About the Webinar: Genomic testing has already become commonplace in oncology, but exponential growth in more comprehensive genomic tests, other innovative tests and testing approaches in oncology, as well as a number of other therapeutic areas is expected in the coming years. With the emergence of more complex, more expensive, and more promising tests, policymakers and healthcare providers may be challenged to provide these to patients at the pace of innovation. Don Husereau will describe what conditions are necessary for equitable access to advanced innovative testing, how major Canadian provinces are doing, and what more needs to be done in the coming years to benefit all patients.
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
Presentation describing the modes of diathermy used in modern day surgery, its working principles, complications associated with diathermy use, precautions to be taken while using diathermy. Valuable for undergraduate students and post graduate residents of general surgery.
Different type of Energy Sources used in Surgery are described In this presentation...
like Radio frequency Electro-surgery
Ultrasound Energy
Laser
Argon beam Coagulation
Surgical Diathermy the For Way in Modern Open SurgeryBatubo Nimi
The surgical diathermy is one of the most important surgical tool in the operating theatre. It is use to cut tissues, controlling bleeding by coagulation haemostasis and destruction of unwanted cells.
Surgical diathermy involves the intra cellular conversion of high frequency alternating current to thermal energy in order to generate a variety of tissue effect during surgery
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
Presentation describing the modes of diathermy used in modern day surgery, its working principles, complications associated with diathermy use, precautions to be taken while using diathermy. Valuable for undergraduate students and post graduate residents of general surgery.
Different type of Energy Sources used in Surgery are described In this presentation...
like Radio frequency Electro-surgery
Ultrasound Energy
Laser
Argon beam Coagulation
Surgical Diathermy the For Way in Modern Open SurgeryBatubo Nimi
The surgical diathermy is one of the most important surgical tool in the operating theatre. It is use to cut tissues, controlling bleeding by coagulation haemostasis and destruction of unwanted cells.
Surgical diathermy involves the intra cellular conversion of high frequency alternating current to thermal energy in order to generate a variety of tissue effect during surgery
Ομιλία - Παρουσίαση: “Βιοδείκτες: Η Κλινική τους Αξία και η Σχέση τους με τον ΕΟΠΥΥ”
Νικόλαος Τσούλος, MSc, MBA, Βιοχημικός, Διευθύνων Σύμβουλος GeneKor Medical SA
Published Research, Flawed, Misleading, Nefarious - Use of Reporting Guidelin...John Hoey
Much published health sciences literature is misleading and biased
Efforts to correct this include use of reporting guidelines- criteria for doing science and reporting the results properly
Also discussion of conflicts of interest - how to report them.
CLARITY BPA: a Novel Approach to study EDCsDES Daughter
by the Collaborative on Health and the Environment
On this call Retha Newbold, MS, Researcher Emeritus, National Toxicology Program, National Institute of Environmental Health Sciences, discussed the program called “The Consortium Linking Academic and Regulatory Insights on the Toxicity of Bisphenol A (CLARITY-BPA)” which is an interagency agreement, conducted under the auspices of the National Toxicology Program (NTP), between The National Institute of Environmental Health Sciences (NIEHS) supported grantees, the staff of the Division of the National Toxicology Program (DNTP) at NIH/NIEHS, and the Food and Drug Administration at the National Center for Toxicological Research (FDA/NCTR). The goals of the consortium are to enhance the utility of a perinatal 2-year GLP chronic toxicity study on BPA for regulatory decision-making by incorporating a wide range of doses and some additional disease-related endpoints that are not usually covered.
To this end, 12 NIEHS grantees are studying hypothesis-driven mechanisms by investigating specific endpoints that maybe altered by BPA including behavioral/neuroendocrine, immune function, cardiac, reproductive tract, cancer, thyroid, and other organ systems. This consortium is unique in that it combines the knowledge and skills of the NTP staff with experts from the academic field who are covering more mechanistic studies. Although this program focuses on BPA, it may provide an example of how to better study effects of other endocrine disrupting chemicals especially since numerous organ systems may be involved.
