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Pragmatic Precision Medicine: Race-Specific Propofol Model

by Samsun Lampotang, PhD

Our app at vam.anest.ufl.edu/WebSims/propofolsim/mobile/ allows users to readily access and compare propofol loss of consciousness data for patients of different races.

Gainesville, FL Medical Education

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About this project

The problem we solve:
Propofol is on the World Health Organization’s Model List of Essential Medicines, which is “a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe, and cost-effective medicines for priority conditions.” Approved for use in more than 50 countries, propofol is routinely used worldwide and thus on patients of different races. During propofol sedation, an ever-present concern is that because of variability in patient pharmacodynamics and sensitivity to propofol, sedation can inadvertently slide into general anesthesia where a patient loses self-protective reflexes such as spontaneous breathing. This situation can become life threatening if the provider is unaware that it has occurred or is not skilled in restoring ventilation and oxygenation.

About our solution:
We provide a point of care app about the differences in the propofol concentration that induces loss of consciousness between, and within, populations of different races. Users select desired times and doses to administer propofol by bolus and/or infusion. Time plots display propofol concentrations at the blood and effect site compartments. Users can view a hydraulic analogue model. A horizontal line is drawn on the hydraulic analogue and the time plot to indicate concentrations as which 50% of patients of a selected race (White, Black, Chinese, Indian) become unconscious. Users can change the time plot duration, patient weight, patient race, and propofol model. Our app provides point of care assistance in precise dosing of propofol to prevent unintended overdose/general anesthesia with loss of self-protective reflexes such as spontaneous breathing, especially when airway management experts are unavailable. It is also an example of pragmatic, actionable precision medicine.
Progress to date: A mobile version online as well as a desktop version are available online. Our peer-reviewed paper "Race-specific pharmacodynamic model of propofol-induced loss of consciousness" has been published in The Journal of Clinical Pharmacology. We have filed an IRB application to conduct clinical studies that will allow us to obtain propofol pharmacodynamic data for other races and ethnicities and will add new data to the app as others or we generate it. The simulation is available online at http://vam.anest.ufl.edu/WebSims/propofolsim/mobile/

About Our Team


Dr. Samsun Lampotang, PhD
Anesthesiology, Medical Student
Location: Gainesville, Florida
Medical school: University of Florida
Bio: Samsun Lampotang is a Professor of Anesthesiology and Director of the Center for Safety, Simulation & Advanced Learning Technologies at the University of Florida in Gainesville, Florida. He received his Ph.D. in Mechanical Engineering at the University of Florida, College of Engineering. His research interest is in simulation in healthcare, healthcare equipment, and promotion of patient safety through enhancement of learning and improved equipment design.
Practice: University of Florida
Hospital Affiliation: UF Health Shands Hospital
Title: Professor of Anesthesiology Director, Center for Safety, Simulation & Advanced Learning Technologies Director, UF CTSI Simulation Core Innovations Director, UFHealth Shands Experiential Learning Ce
LinkedIn: https://www.linkedin.com/in/samsun-sem-lampotang-a7b371a

About Team Members

David Lizdas
BSME, IT Expert/Simulation Engineer, BSME
Biography: Mr. Lizdas has developed simulators, designing, creating and evaluating both software and hardware for these training systems. He has been working in the field of simulation in healthcare with Dr. Lampotang since 1999.
Goeto Dantes
Medical Student, Medical Student, Applied Physiology and Kinesiology B.A.
Biography: Goeto Dantes is a medical student at the University of Florida and research aide for the Center for Safety, Simulation & Advanced Learning Technologies at the University of Florida. He received his bachelors in Applied Physiology and Kinesiology from the University of Florida and is currently working on his medical degree.
Nikolaus Gravenstein
The Jerome H. Modell, MD Professor of Anesthesiology Professor of Neurosurgery Professor of Periodontology University of Florida College of Medicine, Gainesville, Florida, MD, University of Florida College of Medicine
Biography: For Dr. Nikolaus Gravenstein, upholding high standards is a family tradition stretching back 45 years. The University of Florida, College of Medicine recruited Gravenstein’s father, Joachim Gravenstein, to begin the Department of Anesthesiology in 1958. Dr. Nikolaus Gravenstein is the Jerome H. Modell Professor of Anesthesiology, as well as a Professor of Neurosurgery and Professor of Periodontology at the University of Florida. He received his medical degree from the University of Florida.
William Johnson
Simulation Development Assistant, B.S. Computer Science, University of Florida
Biography: William Johnson works at the Center for Safety, Simulation & Advanced Learning Technologies at the University of Florida. He assists in developing, designing and testing software for computer simulations.

