Pharmacogenetic Knowledge Research Articles

Pharmacogenetics in Oncology: A useful tool for individualizing drug therapy.

With the continuous development of genetics in healthcare, there has been a significant contribution to the development of precision medicine, which is ultimately aimed at improving the care of patients. Generally, drug treatments used in Oncology are characterized by a narrow therapeutic range and by their potential toxicity. Knowledge of pharmacogenomics and pharmacogenetics can be very useful in the area of Oncology, as they constitute additional tools that can help to individualize patients' treatment. This work includes a description of some genes that have been revealed to be useful in the field of Oncology, as they play a role in drug prescription and in the prediction of treatment response.

Overcoming Barriers: Strategies for Implementing Pharmacist-Led Pharmacogenetic Services in Swiss Clinical Practice.

There is growing evidence that pharmacogenetic analysis can improve drug therapy for individual patients. In Switzerland, pharmacists are legally authorized to initiate pharmacogenetic tests. However, pharmacogenetic tests are rarely conducted in Swiss pharmacies. Therefore, we aimed to identify implementation strategies that facilitate the integration of a pharmacist-led pharmacogenetic service into clinical practice. To achieve this, we conducted semi-structured interviews with pharmacists and physicians regarding the implementation process of a pharmacist-led pharmacogenetic service. We utilized the Consolidated Framework for Implementation Research (CFIR) to identify potential facilitators and barriers in the implementation process. Additionally, we employed Expert Recommendations for Implementing Change (ERIC) to identify strategies mentioned in the interviews and used the CFIR-ERIC matching tool to identify additional strategies. We obtained interview responses from nine pharmacists and nine physicians. From these responses, we identified 7 CFIR constructs as facilitators and 12 as barriers. Some of the most commonly mentioned barriers included unclear procedures, lack of cost coverage by health care insurance, insufficient pharmacogenetics knowledge, lack of interprofessional collaboration, communication with the patient, and inadequate e-health technologies. Additionally, we identified 23 implementation strategies mentioned by interviewees using ERIC and 45 potential strategies using the CFIR-ERIC matching tool. In summary, we found that significant barriers hinder the implementation process of this new service. We hope that by highlighting potential implementation strategies, we can advance the integration of a pharmacist-led pharmacogenetic service in Switzerland.

A quantitative exploration of the knowledge of pharmacy and medical students about Pharmacogenetics: Findings from a public university in Malaysia

Background: Having a strong foundation in the science of pharmacogenetics is a significant prerequisite for both pharmacy and medical students to apply this knowledge in patient care once they enter into the healthcare setting. This study examines the level of foundational knowledge of pharmacogenetics and interest in learning about pharmacogenetics among third and fourth-year pharmacy and final-year medical students of the University Sultan Zainal Abidin (UniSZA) in Malaysia. Method: A total of 95 students participated in the study. A descriptive, cross-sectional study was conducted using a validated questionnaire from a previously published research paper. It was an electronic-based survey shared among the targeted population. Results: The average knowledge score for pharmacy students was 15.58 (SD ± 0.49) while final-year medical students had an average score of 14.56 (SD ± 0.32). A major percentage of the fourth-year pharmacy students were able to obtain scores higher than their junior counterparts and final-year medical students. Although the overall average knowledge score of the medical students was lower than that of the pharmacy students, nevertheless, they had a greater interest in learning about pharmacogenetics. Conclusion: There is a need to introduce up-to-date curricula for both pharmacy and medical students to enhance student comfort levels in pharmacogenetics practice.

Are Graduate Medical Trainees Prepared for the Personalized Genomic Medicine Revolution? Trainee Perspectives at One Institution.

Although the use of genomics to inform clinical care is increasing, clinicians feel underprepared to integrate personalized medicine (PM) into care decisions. The educational needs of physician residents and fellows, also known as graduate medical trainees (GMTs), have been overlooked. We administered an anonymous, web-based survey to all GMTs participating in training programs affiliated with our institution to evaluate their knowledge, skills, and attitudes toward PM. Of the 1190 GMTs contacted, 319 (26.8%) returned surveys. Most (88.4%) respondents reported receiving PM education in the past. Although the respondents agreed that knowledge of disease genetics (80.9%) or pharmacogenetics (87.1%) would likely lead to improved clinical outcomes, only 33.2% of the respondents felt sufficiently informed about PM. The respondents who had received PM education in residency and/or fellowship had significantly higher self-reported knowledge, ability, awareness, and adoption of PM than those who had not received this education (p < 0.0001, p < 0.0001, p < 0.0001, and p < 0.01, respectively). Targeted training is needed to improve GMTs' confidence in interpreting and explaining genetic test results. The ideal timing for this education appears to be in residency and/or fellowship rather than in medical school.