Sources: http://www.healthandenvironment.org/partnership_calls/14639
Before accessing the clinical evidence associated with a specific variation, one must establish that the variant is likely to be a driver mutation, which generates functional changes that enhance tumor cell proliferation. In this webcast, we will discuss VSClinical’s capabilities for determining the oncogenicity of a variant. This will include a deep dive into our oncogenicity scoring system and a discussion of the various criteria used to distinguish driver mutations from benign variations and variants of uncertain significance
What you will learn in this webcast:
How to evaluate the oncogenicity of a variant in VSClinical
What evidence to consider when classifying LoF variants
How to examine the in-silico evidence for missense variants
How to evaluate a variant's rate of occurrence in somatic catalogs
Efficiently Following the AMP Guidelines with VSClinical and Golden Helix Can...Golden Helix
Interpreting somatic variants for the clinical genetic testing of tumors requires hands-on time of the most skilled clinical lab personnel. Various clinical and genomic sources must be queried, papers and guidelines referenced, and an evaluation of the clinical actionability of the mutation determined by the following the AMP guidelines. Yet, there is tremendous potential for reuse of this time consuming and valuable work!
Earlier this summer we launched our VSClinical AMP Guidelines workflow which integrates a lab-specific knowledgebase that saves every biomarkers interpretation in up to seven different snippets that ar reusable across various genomic and clinical contexts. Furthermore, our cancer workflow is bundled with the Golden Helix CancerKB, our expert-curated interpretations of the most common biomarkers for the most common cancer types, reducing the time to your first precision medicine report.
Follow along as we cover:
The interpretation of clinically actionable biomarkers for targeted molecular therapy and diagnostic/prognostic clinical reports for cancer
The different levels and scopes of re-use of the interpretation for each biomarker
Saving, re-using and updating these interpretations over time by multiple users within a clinical lab with an integrated lab-specific knowledgebase
The built in Golden Helix CancerKB that provides default interpretations for most cancer genes, biomarkers and many clinically actionable Tier I/II drug sensitivity and resistance interpretations.
In the world of genomics shaping precision medicine in oncology, the limiting factor is the time-to-sign-off on fully interpreted molecular profile reports.
About the Webinar: Michelle Colero, Executive Director of Bladder Cancer Canada, will cover the essentials of bladder cancer facts and symptoms while also outlining the support and educational resources provided by Bladder Cancer Canada for those dealing with a diagnosis. Additionally, she’ll share ways individuals can contribute to raising awareness and supporting our community.
About the Webinar: Alcohol is classified as a Group one carcinogen and is estimated to be one of the top three causes of cancer deaths worldwide. Yet, over 40 per cent of people in Canada remain unaware that alcohol consumption increases the risk of developing at least nine cancers. In this presentation, we’ll look at what is and isn’t known about the relationship between alcohol and cancer. We’ll explore what the Canadian Cancer Society is doing to raise awareness of alcohol as a modifiable cancer risk factor, its commitment to funding world-leading research on this subject, and its advocacy for stronger policies that reduce, and increase awareness about the risk of cancer related to, alcohol consumption. Attendees will be invited to seek more information and/or take action on this important topic. We hope you’ll join us in learning more about cancer risk and alcohol — the most commonly used psychoactive substance in Canada.
Dr. Rob Rutledge returns for his first webinar of 2024 to discuss the basics behind emotional intelligence. Learn how to develop greater emotional awareness, and learn how to settle fear and frustration. Dr. Rutledge will also share tips on how to live in a more peaceful and connected way as you navigate through your cancer journey.
About the Webinar: Health technology assessment (HTA), the approval process for drugs and healthcare technology, the processes and organizations that support them, such as Canadian Agency for Drugs and Technologies in Health (CADTH), have evolved over the years in response to changing healthcare system priorities and the need to establish their legitimacy. Don Husereau will provide an overview of current processes in Canada, and highlight their perceived (and real) shortcomings and what can be done to overcome these. He will highlight that some perceived weaknesses (such as review times) are not as bad as they appear while perceived strengths (such as stakeholder involvement) need considerable improvement. He will also discuss other opportunities for HTA to innovate and whether there are current plans to address these.
