We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time.
This presentation provides a basic introduction to genomic or personalized medicine, and discusses how this information can and should be integrated into our electronic medical record systems.
These slides were originally presented at the HIMSS Annual Conference in February of 2007.
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Cancer care is increasingly tailored to individual patients, who can undergo genetic or biomarker testing soon after diagnosis, to determine which treatments have the best chance of shrinking or eliminating tumours.
In this webinar, a pathologist and clinical oncologist discuss:
● how they are using these new tests,
● how they communicate results and treatment options to patients and caregivers, and
● how patients can be better informed on the kinds of tests that are in development or in use across Canada
View the video: https://youtu.be/_Wai_uMQKEQ
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Cancer care is increasingly tailored to individual patients, who can undergo genetic or biomarker testing soon after diagnosis, to determine which treatments have the best chance of shrinking or eliminating tumours.
In this webinar, a pathologist and clinical oncologist discuss:
● how they are using these new tests,
● how they communicate results and treatment options to patients and caregivers, and
● how patients can be better informed on the kinds of tests that are in development or in use across Canada
View the video: https://youtu.be/_Wai_uMQKEQ
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
MT115 Precision Medicine: Integrating genomics to enable better patient outcomesDell EMC World
"The emergence of genomics and real-time screening is helping to transform the practice of medicine as we know it today. New technologies present improved ways to tackle health issues and what was once thought to be “untouchable” due to cost, timing or resources, is now achievable through genetic screenings and genome sequencing.
During this session, we will explore:
1. The benefits of incorporating a genomics strategy early in lifeline
2. The Precision Medicine Initiative – how does this help? Does this encourage more people to get genetic screenings?
3. What’s involved in a genetic screening
"
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...Dexter Hadley
Lecture Objectives:
1) To use examples from my research to define and introduce the ideals of precision medicine and digital health. 2) To introduce how large scale population-wide analysis of data can be used to facilitate these two ideals. 3) To introduce how freely available open data can be used to facilitate these two ideals. 4) To show how mobile technology can be used to facilitate these two ideals.
Date held: February 12, 2015
Presented by: Deb Davison, Genomic Health
Topics discussed:
The latest in genomic testing and its role in cancer treatment
The most recent results from Genomic Health’s second independent clinical validation study of Oncotype DX® in DCIS patients
Q&A session about the implications of this research
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
Wielding the Double-Edge Sword of Cardiac Biomarkers in Clinical Trials: A Di...Medpace
Learn best practices for utilizing cardiac biomarkers across various components of a clinical trial from Dr. James Januzzi, a leading expert in cardiovascular biomarkers.
Personalized Medicine: Are we there yet?Reid Robison
Slides on the future of healthcare, entitled "Personalized Medicine: Are we there yet?" form a lecture given by Reid Robison, MD MBA at Brigham Young University in the College of Life Sciences in December 2014. The presentation covers the arrival of genome-guided precision medicine as well as the digital health movement and the shift towards a patient-centric, consumer-driven healthcare system.
The reality of moving towards precision medicineElia Stupka
How do we move towards precision medicine? How can we deliver on the big data in health promise? Who will be the enablers and players? Pharma, Big Tech, or newcomers?
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Seventh Annual Next Generation Dx SummitJaime Hodges
The Next Generation Dx Summit (www.nextgenerationdx.com), entering its seventh year, brings together more than 800 diagnostics professionals from across the world, providing comprehensive programming and valuable networking opportunities. Spanning from clinical diagnostics to business strategy, this year’s expanded program encompasses predictive cancer biomarkers, companion diagnostics, infectious disease, point-of-care, pharmacy-based diagnostics, cell-free DNA, commercialization, cancer immunotherapy, and reimbursement. With widespread coverage of all the most relevant diagnostics topics, the Next Generation Dx Summit promises to be a must-attend event to hear the latest announcements and developments in this rapidly evolving field.
