Interdisciplinary Collaboration Among Nursing and Computer Science to Refine a Pharmacogenetics Clinical Decision Support Tool Via Mobile Application

In previous work, a prototype clinical decision support mobile application was created that accepts a patient's genomic profile information and provides information and rationale for the prescription of certain oncology medications. The response to the instrument was overwhelmingly positive by healthcare providers in the oncology field who tested the instrument. This article reports on the interdisciplinary collaboration among nursing and computer science to redesign and reimplement a new version of the instrument with expanded functionality and improved usability. This article describes the functionality, usability considerations, and usability evaluation of the instrument over three versions. The current version is Web-based and responsive to different screen sizes (desktop, tablet, mobile), features improved usability, and expands the number of gene-drug recommendations provided based on Clinical Pharmacogenetics Implementation Consortium dosing guidelines. This project represents a successful new collaboration between the nursing and computer science disciplines.

Refinement of a pharmacogenomics app for dosing guidelines for oncology: findings from the usability evaluation

Background

This study extended a precision medicine clinical decision support mobile application (app) for use with oncology medications. Two gene variants (CYP2D6 and DPYD) associated with pharmacogenomic dosing algorithms in oncology was added to a prototype app. Usability of the app was evaluated. The use of smartphones and mobile apps for prescribing medications has exponentially increased since the introduction of physician order entry. Decision support apps have improved provider performance and studies have shown broader adoption is crucial for the success of these tools. Therefore, successful use of mobile apps will depend on perceptions of users. Rogers' Diffusion of Innovation theory will be the guiding framework for this study.

Methods

The main research variable is usability as measured by effectiveness, efficiency, and satisfaction. A mixed method design was used. The setting was inpatient and outpatient oncology practices within North Carolina. The sample included registered nurses and nurse practitioners within the oncology field. A functioning mobile app was extended based on the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines to address the most common gene variants seen in oncology patients. Usability testing is divided into two main categories, inspection and testing methods. Prior to the field study, a heuristic evaluation was conducted. This evaluation inspected the user interface, comparing the elements and aspects of it to a set of principles, heuristics, as a guideline to evaluate the usability of the mobile app.

Results

The testing evaluation was conducted with a sample of 51 health care providers to evaluate usability, measured by the System Usability Scale and open-ended questions. Descriptive statistics was used to summarize usefulness and end-user perceived ease of use. In addition, a thematic analysis of the open-ended questions was conducted.

Conclusions

The development of this mobile app is relevant to nurses who have prescriptive privileges, as well as an educational tool for nurses to understand the rationale behind prescribing certain medications and alternate dosages by providing specific recommendations. Translation of precision medicine into practice will benefit patients by improving care, reducing adverse reactions, and lowering costs.

Tyrosine Kinase Inhibitor Therapy for Brain Metastases in Non-Small-Cell Lung Cancer: A Primer for Radiologists

Treatment options for patients who develop brain metastases secondary to non-small-cell lung cancer have rapidly expanded in recent years. As a key adjunct to surgical and radiation therapy options, systemic therapies are now a critical component of the oncologic management of metastatic CNS disease in many patients with non-small-cell lung cancer. The aim of this review article was to provide a guide for radiologists, outlining the role of systemic therapies in metastatic non-small-cell lung cancer, with a focus on tyrosine kinase inhibitors. The critical role of the blood-brain barrier in the development of systemic therapies will be described. The final sections of this review will provide an overview of current imaging-based guidelines for therapy response. The utility of the Response Assessment in Neuro-Oncology criteria will be discussed, with a focus on how to use the response criteria in the assessment of patients treated with systemic and traditional therapies.

Community change and resident needs: Designing a Participatory Action Research study in Metropolitan Boston

The health implications of urban development, particularly in rapidly changing, low-income urban neighborhoods, are poorly understood. We describe the Healthy Neighborhoods Study (HNS), a Participatory Action Research study examining the relationship between neighborhood change and population health in nine Massachusetts neighborhoods. Baseline data from the HNS survey show that social factors, specifically income insecurity, food insecurity, social support, experiencing discrimination, expecting to move, connectedness to the neighborhood, and local housing construction that participants believed would improve their lives, identified by a network of 45 Resident Researchers exhibited robust associations with self-rated and mental health. Resident-derived insights into relationships between neighborhoods and health may provide a powerful mechanism for residents to drive change in their communities.

Attitudes of oncology nurses concerning pharmacogenomics

Background: The use of genome-guided drug therapy will certainly influence clinical practice within healthcare. However, in spite of the benefits of pharmacogenomic testing, little is known regarding what clinicians think about this promising technology. Objective: The purpose of article was to identify themes within the attitudes of nurses in the field of oncology. Materials & methods: The sample included 246 responses to an open-ended question. A thematic analysis of these responses was completed. Results: The analysis uncovered six themes. Conclusion: Therefore, future research on the assessment of attitudes of oncology nurses concerning pharmacogenomics should incorporate these themes.