About this Webinar: The time between regulatory approval for new drugs and when drugs became publicly available to patients averaged 736 days (25 months) in 2022. This is double the average time reported in comparable Organisation for Economic Development (OECD) countries. This webinar will highlight variations in drug listing time for new drugs across time, provinces, and type of drugs (oncology vs. non-oncology). It will also present the specific phases involved in moving a drug from approval stage to listing, and the time spent in each. This Conference Board of Canada analysis uses IQVIA’s Market Access Metrics Database (2012 to 2023), which tracks all new products and their indications through the Canadian access journey.
About the Webinar: Learn about pancreatic cancer symptoms, diagnosis, treatment options, statistics, supports and barriers. The presentation will also include some helpful tools that can improve quality of life for those with pancreatic cancer, including the Craig's Cause's PERT (Pancreatic Enzyme Replacement Therapy) calculator and available patient support programs.
As referenced by John Adams in his 2024 CCSN Webinar on the US importing drugs from Canada, this is a slide deck from Health Canada which outlines the timetable and actions taken by the government on this particular issue.
About this Webinar: John Adams takes a dive behind the headlines, news stories and media releases to better understand any real threats to Canadian patients getting the prescription drugs they need.
About this Webinar: We know that methods of eating and diet are a large part of cancer care, but how can you make your diet work for you in your cancer journey? Dr. Rob Rutelege is back to present the latest science around healthy eating and cancer care. In addition, Dr. Rutledge will share the benefits of time-restricted eating, and how you can incorporate it into your daily routine.
Colorectal cancer is the second leading cause of cancer death in Canada, with approximately 24,100 Canadians diagnosed with the disease in 2023. The incidence of colorectal cancer has been declining in Canadians over 50 years of age, largely due to population-based screening programs. Recent evidence has shown, however, that rates have been increasing in adults younger than 50 years. Given that younger adults are typically classified as at low risk for colorectal cancer, this epidemiologic shift is cause for concern.
Individuals under the age of 50 now represent a significant number of colorectal cancer cases. The disease is often being diagnosed at a later stage, and tumour characteristics tend to be more lethal. As for what is accounting for the increasing trend, ongoing research efforts focus on environmental toxicities, lifestyle patterns, and the gut microbiome.
In this webinar, we will present an overview of the current evidence surrounding the rising rates of colorectal cancer in young adults and discuss the unique needs of this patient population, through screening, diagnosis, treatment, and survivorship. A young colorectal cancer patient will share his lived experience in managing this disease and the impact that cancer has had on himself and his family.
About this Talk: This talk will provide a nutritional perspective on the role of diet in cancer focusing on healthy fats known as omega-3 fatty acids. Sources, amounts and types of omega-3 fatty acids will be highlighted. Clinical and experimental evidence in support of a role for omega-3 fatty acids in the prevention and treatment of breast cancer will be presented. Lastly, some practical strategies to support a healthy diet will be shared.
About this Webinar: This talk will explore breast screening for women 40-49. The benefits and harms for screening will be discussed, as well as what is unique about breast cancer in women in their 40s. In order to understand the controversy around current guidelines recommending against screening women 40-49, we will review the evidence upon which these guidelines are based, and their impact on breast cancer outcomes for these women.
About this Webinar: This presentation will discuss the pathway to pharmaceutical treatments in Canada that involve health technology assessment reviews and decision making. Observations on the current challenges and the importance of patient input to inform decision making will also be discussed. Finally, the key elements that can be critical to successful outcomes will be presented.
About this Webinar: When Canadians turn on the tap for a drink of water or a shower, we take for granted that the water is safe. Few are aware that old asbestos cement water pipes still deliver water to millions of people. As these pipes age and deteriorate, asbestos erodes into the water and poses health concerns, including cancer.
Dr. Meg Sears, Chair of the Board of Prevent Cancer Now, and board member Julian Branch will talk about the history of asbestos in water, the science behind ingested asbestos, and recent developments.
André Deschamps will show the results of the Europa UOMO Euproms studies. These are the first studies ever from patients for patients, measuring the burden of treatment. More than 5000 patients have shared with us their experiences after treatment. The data has been analyzed by the university of Rotterdam in the Netherlands and has been published in peer reviewed scientific papers.