An Introductory Tutorial on Cardiovascular Pharmacogenetics for Healthcare Providers.

Pharmacogenetics can improve clinical outcomes by reducing adverse drug effects and enhancing therapeutic efficacy for commonly used drugs that treat a wide range of cardiovascular diseases. One of the major barriers to the clinical implementation of cardiovascular pharmacogenetics is limited education on this field for current healthcare providers and students. The abundance of pharmacogenetic literature underscores its promise, but it can also be challenging to learn such a wealth of information. Moreover, current clinical recommendations for cardiovascular pharmacogenetics can be confusing because they are outdated, incomplete, or inconsistent. A myriad of misconceptions about the promise and feasibility of cardiovascular pharmacogenetics among healthcare providers also has halted clinical implementation. Therefore, the main goal of this tutorial is to provide introductory education on the use of cardiovascular pharmacogenetics in clinical practice. The target audience is any healthcare provider (or student) with patients that use or have indications for cardiovascular drugs. This tutorial is organized into the following 6 steps: (1) understand basic concepts in pharmacogenetics; (2) gain foundational knowledge of cardiovascular pharmacogenetics; (3) learn the different organizations that release cardiovascular pharmacogenetic guidelines and recommendations; (4) know the current cardiovascular drugs/drug classes to focus on clinically and the supporting evidence; (5) discuss an example patient case of cardiovascular pharmacogenetics; and (6) develop an appreciation for emerging areas in cardiovascular pharmacogenetics. Ultimately, improved education among healthcare providers on cardiovascular pharmacogenetics will lead to a greater understanding for its potential in improving outcomes for a leading cause of morbidity and mortality.

A scoping review of smoking cessation pharmacogenetic studies to advance future research across racial, ethnic, and ancestral populations.

Abstinence rates among smokers attempting to quit remain low despite the wide availability and accessibility of pharmacological smoking cessation treatments. In addition, the prevalence of cessation attempts and abstinence differs by individual-level social factors such as race and ethnicity. Clinical treatment of nicotine dependence also continues to be challenged by individual-level variability in effectiveness to promote abstinence. The use of tailored smoking cessation strategies that incorporate information on individual-level social and genetic factors hold promise, although additional pharmacogenomic knowledge is still needed. In particular, genetic variants associated with pharmacological responses to smoking cessation treatment have generally been conducted in populations with participants that self-identify as White race or who are determined to be of European genetic ancestry. These results may not adequately capture the variability across all smokers as a result of understudied differences in allele frequencies across genetic ancestry populations. This suggests that much of the current pharmacogenetic study results for smoking cessation may not apply to all populations. Therefore, clinical application of pharmacogenetic results may exacerbate health inequities by racial and ethnic groups. This scoping review examines the extent to which racial, ethnic, and ancestral groups that experience differences in smoking rates and smoking cessation are represented in the existing body of published pharmacogenetic studies of smoking cessation. We will summarize results by race, ethnicity, and ancestry across pharmacological treatments and study designs. We will also explore current opportunities and challenges in conducting pharmacogenomic research on smoking cessation that encourages greater participant diversity, including practical barriers to clinical utilization of pharmacological smoking cessation treatment and clinical implementation of pharmacogenetic knowledge.

Pharmacogenetics: ethnicity, treatment and health in Latin American populations.

The Ibero-American Network of Pharmacogenetics and Pharmacogenomics (RIBEF) studies Latin American populations to benefit from the implementation of personalized medicine. Since 2006, it hasstudied ethnicity to apply pharmacogenetics knowledge in autochthonous populations of Latin America, considering ancestral medicine. The meeting 'Pharmacogenetics: ethnicity, Treatment and Health in Latin American Populations'was held in Mexico City, Mexico, and presented the relevance of RIBEF collaboration with Latin American researchers and the governments of Mexico, Spain and the Autonomous Community of Extremadura. The results of 17years of uninterrupted work byRIBEF, the Declaration of Mérida/T'Hóand the call for the DrJosé María CantúAward for studies focused on the pharmacogenetics of native populations in Latin America were presented.

