Applying Pharmacogenomic Guidelines to Combat Medical Care

ABSTRACT Pharmacogenomics is a pillar of personalized medicine that has the potential to deliver optimized treatment in many medical settings. Military medicine in the deployed setting is unique and therefore warrants separate assessment pertaining to its potential capabilities and impact. Pharmacogenomics for United States Active Duty Service Members medical care in the deployed setting has not, to our knowledge, been previously reviewed. We present potential applications of pharmacogenomics to forward medical care through two comprehensive references for deployed medical care, the Tactical Combat Casualty Care Guidelines (TCCC) and Emergency War Surgery (EWS) fifth edition. All drugs within the deployment manuals, TCCC guidelines and EWS book, were identified and the list was cross-referenced to the Clinical Pharmacogenetics Implementation Consortium guidelines and genes–drugs interactions list as well as the Food and Drug Administration Table of Pharmacogenomics Biomarkers in Drug Labeling. Ten pharmacologic categories were identified, consisting of 15 drugs, along with the classes, aminogylcosides, beta-blockers, and volatile anesthetics. Drugs and pharmacogenomics liabilities were tabulated. Eight specific drugs or classes are expounded upon given the belief of the authors of their potential for impacting future treatment on the battlefield in the setting of prolonged field care. This review outlines several genes with liabilities in the prolonged field care setting and areas that may produce improved care with further study.

Job Satisfaction of Arab Speech-Language Pathologists in Different Work Settings in Kuwait Using the Job Satisfaction Survey

Purpose: Job satisfaction impacts employee work performance, productivity, and retention. We investigated levels of job satisfaction among Arab speech-language pathologists (SLPs) across different work settings in Kuwait. The aims were to determine the differences between work settings for SLPs in terms of job satisfaction and the reasons behind SLPs' migration from one setting to another and to identify the variables that contribute significantly to job satisfaction in each work setting. Method: A 36-item Job Satisfaction Survey (JSS) questionnaire was used to evaluate job satisfaction based on responses to a 6-point Likert-type scale distributed to SLPs across school, hospital, and private clinic settings. Overall JSS score and subscale category ratings were computed and compared between different work settings to assess the influence of variables such as pay, promotion, supervision, benefits, and nature of work on job satisfaction among SLPs working in Kuwait. Results: According to JSS normative data, the highest job satisfaction scores were obtained from SLPs working in private clinics, with average satisfaction scores among those working in government, school, and medical settings. The highest job satisfaction scores for supervision, coworkers, and nature of work subscale categories were similar for SLPs in each setting. The lowest satisfaction scores of subscale categories differed between settings: “promotion” in schools, “fringe benefits” in government medical settings, and “operating conditions” in private clinics. Conclusions: While the need exists to attract SLPs to work in government medical settings (hospitals and clinics) in Kuwait, increased opportunity for professional development courses that are relevant to the discipline, and improved communication among SLPs and departmental heads, is necessary to both attract and retain them. Changes in the government setting need to be made in order to prevent the migration of SLPs from government hospitals to private hospitals where they are desperately needed.

Reflection-in-action: Measuring ‘context’ in medical interpreting

Community interpreting scholarship has solidly established the importance of appreciating the nuances of context to effective interpreting practice (Angelelli, 2004; Wadensjo?, 1998). Several frameworks for identifying and articulating the way context affects interpreting work have been articulated (Dean & Pollard, 2011). What is less well documented is the way interpreters learn to develop an understanding of context and how that subsequently informs their practice. This article describes the development and implementation of a tool to assess interpreters’ facility in identifying and articulating context – specifically in healthcare settings. The activities and the assessment tool are grounded in the educational theories of Donald Schön and his foregrounding of the intuitive practice abilities of professionals. The resulting assessment tool was refined through its use in postgraduate courses in healthcare interpreting, where various aspects of the healthcare context were explained using videos of provider–patient interactions. Through reflective practice activities, students analysed their practical knowledge and skills and improved their context-based insight. Currently designed for signed language interpreters in medical settings based in the United States, this multi-component assessment tool can be adapted to various contexts in community interpreting.

Intellectual disability genomics: current state, pitfalls and future challenges

Intellectual disability (ID) can be caused by non-genetic and genetic factors, the latter being responsible for more than 1700 ID-related disorders. The broad ID phenotypic and genetic heterogeneity, as well as the difficulty in the establishment of the inheritance pattern, often result in a delay in the diagnosis. It has become apparent that massive parallel sequencing can overcome these difficulties. In this review we address: (i) ID genetic aetiology, (ii) clinical/medical settings testing, (iii) massive parallel sequencing, (iv) variant filtering and prioritization, (v) variant classification guidelines and functional studies, and (vi) ID diagnostic yield. Furthermore, the need for a constant update of the methodologies and functional tests, is essential. Thus, international collaborations, to gather expertise, data and resources through multidisciplinary contributions, are fundamental to keep track of the fast progress in ID gene discovery.

