Pharmacogenomics and public health: implementing 'populationalized' medicine

Pharmacogenomics are frequently considered in personalized medicine to maximize therapeutic benefits and minimize adverse drug reactions. However, there is a movement towards applying this technology to populations, which may produce the same benefits, while saving already scarce health resources. We conducted a narrative literature review to examine how pharmacogenomics and public health can constructively intersect, particularly in resource-poor settings. We identified 27 articles addressing the research question. Real and theoretical connections between public health and pharmacogenomics were presented in the areas of disease, drugs and public policy. Suggested points for consideration, such as educational efforts and cultural acceptability, were also provided. Including pharmacogenomics in public health can result in both health-related and economic benefits. Including pharmacogenomics in public health holds promise but deserves extensive consideration. To fully realize the benefits of this technology, support is needed from private, public and governmental sectors in order to ensure the appropriateness within a society.     

A public health discussion series in an advanced pharmacy practice experience

Objectives

To develop and integrate a student-centered, active-learning public health discussion series into an existing advanced pharmacy practice experience (APPE) to enhance knowledge and encourage integration of public health activities into students'' future careers.

Design

Students participated in 3 hour-long discussions to define and identify the scope of public health and to examine public health initiatives outside of and within health care.

Assessment

Improvement in the ability to accurately define public health was observed after students participated in the discussion series compared to baseline. Post-discussion definitions were more broad and accurate. Unsolicited comments about the discussion series documented in post-APPE reflections described students'' initial lack of knowledge, improved knowledge base, and improved interest in participating in public health initiatives.

Conclusions

Time devoted to public health discussions during an APPE can substantially impact student pharmacists'' knowledge base and interest in public health. Additionally, this active-learning technique aids in meeting the Accreditation Council for Pharmacy Education (ACPE) public health standards.     

Antimalarial activity of herbal extracts used in traditional medicine in Korea

Aqueous extracts of 6 traditional Korean medicines used to treat malaria were tested in vitro for their antimalarial activity against Plasmodium falciparum. The EC50 values for the herbal extracts were in the range 1.4-8.1 microg/ml. Significant antimalarial activity was observed with Coptis japonica (EC50=1.4 microg/ml), but it demonstrated no selective toxicity (selectivity=1). In contrast, Kalopanax pictus showed antimalarial activity (EC50=4.6 microg/ml) and higher selective toxicity (>4). This indicated that K. pictus may be potent for a new antimalarial agent.     

Integrating buprenorphine treatment into a public healthcare system: the San Francisco Department of Public Health's office-based Buprenorphine Pilot Program

Despite well-documented efficacy, US physicians have been relatively slow to embrace the use of buprenorphine for the treatment of opioid dependence. In order to introduce and support the use of buprenorphine across the San Francisco Department of Public Health system of care, the Buprenorphine Pilot Program was initiated in 2003. Program treatment sites included a centralized buprenorphine induction clinic and program pharmacy, and three community-based treatment sites; two primary care clinics and a private dual diagnosis group practice. The target patient population consisted of opioid-dependent patients typically seen in an urban, public health setting, including individuals experiencing extreme poverty, homelessness/unstable housing, unemployment, polysubstance abuse/dependence, coexisting mental health disorders, and/or little psychosocial support. This program evaluation reviews patient characteristics, treatment retention, substance use over time, patient impressions, and provider practices for the 57 patients admitted between 9/1/03 and 8/31/05. At baseline, over 80% of patients were injecting heroin, over 40% were homeless, and over one-third were using cocaine. Outcomes included an overall one-year retention rate of 61%, a rapid and dramatic decline in opioid use, very positive patient impressions of the program and of buprenorphine, and significant shifts in provider practices over time.     

Integrating virtual reality to expand the public health role of community pharmacists

ObjectivesTo describe a potential future role of the community pharmacist in public health using virtual centers that provide immediate feedback to patients regarding behavior changes.SummaryCommunity pharmacists would provide a comprehensive standardized patient-centered interview to collect pertinent information regarding patients that, together with a computerized body scan of the individual, would be fed into the virtual center to create a baseline likeness of the person. The virtual center then would predict the person's appearance and overall body health at a predetermined interval in the future, as well as provide feedback to the patient, engaging multiple senses and using an advanced body suit to represent changes in body mass and exercise tolerance as the person moves in the center. Pharmacists would work with the patient to identify patient-centered behavior changes, which would be programmed into the virtual center to demonstrate to the person how their new lifestyle goal may change their future appearance and health. Achievements and social networking in the virtual world would be incorporated to motivate patients to continue to make positive decisions regarding their health.ConclusionVirtual reality technology can be a powerful motivational tool that community pharmacists can use in a variety of ways to help patients implement and sustain positive lifestyle changes.     

中药提取自控系统

本文以中药提取系统自控生产线为论述对象,阐述了自动化控制技术(西门子PCS7系统)对流程工业的实用性及中药提取自控系统的多种优点.通过分析该系统的现状,显示中药提取的自动化及中药自控技术的发展前景.     

Chronological table-II of public medical care, medicine and pharmacy in Korea

The first report from the origin of Korea up until 1659 A.D. appeared previously in this journal. The chronological table of Q.J. Kim from 1660 A.D. to 1994 A.D. was partly revised by adding medical and pharmaceutical events, including the recent Korean history of pharmaceutical education and that of Korean pharmacists, for Japanese pharmacists. In this paper, Table-II, a concise history of public medical care, medicine and pharmacy from 1600 A.D. to present is reported.     

Chronological table-I of public medical care, medicine and pharmacy in Korea

S. Miki wrote a valuable chronological table of Korean medical events from the origin of the country up until 1945 in Japanese, and then published the book in 1985. In 1996, Q.J. Kim made a new chronological table of public medical care in Korea from the origin of the country up until 1994 in Hangul. So, J.H. Kim translated the new table into Japanese, and J. Okuda added some important medical and pharmaceutical events to the table. The revised chronological table has been divided into two parts. This first report covers the history from the origin of the country up until 1659 A.D.     

Integrating healthcare: the Counties Manukau experience

In 1998, Counties Manukau District Health Board (CMDHB) was experiencing rapidly increasing demands on its secondary services. It was finding it increasingly difficult to meet the health needs of its relatively deprived population. There was widespread evidence of "systems failure", with poor coordination of primary and secondary services. A strategic plan was devised to meet identified priorities and this was subsequently implemented with extensive community involvement. A "disruptive change" model was utilised. Thirty separate projects were undertaken to improve coordination and integration of health services. Brief summaries of all projects are presented, and full evaluations were performed of major projects. Factors critical to project success were: dedicated and effective leadership; involvement of clinical staff; early engagement of the Maori and Pacific community; careful selection of stakeholders; reassurance for providers about privacy issues; close monitoring of project progress; realistic timeframes; and adequate initial funding. CMDHB believes that the critical factor to success in improving the performance of the health sector will be the ability of our key leaders in primary and secondary care, in both management and clinical roles, to adopt a systems view to problem analysis and solution building