Challenges and Considerations in Designing and Conducting Immuno-Oncology Cli...Medpace
Given the accelerating pace of immuno-oncology clinical research, awareness of the specific challenges and considerations in designing and conducting successful trials for these new agents is critical.
2015 09-14 Precision Medicine 2015, London, Alain van GoolAlain van Gool
Outline of my view hoe personalized health(care) is more than just targeted medicines, also including personal motivation and actions towards disease prevention. It also outlines 4 key factors that should be in order for optimal personalized health(care): 1. start with patients first, 2. Accelerate translation research to application, 3. Copy best practice, 4. Spread the word.
EuroBioForum 2013 - Day 1 | Sergey SuchkovEuroBioForum
EuroBioForum 2013 2nd Annual Conference
27-28 May 2013 - Hilton Munich City, Munich, Germany
http://www.eurobioforum.eu/2013
=======================================
# NATIONAL PERSPECTIVES #
Russia:
Introduction into PPPM as a new paradigm of public health care service and an example of the ready-to-use Clinical Model in the Area of Medicine
Sergey Suchkov
Professor in Medicine and Immunology at Moscow State Medical & Dental University & I.M. Sechenov Moscow Medical Academy
=======================================
http://www.eurobioforum.eu
MT115 Precision Medicine: Integrating genomics to enable better patient outcomesDell EMC World
"The emergence of genomics and real-time screening is helping to transform the practice of medicine as we know it today. New technologies present improved ways to tackle health issues and what was once thought to be “untouchable” due to cost, timing or resources, is now achievable through genetic screenings and genome sequencing.
During this session, we will explore:
1. The benefits of incorporating a genomics strategy early in lifeline
2. The Precision Medicine Initiative – how does this help? Does this encourage more people to get genetic screenings?
3. What’s involved in a genetic screening
"
From Bits to Bedside: Translating Big Data into Precision Medicine and Digita...Dexter Hadley
Lecture Objectives:
1) To use examples from my research to define and introduce the ideals of precision medicine and digital health. 2) To introduce how large scale population-wide analysis of data can be used to facilitate these two ideals. 3) To introduce how freely available open data can be used to facilitate these two ideals. 4) To show how mobile technology can be used to facilitate these two ideals.
Date held: February 12, 2015
Presented by: Deb Davison, Genomic Health
Topics discussed:
The latest in genomic testing and its role in cancer treatment
The most recent results from Genomic Health’s second independent clinical validation study of Oncotype DX® in DCIS patients
Q&A session about the implications of this research
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
Wielding the Double-Edge Sword of Cardiac Biomarkers in Clinical Trials: A Di...Medpace
Learn best practices for utilizing cardiac biomarkers across various components of a clinical trial from Dr. James Januzzi, a leading expert in cardiovascular biomarkers.
Personalized Medicine: Are we there yet?Reid Robison
Slides on the future of healthcare, entitled "Personalized Medicine: Are we there yet?" form a lecture given by Reid Robison, MD MBA at Brigham Young University in the College of Life Sciences in December 2014. The presentation covers the arrival of genome-guided precision medicine as well as the digital health movement and the shift towards a patient-centric, consumer-driven healthcare system.
The reality of moving towards precision medicineElia Stupka
How do we move towards precision medicine? How can we deliver on the big data in health promise? Who will be the enablers and players? Pharma, Big Tech, or newcomers?
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Seventh Annual Next Generation Dx SummitJaime Hodges
The Next Generation Dx Summit (www.nextgenerationdx.com), entering its seventh year, brings together more than 800 diagnostics professionals from across the world, providing comprehensive programming and valuable networking opportunities. Spanning from clinical diagnostics to business strategy, this year’s expanded program encompasses predictive cancer biomarkers, companion diagnostics, infectious disease, point-of-care, pharmacy-based diagnostics, cell-free DNA, commercialization, cancer immunotherapy, and reimbursement. With widespread coverage of all the most relevant diagnostics topics, the Next Generation Dx Summit promises to be a must-attend event to hear the latest announcements and developments in this rapidly evolving field.