Pharmacogenetics in the Treatment of Huntington's Disease: Review and Future Perspectives.

Huntington's disease (HD) is an autosomal dominant progressive brain disorder, caused by a pathological expansion of a CAG repeat that encodes the huntingtin gene. This genetic neurodegenerative rare disease is characterized by cognitive, motor, and neuropsychiatric manifestations. The aim of the treatment is symptomatic and addresses the hyperkinetic disorders (chorea, dystonia, myoclonus, tics, etc.) and the behavioural and cognitive disturbances (depression, anxiety, psychosis, etc.) associated with the disease. HD is still a complex condition in need of innovative and efficient treatment. The long-term goal of pharmacogenetic studies is to use genotype data to predict the effective treatment response to a specific drug and, in turn, prevent potential undesirable effects of its administration. Chorea, depression, and psychotic symptoms have a substantial impact on HD patients' quality of life and could be better controlled with the help of pharmacogenetic knowledge. We aimed to carry out a review of the available publications and evidence related to the pharmacogenetics of HD, with the objective of compiling all information that may be useful in optimizing drug administration. The impact of pharmacogenetic information on the response to antidepressants and antipsychotics is well documented in psychiatric patients, but this approach has not been investigated in HD patients. Future research should address several issues to ensure that pharmacogenetic clinical use is appropriately supported, feasible, and applicable.

TEACHING CLINICAL PHARMACOLOGY OF UNDERGRADUATE MEDICAL STUDENTS IN EUROPE: CURRENT TRENDS AND PROSPECTS. Review

Relevance. Among the professional competencies, a graduate of a medical faculty should not only determine drugs for the treatment of typical diseases, but also be able to correct errors in prescribing; warn, identify and report adverse drug reactions; advise patients on the correct intake of drug, etc., providing effective, safe and economically justified pharmacotherapy. These professional competencies are acquired when studying the discipline "Clinical pharmacology”.&#x0D; Objective – to consider the current data on teaching of the discipline "Clinical pharmacology" to students of medical faculties in European institutions of higher education.&#x0D; Methods. Analysis of data presented in PubMed using the keywords "clinical pharmacology", "undergraduate education", "medical".&#x0D; Results. Clinical pharmacology, as an educational discipline, is based on the data of evidence-based medicine and modern treatment standards, but at the same time teaches the personalized use of drugs (based on deep knowledge of pharmacokinetics and pharmacogenetics), while the patient receives the "right" drug, in the "right" dose, which allows you to minimize the risk of side effects and reduce adherence to therapy. Every £1 invested in clinical pharmacology saves £6 by reducing prescribing errors and adverse drug reactions, tackling polypharmacy and more.&#x0D; In 2018, European experts in clinical pharmacology and therapeutics reached a consensus on the key learning outcomes of students of medical faculties, - 34 competencies were developed (knowledge with 20 subcategories, skills with 11 subcategories, attitudes – with 3 subcategories), a plan for an integrated context-oriented European educational program in clinical pharmacology and therapy.&#x0D; Conclusions. The developed system of problem-oriented, integrated into the educational program of medicine, study of “Clinical pharmacology and therapy" in European institutions of higher education allows to ensure a uniform standard of prescription of drugs by graduates of medical faculties.

Knowledge and Attitudes of Pharmacogenetics Among Canadian Nurses: Implications for Nursing Education

