Genomics and Epidemiology Student’s Name: Institutional Affiliation: Date:

Reflection of Findings of the Study on Genomics and Epidemiology

Patients hospitalized to healthcare institutions have an increased chance of contracting an infection they acquired while there. There has been a rise in morbidity and mortality due to the presence of these HAIs in the care and safety of patients. For the sake of patient safety, healthcare institutions have implemented techniques to prevent and diagnose certain illnesses. Multi-locus sequence typing and pulsed-field gel electrophoresis were among the techniques used for surveillance as well as screening. Identifying the source of microbial illnesses and the dynamics of their transmission has been made possible thanks in large part to all of these technologies. Hospital-acquired infections have been greatly improved when genomic epidemiology was introduced as one of the strategies for identifying, distinguishing, and isolating infection agents.

With the use of genomic sequencing, it may be possible to anticipate in patients' samples if a microorganism would develop resistance to antimicrobials. This is critical to protecting patients who are at risk of acquiring resistance to any kind of HAIs. Genomic sequencing may also assist identify virulence variables that increase the risk of poor outcomes for individuals who get infected with a nosocomial illness (Tang & Gardy, 2014). Using this technique, previously undetected transmission events and sequences were discovered. Health results may be jeopardized when transmission events and sequences are missed, which raises the risk of patient safety.

There is no better screening tool for hospital-acquired infections than this one because of its capacity to accomplish the aforesaid job. Hospitals and health care professionals may then put in place the preventative measures needed to keep patients safe from developing these illnesses. Genomic sequences have also enhanced patient treatment. In order to avoid multi-drug resistance to certain antibiotics, the approach is able to detect possible candidates for multi-drug resistance (Tang & Gardy, 2014).

Genomic sequence is linked to better healthcare delivery and better health outcomes, in addition to improved patient safety and quality of treatment. Genetic sequencing technology is used to test all patients in care institutions for infection and risk of infection. Since vulnerable populations may be identified, this helps to determine which care measures should be performed (Tang & Gardy, 2014). Environmental or person-to-person transmission of hospital-acquired diseases is possible. Genomic sequencing data for epidemiological purposes help healthcare practitioners identify susceptible individuals who are at risk of contracting specific kinds of nosocomial infections, and therefore place these patients in a care setting that is free of these risk factors. Diagnostics and treatment of outbreaks in healthcare institutions are made easier by genome sequencing in general. This strategy fosters efficient care delivery and enhances patient health outcomes via the use of these roles.

There are additional financial advantages from using genomic sequencing in the diagnosis, characterization, and treatment of hospital-acquired infections. One of the most reliable and accurate ways to diagnose and isolate microbial-based illnesses. Notably, hospital acquired infection management costs in the United States vary from $28 to $45 billion yearly (R Douglas Scott et al., 2019). This is what it really costs to keep these illnesses under control. It is expensive since most illnesses are diagnosed in their most severe stages, necessitating a large amount of time and resources for treatment. Advanced infections are often accompanied by complications that need a significant investment of time and money. Care institutions have gained considerable economic gains from the application of this technology in the management of hospital acquired infections using the genomic sequencing approach, which is capable of detecting all infections and hazards.

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Part II; Application of Epidemiological Genomics in Tuberculosis

Tuberculosis is one of the chronic bacterial diseases affecting the respiratory system. It continues to spread despite there being several approaches that could be used to alter the spread. Some of the approaches used in the management of tuberculosis are rapid molecular tests such as the gene expert. Gene expert is used for diagnosis of primary pulmonary tuberculosis and drug resistance surveillance. Several challenges exist with the use of gene experts in the detection and treatment of tuberculosis. The rapid molecular test is mostly found in referral centers and not as a point-of-care diagnostic (Takii et al., 2019). This makes it hard for tuberculosis to be diagnosed in primary care centers. Despite this, gene expert does guarantee effective treatment of tuberculosis among many patients. Incidences of multi-drug resistant tuberculosis have been on the rise despite the gene expert rapid diagnostic test (Takii et al., 2019). One other biggest problem with tuberculosis is the inactive nature of the disease. Tuberculosis can be present in an individual for as long as two decades without showing signs and symptoms of active infection like other acute conditions. Mutation of tuberculosis-causing bacteria usually occurs after a long time of presence in the body without proper management. As a result, tuberculosis is still transmitted among people globally. Outbreaks of this condition are still prevalent in developing and under-developed countries. The high incidences and outbreaks of tuberculosis are due to the lack of a clear understanding of transmission patterns of the disease (Meehan et al., 2018).   This is because gene expert lacks the capability of providing transmission patterns of tuberculosis.

The introduction of whole genomic sequencing in the management and prevention of tuberculosis is one of the solutions to this epidemiological problem. Use of genomics as a method of detecting tuberculosis among the population. Adopting whole genomic sequencing as one of the diagnostic tests will solve the several challenges associated with the management of tuberculosis. Through epidemiological genomics, the transmission patterns of the disease can be looked at a higher resolution hence providing a higher understanding of the disease (Meehan et al., 2018). Understanding the transmission patterns of the disease is an essential component of epidemiology. Through this information, healthcare providers and public health officials are likely to interrupt the transmission cycle of tuberculosis hence reducing the incidence of the disease.

