Reviewer one:
Very interesting approach and I liked how you connect the hive mind of externally located experts who can say review the images and you can then triangulate the diagnoses and treatment choices based on best evidence. I am still not convinced or probably did not understand well enough your assertion about precision medicine. You are probably referring to more of a personalized medicine here interchanging with precision medicine. Personalised medicine is where you personalise care to the specific condition or subset of patients, not only with respect to molecular signatures that would cluster patients (as happens with precision medicine), but also taking into consideration everything else (as was done for the postmenopausal woman with urethral stricture with septicaemia and metabolic acidosis with pyelonephritis).
Now, isn’t precision medicine a more modern term for personalized medicine and to some extent a more correct term to use? Depends on how you contextualize it. Back in the early twenties the idea was that if you were to use some molecular signatures but otherwise were able to cluster similar groups of patients using some form of prognostic stratification so that despite some generalisations derived from RCTs, you would still be able to identify some subsets of individuals on whom particular treatments might work better than others (say prognosis of chemotherapy for HER-2 receptor positive and negative breast cancer patients). Now, with individualized genomic data, the situation is more precise and you can nearly fine map an individual to tighten the cluster size. So, precision medicine by definition relies on genomic signatures. On the other hand, it appeared to me reading this paper, is what you are doing by drawing on both clinical variables, reading of literature, the patient’s individual profile (with or without molecular signatures), and the hive mind of the Internet, is closer to the ideal of personalised medicine then than that of precision medicine as we know it. More of a P4 (personalized, predictive, participatory, prevention-focused) care that draws on a wider gamut of evidence than previous studies and molecular signatures.
Great innovative application! Loved reading it.
P.s., on that note, need to add a little more on the cricket bit in the final version. Many old-fashioned cricket lovers like me still do not like the idea of dugouts in cricket matches, and not fancy the T20 format. :-)
Reviewer 2:
Excellent concept. Presented in this manner case reports may come back into the mainstream.
Of late many journals shun case reports as they adversely affect the journal impact factor due to lesser citations.
Attaching some minor suggestions in track mode and also a paper which may illustrate where sometimes "less is more" particularly when medicine is practiced "imprecisely" and "inaccurately."
Apologies for the slight delay in my feedback since was busy for the past few weeks due to "MCI Inspection" one of the most unproductive activities in our system.
With compliments to the young participants of the study.
Reviewer 3:
It is fascinating work.
There is a lot to be said in favor of the manuscript and I will not dwell on those things.
Sorry, but some things I found very distracting:
Most are matters of syntax, but some are not. Please allow me to list them without hurting any sentiments. I truly love this body of work. Very inspiring.
1. Repeated reference to "case based blended learning ecosystem" CBBLE - I would prefer for the abbreviation to be introduced once alongside the full form right in the beginning - and, thereafter, only the abbreviation be used.
2. You probably should briefly describe what OMICS is.
3. Repeated reference to "age-old" - is it necessary to repeatedly use the term and sometimes put it in inverted commas?
4. The cricket analogy - I feel it diluted the message through distracting the reader. Too many brackets and inverted commas have been used. I find that simply referring to the participants as online team and offline team would work better because then there are just two terms for the reader to deal with.
5. The Discussion is more about precision medicine in general and less about precision medicine as related to your narratives. If your aim is to critically appraise the narratives through the "precision lens" (inverted commas again), then let's have more discussion on the narratives and the learning that accrued because of them in the CBBLE. I feel that the first 4-6 paragraphs of the Discussion have little to do with your results. Perhaps these could be reduced to one para if they are necessary from your point of view.
6. There is currently no conclusion. Perhaps you could conclude about whether your aim in doing what you did was achieved and what further needs to be done in this fascinating field.
"We aim to offer a fresh perspective on accuracy driven "age-old precision medicine" and illustrate how newer case based blended learning ecosystems CBBLE can strengthen the bridge between age old precision approaches with modern technology and omics driven approaches." Were you able to strengthen the bridge? What were the limitations? What would you change? What next?
Comments
Post a Comment