Pharmacogenetic testing is used to tailor medication recommendations based on an individual's genetic makeup. Increased precision in prescribing medication through the use of genetics leads to a reduction in adverse drug reactions resulting in decreased morbidity and mortality. Due to the noted benefits to patient health outcomes and reduction in healthcare costs, a growing number of Canadian health centers and community pharmacies are beginning to offer pharmacogenetic testing. Previous studies indicate that Canadian nurses have minimal education in genomics; however, there has been an increase in attention to nursing roles in the implementation of genomic health practices in recent years. As the use of pharmacogenetics increases, nurses will be expected to be knowledgeable about pharmacogenetic testing and will play a key role in patient education. Results of previous studies show a low level of knowledge about pharmacogenetic testing among physicians and pharmacists; however, this area of knowledge has not been systematically assessed for nurses. To address this gap, a cross-sectional study was conducted to assess knowledge and attitudes about pharmacogenetics of nurses across Canada. An anonymous online survey was completed by 236 participants, including nursing students (n = 84), registered nurses (n = 144), and nurse practitioners/nurse clinicians (n = 9). Participants represented 9/10 provinces and 2/3 territories across Canada. The majority of the participants (65.9%) lacked formal education in genetics and indicated a fair or poor level of understanding of pharmacogenetic testing in the clinical setting (93%). The mean score for pharmacogenetic knowledge questions was 34.5%, while the mean score for genetics knowledge questions was 61.1%. Despite their self-reported lack of knowledge and understanding, most participants had positive attitudes towards pharmacogenetic testing and recognized its ability to decrease adverse drug reactions and improve clinical efficacy (81.3%). Most participants (73.7%) were interested in educational offerings related to pharmacogenetic testing, particularly web-based courses and seminars/lectures. The results of this study indicate that nurses across Canada may not have the necessary knowledge to support the implementation of pharmacogenetic testing into clinical practice. However, positive attitudes and interest in learning about pharmacogenetics indicate opportunities for the development of educational activities to ensure that Canadian nurses are prepared for upcoming changes that will impact nursing practice.

Precision Health and Nursing Care in the Digital Age

Individualizing healthcare and treatment is a core value of the healthcare sector because of the professional importance of accurately diagnosing, treating, and caring for people who are ill (Ho et al., 2020). Although clinicians may have been working to personalize care to the individual health needs of their patients throughout the history of medicine, predicting how specific individuals will respond to specific treatments or healthcare interventions has long been a goal impossible to achieve. Precision health, a broad concept that includes precision medicine, is a term that refers to personalized healthcare based on a person's unique genetic composition as well as related lifestyle, social, economic, cultural and environmental influences that is designed to help individuals achieve well-being and optimal health (Fu et al., 2019). The term "personal medicine" is frequently used in the healthcare sector to describe a population-based approach. However, this approach is less-individualized than precision medicine. Several rising trends in healthcare are providing doctors and nurses with the tools necessary to better access and manage the vast amounts of data needed to provide individualized care in a manner that both improves outcomes and lowers costs. By focusing on health and wellness, nurses can have a meaningful impact on reducing healthcare cost. One way to support the development of precision health initiatives within the nursing context is to develop interventions that match patients' complex phenomena. Tailoring intervention is an intervention method that selects and applies strategies to treat each patient based on her / his specific characteristics (Salmond & Echevarria, 2017). Furthermore, continuous-tuning interventions are one class of tailoring that adjusts and tunes interventions to the changing needs of individuals based on their data (Hekler et al., 2020). Precision health links health-related research and practice as well as medicine, population health, and public health. Nursing roles are important in the implementation of precision health. They provide precision delivery of medications based on knowledge of pharmacogenetics, patient and family education related to the meaning of genomics, health and family assessments, and critical feedback and insights on the feasibility of implementing new technologies into clinical point-of-care or community workflows. Therefore, the domain knowledge of precision health is critical to clinical practice. In line with the rapid pace of development in digital health technologies, the role of medical informatics in advancing personalized healthcare and precision healthcare has been increasingly emphasized (Hussein, 2020). As medical care and healthcare have entered the information era, digital health technologies provide significant opportunities to optimize clinical care. Using digital health technology should provide opportunities to better generate evidence and provide evidence-based medical care and healthcare. To share more information related to clinical trends in precision health and digital care, we have invited expert groups to share their related expertise and experiences. We do hope nurse professionals and healthcare providers are inspired by this topic and the articles in this issue of the journal.

Venlafaxine and Genetic Variation; Implications for Therapeutic Efficacy and Adverse Effects

Response to antidepressant drugs vary considerably and a significant portion of this variation stems from genetics. Venlafaxine (VEN) is one of the most prescribed antidepressant drugs in the world. There is substantial interindividual variation in therapeutic response and adverse effects to VEN. Several studies suggest the importance of single nucleotide polymorphisms (SNPs) in determining the therapeutic outcome of VEN. In this paper, we reviewed several studies showing significant associations with VEN therapeutic efficacy and/or adverse effects. We propose that pharmacogenetic knowledge should be incorporated in decisions regarding VEN treatment outcome and adverse effect management. However, we also recommend additional, larger pharmacogenetic studies with VEN to reproduce already produced data and to incorporate additional variables. The issue of personalized medicine could be a key driver for providing the highest possible quality of treatment to patients. Bringing pharmacogenomics profile of patients on depression therapy with VEN into consideration will help patients gain maximum benefits from available treatments in terms of safety, therapeutic optimization and minimizing adverse effects. .

