Value of Genetics-informed Drug Dosing Guidance in Pregnant Women: A Needs Assessment with Obstetric Healthcare Providers at Johns Hopkins

In order to better understand the potential value of genetics-informed drug dose guidance to obstetric healthcare providers at Johns Hopkins we administered a web-based needs assessment survey. The survey included questions about: 1) experience with adjusting drug doses during pregnancy; 2) comfort prescribing medications to pregnant women with chronic conditions; 3) awareness and use of genetics-informed dosing guidance; and 4) perceived value of access to services to provide genetics-informed dosing guidance. Among thirty-one respondents, 81% indicated an interest in access to genetics-informed drug dose guidance, particularly a mobile or electronic health record (EHR) application. It was indicated, however, that genetics is one of many characteristics that influence dose adjustments during pregnancy. This study motivates future research to help obstetric healthcare providers tailor drug dose to individual patients based upon models integrating multiple patient characteristics, including genetics.

The Informatics Stack: A Heuristic Tool for Informatics Teaching

Objective: To develop a heuristic framework for students to organize and apply the many concepts of informatics for rapid use.

Method: Organization of curriculum material and recurrent refinement by student feedback. An Informatics Stack was developed based on several existing informatics and software-development frameworks comprising several levels of abstraction, from what a system is supposed to accomplish (4 levels) to how it accomplishes it (5 levels). At each level, there are specific concerns, types of interoperability, ethical and legal issues, testing and evaluation approaches and methods, and relevant scientific disciplines, and privacy (upper 5 levels), confidentiality (middle 3 levels), and security (lower 4 levels ) concerns whose levels overlap. An 8-week Introduction to Informatics course was taught for 6 years to masters students of informatics and of public health, based on the Stack, with a Final Project continually filled in during the course, where students applied the Stack to existing reports describing health information systems and their deployments.

Results: Student feedback from 538 students working in 116 groups over 6 years shows near-universal appreciation that the Stack helped to organize their review of the report. Each student, from a wide variety of backgrounds, identified some level of the Stack as something they might have otherwise missed, and all levels were invoked by some student. Attributes identified by the students as missing from the Stack concerned the practicalities of system development.

Conclusion: The Stack is a broadly-encompassing heuristic whose application can be learned and applied by students from a wide variety of backgrounds in an 8-week course.

A New Haemoglobin Variant Haemoglobin J Birmingham a 120 (H3) Ala → Glu

An abnormal haemoglobin, which on paper electrophoresis has the mobility of Hb J, has been found in two brothers and, in the heterozygous state at least, is not associated with serious clinical abnormality. The structure of this hitherto unreported haemoglobin is α 120 (H3) Ala → Glu and it is named Haemoglobin J Birmingham.

[Phytovigilance: A medical requirement and a legal obligation]

Phytovigilance consists in supervision of side effects and drug interactions consequential to use of herbal medicinal products, herbal food supplements, herbal cosmetics and/or medicinal plants. It includes thus pharmacovigilance applied to phytotherapy, nutrivigilance and cosmetovigilance but also addictovigilance in case of plants, which lead to drug addiction, and toxicovigilance in case of toxic plants. Becoming necessary owing to (acute or chronic) toxicity risks or to drug interactions risks (of pharmacocinetical or pharmacodynamical kind)--as far as it concerns interactions between several associated plants or between a plant and a chemical or biotechnological allopathic medicine--phytovigilance represents moreover a legal obligation. Pharmacovigilance--in case of herbal medicinal products--is indeed becoming mandatory according to title IX of the European directive 2001/83/EC, whereas nutrivigilance is imposed by the European Food Safety Agency (EFSA).

[Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]

Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.

Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia

BACKGROUND

Silent cerebral infarcts are the most common neurologic injury in children with sickle cell anemia and are associated with the recurrence of an infarct (stroke or silent cerebral infarct). We tested the hypothesis that the incidence of the recurrence of an infarct would be lower among children who underwent regular blood-transfusion therapy than among those who received standard care.

