Future of Medicine: Gene Editing & Health Priorities

Week 1: The Future of Medicine

• CRISPR is a gene-editing tool that allows altering DNA and genome patterns.
• CRISPR acts like molecular scissors to cut DNA.
• CRISPR allows for cutting defective genes.
• The nanobot technology can achieve gene editing.
• Regenerative medicine regenerates/replaces human cells, tissues, or organs for restoring normal bodily functions.
• The main idea is of the National Health and Medical Research Council (NHMRC) regarding determining health priorities and goals.
• Priorities include promoting wellness for Aboriginal and Torres Strait Islander health equity.
• Other priorities involve promoting the use of AI in health and medicine research.
• Identifying health threats and emergencies includes antimicrobial resistance (AMR), biodiversity, changes in the environment, and climate change.
• Identifying and preventing long-term illnesses, chronic diseases, and promoting integration of living with long-term illnesses is prioritized.
• Medical milestones are identified through creating a panel.
• Medicine focuses on a patient's account and the doctor's interpretation.
• Medical milestones provide information for answering questions about future medicine and how medicine advances.
• Evidence-based medicine has risen.
• Important milestones include penicillin discovery, vaccines, the pill, computers in medicine, and oral rehydration therapy.
• The public voted on the most important milestones.

21st Century Global Health Priorities

• Emerging threats to health exist.
• Life expectancy shows reduced progress over the next 50 years, but some progress remains.
• Life expectancies drop due to conflicts and epidemics.
• Future mortality can be modeled by forecasting risk factors.
• Drivers of health are being forecasted.
• An explicit vs. implicit approach is used.
• Sub-Saharan African countries feature a population with an inverted age pyramid.
• Forecast samples from the past 40 years serve as references.
• Event rate, initial speed, probability of detection, response delay, and effectiveness are all factors.
• The future and the impacts the planet and society will have are being modeled.
• Climate, conflicts, pandemics, habitability, fertility rates and migration, and the physical environment (air pollution) are included in the models
• Diet, obesity and physical activity appear to non-reversible.
• Antimicrobial resistance (AMR) trends increasing.
• The Sahel region in Africa has low nutrition rates and child mortality.
• Social and fiscal strategies can be used to invert population pyramids.
• Financial support for these strategies is provided.
• Accelerated innovation, as well as global and regional cooperation, is important.
• Focus is given to high-risk locations and resilient health systems.
• Electronic health data is vital.

HealthCare Delivery in the 21st Century

• The aging population is growing rapidly.
• Rising healthcare costs are an issue, as well as who pays.
• Educating consumers about the healthcare system is important.
• Education is needed to keep people healthy.
• Healthcare can be considered a privilege rather than a right.
• Unsustainable median drug costs are rising.
• Drug values are non-transparent, with prices made up.
• Healthcare expenditures show declining rates, resulting in fiscal oxygen.
• The pressure on medical costs continue to increase.
• A system that incentivizes quantity over quality prevails.
• Quality has diverse definitions.
• Innovation precedes implementation.
• Most diseases are from chronic conditions.
• Resources should be allocated to either the patient or a family member who can moderate behavior.
• The lowest price at easiest accessibility is the goal for primary care.
• Secondary care needs more specialized (and expensive) professionals.
• Patients should decide whether to wait for more sophisticated care or receive standard procedures.
• Hospital readmissions have decreased.
• Larger hospitals show higher readmission rates.
• Innovation in access to data exists, such as access to medical records.
• Healthcare expenditures have increased over the years.
• The goal is to create fiscal stability by saving money and reducing expenditure.

