血液肿瘤相关药物基因组学研究和应用进展

由于多数血液肿瘤治疗药物不良反应多、治疗窗窄、个体差异大,正确合理地应用抗肿瘤药物有助于降低死亡率、复发率和不良反应发生率。近年来在药物基因组学检测指导下的个体化治疗被日益重视。药物基因组学的主要研究对象包括药物代谢酶、药物转运体及药物作用靶标等相关基因的多态性或突变对药代动力学、药效动力学的影响。本文就血液肿瘤治疗相关的药物基因组学的研究和应用进展进行综述。     

慢性阻塞性肺疾病个体化治疗与药物基因组学研究

随着分子生物学、分子遗传学与分子药理学,特别是药物基因组学的发展,人们逐渐认识到,不同个体对同一药物的不同反应,大多源于基因的差异。由此,在遗传药理学的基础上,发展形成了药物基因组学这一新学科,以分子和基因水平上的研究揭示个体对药物不同反应的机制,为科学合理用药开拓了新的思路和途径。现就慢性阻塞性肺疾病患者常用药物的药物基因组学与个体化治疗进行综述。     

华法林药物基因组学的发展及其临床应用前景

华法林是临床广泛使用的口服抗凝药物。由于自身狭窄的有效抗凝治疗范围以及个体间每日用药剂量的显著差异,困扰着许多患者和临床医生。近年来,许多研究均报道基因多态性是引起华法林个体间用药剂量差异的主要因素之一。部分学者建立基于药物基因组学的剂量方程,并在进行验证,评估其临床价值。本文综述了华法林相关药物基因组学的国内外最新进展,为进一步针对华法林的临床研究提供参考依据。     

个体化医学的现状、挑战与对策

现代药物基因组学研究证明,人类遗传和基因多态性是药物不良反应及其疗效个体差异的首要原因.个体化医学则是根据个体的遗传结构,选择适合患者的药物种类和剂量,以显著提高药物疗效并减少药物毒性.本文介绍国内外药物基因组学进展,评述个体化医学由科研推向临床应用的各种影响因素,阐明个体化医学实施面临的挑战,展望个体化医学的未来.     

个体化医学的现状、挑战与对策

现代药物基因组学研究证明,人类遗传和基因多态性是药物不良反应及其疗效个体差异的首要原因.个体化医学则是根据个体的遗传结构,选择适合患者的药物种类和剂量,以显著提高药物疗效并减少药物毒性.本文介绍国内外药物基因组学进展,评述个体化医学由科研推向临床应用的各种影响因素,阐明个体化医学实施面临的挑战,展望个体化医学的未来.     

MALDI-TOF MS在药物基因组学检测中的应用及展望

药物基因组学是临床基因检测的新兴领域,是个体化医学模式的重要组成部分。药物基因组学检测的结果能够在安全、合理用药中发挥指导作用,这使得越来越多的研究者更加关注遗传信息多态性与个体药物反应差异之间的关系。诞生于上世纪80年代的基质辅助激光解吸飞行时间质谱(MALDI-TOF MS)已成为临床领域进行基因检测的主流技术之一。对于药物基因组学检测中常见的单核苷酸多态性(SNP)、拷贝数变异(CNV)、插入/缺失(In/Del)等分子标记,MALDI-TOF MS均能实现准确检出,同时以其检测的多重性、精准性、简便性、经济性得到越来越多的关注和应用。本文介绍了MALDI-TOF MS的技术原理并总结了MALDI-TOF MS在药物基因组学检测中的多个研究案例,旨在推广该技术在药物基因组研究中的应用,并加深研究者对该技术平台的认识,通过该技术平台的推广促进药物基因组学在临床的转化应用。     

药物基因组学与个体化用药

药物反应个体差异是药物治疗中的普遍现象,也是临床药物治疗失败的重要原因。个别患者对常规药物治疗非常敏感而出现各种程度不等的药物不良反应的情况也十分普遍,这些异常药物反应是由许多特殊基因型构成的特定基因型组所决定的,是目前药物基因组学需要明确的研究内容。现依据有关文献分析,归纳、总结药物基因组学的发展、研究内容及与个体化给药的关系,为安全、合理用药提供理论依据。     

