medical genetics

医学遗传学
  • 文章类型: Journal Article
    目的:遗传学和基因组学领域继续以前所未有的速度扩展。随着科学知识转化为临床实践,基因组信息通常用于预防,诊断,以及各种临床实践领域的治疗决策。随着基因组医学的进一步发展,卫生专业人员将被要求跟上新的遗传发现和技术,并在其实践范围内实施这些进展。
    方法:人类和医学遗传学教授协会先前开发了医学院遗传学核心能力,最后更新于2013年。通过采用改进的Delphi方法的结构化方法对能力进行了审查和更新。
    结果:介绍了最新的人类和医学遗传学教授核心能力协会。当前的修订包括简洁的能力,具体,和评估。此外,它们结合了临床实践的最新进展,促进了临床护理的公平和包容。
    结论:2022年能力将作为医学院领导和参与课程开发的教育工作者的指南,实施,和评估。在整个本科医学课程中使用这些能力将培养知识,技能,以及医疗实践中广泛的专业所需的行为。
    OBJECTIVE: The field of genetics and genomics continues to expand at an unprecedented pace. As scientific knowledge is translated to clinical practice, genomic information is routinely being used in preventive, diagnostic, and therapeutic decision-making across a variety of clinical practice areas. As adoption of genomic medicine further evolves, health professionals will be required to stay abreast of new genetic discoveries and technologies and implementation of these advances within their scope of practice will be indicated.
    METHODS: The Association of Professors of Human and Medical Genetics previously developed medical school genetics core competencies, last updated in 2013. The competencies were reviewed and updated through a structured approach incorporating a modified Delphi method.
    RESULTS: The updated Association of Professors of Human and Medical Genetics core competencies are presented. Current revisions include competencies that are concise, specific, and assessable. In addition, they incorporate recent advances in clinical practice and promote equity and inclusion in clinical care.
    CONCLUSIONS: The 2022 competencies will serve as a guide for medical school leadership and educators involved in curriculum development, implementation, and assessment. Use of these competencies across the undergraduate medical curricula will foster knowledge, skills, and behaviors required in medical practice across a wide range of specialties.
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  • 文章类型: Journal Article
    最近,我们证明,用于评估孟德尔疾病基因变异的美国医学遗传学和基因组学学会/医学病理学协会(ACMG/AMP)定性指南与定量贝叶斯公式基本兼容.这里,我们表明,基础ACMG/AMP“证据类别强度”可以抽象为一个积分系统。这些点与Log(赔率)成正比,是添加剂,并产生一个系统,该系统概括了ACMG/AMP指南的贝叶斯公式。该系统的优势在于其简单性,并且点值和致病性几率之间的联系允许对单个数据类型的证据强度进行经验校准。弱点包括锁定了狭窄范围的先验概率,并且系统的贝叶斯性质不明显。我们得出的结论是,基于点的系统具有用户友好性的实际属性,只要基本的贝叶斯原理得到承认,它就可以有用。
    Recently, we demonstrated that the qualitative American College of Medical Genetics and Genomics/Association for Medical Pathology (ACMG/AMP) guidelines for evaluation of Mendelian disease gene variants are fundamentally compatible with a quantitative Bayesian formulation. Here, we show that the underlying ACMG/AMP \"strength of evidence categories\" can be abstracted into a point system. These points are proportional to Log(odds), are additive, and produce a system that recapitulates the Bayesian formulation of the ACMG/AMP guidelines. The strengths of this system are its simplicity and that the connection between point values and odds of pathogenicity allows empirical calibration of the strength of evidence for individual data types. Weaknesses include that a narrow range of prior probabilities is locked in and that the Bayesian nature of the system is inapparent. We conclude that a points-based system has the practical attribute of user-friendliness and can be useful so long as the underlying Bayesian principles are acknowledged.
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  • 文章类型: Journal Article
    我们评估了美国医学遗传学和基因组学学院/分子病理学协会(ACMG/AMP)变异致病性指南的内部一致性和与贝叶斯统计推理的兼容性。
    ACMG/AMP标准被转化为朴素贝叶斯分类器,假设四个水平的证据和指数缩放的致病性几率。我们用一系列的先验概率和致病性几率测试了这个框架。
    我们使用生物学上合理的假设对ACMG/AMP指南进行建模。大多数ACMG/AMP组合标准是兼容的。一个ACMG/AMP可能的致病性组合在数学上等同于致病性,一个ACMG/AMP致病性组合实际上可能是致病性。我们对包括支持和反对致病性的证据的组合进行了建模,表明我们的方法将某些组合评分为致病性或可能致病性,ACMG/AMP将其指定为不确定意义(VUS)的变体。
    通过将ACMG/AMP准则转换为贝叶斯框架,我们为什么是定性启发式提供了数学基础。现有的18种ACMG/AMP证据组合中只有2种在数学上与整体框架不一致。致病性和良性证据的混合组合可能会产生可能的致病性,可能是良性的,或VUS结果。这个定量框架验证了ACMG/AMP采用的方法,提供了进一步完善证据类别和组合规则的机会,并支持自动化变异致病性评估组件的努力。
    We evaluated the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) variant pathogenicity guidelines for internal consistency and compatibility with Bayesian statistical reasoning.
    The ACMG/AMP criteria were translated into a naive Bayesian classifier, assuming four levels of evidence and exponentially scaled odds of pathogenicity. We tested this framework with a range of prior probabilities and odds of pathogenicity.
    We modeled the ACMG/AMP guidelines using biologically plausible assumptions. Most ACMG/AMP combining criteria were compatible. One ACMG/AMP likely pathogenic combination was mathematically equivalent to pathogenic and one ACMG/AMP pathogenic combination was actually likely pathogenic. We modeled combinations that include evidence for and against pathogenicity, showing that our approach scored some combinations as pathogenic or likely pathogenic that ACMG/AMP would designate as variant of uncertain significance (VUS).
    By transforming the ACMG/AMP guidelines into a Bayesian framework, we provide a mathematical foundation for what was a qualitative heuristic. Only 2 of the 18 existing ACMG/AMP evidence combinations were mathematically inconsistent with the overall framework. Mixed combinations of pathogenic and benign evidence could yield a likely pathogenic, likely benign, or VUS result. This quantitative framework validates the approach adopted by the ACMG/AMP, provides opportunities to further refine evidence categories and combining rules, and supports efforts to automate components of variant pathogenicity assessments.
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  • 文章类型: Journal Article
    This is a guide for fieldwork in Population Medical Genetics research projects. Data collection, handling, and analysis from large pedigrees require the use of specific tools and methods not widely familiar to human geneticists, unfortunately leading to ineffective graphic pedigrees. Initially, the objective of the pedigree must be decided, and the available information sources need to be identified and validated. Data collection and recording by the tabulated method is advocated, and the involved techniques are presented. Genealogical and personal information are the two main components of pedigree data. While the latter is unique to each investigation project, the former is solely represented by gametic links between persons. The triad of a given pedigree member and its two parents constitutes the building unit of a genealogy. Likewise, three ID numbers representing those three elements of the triad is the record field required for any pedigree analysis. Pedigree construction, as well as pedigree and population data analysis, varies according to the pre-established objectives, the existing information, and the available resources.
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