as well as a historical lack of detailed annotation. However, recent advances in omics technologies have begun to unravel these complexities, providing a more informed and nuanced understanding of TCM's therapeutic potential in contemporary healthcare.

AIM OF THE REVIEW

This review summarizes the application of omics technologies in TCM modernization, emphasizing components analysis, quality control, biomarker discovery, target identification, and treatment optimization. In addition, future perspectives on using omics for precision TCM treatment are also discussed.

MATERIALS AND METHODS

We have explored several databases (including PubMed, ClinicalTrials, Google Scholar, and Web of Science) to review related articles, focusing on Traditional Chinese Medicine, Omics Strategy, Precision Medicine, Biomarkers, Quality Control, and Molecular Mechanisms. Paper selection criteria involved English grammar, publication date, high citations, and broad applicability, exclusion criteria included low credibility, non-English publications, and those full-text inaccessible ones.

RESULTS

TCM and the popularity of Chinese herbal medicines (CHMs) are gaining increasing attention worldwide. This is driven, in part, by a large number of technologies, especially omics strategy, which are aiding the modernization of TCM. They contribute to the quality control of CHMs, the identification of cellular targets, discovery of new drugs and, most importantly, the understanding of their mechanisms of action.

CONCLUSION

To fully integrate TCM into modern medicine, further development of robust omics strategies is essential. This vision includes personalized medicine, backed by advanced computational power and secure data infrastructure, to facilitate global acceptance and seamless integration of TCM practices.

AI-Reinforced Wearable Sensors and Intelligent Point-of-Care Tests

Artificial intelligence (AI) techniques offer great potential to advance point-of-care testing (POCT) and wearable sensors for personalized medicine applications. This review explores the recent advances and the transformative potential of the use of AI in improving wearables and POCT. The integration of AI significantly contributes to empowering these tools and enables continuous monitoring, real-time analysis, and rapid diagnostics, thus enhancing patient outcomes and healthcare efficiency. Wearable sensors powered by AI models offer tremendous opportunities for precise and non-invasive tracking of physiological conditions that are essential for early disease detection and personalized treatments. AI-empowered POCT facilitates rapid, accurate diagnostics, making these medical testing kits accessible and available even in resource-limited settings. This review discusses the key advances in AI applications for data processing, sensor fusion, and multivariate analytics, highlighting case examples that exhibit their impact in different medical scenarios. In addition, the challenges associated with data privacy, regulatory approvals, and technology integrations into the existing healthcare system have been overviewed. The outlook emphasizes the urgent need for continued innovation in AI-driven health technologies to overcome these challenges and to fully achieve the potential of these techniques to revolutionize personalized medicine.

Genetic testing in psychiatry, the perceptions of healthcare workers and patients: a mini review

Background

Genetic testing in psychiatry has gained attention, raising questions about its application and impact. Understanding stakeholders' perspectives, including healthcare providers and patients, is vital for informed policy development. The aim of this systematic review was to focus on the perceptions and concerns of patients and healthcare workers in psychiatry regarding the use of genetic testing.

Methods

We conducted a systematic review following PRISMA guidelines, for the period 1/2/2014, to 1/1/2024, via PubMed and Embase databases identifying 50 articles in total. After excluding duplicates (n = 12), 38 articles went through screening. After careful full-text article assessment for eligibility and applying the inclusion and exclusion criteria, only fifteen (n = 15) of the articles were included.

Results

Among 15 selected studies involving 3,156 participants (2,347 healthcare professionals; 809 patients), thematic analysis identified four primary themes: Organizational-implementation concerns, Ethical Considerations, Concerns on changes in clinical praxis, and Legal implications. Despite these concerns, seven out of eleven studies indicated that healthcare workers viewed genetic testing in psychiatry positively. Patients' perspectives varied, with two of the four studies reflecting positive attitudes. No pervasive negative sentiment was observed.

Conclusion

Our review highlights the multidimensional perspectives of healthcare professionals and patients surrounding the application of genetic testing in psychiatry. These considerations need to be addressed to facilitate the implementation of genetic testing in clinical praxis in psychiatry. Further research is needed for validation of the results and to guide policies and clinicians in the integration of genetic testing into mental healthcare practice.