静脉用药闭环监控信息系统在PIVAS与临床中的应用实践

[目的]探讨静脉用药执行监控系统在静脉药物配置中心(PIVAS)与临床全程信息化管理的应用,通过静脉用药调配全程信息化闭环管理及流程优化,使静脉用药更加及时、有效、规范执行。[方法]通过静脉用药执行监控及交互系统监控静脉用药的调配、运送、执行等各环节时间,系统设置提醒临床护士执行静脉用药时间为调配后2h内,统计超过2h执行情况,分析不及时执行原因进行流程优化。[结果]通过分析不及时执行原因,从输液顺序安排、调配、运送接收、临床PDA执行方面进行了流程优化及改善。2017年6月进行流程优化后,静脉用药运送接收流程优化后比优化前平均时间减少15～20min,提高了静脉用药调配后送达病区的效率;2018年1月—2018年6月静脉用药不及时执行率比2017年1月—2017年6月下降40%,PIVAS临床满意度提高到9分,均得到改善。[结论]静脉用药执行监控系统的建立,有利于PIVAS对于静脉用药全流程质控与优化,从而更好地保证临床静脉用药及时执行,降低了静脉用药调配后在临床滞留可能造成的医院感染风险和差错风险,提高了临床静脉用药满意度,保证了病人用药安全。     

药物医嘱闭环执行系统的设计及应用

通过设计药物医嘱闭环执行系统,将执行医嘱的全过程及对药物疗效观察的所有数据写入医院信息系统中,进行全流程数据跟踪及医嘱闭环管理。临床应用后,提高了医嘱录入和药物配置的准确性,护士医嘱执行正确率和药物宣教记录的符合率均>99%,给药错误发生率由0.51次/千床日降至0.42次/千床日,护理质量和患者安全明显提高。     

痛觉敏感性与阿片镇痛个体差异—药物基因组学的双生子研究

阿片类药物是治疗中重度疼痛的主要药物,然而,它并不是最理想的药物,原因之一在于临床上阿片类镇痛药的安全有效用量存在很大的个体差异。目前,阿片类药物个体差异的机制尚不清楚,可能由多方面的原因参与(比如基因或环境因素等)。本研究使用药物基因组学的双生子研究方法,研究基因与环境因     

Pharmacogenomics: implications for laboratory medicine.

Pharmacogenomics deals with the interactions of individual genetic constitution with drug therapy. It has potentially far reaching consequences for drug development and future treatment strategies, but also for clinical in vitro diagnostics. With increasing knowledge about interactions between genes and drug treatment, there will be an equally increasing demand for rapid and reliable diagnostic tests prior to the institution of therapy. In fact, it is very likely that pharmacogenetic tests will make up a significant proportion of total molecular biology testing in the coming years. Therefore, this review focuses on the implications of pharmacogenomics on the clinical laboratory.     

Pharmacogenomics: Precision Medicine and Drug Response

Pharmacogenomics is the use of genomic and other “omic” information to individualize drug selection and drug use to avoid adverse drug reactions and to maximize drug efficacy. The science underlying pharmacogenomics has evolved rapidly over the 50 years since it was first suggested that genetics might influence drug response phenotypes. That process has occurred in parallel with advances in DNA sequencing and other molecular technologies, with striking increases in our understanding of the human genome. There are now many validated examples of the clinical utility of pharmacogenomics, and this type of clinical genomic information is increasingly being generated in clinical laboratories, incorporated into electronic health records, and used to “tailor” or individualize drug therapy. This review will survey the origins and development of pharmacogenomics; it will address some of the challenges associated with the clinical implementation of pharmacogenomics; and it will attempt to foresee future advances in this important genomic discipline, one that almost certainly will be among the earliest and most widely adopted aspects of clinical genomics.     

Getting guidelines into practice: a literature review

BACKGROUND: Clinical guidelines have the potential to ensure that a research knowledge base underpins practice. Their development nationally and locally has increased dramatically in recent years. The challenge lies in implementing them. This literature review of guideline implementation was conducted to inform the development of implementation strategies for the Royal College of Nursing national clinical guidelines. CONCLUSION: The evidence base for guideline implementation is still developing and many ideas and strategies require further testing. Although strategies can be developed around some core principles, as yet there is no single definitive strategy. This selective literature review offers some insight into successful implementation strategies.     

Pharmacogenomics and adverse drug reactions in diagnostic and clinical practice.

Pharmacogenetics and pharmacogenomics deal with genetically determined variations in how individuals respond to drugs. They hold the potential to revolutionize drug therapy. The clinical need for novel approaches to improve pharmacotherapy stems from the high rate of adverse reactions to drugs and their lack of effectiveness in many individuals. Despite the accumulation of research findings showing the potential for clinical benefit for several drug-metabolizing enzymes and some receptors that constitute drug targets, the translation of these findings into tangible clinical applications occurs very slowly. The main steps for clinical implementation of pharmacogenomics include: a) education of clinicians and all other parties involved in the use and benefits of pharmacogenomics; b) execution of large prospective clinical and pharmacoeconomic studies showing the benefit of pharmacogenomic genotyping; c) provision of incentives to develop tests; d) development of specific clinical guidelines; and e) creation of a solid regulatory and ethical framework. Furthermore, the potential should be explored to use existing therapeutic drug monitoring laboratories to introduce pharmacogenomic testing into hospitals. Overall, our thesis is that pharmacogenomics is already a reality in clinical practice and is bound to continue gaining acceptance by clinicians in the coming years.     

