Scholars@Duke
Lori Ann Orlando

Lori Ann Orlando

Professor of Medicine
Medicine, General Internal Medicine
orlan002@duke.edu
102906, Aesthetic Center 2nd Floor, Durham, NC 27705
3475 Erwin Rd, 2nd Floor Aesthetics Bldg, Durham, NC 27705

Selected Publications

Recommendations for pharmacogenetic testing in clinical practice guidelines in the US.

Journal Article Am J Health Syst Pharm · August 12, 2024 PURPOSE: Pharmacogenetic testing can identify patients who may benefit from personalized drug treatment. However, clinical uptake of pharmacogenetic testing has been limited. Clinical practice guidelines recommend biomarker tests that the guideline authors ... Full text Link to item Cite

Conducting inclusive research in genetics for transgender, gender-diverse, and sex-diverse individuals: Case analyses and recommendations from a clinical genomics study.

Journal Article J Genet Couns · August 2024 A person's phenotypic sex (i.e., endogenous expression of primary, secondary, and endocrinological sex characteristics) can impact crucial aspects of genetic assessment and resulting clinical care recommendations. In studies with genetics components, it is ... Full text Link to item Cite

Implementing a pragmatic clinical trial to tailor opioids for chronic pain on behalf of the IGNITE ADOPT PGx investigators.

Journal Article Clin Transl Sci · August 2024 Chronic pain is a prevalent condition with enormous economic burden. Opioids such as tramadol, codeine, and hydrocodone are commonly used to treat chronic pain; these drugs are activated to more potent opioid receptor agonists by the hepatic CYP2D6 enzyme. ... Full text Link to item Cite

Rationale and design for a pragmatic randomized trial to assess gene-based prescribing for SSRIs in the treatment of depression.

Journal Article Clin Transl Sci · June 2024 Specific selective serotonin reuptake inhibitors (SSRIs) metabolism is strongly influenced by two pharmacogenes, CYP2D6 and CYP2C19. However, the effectiveness of prospectively using pharmacogenetic variants to select or dose SSRIs for depression is uncert ... Full text Link to item Cite

Does genetic testing offer utility as a supplement to traditional family health history intake for inherited disease risk?

Journal Article Fam Pract · December 22, 2023 CONTENT: This study examines the potential utility of genetic testing as a supplement to family health history to screen for increased risk of inherited disease. Medical conditions are often misreported or misunderstood, especially those related to differe ... Full text Link to item Cite

Education and electronic medical records and genomics network, challenges, and lessons learned from a large-scale clinical trial using polygenic risk scores.

Journal Article Genet Med · September 2023 Polygenic risk scores (PRS) have potential to improve health care by identifying individuals that have elevated risk for common complex conditions. Use of PRS in clinical practice, however, requires careful assessment of the needs and capabilities of patie ... Full text Link to item Cite

Critical components of genomic medicine practice for non-genetics healthcare professionals: Genetic counselors' perspectives and implications for medical education.

Journal Article J Genet Couns · August 2023 Genetic services are increasingly provided by non-genetics healthcare professionals (NGHPs) with minimal formal training in genetics/genomics. Research demonstrates gaps in knowledge and clinical practices in genetics/genomics among NGHPs, but there is a l ... Full text Link to item Cite

A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer.

Journal Article J Gen Intern Med · May 2023 BACKGROUND: Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE: To examine the effectiveness of a patient-facing FHH platform to identify and manage patie ... Full text Link to item Cite

Returning integrated genomic risk and clinical recommendations: The eMERGE study.

Journal Article Genet Med · April 2023 PURPOSE: Assessing the risk of common, complex diseases requires consideration of clinical risk factors as well as monogenic and polygenic risks, which in turn may be reflected in family history. Returning risks to individuals and providers may influence p ... Full text Link to item Cite

Expanding Family Health History to Include Family Medication History.

Journal Article J Pers Med · February 25, 2023 The collection of family health history (FHH) is an essential component of clinical practice and an important piece of data for patient risk assessment. However, family history data have generally been limited to diseases and have not included medication h ... Full text Link to item Cite

The role of family history in precision medicine

Chapter · January 1, 2023 Family health history (FHH) is one of the most important tools in precision medicine and is integral to improving health outcomes through early identification of individuals at risk for both rare and chronic conditions. Additionally, FHH represents both a ... Full text Cite

Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities.

