A Quality Improvement Initiative: Developing a Multi-Disciplinary Team for Infective Endocarditis.

BACKGROUND: As guidelines do not describe how to develop a multi-disciplinary team(MDT), we provide a model using quality improvement tools to design a MDT for infective endocarditis (IE). METHODS: Primary service, specialty teams and whether they had surgery or not (indications, reasons, outcomes and complications) were recorded for IE patients for January-December 2016. Criteria: age >18years and definite IE per modified Duke criteria. RESULTS: Of all cases, 29/82 met criteria. Primary service: internal medicine 18(62.1%), medical intensive care and cardiology 4(13.8%) each, family medicine 2(7.9%) and pediatrics 1(3.4%). Surgery was indicated in 21(72.4%), 9 (42.9%) underwent surgery, 12 (57.1%) did not [6/9(66.67%) left side IE died, all right side IE (3,25%) survived] and 2 (22.2%) had missed opportunities and this was chosen as the leverage point. MDT was developed to reduce the number of left sided IE patients not undergoing surgery despite indications. CONCLUSIONS: Quality improvement and team development tools help in developing MDT for IE.

Tailoring of recommendations to reduce serious cutaneous adverse drug reactions: a pharmacogenomics approach.

The Health Sciences Authority launched a pharmacogenetics initiative in 2008 to facilitate evaluation of pharmacogenetics associations pertinent for Chinese, Malays and Indians in Singapore. The aim was to reduce the incidence and unpredictability of serious adverse drug reactions, with a focus on serious skin adverse drug reactions. This paper describes the gathering of evidence and weighing of factors that led to different genotyping recommendations for HLA-B*15:02 with carbamazepine and HLA-B*58:01 with allopurinol, despite both having strong genetic associations. Translation of pharmacogenomics at a national level requires careful deliberation of the prevalence of at-risk allele, strength of genetic associations, positive predictive value, cost-effectiveness and availability of alternative therapies. Our experience provides a perspective on translating genomic discoveries in advancing drug safety.