Radically different
Nature Medicine, Published online: 28 July 2026; doi:10.1038/s41591-026-04552-x
This cluster-randomized phase 3 trial examining the effectiveness of integrated care pathways comparing usual care with the addition of MRI imaging (Coverscan), or a digitally enabled rehabilitation platform app, or both (Coverscan + app), or neither, found specialist Long COVID care improved fatigue response in all arms.
Nabla, the Paris-based maker of ambient scribes used to automate clinical documentation, says it’s playing the long game. On Tuesday the company announced a new leader and reiterated its commitment to fundamentally new AI technology it believes can help it beat the competition.
The company, which last raised a $70 million Series B last summer, announced a new CEO, Brian Manning, who has served as chief revenue officer at care coordination software company PatientPing and its acquirer, Bamboo Health, before taking over as Bamboo’s president. The shift “marks the next phase of Nabla’s go-to-market strategy,” the company wrote in a press release.
“We really haven’t built our brand in the United States. We really haven’t accelerated our go-to-market in line with what others are doing. And as we look towards 2027, that’s something we’re absolutely going to be doing,” Manning said in an interview with STAT. Chief operating officer Delphine Groll said that 100% of the company’s revenue is from the U.S.
Background: Although patient outcomes are improved by stroke rehabilitation, the suggested amount of therapy is rarely maintained. The COVID-19 pandemic aggravated this situation further due to disruptions in health care. One solution was the rapid and extensive transition to virtual care. A hybrid outpatient stroke telerehabilitation program (HOSTP) was introduced by St John’s Rehab—a tertiary rehabilitation hospital in Toronto, Ontario. The HOSTP integrated in-person and virtual care in an effort to alleviate long-standing obstacles that challenge stroke rehabilitation. Objective: This study explored health care providers’ (HCPs) experiences with the HOSTP and their perspectives on its implementation, quality, and impact to determine the modifications needed to optimize its delivery and sustainability. Methods: A qualitative implementation study was conducted, with semistructured interviews conducted among HCPs involved in the HOSTP. The interview guide was informed by the CFIR (Consolidated Framework for Implementation Research). In total, 14 HCPs were recruited and interviewed from St John’s Rehab outpatient program. Interview transcripts were analyzed using a 2-stage analytic approach involving inductive thematic analysis, followed by deductive categorization using CFIR. Results: Four main themes were identified across CFIR domains: (1) adaptability and flexibility of the hybrid care model (intervention characteristics), (2) alignment with patient needs and resources (outer setting), (3) the impact of organizational resources and infrastructure (inner setting), and (4) variability in provider confidence and perceptions of virtual care (characteristics of individuals). Key determinants were identified as adaptability, patient-related factors, resource availability, and provider beliefs about virtual care. Conclusions: Our findings suggest that, from HCPs’ viewpoints, optimizing virtual care processes and resources may support access and care quality within hybrid outpatient stroke rehabilitation. HCPs viewed maintaining virtual care as important for supporting ongoing access and patient-centered care. Lastly, optimizing the benefits and mitigating the drawbacks of hybrid care can ensure future integration of virtual care into standard outpatient stroke rehabilitation.
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To date, precision oncology has largely focused on selecting therapies based on tumor genomics. One of the most persistent challenges in clinical practice remains knowing what to do next. After surgery, during systemic therapy or in surveillance, clinicians are often navigating uncertainty, balancing overtreatment against the risk of recurrence.
Circulating tumor DNA (ctDNA)–based minimal residual disease (MRD) assessment with tumor-informed Signatera
is reshaping this paradigm by providing a dynamic, patient-specific signal that can illuminate next steps across the continuum of care. Unlike conventional imaging or clinicopathologic risk factors, ctDNA offers a real-time measure of tumor burden at the molecular level. Signatera is designed using the patient’s tumor, enabling highly sensitive and specific detection of residual disease at levels far below radiographic visibility. This creates a new layer of clinical intelligence that is actionable across neoadjuvant, adjuvant, surveillance, metastatic, and treatment response settings.
