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Article ; Online: Pharmacogenomics education and perceptions: is there a gap between internal medicine resident and attending physicians?

Rohrer Vitek, Carolyn R / Giri, Jyothsna / Caraballo, Pedro J / Curry, Timothy B / Nicholson, Wayne T

2021 Volume 22, Issue 4, Page(s) 195–201

Abstract: Aim: ...

Abstract	Aim:
MeSH term(s)	Attitude of Health Personnel ; Health Knowledge, Attitudes, Practice ; Humans ; Internal Medicine/education ; Internship and Residency ; Pharmacogenetics/education ; Physicians ; Precision Medicine ; Surveys and Questionnaires
Language	English
Publishing date	2021-02-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2019513-8
ISSN	1744-8042 ; 1462-2416
ISSN (online)	1744-8042
ISSN	1462-2416
DOI	10.2217/pgs-2020-0141
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Article: Concepts Driving Pharmacogenomics Implementation Into Everyday Healthcare.

Giri, Jyothsna / Moyer, Ann M / Bielinski, Suzette J / Caraballo, Pedro J

Pharmacogenomics and personalized medicine

2019 Volume 12, Page(s) 305–318

Abstract: Pharmacogenomics (PGx) is often promoted as the domain of precision medicine with the greatest potential to readily impact everyday healthcare. Rapid advances in PGx knowledge derived from extensive basic and clinical research along with decreasing costs ...

Abstract	Pharmacogenomics (PGx) is often promoted as the domain of precision medicine with the greatest potential to readily impact everyday healthcare. Rapid advances in PGx knowledge derived from extensive basic and clinical research along with decreasing costs of laboratory testing have led to an increased interest in PGx and expectations of imminent clinical translation with substantial clinical impact. However, the implementation of PGx into clinical workflows is neither simple nor straightforward, and comprehensive processes and multidisciplinary collaboration are required. Several national and international institutions have pioneered models for implementing clinical PGx, and these initial models have led to a better understanding of unresolved challenges. In this review, we have categorized and explored the most relevant of these challenges to highlight potential gaps and present possible solutions. We describe the ongoing need for basic and clinical research to drive further developments in evidence-based medicine. Integration into daily clinical workflows introduces new challenges requiring innovative solutions; specifically those related to the electronic health record and embedded clinical decision support. We describe advances in PGx testing and result reporting and describe the critical need for increased standardization in these areas across laboratories. We also explore the complexity of the PGx knowledge required for clinical practice and the need for educational strategies to ensure adequate understanding among members of current and future healthcare teams. Finally, we evaluate knowledge obtained from previous implementation efforts and discuss how to best apply these learnings to future projects. Despite these challenges, the future of precision medicine appears promising due to the rapidity of recent advances in the field and current multidisciplinary efforts to effectively translate PGx to everyday clinical practice.
Language	English
Publishing date	2019-10-30
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2508173-1
ISSN	1178-7066
ISSN	1178-7066
DOI	10.2147/PGPM.S193185
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Article ; Online: Considerations When Applying Pharmacogenomics to Your Practice.

Nicholson, Wayne T / Formea, Christine M / Matey, Eric T / Wright, Jessica A / Giri, Jyothsna / Moyer, Ann M

Mayo Clinic proceedings

2020 Volume 96, Issue 1, Page(s) 218–230

Abstract: 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. ... ...

Abstract	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.
MeSH term(s)	General Practitioners ; Genetic Testing ; Humans ; Pharmacogenetics/methods
Language	English
Publishing date	2020-12-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2020.03.011
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Article ; Online: PARC report: a perspective on the state of clinical pharmacogenomics testing.

Eichmeyer, Jennifer / Rogers, Sara / Formea, Christine M / Giri, Jyothsna / Jones, J Shawn / Schnettler, Erica / Schmidlen, Tara / Glogowski, Emily / Kurz, Raluca N

Pharmacogenomics

2020 Volume 21, Issue 11, Page(s) 809–820

Abstract: In this Perspective, the authors discuss the state of pharmacogenomics testing addressing a number of advances, challenges and barriers, including legal ramifications, changes to the regulatory landscape, coverage of testing and the implications of ... ...