Pharmacogenetics of Bronchodilator Response: Future Directions.

Several genome-wide association studies (GWASs) of bronchodilator response (BDR) to albuterol have been published over the past decade. This review describes current knowledge gaps, including pharmacogenetic studies of albuterol response in minority populations, effect modification of pharmacogenetic associations by age, and relevance of BDR phenotype characterization to pharmacogenetic findings. New approaches, such as leveraging additional "omics" data to focus pharmacogenetic interrogation, as well as developing polygenic risk scores in asthma treatment responses, are also discussed. Recent pharmacogenetic studies of albuterol response in minority populations have identified genetic polymorphisms in loci (DNAH5, NFKB1, PLCB1, ADAMTS3, COX18, and PRKG1), that are associated with BDR. Additional studies are needed to replicate these findings. Modification of the pharmacogenetic associations for SPATS2L and ASB3 polymorphisms by age has also been published. Evidence from metabolomic and epigenomic studies of BDR may point to new pharmacogenetic targets. Lastly, a polygenic risk score for response to albuterol has been developed but requires validation in additional cohorts. In order to expand our knowledge of pharmacogenetics of BDR, additional studies in minority populations are needed. Consideration of effect modification by age and leverage of other "omics" data beyond genomics may also help uncover novel pharmacogenetic loci for use in precision medicine for asthma treatment.

Perception and knowledge of pharmacogenetics among Brazilian psychiatrists

Pharmacogenetics (PGx) can optimize drug therapy in psychiatry and is particularly important in admixed populations. Here we developed and successfully validated a questionnaire for assessing the perception and knowledge of PGx among Brazilian psychiatrists. Overall, the participants showed some familiarity with PGx. Most psychiatrists reported to have knowledge of PGx and recognized its usefulness in psychiatry; however, they declared concerns regarding PGx education, the request of tests and their interpretation, cost-effectiveness, and ethical issues. PGx testing is relatively prevalent in their clinical practice, but education on the topic is lacking. Bivariate analysis revealed significant associations. Psychiatrists > 40 years of age more frequently had a positive perception of other clinicians’ familiarity with PGx. Psychiatrists in private health services showed less self-reported competency in the use of PGx testing. Furthermore, women had better perception of PGx education. The present study adds knowledge about PGx in psychiatry and encourages the development of educational and training resources for PGx to improve its clinical implementation.

Pharmacogenetics: Knowledge assessment amongst Syrian pharmacists and physicians

BackgroundPharmacogenetics targets genetic variations that influence drug response. It is relatively a new science that has not been vastly employed in most developing countries including Syria. Therefore we aimed at evaluating the depth of knowledge in pharmacogenetics and the attitude towards it amongst Syrian pharmacists and physicians.MethodsWe carried out an internet-based questionnaire consisted of 26 questions, sent through specialized websites and private groups with a large number of pharmacists and physicians members. The survey was available online for a period of 1 month.ResultsThe total number of respondents was 154, mostly female pharmacists. Our statistical analysis showed a strong positive association between profession (in favour of pharmacists) and pharmacogenetics knowledge p = 0.049; however, no correlation with experience p = 0.811 was found. A significant difference was reported between the knowledge of pharmacists and physicians p = 0.001 concerning drugs that need pharmacogenetics testing before being prescribed. The majority of respondents had no information about applying genetic tests in Syria before prescribing medications nor did they possess the knowledge regarding drugs that show differential responses in patients according to their unique genotypes. In our study, the percentage knowledge assessment score was low in general (mean ± Standard deviation, SD) (46% ± 13.9%). The majority of the respondents agreed that pharmacists should provide counselling to patients on the subject of pharmacogenetics. Respondents’ opinions varied concerning making pharmacogenetics learning a priority.ConclusionLack of pharmacogenetics knowledge was found amongst respondents in general. Our findings raise concerns about the lack of awareness amongst physicians, which may hinder the implementation of this crucial field in Syria. We suggest an emphasis on the role of education, training, and conducting genotyping research on the Syrian population.

Machine Learning: An Overview and Applications in Pharmacogenetics.

