转化医学中的数字医学-杨胜利

转化医学的目标
更精确的预警与诊断 更有效的干预和治疗 降低发病率、推迟发病平均年令 提高冶愈率、减少重症病人 降低医疗的综合成本 提高人民的健康水平和生活质量
转化医学的主要研究内容
从基因组到3P医学 数字医学 (3P---4P)
系统医学的主要研究内容
个体基因组
疾病的全基因组关联研究
基因、环境和生活方式相互作用的动态变化
Transforming Medicine via Digital Innovation
Eric J. Topol Science Translational Medicine Volume 2 Issue 16: 1-3(2010)
The lack of plasticity of the medical profession and health care system in the face of new technology and information is about to be challenged on two major fronts in digital medicine: wireless technologies and genomics. Whereas the 2000s saw the introduction of digital life-style devices, the 2010s will probably be known as the era of digital medical devices. These devices have exceptional promise for changing the future of medicine because of their ability to produce exquisitely detailed individual biological and physiological data.
Airstrip Technologies
Remote continuous vital sign monitoring via the iPhone.
This software delivers real-time data about the vital signs (including blood pressure, heart rhythm and rate, blood oxygen level, and body temperature) of any patient who is in a hospital intensive care unit to a doctor’s or nurse’s smart phone
转化医学
由实验室到临床 (B to B)
由人类基因组到4P医学 由科学发现到社区卫生
人类基因组计划
〝将使多数人类疾病的诊断、预防、和治疗发生 革命性变化〞
克林顿 2000年6月26日
转化医学的战略
将生命科学和生物技术及相关的现代科学技术整
合、凝聚到4P医学，推动医疗改革、提高人民的
健康水平和生活质量
转化医学中的数字医学
杨 胜 利 中国科学院上海生命科学研究院
转化医学---战略需求
医学模式转换
医疗改革
迎接二十一世纪的挑战
二十一世纪的医学不应该继续以疾病为主要研
究领域,应当以人类的健康为主要研究方向
世界卫生组织
健康问题不能光靠打针吃药
陈竺
重申卫生事业模式要转换，要从大病晚期治疗 为主向预防为主转变，关口前移、重心下沉 加强公共卫生体系建设、加强预防医学是我国 也是全球医学模式转换的重大课题。
Medicine in the 21th century 二十一世纪的医学
4P Medicine
Predictive medicine
Preventive medicine Personalized medicine Participatory medicine
预测医学
预防医学 个性化医学 参与医学
N0. 1 of the Time’s invention of 2008
数字医学
提高预防、医疗系统质量和效率的新战略 建立高效、低成本的医学卫生系统 推动3P医学到4P医学
Digital Medicine
Standardized interfaces and shared components
Closely related activities in health care and research
Standards and initiatives
Liberating Health Data for Clinical Research Applications
Jessica J. Nadler and Gregory J. Downing* Science Translational Medicine Volume 2 Issue 18 18cm6(2010)
Open mHealth Architecture: An Engine for Health Care Innovation
Deborah Estrin and Ida Sim Science 330:759 (2010)
Mobile communication devices, in conjunction with Internet and social media, present opportunities to enhance disease prevention and management by extending health interventions beyond the reach of traditional care—an approach referred to as mHealth. An ―open‖ mHealth architecture could support medical discovery and evidence based practice about managing and preventing chronic disease. Standardized interfaces and shared components are critical for realizing the potential of mobile-device–enabled health care delivery and research. mHealth apps (a patchwork of incompatible applications ) can contribute to a rapid, learning health system.
c, Disease gene networks sense constellations of genetic and environmental perturbations.
Nature 416:218,2009
The correlation network of all biomarkers found in a study on the early onset of atherosclerosis in the ApoE3 transgenic mouse model
Information source
Data from clinical care can contribute to clinical research, which in turn can improve patient care. This feedback loop will work best if data can be easily exchanged.
Rebecca Daniels Kush Science Translational Medicine Volume 1 Issue 3 : 1-5 (2009)
The use of electronic health records to directly support clinical research concurrent with patient care.
"AmpliChip CYP450" will test for variations in two genes: CYP2D6 and CYP2C19 They affect how people process about 25% of drugs on the market
Roche and Affymetrix are seeking approval for a new pharmacogenomics device
Hierarchy of causal relationships
a, Classic genetic association approaches.
b, Changes in DNA, lead to changes in molecular traits that go on to affect disease risk.
Improving the exchange of information and integrating workflow between research and health care are inherently necessary to accelerate the pace of informing clinical decisions based on current research findings and for an efficient, cost-effective health care system to improve the quality of patient care.
Clish CB et al. OMICS 2004, 1:3-13.
The development of disease from healthy (homeostasis within black dotted lines) to sub-(homeostasis within black dotted lines) to sub-optimal health and eventually an overt disease state.
Clish CB et al. OMICS 2004, 1:3-13.
Clinical translation of findings from GWA studies
Nature reviews genetics 9:356-369 (2008)
First Check My Genome,Doctor 医生，先看一下我的基因组
Information-sharing policies
Infrastructure
Digital Medicபைடு நூலகம்ne
His and Lis Mobile medical devices Open mHealth system Nationwide learning health system
What the Patient Should Order
Global investments in health information technology (HIT) in the form of electronic health record systems represent important new strategies to improve the quality and efficiency of health care. These potential benefits of HIT will not be achieved without direct attention to the use of health care information for clinical research purposes. To support clinical research effectively, the systems put in place in the next few years must implement appropriate interoperability, information-sharing policies, and infrastructure that can liberate health data from clinical records.