Abstract	In this Perspective, the authors discuss the state of pharmacogenomics testing addressing a number of advances, challenges and barriers, including legal ramifications, changes to the regulatory landscape, coverage of testing and the implications of direct-to-consumer genetic testing on the provision of care to patients. Patient attitudes toward pharmacogenomics testing and associated costs will play an increasingly important role in test acquisition and subsequent utilization in a clinical setting. Additional key steps needed include: further research trials demonstrating clinical utility and cost-effectiveness of pharmacogenetic testing, evidence review to better integrate genomic information into clinical practice guidelines in target therapeutic areas to help providers identify patients that may benefit from pharmacogenetic testing and engagement with payers to create a path to reimbursement for pharmacogenetic tests that currently have sufficient evidence of clinical utility. Increased adoption of testing by payers and improved reimbursement practices will be needed to overcome barriers, especially as the healthcare landscape continues to shift toward a system of value-based care.
MeSH term(s)	Cost-Benefit Analysis/economics ; Cost-Benefit Analysis/legislation & jurisprudence ; Direct-To-Consumer Screening and Testing/economics ; Direct-To-Consumer Screening and Testing/legislation & jurisprudence ; Drug Labeling/economics ; Drug Labeling/legislation & jurisprudence ; Humans ; Malpractice/economics ; Malpractice/legislation & jurisprudence ; Pharmacogenomic Testing/economics ; Pharmacogenomic Testing/legislation & jurisprudence ; Precision Medicine/economics
Language	English
Publishing date	2020-07-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2019513-8
ISSN	1744-8042 ; 1462-2416
ISSN (online)	1744-8042
ISSN	1462-2416
DOI	10.2217/pgs-2019-0193
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Article ; Online: PARC report: a health-systems focus on reimbursement and patient access to pharmacogenomics testing.

L Rogers, Sara / Keeling, Nicholas J / Giri, Jyothsna / Gonzaludo, Nina / Jones, J Shawn / Glogowski, Emily / Formea, Christine M

Pharmacogenomics

2020 Volume 21, Issue 11, Page(s) 785–796

Abstract: Pharmacogenomics test coverage and reimbursement are major obstacles to clinical uptake. Several early adopter programs have been successfully initiated through dedicated investments by federal and institutional research funding. As a result of research ... ...

Abstract	Pharmacogenomics test coverage and reimbursement are major obstacles to clinical uptake. Several early adopter programs have been successfully initiated through dedicated investments by federal and institutional research funding. As a result of research endeavors, evidence has grown sufficiently to support development of pharmacogenomics guidelines. However, clinical uptake is still limited. Third-party payer support plays an important role in increasing adoption, which to date has been limited to reactive single-gene testing. Access to and interest in direct-to-consumer genetic testing are driving demand for increasing healthcare providers and third-party awareness of this burgeoning field. Pharmacogenomics implementation models developed by early adopters promise to expand patient access and options, as testing continues to increase due to growing consumer interest and falling test prices.
MeSH term(s)	Community Health Planning/economics ; Community Health Planning/trends ; Health Personnel/economics ; Health Personnel/education ; Health Personnel/trends ; Health Services Accessibility/economics ; Health Services Accessibility/trends ; Humans ; Insurance, Health, Reimbursement/economics ; Insurance, Health, Reimbursement/trends ; Medical Assistance/economics ; Medical Assistance/trends ; Pharmacogenomic Testing/economics ; Pharmacogenomic Testing/trends ; Precision Medicine/economics ; Precision Medicine/trends
Language	English
Publishing date	2020-08-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2019513-8
ISSN	1744-8042 ; 1462-2416
ISSN (online)	1744-8042
ISSN	1462-2416
DOI	10.2217/pgs-2019-0192
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Article ; Online: Education and Knowledge in Pharmacogenomics: Still a Challenge?

Giri, Jyothsna / Curry, Timothy B / Formea, Christine M / Nicholson, Wayne T / Rohrer Vitek, Carolyn R

Clinical pharmacology and therapeutics

2018 Volume 103, Issue 5, Page(s) 752–755

Abstract: A number of barriers exist for adoption of pharmacogenomics into practice. Physicians, pharmacists, and nurses report limited knowledge about pharmacogenomics and its use in patient care. Lack of pharmacogenomics education curricula as part of ... ...

Abstract	A number of barriers exist for adoption of pharmacogenomics into practice. Physicians, pharmacists, and nurses report limited knowledge about pharmacogenomics and its use in patient care. Lack of pharmacogenomics education curricula as part of professional schools or postgraduate training programs has been reported as a potential cause. Understanding pharmacogenomics is further complicated by a complex and nonstandard lexicon, limited medication guidelines, rapidly changing evidence, and insufficient awareness of test availability and utility.
MeSH term(s)	Curriculum ; Education, Pharmacy/methods ; Health Knowledge, Attitudes, Practice ; Humans ; Patient Care/methods ; Pharmacists ; Pharmacogenetics/education ; Physicians ; Professional Role
Language	English
Publishing date	2018-02-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	123793-7
ISSN	1532-6535 ; 0009-9236
ISSN (online)	1532-6535
ISSN	0009-9236
DOI	10.1002/cpt.1019
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Article ; Online: Challenges in Ordering and Interpreting Pharmacogenomic Tests in Clinical Practice.

