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Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Sentiment and barriers may limit PGx testing. Here we compare confidence in utilizing PGx testing and barriers to implementation by type of provider and treatment condition as identified in a survey.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], 32% of NPs/PAs and 29% of MDs/DOs had used PGx testing for mental health conditions. The major barriers to adopt PGx testing were similar for mental health and primary care conditions yet differed by provider type. NPs/PAs (72-77%) were more concerned with patient cost than MDs/DOs (46-55%), whereas MDs/DOs were more concerned with evidence of clinical utility (54-59%) than NPs/PAs (40-42%). In respondents who use PGx testing, MDs/DOs reported slightly more confidence utilizing PGx than NPs/PAs. For both groups, confidence in using PGx for mental health conditions was somewhat greater than for non-mental health conditions.
Conclusions
These data illuminate the implementation barriers and confidence levels of clinicians utilizing PGx testing. Increasing awareness around patient cost and evidence of clinical utility for PGx testing may improve utilization.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Lack of awareness and education may be barriers to implementing routine PGx testing. To characterize current PGx testing utilization and educational needs we conducted a survey of various provider types.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], most indicated that they “don’t use” (44-49%) or “have never heard of” (19-20%) PGx testing for mental health conditions. The most helpful sources to learn about PGx testing were accredited CE/CME activities (55-61%) and peer-reviewed publications (57-59%). Most NPs/PAs preferred webinars (62%) or online learning portal (57%) formats. MDs/DOs had no preference for webinars or learning portals over conferences, written materials, or academic presentations (45-47%). NPs/PAs were more interested in learning about PGx testing than MDs/DOs (4.29/5 vs. 3.96/5 average score).
Conclusions
These data reveal awareness level and desired learning opportunities for PGx testing between types of healthcare providers. Education should be tailored to meet providers’ preferred learning formats and information sources, such as offering CE/CME through an online learning portal.
The range of roles in healthcare knowledge and library services are many and varied. From 'traditional' librarian roles to those that break new ground - including clinical, embedded and outreach librarians and knowledge managers - they are a vital ongoing support for this important sector.
This work brings together health information practitioners and researchers with a variety of experience across health information work within knowledge and library services in the NHS. It provides a comprehensive, practitioner-focused introduction to all aspects of knowledge and library work in the health sector with a focus on NHS England. The book begins with an overview of the NHS and how knowledge and library work sit within it. It then addresses such critical areas as services supporting evidence-based practice, the developing area of health information literacy, reflective practice, collaborative working, demonstrating impact and employing digital technology. The book ends with an exploration of what the future might hold for healthcare knowledge and library services such as, the rapid advance of artificial intelligence/machine learning and how it might shape those services and knowledge specialist roles.
Knowledge and library specialists offer a valuable gift to healthcare professionals - the 'gift of time' enabling them to make informed decisions which directly impact upon patient care. This timely book provides a valuable reference for anyone studying or looking to enter this relevant and diverse field.
Latino patients have been shown to engage in advance care planning (ACP) at much lower rates than non-Latino White patients. Coping strategies, such as the use of emotional support, may differentially relate to engagement in ACP among Latino and non-Latino patients. The present study sought to examine the moderating effect of ethnicity on the relationship between the use of emotional support as a coping strategy and completion of advance directives.
Methods
The present study employed a weighted sample (Nw = 185) of Latino and non-Latino White patient participants in Coping with Cancer III, an National Institutes of Health–sponsored, multisite, longitudinal, observational cohort study of patients with advanced cancer and their informal caregivers and oncology providers designed to evaluate Latino/non-Latino disparities in ACP and end-of-life cancer care. Main and interaction effects of Latino ethnicity and use of emotional support on patient use of advance directives were estimated as odds ratios.
Results
Use of emotional support was associated with dramatically lower do-not-resuscitate (DNR) order completion to a greater extent among Latino as compared to non-Latino patients (interaction AOR = 0.33, p = 0.005). Interaction effects were not statistically significant for living will or health-care proxy form completion.
Significance of results
Use of emotional support is associated with lower odds of completing DNRs among Latino than among non-Latino patients. Seeking and/or receiving emotional support may deter Latino patients from completing DNR orders. Research is needed to address both emotional needs and practicalities to ensure high quality end-of-life care among Latino patients with cancer.
The first public screening of projected moving images by the Lumière Brothers in Paris in 1895 marked the beginning of an artistic revolution. Almost immediately, music became an integral part of the film industry, first being performed live to silent film screenings before becoming fully integrated into the cinematic apparatus on the advent of sound film. While the placement of music against the moving image for commercial film built on centuries of dramatic practice, it also developed forms of audiovisual communication unique to the twentieth century. In fact, we can say that moving-image art is a form exclusive to modern life. As the decades passed, many of the audiovisual conventions established in early film practice began to be appropriated by other moving-image genres, from television (1950s) and music video (1980s) to the interactive forms of video art (1960s), gaming (1970s) and online culture (1990s). These new audiovisual textures were also used by composers and artists to refresh the processes of music composition, while screen media quickly became an integral part of live music performance, from opera to stadium rock.