About Our Company


Center for Safety, Simulation & Advanced Learning Technologies
Location: Gainesville, Florida
Website: http://simulation.health.ufl.edu/CSSALT/index.php
Product stage: ready
Sales: Working on it
Employees: 5-10

How We Help Patients

Cookie cutter, formulaic medicine that ignores differences within and between races can cause medical errors, the 3rd leading cause of death in the US (~250,000/yr). In our point of care app, we focus on pragmatic precision medicine via interracial variability, specifically racial differences in propofol concentrations inducing loss of consciousness (LOC). A simulation-based study and a survey at an international anesthesia meeting (unpublished data) indicate that anesthesia providers are unaware of data in peer-reviewed papers from emerging countries (India, China) documenting racial differences in propofol sensititivity. We developed our point of care app to help clinicians account for interracial differences in propofol sensitivity to make it less likely that patients from races known to be sensitive to propofol (some by a factor of 1.5) will suffer inadvertent overdosing and complications, including death, if self-protective reflexes are blunted and if rescuers are unavailable.

How We Help Education

Precision medicine, considered a research area, is not part of mainstream medical education curricula. We provide with our app a tangible example of pragmatic precision medicine that is inexpensive (no genetic analysis required), immediately actionable and can sensitize medical/healthcare students, in their early formative stages, about instances where patients of different races generally respond differently. Via an intuitive user interface, students can experiment and compare patient response within, and between, races to propofol infusion and bolus, preventing accidental overdosing. With our app, instructors have a tangible, concrete example of precision medicine for their students while they are learning, making them aware of the hazards of cookie cutter formulaic medicine. In addition, the app, designed to run on mobile phones, is easy for students to access. We are providing a new mobile tool to provide early exposure to precision medicine to students.

How We Help Physicians

Results from simulation-based studies with medical students and anesthesiologists and surveys of anesthesiologists at academic hospitals and international anesthesia meetings strongly indicate lack of awareness in both groups that propofol sensitivity is race specific. Our app is a pragmatic precision medicine tool to help physicians tailor care for diverse patients and avoid accidental overdosing, especially in office/day surgery centers where airway management experts may not be available to restore oxygenation, if patients stop breathing. Our mobile app provides a point of care tool to dose propofol by bolus and/or infusion and predict resulting blood/effect site compartment concentrations (prior to giving propofol) to avoid preventable overdosing and prolonged patient recovery times. Precision dosing of propofol as a form of pragmatic precision medicine can reduce overdosing, decrease recovery times, increase throughput (# of procedures performed per workday) and patient safety.

Challenge Mission

Mission: Our solution will support improving the nation’s health by training students and physicians in using pragmatic precision medicine, thus reducing medical errors, the 3rd leading cause of death in US.
Use of funds: We would use the funds to address a glaring health disparity gap, the lack of definitive propofol-induced loss of consciousness data collected from the African-American population in the US. The data for Black patients that we present in our point of care app is derived from a study of British Blacks which is our best available approximation to African Americans at the moment.
Intellectual Property Status: No intellectual property in our point of care app for pragmatic precision medicine when dosing propofol to patients of the White, Black, Chinese and Indian races. Our race-specific model is in the public domain as a 2016 J Clin Pharm peer-reviewed paper
FDA Status: Not applicable. Not a medical device.
Personal Message: We are a small group of engineers and physicians who have been privileged to work on exciting but, more importantly, meaningful projects that have positively impacted patient safety and medical education worldwide. Our simulation lab helped launch the rebirth in the late ‘80s of simulation in healthcare as a training tool though its Human Patient Simulator mannequin. We strongly believe that much good will similarly result from our precision medicine project and humbly request your votes.

