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精准医学技术:炒作还是现实?以计算机辅助给药为例。

Precision medicine technology hype or reality? The example of computer-guided dosing.

作者信息

Polasek Thomas M, Shakib Sepehr, Rostami-Hodjegan Amin

机构信息

Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA.

Centre for Medicines Use and Safety, Monash University, Melbourne, Victoria, Australia.

出版信息

F1000Res. 2019 Oct 1;8:1709. doi: 10.12688/f1000research.20489.1. eCollection 2019.

Abstract

Novel technologies labelled as 'precision medicine' are targeting all aspects of clinical care. Whilst some technological advances are undeniably exciting, many doctors at the frontline of healthcare view precision medicine as being out of reach for their patients. Computer-guided dosing is a precision medicine technology that predicts drug concentrations and drug responses based on individual patient characteristics. In this opinion piece, the example of computer-guided dosing is used to illustrate eight features of a precision medicine technology less likely to be hyperbole and more likely to improve patient care. Positive features in this regard include: (1) fitting the definition of 'precision medicine'; (2) addressing a major clinical problem that negatively impacts patient care; (3) a track record of high-quality medical science published via peer-reviewed literature; (4) well-defined clinical cases for application; (5) quality evidence of benefits measured by various clinical, patient and health economic endpoints; (6) strong economic drivers; (7) user friendliness, including easy integration into clinical workflow, and (8) recognition of importance by patients and their endorsement for broader clinical use. Barriers raised by critics of the approach are given to balance the view. The value of computer-guided dosing will be decided ultimately by the extent to which it can improve cost-effective patient care.

摘要

被称为“精准医学”的新技术正瞄准临床护理的各个方面。虽然一些技术进步无疑令人兴奋,但许多医疗一线的医生认为精准医学对他们的患者来说遥不可及。计算机辅助给药是一种精准医学技术,它根据患者的个体特征预测药物浓度和药物反应。在这篇观点文章中,以计算机辅助给药为例来说明精准医学技术的八个特征,这些特征不太可能是夸张之词,而更有可能改善患者护理。这方面的积极特征包括:(1)符合“精准医学”的定义;(2)解决对患者护理产生负面影响的一个主要临床问题;(3)通过同行评审文献发表的高质量医学科学记录;(4)明确的临床应用案例;(5)通过各种临床、患者和卫生经济终点衡量的益处的高质量证据;(6)强大的经济驱动力;(7)用户友好性,包括易于融入临床工作流程,以及(8)患者认可其重要性并支持其更广泛的临床应用。同时也列出了该方法的批评者提出的障碍,以平衡观点。计算机辅助给药的价值最终将取决于它能在多大程度上改善具有成本效益的患者护理。

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Expert Rev Clin Pharmacol. 2018 Aug;11(8):743-746. doi: 10.1080/17512433.2018.1501271. Epub 2018 Jul 20.
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Precision Medicine Is Not Just Genomics: The Right Dose for Every Patient.精准医疗不仅仅是基因组学:为每位患者提供合适的剂量。
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