Moyer, Ann M / Rohrer Vitek, Carolyn R / Giri, Jyothsna / Caraballo, Pedro J

The American journal of medicine

2017 Volume 130, Issue 12, Page(s) 1342–1344

MeSH term(s)	Cytochrome P-450 CYP2C19/genetics ; Cytochrome P-450 CYP2D6/genetics ; Humans ; Laboratories ; Patient Care/methods ; Pharmacogenetics/economics ; Pharmacogenetics/methods ; Pharmacogenomic Testing ; Precision Medicine/economics ; Precision Medicine/methods ; United States
Chemical Substances	Cytochrome P-450 CYP2C19 (EC 1.14.14.1) ; Cytochrome P-450 CYP2D6 (EC 1.14.14.1)
Language	English
Publishing date	2017-07-27
Publishing country	United States
Document type	Editorial
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2017.07.012
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Article ; Online: Integrating pharmacogenomics into the electronic health record by implementing genomic indicators.

Caraballo, Pedro J / Sutton, Joseph A / Giri, Jyothsna / Wright, Jessica A / Nicholson, Wayne T / Kullo, Iftikhar J / Parkulo, Mark A / Bielinski, Suzette J / Moyer, Ann M

Journal of the American Medical Informatics Association : JAMIA

2019 Volume 27, Issue 1, Page(s) 154–158

Abstract: Pharmacogenomics (PGx) clinical decision support integrated into the electronic health record (EHR) has the potential to provide relevant knowledge to clinicians to enable individualized care. However, past experience implementing PGx clinical decision ... ...

Abstract	Pharmacogenomics (PGx) clinical decision support integrated into the electronic health record (EHR) has the potential to provide relevant knowledge to clinicians to enable individualized care. However, past experience implementing PGx clinical decision support into multiple EHR platforms has identified important clinical, procedural, and technical challenges. Commercial EHRs have been widely criticized for the lack of readiness to implement precision medicine. Herein, we share our experiences and lessons learned implementing new EHR functionality charting PGx phenotypes in a unique repository, genomic indicators, instead of using the problem or allergy list. The Gen-Ind has additional features including a brief description of the clinical impact, a hyperlink to the original laboratory report, and links to additional educational resources. The automatic generation of genomic indicators from interfaced PGx test results facilitates implementation and long-term maintenance of PGx data in the EHR and can be used as criteria for synchronous and asynchronous CDS.
MeSH term(s)	Decision Support Systems, Clinical ; Decision Support Techniques ; Electronic Health Records ; Genomics ; Humans ; Pharmacogenetics ; Precision Medicine/methods
Language	English
Publishing date	2019-10-04
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocz177
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Article: Validation of computerized sniffer for monitoring perioperative normothermia.

Giri, Jyothsna / Li, Man / Pickering, Brian / Subramanian, Arun / Kor, Daryl J / Herasevich, Vitaly

Studies in health technology and informatics

2013 Volume 192, Page(s) 943

Abstract: Introduction: The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing ... ...

Abstract	Introduction: The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. Methodology: Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. Results: The clinical tool (alert) was found to be 97 % sensitive.
MeSH term(s)	Body Temperature ; Clinical Alarms ; Diagnosis, Computer-Assisted/methods ; Humans ; Monitoring, Intraoperative/methods ; Reproducibility of Results ; Sensitivity and Specificity ; Software ; Surgery, Computer-Assisted/methods ; Thermography/methods
Language	English
Publishing date	2013
Publishing country	Netherlands
Document type	Journal Article ; Validation Studies
ISSN	0926-9630
ISSN	0926-9630
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Article ; Online: Outcome of adverse events and medical errors in the intensive care unit: a systematic review and meta-analysis.

Ahmed, Adil H / Giri, Jyothsna / Kashyap, Rahul / Singh, Balwinder / Dong, Yue / Kilickaya, Oguz / Erwin, Patricia J / Murad, M Hassan / Pickering, Brian W

American journal of medical quality : the official journal of the American College of Medical Quality

2015 Volume 30, Issue 1, Page(s) 23–30

Abstract: Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects ...

Abstract	Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.
MeSH term(s)	Checklist ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Medical Errors/statistics & numerical data ; Patient Safety ; Quality Indicators, Health Care/statistics & numerical data
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1131772-3
ISSN	1555-824X ; 1062-8606
ISSN (online)	1555-824X
ISSN	1062-8606
DOI	10.1177/1062860613514770
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