scholarly journals Barriers to clinical adoption of pharmacogenomic testing in psychiatry: a critical analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Catherine R. Virelli ◽  
Ayeshah G. Mohiuddin ◽  
James L. Kennedy
Keyword(s):  
Critical Analysis ◽  
Clinical Utility ◽  
Clinical Care ◽  
Routine Practice ◽  
Barriers To Adoption ◽  
Randomized Controlled ◽  
The Past ◽  
Commercial Markets ◽  
Healthcare Innovation ◽  
Clinical Adoption

AbstractPharmacogenomics (PGx) is the study of genetic influences on an individual’s response to medications. Improvements in the quality and quantity of PGx research over the past two decades have enabled the establishment of commercial markets for PGx tests. Nevertheless, PGx testing has yet to be adopted as a routine practice in clinical care. Accordingly, policy regulating the commercialization and reimbursement of PGx testing is in its infancy. Several papers have been published on the topic of challenges, or ‘barriers’ to clinical adoption of this healthcare innovation. However, many do not include recent evidence from randomized controlled trials, economic utility studies, and qualitative assessments of stakeholder opinions. The present paper revisits the most cited barriers to adoption of PGx testing: evidence for clinical utility, evidence for economic effectiveness, and stakeholder awareness. We consider these barriers in the context of reviewing PGx literature published over the past two decades and emphasize data from commercial PGx testing companies, since they have published the largest datasets. We conclude with a discussion of existing limitations to PGx testing and recommendations for progress.

Evidence-Informed Policy from an International Perspective

2018 ◽  
Vol 678 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Thomas Chupein ◽  
Rachel Glennerster
Keyword(s):  
Development Policy ◽  
Scale Up ◽  
International Perspective ◽  
Routine Practice ◽  
Policy Makers ◽  
Randomized Controlled ◽  
The Past ◽  
Policy Debates ◽  
The World ◽  
History Of

This article discusses the history of randomized controlled trials (RCTs) in development economics and the ways in which their use has shaped disciplinary practices and development policy over the past two decades. We first explain how increased use of academic-run RCTs internationally has led to important methodological breakthroughs that have advanced our knowledge of human behavior as well as changes in how research is conducted, including routine practice of in-field apprenticeships for young researchers and the establishment of robust research infrastructure in numerous developing countries around the world. We then explore three ways in which the scale-up of evidence-informed programs and policies based on findings from RCTs have achieved real-world impact, giving examples for each. These include how rigorous evidence can help to resolve contentious policy debates; enable policy-makers to assess external validity of findings and draw lessons across contexts; and support institutionalization of evidence use in various types of organizations.

scholarly journals Clinical Utility of Definitive Drug–Drug Interaction Testing in Primary Care

2018 ◽  
Vol 7 (11) ◽  
pp. 384
Author(s):  
John Peabody ◽  
Mary Tran ◽  
David Paculdo ◽  
Joshua Schrecker ◽  
Czarlota Valdenor ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Clinical Utility ◽  
Controlled Trial ◽  
Clinical Care ◽  
Specific Treatment ◽  
Simulated Patients ◽  
Randomized Controlled ◽  
Previous Round ◽  
Interaction Testing

Drug–drug interactions (DDIs) are a leading cause of morbidity and mortality. New tools are needed to improve identification and treatment of DDIs. We conducted a randomized controlled trial to assess the clinical utility of a new test to identify DDIs and improve their management. Primary care physicians (PCPs) cared for simulated patients presenting with DDI symptoms from commonly prescribed medications and other ingestants. All physicians, in either control or one of two intervention groups, cared for six patients over two rounds of assessment. Intervention physicians were educated on the DDI test and given access to these test reports when caring for their patients in the second round. At baseline, we saw no significant differences in making the DDI diagnosis (p = 0.071) or DDI-related treatment (p = 0.640) between control and intervention arms. By round two, providers who accessed the DDI test performed significantly better in making the DDI diagnosis (+41.6%) and performing DDI-specific treatment (+12.2%) than in the previous round, and were 9.8 and 20.4 times more likely to diagnose and identify the DDI (p < 0.001 for all). The introduction of a definitive DDI test significantly increased identification, appropriate management, and counseling of DDIs among PCPs, which has the potential to improve clinical care.

Type V Bekesy Pattern: Interpretation and Clinical Utility

1967 ◽  
Vol 10 (4) ◽  
pp. 733-744 ◽  
Author(s):  
William F. Rintelmann ◽  
Earl R. Harford
Keyword(s):  
Clinical Utility ◽  
The Past ◽  
Type V ◽  
Clinical Cases

Recent studies indicate there is some disagreement concerning the interpretation and clinical utility of the Type V Bekesy pattern. Bekesy tracings obtained over the past six years from a sample of clinical cases were analyzed and a definition was established for the Type V pattern. This definition was applied to Bekesy tracings obtained from normal listeners, hypoacusics, and pseudohypoacusics. The Type V pattern was found frequently among pseudohypoacusics and only rarely among other individuals.