This narrative review aims to provide an overview of the main Machine Learning (ML) techniques and their applications in pharmacogenetics (such as antidepressant, anti-cancer and warfarin drugs) over the past 10 years. ML deals with the study, the design and the development of algorithms that give computers capability to learn without being explicitly programmed. ML is a sub-field of artificial intelligence, and to date, it has demonstrated satisfactory performance on a wide range of tasks in biomedicine. According to the final goal, ML can be defined as Supervised (SML) or as Unsupervised (UML). SML techniques are applied when prediction is the focus of the research. On the other hand, UML techniques are used when the outcome is not known, and the goal of the research is unveiling the underlying structure of the data. The increasing use of sophisticated ML algorithms will likely be instrumental in improving knowledge in pharmacogenetics.

Pharmacogenetics Guidelines: Overview and Comparison of the DPWG, CPIC, CPNDS, and RNPGx Guidelines.

Many studies have shown that the efficacy and risk of side effects of drug treatment is influenced by genetic variants. Evidence based guidelines are essential for implementing pharmacogenetic knowledge in daily clinical practice to optimize pharmacotherapy of individual patients. A literature search was performed to select committees developing guidelines with recommendations being published in English. The Dutch Pharmacogenetics Working Group (DPWG), the Clinical Pharmacogenetics Implementation Consortium (CPIC), the Canadian Pharmacogenomics Network for Drug Safety (CPNDS), and the French National Network (Réseau) of Pharmacogenetics (RNPGx) were selected. Their guidelines were compared with regard to the methodology of development, translation of genotypes to predicted phenotypes, pharmacotherapeutic recommendations and recommendations on genotyping. A detailed overview of all recommendations for gene-drug combinations is given. The committees have similar methodologies of guideline development. However, the objectives differed at the start of their projects, which have led to unique profiles and strengths of their guidelines. DPWG and CPIC have a main focus on pharmacotherapeutic recommendations for a large number of drugs in combination with a patient’s genotype or predicted phenotype. DPWG, CPNDS and RNPGx also recommend on performing genetic testing in daily clinical practice, with RNPGx even describing specific clinical settings or medical conditions for which genotyping is recommended. Discordances exist, however committees also initiated harmonizing projects. The outcome of a consensus project was to rename “extensive metabolizer (EM)” to “normal metabolizer (NM)”. It was decided to translate a CYP2D6 genotype with one nonfunctional allele (activity score 1.0) into the predicted phenotype of intermediate metabolizer (IM). Differences in recommendations are the result of the methodologies used, such as assessment of dose adjustments of tricyclic antidepressants. In some cases, indication or dose specific recommendations are given for example for clopidogrel, codeine, irinotecan. The following drugs have recommendations on genetic testing with the highest level: abacavir (HLA), clopidogrel (CYP2C19), fluoropyrimidines (DPYD), thiopurines (TPMT), irinotecan (UGT1A1), codeine (CYP2D6), and cisplatin (TPMT). The guidelines cover many drugs and genes, genotypes, or predicted phenotypes. Because of this and their unique features, considering the totality of guidelines are of added value. In conclusion, many evidence based pharmacogenetics guidelines with clear recommendations are available for clinical decision making by healthcare professionals, patients and other stakeholders.

Healthcare Professionals' Knowledge of Pharmacogenetics and Attitudes Towards Antimicrobial Utilization in Zambia: Implications for a Precision Medicine Approach to Reducing Antimicrobial Resistance.

Introduction: Sub-Saharan Africa and other low- and middle-income countries (LMICs) have the highest rates of antimicrobial resistance (AMR) driven by high rates of antimicrobial utilization. This is a concern as AMR appreciably increases morbidity, mortality and costs. Pharmacogenetics (PGx) and precision medicine are emerging approaches to combat AMR. Consequently, as a first step there is a need to assess AMR knowledge and attitudes, and knowledge of PGx, among healthcare professionals and use the findings to guide future interventions. Methodology: We conducted a cross-sectional study involving 304 healthcare professionals at tertiary hospitals in Lusaka, Zambia. Structural Equation Modeling (SEM) was used to analyze relationships among latent variables. Results: Overall correctness of answers concerning AMR among healthcare professionals was 60.4% (7/11). Knowledge of pharmacogenetics was low (38%). SEM showed that high AMR knowledge score correlated with a positive attitude toward combating AMR (p < 0.001). Pharmacists had relatively higher AMR knowledge scores (mean = 7.67, SD = 1.1), whereas nurses had lower scores (mean = 5.57, SD = 1.9). A minority of respondents [31.5% (n = 95)] indicated that poor access to local antibiogram data promoted AMR, with the majority [56.5% (n = 190)] responding that poor adherence to prescribed antimicrobials can lead to AMR. Pharmacists had the highest scores for attitude (mean = 5.60, SD = 1.6) whereas nurses had the lowest scores (mean = 4.02, SD = 1.4). Conclusion: AMR knowledge and attitudes, as well as knowledge on PGx among healthcare professionals in Zambia, is sub-optimal and has the potential to affect the uptake of precision medicine approaches to reduce AMR rates. Educational and positive behavioral change interventions are required to address this and in future, we will be seeking to introduce these to improve the use of antimicrobials.

