Harefuah
-
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.
-
Clinical guidelines for the management of hip fractures strongly emphasize the critical role of early surgery as a major factor affecting better health outcomes. Shortening the time from admission to pre-operative consultation by bringing the consultants to the emergency room, before patient admission to the orthopedic ward, is am efficient cost effective hospital policy that enables adherence to guideline recommendations. Early pre-operative specialist consultation is an efficient cost effective policy for preventing delay of surgery following hip fracture in the elderly.
-
In an amendment to the law regarding the treatment of the Mental Health patient in 1991, authority was given to the regional psychiatrists' committee to oversee compulsory orders for psychiatric hospitalization and compulsory orders for outpatient psychiatric treatment--and the extension of these orders. On 1st of June 2002 a pilot study was started in the Jerusalem region, in which mental health patients were to be represented by lawyers employed by the Ministry of Justice. The pilot study began as an initiative of the Ministry of Justice, in agreement with the Ministry of Health. ⋯ A pilot study compared between patients discharged from compulsory hospitalization through regional psychiatrists' committee or court and patients discharged on a medical basis without legal interference. The study showed a shorter stay in the community in the first group (42%) compared to 75% stay in the community in the second group, after six months. We are of the opinion that the current provision of legal assistance is lacking the necessary balance between medical and legal considerations; the 'wish for freedom' as a default, although illogical, is within the new system of legal aid, and is more considerate and important than the 'best interests' of the patient and his health.