scholarly journals Clinical Application and Educational Training for Pharmacogenomics

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 163 ◽  
Author(s):  
Jason W. Guy ◽  
Isha Patel ◽  
Julie H. Oestreich
Keyword(s):  
Clinical Application ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Healthcare Providers ◽  
The United States ◽  
Current Evidence ◽  
Clinical Settings ◽  
Educational Training ◽  
Secondary Objective ◽  
Medication Selection

Pharmacogenomics—defined as the study of how genes affect a person’s response to drugs—is growing in importance for clinical care. Many medications have evidence and drug labeling related to pharmacogenomics and patient care. New evidence supports the use of pharmacogenomics in clinical settings, and genetic testing may optimize medication selection and dosing. Despite these advantages, the integration of pharmacogenomics into clinical decisions remains variable and challenging in certain practice settings. To ensure consistent application across settings, sufficient education amongst current and future healthcare providers is necessary to further integrate pharmacogenomics into routine clinical practice. This review highlights current evidence supporting clinical application of medications with pharmacogenomic labeling. The secondary objective is to review current strategies for educating health professionals and student trainees. One national organization predicts that most regions in the United States will soon contain at least one healthcare system capable of applying pharmacogenomic information. Applying genotype-guided dosing to several FDA-approved medications may help produce beneficial changes in patient outcomes. Identifying best practices for educating health care professionals and trainees remains vitally important for continuing growth of pharmacogenomic services. As pharmacogenomics continues to expand into more areas of healthcare, current and future practitioners must pursue and maintain competence in pharmacogenomics to ensure better outcomes for patients.

scholarly journals From Experimental Procedure to Clinical Practice: How Much Evidence Do We Need in Uterine Transplantation?

2018 ◽  
Author(s):  
Sabina Gainotti ◽  
Carlo Petrini
Keyword(s):  
Clinical Practice ◽  
Therapeutic Option ◽  
Clinical Care ◽  
Embryo Implantation ◽  
Healthcare Providers ◽  
The United States ◽  
Public Healthcare ◽  
Routine Practice ◽  
Functional Abnormality ◽  
Experimental Procedure

Background: Absolute uterine factor infertility (AUFI) is a kind of infertility that is completely attributable to uterine absence (surgical or congenital for women with Mayer-Rokitansky-Küster-Hauser syndrome: MRKH) or anatomic or functional abnormality that prevents embryo implantation or completion of pregnancy to term. Until recently, the only viable option to parenthood for couples with AUFI were adoption or surrogacy. Since a first attempt of uterus transplant (UTx) in 2000, nine babies were born from women with a transplanted uterus from 2014, eight of which in Sweden, and one in the United States. These promising results are raising immense hopes for the women with AUFI and there is optimism about the possibility for UTx to become part of clinical care even though, besides encouraging results, the procedure has also resulted in increased risks and harms for both the donors and recipients and increased risks of premature birth for the fetus. At present UTx is still considered as experimental and requiring more research and safety assessment before becoming a therapeutic option for AUFI. The transition from experimental procedure to therapeutic care would result in less strict ethical scrutiny for UTx and in the possibility for patients to get reimbursement for the procedure by the relevant healthcare insurance or public healthcare providers. In turn, an increase in the number of UTx performed yearly by specialized surgical teams would result in a general improvement of the “field strength”. However, at present it is difficult to establish the amount of evidence that we need in order to consider UTx as no longer experimental but routine clinical practice. The literature on UTx provides recommendations on the different outcomes that should be monitored in this experimental phase but no study is anticipating the number of subjects that should be followed and for how long. Conclusion: As for other transplants that have become routine practice, like renal transplant and heart transplant, it is likely that the decision on “routine practice readiness” will result from available cumulated evidences, from expert capacity to find a consensus on best practices and on political considerations as well, including pressures form patients and patient groups.

scholarly journals Clinical Progress Note: Procalcitonin in the Management of Pediatric Lower Respiratory Tract Infection

