Recommendations for educating nurses in genetics.

With the ongoing and increasingly rapid pace of genetic discoveries, nurses must be able to incorporate genetic knowledge into their everyday practices of promoting the genetic health of individuals, families, and communities. Although development of genetic health knowledge is in its infancy, nurses are currently expected to integrate information about genetic risks, testing, and treatments for clients throughout the clients' entire lifespan. All nurses must have an understanding of the relationship between genetics and health to appropriately identify and address genetic concerns in their clients. To fulfill these roles, nurses need to improve their knowledge base in genetics. This article provides recommendations for genetics curriculum in continuing and entry-level nursing education programs. These recommendations are outcomes of a research project involving genetics nurse experts as well as nurses new to the area of genetics, and a consensus workshop of nursing faculty involved in curriculum changes subsequent to an intensive genetics continuing education program. Nursing educators are beginning to recognize the importance of education of all nurses about genetics. If, however, all educators do not accept this responsibility, nurses will be left behind in designing and offering health care for the 21st century.

Preparing for the future through genetics nursing education.

PURPOSE: To determine recommendations for curriculum change that are indicated by innovations in genetics. METHODS: Both quantitative and qualitative. The sample (n = 356) consisted of nurses identified as experts in genetics (n = 228) and nurses identified as potential users of genetics education (n = 128). Nurses' opinions of core components of a genetics curriculum were elicited via a mailed survey questionnaire. Participants also provided demographic information and completed the Jones Innovativeness Scale (1997). FINDINGS: Recommended content in genetics education for practicing nurses was identified by both groups of nurses. Innovativeness characterized 3% of the respondents. Ninety-eight percent of respondents said that adopting genetics education is important. In total, 398 items were identified as potential consequences of education that incorporates genetic information. CONCLUSIONS: Identified content provides a template for genetics education programs for nurses. Genetics nursing education was perceived to have positive outcomes for both nurses and clients.

Cancer genetics fundamentals.

It is often said that cancer is genetic. What exactly does that mean? This article is our answer to that question at the turn of the millennium. We present models of carcinogenesis, review basic cancer genetics terminology, and explain some of the fundamental genetic changes common to all types of cancer. These are organized into 6 sections of (1) self-sufficiency in growth signals, (2) insensitivity to growth-inhibitory signals, (3) evasion of programmed cell death, (4) limitless replicative potential, (5) sustained angiogenesis, and (6) tissue invasion and metastases. Underlying all of these changes are the even more fundamental enabling factors of genetic instability on both the chromosomal and the gene level. Finally, we look toward the future in a field where the future is now!

Mutations in beta-catenin are uncommon in colorectal cancer occurring in occasional replication error-positive tumors.

Beta-catenin has been identified as an oncogene in colon cancer and melanoma. Phosphorylation of sites in exon 3 of beta-catenin leads to degradation of this protein. These sites are primary targets for activating mutations. The frequency with which oncogenic mutations at these sites are found in colorectal cancer is unknown, as is the frequency of their occurrence in other malignancies. We analyzed 92 colorectal cancers (CRCs) and 57 cancer cell lines (representing a diversity of tumor types) to determine the frequency of activating mutations in this gene. Mutations in exon 3 of beta-catenin were found in 2 of 92 CRCs and in the colorectal cancer cell line HCT 116. Both tumors with beta-catenin mutations exhibited widespread microsatellite instability, which is indicative of a replication error phenotype, a phenotype known to be present in HCT 116. This suggests that mutations in beta-catenin are infrequent in CRC and miscellaneous cancer cell lines and may occur in association with a replication error phenotype.

Discard volumes necessary for clinically useful coagulation studies from heparinized Hickman catheters.