Challenges and Considerations in Designing and Conducting Immuno-Oncology Cli...Medpace
Given the accelerating pace of immuno-oncology clinical research, awareness of the specific challenges and considerations in designing and conducting successful trials for these new agents is critical.
2015 09-14 Precision Medicine 2015, London, Alain van GoolAlain van Gool
Outline of my view hoe personalized health(care) is more than just targeted medicines, also including personal motivation and actions towards disease prevention. It also outlines 4 key factors that should be in order for optimal personalized health(care): 1. start with patients first, 2. Accelerate translation research to application, 3. Copy best practice, 4. Spread the word.
EuroBioForum 2013 - Day 1 | Sergey SuchkovEuroBioForum
EuroBioForum 2013 2nd Annual Conference
27-28 May 2013 - Hilton Munich City, Munich, Germany
http://www.eurobioforum.eu/2013
=======================================
# NATIONAL PERSPECTIVES #
Russia:
Introduction into PPPM as a new paradigm of public health care service and an example of the ready-to-use Clinical Model in the Area of Medicine
Sergey Suchkov
Professor in Medicine and Immunology at Moscow State Medical & Dental University & I.M. Sechenov Moscow Medical Academy
=======================================
http://www.eurobioforum.eu
Precision medicine is an emerging strategy that considers individual variability in genes, environment, and lifestyle to diagnose, treat, forecast, and prevent disease. As regulatory health authorities begin to develop clearer regulatory pathways in precision medicine, industries must prepare to swiftly adopt to any regulatory changes. This white paper aims to provide a broad overview on the following key topics in precision medicine:
1. Genomics and Pharmacogenetics
2. Precision Medicine vs Personalized Medicine
3. Foundation of Precision Medicine as A Treatment Tool
4. Examples of Precision Medicine as A Treatment, Predictive, and Preventative Tool
5. Precision Medicine and Cancer
6. Challenges, Next Step & Opportunities in Precision Medicine
7. Regulatory insight on Precision medicine
Predictive Analytics and Machine Learning for Healthcare - DiabetesDr Purnendu Sekhar Das
Machine Learning on clinical datasets to predict the risk of chronic disease conditions like Type 2 Diabetes mellitus beforehand; as well as predicting outcomes like hospital readmission using EMR RWE data.
Bridging the Gap in Personalized Oncology using Omics Data and Epidemiology_C...CrimsonpublishersCancer
As Personalized Medicine tailored the field of precision oncology, many challenges have been arising to fulfill the dream of a full personalized health integrated system in cancer therapy. Personalized oncology has been addressed through the past decades in multiple disease and various stages using high throughput technology. This review gives hand on recent advances of personalized oncology in several cancer disease models including leukemia, melanoma, breast cancer, lung cancer, colorectal cancer, and prostate cancer. Moreover, the review enumerates technology-based assessment of personalized biomarkers, including chip micro-array, organ on chip, and next generation sequencing. Meanwhile addressing challenges faced in implementing true personalized health cancer in oncology setting, this review focuses on bridging the gap between omics data analytics and epidemiology to overcome the true challenge of direct application.
Next Generation Dx Summit 2015 - Moving Assays to the ClinicJames Prudhomme
The Next Generation Dx Summit, entering its seventh year, brings together more than 800 diagnostics professionals from across the world, providing comprehensive programming and valuable networking opportunities. Spanning from clinical diagnostics to business strategy, this year’s expanded program encompasses predictive cancer biomarkers, companion diagnostics, infectious disease, point-of-care, pharmacy-based diagnostics, cell-free DNA, commercialization, cancer immunotherapy, and reimbursement. With widespread coverage of all the most relevant diagnostics topics, the Next Generation Dx Summit promises to be a must-attend event to hear the latest announcements and developments in this rapidly evolving field.