States and state-like supranational bodies have always sought to control music’s creation and dissemination. As early as the fourth century BC, Plato made explicit (in The Republic) the laws that a state should enact in response to the social benefits and threats posed by different musical scales. Twelve centuries later the Council of Trent considered the role of music among many of its reforms to the Catholic Church, recommending intelligibility of text, avoidance of secular expression and ‘only the divine phrases of hymnody’ be used in its music, such that ‘the hearts of listeners should be ravished by longing for heavenly harmony and by contemplation of the joys of the blessed’. Later still, in nineteenth-century Vienna, Franz Schubert laboured under a censorial regime promoted by Emperor Franz I and his anti-liberal foreign minister Prince Clemens von Metternich. In each of these examples, the battle can be seen as one between conservatism and modernity. The intervention of the state (or the church, as it may be), is almost always an attempt to regain control of meaning in the face of change. As the sociologist Howard S.
The prerogatives of the new, of progress and the future, had been more important than ever in the wake of World War II. But, by the 1970s, the grand schemes that had characterised Western modernity and modernism seemed all to be failing. This was true on the broadest scale: while Nazi genocide was in the past, the Soviet experiment that had given much early modernist art its force – and postwar Western social democratic reforms their urgency – was now crumbling in totalitarian misery. It was true of people’s lived experience: rather than ushering in a life in the sky, new high-rise housing had further ripped at an already tattered social fabric. And it was true of the arts: as much as unveiling a new lingua franca for an international modern music, serial composition had seemed to renounce its own audience, and listeners now turned to popular musics even for the experiment and challenge that art music had once vaunted. Here was the crisis: a loss of intellectual and spiritual confidence in the West’s ability – taken as read since the Enlightenment – to envisage and work towards a better future by way of rational means (Berman 1982).
The concept of the ‘centre and periphery’ was a key one in twentieth-century music and culture. It took many forms: ‘mainstream and margins’ or ‘culture and counterculture’ oppositions; more personal ‘insider and outsider’ dynamics; and spatial relationships between centres of cultural power and their peripheries. This chapter examines such centre-and-periphery dynamics from a number of angles. It starts by tracking countercultures across the century, looking at the 1960s counterculture as a typical example in which competing values eventually become absorbed in the mainstream. The first case study surveys free jazz as a countercultural or marginal practice that largely managed to resist incorporation into the mainstream. The chapter then pivots to examine the insider and outsider dynamics inherent in noise music, where both aesthetic and social separation from the mainstream is prized as a core value. The second case study, on noise in Japan, extends and develops that discussion, examining the transnational dynamics that underpin even this obscure, marginal musical form. The chapter closes with a discussion of ‘downtown’ and ‘uptown’ music as a typical struggle between official and unofficial centres of musical power in the last decades of the century.
This chapter explores twentieth-century music’s entanglement in various racial and ethnic (or national) struggles. We start by looking at the concepts of ‘essentialism’ and ‘constructivism’, two ideas that shaped how music was talked about and experienced in the period. We extend that discussion in turning to ethnicity and nationalism in twentieth-century music. Our first case study examines Béla Bartók’s (1881–1945) folk-song collecting through the lens of national and ethnic identity. We then discuss the concept and traditions of Black music in the twentieth century, in turn looking at the post-human in Black and white music in our second case study. The final section draws together previous discussions in looking at end-of-the-century transnational musics as symbols of changing racial, ethnic and national dynamics. We should acknowledge the complexity of ‘race’ and ‘ethnicity’ at the outset. Though the shorthand of race as biology (physical characteristics) and ethnicity as culture (customs tied to heritage or nationality) is useful, it masks a more complex reality where race is shaped by cultural experience, and ethnicity can refer to shared physical as much as cultural characteristics.
In the twentieth century as in our own time, ‘rhythm’ meant different things in different contexts. Popularly, it often suggested a type of beat or musical feel, usually something lively or active. To music specialists, it could also refer to any one of the aspects of the relationship between sound and time: attack, metre or phrase structure (or ‘period’). As the century progressed, and the new discipline of ethnomusicology began to suggest ways of understanding local music cultures as local participants did, it became apparent that many peoples had other ways of perceiving and describing what Westerners described as rhythm (Agawu 1995). In what follows, we will address changing ‘cultural’ and musicological understandings of rhythm across the century. Yet our attention will often be on the ways that musicians developed rhythmic approaches to particular aesthetic and technical ends; in these discussions we will follow the definition of Anne Danielsen (2010a: 4) and take rhythm to refer to ‘an interaction between non-sounding reference structures’, such as metre, ‘and sounding rhythmic events’, such as an attack or beat.