Pharmacogenomic alerts: Developing guidance for use by healthcare professionals.

AIMS: For diseases with a genetic cause, genomics can deliver improved diagnostics and facilitate access to targeted treatments. Drug pharmacodynamics and pharmacokinetics are often dependent on genetic variation underlying these processes. As pharmacogenomics comes of age, it may be the first way in which genomics is utilised at a population level. Still required is guidance and standards of how genomic information can be communicated within the health record, and how clinicians should be alerted to variation impacting the use of medicines. METHODS: The Professional Record Standards Body commissioned by NHS England developed guidance on using pharmacogenomics information in clinical practice. We conducted research with those implementing pharmacogenomics in England and internationally to produce guidance and recommendations for a systems-based approach. RESULTS: A consensus viewpoint is that systems need to be in place to ensure the safe provision of pharmacogenomics information that is curated, actionable and up-to-date. Standards should be established with respect to notification and information exchange, which could impact new or existing prescribing and these must be in keeping with routine practice. Alerting systems should contribute to safer practices. CONCLUSION: Ensuring pharmacogenetics information is available to make safer use of medicines will require a major effort, of which this guidance is a beginning. Standards are required to ensure useful genomic information within the health record can be communicated to clinicians in the right format and at the right times to be actioned successfully. A multidisciplinary group of stakeholders must be engaged in developing pharmacogenomic standards to support the most appropriate prescribing.

Salience-driven overestimation of total somatosensory stimulation.

Psychological characterisation of sensory systems often focusses on minimal units of perception, such as thresholds, acuity, selectivity and precision. Research on how these units are aggregated to create integrated, synthetic experiences is rarer. We investigated mechanisms of somatosensory integration by asking volunteers to judge the total intensity of stimuli delivered to two fingers simultaneously. Across four experiments, covering physiological pathways for tactile, cold and warm stimuli, we found that judgements of total intensity were particularly poor when the two simultaneous stimuli had different intensities. Total intensity of discrepant stimuli was systematically overestimated. This bias was absent when the two stimulated digits were on different hands. Taken together, our results showed that the weaker stimulus of a discrepant pair was not extinguished, but contributed less to the perception of the total than the stronger stimulus. Thus, perception of somatosensory totals is biased towards the most salient element. 'Peak' biases in human judgements are well-known, particularly in affective experience. We show that a similar mechanism also influences sensory experience.