Les héritages chrétiens: quel avenir?

Moreana ◽  
2009 ◽  
Vol 46 (Number 176) (1) ◽  
pp. 175-190
Author(s):  
Bernard Bourdin
Keyword(s):  
European Union ◽  
Human Rights ◽  
Middle Ages ◽  
Critical Analysis ◽  
Religious Affiliation ◽  
The European Union ◽  
Modern Times ◽  
The Past ◽  
Religious Significance ◽  
Politics And Religion

The legacy from Christianity unquestionably lies at the root of Europe, even if not exclusively. It has taken many aspects from the Middle Ages to modern times. If the Christian heritage is diversely understood and accepted within the European Union, the reason is essentially due to its political and religious significance. However, its impact in politics and religion has often been far from negative, if we will consider what secular societies have derived from Christianity: human rights, for example, and a religious affiliation which has been part and parcel of national identity. The Christian legacy has to be acknowledged through a critical analysis which does not deny the truth of the past but should support a European project built around common values.

أوهام القراءة الحداثية المعاصرة: دراسة تحليلية نقدية (Misunderstandings of Modern Contemporary Reading: A Critical Analysis )

2018 ◽  
Vol 15 (3) ◽  
pp. 258-299
Author(s):  
حنان ساري ◽  
محمد أبو الليث الخيرآبادي
Keyword(s):  
Critical Analysis ◽  
Natural Extension ◽  
Modern Times ◽  
The Past ◽  
Religious Issues ◽  
European Experience ◽  
Islamic Thought ◽  
Critical Approaches ◽  
Muslim Scholars

انتشرت لفظة الحداثة في عصرنا الحالي انتشاراً واسعاً، وأخذت مفهومات متعددة، ونحن لا نراها أكثر من أنها امتداد طبيعي للقلق الأوروبي.وسعى التيار الحداثي لتقديم مشاريع تعتمد كلية على مناهج وآليات غربية في دراستها وتعاملها مع القرآن الكريم والسنة، ولعل أهم الذين تقدموا بتلك المشاريع؛ محمد أركون، عبد المجيد الشرفي التونسي، محمد عابد الجابري، حسن حنفي، نصر حامد أبوزيد، الطيب التيزني السوري، محمد شحرور، جمال البنا وغيرهم، وطالبوا بإعادة قراءة القرآن الكريم على ضوء المناهج النقدية الغربية في عملية التقليد الأعمى، ومن ثم نقلوا التجربة الأوروبية بكل آثارها الفوضوية إلى ساحة الفكر الإسلامي. وإن مدعي تجديد الدين من هؤلاء، ليس لهم صلة بالدين أو علومه، بقدر ما تشبعت أفكارهم بمناهج علمانية، فالمراد من جهودهم ليس الدين، وإنما غرس الحداثة بدل الدين، فهي خطَّةٌ تقوم على التَّغيير من داخل البيت الإسلاميِّ من خلال العبث بالنُّصوص الشَّرعيَّة بتحريفها وتفريغها من محتواها الحقيقيِّ، ووضع المحتوى الذي يريدون؛ فهم يَطرحون أفكارَهم وآراءَهم على أنَّها رؤى إسلاميَّة ناشئة عن الاجتهاد في فهم الدِّين. وقد حَمَلَ هذا الاتجاهُ شعار (التَّحديث والعصرنة للإسلام)؛ فهم يريدون منَّا تركَ ما أَجْمَعَتْ عليه الأُمَّةُ من معاني القرآن والسُّنَّة، لفهم جديد مغاير لفهم السَّلَف الصَّالح يكون متناسبًا مع هذا العصر الذي نعيش فيه. الكلمات المفتاحيّة: الحداثة، أوهام، الحداثيون، قراءة معاصرة، العصرنة للإسلام. Abstract In modern times, the word Modernity has spread widely and has become widely understood, and we see it as a natural extension of European concern and confusion. The Modernist Movement strived to present the ideas that rely completely on Western methodologies and approaches in their study and dealing with Qur’an and Sunnah. The most important scholars that have presented these ideas are; Mohammad Arkoun, ‘Abd Al-Majid Sharafi al-Tunisi, Mohammed ‘Abed al-Jabri, Hassan Hanafi, Nasr Hamid Abu Zayd, Tayyeb Tizini, Muhammad Shahrour, Jamal Al-Banna, and others, they called for a re-reading and reinterpret the Qur’an in the light of Western critical approaches. Then, conveyed and brought the European experience and practice with all its chaotic effects to Islamic thought. The slogan of “Renewal of Religion” from these people has no relation to religion (Islam) or its sources, but instead saturated their ideas with secular methods. They tried to instill modernity rather than religion, and misinterpreted the Islamic sources by distorting it and evacuating it from the true context and setting it with their own understanding. They claim their ideas and opinions as the effort to understand religion and carried the slogan of “Modernization and Modernization of Islam”; they want us to leave the consensus of the Muslim scholars on religious issues (Ijmaa’ al-Ummah) especially relating to the meaning of the Qur’an and Sunnah and bring us to a new views and understanding on religious issues which are contradictory to the views of the past Muslim scholars (al-salaf al-soleh) to fulfill their opinions. Keywords: Modernity, Misunderstanding, Modernists, Contemporary Reading, Modernization of Islam.