2019 ◽  
Vol 14 (11) ◽  
pp. 688-690 ◽  
Author(s):  
Sophie E Katz ◽  
Laura F Sartoni ◽  
Derek J Williams
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract Infection ◽  
Lower Respiratory Tract ◽  
Clinical Care ◽  
The United States ◽  
Current Evidence ◽  
Diagnostic Aid ◽  
Antibiotic Overuse

Procalcitonin (PCT) is a biomarker that has shown promise to identify bacterial etiology in acute infections, including bacterial lower respiratory tract infection (LRTI). In 2017, the United States Food and Drug Administration (FDA) approved the use of PCT as a diagnostic aid to guide the decisions around antibiotic therapy in acute LRTI.1 Although most of the data supporting the use of PCT for LRTI stems from adult studies, the high disease burden, predominance of viral etiologies, and frequent diagnostic uncertainty resulting in antibiotic overuse make pediatric LRTI an ideal target for the use of PCT as a diagnostic aid. This review evaluates and summarizes the current evidence regarding the role of PCT in the clinical care of pediatric LRTI, including its use in guiding antibiotic use and prognosticating disease severity.

scholarly journals Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 665-680 ◽  
Author(s):  
Amy Akers ◽  
Rustam Al-Shahi Salman ◽  
Issam A. Awad ◽  
Kristen Dahlem ◽  
Kelly Flemming ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Clinical Care ◽  
Heart Association ◽  
The United States ◽  
Current Evidence ◽  
Cerebral Cavernous Malformations ◽  
Class Iii ◽  
Knowledge Gaps ◽  
Cavernous Malformations ◽  
Patient Support Group

Abstract BACKGROUND: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. OBJECTIVE: To develop guidelines for CCM management. METHODS: The Angioma Alliance (www.angioma.org), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. RESULTS: Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). CONCLUSION: Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines.

scholarly journals Developing a Quality of Cancer Survivorship Care Framework: Implications for Clinical Care, Research, and Policy

2019 ◽  
Vol 111 (11) ◽  
pp. 1120-1130 ◽  
Author(s):  
Larissa Nekhlyudov ◽  
Michelle A Mollica ◽  
Paul B Jacobsen ◽  
Deborah K Mayer ◽  
Lawrence N Shulman ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Clinical Care ◽  
The United States ◽  
Care Quality ◽  
Clinical Settings ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Quality Framework ◽  
Research And Policy

Abstract There are now close to 17 million cancer survivors in the United States, and this number is expected to continue to grow. One decade ago the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, outlined 10 recommendations aiming to provide coordinated, comprehensive care for cancer survivors. Although there has been noteworthy progress made since the release of the report, gaps remain in research, clinical practice, and policy. Specifically, the recommendation calling for the development of quality measures in cancer survivorship care has yet to be fulfilled. In this commentary, we describe the development of a comprehensive, evidence-based cancer survivorship care quality framework and propose the next steps to systematically apply it in clinical settings, research, and policy.

Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1168-1180 ◽  
Author(s):  
Aram S Mardian ◽  
Eric R Hanson ◽  
Lisa Villarroel ◽  
Anita D Karnik ◽  
John G Sollenberger ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Clinical Care ◽  
The United States ◽  
Current Evidence ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Practice Gap ◽  
Pain Care

Abstract Objective Much of the pain care in the United States is costly and associated with limited benefits and significant harms, representing a crisis of value. We explore the current factors that lead to low-value pain care within the United States and provide an alternate model for pain care, as well as an implementation example for this model that is expected to produce high-value pain care. Methods From the perspective of aiming for high-value care (defined as care that maximizes clinical benefit while minimizing harm and cost), we describe the current evidence practice gap (EPG) for pain care in the United States, which has developed as current clinical care diverges from existing evidence. A discussion of the biomedical, biopsychosocial, and sociopsychobiological (SPB) models of pain care is used to elucidate the origins of the current EPG and the unconscious factors that perpetuate pain care systems despite poor results. Results An interprofessional pain team within the Veterans Health Administration is described as an example of a pain care system that has been designed to deliver high-value pain care and close the EPG by implementing the SPB model. Conclusions Adopting and implementing a sociopsychobiological model may be an effective approach to address the current evidence practice gap and deliver high-value pain care in the United States. The Phoenix VA Health Care System’s Chronic Pain Wellness Center may serve as a template for providing high-value, evidence-based pain care for patients with high-impact chronic pain who also have medical, mental health, and opioid use disorder comorbidities.

