Current Testing Guidelines: A Retrospective Analysis of a Community-Based Hereditary Cancer Program.

It is estimated that 5% to 10% of all cancers are related to a hereditary cancer syndrome. However, specific cancers, such as pancreatic and ovarian cancers, are related to hereditary cancer syndromes 15% to 20% of the time. Genetic testing guidelines for hereditary cancer syndromes are frequently reviewed and updated by the National Comprehensive Cancer Network (NCCN). The purpose of this retrospective analysis is to identify carriers of pathogenic variants or hereditary cancer syndrome who do not meet NCCN criteria for testing and compare the results with previous studies. The data obtained can be used to provide recommendations to assess current guidelines for testing and evaluate the benefit of comprehensive panel testing vs. standard testing for specific hereditary cancer syndromes. This project is a retrospective review of clinical histories of patients who had multigene panel testing between September 2015 and February 2019 through a cancer outreach and risk assessment (CORA) program. Frequencies analyses were performed to analyze results. A total of 233 individuals were included in the analysis: 171 met BRCA1/2 testing criteria, 66 met Lynch syndrome criteria, and 4 met polyposis criteria. Of the individuals meeting established criteria for testing, 39 were identified with pathogenic variants. However, only 10 of these individuals were identified with a pathogenic variant associated with the criteria for which they met. Genetic testing that is limited to only those patients with genes associated with hereditary cancer syndromes may lead to exclusion of other potentially actionable genes, which may impair a patient's ability to receive additional screening or preventative measures.

Brown Bag Medication Review: Using AHRQ's Brown Bag Medication Tool.

BACKGROUND: Medication nonadherence has been linked to health literacy and poor patient outcomes. The Health Literacy Universal Precautions Toolkit addresses both issues. PURPOSE: A brown bag medication review was implemented to identify medication nonadherence in a Midwestern clinic. METHODS: Adult patients were instructed to bring all prescribed and over-the-counter medication to office visits. A reviewer transcribed administration directions and the patient's verbal instruction of how the medication is taken. RESULTS: The study found 58% (n = 28) of 48 participants were nonadherent for at least 1 medication; 26% (n = 72) of all medications were nonadherent; and mental health drugs were the highest nonadherence category at 38% (n = 11). The majority of medication nonadherence was due to lack of access. CONCLUSIONS: This drug utilization review was found helpful in identification of causes for medication nonadherence, assisting prescribers, and improving patient education.

Using Physiologic, Genetic, and Epigenetic Information to Provide Care to Clients Who Are Obese.

The pathology of obesity is a complex process involving interactions among behavioral, environmental, immunologic, genetic, and epigenetic factors. This article gives a broad overview of obesity. The physiology of fat storage, influence of eating behaviors on obesity, and the genetic relationship between eating and food sources are discussed. Specific genes that have been associated with obesity are introduced, with information on leptin and genes such as FTO, GLUT4, and others. This synopsis of obesity expands into environmental influences and epigenetic factors. These include food selection, gut microbiota, pregnancy, and exercise. The nurse will gain specific knowledge to assist in tailoring therapies specific to clients who are working to overcome the long-term effects of this disorder.

Effectiveness of Platelet-Rich Plasma in the Management of Knee Osteoarthritis in a Rural Clinic.

BACKGROUND: Osteoarthritis (OA) is a degenerative disease causing decreased mobility. Use of autologous platelet-rich plasma (PRP) provides a reparative alternative in the management of OA. METHODS/PURPOSE: This study assessed effectiveness of nurse practitioner-injected PRP to manage knee OA in a rural setting. RESULTS: Twenty patients were followed for 1 month after PRP treatment. Knee function and pain levels were assessed using a knee function score (Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form [KOOS-PS]). CONCLUSIONS: Overall, the 20 patients who participated in this study experienced significant improvement in knee function scores, decreased pain, and decreased use of pain medications.

Sleep Duration, Activity Levels, and Measures of Obesity in Adults.

OBJECTIVE: The purpose of this study was to investigate sleep and activity as they relate to obesity measures of body mass index (BMI) and waist circumference (WC) in adults. Findings from recent studies have linked physical inactivity and short sleep with obesity. DESIGN AND SAMPLE: A total of 337 subjects were collected from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). MEASURES: The sample was evaluated to determine if a relationship existed between sleep duration, activity levels, and measures of obesity. RESULTS: Pearson r correlation revealed a significant positive relationship between WC and sedentary activity, r(318) = .168, p = .003. Analysis also showed a significant inverse association between sleep duration and WC, r(319) = -.113, p = .043. No statistical significance was found using BMI as the measure of obesity in relation to duration of sleep or activity level. CONCLUSIONS: In support of recent literature, this study found duration of sleep and sedentary activity in adults may relate to the development of obesity as measured by WC.

Identification and support of at-risk students using a case management model.

This study evaluated a program to identify and support students at risk for failure in nursing courses or NCLEX-RN. A case management model (CMM) was implemented to provide assessment of and support for 183 bachelor of science in nursing students; 83 were identified as at risk by the CMM criteria. The CMM involved student self-evaluation and grade assessment of prerequisite and nursing courses. Science course grades were all found to be significantly higher for those students who passed NCLEX-RN on the first attempt than those who did not. Admission GPA was significant (t=2.443, P=.018). Using a Motivated Strategies for Learning Questionnaire for self-evaluation, at-risk students rated their performance in nursing courses higher in every area than the non-at-risk student group, significantly higher for self-efficacy (t = 2.829, P=.005) and metacognition (t =2.426, P=.016). Neither task value nor critical thinking scores were significant. Graduation rate was 100% with 158 students passing NCLEX-RN on the first attempt (64 of 83 at risk and 94 of 100 non-at risk). The CMM was effective in identification and support of at-risk students.

Integrating genetics and genomics into nursing curricula: you can do it too!

Rapid advances in knowledge and technology related to genomics cross health care disciplines and touch almost every aspect of patient care. The ability to sequence a genome holds the promise that health care can be personalized. Health care professionals are faced with a gap in the ability to use the rapidly expanding technology and knowledge related to genomics in practice. Yet, nurses are key to bridging the gap between genomic discoveries and the human experience of illness. This article presents a case study documenting the experience of five nursing schools/colleges of nursing as they work to integrate genetics and genomics into their curricula.

Genetics of depression: an overview of the current science.

Most psychiatric disorders, including major depressive disorder (MDD), are known to involve complex interactions between genetic and environmental influences that impact the development and severity of symptomatology. Health care practitioner competencies have been expanded to include application of genetic knowledge in mental health. Yet this information is difficult to decipher and apply. To assist with these challenges, this article synthesizes recent literature related to the genetics of MDD and illustrates the genetic pathways for major depression.

Assessment tool for nursing student computer competencies.

Computer skills have been established as important for nursing students and for graduate nurses. No current research was found on the best method to evaluate the skills of incoming nursing students. The purpose of this descriptive, correlational study was to compare student ratings of their computer competency to their performance of those skills on a computer-graded assessment. A convenience sample of 87 nursing students was used. There was a low, but significant correlation between the scores on the survey and the assessment. The results suggest that students rate themselves higher on their skills than their actual performance of computer skills. Implications for educators are presented, and the value of using a computer-graded assessment is discussed.