This webinar will serve as an introduction to Cancer and Work, a website that “was designed to address the unique needs of cancer survivors with returning, remaining, changing work or looking for work after a diagnosis of cancer. The website provides newly created information, resources, and interactive tools for cancer survivors, healthcare providers, employers, and highlights helpful information from across the globe.” The talk will include 10 steps to return to work, and job search ideas for cancer survivors
This webinar will have two perspectives.
Jasveen will be presenting about the impact of cancer and treatment on a person’s physical, cognitive & mental health and how an Occupational therapist can work with the person to gradually overcome these challenges to return to work with or without modifications. The presentation will cover some case studies of past success with the opportunity to answer questions at the end.
Then we will hear from Jen who has experienced her own journey with breast cancer and how she advocated for herself and occupational therapy to help her return to full time employment.
About this Webinar: we’ll summarize the findings of a 10-minute online study conducted by Leger among cancer patients who experienced Long-COVID. We identified 119 cancer patients, diagnosed within the past 10 years, who developed symptoms or were diagnosed with Long-COVID. We primarily wanted to understand how Long-COVID impacted cancer patients and their ability to receive treatment. We also asked about the effect on their overall wellbeing, their ability to access Long-COVID treatments and assistance, and the ongoing impact to this day.
About this Presenter: Colette Faust is a Research Director at Leger (largest Canadian-owned market research company) and has 10 years of market research experience, spending the last 3 years in the healthcare industry. As a member of Leger’s North American Healthcare team, Colette has worked on both quantitative and qualitative healthcare research among healthcare professionals, patients, and the general population across a variety of topics including oncology. Colette received her B.A. in Psychology and Media & Communications from Muhlenberg College in Allentown, PA.
Various cancer treatments can impact one’s gut health and digestive system. This presentation will discuss why a healthy gut is important to overall health. We will talk about the roles the gut is involved in beyond just digestion. We will also discuss nutrition strategies that will support our gut health and promote a healthy microbiome.
In this Webinar, participants will learn about:
– Balancing rising costs and a limited budget
– Eating healthily, food banks, other resources in your community
– Budget formats that work for cancer patients
– Money management
– Debit and credit management
– Credit counselling
– Consumer protection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. A State of Readiness
Progress Report
Nov 2,2023
Towards the routine use of genome-based
testing in Canada’s major regions
CCSN Presentation, 2 Nov, 2023 (Virtual)
2. Disclosures
I have worked for public and private sector organizations that might be
interested in what I have to say.
2
Research support was provided by the following companies: Amgen Canada Inc., AstraZeneca Canada, Eli Lilly Canada Inc., GlaxoSmithKline Inc.
(GSK Canada), Janssen Inc./J&J, Pfizer Canada ULC,Thermo Fisher Scientific Inc., and Roche Canada.
Public / not-for-profit
Ontario Ministry 2019- Ÿ OntarioCED member 2015-2019
Ÿ PMPRBAdvisor /WorkingGroup member ŸCADTH
(pCODR EGP 2015-present, pERC committee member
2015-2017, Strategic advisor (early scientific advice / real-
world evidence),CDR)Ÿ PAAB consultant (code changes)
Ÿ HealthCanadaStrategic Policy Branch Ÿ Federal
InnovationCouncil ŸGenomeCanada Ÿ CD Howe
Institute Ÿ ISPOR Ÿ IHE Ÿ HTAi ŸCPhA ŸCHEO
Research Institute Ÿ Legal firms (as expert witness)
Private / for-profit
AbbVie Ÿ Amgen ŸAstraZeneca Ÿ Bei-Gene Boehringer
Ingelheim (Canada) Ltd. Ÿ Bristol Meyers Squibb ŸCelgene
Ÿ CSL Behring Ÿ FerringGlobal andCanadian
consultancies (Cornerstone, Evidera, IQVIA, Maple,
PDCI/McKesson, Pivina etc. ) Ÿ Danish LifeSciencesCouncil
Ÿ Eli Lilly Ÿ Elvium Ÿ Esai Ÿ GSK Ÿ Hoffman-La Roche Ÿ
Janssen Ÿ Leo Pharma Ÿ Lundbeck Ÿ Merck Ÿ Novo
Nordisk ŸOtsuka Ÿ Pfizer Ÿ Purdue ŸTaiho ŸTakeda Ÿ
ThermoFisher
3. Overview
3
• What is the issue?