Knee Arthroscopy in the Era of Precision Medicine: A Comprehensive Review of Tailored Approaches and Emerging Technologies

Knee arthroscopy, a minimally invasive procedure, has transformed the treatment of knee pathologies by enabling direct visualization and management with minimal tissue disruption. Recent advances in precision medicine have introduced a new dimension to this field, allowing for highly individualized surgical approaches considering each patient's unique genetic, environmental, and biomechanical characteristics. This review explores the integration of precision medicine into knee arthroscopy, focusing on tailored approaches and emerging technologies. Key innovations such as robotic-assisted surgery, advanced imaging, and patient-specific instrumentation have enhanced surgical accuracy and patient outcomes, reduced recovery times, and minimized postoperative complications. The review also examines the role of biomarkers in guiding personalized treatment strategies, including ligament reconstructions, meniscal repairs, and cartilage restoration, which are now being refined to cater to the specific needs of individual patients. While the benefits of these innovations are clear, there are challenges to widespread adoption, including cost, resource allocation, and the need for further research to validate the efficacy of precision-driven approaches in knee arthroscopy. Moreover, the ethical considerations surrounding personalized medicine, such as patient privacy and genetic data usage, must also be addressed. Despite these barriers, the future of knee arthroscopy in the era of precision medicine holds great promise, with ongoing developments in artificial intelligence, genomics, and biomarker discovery poised to further refine patient-centered care. This comprehensive review provides valuable insights into how precision medicine reshapes knee arthroscopy, offering a glimpse into the future of more targeted and effective orthopedic interventions. By embracing these advancements, surgeons and healthcare providers can ensure optimal outcomes for patients undergoing knee arthroscopy.

Tumor Cell Communications as Promising Supramolecular Targets for Cancer Chemotherapy: A Possible Strategy

Fifty-two years have passed since President Nixon launched the "War on Cancer". Despite unparalleled efforts and funds allocated worldwide, the outlined goals were not achieved because cancer treatment approaches such as chemotherapy, radiation therapy, hormonal and targeted therapies have not fully met the expectations. Based on the recent literature, a new direction in cancer therapy can be proposed which targets connections between cancer cells and their microenvironment by chemical means. Cancer-stromal synapses such as immunological synapses between cancer and immune cells provide an attractive target for this approach. Such synapses form ligand-receptor clusters on the interface of the interacting cells. They share a common property of involving intercellular clusters of spatially proximate and cooperatively acting proteins. Synapses provide the space for the focused intercellular signaling molecules exchange. Thus, the disassembly of cancer-stromal synapses may potentially cause the collapse of various tumors. Additionally, the clustered arrangement of synapse components offers opportunities to enhance treatment safety and precision by using targeted crosslinking chemical agents which may inactivate cancer synapses even in reduced concentrations. Furthermore, attaching a cleavable cell-permeable toxic agent(s) to a crosslinker may further enhance the anti-cancer effect of such therapeutics. The highlighted approach promises to be universal, relatively simple and cost-efficient. We also hope that, unlike chemotherapeutic and immune drugs that interact with a single target, by using supramolecular large clusters that include many different components as a target, the emergence of a resistance characteristic of chemo- and immunotherapy is extremely unlikely.

2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda

OBJECTIVES

Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM.

METHODS

We held a conference to (1) define precision EM, (2) develop an evidence-based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus-building process.

RESULTS

A total of 217 individuals participated in this initiative, of whom 115 were conference-day attendees. Consensus-building activities yielded a definition of precision EM and key research questions that comprised a new 10-year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty.

CONCLUSIONS

A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain.