2015 04-13 Pharma Nutrition 2015 Philadelphia Alain van GoolAlain van Gool
Keynote lecture at the Pharma-Nutrition 2015 conference, outline global paradigm shifts and activities in pharma, personalized healthcare and pharmanutrition combination therapies.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Genomics, Personalized Medicine and Electronic Medical Records
1. Enabling the Future of Care Delivery: IT-Driven, Molecular Medicine HIMSS Annual Conference February 27, 2007 Lyle Berkowitz, MD Keith Strier, JD, PAHM
2. Our Ambitions “ To wrest from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they may be quickly available for the prevention and cure of disease — these are our ambitions.” — Sir William Osler (1849 – 1919)
3.
4.
5. Disease Burden Time Cost 1/reversibility Decision Support Tools: Baseline Risk Preclinical Progression Disease Initiation and Progression Assess Risk Refine Assessment Predict Diagnose Track Progression Predict Events Inform Therapeutics Sources of New Biomarkers: Stable Genomics: Single Nucleotide Polymorphisms Haplotype Mapping Gene Sequencing Dynamic Genomics: Gene Expression Proteomics Metabolomics Molecular Imaging Therapeutic Decision Support Source: “Personalized Medicine: Current and Future Perspectives,” Patricia Deverka, MD, Duke University, Institute for Genome Sciences and Policy; and Rick J. Carlson, JD, University of Washington Changing Paradigm of Care Typical Current Intervention Earliest Clinical Detection Earliest Molecular Detection Initiating Events Baseline Risk
10. NUGene: Data Flow & Privacy NUgene Database Coded Data Phenotypic Engine Encryption Decryption De-identification Process Medical Record Participant Enrollment Materials Patient Identifiers NOTIS Phenotypic Data Warehouse
11.
12.
13.
14. Pharmacogenomic Alert Pharmacogenomic Alert This patient has a TMPT gene defect which indicates a high sensitivity to standard doses of mercaptopurine. [] Cancel Drug Order [] Lower the standard dose (75mg/m2) by 85% to a modified dose (11.25 mg/m2) [] Ignore this Alert
15.
16. Diagnostic Alert Dx Alert This patient fits the profile for MODY. Consider checking for MODY genetics [] Order MODY Genetic Screen [] Ignore Alert [] Learn more about MODY
17. Treatment Alert Treatment Alert Based on known genomic data and phenotype expression in this patient, the best treatment for their Type 1 MODY diabetes is to start with a sulfanurea. [] Change Order to a Sulfanurea [] Ignore Alert
18. Implications Things to start thinking about Personnel Storage Diagnose Treat Predict CDS
Lyle Berkowitz, MD is a practicing internal medicine physician who has researched and consulted in the field of applied medical informatics throughout his professional career. Dr. Berkowitz is an attending physician at Northwestern Memorial Hospital and is the Medical Director of Clinical Information Systems for the largest primary care medical group in Chicago. In this latter capacity, he has helped his group successfully implement an enterprise-wide electronic medical record system, and has been paperless in his own clinical practice since the Fall of 2002. Dr. Berkowitz is on the Advisory Board for the Association of Medical Directors of Information Systems and the Editorial Board of Healthcare Informatics. Mr. Strier is the National Innovation Leader for Deloitte Consulting's Healthcare Provider Practice, specializing in the convergence between healthcare and technology as well as disruptive market and product development strategies ranging from personalized medicine to telehealthcare. He is a Guest Faculty at the joint Harvard Medical School/MIT Health Science & Technology Program, a member of Global eHealth Advisory Board at the World Bank, member of the Conference Advisory Board at Healthcare Research & Innovations Congress and member of the National Advisory Board at the Emerging Technologies and Healthcare Innovations Congress.
The ambitions of healthcare providers have not changed in the past hundred years, but the capabilities certainly have. We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time. There are 3 billion letters in the human DNA code. While more than 99.9 percent of DNA is identical between any two humans, about on in every 1200 amino acid pairs varies from one person to another. These single nucleotide polymophisms (SNPs) are what differentiates us from each other. Furthermore, haplotypes are a set of SNPs on a single chromatid that are statistically associated. It is thought that these associations, and the identification of a few alleles of a haplotype block, can unambiguously identify all other polymorphic sites in its region. The causes of common disease are very complex. We know that both environment and genetics play important roles. Furthermore, most diseases, as well as responses to medicines, involve the interaction of multiple genes.
