Clinical use

On decision support: use of drug interaction databases

A survey with 1871 respondents, ‘75% from drug prescribing professionals (n = 1402) or pharmacists (n = 469)’

“74% of the prescribers stated that the information provided by SFINX make them change their prescribing or ongoing treatment ‘sometimes’ or more often (Figure 2). The most common action was to change the choice of drug (73%) followed by informing the patient […]

February 4th, 2015|Clinical use|0 Comments|

on bioelectronics – ‘digital drugs’ (literally)

GSK switches to electronic medicine
http://gulfnews.com/business/retail/gsk-switches-to-electronic-medicine-1.1218127

“GlaxoSmithKline is betting on this new vision of medicine — curing patients through electronics instead of chemicals”
By Clive Cookson, Financial Times
Published: 15:57 August 8, 2013

“The ambition of Moncef Slaoui, GSK head of research and development, is “to have the first medicine that speaks the electrical language of our body ready for approval by the end […]

January 23rd, 2015|Business, Clinical use|0 Comments|

3D bioprinting – printing cranial plugs, hearts, lungs, limbs … could we be printing drugs?

Maruthappu, M. and B. Keogh (2014). How might 3D printing affect clinical practice? BMJ 2014;349:g7709 http://www.bmj.com/content/349/bmj.g7709

Changing clinical practice and business models:

“When added to the ever increasing availability of printers,… The internet is no longer simply an information vehicle but a delivery vehicle, decentralising and accelerating the manufacturing process.”

“…combined with medical imaging, 3D printing also has the potential to revolutionise […]

Technology-enabled change envisaged for the NHS: NHS England’s medical director, on wearable devices,

Technology “enables you to predict things, to act early and to prevent unnecessary admissions, thereby not only taking a load off the NHS but, more importantly, actually keeping somebody safe and feeling good”.

Prof Sir Bruce Keogh, NHS England’s medical director, on wearable devices, in The Guardian.

January 21st, 2015|Clinical use|0 Comments|

On genetics and electronic health record

A Special Issue of the Genetics in Medicine journal on genetics and electronic health record

Volume 15, Issue 10 (October 2013)
http://www.nature.com/gim/journal/v15/n10/index.html

Among others, in this issue:

Integration of genomics into the electronic health record: mapping terra incognita
Joseph L. Kannry MD and Marc S. Williams MD
http://www.nature.com/gim/journal/v15/n10/full/gim2013102a.html

“… To date, no commercial EHR system has been described that systematically integrates genetic or genomic […]

Molecular profiling for deciding therapy—the French initiative

Nowak, F., J.-C. Soria and F. Calvo (2012). “Tumour molecular profiling for deciding therapy – the French initiative.” Nat Rev Clin Oncol 9(8): 479-486. http://dx.doi.org/10.1038/nrclinonc.2012.42

From the abstract:

In France a national network of 28 regional molecular genetics centres. Selected molecular tests, free of charge, to all patients and “specific programme has also been implemented to anticipate the launch […]

Translating Big Data into Decision Support systems?

How to go from Big Data to Decision Support systems:

A point in a recent JAMIA editorial suggests interesting questions on the design of systems for research and for clinical practice, and the required technical specifications:

“… in most academic health systems there is still a clear separation between basic and translational research involving genome data and clinical research. Computational environments […]

Definitions: Efficacy, Effectiveness, Efficiency

Borrowing from
John Marley, Professor, Department of General Practice, University of Adelaide, Adelaide
Aust Prescr 2000;23:114-5
http://www.australianprescriber.com/magazine/23/6/114/5

Efficacy –  can a treatment work?
As in a clinical trial, i.e. in ideal circumstance of a controlled trial population.

Effectiveness – ‘the extent to which a drug achieves its intended effect in the usual clinical setting’

Effectiveness “can be evaluated through observational studies of real practice”; local and […]

Pharmacogenetics test lab embedded in ePrescribing, for personalised medicine?

“Pharmacogenetics (PG) examines inherited or acquired variations in genes that dictate drug response, disposition, or toxicity and explores how these variations can be used to optimize medication therapy”…

Lab tests are done before the prescription; the CPOE alerts the doctor if the test is positive.

Perhaps an example of enhancing traditional CPOE/ePrescriing systems with personalised medicine?

Goldspiel BR, Flegel WA, DiPatrizio […]