Supporters

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    06/14/2016 Erik Black - Healthcare Innovator

    Liked the project.

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    06/14/2016 Erik Black - Healthcare Innovator

    Followed the project.

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    06/14/2016 Erik Black - Healthcare Innovator

    Interested in trying the project.

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    05/21/2016 David Estores - Physician

    Liked the project.

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    05/21/2016 Giuliano De Portu - Physician

    Interested in trying the project.

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    05/21/2016 David Estores - Physician

    Followed the project.

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    05/21/2016 Ferenc Rabai - Physician

    Liked the project.

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    05/21/2016 Ferenc Rabai - Physician

    Interested in trying the project.

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    05/21/2016 Ferenc Rabai - Physician

    Followed the project.

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    05/21/2016 Deborah Curry - Private

    Liked the project.

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    05/21/2016 Ferenc Rabai - Physician

    Interested in other factor.

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    05/21/2016 Giuliano De Portu - Physician

    Liked the project.

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    05/21/2016 Ferenc Rabai - Physician

    Interested in piloting the project.

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    05/21/2016 Diane Sartore - Concerned Citizen

    Followed the project.

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    05/21/2016 Ferenc Rabai - Physician

    Interested in partnership.

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    05/21/2016 Giuliano De Portu - Physician

    Followed the project.

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    05/21/2016 Diane Sartore - Concerned Citizen

    Liked the project.

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    05/20/2016 Matthew Ruppert - Engineer

    Followed the project.

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    05/20/2016 Matthew Ruppert - Engineer

    Liked the project.

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    05/20/2016 Jeffrey Feldman - Physician

    Followed the project.

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    05/20/2016 Jeffrey Feldman - Physician

    Liked the project.

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    05/20/2016 Jeffrey Feldman - Physician

    Interested in trying the project.

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    05/20/2016 stephanie lampotang - Concerned Citizen

    Followed the project.

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    05/20/2016 stephanie lampotang - Concerned Citizen

    Liked the project.

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    05/19/2016 Yury Zasimovich - Physician

    Interested in trying the project.

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    05/19/2016 Etem Alnigenis - Physician

    Liked the project.

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    05/19/2016 Yury Zasimovich - Physician

    Interested in piloting the project.

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    05/19/2016 Yury Zasimovich - Physician

    Followed the project.

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    05/19/2016 Yury Zasimovich - Physician

    Liked the project.

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    05/19/2016 Yury Zasimovich - Physician

    Interested in partnership.

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    05/19/2016 Yury Zasimovich - Physician

    Interested in mentorship.

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    05/19/2016 Sean Kelly - Entrepeneur

    Liked the project.

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    05/19/2016 carlos plateroti - Hospital Staff

    Liked the project.

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    05/19/2016 Justin Newman - Healthcare Innovator

    Liked the project.

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    05/19/2016 Alan Schwartz - Physician

    Liked the project.

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    05/18/2016 Clifford Richmond - Engineer

    Liked the project.

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    05/18/2016 Clifford Richmond - Engineer

    Followed the project.

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    05/17/2016 David Lizdas - Engineer

    Liked the project.

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    05/17/2016 David Lizdas - Engineer

    Followed the project.

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    05/17/2016 SangChun Choi - Physician

    Interested in trying the project.

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    05/17/2016 Jerry Johnson - Pharmacist

    Liked the project.

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    05/17/2016 SangChun Choi - Physician

    Interested in piloting the project.

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    05/17/2016 SangChun Choi - Physician

    Interested in partnership.

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    05/17/2016 SangChun Choi - Physician

    Interested in mentorship.

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    05/17/2016 SangChun Choi - Physician

    Liked the project.

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    05/17/2016 SangChun Choi - Physician

    Followed the project.

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    05/17/2016 SangChun Choi - Physician

    Interested in other factor.

20

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14

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3

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0

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75

Interest
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16

Adoption
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Samsun Lampotang, PhD
Medical Student
Professor of Anesthesiology Director, Center for Safety, Simulation & Advanced Learning Technologies Director, UF CTSI Simulation Core Innovations Director, UFHealth Shands Experiential Learning Ce
University of Florida

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