Journal Article BMC Health Serv Res · December 6, 2022 BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary ... Full text Link to item Cite

Implementing a pragmatic clinical trial to tailor opioids for acute pain on behalf of the IGNITE ADOPT PGx investigators.

Journal Article Clin Transl Sci · October 2022 Opioid prescribing for postoperative pain management is challenging because of inter-patient variability in opioid response and concern about opioid addiction. Tramadol, hydrocodone, and codeine depend on the cytochrome P450 2D6 (CYP2D6) enzyme for formati ... Full text Link to item Cite

Design and rationale of GUARDD-US: A pragmatic, randomized trial of genetic testing for APOL1 and pharmacogenomic predictors of antihypertensive efficacy in patients with hypertension.

Journal Article Contemp Clin Trials · August 2022 RATIONALE AND OBJECTIVE: APOL1 risk alleles are associated with increased cardiovascular and chronic kidney disease (CKD) risk. It is unknown whether knowledge of APOL1 risk status motivates patients and providers to attain recommended blood pressure (BP) ... Full text Link to item Cite

Comparative study of different SES neighborhood clinics for health literacy and internet access.

Journal Article Digit Health · 2022 BACKGROUND: As healthcare services are increasingly dependent on patient utilization of technology to effectively deliver services, the digital divide has the potential to exacerbate health disparities if health literacy and internet access present formida ... Full text Link to item Cite

Family health history and health risk assessment in oncology

Chapter · January 1, 2022 Health risk assessments (HRAs) have the potential to play a key role in cancer prevention and early detection both at an individual and a population level. While the idea has been around since the 1950s and HRAs are commonly performed in the workplace, the ... Full text Cite

Experience and Perceptions of a Family Health History Risk Assessment Tool among Multi-Ethnic Asian Breast Cancer Patients.

Journal Article J Pers Med · October 19, 2021 A family health history-based risk assessment is particularly valuable for guiding cancer screening and treatment strategies, yet an optimal implementation depends upon end-users' values and needs. This is not only true prior to disease development, but al ... Full text Open Access Link to item Cite

Genomic medicine implementation protocols in the PhenX Toolkit: tools for standardized data collection.

Journal Article Genet Med · September 2021 PURPOSE: The PhenX Toolkit ( www.phenxtoolkit.org ), an online catalog of recommended measurement protocols, facilitates cross-study analyses for research with human participants. The PhenX Steering Committee recommended genomic medicine implementation as ... Full text Link to item Cite

Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network.

Journal Article J Pers Med · July 8, 2021 The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this pur ... Full text Link to item Cite

Establishing the value of genomics in medicine: the IGNITE Pragmatic Trials Network.

Journal Article Genet Med · July 2021 PURPOSE: A critical gap in the adoption of genomic medicine into medical practice is the need for the rigorous evaluation of the utility of genomic medicine interventions. METHODS: The Implementing Genomics in Practice Pragmatic Trials Network (IGNITE PTN) ... Full text Open Access Link to item Cite

Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management.

Journal Article J Pers Med · May 27, 2021 (1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of anti ... Full text Link to item Cite

Clinical implementation of an oncology-specific family health history risk assessment tool.

Journal Article Hered Cancer Clin Pract · March 20, 2021 BACKGROUND: The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routin ... Full text Open Access Link to item Cite

Family history assessment significantly enhances delivery of precision medicine in the genomics era.

Journal Article Genome Med · January 7, 2021 BACKGROUND: Family history has traditionally been an essential part of clinical care to assess health risks. However, declining sequencing costs have precipitated a shift towards genomics-first approaches in population screening programs rendering the valu ... Full text Link to item Cite

Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation.

Journal Article Orthop J Sports Med · December 2020 BACKGROUND: Treatment of a first-time anterior shoulder dislocation (FTASD) is sensitive to patient preferences. The operative or nonoperative management debate provides an excellent opportunity to learn how surgeons apply patient preferences in treatment ... Full text Open Access Link to item Cite

At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care.

Journal Article BMC health services research · November 2020 BackgroundRisk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potent ... Full text Cite

Variant Interpretation in Current Pharmacogenetic Testing.

