Military medicine
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Genetic counseling for military beneficiaries poses unique challenges and counseling opportunities. In order to fully meet the needs of this population, genetic counseling involves critical ethical and psychosocial considerations. This article reviews some elements of genetic counseling that must be considered when working with beneficiaries in the military health system.
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Clinical utilization of pharmacogenomics (PGx) testing is highly institutionally dependent, and little information is known about provider practices of PGx testing in the Military Health System (MHS). In this study, we aimed to characterize Clinical Pharmacogenetics Implementation Consortium (CPIC) actionable prescription (Rx) patterns and their temporal relationship with PGx testing in the MHS. ⋯ PGx testing was generally limited to high Rx-drug users and was found to be an under-utilized resource. PGx testing did not typically follow CPIC guidelines. Implementing PGx testing protocols, simplifying PGx test-ordering by incorporating at minimum CYP2D6, CYP2C19, and CYP2C9 into PGx-testing panels, and unifying providers' PGx knowledgebase in the MHS are feasible and would improve the clinical utilization of PGx tests in the MHS.
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Developments in genetics, pharmacology, biomarker identification, imaging, and interventional biotechnology are enabling medicine to become increasingly more precise in "personalized" approaches to assessing and treating individual patients. Here we describe current scientific and technological developments in precision medicine and elucidate the dual-use risks of employing these tools and capabilities to exert disruptive influence upon human health, economics, social structure, military capabilities, and global dimensions of power. We advocate continued enterprise toward more completely addressing nuances in the ethical systems and approaches that can-and should-be implemented (and communicated) to more effectively inform policy to guide and govern the biosecurity and use of current and emerging bioscience and technology on the rapidly shifting global stage.
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Hospital waste adds to the ecological footprint of the healthcare system, whereas inattention to recyclables may increase costs. The primary objective of this study was to assess the amount of recyclable and nonrecyclable intraoperative waste produced across representative otolaryngology surgical procedures. ⋯ This study supports that otolaryngology surgical procedures generate a significant amount of waste, a large component of which is recyclable. It highlights the need for proper disposal of this waste and the implementation of a recycling program at our institution with the potential for both ecologic and economic benefits.
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Pressed by the accumulating knowledge in genomics and the proven success of the translation of cancer genomics to clinical practice in oncology, the Obama administration unveiled a $215 million commitment for the Precision Medicine Initiative (PMI) in 2016, a pioneering research effort to improve health and treat disease using a new model of patient-powered research. The objectives of the initiative include more effective treatments for cancer and other diseases, creation of a voluntary national research cohort, adherence to privacy protections for maintaining data sharing and use, modernization of the regulatory framework, and forging public-private partnerships to facilitate these objectives. ⋯ Our hypothesis is that there is a growing urgency for the development of educational experiences, formal and informal, to enable clinicians to acquire competency in genomics commensurate with their level of practice. Several educational approaches, both in practice and in development, are presented to inform decision-makers and empower military providers to pursue courses of action that respond to this need.