Evolutionistic or revolutionary paths? A PACS maturity model for strategic situational planning

Purpose  

While many hospitals are re-evaluating their current Picture Archiving and Communication System (PACS), few have a mature strategy for PACS deployment. Furthermore, strategies for implementation, strategic and situational planning methods for the evolution of PACS maturity are scarce in the scientific literature. Consequently, in this paper we propose a strategic planning method for PACS deployment. This method builds upon a PACS maturity model (PMM), based on the elaboration of the strategic alignment concept and the maturity growth path concept previously developed in the PACS domain.     

Considerations When Applying Pharmacogenomics to Your Practice

Many practitioners who have not had pharmacogenomic education are required to apply pharmacogenomics to their practices. Although many aspects of pharmacogenomics are similar to traditional concepts of drug-drug interactions, there are some differences. We searched PubMed with the search terms pharmacogenomics and pharmacogenetics (January 1, 2005, through December 31, 2019) and selected articles that supported the application of pharmacogenomics to practice. For inclusion, we gave preference to national and international consortium guidelines for implementation of pharmacogenomics. We discuss special considerations important in the application of pharmacogenomics to assist clinicians with ordering, interpreting, and applying pharmacogenomics in their practices.     

Rapid response teams in hospitals: improving quality of care for patients and quality of the work environment for nursing staff

As the healthcare delivery system continues to evolve in the new millennium, initiatives such as the Institute for HealthCare Improvement's 100,000 Lives Campaign include the development of rapid response teams in hospitals. Introduction of rapid response teams provides nurses assistance in difficult clinical situations and provides early clinical intervention to mitigate negative patient outcomes and save lives. Development, implementation strategies, and benefits of rapid response teams are described.     

Pharmacogenomics: application to the management of cardiovascular disease

The past decade has seen substantial advances in cardiovascular pharmacogenomics. Genetic determinants of response to clopidogrel and warfarin have been defined, resulting in changes to the product labels for these drugs that suggest the use of genetic information as a guide for therapy. Genetic tests are available, as are guidelines for incorporation of genetic information into patient-care decisions. These guidelines and the literature supporting them are reviewed herein. Significant advances have also been made in the pharmacogenomics of statin-induced myopathy and the response to β-blockers in heart failure, although the clinical applications of these findings are less clear. Other areas hold promise, including the pharmacogenomics of antihypertensive drugs, aspirin, and drug-induced long-QT syndrome (diLQTS). The potential value of pharmacogenomics in the discovery and development of new drugs is also described. In summary, pharmacogenomics has current applications in the management of cardiovascular disease, with clinically relevant data continuing to mount.     

Cardiovascular pharmacogenomics: current status,future prospects

Pharmacogenomics is a field dedicated to exploring the contribution of genetics to interindividual variability in drug response. A goal of cardiovascular pharmacogenomics is to guide cardiovascular drug development and selection so as to optimize therapeutic benefit and minimize the potential for toxicity. Genetic-based differences in drug metabolism have long been recognized but just now are on the verge of wider clinical application. Differences in efficacy of cardiovascular drugs (independent of drug concentration) based on common genetic variations (polymorphisms) only recently have begun to be explored, but the potential for clinical application appears promising. Examples are presented of important pharmacodynamic effects of genetic variants on several drugs, including those in antiarrhythmic, reninangiotensin, beta-blocker, lipid-lowering, and antithrombotic classes. Principles of pharmacogenomics applied to drug metabolism are discussed that are relevant to drug development and clinical use, and examples are given for CYP450 phase I enzymes, phase II enzymes, and drug transporters. Challenges in establishing true pharmacogenetic associations are discussed, and current and future clinical potential is summarized. Rapid research progress and initial clinical applications with pharmacogenomics are foreseen in the near future.     

The impact of pharmacogenomics on the management of cardiac disease

Pharmacogenomics promises to help maximize efficacy and minimize adverse drug reactions. It could have a significant impact on the treatment of cardiovascular disease, the leading cause of death in the United States. The past decade has seen pharmacogenomics move from study of a candidate gene to genome-wide approaches, with the development of a series of pharmacogenetic tests. However, many barriers need to be overcome for cardiovascular pharmacogenomics to have its promised clinical impact.