Appraisal and development of evidence-based clinical decision support to enable perioperative pharmacogenomic application
| Autor: | Mark J. Ratain, Sajid Shahul, Keith Danahey, Peter H. O'Donnell, Jeffrey L. Apfelbaum, Ellie H. Jhun, Randall W. Knoebel, Emily Schierer, Tien M. Truong, Brittany A. Borden, Magdalena Anitescu |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Evidence-based practice Pharmacogenomic Variants Clinical Decision-Making Risk Assessment Perioperative Care Decision Support Techniques Desflurane Diclofenac Predictive Value of Tests Risk Factors Genetics medicine Humans Anesthetics Pharmacology Analgesics Evidence-Based Medicine business.industry Codeine Guideline Perioperative Pharmacogenomic Testing Pharmacogenetics Emergency medicine Molecular Medicine Tramadol business Oxycodone medicine.drug |
| Zdroj: | The pharmacogenomics journal. 21(6) |
| ISSN: | 1473-1150 |
| Popis: | Variable responses to medications complicates perioperative care. As a potential solution, we evaluated and synthesized pharmacogenomic evidence that may inform anesthesia and pain prescribing to identify clinically actionable drug/gene pairs. Clinical decision-support (CDS) summaries were developed and were evaluated using Appraisal of Guidelines for Research and Evaluation (AGREE) II. We found that 93/180 (51%) of commonly-used perioperative medications had some published pharmacogenomic information, with 18 having actionable evidence: celecoxib/diclofenac/flurbiprofen/ibuprofen/piroxicam/CYP2C9, codeine/oxycodone/tramadol CYP2D6, desflurane/enflurane/halothane/isoflurane/sevoflurane/succinylcholine/RYR1/CACNA1S, diazepam/CYP2C19, phenytoin/CYP2C9, succinylcholine/mivacurium/BCHE, and morphine/OPRM1. Novel CDS summaries were developed for these 18 medications. AGREE II mean ± standard deviation scores were high for Scope and Purpose (95.0 ± 2.8), Rigor of Development (93.2 ± 2.8), Clarity of Presentation (87.3 ± 3.0), and Applicability (86.5 ± 3.7) (maximum score = 100). Overall mean guideline quality score was 6.7 ± 0.2 (maximum score = 7). All summaries were recommended for clinical implementation. A critical mass of pharmacogenomic evidence exists for select medications commonly used in the perioperative setting, warranting prospective examination for clinical utility. |
| Databáze: | OpenAIRE |
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