Critical Review of Complementary Therapies for Prostate Cancer

2003 ◽  
Vol 21 (11) ◽  
pp. 2199-2210 ◽  
Author(s):  
Simon Wilkinson ◽  
Gerald W. Chodak
Keyword(s):  
Prostate Cancer ◽  
Health Care Professionals ◽  
Critical Review ◽  
Complementary Therapies ◽  
Treatment Strategies ◽  
Complementary Therapy ◽  
The United States ◽  
Sufficient Evidence ◽  
Current Evidence ◽  
Prostate Cancer Prevention

Despite its prominence as the most frequently diagnosed solid tumor among men in the United States, relatively little is known about the etiology of prostate cancer. Furthermore, research into treatment strategies for prostate cancer continues to lag behind research for the other most common cancers. At the same time, however, the popularity of complementary therapies among prostate cancer patients continues to grow. In this article, we provide a critical review of the most recent evidence for dietary modifications, food supplements, and herbs in prostate cancer prevention and treatment. Despite encouraging data for some of these interventions, even the strongest proponents of complementary therapy agree that only randomized controlled trials can provide sufficient evidence on which to create universal guidelines. However, such trials are highly complex and expensive, and they require lengthy follow-up. Until such trials are completed, an opportunity exists for health care professionals to improve their knowledge and understanding of the current evidence for or against complementary therapy in prostate cancer.

Clinician attitudes, experiences, and use of coercion

2016 ◽  
Author(s):  
Beth Angell
Keyword(s):  
Health Care Professionals ◽  
Large Scale ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Local Health ◽  
Voluntary Organizations ◽  
Staff Attitudes ◽  
The People ◽  
Care And Support ◽  
Key Factor

This chapter focuses on the people who provide clinical care and support in the community, including doctors, nurses, social workers, support workers, and psychologists who may be employed by the local health or social care authority, voluntary organizations, or private healthcare providers or occupational schemes. This chapter considers the evidence available from large-scale surveys in several countries of the opinions of mental health-care professionals about community coercion and their experiences of its use. Differences between different staff groups will be identified and conclusions drawn about what can or should be learnt from this. The often markedly similar staff attitudes will be described and the potential implications of this for practice outlined. Where formal powers to compel exist, their use varies both between and within jurisdictions and it is generally believed that staff attitudes are a key factor in this.

scholarly journals Common Data Elements for Concussion in Tertiary Care: Phase One in Ontario

2017 ◽  
Vol 44 (6) ◽  
pp. 676-683 ◽  
Author(s):  
Cindy Hunt ◽  
Alicja Michalak ◽  
Donna Ouchterlony ◽  
Shawn Marshall ◽  
Cheryl Masanic ◽  
...  
Keyword(s):  
Brain Injury ◽  
Data Collection ◽  
Clinical Care ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
The United States ◽  
Shared Vision ◽  
Common Data Elements ◽  
Consensus Statements ◽  
Data Elements

AbstractBackground:Standardized data collection for traumatic brain injury (TBI) (including concussion) using common data elements (CDEs) has strengthened clinical care and research capacity in the United States and Europe. Currently, Ontario healthcare providers do not collect uniform data on adult patients diagnosed with concussion.Objective:The Ontario Concussion Care Strategy (OCCS) is a collaborative network of multidisciplinary healthcare providers, brain injury advocacy groups, patient representatives, and researchers with a shared vision to improve concussion care across the province, starting with the collection of standardized data.Methods:The International Framework of Functioning Disability and Health was selected as the conceptual framework to inform the selection of CDEs. The CDEs recommended by the OCCS were identified using key literature, including the National Institute of Neurological Disorders and Stroke–Zurich Consensus Statements for concussion in sport and the Ontario Neurotrauma Foundation Concussion/mTBI clinical guidelines.Results:The OCCS has recommended and piloted CDEs for Ontario that are readily available at no cost, clinically relevant, patient friendly, easy to interpret, and recognized by the international scientific community.Conclusions:The implementation of CDEs can help to shift Ontario toward internationally recognized standard data collection, and in so doing yield a more comprehensive evidence-based approach to care while also supporting rigorous research.

