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Cody P. Sexual and reproductive health screening and counseling in adolescent and young adult transplant recipients. Pediatr Transplant 2024; 28:e14741. [PMID: 38566317 DOI: 10.1111/petr.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Adolescents and young adults with and without chronic illnesses partake in risk-taking behavior. Clinicians in transplant clinics should be aware of the prevalence of risk-taking behavior in their adolescent and young adult solid organ transplant patients in order to provide complete care. Creating an environment where teens and young adults feel comfortable discussing risky behavior is important and includes creating a privacy policy and increasing comfort of the healthcare provider in asking sensitive questions. This review is intended to help the providers in the transplant clinic screen for and counsel about risk-taking behaviors with their adolescent and young adult patients, specifically around sexual and reproductive health.
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Affiliation(s)
- Paula Cody
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Dolin RH, Shenvi E, Alvarez C, Barrows RC, Boxwala A, Lee B, Nathanson BH, Kleyner Y, Hagemann R, Hongsermeier T, Kapusnik-Uner J, Lakdawala A, Shalaby J. PillHarmonics: An Orchestrated Pharmacogenetics Medication Clinical Decision Support Service. Appl Clin Inform 2024; 15:378-387. [PMID: 38388174 PMCID: PMC11098593 DOI: 10.1055/a-2274-6763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Pharmacogenetics (PGx) is increasingly important in individualizing therapeutic management plans, but is often implemented apart from other types of medication clinical decision support (CDS). The lack of integration of PGx into existing CDS may result in incomplete interaction information, which may pose patient safety concerns. We sought to develop a cloud-based orchestrated medication CDS service that integrates PGx with a broad set of drug screening alerts and evaluate it through a clinician utility study. METHODS We developed the PillHarmonics service for implementation per the CDS Hooks protocol, algorithmically integrating a wide range of drug interaction knowledge using cloud-based screening services from First Databank (drug-drug/allergy/condition), PharmGKB (drug-gene), and locally curated content (drug-renal/hepatic/race). We performed a user study, presenting 13 clinicians and pharmacists with a prototype of the system's usage in synthetic patient scenarios. We collected feedback via a standard questionnaire and structured interview. RESULTS Clinician assessment of PillHarmonics via the Technology Acceptance Model questionnaire shows significant evidence of perceived utility. Thematic analysis of structured interviews revealed that aggregated knowledge, concise actionable summaries, and information accessibility were highly valued, and that clinicians would use the service in their practice. CONCLUSION Medication safety and optimizing efficacy of therapy regimens remain significant issues. A comprehensive medication CDS system that leverages patient clinical and genomic data to perform a wide range of interaction checking and presents a concise and holistic view of medication knowledge back to the clinician is feasible and perceived as highly valuable for more informed decision-making. Such a system can potentially address many of the challenges identified with current medication-related CDS.
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Affiliation(s)
| | - Edna Shenvi
- Elimu Informatics, El Cerrito, California, United States
| | - Carla Alvarez
- Elimu Informatics, El Cerrito, California, United States
| | | | - Aziz Boxwala
- Elimu Informatics, El Cerrito, California, United States
| | - Benson Lee
- College of Pharmacy, Touro University California, Vallejo, California, United States
| | | | - Yelena Kleyner
- Elimu Informatics, El Cerrito, California, United States
| | - Rachel Hagemann
- Independent Contractor, San Francisco, California, United States
| | | | | | | | - James Shalaby
- Elimu Informatics, El Cerrito, California, United States
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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Liu Q, Ou-Yang QG, Lin QM, Lu XR, Ma YQ, Li YH, Xu RA, Lin DD, Hu GX, Cai JP. Effects of 27 CYP3A4 protein variants on saxagliptin metabolism in vitro. Fundam Clin Pharmacol 2021; 36:150-159. [PMID: 33961299 DOI: 10.1111/fcp.12693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/27/2021] [Indexed: 12/20/2022]
Abstract
Saxagliptin is a dipeptidyl peptidase 4 (DPP-4) inhibitor widely used in patients with type 2 diabetes. It can increase the amount of insulin after meals and lower blood sugar. CYP450 3A4 (CYP3A4) can metabolize about 30%-40% of therapeutic drugs. Individual differences caused by CYP3A4 genetic polymorphisms can lead to treatment failure, unpredictable side effects, or severe drug toxicity. The aim of this study was to evaluate the catalytic activities of 27 CYP3A4 variants on saxagliptin metabolism in vitro, which were identified in human CYP alleles. We successfully constructed 27 kinds of wild-type and variant vectors of pFast-dual-OR-3A4 by overlap extension PCR and prepared 27 kinds of CYP3A4 highly expressed cell microsomes by baculovirus insect cell expression system. The ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was used to detect the concentrations of the metabolite of saxagliptin (5-hydroxysaxagliptin) and the internal standard. Compared with the wild-type CYP3A4.1, the intrinsic clearance values of most varieties decreased to 1.91%-77.08%. Most of these varieties showed a decrease in Vmax and an increase in Km values compared with wild type. We are the first to report the vitro metabolic data of 27 CYP3A4 variants of the metabolism of saxagliptin which can deepen our understanding of individualized drug use by combining previous studies about the effects of CYP3A4 variants of drug metabolism. With further in vivo studies, we hope it can guide individualized drug use in the clinic when the variants with low metabolic activity to saxagliptin were sequenced in the human body.
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Affiliation(s)
- Qian Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiu-Geng Ou-Yang
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qian-Meng Lin
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, XiangYa Hospital, Central South University, Changsha, China
| | - Xiang-Ran Lu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ya-Qing Ma
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-Hui Li
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ren-Ai Xu
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dong-Dong Lin
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guo-Xin Hu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian-Ping Cai
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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