Learning Objective 1: Understand the importance of integrating clinical IT systems with molecular science and consider how your organizations will take advantage of this synergy. Learning Objective 2: Provide examples of successful integrations between molecular science and clinical IT systems, and discuss the potential for future projects that unite these two fields. Learning Objective 3: Review and improve your organization's strategic IT plan to fully incorporate the emerging needs of a more personalized, molecular-based care delivery system that is well integrated with your current and future plans for clinical information systems. Learning Objective 4: Relate the implications of emerging models of care, based on molecular medicine, to clinical staff to build consensus around the acquisition and adoption of new IT systems and applications.
Understanding molecular medicine, through both laboratory and imaging techniques, deepens our ability to detect, diagnose and treat disease. Genomics, the study of genes, is the most common area of study since it involves a stable, albeit large, data set. Genomic data is particularly useful in identifying certain diseases, unveiling risk factors for other diseases, and predicting how well certain drugs will work in humans. This last area, called pharmacogenomics, is an increasingly popular area of study involving both drug effectiveness (efficacy) and drug side effects. This is a critical field since many medications are only effective in 50% of the population and cause side effects in another large percentage, but we don’t know ahead of time how individuals will react. Being able to test for gene differences ahead of time will both improve effectiveness and decrease side effects for patients. Other important areas of study include proteinomics and metabolomics. While genetic markers are stable, these biomarkers are constantly changing as a function of both genetic and environmental exposures. They are particularly important in diagnosing diseases and calibrating treatment regimens. Finally, molecular imaging (e.g. PET Scans) is an increasingly important area in the field of cancer diagnosis and treatment calibration.
Current day medicine involves disease prevention (e.g. guidance on diet and exercise habits), early detection of problems (e.g. Colonoscopy, Mammograms), and treating a problem that has occurred. However, we are limited in each of these areas. For preventive care, our guidance could be more specific and could carry more weight if we had genetic testing to help a patient understand their risk. For early detection, we must rely on “macro” level events, such as visualizing polyps, feeling masses, imaging structural distortions, and tracking non-specific biomarkers (e.g. PSA). The field of molecular detection will help us to more quickly identify diseases and thus have more success in treating them before they spread or cause excessive damage. For disease treatment, we know that not all medications or other treatment options work for all patients. Molecular medicine has the ability to help us choose the best treatment regimens, as well as more easily follow the progression of disease over time.
BRCA1 gene mutations are associated with increased breast, ovarian, and possibly prostate, and colon cancers; while BRCA2 gene mutations are associated with breast, pancreatic, gallbladder, and stomach cancers. BRCA positive patients should get more aggressive monitoring, and some opt for even more aggressive measures including bilateral mastectomies and oopherectomies to minimize their future risk of breast and ovarian cancer. Several genes affecting the Cytochrome P450 pathway determine a patient’s ability to metabolize a large variety of medications. Depending on results, a patient is usually put into four categories of metabolism: Normal, Ultrarapid, Intermediate, and Poor. The ultrarapid group may therefore not respond well to normal dosages, while the Intermediate and Poor groups may suffer side effects related to the drug levels getting too high. About 20-30% of women with breast cancer are HER-2 positive (meaning they have too many copies of the HER-2 gene, and thus too much HER2 protein). These breast cancers are often more aggressive and harder to treat. Herceptin is a monoclonal antibody that specifically targets the HER-2 genes and thus is only effective for HER-2 positive cancers. The FDA therefore requires that molecular testing confirm elevated HER-2 levels before allowing physicians to prescribe Herceptin.