Ethical frameworks of informed consent in the age of pediatric precision medicine

Precision medicine is an emergent medical paradigm that uses information technology to inform the use of targeted therapies and treatments. One of the first steps of precision medicine involves acquiring the patient's informed consent to protect their rights to autonomous medical decision-making. In pediatrics, there exists mixed recommendations and guidelines of consent-related practices designed to safeguard pediatric patient interests while protecting their autonomy. Here, we provide a high-level, clinical primer of (1) ethical informed consent frameworks widely used in clinical practice and (2) promising modern adaptations to improve informed consent practices in pediatric precision medicine. Given the rapid scientific advances and adoption of precision medicine, we highlight the dual need to both consider the clinical implementation of consent in pediatric precision medicine workflows as well as build rapport with pediatric patients and their substitute decision-makers working alongside interdisciplinary health teams.

How to translate genetic findings into clinical applications in spondyloarthritis?

Spondyloarthritis (SpA) is characterized by a strong genetic predisposition evidenced by the identification of up to 50 susceptibility loci, in addition to HLA-B27, the major genetic factor associated with the disease. These loci have not only deepened our understanding of disease pathogenesis but also offer the potential to improve disease management. Diagnostic delay is a major issue in SpA. HLA-B27 testing is widely used as diagnostic biomarker in SpA but its predictive value is limited. Several attempts have been made to develop more sophisticated polygenic risk score (PRS). However, these scores currently offer very little improvement as compared to HLA-B27 and are still difficult to implement in clinical routine. Genetics might also help to predict disease outcome including treatment response. Several genetic variants have been reported to be associated with radiographic damage or with poor response to TNF blockers, unfortunately with lack of coherence across studies. Large-scale studies should be conducted to obtain more robust findings. Genetic and genomic evidence in complex diseases can be further used to support the identification of new drug targets and to repurpose existing drugs. Although not fully driven by genetics, development of IL-17 blockers has been facilitated by the discovery of the association between IL23R variants and SpA. Development of recent approaches combining GWAS findings with functional genomics will help to prioritize new drug targets in the future. Although very promising, translational genetics in SpA remains challenging and will require a multidisciplinary approach that integrates genetics, genomics, immunology, and clinical research.

The Buzz Surrounding Precision Medicine: The Imperative of Incorporating It into Evidence-Based Medical Practice

Precision medicine (PM), through the integration of omics and environmental data, aims to provide a more precise prevention, diagnosis, and treatment of disease. Currently, PM is one of the emerging approaches in modern healthcare and public health, with wide implications for health care delivery, public health policy making formulation, and entrepreneurial endeavors. In spite of its growing popularity and the buzz surrounding it, PM is still in its nascent phase, facing considerable challenges that need to be addressed and resolved for it to attain the acclaim for which it strives. In this article, we discuss some of the current methodological pitfalls of PM, including the use of big data, and provide a perspective on how these challenges can be overcome by bringing PM closer to evidence-based medicine (EBM). Furthermore, to maximize the potential of PM, we present real-world illustrations of how EBM principles can be integrated into a PM approach.

Precision medicine in nasopharyngeal carcinoma: comprehensive review of past, present, and future prospect

Nasopharyngeal carcinoma (NPC) is an aggressive malignancy with high propensity for lymphatic spread and distant metastasis. It is prominent as an endemic malignancy in Southern China and Southeast Asia regions. Studies on NPC pathogenesis mechanism in the past decades such as through Epstein Barr Virus (EBV) infection and oncogenic molecular aberrations have explored several potential targets for therapy and diagnosis. The EBV infection introduces oncoviral proteins that consequently hyperactivate many promitotic pathways and block cell-death inducers. EBV infection is so prevalent in NPC patients such that EBV serological tests were used to diagnose and screen NPC patients. On the other hand, as the downstream effectors of oncogenic mechanisms, the promitotic pathways can potentially be exploited therapeutically. With the apparent heterogeneity and distinct molecular aberrations of NPC tumor, the focus has turned into a more personalized treatment in NPC. Herein in this comprehensive review, we depict the current status of screening, diagnosis, treatment, and prevention in NPC. Subsequently, based on the limitations on those aspects, we look at their potential improvements in moving towards the path of precision medicine. The importance of recent advances on the key molecular aberration involved in pathogenesis of NPC for precision medicine progression has also been reported in the present review. Besides, the challenge and future outlook of NPC management will also be highlighted.