Analysis of clinicians’ attitudes towards pharmacogenomics

Aim: The use of genetic information to guide a patient’s drug therapy will have a great influence on clinical practice within healthcare. However, despite the prospective benefits of pharmacogenetic testing, little is known regarding what clinicians actually think about this promising technology. The purpose of this study was to assess attitudes towards pharmacogenetic testing not previously highlighted within a larger study on clinicians’ knowledge and attitudes about pharmacogenetic testing conducted by an interdisciplinary group of researchers at the University of North Carolina at Chapel Hill. Materials & methods: The sample included 184 responses to an open-ended question. A thematic analysis of these responses was completed. Results: The thematic analysis identified several themes that were not previously delineated within the original study. The analysis uncovered five additional themes including: application concerns, lack of successful integration, accessibility, potential harm and optimism. Conclusion: Future research on the assessment of attitudes of clinicians concerning pharmacogenomics should incorporate these themes. In addition, educational activities conveying knowledge concerning pharmacogenomics needs to become readily available to healthcare providers. Finally, a study that addresses any disparity related to pharmacogenomics needs to be undertaken.

Knowledge and attitudes concerning pharmacogenomics among healthcare professionals

Pharmacogenomics has become an area of great potential in the medical community. Therefore, the assessment of the knowledge and attitudes among healthcare professionals is essential. The purpose of this systematic literature review is to explore the knowledge and attitudes of healthcare professionals regarding pharmacogenetic testing with a specific emphasis in oncology. A total of 12 articles were found and reviewed. A majority of the articles reported only on the attitudes of healthcare professionals. Four of the articles reported on both knowledge and attitudes of healthcare professionals concerning pharmacogenetic testing, and one article reported only on the knowledge level of healthcare professionals. This systematic literature review revealed that healthcare professionals generally perceive themselves to have limited knowledge regarding pharmacogenetic testing. In addition, these articles highlighted the overwhelming ethical concerns surrounding pharmacogenomics. However, these articles also revealed that healthcare professionals believed that there were also many advantages regarding the utilization of pharmacogenomics.

Mass-sensing, multianalyte microarray immunoassay with imaging detection

Miniaturization of ligand binding assays may reduce costs by decreasing reagent consumption, but it is less apparent that miniaturized assays can simultaneously exceed the sensitivity of macroscopic techniques by analyte "harvesting" to exploit the total analyte mass available in a sample. Capture reagents (avidin or antibodies) immobilized in 200-microm diameter zones are shown to substantially deplete analyte from a liquid sample during a 1-3-h incubation, and the assays that result sense the total analyte mass in a sample rather than its concentration. Detection of as few as 10(5) molecules of analyte per zone is possible by fluorescence imaging in situ on the solid phase using a near-infrared dye label. Single and multianalyte mass-sensing sandwich array assays of the IgG subclasses show the sensitivity and specificity of ELISA methods but use less than 1/100 the capture antibody required by the 96-well plate format.

Lead Exposure among Adult Temporary Residents in Eastern Europe: Should Blood Lead Levels Be Monitored?

Background: The risk of lead exposure among temporary residents in Eastern Europe is unknown. We monitored blood lead levels (BLLs) of Peace Corps Volunteers serving in Albania, Bulgaria, the Czech Republic, Hungary, Poland, Romania, and Slovakia from June 1991 through June 1994. Methods: BLLs were analyzed before the Volunteers left the United States (Sample 1), at mid-service (median of 15 months in-country, Sample 2), and at end-of-service (median of 22 months in-country, Sample 3). Results: Among 425 study participants who provided at least one follow-up blood sample, BLLs were significantly higher at Samples 2 and 3 compared to the U.S. baseline (paired t-test, p<.0001); however, the mean increase in BLL was only 1.0 ug/dL (range = -9.6 to 10.7). Overall, 74% of Volunteers experienced an increase in BLLs, 24% a decrease in BLLs, and 2% no change in BLLs at Sample 3 compared to their U.S. baseline. The highest increases in BLLs were among Volunteers in Albania, Bulgaria, and Romania (analysis of variance, p<.0001). In addition, men had higher mean increases in BLLs at Samples 2 and 3 compared to women (t-test, p=.017 and.029). Conclusions: The risk of significant lead exposure among our study population was low, and monitoring of BLLs among adult short-term residents in Eastern Europe does not seem to be indicated.

Submaxillary secretion in rats treated with guanethidine

The composition of final submaxillary saliva and of whole gland homogenates were compared in rats treated with 14 daily doses of guanethidine (20 mg/kg body weight) and in untreated controls after stimulation with pilocarpine (10 mg/kg) or carbamylcholine (50-100 mg/kg). A 44% reduction in the volume of saliva and elevations in the salivary concentrations of K+, Ca2+ and protein were found in the treated animals after pilocarpine stimulation. Similarly, a 25% reduction in salivary volume and elevations in salivary Ca2+ and protein concentrations were observed following stimulation with carbamylcholine. A less significant elevation in salivary K+ was seen after this secretagogue. The Na+ and protein contents, but not the K+ and Ca2+ contents, were found to be elevated in the glands of the treated animals in the resting (unstimulated) state. After stimulation with the two secretagogues, however, similar changes in glandular Na+ and K+ contents were found in the glands of control and treated animals. The glandular water content was also similar in both types of glands in the resting and stimulated states. It is concluded that a reduced salivary secretion, rather than supersensitivity, is observed in the rat submaxillary gland following chronic guanethidine administration. The drug treatment does not impair the glandular electrolyte changes that occur upon stimulation, but most likely impairs the release of protein from the gland and also transductal K+ transport. Both these effects may result from the depletion of sympathetic neurotransmitter caused by the guanethidine administration.