The future of molecular medicine will track the pace of information liquidity. With social networking, advances in communications and a broad social compact amongst health researcher, the most powerful tools for personalizing medicine may not come from proprietary informatics vendors, but rather through open source networks, shared collaboration – especially given the scale of the informational challenges at hand. Some current examples include: The cancer Biomedical Informatics Grid™, or caBIG™, is a voluntary network or grid connecting individuals and institutions to enable the sharing of data and tools, creating a World Wide Web of cancer research. The goal is to speed the delivery of innovative approaches for the prevention and treatment of cancer. The infrastructure and tools created by caBIG™ also have broad utility outside the cancer community. caBIG™ is being developed under the leadership of the National Cancer Institute's Center for Bioinformatics . Adjuvant! Online is an application designed to help health professionals and patients with early cancer discuss the risks and benefits of getting additional therapy (adjuvant therapy: usually chemotherapy, hormone therapy, or both) after surgery. The goal is to help health professionals make estimates of the risk of negative outcome (cancer related mortality or relapse) without systemic adjuvant therapy, estimates of the reduction of these risks afforded by therapy, and risks of side effects of the therapy. These estimates are based on information entered about individual patients and their tumors (for example, patient age, tumor size, nodal involvement, histologic grade, etc.) These estimates are then provided on printed sheets in simple graphical and text formats to be used in consultations. It is available online http://www.adjuvantonline.com/index.jsp.
Much of molecular medicine is still a basic science that has not yet been integrated into clinical care. This is related to multiple factors, including the still early nature of the science, the cost of testing, and the immense amount of information generated. It is clear that the use of information technology is critical to enabling the true integration of molecular medicine with clinical care. The first area of integration will involve “Understanding” how these molecular findings actually affect the human population. We need to answer questions such as “Which gene differences cause what diseases”, “Which gene differences affect therapy” and “which dynamic biomarkers and imaging changes are associated with what diseases and other processes”. Much of this will involve brute force of searching billions of data elements, looking for differences that are associated with clinical findings, and then testing to ensure reliability. The second area of integration involves the ability to “Apply” this information in a normal clinical workflow. The use of electronic medical records will greatly facilitate this process by allowing a platform that enables appropriate storage of molecular data and real-time clinical decision support during preventive care, diagnostic and treatment workflows.
The NUgene Project ( www.nugene.org ), a long-term research study sponsored by the Center for Genetic Medicine at Northwestern University, is one of the first genetic banking studies in the country. Patients at Northwestern-affiliated hospitals and clinics are able to anonymously donate DNA from their blood samples and health information from their electronic medical records. This information will be used by researchers to examine the role genes play in the development and treatment of common diseases. There are currently over 5000 people enrolled, with a goal of 100,000 people by 2010. The first example of this integration involves a study on the possible causes of abdominal aortic aneurysms. Researchers will isolate and compare DNA from a group of participants with a history of abdominal aortic aneurysms, a disease control group consisting of participants with vascular diseases other than aortic aneurysms, and an ethnically matched control samples from NUgene participants without a history of vascular disease or chronic inflammation. DNA sequences of relevant pro-inflammatory cytokines will be compared between these groups of participants and controls to help determine whether certain gene sequences are associated with abdominal aortic aneurysms or other vascular diseases. The International HapMap ( www. hapmap .org ) is a similar project.
Assuring anonymity and security of donated patient data is of extreme importance for biobanks such as the NUGene Project. Some of the participant protection mechanisms include the following: NUgene has been granted an NIH Certificate of Confidentiality that protects the privacy of research study participants All study materials are coded with unique serial numbers to minimize the likelihood that non-study personnel will learn the identity of NUgene participants All study information routed over the Internet uses secure websites with advanced encryption technologies The data repository itself consists of a dual database system where primary identifiers, such as names, are housed in a separate database from all NUgene data NOTIS = Northwestern Oncology Trial Information System. It tracks participants on protocols for all the cancer trials and studies at Northwestern. NUGene uses components of this infrastructure to track its participants and their identifiable information separate from the NUgene system.