METHODS

In this randomized, single-blind clinical trial, we randomly assigned children with sickle cell anemia to receive regular blood transfusions (transfusion group) or standard care (observation group). Participants were between 5 and 15 years of age, with no history of stroke and with one or more silent cerebral infarcts on magnetic resonance imaging and a neurologic examination showing no abnormalities corresponding to these lesions. The primary end point was the recurrence of an infarct, defined as a stroke or a new or enlarged silent cerebral infarct.

RESULTS

A total of 196 children (mean age, 10 years) were randomly assigned to the observation or transfusion group and were followed for a median of 3 years. In the transfusion group, 6 of 99 children (6%) had an end-point event (1 had a stroke, and 5 had new or enlarged silent cerebral infarcts). In the observation group, 14 of 97 children (14%) had an end-point event (7 had strokes, and 7 had new or enlarged silent cerebral infarcts). The incidence of the primary end point in the transfusion and observation groups was 2.0 and 4.8 events, respectively, per 100 years at risk, corresponding to an incidence rate ratio of 0.41 (95% confidence interval, 0.12 to 0.99; P=0.04).

CONCLUSIONS

Regular blood-transfusion therapy significantly reduced the incidence of the recurrence of cerebral infarct in children with sickle cell anemia. (Funded by the National Institute of Neurological Disorders and Stroke and others; Silent Cerebral Infarct Multi-Center Clinical Trial ClinicalTrials.gov number, NCT00072761, and Current Controlled Trials number, ISRCTN52713285.).

PaTH: towards a learning health system in the Mid-Atlantic region

The PaTH (University of Pittsburgh/UPMC, Penn State College of Medicine, Temple University Hospital, and Johns Hopkins University) clinical data research network initiative is a collaborative effort among four academic health centers in the Mid-Atlantic region. PaTH will provide robust infrastructure to conduct research, explore clinical outcomes, link with biospecimens, and improve methods for sharing and analyzing data across our diverse populations. Our disease foci are idiopathic pulmonary fibrosis, atrial fibrillation, and obesity. The four network sites have extensive experience in using data from electronic health records and have devised robust methods for patient outreach and recruitment. The network will adopt best practices by using the open-source data-sharing tool, Informatics for Integrating Biology and the Bedside (i2b2), at each site to enhance data sharing using centrally defined common data elements, and will use the Shared Health Research Information Network (SHRINE) for distributed queries across the network.

Elektronenrückstreuraten leichter Elemente in Molièrescher Näherung / Electron Backscattering Rates of Light Elements in Molière Approximation

Electron backscattering rates of light elements (atomic number Z = 6, 13, 29) are evaluated for electron energies of E = 20···60 keV. The scattering amplitude in Moliere approximation is expanded as a series. The series elements are calculated in closed form with the aid of substitute functions. By comparison with the first Born approximation this yields correction factors of 1···1,25.

Der Gültigkeitsbereich der Molièreschen Näherung/ The Range of Validity of the Molière Approximation

The Moliere approximation of the scattering amplitude is, following earlier statements, a high-energy and small-angle approximation. Recent investigations show that there is no intrinsic small-angle restriction, the restriction being due to special derivations. A method is given, to obtain the scattering amplitude in the Moliere approximation without small-angle assumption. This enables to evaluate electron backscattering rates with the aid of the Moliere scattering amplitude.

Recommendations for the use of operational electronic health record data in comparative effectiveness research

There is an increasing amount of clinical data in operational electronic health record (EHR) systems. Such data provide substantial opportunities for their re-use for many purposes, including comparative effectiveness research (CER). In a previous paper, we identified a number of caveats related to the use of such data, noting that they may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, or incompatible with research protocols. In this paper, we provide recommendations for overcoming these caveats with the goal of leveraging such data to benefit CER and other health care activities. These recommendations include adaptation of "best evidence" approaches to use of data; processes to evaluate availability, completeness, quality, and transformability of data; creation of tools to manage data and their attributes; determination of metrics for assessing whether data are "research grade"; development of methods for comparative validation of data; construction of a methodology database for methods involving use of clinical data; standardized reporting methods for data and their attributes; appropriate use of informatics expertise; and a research agenda to determine biases inherent in operational data and to assess informatics approaches to their improvement.