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  • Government Action & Communication Institute

    Government Action and Communication Institute (GACI) is a non-partisan 501(c)(3) public policy, education, and research organization specializing in health care, social services, and education issues.

    GACI’s mission is to bring the most relevant information - research, best practices, and model programs - to policy leaders and decision makers at the federal, state, and local levels. We use events to provide opportunities for government, academia, and business leaders to talk and work together.

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    Policy Insights 2015 California Budget Project Conference
    Wednesday, March 4, 2015
    8:30am – 4:30pm, Reception following Sacramento Convention Center, 3rd Floor

    The SCAN Foundation 4th LTSS Summit
    Tuesday, September 30, 2014
    9:00am – 4:00pm – Reception following Sacramento Convention Center
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    Fferentiation, medullary growth pattern, or other reported features) at least one first-degree relative (parent, sibling, child) with an hnpcc-related tumor, one of whom was diagnosed before age 50 at least two first- or second-degree relatives with hnpcc-related tumors at any age no specific tumor screening strategy has been recommended, but studies suggest that both msi and ihc are cost-effective. 1 msi and ihc together have better sensitivity for hnpcc than either test alone. 4 any individual with msi or ihc evidence of hnpcc should be offered blood or buccal swab based genetic mutation analysis1,9,10 to identify the inherited mutation. The decision about which gene(s) to test first may be informed by the msi and/or ihc results. 1,3,9 when tumor tissue is not available, direct genetic testing is reasonable for an individual with a history of colorectal cancer that meets one of the first three revised bethesda guidelines (diagnosed <50yo, multiple primaries, or microsatellite unstable tumor pathology <60yo) or whose family meets the amsterdam ii criteria. 1,9 these criteria are:12 there are at least three relatives with hnpcc associated tumors one affected relative is a first-degree relative of the other two affected relatives are in two or more successive generations at least one hnpcc-related tumor was diagnosed before age 50 fap has been excluded (generally on the basis of no polyposis) tumors should be verified by pathology testing asymptomatic family members if an affected family member is unavailable for testing, hnpcc genetic testing can be considered for individuals whose family history meets the amsterdam ii criteria. Testing typically starts with mlh1 and msh2, and if negative, further testing for msh6 and pms2 can be considered. 1 without ihc information, the role of separate epcam testing is unclear. Some laboratories may include epcam as part of an hnpcc testing panel. generic viagra customer reviews discount viagra lowest prices order generic viagra online usa hours cheap viagra online cheapest generic super viagra viagra for sale do you need a prescription to buy viagra cheap viagra online classicmotocrossimages.com/mbs-viagra-cheap-pills-ji/ viagra pills for sale uk Use the test options tool for a testing discussion individualized to your patient. See this clinical flowchart for an overview of the process. Guidelines the american gastroenterological association (aga),9 the national comprehensive cancer network (nccn),1 and the american college of gastroenterology 10 have published practice guidelines that specifically address hnpcc genetic testing. These guidelines are very similar in the overall testing strategy recommendations although the details differ based on how recently the guideline was published (i. E. , genes and testing methods mentioned). Generally, these recommendations are: test colorectal tumors by msi and/or ihc when the patient's personal and family history meets the revised bethesda guidelines. 1,9,10 note that nccn also includes endometrial cancer before age 50 as an indication for tumor testing. 1 if abnormal msi and/or ihc are found, blood-based testing for the specific inherited mutation can be undertaken to confirm the diagnosis and to allow reliable predictive testing for at-risk family member.
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