Journal Article J Pers Med · October 31, 2020 In the current marketplace, there are now more than a dozen commercial companies providing pharmacogenetic tests. Each company varies in the panel of genes they test and the variants they are able to screen for. The reports generated by these companies pro ... Full text Link to item Cite

Correction: Developing a common framework for evaluating the implementation of genomic medicine interventions in clinical care: the IGNITE Network's Common Measures Working Group.

Journal Article Genet Med · October 2020 An amendment to this paper has been published and can be accessed via a link at the top of the paper. ... Full text Link to item Cite

Correction: Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network.

Journal Article Genet Med · October 2020 An amendment to this paper has been published and can be accessed via a link at the top of the paper. ... Full text Link to item Cite

Evaluation of family health history collection methods impact on data and risk assessment outcomes.

Journal Article Prev Med Rep · June 2020 Information technology applications for patient-collection of family health history (FHH) increase identification of elevated-risk individuals compared to usual care. It is unknown if the method of collection impacts data collected or if simply going direc ... Full text Link to item Cite

The enduring importance of family health history in the era of genomic medicine and risk assessment.

Journal Article Per Med · May 1, 2020 Improving disease risk prediction and tailoring preventive interventions to patient risk factors is one of the primary goals of precision medicine. Family health history is the traditional approach to quickly gather genetic and environmental data relevant ... Full text Open Access Link to item Cite

Family History Assessment Significantly Enhances Delivery of Precision Medicine in the Genomics Era

Journal Article · January 30, 2020 AbstractBackgroundFamily history has traditionally been an essential part of clinical care to assess health risks. However, declining sequencing costs have precipitated a shift towards gen ... Full text Cite

Managing Health in the Genomic Era: A Guide to Family Health History and Disease Risk

Book · January 1, 2020 In Managing Health in the Genomic Era: A Guide to Family Health History and Disease Risk, Drs. Vincent C. Henrich, Lori A. Orlando, and Brian H. Shirts discuss the practical considerations surrounding the use of genomic and genetic tests to manage patient ... Full text Cite

An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

Journal Article Trials · October 7, 2019 BACKGROUND: Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, ... Full text Link to item Cite

Family health history: underused for actionable risk assessment.

Journal Article Lancet · August 17, 2019 Family health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to scr ... Full text Link to item Cite

Building evidence and measuring clinical outcomes for genomic medicine.

Journal Article Lancet · August 17, 2019 Human genomic sequencing has potential diagnostic, prognostic, and therapeutic value across a wide breadth of clinical disciplines. One barrier to widespread adoption is the paucity of evidence for improved outcomes in patients who do not already have an i ... Full text Link to item Cite

Correction: Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network.

Journal Article Genet Med · July 2019 The original version of this Article contained an error in the spelling of the author Geoffrey S. Ginsburg, which was incorrectly given as Geoffrey Ginsburg. This has now been corrected in both the PDF and HTML versions of the Article. ... Full text Link to item Cite

Qualitative study of system-level factors related to genomic implementation.

Journal Article Genet Med · July 2019 PURPOSE: Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Imp ... Full text Link to item Cite

What will it take to implement genomics in practice? Lessons from the IGNITE Network.

Journal Article Per Med · July 2019 “IGNITE provides an exemplar of this novel science and it has sparked an opportunity for community-based practices to begin implementing genomics in their own environments and for patients and advocates to form genomic programs designed to improve their ow ... Full text Link to item Cite

The Genomic Medicine Integrative Research Framework: A Conceptual Framework for Conducting Genomic Medicine Research.

Journal Article Am J Hum Genet · June 6, 2019 Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypot ... Full text Link to item Cite

IGNITE network: Response of patients to genomic medicine interventions.

Journal Article Mol Genet Genomic Med · May 2019 BACKGROUND: The IGNITE network funds six genomic medicine projects. Though interventions varied, we hypothesized that synergies across projects could be leveraged to better understand the participant experiences with genomic medicine interventions. Therefo ... Full text Link to item Cite

Efficacy of a Preference-Based Decision Tool on Treatment Decisions for a First-Time Anterior Shoulder Dislocation: A Randomized Controlled Trial of At-Risk Patients.

Journal Article Med Decis Making · April 2019 BACKGROUND: First-time anterior shoulder dislocations (FTASD) provide an opportunity to examine the value of integrating stated-preference data with decision modeling to differentiate between patients whose preferred management strategy involves operative ... Full text Link to item Cite

Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network.