• Approach to assessing Canada’s progress
• Findings
• Conditions for health system readiness
• Progress in Canada and individual provinces (BC, AB, ON, QC, NS)
• Priority actions for Canada and Quebec
• Q&A
4. Genetic testing
is a complex
intervention
4
These are context dependent-- Defined by interacting
components, reliance on behaviours, reliance on
groups/organizational levels, and allowance for
tailoring1,2
…
1. Craig, Peter, Paul Dieppe, Sally Macintyre, Susan Michie, Irwin Nazareth, and Mark Petticrew. 2008. “Developing and Evaluating Complex Interventions: The New Medical Research Council Guidance.” BMJ 337 (September): a1655.
https://doi.org/10.1136/bmj.a1655.
2. Skivington, Kathryn, Lynsay Matthews, Sharon Anne Simpson, Peter Craig, Janis Baird, Jane M. Blazeby, Kathleen Anne Boyd, et al. 2021. “A New Framework for Developing and Evaluating Complex Interventions: Update of Medical Research Council
Guidance.” BMJ 374 (September): n2061. https://doi.org/10.1136/bmj.n2061.
Context
Why Genome-Based Testing?
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5. Testing can serve many purposes
Uses of testing
• Diagnosis: e.g., CD20 and Ki67 to confirm diagnosis of diffuse large B-cell lymphoma (DLBCL)
• Prognosis: e.g.,TP53 mutation in chronic lymphocytic leukemia predicts poor outcomes and
response to therapy
• Prediction and monitoring: e.g., lack of (wild type) K-ras gene in (stage IV) metastatic colorectal
cancer predicts improved response and lower costs from targeted therapy
• Research: e.g., positivity for FGFR2-BICC1 fusion, MYC amplification, and NF2 inactivation in
cholangiocarcinoma can identify candidates for a trial
5
6. Testing is here and on the rise
6
U.S. oncology medicines that recommend or require pharmacogenomic testing on their prescribing labels prior to use1
Key Therapeutic areas
• Oncology
• Prenatal and newborn screening
• Neonatal care
• Rare disease
• Cell and gene therapies
• Autoimmune disease
• Psychiatry
• Ophthalmologic conditions
• Lung disease
• Neurologic disease
1. IQVIA Institute, Supporting Precision Oncology: Targeted Therapies, Immuno-oncology, And Predictive Biomarker-based Medicines, Aug 2020
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appointments
Subspecialist
appointments $ʻȻʂȳȺȹʁȺȵ
Pathology
ƒ AnatomicʻLJĦǟųƤƏƤūȅʻʻ $ʻȳȶʂȶȲȻʁȵȴ
ƒ Basic biochemistry $ʻȶʂȴȺȻʁȳȴ
ƒ ComplexʻŁŸƤłųőƘŸǒǟNJȅ $ʻȻʂȶȵȹʁȲȶ
ƒ Serology/immunology $ʻȳʂȷȴȲʁȹȴ
ƒ Other
$0.00
Diagnostic imaging $ʻȷȲʂȳȸȷʁȶȷ
Electrophysiology $ʻȴȴʂȲȴȹʁȻȹ
Genetic testing
ƒ SNP microarray $ʻȴȵʂȺȺȲʁȲȲ
ƒ Other genetic tests $ʻȴȷʂȳȷȳʁȹȻ
Other
ƒ MedicalʻLJųƤǟƤūNJĦLJųȅ $ʻȺȲȻʁȸȴ
ƒ DNA extractionʻ
andʻshipping
$ʻȴʂȷȶȳʁȲȲ
OT/anaesthesia costs $ʻȵʂȸȻȵʁȷȵ
Geneticist
appointment
(new or review)
- $ʻȳȺʂȵȲȵʁȸȲ
Geneticist
appointment review
- $ʻȳȶʂȸȶȴʁȺȲ
Genetic counselor
appointment
- $ʻȹʂȵȷȺʁȶȲ
Genetic counselor
appointment review
- $ʻȷʂȺȺȸʁȺȲ
WES (sequencing,
analysis, reporting)
- $ʻȺȲʂȲȲȲʁȲȲ
TOTAL costs $ʻȳȺȻʂȵȷȴʁȷȵ $ʻȳȷȲʂȲȹȳʁȸȲ
TOTAL number of
diagnoses per 40 patients
7 25
TƚłNJőƘőƚǟĦƏʻcost per
diagnosis (95% CI)
-2,182.27
(-5,855.02,129.92)
Table 1 Cost savings (avoidance) associated with whole-exome sequencing as an
early routine test for infants with suspected genetic disease, adapted from [21]
12
$ʻȴȵʂȺȺȲʁȲȲ
Testing can improve outcomes, and lower costs
7
Example
• Whole-exome sequencing
(WES) as an early, routine
clinical test for infants with
suspected monogenic
disorders1
• More effective (25 vs. 7
diagnoses)
• Less costly ($150,071.60 vs.
