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Cleveland Clinic announces top 10 innovations of 2018

Insulin Pen and Glucometer on Night Stand

Cleveland Clinic has announced its list of up-and-coming technologies with the potential to enhance healing and transform health care in 2018.

The Top 10 Medical Innovations were announced Wednesday, Oct. 25, at the Clinic’s 15th annual Medical Innovation Summit.

The list was selected by a panel of Clinic doctors and researchers, led by Dr. Michael Roizen, chief wellness officer at the Clinic.

“It’s published both as a prediction and because it does tell the rest of the medical community, ‘Hey, look at these things,'” Roizen said. “The Cleveland Clinic, we’re lucky enough to be large enough, on the forefront (and) located in a real medical complex city where innovation is fostered. So this is essentially getting together some of the best minds. And then it alerts the rest of medicine we think this is going to make a change.”

Here, in order of anticipated importance, are descriptions of the Top 10 Medical Innovations of 2018, according to a news release from the Clinic.

 

1. Hybrid Closed-Loop Insulin Delivery System

A hybrid closed-loop insulin delivery system, approved by the FDA in late 2016, helps make Type 1 diabetes more manageable by enabling direct communication between the continuous glucose monitoring device and insulin pump. It stabilizes blood glucose at an unprecedented level and replaces the “open loop” concept in which patients use the information from their monitor to determine how much insulin to inject. Experts are optimistic that outcomes in Type 1 diabetes will push forward a similar product for Type 2 diabetes in the “near future.”

“I think it’s a great number one pick that’s going to have a dramatic impact on diabetes management in my opinion,” said Dr. James Young, chairman of the Clinic’s Endocrinology and Metabolism Institute.

The Clinic predicts the market will be disrupted in 2018 as more patients demand the technology and more insurers reimburse for the system.

 

2. Neuromodulation to Treat Obstructive Sleep Apnea

 It’s estimated that more than 40% of patients with sleep apnea refuse to wear a continuous positive airway pressure device, (C.P.A.P.), which is considered the gold standard of treatment for the condition, which impacts 21 million Americans and can lead to high blood pressure, heart disease and stroke.

Companies are marketing an implant that acts like a pacemaker and helps to synchronize the intake of air with the action of the tongue using a breathing sensor and a stimulation lead powered by a small battery. Controlled by a remote or wearable patch, the technology delivers stimulation to open key airway muscles during sleep.

The neuromodulation systems have shown positive results in clinical testing and are predicted to deliver a better night’s sleep to more patients and spouses, as well as healthier communities nationwide.

3. Gene Therapy for Inherited Retinal Diseases

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Optical Coherence Tomography (OCT)

The FDA is anticipated to approve a new gene therapy for inherited retinal diseases in 2018. Delivering a new gene to targeted cells in the body, via viral “vectors,” is expected to provide visual function improvements in some patients with forms of Leber congenital amaurosis and retinitis pigmentosa.

Caused by biallelic RPE65 mutations, these rare genetic conditions result in progressive vision loss and blindness, but there are currently no FDA-approved treatments.

Researchers place a new “normal” working copy of a gene, which results in a functional protein, inside a modified virus that delivers it to retinal cells.

This year, the FDA awarded orphan drug status to RPE65 gene therapy. A panel of U.S. health advisers recently recommended approval for the innovative approach, which experts believe could lead to more gene therapies getting orphan drug and breakthrough status.

4. The Unprecedented Reduction of LDL Cholesterol

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Blood sample for cholesterol testing

New drug combinations can help lower by 75% levels of low-density lipoprotein (“LDL”) cholesterol, known as bad cholesterol, that brings fatty deposits that can clog arteries.

There are more than 400,000 coronary disease deaths and 102 million Americans live with high cholesterol levels.

While some patients and doctors wonder how low is too low, the floor is yet to be found following a number of trials that have been in progress testing this theory. New studies report a 20% reduction in the risk of cardiovascular death, myocardial infarction or stroke for patients who took statins combined with a new class of cholesterol-lowering drugs (PCSK9 inhibitors) to reach ultra-low LDL levels.

5. The Emergence of Distance Health

 Removing geographic barriers to care can result in timelier, more efficient/optimal outcomes and significant cost savings. Distance health technologies, or telehealth, can enable care for both the physically challenged and those most vulnerable to infection.