Journal Article Genet Med · March 2019 PURPOSE: While there is growing scientific evidence for and significant advances in the use of genomic technologies in medicine, there is a significant lag in the clinical adoption and sustainability of genomic medicine. Here we describe the findings from ... Full text Link to item Cite

Effect of Sociodemographic Factors on Uptake of a Patient-Facing Information Technology Family Health History Risk Assessment Platform.

Journal Article Appl Clin Inform · March 2019 OBJECTIVE: Investigate sociodemographic differences in the use of a patient-facing family health history (FHH)-based risk assessment platform. METHODS: In this large multisite trial with a diverse patient population, we evaluated the relationship between s ... Full text Link to item Cite

Implementation, adoption, and utility of family health history risk assessment in diverse care settings: evaluating implementation processes and impact with an implementation framework.

Journal Article Genet Med · February 2019 PURPOSE: This paper describes the implementation outcomes associated with integrating a family health history-based risk assessment and clinical decision support platform within primary care clinics at four diverse healthcare systems. METHODS: A type III h ... Full text Link to item Cite

Assessing the Effectiveness of Evidence-Based Medicine in Practice: A Case Study of First-Time Anterior Shoulder Dislocations.

Journal Article J Bone Joint Surg Am · January 16, 2019 BACKGROUND: The dissemination of evidence-based information into medical practice is essential to provide patients with optimal care and realize society's substantial investments in medical research. Effective information delivery and treatment utilization ... Full text Link to item Cite

Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka.

Journal Article BMJ Glob Health · 2019 BACKGROUND: Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The econo ... Full text Link to item Cite

Awareness of family health history in a predominantly young adult population.

Journal Article PLoS One · 2019 Family health history (FHH) is a key predictor of health risk and is universally important in preventive care. However, patients may not be aware of the importance of FHH, and thus, may fail to accurately or completely share FHH with health providers, ther ... Full text Link to item Cite

23.4 Creating Early-Childhood Research Tools That Families Want to Use: The When to Wonder Platform

Conference Journal of the American Academy of Child & Adolescent Psychiatry · October 2018 Full text Cite

Developing a common framework for evaluating the implementation of genomic medicine interventions in clinical care: the IGNITE Network's Common Measures Working Group.

Journal Article Genet Med · June 2018 PurposeImplementation research provides a structure for evaluating the clinical integration of genomic medicine interventions. This paper describes the Implementing Genomics in Practice (IGNITE) Network's efforts to promote (i) a broader understanding of g ... Full text Link to item Cite

Family Health History and Health Risk Assessment For Cardiovascular Disease in Health Care

Chapter · January 1, 2018 Health risk assessments (HRAs) have the potential to play a key role in health promotion and disease prevention both at an individual and a population level. While the idea has been around since the 1950s and HRAs are commonly performed in the workplace, t ... Full text Cite

Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research.

Journal Article Genet Med · October 2017 Comparative effectiveness research (CER) in genomic medicine (GM) measures the clinical utility of using genomic information to guide clinical care in comparison to appropriate alternatives. We summarized findings of high-quality systematic reviews that co ... Full text Open Access Link to item Cite

Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network.

Journal Article BMC Med Genomics · May 22, 2017 BACKGROUND: To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified b ... Full text Open Access Link to item Cite

Health Risk Assessments, Family Health History, and Predictive Genetic/Pharmacogenetic Testing

Chapter · March 23, 2017 Primary care, the first point of contact for patients, is in an ideal position to promote integration of genomic medicine in wider healthcare use. Most primary-care physicians spend a majority of their time treating chronic conditions. The discovery of gen ... Full text Cite

Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.

Journal Article Orthop J Sports Med · March 2017 BACKGROUND: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While ... Full text Open Access Link to item Cite

Impact of Genetic Testing and Family Health History Based Risk Counseling on Behavior Change and Cognitive Precursors for Type 2 Diabetes.

Journal Article J Genet Couns · February 2017 Family health history (FHH) in the context of risk assessment has been shown to positively impact risk perception and behavior change. The added value of genetic risk testing is less certain. The aim of this study was to determine the impact of Type 2 Diab ... Full text Open Access Link to item Cite

Family Health History and Health Risk Assessment in Health Care

Chapter · January 1, 2017 Health risk assessments have the potential to play a key role in health promotion and disease prevention both at an individual and a population level. While the idea has been around since the 1950s and health risk assessments are commonly performed in the ... Full text Cite

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

Journal Article Genet Med · October 2016 PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate upt ... Full text Open Access Link to item Cite

Family health history: an essential starting point for personalized risk assessment and disease prevention.