Week 2: Global Action Plan on Antimicrobial Resistance

• The 2015 World Health Assembly produced a global action plan to address the misuse and overuse of antimicrobials, which puts every country at risk.
• Without global harmonization and action, the world is moving towards a post-antibiotic era, where common infectious diseases could become lethal again.
• There are five main objectives to combat antimicrobial resistance (AMR).
• Improve the understanding and awareness of AMR through communication, education, and training.
• Raise the knowledge and evidence base through surveillance and research.
• Lower the incidence of infection through sanitation, hygiene, and infection prevention measures.
• Optimize the use of antimicrobial medicines in human and animal health.
• Develop the economic case for sustainable investment, while considering the needs of all countries.
• The goal of the action plan is to ensure the sustained effectiveness of quality-assured infectious disease treatments.
• Countries are expected to develop AMR national action plans in line with the global plan.
• Collaborations between human health, animal health, and agriculture are emphasized.
• Actions to combat AMR should not be impeded by gaps in knowledge.
• An incremental approach using key actions from various actors will be used in the next 5-10 years.
• Background information on AMR consists of little widespread awareness of AMR's socioeconomic impacts.
• The WHO reported that progress is slow because of inadequate monitoring and reporting alongside inadequate recognition of necessary action.
• All member states should have national action plans aligned with the global one with target dates set by intergovernmental bodies, within two years of health assembly endorsement.
• Stakeholders and partners are responsible for implementing action plans.
• Plans should include whole-of-society engagement, prioritizing prevention through sanitation and hygiene, equitable access to antimicrobials, and sustainability with resources and long-term investments.
• Political will and global collaboration are vital elements.
• Incremental targets provide implementation flexibility for countries at different development stages.
• Actions should take into account benefits and cost effectiveness for solutions.
• Data on pathogens and geographical patterns are important.
• Understanding will allow for developing tools, policies and regulations.
• The monitoring and understanding of social change and behavior is vital.
• Research on treatments and prevention for common bacterial infections helps.
• Alternatives to antimicrobials in agriculture are vital.
• Economic research is important.
• Vaccination reduces primary infections inappropriately treated with antibiotics, thus preventing diseases that may be difficult to treat.
• Enhanced hygiene, sanitation, hand washing, and food and water safety will limit the spread of antibiotic resistance.
• Sustainable animal husbandry can reduce antibiotic reliance by reducing infection rates.
• Antimicrobials should be seen as a public good requiring widespread recognition, not just product promotion.
• Low-cost diagnostic tools should be integrated into healthcare for evidence-based medicine practices.
• More investment in the creation of new medicines and diagnostic tools can support the fight,.
• Capitalistic pharmaceutical perspectives need rethinking.
• Affordable diagnostic tools can inform health practices/ understanding for pathogen susceptibility.
• The secretariat will support countries in developing and monitoring national action plans, coordinate investment needs, etc.

Antimicrobial Resistance in the Western Pacific Region (WHO)

• The WHO will provide an in-depth situational review.
• There are three main categories for action in combating AMR following the 2014 World Health Assembly.
• These categories include surveillance of AMR, monitoring of antimicrobial use, and health systems responses.

Surveillance and External Quality Assurance

• AMR surveillance allows tracking of microbial populations, early detection of resistant strains, support in developing treatments, and rapid containment of new threats.
• The TWG-AMR prioritizes enhancing lab testing capacities and strengthening AMR surveillance networks.
• AMR data use is linked with clinical and pharmaceutical data to provide support for decision making.
• Community infections are a core element for strategy.
• Implementation includes strengthening national programs, regional collaboration and linking findings with policy and national authorities.
• Strengthening local networks and a means for data-sharing is the regional network's goal.
• Unifying surveillance efforts, data-sharing/collection, and the use of accurate/early mechanisms will benefit the control of AMR.
• Lab/epidemiological capacities will also need to improve.
• Providing quality AMR surveillance to guide prescriptions reduces mortality rates.

Quality Assurance Strategies for AMR Surveillance

• A strategy to address relevance of samples collected is vital.
• CLSI and EUCAST standards ensure lab test reliability and reduce the effects of bias.
• Monitoring antimicrobial use can help track antimicrobial use by patients and facilities.
• The WHO states the Western Pacific Region (WPR) lacks regional monitoring of current antimicrobial use.
• Antimicrobial use should be monitored at all levels to communicate patterns of resistance.
• A challenge includes implementing and requiring policies regarding consumption and use.
• The lack of resources impacts systematic data collection. Recommendations.
• Information derived from use and resistance as public goods has influence with governments and the private sector.
• Networks that survey the valid use of antibiotics will support agencies of international and local origin.
• Systems of surveillance must include inpatients, outpatients, humans/non-humans.

Proposed Regional System to Monitor Antimicrobial Use

• Developing national antimicrobial monitoring can help combat resistance by informing makers of policy.
• Data will be developed for prescribing.
• Indicators needs to be measured for prescribing medication.
• The WHO recommends using ATC classification and DDD to measure drug implementation.
• Analysis and examination of trends can occur
• Antimicrobial is collected via:
  • Sales and dispensing data
  • Reimbursement systems
  • Patient encounter/survey data
  • Healthcare facility data

Data Presentation and Dissemination of Surveillance

• Data must be measured and tracked.
• Data collection and surveillance will track resistance.
• Lack of baselines make measuring the effects of interventions impossible.
• Challenges for monitoring antimicrobial use locally include a lack of commitment, a lack valid methodologies, and a lack of infrastructure (human resources).
• Accurate consumption data is also important.
• Collaboration is necessary between sectors.
• Developing countries own the data. -Common methods should be sought to track progress.