Rooting for Wellness: An Initiative Introducing Plant-Based Nutrition to First Year Medical Students

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Lakshman Mulpuri ◽  
Nakia Allen ◽  
Audrey Lunde ◽  
Shanita Thomas ◽  
Marissa Ray ◽  
...  
Keyword(s):  
Nutrition Education ◽  
Patient Population ◽  
Medical Curriculum ◽  
Journal Club ◽  
Clinical Care ◽  
Healthcare Providers ◽  
The United States ◽  
Guest Speaker ◽  
Lifestyle Modifications ◽  
Nutrition And Diet

Advances in preventive medicine have demonstrated the crucial role of whole-food unprocessed plant-based nutrition in reducing disease burden. Nutrition education and plant-based nutrition is seldom included in medical curriculum and is thus seldom incorporated into clinical care. Additionally, personal exposure to lifestyle modifications, including nutrition and diet, is associated with a provider’s willingness to recommend lifestyle modifications in clinical encounters. We offer this editorial to our fellow health professions’ students, practicing healthcare providers, and those community leaders intending to advocate for the patient population via evidence-based curricular enhancement. Our primary effort, Rooting for Wellness, consisted of a mandatory four-week segment within Wayne State University School of Medicine’s (WSUSOM’s) Patient, Population, Physician and Professional (P4) curriculum, which culminated in a required half-day event consisting of patient/provider panels and an interactive cooking demonstration. Prior to the curriculum, we provided several voluntary extracurricularopportunities for plant-based engagement including a 4-week plant-based kickstart program, cooking demonstration, journal club, and guest speaker events. To our knowledge, this is the first exclusively mandatory plant-based nutritional intervention undertaken at a medical institution in the United States. The strategy presented here may serve as a model for similar initiatives at a variety of institutions and settings.

Direct-Acting Antivirals to Prevent Vertical Transmission of Viral Hepatitis C: When Is the Optimal Time to Treat?

2018 ◽  
Vol 52 (11) ◽  
pp. 1152-1157 ◽  
Author(s):  
Leigh Cervino ◽  
Lauren M. Hynicka
Keyword(s):  
Hepatitis C ◽  
Vertical Transmission ◽  
Pediatric Patients ◽  
Clinical Care ◽  
The United States ◽  
Current Evidence ◽  
Direct Acting Antivirals ◽  
Viral Hepatitis C ◽  
Route Of Transmission ◽  
Direct Acting

Objective: To describe the most current evidence for the use of direct-acting antivirals (DAAs) to treat hepatitis C along the pregnancy-pediatric continuum in the United States. Data Sources: The MEDLINE/PubMed databases were searched (January 1995 to February 2018) for articles in English using the terms: hepatitis C, vertical transmission, pregnancy, pediatrics, ribavirin, interferon, direct acting antivirals, daclatasvir, dasabuvir, elbasvir, glecaprevir, grazoprevir, ledipasvir, ombitasvir, paritaprevir, pibrentasvir, simeprevir, sofosbuvir, and velpatasvir. Study Selection and Data Extraction: All relevant studies, meta-analyses, systematic reviews, guidelines, and review articles were evaluated for inclusion. References from pertinent articles were assessed for additional content that was not found during the initial search. Data Synthesis: The primary route of transmission for hepatitis C virus (HCV) in pediatric patients is vertical transmission (VT), with the rate estimated to be 5.8%. Screening for HCV during pregnancy is not routinely part of clinical care, and the data for the use of DAAs in pregnancy is limited. A significant number of infected infants will clear the HCV infection spontaneously, and ledipasvir/sofosbuvir and sofosbuvir have recently been Food and Drug Administration approved for use in pediatric patients older than 12 years. Conclusions: Data to determine the best treatment point along the pregnancy-pediatric continuum are limited; however, given the lack of human data for use of DAAs during pregnancy, low rate of VT, high rate of spontaneous pediatric clearance, and recent approval of DAAs for pediatric patients, treatment of chronically infected children seems to be the optimal strategy currently.

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