$189,352.53)
1. Stark Z, Schofield D, Alam K, et al. Prospective comparison of the cost-effectiveness of clinical whole-exome sequenc- ing with that of usual care overwhelmingly supports early use and reimbursement. Genetics in
Medicine 2017;19:867–74. doi:10.1038/gim.2016.221
Unmet Need in Canada
nd Care
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Assessments
and tests
Standard
diagnostic
care
Whole-exome
sequencing first
line
Genetics
appointments $ʻȴȴʂȴȵȻʁȴȶ
Subspecialist
appointments $ʻȻʂȳȺȹʁȺȵ
Pathology
ƒ AnatomicʻLJĦǟųƤƏƤūȅʻʻ $ʻȳȶʂȶȲȻʁȵȴ
ƒ Basic biochemistry $ʻȶʂȴȺȻʁȳȴ
ƒ ComplexʻŁŸƤłųőƘŸǒǟNJȅ $ʻȻʂȶȵȹʁȲȶ
ƒ Serology/immunology $ʻȳʂȷȴȲʁȹȴ
ƒ Other
$0.00
Diagnostic imaging $ʻȷȲʂȳȸȷʁȶȷ
Electrophysiology $ʻȴȴʂȲȴȹʁȻȹ
Genetic testing
ƒ SNP microarray $ʻȴȵʂȺȺȲʁȲȲ
ƒ Other genetic tests $ʻȴȷʂȳȷȳʁȹȻ
Other
ƒ MedicalʻLJųƤǟƤūNJĦLJųȅ $ʻȺȲȻʁȸȴ
ƒ DNA extractionʻ
andʻshipping
$ʻȴʂȷȶȳʁȲȲ
OT/anaesthesia costs $ʻȵʂȸȻȵʁȷȵ
Geneticist
appointment
(new or review)
- $ʻȳȺʂȵȲȵʁȸȲ
Geneticist
appointment review
- $ʻȳȶʂȸȶȴʁȺȲ
Genetic counselor
appointment
- $ʻȹʂȵȷȺʁȶȲ
Genetic counselor
appointment review
- $ʻȷʂȺȺȸʁȺȲ
WES (sequencing,
analysis, reporting)
- $ʻȺȲʂȲȲȲʁȲȲ
TOTAL costs $ʻȳȺȻʂȵȷȴʁȷȵ $ʻȳȷȲʂȲȹȳʁȸȲ
TOTAL number of
diagnoses per 40 patients
7 25
TƚłNJőƘőƚǟĦƏʻcost per
diagnosis (95% CI)
-2,182.27
(-5,855.02,129.92)
Table 1 Cost savings (avoidance) associated with whole-exome sequencing as an
early routine test for infants with suspected genetic disease, adapted from [21]
12
$PTUTGPSQBUJFOUT 6%
$ʻȴȵʂȺȺȲʁȲȲ
8. Testing has multiple impacts.
Why prepare for genomic medicine?
• Improved care – including better health outcomes, reducing harm from therapy, and improving
survival and quality of life.
• Better patient and care provider experiences –reducing the need for referrals and other
diagnostic tests, and improving time to diagnosis.
• Better science and economic growth – aiding scientific discovery and clinical trial enrollment,
creating commercial and investment opportunities as well as future-proofing Canada’s
healthcare workforce.
8
9. Testing has multiple impacts. (2/2)
Why prepare for genomic
medicine?
