Harefuah
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For 50 years, pharmacogenetics has been studying the genetic basis for variability in drug response between individual patients, both with respect to drug toxicity and drug efficacy. Following the completion of The Human Genome Project about three years ago, and the development of technologies allowing rapid identification of polymorphic alleles using DNA chips, pharmacogenetics would soon allow the introduction of personalized medicine. For most medical disciplines, this would allow pharmacotherapy according to each patient's individual genetic data. ⋯ The purpose of this review is to delineate the principles of pharmacogenetics, focusing on the aspects closest to implementation in the clinic: the polymorphism of liver CYP450 metabolic enzymes, mostly CYP2D6 and CYP2C19. We shall also review current efforts to better understand the scope of human genome diversity, and present several examples for variability in drug efficacy and genetic polymorphism of drug target genes. Education of health professionals in pharmacogenetics as part of their pharmacology curricula, and explaining its potential to the general public, would be indispensable for the success of personalized medicine.
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University Departments from many countries recruit their faculty members for academic duties without prior formal training (specific for their jobs). This has been the common approach in Israel. Other countries however, have created faculty development (FD) programs to help new faculty accomplish their new tasks. ⋯ Twenty-three family physicians enrolled in the course. Half of the participants were born and trained in medicine in Israel. After completing the first year of this program, both participants and teachers provided positive feedback and requests were received for a second course for new participants.
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Cranberries have long been the focus of interest for their beneficial effects in preventing urinary tract infections (UTIs). Cranberries contain two compounds with anti-adherence properties, which prevent fimbriated E. coli from adhering to uroepithelial cells in the urinary tract. ⋯ Most importantly, the trials have used a wide variety of cranberry products, such as cranberry juice concentrate, juice cocktail, and cranberry capsules, and have employed different dosing regimens. Further research is required to clarify unanswered questions regarding the role of cranberries in protecting against UTI in general and in women with anatomical abnormalities in particular.
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Management of body temperature is considered crucial in the management of acute stroke patients. Hyperthermia exacerbates ischaemic neuronal injury and physiological dysfunction. Hypothermia has been suggested as the "gold standard" for neuroprotection to which new pharmacological therapies should be compared. ⋯ We also examined the derived effect of using hypothermic procedures and antipyretic agents as a treatment measure in acute stroke patients for improving outcomes. Immediate effective treatment of the fever, while simultaneously evaluating its origin, is found to be crucial in the acute stroke for improving outcomes. The hypothermic effect of acetaminophen as a preventive measure for all patients requires further evaluation.
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The duty to maintain medical confidentiality is one of the fundamental and well-known obligations imposed on physicians, and is incorporated in the Law of Patient's Rights 1996 (the Law). Medical confidentiality applies to information conveyed to a physician for medical purposes trusting that the physician will not disclose it. The patient's identity and financial arrangements are not confidential. ⋯ The duty to maintain medical confidentiality is relevant to the patient's relatives. Obtaining written consent to convey the information to family members is not practical. However, it is recommended that a physician should provide the information only to relatives he knows, and only when he can reasonably assume that the patient will agree.