Journal Article Per Med · September 2016 Family health history (FHH) information is well established as a basis for assessing a patient's personal disease risk, but is underutilized for diagnosis and making medical recommendations. Epidemiological and genetic information have heightened the value ... Full text Link to item Cite

The IGNITE network: a model for genomic medicine implementation and research.

Journal Article BMC Med Genomics · January 5, 2016 BACKGROUND: Patients, clinicians, researchers and payers are seeking to understand the value of using genomic information (as reflected by genotyping, sequencing, family history or other data) to inform clinical decision-making. However, challenges exist t ... Full text Open Access Link to item Cite

Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

Journal Article Implement Sci · November 24, 2015 BACKGROUND: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers ... Full text Open Access Link to item Cite

Implementation of health risk assessments with family health history: barriers and benefits.

Journal Article Postgrad Med J · September 2015 Health risk assessments provide an opportunity to emphasise health promotion and disease prevention for individuals and populations at large. A key component of health risk assessments is the detailed collection of family health history information. This i ... Full text Link to item Cite

Use of a patient-entered family health history tool with decision support in primary care: impact of identification of increased risk patients on genetic counseling attendance.

Journal Article J Genet Couns · February 2015 Several barriers inhibit collection and use of detailed family health history (FHH) in primary care. MeTree, a computer-based FHH intake and risk assessment tool with clinical decision support, was developed to overcome these barriers. Here, we describe th ... Full text Link to item Cite

Cost-effectiveness analysis of the diagnosis of meniscus tears.

Journal Article Am J Sports Med · January 2015 BACKGROUND: Diagnostic imaging represents the fastest growing segment of costs in the US health system. This study investigated the cost-effectiveness of alternative diagnostic approaches to meniscus tears of the knee, a highly prevalent disease that tradi ... Full text Open Access Link to item Cite

Patient beliefs and behaviors about genomic risk for type 2 diabetes: implications for prevention.

Journal Article J Health Commun · 2015 Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing typ ... Full text Open Access Link to item Cite

The future of genomic testing in primary care: the changing face of personalized medicine.

Journal Article Per Med · July 2014 Primary care is recognized worldwide as a key component for improving health outcomes in the population. At the same time, healthcare systems are rapidly changing with increasing expectations from technological advances. Genomics is a major driver in chang ... Full text Link to item Cite

Providing patient education: impact on quantity and quality of family health history collection.

Journal Article Fam Cancer · June 2014 BACKGROUND: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. OBJECTIVE: Evaluate the influence of patient education on quantity and quality of FHH entered into a prim ... Full text Link to item Cite

Genetically guided statin therapy on statin perceptions, adherence, and cholesterol lowering: a pilot implementation study in primary care patients.

Journal Article J Pers Med · March 27, 2014 Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 ... Full text Link to item Cite

Implementing family health history risk stratification in primary care: impact of guideline criteria on populations and resource demand.

Journal Article Am J Med Genet C Semin Med Genet · March 2014 UNLABELLED: The Genomic Medicine Model aims to facilitate patient engagement, patient/provider education of genomics/personalized medicine, and uptake of risk-stratified evidence-based prevention guidelines using MeTree, a patient-facing family health hist ... Full text Link to item Cite

Quality of family history collection with use of a patient facing family history assessment tool.

Journal Article BMC Fam Pract · February 13, 2014 BACKGROUND: Studies have shown that the quality of family health history (FHH) collection in primary care is inadequate to assess disease risk. To use FHH for risk assessment, collected data must have adequate detail. To address this issue, we developed a ... Full text Link to item Cite

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty.

Journal Article BMC Musculoskelet Disord · January 18, 2014 BACKGROUND: The projected demand for total knee arthroplasty is staggering. At its root, the solution involves increasing supply or decreasing demand. Other developed nations have used rationing and wait times to distribute this service. However, economic ... Full text Open Access Link to item Cite

Quality of family history collection with use of a patient facing family history assessment tool

Journal Article BMC Family Practice · 2014 Background: Studies have shown that the quality of family health history (FHH) collection in primary care is inadequate to assess disease risk. To use FHH for risk assessment, collected data must have adequate detail. To address this issue, we developed a ... Full text Cite

Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial.

