November 2011

News read or heard lately

Genomics education—from push to pull

The clinical application of genomic discoveries will require that clinicians understand when genomics should be used and be able to communicate the potential limitations and benefits to their patients. But recent evidence suggests that many physicians are not adequately trained to make use of genomic advances, say W. Gregory Feero, MD, PhD, and Eric D. Green, MD, PhD, of the National Human Genome Research Institute, citing a recent article in Science (Marshall E. 2011;331[6017]: 526–529).

Writing in the Sept. 7 issue of JAMA (2011; 306:989–990), Drs. Feero and Green say past efforts to make health care professionals more literate about genomics often took the form of a “push of information from the genomics community to other professional groups.” But unlike in the nursing profession, which has developed genomics education competencies, they say, the push approach to genomics education hasn’t worked well among physicians. They cite four main reasons:

• Physicians are “relentlessly practical” and “Until recently, most genomic advances were relevant to a very small subset of clinicians….”
• “The initial fruits of genomic medicine, such as testing for hereditary cancer syndromes, arrived at a time when the health care ecosystem was under great stress,” ensuring passive neglect of or active resistance to new ideas.
• “Often a lack of robust evidence has impeded adoption of genomic advances….”
• “Efforts to ramp up genomics education are not occurring in a vacuum; increasingly structured and rigorous educational content demands are confronting clinicians and educators in multiple settings….”

Moving from a push model of genomics education to an environment in which physicians pull for the knowledge, Drs. Feero and Green say, will require that the genomics community:

• Focus on establishing unambiguous evidence that links the use of genomic information to improved health outcomes.
• Align the “scope and depth of its educational priorities with those of the health professional groups it wishes to educate, rather than expecting the converse to happen.”
• “Step back from traditional approaches to education and carefully consider how to systematize the clinical use of genomic advances, while at the same time educating clinicians.” All clinicians will need informatics support, they write, adding: “Ensuring that high-quality software tools are available to clinicians will be more important than forcing them to understand the intricacies of how those tools work.”

Japan’s Miraca to buy Caris Diagnostics

Miraca Holdings, a Japanese provider of laboratory testing services, will buy Caris Diagnostics for $725 million. Caris specializes in anatomic pathology testing services in labs in Texas, Massachusetts, and Arizona.

Created through a merger of two firms in 2005, Miraca generates the bulk of its revenues through its clinical laboratory testing business. Its president, Hiromasa Suzuki, said the acquisition would provide a platform for Miraca to expand outside the Japanese market.

Phlebotomy best practices series

The Center for Phlebotomy Education continues its best practices webinar series with four new programs beginning this month.

• Safety Survey: How Vulnerable Are You to a Needlestick?—Nov. 17.
• Preanalytical Benchmarks: How Does Your Lab Compare?—Dec. 13.
• Ten Commandments of Phlebotomy—Jan. 17, 2012.
• Seizing Control of Blood Culture Contamination Rates—Feb. 14, 2012.

The presenters are the center’s Dennis J. Ernst, MT (ASCP), and Lisa O. Ballance, BS, MT (ASCP), CLC(AMT). For more information, contact the center at www.phlebotomy.com/webinars or 866-657-9857.

GE earmarks $1 billion for cancer R&D

GE Healthcare will devote $1 billion of its total R&D budget through 2020 to the development of oncology solutions. The funding will enable GE to expand its advanced cancer diagnostic and molecular imaging capabilities.

In related news, GE launched a $100 million open innovation challenge to bring to market ideas that advance targeted breast cancer diagnostics.

“Cancer research and treatment is at a major tipping point, and we can no longer afford to act independently. We must think and act systemically and in concert with partners across the private sector, government, nonprofits, and academia to knock down barriers and stretch our thinking,” said Andrew von Eschenbach, an advisory board member of the GE Healthymagination Fund.

Reducing ICU mortality, hospital costs

A new study documents decreases in ICU mortality and hospital costs for patients with bloodstream infections after PNA FISH tests were used for rapid identification of bloodstream pathogens. The study was performed at the University of Arizona Medical Center—University Campus in Tucson in a collaboration between the clinical microbiology laboratory and infectious diseases pharmacists as part of the institution’s antimicrobial stewardship program. Results were presented in September at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago.

The retrospective study (pre-PNA FISH versus post-PNA FISH intervention) assessed the clinical and financial impact of lab testing and reporting of PNA FISH results to guide therapeutic intervention by infectious diseases pharmacists and physicians using treatment algorithms. The study included patients with positive blood cultures admitted to the medical center between August 2007 and March 2011. Four hundred sixty patients with results indicative of enterococcal or streptococcal bacteremia were included. Of these patients, 262 had PNA FISH performed. One hundred twenty-five patients with yeast-positive blood cultures, indicative of candidemia, were also included, of which 82 had PNA FISH performed. The findings:

• Turnaround time for confirmation of results for E. faecalis, E. faecium, and other streptococci was shortened by 3.3 days (4.4 to 1.1 days) and by 3.9 days (6.2 to 2.3 days) for Candida species.
• ICU mortality for enterococcal/streptococcal bacteremia decreased by 47 percent (34.6 percent to 18.3 percent), P=0.04.
• ICU mortality for candidemia was decreased by 86 percent (41.7 percent to 5.9 percent), P=0.02.
• More than $4.7 million per year in costs avoided.