• More efficient / cost-effective care –
genomic medicine creates
opportunities to reduce costs OR
deliver care efficiently (i.e., cost-
effectively).
• Additional opportunities for
commercial development,
investments in research
9
Type Intervention Health Experience Spend
(Savings)
Value Ref
Prognosis
School-based
screening for
Tay-Sachs and
Cystic Fibrosis
22 more
/1000
screened
Faster diagnosis
/ care
$AUD
670M Cost neutral [1]
Diagnosis
Testing for
familial
hypercholester
olemia
Reduced
heart and
stroke
Faster diagnosis
/ care
($60M) Excellent [2]
Treatment
EGFR t790
resistance
mutation
(liquid based,
alone)
•Improved
response
• Less
toxicity
• Avoid biopsy
• Improve equity
of access to
testing
($9.3M) Excellent [3]
1. Warren E, Anderson R, Proos AL, et al. Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program. Genet- ics in Medicine 2005;7:484–94.
doi:10.1097/01.gim.0000178496.91670.3b
2. Maguire T. Genetic Testing for Familial Hypercholesterolemia: Health Technology Assessment. 2022;168.
3. Ontario Health (Quality). Cell-Free Circulating Tumour DNA Blood Testing to Detect EGFR T790M Mutation in People With Advanced Non- Small Cell Lung Cancer: A Health Technology Assessment. Ont Health
Technol Assess Ser 2020;20:1–176.
11. Why a Progress Report?
11
The progress report was created to:
• Objectively communicate current and future care gaps that
may impact
• Quality of health care
• Health system effectiveness efficiency
• Opportunities for innovation in healthcare
• Provide future direction for policymakers and researchers
12. Approach
12
Information gathering
• A Project Authority and regional teams consisting of
sponsor representatives informed scope and validated
findings
• A mixed methods (literature review and semi-structured
interview was conducted)
Create and Validate List of Conditions and Good Practices
• Working with National and International experts
• Peer-reviewed publication
Develop Progress Report
• Focus on unmet need, impact (humanistic, organizational,
economic), and specific policy recommendations
Communication
• Release materials to aid discussion
• Socialize the report
13. Information gathering
13
• Report is evidence-based with a
clear search strategy (Appendix A)
• Interviews were conducted with
interview form (Appendix B) and
interviewees acknowledged
International
• Vivek Muthu
• DavidThomas
• Daryl Spinner
• Lotte Steuten
Alberta
• Chris McCabe
• Michael Mengel
British Columbia
• Craig Ivany
• Arminee Kazanjian
Quebec
• Francois Sanschagrin
• EvaVillalba
• Jean Latreille
• Guy Rouleau
Nova Scotia
• Mike Carter
Ontario
• Chris Simpson
• Harriet Feilotter
• Christine Williams
• Raymond Kim
14. Layout of progress report
14
Introduction / context – why is this important?
(see previous slides)
Approach taken to create report
What Conditions Are Necessary for Health System
Readiness?
Progress report - State of readiness in AB, BC, ON, QC,
NS (based on mapping against conditions)
Impact of system readiness on healthcare and research
and a business case for change
Implications for policy, patients and research
with specific directions for provinces
Section 1
Section 2
Section 3
Section 4
Section 5
Section 6
Husereau D, Villalba E,
Steuten L, Muthu V, Thomas,
DM, Spinner DS, Ivany C,
Mengel M, Sheffield B, Yip S,
Jacobs, P, Sullivan T. Towards
the routine use of genome-
based testing in Canada’s
largest regions: A State of
Readiness Progress Report.
2023. 72 p. ISBN###
74 pages,
6 sections
17. Why conditions?
Infrastructure
What is the nature of the problem?
• Inconsistent service delivery,
inequitable care delivery
• Unsustainable care delivery
• Duplication of testing, inconsistent
quality, no information for evaluation
17
What is the solution / condition?