Journal Article BMC Fam Pract · August 6, 2013 BACKGROUND: Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree, that uses risk stratification to generate clinical ... Full text Link to item Cite

Clinical utility of genetic risk testing in primary care: the example of Type 2 diabetes.

Journal Article Per Med · August 2013 Genetic advances in Type 2 diabetes (T2D) have led to the discovery and validation of multiple markers for this complex disease. Despite low predictive value of current T2D markers beyond clinical risk factors and family history, researchers are exploring ... Full text Link to item Cite

The genomic medicine model: an integrated approach to implementation of family health history in primary care.

Journal Article Per Med · May 2013 As an essential tool for risk stratification, family health history (FHH) is a central component of personalized medicine; yet, despite its widespread acceptance among professional societies and its established place in the medical interview, its widesprea ... Full text Link to item Cite

Collection of family health history for assessment of chronic disease risk in primary care.

Journal Article N C Med J · 2013 BACKGROUND: Family health history can predict a patient's risk for common complex diseases. This project assessed the completeness of family health history data in medical charts and evaluated the utility of these data for performing risk assessments in pr ... Link to item Cite

Development and validation of a primary care-based family health history and decision support program (MeTree).

Journal Article N C Med J · 2013 INTRODUCTION: Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to ... Link to item Cite

Clinical Implementation of Genomic Medicine in Primary Care

Chapter · November 15, 2012 This two-volume set provides an in-depth look at one of the most promising avenues for advances in the diagnosis, prevention and treatment of human disease. ... Cite

Protocol for implementation of family health history collection and decision support into primary care using a computerized family health history system.

Journal Article BMC Health Serv Res · October 11, 2011 BACKGROUND: The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is ... Full text Open Access Link to item Cite

Genomic risk profiling: attitudes and use in personal and clinical care of primary care physicians who offer risk profiling.

Journal Article J Gen Intern Med · August 2011 BACKGROUND: Genomic risk profiling involves the analysis of genetic variations linked through statistical associations to a range of disease states. There is considerable controversy as to how, and even whether, to incorporate these tests into routine medi ... Full text Link to item Cite

The chronic kidney disease model: a general purpose model of disease progression and treatment.

Journal Article BMC Med Inform Decis Mak · June 16, 2011 BACKGROUND: Chronic kidney disease (CKD) is the focus of recent national policy efforts; however, decision makers must account for multiple therapeutic options, comorbidities and complications. The objective of the Chronic Kidney Disease model is to provid ... Full text Open Access Link to item Cite

A predictive model of shoulder instability after a first-time anterior shoulder dislocation.

Journal Article J Shoulder Elbow Surg · March 2011 INTRODUCTION: Management of a first-time anterior shoulder dislocation (FTASD) involves important clinical and policy decisions. Predictive disease modeling can improve the quality of information disseminated in treatment discussions. In this paper, we des ... Full text Link to item Cite

Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head.

Journal Article J Surg Orthop Adv · 2011 Management of symptomatic pre-collapse osteonecrosis of the femoral head continues to be controversial. Patients are often young and active, therefore hip-preserving procedures such as free vascularized fibular grafting (FVFG) have been developed to reliev ... Link to item Cite

Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty.

Journal Article J Shoulder Elbow Surg · April 2010 BACKGROUND: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have super ... Full text Link to item Cite

Evaluation of the PharmGKB knowledge base as a resource for efficiently assessing the clinical validity and utility of pharmacogenetic assays.

Journal Article AMIA Annu Symp Proc · November 14, 2009 Prior to clinical use, pharmacogenetic tests should be systematically evaluated for their clinical validity and utility. Here, we evaluated whether the publicly available, online Pharmacogenomics Knowledge Base (PharmGKB) could facilitate such assessments ... Link to item Cite

Dilated intercellular spaces as a marker of GERD.

Journal Article Curr Gastroenterol Rep · June 2009 Gastroesophageal reflux disease (GERD) is typically heralded by the substernal burning pain of heartburn. On endoscopic examination, about one third of GERD subjects with heartburn have erosive disease, and the remainder have nonerosive reflux disease (NER ... Full text Link to item Cite

Systematic review: reliability of compendia methods for off-label oncology indications.

