Paying for personalized care: cancer biomarkers and comparative effectiveness

Genomic-based diagnostics can play a key role in creating a more efficient healthcare system by directing patients toward beneficial therapies and away from therapies that pose substantial risk or are unlikely to improve outcomes for the patient. We outline how the value provided by diagnostics is closely linked to a range of factors including magnitude of health outcome improvement, avoiding adverse effect, diagnostic parameters, process of care, resource utilization, and costs. Comparative effectiveness approaches to evidence generation, including health outcome measurements, quality of life, economic analyses, decision modeling, and pragmatic clinical trials, can be used to provide stakeholders with a range of information to inform treatment, guidelines, coverage, and reimbursement decisions. Evidence of comparative effectiveness can also help support value-based reimbursement of cancer biomarkers and treatment strategies as means of paying for personalized medicine.     

在线教学模式下医学留学生实验诊断学实验教学的探索与实践

受不同国家新冠肺炎疫情防控措施影响,留学生短时间内仍不能返校进行正常教学活动,在线教学成为替代线下教学的主要教学方式。首都医科大学面向临床医学专业留学生开设的实验诊断学（Clinical Laboratory Diagnostics）课程,以实践操作为主的实验课程的教学工作则面临着新的问题：一是留学生群体本身的特殊性,他们来自不同的国家和地区,由于地域分散,与中国存在不同时长的时差,难以集中线上授课;另一方面,实验教学是以实际操作和可视化为主要特点的授课方式,如果仅通过视频分享自行学习,失去动手机会,效果欠佳。教学中通过调查问卷、集体备课、组建专家团队等方式集思广益,并积极采取应对措施,通过探索新的在线教学模式,使得教学产品多样化,组建及组织小组内在线平台实现线上交流,全面提高留学生实验教学的质量,为培养优秀的国际医学人才提供了保障。     

Real-time magnetic resonance imaging: mechanics of oral and facial function

We report a summary of developmental work to explore, develop, and establish clinical applications of real-time magnetic resonance imaging (rtMRI) with a temporal resolution of 70 frames/second in oral and maxillofacial surgery (OMFS). Real-time MRI can contribute to procedure planning, diagnostics, rehabilitation, monitoring, and patient education. At present, conventional MRI is used extensively in the diagnosis, staging, and follow up of head and neck cancer patients, with scanning durations typically of several minutes and temporal resolution of up to 0.5 frames/second. The potential for rtMRI, where function can be assessed, could go far beyond the established clinical application of conventional MRI. Preliminary prototyping is a first stage in the establishment of rtMRI in OMFS. We follow best-practice approaches in co-creation across multiple disciplines, an indispensable aspect in the development of new methodologies and diagnostic tools.     

Symptoms after sport-related concussions alter gestural functions

ObjectivesSymptoms after sport-related concussions (SRC) are common. Because post-concussion symptoms are often not clearly visible, speech-accompanying gestures may help clinicians to gain additional information about the patient’s history and symptoms during medical consultation. We hypothesized that athletes with SRC and who suffered from persisting symptoms would display more gestures during concussion assessment protocols when compared to non-concussed athletes because of the athletes’ previous motor-sensory experiences made during the concussive event.DesignA retrospective cross-sectional study.MethodsThree matched groups of 40 (active) athletes were investigated in the context of concussion assessment (/and baseline) protocols: 14 symptomatic and 14 asymptomatic athletes with a SRC, and 12 non-concussed athletes. Certified raters using a standard analysis system for nonverbal behaviour analysed videotaped hand movements and gestures during a standardized concussion assessment protocol.ResultsSymptomatic athletes spent significantly more time with in space hand movements, i.e., movements that act in the body-external free space without touching anything and specifically, motion quality presentation gestures than non-concussed athletes.ConclusionsIncreased in space movements, which are functionally gestures, and specifically, motion quality presentation gestures in symptomatic athletes indicate that the more vivid sensory motor experience of the head trauma is reflected in more gestural expressions. Thus, hand movements and gestures differentiate athletes who suffer from post-concussion symptoms from non-concussed athletes indicating the athletes’ motor-sensory experiences of the event and its aftereffects. The present study highlights the fact that gestures can be employed as behavioural markers of symptoms after sport-related concussions.     

Development and validation of three Capripoxvirus real-time PCRs for parallel testing

Capripoxviruses have the potential to cause outbreaks with a severe socio-economic impact. The latter, combined with an altered virus dissemination pattern, warrants its status as an important emerging disease. Disease control or eradication programmes can only be applied successfully if the necessary diagnostic tools are available allowing clear and unequivocal identification of the pathogen. Real-time PCR combines high sensitivity/specificity with a reduced analysis time and is thus a proven useful tool for identification of many pathogens, including Capripoxviruses. In order for a real-time PCR to be used in a diagnostic capacity, the different analytical and diagnostic parameters need to be evaluated to assure data quality. The implementation of parallel testing using multiple real-time PCRs with similar characteristics can improve further Capripoxvirus diagnosis. It was therefore the purpose of this study to develop a triplet real-time PCR panel with similar high sensitivity/specificity and provide sufficient validation data regarding the performance characteristics that the panel can be used in parallel, depending on the purpose and local situation.