Course of Action

• A survey of the area is needed to determine antibiotic consumption
• Create new strategies for data collection.
• Mobilize resources to build local and regional infrastructure.
• Coordinated responses are vital in the process.
• Reduce misuse by influencing a prescribers and patients knowledge of the environment
• China/Vietnam and Australia are countries with high antimicrobial resistance

Regional Specific Challenges

• Developing antibiotic policies is needed.
• Licencing and accreditation may vary.
• Training is often lacking.
• Awareness is low.
• Poor test results and limited labs can also impact AMR (as well as pressure).
• Education programs are vital.
• Mongolian population give medication that is not required to children

Improving Regulations

• Frameworks are needed to enforce antibiotic use.
• Regulations may improve outcomes (quality).
• Limiting sales and the implementation by doctors can fix the problem of overconsumption.
• Governments will need qualifications.

Strengthening Infection Prevention and Control

• Control programs help reduce AMR.
• IPCs in hospitals require more development.
• Education for staff will improve the maintenance (also the microbiology labs).

Vaccines as a Method of Combating AMR

• The paper seeks to find new ways to combat vaccine development aimed at bacterial pathogens.
• A literature review methodology and analyses have found revolving studies revolving AMR.
• Alternative strategies include using MABs.

Vaccine Technologies

• Technologies include genomics-based approaches, stabilizing proteins, novel delivery systems.
• Reverse vaccinology uses genome to identify antigen.
• Structural vaccinology uses antigen structures to enhance vaccine effectiveness.
• GMMAS uses outer to provide a way to present antigens. -Bioconjugation allows the production of vaccines.

Adjuvants

• Adjuvants can impact the immune response linked to a vaccine (Malaria/Herpes)
• The author says vaccines can be effective before the bacteria multiplies
• Vaccines usually contain multiple epitopes resulting in a more difficult process of change.
• Vaccines can reduce pathogens.

Antibiotics vs. Vaccines

• Antibiotics is reactive and vaccines are more proactive (Table provided).
• Vaccines have a different amount of probability of change
• Vaccines are promising in reducing bacteria, but will not solve the problem.
• At-risk population needs to be vaccinated and pharmaceutical has been taking steps toward development
• New strategies for synthetic strategies are being implemented
• Vaccines can be improved
• Vaccines may reduce AMR.
• Factors will influence the impact on AMR
• Other tools can be implemented

Week 3: Social Determinants of Health

• Social determinants of health are factors apart from medical care that are influenced by social policies and shape health.
• SDH are the conditions in which people are born, grow, live, work, and age.
• The article reviews how social factors and socioeconomic issues shape health along with biological mechanisms that cause these.
• Relationships between health and factors are complex.
• Thomas McKeown showed the limits of work between mid 19th and early 1960s.
• Behavior can lead to health outcomes
• Low education can lead to death in a comparable manner as myocardial infarction.

Social Factors Effects

• Strong and widely observed association between a range of indicators such as resources and position.
• Income and education impact hierarchy.
• Blacks do not have birth outcomes as educated women.
• Racial discrimination can lead to psychological stress and damaging of the health.
• Health effects and poverty may lead to health concerns.
• Reverse effects exist too
• Social aspects effects health, even with effectiveness and limited questions.
• Health has increased exponentially.
• The effects can influence the outcomes.
• There is little answer on the effects of health
• 1. Complex and multifactorial causal is a challenge
• 2. Time is also a long lag.
• Overall, social factors are important.

Organisational Culture on Patients

• The measure of the article observes whether the mortality of organizational structure on acute patients are impacted.
• 5 domains are studied:

1. Learning
2. Management
3. Safety
4. Commitment

• Changes are from feedback and efforts.
• Shifting has substantial changes
• Learning is critical.
• In hospitals without culture and management support.

Week 4: Redefining Public Health

• The full scope and diverse factors are analyzed by this study.
• While health efforts are crucial factors like medical care and socio-economic conditions are key factors.
• Organization effort helps
• The mission assures health.
• Organized efforts will help promote health.
• These definitions new meaning.
• Data and trends is important for health.
• Prevention is critical with action.
• Equality leads to action
• Commitment can lead to the political process with health.
• CDC produced the information, with the data, that the society.

Public Health Efforts (Australian vs. Global)

• Australians have boosted health quality by preventing infant death.
• Smoking is preventable via global public health.
• The outcomes all have been great and epidemiology is key.
• Australia's information comes through the WHO and participation will drive further benefits
• The environment effects the population

Measuring Health Outcomes

• The article seeks to convey similarities.
• Quality adjusted life years, health, and disability is the goal
• The professionals and public sectors will gain access to information and benefit..
• QALYS were developed over time.

Week 5: Data From Sierra leone and Ebola (2014 in Kailahun)

• EVD was first detected and eliminating
• Analyse the transmissions and how areas can be applied
• EVD cases were recorded from to 2014
• Treatment strategies were implemented.
• Detection was put into action

Other Control Methods

• Contacts made with disease.

• Communities participated

• Burial process

• Rapid diagnostic helped (CT and survelilance)

• Promoters worked to build patient information.

• Understand is required.

• Size aided issues.

• Infection was prevented.

• Community support is vital.

• Those infected must be identified.