Journal Article Ann Intern Med · March 3, 2009 BACKGROUND: The Centers for Medicare & Medicaid Services limit coverage of cancer drugs for off-label indications to indications listed in specified compendia. PURPOSE: To assess whether compendia provide comprehensive, research-based, and timely informati ... Full text Link to item Cite

Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension.

Journal Article Ann Intern Med · January 1, 2008 BACKGROUND: The relative effectiveness of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) for lowering blood pressure is unknown. PURPOSE: To compare the benefits and harms of ACE inhibitors versus ARBs for treati ... Full text Link to item Cite

Review of evidence for genetic testing for CYP450 polymorphisms in management of patients with nonpsychotic depression with selective serotonin reuptake inhibitors.

Journal Article Genet Med · December 2007 PURPOSE: Cytochrome P450 (CYP450) enzymes metabolize selective serotonin reuptake inhibitor (SSRI) drugs used in treatment of depression. Variants in these genes may impact treatment efficacy and tolerability. The purpose of this study was 2-fold: to syste ... Full text Link to item Cite

Chronic hypergastrinemia: causes and consequences.

Journal Article Dig Dis Sci · October 2007 The hormone gastrin plays 2 important roles in gastrointestinal physiology--1 as a major factor in meal-stimulated gastric acid secretion and the other as a trophic hormone for epithelial and enterochromaffin cells. These roles are exaggerated to the point ... Full text Link to item Cite

Noninvasive imaging for coronary artery disease: a technology assessment for the Medicare Coverage Advisory Commission.

Journal Article Am Heart J · February 2007 This report describes a review of the available scientific evidence through 2005 on direct noninvasive imaging tests (NITs) for coronary artery disease. In particular, the report addresses 6 key questions provided by the Agency for Healthcare Research and ... Full text Link to item Cite

Relationship between nephrologist care and progression of chronic kidney disease.

Journal Article N C Med J · 2007 BACKGROUND: Since chronic kidney disease (CKD) affects 11% of the United States population, and its incidence is rising, experts recommend early referral to nephrologists in the hope that it may delay the onset of end-stage disease and improve survival. Ho ... Link to item Cite

Testing for cytochrome P450 polymorphisms in adults with non-psychotic depression treated with selective serotonin reuptake inhibitors (SSRIs).

Journal Article Evid Rep Technol Assess (Full Rep) · January 2007 OBJECTIVES: To determine if testing for cytochrome P450 (CYP450) polymorphisms in adults entering selective serotonin reuptake inhibitor (SSRI) treatment for non-psychotic depression leads to improvement in outcomes, or if testing results are useful in med ... Link to item Cite

Chronic kidney disease: Relationship of nephrologist involvement and disease course

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · April 1, 2005 Link to item Cite

Chronic kidney disease: Relationship of nephrologist involvement and disease course.

Journal Article JOURNAL OF INVESTIGATIVE MEDICINE · January 1, 2005 Link to item Cite

Meta-analysis: the detection of pancreatic malignancy with positron emission tomography.

Journal Article Aliment Pharmacol Ther · November 15, 2004 BACKGROUND: Several factors contribute to the high mortality of pancreatic cancer, including limitations of diagnostic imaging. AIM: To perform a meta-analysis to assess the diagnostic accuracy of Fluro-deoxy-glucose positron emission tomography with compu ... Full text Link to item Cite

Pathophysiology of GERD: Esophageal epithelial defense

Journal Article Practical Gastroenterology · July 1, 2004 Doctors Orlando write that the esophagus has several mechanisms to prevent injury from gastric acid and pepsin. Their article details these mechanisms. ... Cite

When to stress over triptans: a Markov analysis of cardiovascular risk in migraine treatment.

Journal Article Headache · 2004 BACKGROUND: Migraines affect 10% of the U.S. population and the episodes are frequently associated with significant disability. Triptans, 5HT1 receptor agonists, can be highly effective in treating pain and reducing disability. However, reports of cardiac ... Full text Link to item Cite

Review and assessment of pharmacologic management strategies for reflux esophagitis

Journal Article Formulary · January 1, 2002 Pharmacologic therapy is the second cornerstone, after lifestyle modifications, in the medical management of reflux esophagitis. The two primary strategies for pharmacologic management of the condition are "step-up" therapy and empiric therapy with a proto ... Cite