PURPOSE/OBJECTIVES: Determine the blood volume that must be wasted to obtain a clinically useful prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen concentration for blood drawn from a heparinized (2.5 ml of 100 units/ml), double-lumen venous catheter. DESIGN: Prospective, nonrandomized study comparing test results obtained from blood samples drawn through the catheters with those obtained via peripheral venipuncture. Patients acted as their own control. SETTING: Inpatient and outpatient units of a cancer research center located in a mid-Atlantic city in the United States. SAMPLE: Twenty double-lumen 10 Fr. Hickman catheters (Bard Access Systems, Salt Lake City, UT) were studied in 20 adult patients with cancer who had no history of coagulation disorders. METHODS: Samples were collected from the red lumen of 20 heparinized, double-lumen Hickman catheters after 5, 10, 15, 20, and 25 ml of blood first were discarded. PTs, APTTs, and fibrinogen concentrations were measured on each sample. The results were compared with those derived from a simultaneously obtained peripheral blood sample. MAIN RESEARCH VARIABLES: PT, APTT, and fibrinogen values of blood samples after 5, 10, 15, 20, and 25 ml discards and PT, APTT, and fibrinogen of peripheral blood samples. FINDINGS: The coagulation results using peripheral blood were always within the normal range except for one slightly elevated APTT. After 25 ml of discard, all of the PTs and fibrinogen concentrations and 95% of the APTTs of catheter blood were within the normal range and therefore clinically useful. CONCLUSIONS: Clinically useful PTs, APTTs, and fibrinogen concentrations often can be derived with catheter-drawn blood when the objective is to confirm normal coagulation. However, because it is very difficult to obtain heparin-free samples through heparinized, double-lumen Hickman catheters, peripheral blood should be drawn for coagulation testing when a totally heparin-free sample is needed to make a critical clinical decision. IMPLICATIONS FOR NURSING PRACTICE: These findings provide important information for practice when nurses have to decide whether to draw coagulation tests through a heparinized catheter. Further research is needed with larger samples in varied populations (e.g., pediatrics) to study catheters made of different materials and of different calibers.

A cancer day hospital: an alternative approach to caring for patients in clinical trials.

The National Institutes of Health recently established a large cancer day hospital (CDH) to address the need to support new research initiatives in the face of a shrinking research budget. By design, the CDH is very much a nursing unit. It employs a collaborative practice model of patient care delivery that emphasizes the nurses' independent clinical- and protocol-related responsibilities and roles. The CDH is designed to be budget neutral. An increased outpatient throughput and a decrease in inpatient days for at least one large protocol population (patients receiving therapy for prostate cancer) have been demonstrated. With a steadily increasing number of patients, the CDH appears to be a well-accepted and cost-effective site for the care of patients enrolled in oncology clinical trials.

The oncology nurse's role in patient advance directives.

In December 1991, Patient Self-Determination Amendment (PSDA) legislation was implemented. The PSDA requires facilities funded by Medicare/Medicaid to inform patients of their decision-making rights regarding medical care. An advance directive (AD), a living will, or a durable power of attorney for health care contains statements made by competent people directing their medical care if they should become incompetent. Oncology nurses are in an advantageous position to educate and advocate for their patients with respect to end-of-life decisions. They are qualified to facilitate the AD process by virtue of their ability to relate to patients and families their extensive experience with the terminally ill and their expertise as liasons between patients, families, and the multidisciplinary team. A clear understanding of the patient's wishes regarding life-sustaining treatments enables the oncology nurse to advocate more effectively on the patient's behalf. This article highlights definitions of ADs, advantages and disadvantages of each, and recommendations for the oncology nurse's practice.

The UMKC medical education experiment. An alternative pathway to physicianhood.

The UMKC plan for medical education offers an alternative pathway for motivated high achievers with early evidence of health care commitment. Essentially, such a program is an honors program for the academically elite. The UMKC plan makes a large, sustained effort to influence attitude. In our descriptive literature and in our curriculum content, we have emphasized that we seek health care talent at the earliest age possible and that we use these formative years to enhance, to influence, and to inculcate the qualities of compassion, sensitivity, honesty, integrity, dependability, and responsibility. The reason for early admission is to influence attitude. We hold to the national standards in terms of science and technology, and all graduates have been required to pass Parts I and II of the National Board of Medical Examiners examinations. The graduate of this program, using performance in the first postgraduate year as a measure, is comparable with the product of the traditional eight-year concept, with a dividend of two extra years of career time. The UMKC program is not for all students; it is not offered as a replacement for the traditional American system. However, a proper distribution of medical admissions spaces should be made that takes advantage of the high level of ability, commitment, and dedication already present in the best of our high school students. A program such as the UMKC plan offers the prospect of educating American physicians, fully prepared technically but especially concerned with the important attitudinal values sought by the American public. Ward Darley, MD, was a consultant and guide during the founding years of this medical school. In his words, "The UMKC program is aimed at humanizing medicine, lowering the cost per student for education, providing a pool of dedicated physicians educated broadly enough to provide community leadership for future changes in the function and structure of society." Dr Darley's anticipation that this six-year program would lower the cost of medical education was always inherent in the simple arithmetic of six years compared with eight. These fiscal savings have been realized by our students and their parents. The additional bonus of two years of medical career is another kind of cost savings. However, the economy of the UMKC program is not the merit by which to judge. Instead, it should be judged on the basis of the opportunity to influence attitude and conduct and to inculcate an unusual quality of caring.(ABSTRACT TRUNCATED AT 400 WORDS)