Periodontopathogens: a new view. Systematic review. Part 2

2020 ◽  
Vol 20 (2) ◽  
pp. 160-167
Author(s):  
E. S. Slazhneva ◽  
E. A. Tikhomirova ◽  
V. G. Atrushkevich
Keyword(s):  
Systematic Review ◽  
Periodontal Disease ◽  
Pathogenic Bacteria ◽  
Periodontal Diseases ◽  
Oral Microbiome ◽  
Controlled Trials ◽  
New Paradigm ◽  
Microbial Composition ◽  
Randomized Controlled ◽  
The Past

Relevance. The modern view of periodontitis as a dysbiotic disease that occurs as a result of changes in the microbial composition of the subgingival region is considered in a systematic review.Purpose. To study a new paradigm of development of generalized periodontitis.Materials and methods. Randomized controlled trials (RCTS) were selected for the study, including cluster RCTS, controlled (non-randomized) microbiological and clinical studies of the oral microbiome in adult patients with generalized periodontitis over the past 10 years.Results. The transition from a symbiotic microflora to a dysbiotic pathogenic community triggers the host's inflammatory response, which contributes to the development of periodontal diseases. Modern ideas about periodontal pathogenic bacteria dictate new requirements for the treatment of periodontal diseases. The second part of the review examines the microbial profiles of periodontal disease in various nosological forms, the mechanisms of the immune response and approaches to the treatment of periodontal disease from the perspective of biofilm infection.Conclusions. As follows from modern literature periodontitis is to a certain extent caused by the transition from a harmonious symbiotic bacterial community to a dysbiotic one. Recent scientific studies have shown that not single microorganism is not able to cause disease but the microbial community as a whole leads to the development of pathology.

Novel Drugs and Biologics of 2016: A Boom for Neurodrugs in the Pipelin

2017 ◽  
Vol 10 (5) ◽  
pp. 3809-3814
Author(s):  
D Samba Reddy
Keyword(s):  
Muscular Atrophy ◽  
Clinical Care ◽  
New Drugs ◽  
Essential Medicines ◽  
High Demand ◽  
The Past ◽  
Novel Drugs ◽  
Innovative Products ◽  
Cns Drugs ◽  
The U.S

This article provides a brief overview of novel drugs approved by the U.S. FDA in 2016.  It also focuses on the emerging boom in the development of neurodrugs for central nervous system (CNS) disorders. These new drugs are innovative products that often help advance clinical care worldwide, and in 2016, twenty-two such drugs were approved by the FDA. The list includes the first new drug for disorders such as spinal muscular atrophy, Duchenne muscular dystrophy or hallucinations and delusions of Parkinson’s disease, among several others. Notably, nine of twenty-two (40%) were novel CNS drugs, indicating the industry shifting to neurodrugs. Neurodrugs are the top selling pharmaceuticals worldwide, especially in America and Europe. Therapeutic neurodrugs have proven their significance many times in the past few decades, and the CNS drug portfolio represents some of the most valuable agents in the current pipeline. Many neuroproducts are vital or essential medicines in the current therapeutic armamentarium, including dozens of “blockbuster drugs” (drugs with $1 billion sales potential).  These drugs include antidepressants, antimigraine medications, and anti-epilepsy medications. The rise in neurodrugs’ sales is predominantly due to increased diagnoses of CNS conditions. The boom for neuromedicines is evident from the recent rise in investment, production, and introduction of new CNS drugs.  There are many promising neurodrugs still in the pipeline, which are developed based on the validated “mechanism-based” strategy. Overall, disease-modifying neurodrugs that can prevent or cure serious diseases, such as multiple sclerosis, epilepsy, and Alzheimer’s disease, are in high demand. 

It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

2021 ◽  
pp. 1-9
Author(s):  
Sarayna S. McGuire ◽  
Anuradha Luke ◽  
Aaron B. Klassen ◽  
Lucas A. Myers ◽  
Aidan F. Mullan ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Performance Feedback ◽  
Life Support ◽  
Clinical Care ◽  
Medical Services ◽  
The Past ◽  
Emergency Medical ◽  
Overall Job Satisfaction

Abstract Objective: Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction. Methods: This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups. Conclusion: Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

scholarly journals 165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Placella ◽  
V Pace ◽  
P Antinolfi ◽  
V Salini
Keyword(s):  
Meta Analysis ◽  
Convincing Evidence ◽  
Just In Time ◽  
Medical Complications ◽  
Randomized Controlled ◽  
The Past ◽  
Cochrane Database ◽  
Major Orthopedic Surgery ◽  
Major Orthopaedic Surgery ◽  
The One

Abstract Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated. Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS. Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding. With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).

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