Emotional intelligence and its impacts on the clinical performance of nurses in general public hospitals

Objectives The nursing profession is considered to be at a high risk of workplace stress, workload, and burnout due to the high job demands. The nurses require the appropriate and prompt coping mechanisms to relieve the effects of stress. The nurses have to be emotionally intelligent to overcome the work-related stress to meet the clinical-based duties. But there is a paucity of the effect of emotional intelligence (EI) on the clinical performance of nurses in the literature. Therefore, the role of dimensions of EI in the improvement of clinical performance of nurses was explored in this study. Methods A total of 194 nurses with different education levels and experiences were included from various clinical departments and shifts of public hospitals in Iraqi Kurdistan. Results The mean age of the nurses was 29.44 years, with ages ranging from 23 years to 36 years. The nurses were men (56.70%), married (53.10%), non-smokers (86.10%), physically active (55.70%), and irregular physically active (63.90%). Nurses were able to appraise their own emotions but not the emotions of other nurses. They regulated their own emotions but were weak in regulating the emotions of other nurses. They did not utilize emotions in coming up with new ideas and facing obstacles in clinical settings. Generally, the nurses reported that a little clinical performance is required in medical settings. The levels of interpersonal communication and problem solving were improved with an increasing appraisal and regulating own emotions. The level of problem solving was improved with appraising own emotions and utilizing emotions in facing obstacles. Conclusions Nurses need to know how to regulate others’ emotions and utilize these emotions in coming up with new ideas and facing the obstacles positively in medical settings.

Ethical Considerations in Psychological Consultation to Critical Care Settings

This chapter discusses the ethical and professional standards affecting psychologists who provide consultation as members of interdisciplinary treatment teams in critical care and intensive care settings. The authors describe the unique characteristics of critical and intensive care units and how they contribute to complex life and death decisions, which in turn can result in unique moral, ethical, and clinical psychological dilemmas. In particular, this chapter focuses on the ethical quandaries that are commonly faced by psychologists in these highly specialized medical settings, and provides a mechanism for resolving ethical conflicts when they occur. Case examples are provided, each of which illustrate one of the ten ethical standards listed in the American Psychological Association’s code of ethics. Lastly, a model for maintaining ethical situational awareness in psychological consultations in critical care settings is proposed to serve as a guide for psychologists as they navigate and ultimately resolve challenging ethical dilemmas.

Role of platelet-rich plasma in maxillofacial surgery

Platelet-rich plasma (PRP) has been reported as an efficacious modality that can enhance the process of wound healing and tissue regeneration and has been validated in different medical settings, including cardiovascular surgery, otolaryngology, head and neck surgery, and maxillofacial surgery. In dental and oral surgery settings, PRP has been reported as an efficacious approach with favorable outcomes in different settings. Some of these procedures include surgical repair of the alveolar cleft, mandibular reconstruction, ablative surgical procedures, placement of osseointegrated implants, periodontal plastic surgery, and management of infrabony periodontal defects. In the present study, we aim to discuss the role and mechanisms that PRP plays in the settings of maxillofacial surgery based on evidence from the relevant studies in the literature. Evidence indicates the wide acceptance of the modality, which has been proven to increase the rate of wound healing and reduce the frequency of pain and swelling. The administration of PRP has been reported to dispense with the need for invasive approaches that might be furtherly associated with complications and different morbidities. However, in most of the favorable events where the PRP administration of was associated with enhanced outcomes, the modality was used in combination with another therapeutic approach. Therefore, further research is needed to validate the efficacy of the modality in the different settings.

Validity and Reliability of the Sport Readiness Questionnaire Focused on Musculoskeletal Injuries

Background: The pre-participation physical evaluation (PPE), which includes a musculoskeletal system evaluation, identifies factors that may be a risk for athletes while practicing sport. Thus, the Sport Readiness Questionnaire, focused on musculoskeletal injuries (MIR-Q) was developed to screen athletes at risk of future injuries or worsening pre-existing injuries during training or competition. However, the criterion-related validity and reliability of the MIR-Q have not yet been analyzed. Objectives: To test the criterion-related validity and reliability (internal consistency and test-retest) of the MIR-Q. Methods: One hundred and twenty adult athletes from different sports (17 women) completed the MIR-Q and underwent a physical orthopedic examination (POE) performed by an orthopedic physician. At least one affirmative answer on the MIR-Q, as well as one positive finding on the POE, was considered “a risk factor for sport injury”. The validity was assessed from sensitivity, specificity, and accuracy measurements. Internal consistency was obtained through the KR-20 test. Reliability was measured using the test-retest method in a 7-14-day interval with a sub-sample (n = 41) and verified by the Kappa index. Results: Eighty-one (67.5%) questionnaires contained positive responses. The sensitivity of the MIR-Q against POE was high (84.4%), while specificity and accuracy were considered moderate, with values of 42.7% and 58.0%, respectively. Internal consistency was moderate (KR-20 = 0.57), and test-retest was reduced (K = 0.30; P = 0.02). Conclusions: The MIR-Q was associated with high values of validity and low values of reliability. The questionnaire may be an alternative tool for musculoskeletal screening during PPE in limited medical settings (sports OR orthopedic physician) conditions. Future studies should investigate the predictive validity of the MIR-Q, and psychometric properties of the questionnaire with younger athletes.