• Creating communities of practice and
healthcare system networks
• Resource planning
• Informatics – linked information
systems
18. Examples of good practice
Informatics
The UK Department of Health Social
Care committed “£4 billion over a five-
year period (2016-21) in digital
technology, systems and infrastructure, to
provide the health and care system with
the digital capability and capacity it
needs . . . .1
18
Resource planning
“The US Government Accountability
Office conducted a study forecasting a
future shortfall of genetic counsellors
and medical geneticists in general, and
by geographic region.”2
(1) Dong, O.M.; Bates, J.; Chanfreau-Coffinie , C.; Naglich, M.; Kelley, M.J.; Meyer, L.J.; Icardi, M.; Vassy, J.L.; Sriram, P.; Heise, C.W.; et al. Veterans
Affairs Pharmacogenomic Testing for Veterans (PHASER) Clinical Program. Pharmacogenomics 2021, 22, 137–144
(2) Barwell,J.;Snape,K.;Wedderburn,S.TheNewGenomicMedicineServiceandImplicationsforPatients.Clin.Med.2019,19,273–277
19. Additional conditions for readiness
Operations
What is the nature of the problem?
• Technology creep; lack of intra-
operability; duplication
• Low value care
• Uncoordinated care; delays
• Confusion , lack of information
regarding test availability
19
What is the solution / condition?
• Single entry/exit point for innovation
proposals
• Evaluation function
• Service models – coordinate care
• Tools for awareness and care
navigation
20. Additional conditions for readiness
Health care environment
What is the nature of the problem?
• Care lags behind pace of innovation
• Care interruptions, wait times, or
unsustainable care
• Medical error, low quality care, care lagging
behind pace of innovation
• Substandard care , negligence and legal
liability
20
What is the solution?
• Integration of innovation and care
delivery
• Financing approach
• Education and Training
• Regulation
• Data privacy legislation
22. How did Canada do (Ch 4)?
22
• Overall, Canada appears to be making some
progress
• Partially ready for a future of genomic
medicine.
• Important gaps are
• Need for linked information systems and data
integration (informatics);
• Evaluative processes that adhere to HTA
principles of timeliness transparency and
engagement;
• Navigational tools for care providers;
dedicated funding to facilitate rapid
onboarding or a funding formula that supports
test development and proficiency testing; and
• Broader engagement with a broader set of
innovation stake-holders (e.g., patients,
administrators, IT professionals,
implementation and genome scientists, public
and private sector innovators and others).
24. How did Quebec do?
24
Needs Improvement
Partially Established
Established
Takeaway: Quebec began taking
necessary steps to reform its
approach to genome-based testing
over a decade ago. There are still
opportunities to improve the
optimal use of testing in Quebec
À retenir :
Le Québec a commencé à prendre
les mesures nécessaires pour
réformer son approche des tests
génomiques il y a plus de dix ans.
Il existe encore des possibilités
d'améliorer l'utilisation optimale
des tests au Québec.
25. Peer-reviewed publication – main report
25
• A synopsis of the report (no
grades or infographics)
• Published June 1, 2023 in Current
Oncology
26. Summary
26
• Canada's major healthcare regions are moving toward a state of
readiness for genomic medicine
• Although using different approaches and at different rates.
• Highlights the many challenges that health systems face when they are
required to quickly respond to a disruptive technology.
• There may be opportunities through recent rare disease funding to create
necessary infrastructure for genomic testing.
28. Supporting materials
28
Four page Executive summaries in French
and English (same as report + sponsorship
acknowledged)
Two-page provincial briefs in English
for each province (plus QC in french)
Master slide deck (in development)
Two peer reviewed reports (one
published, one in development)
29. Briefing report Layout
29
• 2 pages, 4 sections
• Why the province needs to be
prepared (impacts, Chapter 5)
• Summary of strengths and
weakness of each province with
an accompanying infographic
(progress , Chapter 4)
• Policy priorities and implications
(implications, Chapter 6)
• Description of conditions that
were met (progress, Chapter 4)
30. Special Issue
30
• Special Issue Health System Readiness for Genomic Medicine in
Oncology”
• Deadline for submission 25 June 2023
• The aim of the Special Issue is to highlight new approaches intended to
make health systems ready for the future of genomic medicine. It is
intended to highlight the increasingly important role of the laboratory
function and how this must evolve to be most beneficial to patients.
• https://www.mdpi.com/journal/curroncol/special_issues/Health_System_
Readiness_Genomic_Medicine_Oncology