Evolution of pharmacogenomic services and implementation of a multi-state pharmacogenomics clinic across a large rural healthcare system

Introduction: Pharmacogenomics (PGx) aims to maximize drug benefits while minimizing risk of toxicity. Although PGx has proven beneficial in many settings, clinical uptake lags. Lack of clinician confidence and limited availability of PGx testing can deter patients from completing PGx testing. A few novel PGx clinic models have been described as a way to incorporate PGx testing into the standard of care.Background: A PGx clinic was implemented to fill an identified gap in provider availability, confidence, and utilization of PGx across our health system. Through a joint pharmacist and Advanced Practice Provider (APP) collaborative clinic, patients received counseling and PGx medication recommendations both before and after PGx testing. The clinic serves patients both in-person and virtually across four states in the upper Midwest.Results: The majority of patients seen in the PGx clinic during the early months were clinician referred (77%, n = 102) with the remainder being self-referred. Patients were, on average, taking two medications with Clinical Pharmacogenetics Implementation Consortium guidelines. Visits were split almost equally between in-person and virtual visits.Conclusion: Herein, we describe the successful implementation of an interdisciplinary PGx clinic to further enhance our PGx program. Throughout the implementation of the PGx clinic we have learned valuable lessons that may be of interest to other implementors. Clinicians were actively engaged in clinic referrals and early adoption of telemedicine was key to the clinic’s early successes

Professional development through mentoring: Final evaluation of the pilot mentoring programme of the European society of radiotherapy and oncology

: The European SocieTy for Radiotherapy and Oncology (ESTRO) organized a one-year pilot mentoring programme. At evaluation after one year, both mentors and mentees scored the programme with a median score of 9 on a scale of 10. All of the mentors indicated that they wanted to participate again as mentors

Why is Behavioral Game a Game for Economists? : The concept of beliefs in equilibrium

The interdisciplinary exchange between economists and psychologists has so far been more active and fruitful in the modifications of Expected Utility Theory than in those of Game Theory. We argue that this asymmetry may be explained by economists' specific way of doing equilibrium analysis of aggregate-level outcomes in their practice, and by psychologists' reluctance to fully engage with such practice. We focus on the notion of belief that is embedded in economists' practice of equilibrium analysis, more specifically Nash equilibrium, and argue that its difference from the psychological counterpart is one of the factors that makes interdisciplinary exchange in behavioral game theory more difficult.Peer reviewe

Alcohol and Drug Prevalence Among Seriously or Fatally Injured Road Users

DTNH2217D00031/693JJ920F000082Interest in how drugs other than alcohol affect roadway safety has increased. Studies conducted by NHTSA and others gave insights, but a knowledge gap exists on drug prevalence among drivers, pedestrians, and bicyclists seriously or fatally injured in crashes. This study sought to fill this gap by examining drug prevalence among a large sample (N = 7,279) of seriously injured roadway users at seven trauma centers and fatally injured crash victims at four medical examiners. Overall, 55.8% of the injured or killed tested positive for one or more drugs including alcohol, and, overall, 19.9% tested positive for two or more categories of drugs. The results are a first look at drug prevalence among a large sample of seriously or fatally injured roadway users

Altered purine and pyrimidine metabolism in erythrocytes with purine nucleoside phosphorylase deficiency

Purine and pyrimidine metabolism was compared in erythrocytes from three patients from two families with purine nucleoside phosphorylase deficiency and T-cell immunodeficiency, one heterozygote subject for this enzyme deficiency, one patient with a complete deficiency of hypoxanthine-guanine phosphoribosyltransferase, and two normal subjects. The erythrocytes from the heterozygote subject were indistinguishable from the normal erythrocytes. The purine nucleoside phosphorylase deficient erythrocytes had a block in the conversion of inosine to hypoxanthine. The erythrocytes with 0.07% of normal purine nucleoside phosphorylase activity resembled erythrocytes with hypoxanthine-guanine phosphoribosyltransferase deficiency by having an elevated intracellular concentration of PP-ribose-P, increased synthesis of PP-ribose-P, and an elevated rate of carbon dioxide release from orotic acid during its conversion to UMP. Two hypotheses to account for the associated immunodeficiency—that the enzyme deficiency leads to a block of PP-ribose-P synthesis or inhibition of pyrimidine synthesis—could not be supported by observations in erythrocytes from both enzyme-deficient families.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44134/1/10528_2004_Article_BF00484238.pd

Promotie

Contains fulltext : 78485.pdf (publisher's version ) (Closed access)1 p