Deliberations about clinical pharmacogenetic testing in pediatric oncology

This article summarizes the background, content and outcomes of a special meeting that was convened among oncologists and scientists to discuss the role of pharmacogenetic (PGx) testing in pediatric clinical oncology practice. This meeting provided an opportunity for what the lead author (AM Issa) refers to as the 'voice of the clinician' dynamic to be amplified in order to better understand how personalized or precision medicine applications such as PGx testing are adopted and incorporated into clinical settings and what we can learn from the experiences of current and ongoing implementation PGx approaches to further the implementation of precision medicine applications in real-world environments. Group dynamics and clinical experience with PGx testing and return of results shaped the discussion.

The Genome-based Knowledge Management in Cycles model: a complex adaptive systems framework for implementation of genomic applications

The main mission of the Genomic Applications in Practice and Prevention Network™ is to advance collaborative efforts involving partners from across the public health sector to realize the promise of genomics in healthcare and disease prevention. We introduce a new framework that supports the Genomic Applications in Practice and Prevention Network mission and leverages the characteristics of the complex adaptive systems approach. We call this framework the Genome-based Knowledge Management in Cycles model (G-KNOMIC). G-KNOMIC proposes that the collaborative work of multidisciplinary teams utilizing genome-based applications will enhance translating evidence-based genomic findings by creating ongoing knowledge management cycles. Each cycle consists of knowledge synthesis, knowledge evaluation, knowledge implementation and knowledge utilization. Our framework acknowledges that all the elements in the knowledge translation process are interconnected and continuously changing. It also recognizes the importance of feedback loops, and the ability of teams to self-organize within a dynamic system. We demonstrate how this framework can be used to improve the adoption of genomic technologies into practice using two case studies of genomic uptake.

Human drug hepatotoxicity: a contemporary clinical perspective

BACKGROUND

Drug-induced liver injury (DILI) constitutes a significant medical challenge. The rising number of marketed drugs, aging population and polypharmacy make it imperative to understand the clinical presentation of DILI and the processes used in the assessment of causality and early detection.

OBJECTIVE

This article reviews the current clinical understanding of DILI including presentation patterns, causality assessment, risk factor ascertainment and early detection strategies including liver test monitoring. Significant initiatives such as the Drug-Induced Liver Injury Network (DILIN) are also discussed.

METHODS

A narrative review of clinical studies of DILI, with emphasis on clinical features, causality and surveillance.

CONCLUSION

DILI remains a serious challenge in contemporary clinical practice. Further research and collaboration in the areas of epidemiology, causality and early detection are required to enhance the diagnosis and management of DILI.