Increased connectivity, thanks to mobile technology and consumer demand, mean hospitals are preparing for widespread adoption in 2018. Ninety percent of health care executives reported to have or are currently building a telehealth program. Reports predict 7 million patient users in 2018, a 19-fold increase from 2013.

Technology is expanding beyond the two-way video platform, with patients now equipped with attachable devices that record and report medical information to doctors monitoring their condition. More than 19 million patients are projected to use such remote monitoring devices next year.

6. Next Generation Vaccine Platforms

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A vial of blue medicine or vaccine amongst many clear vials. Very narrow depth of field.

The toughest challenges in vaccine development are often in timing and delivery. But developing a vaccine is estimated to cost $200 million and take at least 10 years. Especially given the recent Ebola and Zika outbreaks, it’s clear that the process needs to be expedited. More than 21 million hospitalizations and 732,000 deaths in the last 20 years could have been saved by existing vaccines in the U.S. alone.

In 2018, innovators will be upgrading the entire vaccine infrastructure to support the rapid development of new vaccines and breaking ground on novel mechanisms to deliver new and existing vaccines to broad populations.

New ways of developing, shipping, storing and vaccinating are being connected to stave off current and future diseases and epidemics. Innovators are also thinking beyond the syringe, with oral, edible and mucosally delivered vaccines, intranasal vaccines and vaccine chips all under development. A Band-Aid-sized patch for the flu vaccine is expected to be on the market next year.

The new platforms could help keep individuals healthier than ever.

7. Arsenal of Targeted Breast Cancer Therapies

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Cancer Cell

Tried-and-true treatment mechanisms for breast cancer — hormone therapy, chemotherapy and radiation — are valuable options for prolonging life, but are often not enough to keep cancer at bay, and can also lead to the collateral damage of healthy cells.

Next year, the Clinic predicts, will be the year that targeted therapies are most widely used to treat breast cancer, which kills more than 40,000 American women every year.

Various new targeted treatments — such as PARP inhibitors for patients with specific mutations in BRCA1 or BRCA2, and novel CD K 4/6 inhibitors for ER-Positive/HER-2-negative breast cancer — are having positive outcomes in clinical trials. Also, novel HER-2 targeted agents continue to show benefit in this subgroup of HER-2-positive patients. Experts believe the cumulative results from these studies point to an increasing survival rate, and perhaps the eventual end of chemotherapy for a “significant population” of breast cancer patients.

8. Enhanced Recovery After Surgery

Following substantial growth in hospital readmissions and an opioid epidemic ravaging the country, innovators are overhauling post-surgery procedures after decades of the same pre- and post-surgery routine: No eating before surgery; use pain medications for comfort; and stay in bed during recovery. The innovators are delivering impressive results, including ultra-low readmission rates.

Several center have been developing a “fast-track” or “enhanced” recovery concept for after surgery. Research shows that an “Enhanced Recovery After Surgery” protocol reduces complication rates and speeds recovery. An ERAS protocol permits patients to eat before surgery, limits opioids by prescribing alternate medications and encourages regular walking, as well as gives patients a post-operative nutrition plan to accelerate recovery. The protocols can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more.

In 2017 surgical societies and larger health care systems formed collaborations to drive funding and education for hospitals looking to implement the protocols on a larger scale.

9. Centralized Monitoring of Hospital Patients

Busy caregivers can become desensitized to the constant noise coming from cardiac telemetry monitoring systems and important warning signs can be missed. Known as “alarm fatigue,” hospitals have long struggled to solve this problem. Reports show that up to 44% of inpatient cardiac arrests are not detected appropriately and, according to the American Heart Association, fewer than one in four patients survive an in-hospital cardiac arrest.

An emerging answer is centralized monitoring, in which off-site personnel are part of a “mission control” operation, using advanced equipment, including sensors and high-definition cameras to monitor blood pressure, heart rate, respiration, pulse oximetry and more.

Data are used to filter out unimportant alarms and trigger on-site interventions when needed.

Further innovation has yielded a system that can double the number of monitored patients per technician, while improving clinical outcomes and decreasing communication transit times.

10. Scalp Cooling for Reducing Chemotherapy Hair Loss

A new technology making its way to the United States looks to reduce hair loss for cancer patients going through chemotherapy.

The practice of “scalp cooling,” a system for which was approved by the FDA in May, works by reducing the temperature of the scalp a few degrees immediately before, during and after chemotherapy. It has been shown to be “highly effective” in preserving hair in women receiving chemotherapy for early-stage breast cancer

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