The Clinical Proteomics initiative is a joint initiative between the NCI and the FDA to correlate protein and gene expression patterns for early detection and cancer screening, to establish therapeutic response endpoints, and to monitor drug toxicity during treatment. An initial study using computer-assisted detection of proteomic patterns in ovarian cancer was completed in 2004, marking the first application of proteomic technology to patient diagnosis. The study analyzed blood proteins in 50 women with known ovarian cancer, and 50 without. A computer-based artificial intelligence algorithm identified diagnostic proteinomic patterns that distinguished cancer from non-cancer. Ongoing research is trying to validate these findings. This early detection method has the potential to make a substantial difference in the mortality rate of ovarian cancer as more than 80% of ovarian cancer patients are diagnosed at a late stage and have a 20% or less chance of survival at five years. In contrast, the 20% of women diagnosed with early stage disease have a 95% survival rate at five years. There is also the exciting potential of using this technique to diagnose additional types of diseases.
Correlagen Diagnostics, Inc develops and commercializes genetic testing services using a high throughput automated approach that incorporates sequencing, variant analysis, and results reporting. They focus on Genes that Matter ™, where variation is correlated with disease and where testing would impact diagnosis and treatment. Integrated results reporting is the concept that the test findings can be reported in the context of a specific patient’s other data, including demographics, known diagnoses, vital signs and other lab results. Some typical examples of Genes that Matter ™ include those for Maturity-Onset Diabetes of the Young (MODY), Early-Onset Coronary Heart Disease and Severe Combined Immunodeficiency (SCID).
Heterogeneity in patient response to chemotherapy is consistently observed across patient populations, including both efficacy and toxicity. Much of this variance is likely due to genetic differences that affect drug metabolism. One of the most common of these situations involves the use of Purinethol (mercaptopurine) to treat leukemia in children. One in 300 children (0.3%) has a gene defect for the enzyme thiopurine methyltransferase (TPMT) which can result in mercaptopurine toxicity and associated bone marrow failure. If this defect is identified, the drug can still be safely used at a lower dose. New labeling now includes information about the risk of severe bone marrow suppression in TPMT activity-deficient genotypes and TMPT testing has now become standard practice for children who may receive this medication.
In the ideal scenario, a patient with a TPMT deficiency has that genetic information stored in their electronic medical record. So when mercaptopurine is ordered, the physician will get an alert explaining that they need to lower the dose of the medication or consider a separate treatment. Ideally, the alert would actually allow them to modify the order at the same time. If they ignore this alert, they will need to explain their reasoning.
Primary care physicians diagnose diabetes in adults on a regular basis and reasonably assume adult onset diabetics are “Type 2 diabetics”. They initiate treatment in a consistent manner and adjust treatment regimens if they do not respond to the standard medications. However, 2-5% of diabetics are actually in new category often called “Maturity Onset Diabetes of the Young” (MODY). MODY is distinct from both Type 1 and 2 diabetics because it has components of both decreased insulin production and decreased insulin sensitivity. Additionally, there are 6 main sub-types of MODY, each of which have their own genetic variations and implications for treatment. This is a good example of the increasing information and complexity physicians have to comprehend on a regular basis. Accomplishing this task in a paper-based world would be extremely hard and inconsistent. Additionally, new medical information often takes 10-15 years to travel from bench research to clinical care. Consider how the use of information technologies like electronic medical records integrated with molecular medicine can facilitate and accelerate this process.
A physician using an EMR enters a new diagnosis of Diabetes for a patient. An alert can be created that asks the physician to consider ordering genetic testing for MODY. The sensitivity of this alert can be improved by additionally relating it to demographics (e.g. patient under 50), vital signs (e.g. high weight/obesity), and previous blood results (e.g. glucose, ketones in urine, insulin antibodies). In addition to adding a new diagnosis to a patient’s problem list, other EMR actions could also be used as the trigger. For example, an alert for diagnostic testing could be triggered by the report of a specific lab (e.g. elevated HbA1C for diabetes), or pathology finding (e.g. ordering HER-2 testing if a breast biopsy comes back positive), or input of family history (e.g. early CAD testing). If one of these genetic variations are present, the system might also prompt the physician to inform the patient to get family members tested, and facilitate documentation of that discussion.