Characterizing Pharmacogenetic Testing Among Children's Hospitals.

Although pharmacogenetic testing is becoming increasingly common across medical subspecialties, a broad range of utilization and implementation exists across pediatric centers. Large pediatric institutions that routinely use pharmacogenetics in their patient care have published their practices and experiences; however, minimal data exist regarding the full spectrum of pharmacogenetic implementation among children’s hospitals. The primary objective of this nationwide survey was to characterize the availability, concerns, and barriers to pharmacogenetic testing in children’s hospitals in the Children’s Hospital Association. Initial responses identifying a contact person were received from 18 institutions. Of those 18 institutions, 14 responses (11 complete and 3 partial) to a more detailed survey regarding pharmacogenetic practices were received. The majority of respondents were from urban institutions (72%) and held a Doctor of Pharmacy degree (67%). Among all respondents, the three primary barriers to implementing pharmacogenetic testing identified were test reimbursement, test cost, and money. Conversely, the three least concerning barriers were potential for genetic discrimination, sharing results with family members, and availability of tests in certified laboratories. Low‐use sites rated several barriers significantly higher than the high‐use sites, including knowledge of pharmacogenetics (P = 0.03), pharmacogenetic interpretations (P = 0.04), and pharmacogenetic‐based changes to therapy (P = 0.03). In spite of decreasing costs of pharmacogenetic testing, financial barriers are one of the main barriers perceived by pediatric institutions attempting clinical implementation. Low‐use sites may also benefit from education/outreach in order to reduce perceived barriers to implementation.

Evaluating an interactive teaching approach with personal genotyping to provide pharmacy students with a knowledge base for clinical pharmacogenetics

AbstractIntroductionAlthough the majority of pharmacy schools are teaching pharmacogenetics in their curricula, there is limited coverage of important clinical concepts and pharmacists report low comfortability in utilizing pharmacogenetic results.ObjectivesTo compare the effectiveness of a combined didactic and patient case‐based, interactive teaching approach (including optional personal genotyping) with a traditional didactic teaching strategy on students' knowledge and confidence in their ability to use pharmacogenetic data in clinical decision‐making.MethodsThe University of Florida College of Pharmacy offered elective and required courses in personalized medicine from 2014 to 2016. The elective course, Clinical Applications of Personalized Medicine, emphasized interactive patient case‐based teaching and incorporated personal genotype results into learning activities, while the required course, Personalized Medicine, primarily used a didactic lecture‐based format. Students enrolled in both courses concurrently (intervention group) and the required course alone (control group) completed pre‐ and post‐course surveys with patient case‐based assessments to evaluate their knowledge and confidence in their ability to apply genotype data to drug therapy recommendations.ResultsFifty‐two students (intervention: n = 21; control: n = 31) completed both surveys. Between the intervention and control groups respectively, there were no differences in mean pre‐course knowledge (43.1% vs 37.7% questions correct, P = .15) or median confidence scores (35 vs 40, P = .84). Mean post‐course knowledge (65.4% vs 46.9% questions correct, P &lt; .001) and median confidence scores (97 vs 81, P = .0003) were significantly higher in the intervention vs control group, respectively. There was no correlation between students' knowledge and confidence for pre‐course assessment in either group. For the post‐course assessment, knowledge and confidence were positively correlated in the intervention group (adjusted r = .46, adjusted P = .04), but were not correlated in controls.ConclusionOur data suggest that a combined teaching strategy that employs didactic lecture plus patient‐centered, case‐based teaching and personal genotype application improves students' ability to accurately self‐assess their knowledge in pharmacogenetics.