Genomic sequencing also plays a significant role in the management and prevention of tuberculosis. It is widely known that tuberculosis is currently developing resistance to its first- line antibiotics. Gene expert has not been able to identify the factors contributing to these outcomes among patients with the disease and on antibiotic therapy. Whole genomic sequencing can identify and isolate the microbial strains that are likely to develop resistance against these antibiotics. In line with this, genomic sequencing helps develop antibiotics that will be sensitive enough to treat the active cases of tuberculosis and resolve those (Comas, 2017). This is because genomic sequencing provides high-resolution information on the genetic makeup of the strains causing tuberculosis hence informing on the composition of medication to be developed to target these strains. Genomic sequencing can also isolate the microorganism based on the place of origin. This important in the classification of the epidemic. At the moment, tuberculosis is almost completely eradicated in America among those born in the country. High incidences are reported among immigrants from developing countries. This has only been possible due to the use of whole genomic sequencing that can isolate microbial pathogens based not only on genetic composition but also on the microorganism's geographical origin.

Prevention of tuberculosis is primarily achieved through vaccination of the population with drugs against replication of the disease-causing microorganism. Understanding the genetic composition of mycobacterium bacilli is essential in the development of vaccines to prevent the population from tuberculosis. Currently are several vaccines against tuberculosis, but outbreaks of the disease even among vaccinated individuals. This is due to the lack of understanding of the comprehensive genetic composition of the bacilli during the development of the vaccines (Comas, 2017). Hence, whole genomic sequencing will reveal the full genetic typing of the bacilli that will enhance the development of an effective vaccine against tuberculosis disease.

Genomics in the diagnosis of tuberculosis should adhere to all ethical guidelines of genetics as a diagnostic technique. Some of the common ethical considerations are respected for the privacy of genetic information, responsibility for genetic health, cost-effectiveness, and safety (WHO, 2016.). Use of genomic should not interfere with the privacy of individuals. The methods should also be affordable for all and assure the public of their safety using this technology. There should be policies by healthcare facilities that require genomic sequencing for all suspected cases of tuberculosis. This will promote effective diagnosis and management of the disease hence improving the health outcome of the people.

Part III: Application of Epidemiologic Genomics in Advanced Practice

One of the areas of advanced practice that I have chosen is cardiology. Cardiology is concerned with studying diseases affecting the cardiovascular system such as hypertension, stroke, heart attack, myocardial infarction, coronary artery disease, and heart failure. Heart disease continues to be the leading cause of mortality in America despite the resources that the government has invested in preventing this disease. It is well known that heart disease is a lifestyle condition, but genetic factors play a significant role in developing this condition. Therefore, I believe that applying epidemiological genomics in the prevention and management of this condition will be a greater milestone towards improving the health outcomes of people with different types of cardiovascular diseases.

Coronary artery disease, hypertension, and heart failure continue to affect many individuals who are not smoking tobacco, consuming alcohol, exercising regularly, practicing healthy nutrition, and managing their weight well. One factor that results in the development of these conditions without the above-named risk factors is genetic exposure (Genomic epidemiology of cardiovascular disease, n.d.). Genetic exposure refers to having genes that are likely to induce a specific type of cardiovascular disease among people. The genes are responsible for structural and physiological alterations in the body, giving rise to conditions such as coronary artery disease and hypertension. Epidemiological genomics provides comprehensive information on how the genetic makeup of individuals is likely to cause heart disease soon. Using genomic sequencing of individuals can help predict the likelihood of a person developing any kind of cardiovascular disease. This approach makes it easy to determine the vulnerable individuals and plan for interventions to prevent them from acquiring these conditions. Using genomics in heart disease is also important in determining the difference in clinical presentation among patients with the conditions. Understanding this is essential to plan for effective intervention to manage these symptoms.

Advanced practice nurses are likely to benefit from epidemiological genomics in cardiovascular disease management for several reasons. Advanced practice nurses are responsible for drawing plans of care for patients with chronic diseases. Improvement in identifying those at risk of developing such conditions helps these types of nurses isolate these individuals and manage them closely to prevent the development of these conditions. Understanding how different conditions manifest clinically and progress is another essential component of advanced practice nurses. Nurses need to understand this to know what to include in the management interventions for the specific type of cardiovascular disease. This is important since the majority of heart disease will present with relatively clinical signs and symptoms.

Therefore, epidemiological genomics is one of the major steps in diagnosing and managing different diseases. There is a need for all care providers to understand the basics of this technology. nurses need to understand how genomic sequencing works to determine the transmission of diseases, how the disease present, and the likely outcome of the diseases based on the individual genetic makeup and other factors such as prognosis and virulence factors microbial diseases

References

Comas, I. (2017). Genomic epidemiology of tuberculosis. Strain Variation in the Mycobacterium tuberculosis Complex: Its Role in Biology, Epidemiology and Control, 79-93.

Genome medicine, 6(11), 1-3.

Genomic       epidemiology        of        cardiovascular        disease.        (n.d.).        Grantome.

https://grantome.com/grant/NIH/ZIA-HL006002-09

Meehan, C. J., Moris, P., Kohl, T. A., Pečerska, J., Akter, S., Merker, M., ... & De Jong, B. C. (2018). The relationship between transmission time and clustering methods in Mycobacterium tuberculosis epidemiology. EBioMedicine, 37, 410-416.

R Douglas Scott, I. I., Culler, S. D., & Rask, K. J. (2019). Understanding the economic impact of health care-associated infections: A cost perspective analysis. Journal of Infusion Nursing, 42(2), 61-69.

Takii, T., Seki, K., Wakabayashi, Y., Morishige, Y., Sekizuka, T., Yamashita, A., ... & Kato, S. (2019). Whole-genome sequencing-based epidemiological analysis of anti-tuberculosis drug resistance genes in Japan in 2007: Application of the Genome Research for Asian Tuberculosis (GReAT) database. Scientific reports, 9(1), 1-8.

Tang, P., & Gardy, J. L. (2014). Stopping outbreaks with real-time genomic epidemiology.

World Health Organization. (2016). Human genomics in global health. Genetic testing. Dostupné na: https://www. who. int/genomics/elsi/gentesting/en.