A physician using an EMR prescribes a new diabetic medication for a patient with known Type 3 MODY. A sophisticated alert could use both this genetic information and knowledge about whether other drugs have been tried first, and then offer advice if the physician has not chosen the best established protocol. In this case, the physician is attempting to first prescribe Glucophage for a MODY Type 1 patient, and the EMR system is recommending they consider a sulfanurea instead, which is the recommended first line drug for this type of MODY. If the physician ignores this alert, they will be asked to explain their reasoning. Assume the patient also had been found to have a abnormality in the genes controlling her cytochrome P450 pathway. When the physician then changes the medication to glipizide, the EMR can remind them of this abnormality and suggest a modification to the usual dosing, or to choose a sulfanurea that is not affected by that pathway. In a well integrated and relatively painless way, the EMR can thus improve both the efficacy and safety of the prescribing process.
Molecular data storage Once identified, how will molecular data be stored and accessed in your EMR system? Ideally it needs to be stored in a structured way for future queries related to reporting and alerts (via CDS). Consider the EMR’s Problem List, possibly using Snomed, an organization’s unique nomenclature, and/or a new Human Genome nomenclature. Consider creating a unique EMR form that holds the genomic data elements. Perhaps most ideal would be if the genomic results could be stored in a structured manner in the EMR’s results database so that they can automatically interact with a CDS system without the need for manual population into another vehicle. Clinical Decision Support (CDS) Diagnostic Workflow: When/Where/How should you alert physicians to consider ordering a predictive or diagnostic test? Treatment Workflows: When/Where/How should you use CDS to help physicians manage treatment options? Personnel Issues Bioinformatics Manager: Who in your organization is responsible for understanding the use of molecular data within your IT systems? Genetic Counselors: Will you have enough genetic counselors to deal with the increase of genetic information expected on the scene. How will you bill for these services.
Hospitals Importance of integrating their molecular lab resulting system with their clinical IT systems More specialization of healthcare providers as we identify more sub-types of diseases Rise of Genetic Counseling and related programs Researchers Increased money and attention to the molecular sciences Improve importance and ability to perform translational research that brings bench-top findings into the clinic. The NIH has made it clear that future funding will be biased towards academic centers that are performing more clinical and translational research ( http:// www.ncrr.nih.gov/clinicaldiscipline.asp ). Pharmaceutical Companies Pharmacogenomics: More targeting of drugs in R&D and then clinical trials. This may save some drugs that only treat 10% of the population, but will also likely mean the demise of the “Blockbuster Drug” philosophy of “one size fits all”. Marketing shift to help educate patients and physicians about the importance of genetic testing. FDA approval process that might include more genetic testing (e.g. Herceptin) Insurance Companies Cost of tests can potentially hurt profits, or the costs will be shifted to the employers and individuals. Discrimination concerns
Technology Advancements (Better, Faster, Cheaper) The $1000 Complete Genome would allow every individual to have their human genome fully mapped and available electronically to interact with preventive, diagnostic and treatment decision. Data such as genetic markers, proteomics, metabolomics and molecular imaging will become more commonplace in helping with early detection and treatment guidance, especially with cancers. Ethical, Financial and Regulatory Issues Ethic debates may likely slow down this process. On one side will be patients or family members who could greatly benefit from this knowledge, while the other side will be privacy advocates who fear the use of these tests for discrimination. Fortunately, the government has already passed the “Genetic Information Non-Discrimination Act of 2005”. Financial issues will limit some tests at first, but eventually insurance companies will realize the cost-benefit of doing at least some selected testing. The use of HSAs will mean patients may find themselves having to decide whether or not to get a very expensive test that might affect their life greatly. Regulatory issues will involve the government’s plan to quickly create standards about the storage of molecular level data.