In the neoadjuvant setting, clinicians often need to wait until the time of surgery to determine whether therapy was effective. Assessing ctDNA dynamics during neoadjuvant therapy can provide an early indication of treatment response; ctDNA clearance has been associated with improved outcomes while conversely, persistent ctDNA may signal resistance, prompting consideration of treatment escalation, clinical trial enrollment, or alternative regimens.1 This creates an opportunity to move beyond static endpoints toward adaptive treatment strategies. Clinicians can watch ctDNA trends to refine therapy in real time. This is especially relevant in aggressive tumor types where early response assessment is critical.
MRD testing may provide immediate clinical impact in the adjuvant setting. Current decision-making relies heavily on population-level risk factors, often leading to overtreatment in some patients and undertreatment in others. Postoperative ctDNA positivity is a strong, independent predictor of recurrence across multiple tumor types. Signatera data demonstrates that ctDNA-positive patients after surgery can have dramatically higher recurrence risk compared with ctDNA-negative patients.2 More importantly, Signatera ctDNA status can help predict who benefits from adjuvant therapy. Evidence suggests that ctDNA-positive patients derive meaningful benefit from additional systemic treatment, while ctDNA-negative patients may not.3
Surveillance after curative-intent therapy remains a gray zone as imaging can often be intermittent and insensitive to early recurrence. While many biomarkers like CEA, CA-19-9, CA-125 generally have limitations in both sensitivity and specificity, Signatera ctDNA testing offers a more sensitive approach to detect molecular relapse earlier than imaging and other blood biomarkers. Studies have shown that Signatera can identify recurrence months before it becomes radiographically apparent with high sensitivity and specificity and substantial lead times.4 Earlier detection opens the door to intervention at a lower disease burden, when therapies may be more effective. It also enables more tailored surveillance strategies to intensify monitoring or imaging when ctDNA becomes positive, provides reassurance, and potentially reduces imaging frequency in persistently negative patients. Rather than a fixed surveillance schedule, ctDNA enables a response-guided follow-up strategy.
TOMR is a new paradigm in precision oncology that is used to guide earlier, more proactive therapy decisions to escalate treatment in MRD-positive patients at high risk of relapse and de-escalate or avoid unnecessary toxicity in MRD-negative patients. For clinicians, this moves decision-making from prognostic to personalized, anchored by the presence of residual disease at an earlier and potentially curable stage.
In metastatic disease, treatment decisions are often based on imaging intervals that may lag behind molecular changes in disease burden. A newer technology like ctDNA introduces a more immediate and dynamic tool. Because ctDNA reflects tumor burden and molecular activity, it can be used to monitor treatment response earlier than imaging and identify emerging resistance to inform timely switches in therapy. In practice, this allows clinicians to avoid prolonged exposure to ineffective therapies and pivot more quickly. Additionally, Signatera is being used to monitor response to immunotherapy across tumor types, providing a pan-cancer application in advanced disease.
Across all stages, one of the most powerful aspects of ctDNA is its ability to create a longitudinal feedback loop. Serial testing enables clinicians to track ctDNA trends over time:
This transforms monitoring from episodic snapshots into a continuous signal, providing actionable insight at each decision point.
What makes Signatera particularly compelling is its pan-cancer applicability. Its tumor-informed design allows it to be used across multiple solid tumors, including colorectal, breast, lung, bladder, ovarian, and melanoma. This consistency enables a unified framework for integrating MRD into clinical workflows:
Rather than being confined to a single decision point, ctDNA becomes a longitudinal biomarker embedded throughout the care pathway.
Signatera ctDNA testing bridges the gap from uncertainty to actionability by answering clinically meaningful questions at each stage of the patient’s journey: Is there still disease present, and is it changing? By doing so, ctDNA doesn’t just add another biomarker. It redefines how clinicians navigate the care pathway, moving from reactive to proactive care.
References
For additional information: www.natera.com.
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