Assumptions, conjectures, and other miracles: The application of evaluative thinking to theory of change models in community development.

Unexamined and unjustified assumptions are the Achilles' heel of development programs. In this paper, we describe an evaluation capacity building (ECB) approach designed to help community development practitioners work more effectively with assumptions through the intentional infusion of evaluative thinking (ET) into the program planning, monitoring, and evaluation process. We focus specifically on one component of our ET promotion approach involving the creation and analysis of theory of change (ToC) models. We describe our recent efforts to pilot this ET ECB approach with Catholic Relief Services (CRS) in Ethiopia and Zambia. The use of ToC models, plus the addition of ET, is a way to encourage individual and organizational learning and adaptive management that supports more reflective and responsive programming.

Guidance of pharmacotherapy in a complex psychiatric case by CYP450 DNA typing.

PURPOSE: To illustrate the utility of CYP450 genotyping to guide clinical psychopharmacological treatment decisions and minimize or avoid harmful and costly adverse drug reactions (ADRs). DATA SOURCES: DNA was extracted from a whole blood sample from the case study subject and tested for CYP450 gene polymorphisms in the CLIA certified Laboratory of Personalized Health at Genomas, Inc. Clinical data were obtained from patient records and clinician observations. CONCLUSIONS: We present a case in which the ascertainment of multiple CYP450 isoenzyme deficiencies resulted in a dramatic change in psychotropic treatment approach. Shortly after making these adjustments, the patient saw a significant improvement in most of her debilitating psychiatric symptoms. IMPLICATIONS FOR PRACTICE: In complex cases, CYP450 DNA testing can guide pharmacotherapy by exposing innate hepatic metabolic deficiencies as a result of DNA polymorphism. In such cases, clinicians can favor treatments that target functional isoenzyme pathways rather than deficient or null pathways thus leading to decreased risk of ADRs and improved patient response.