CYP2C19 Genetic Testing for Oral P2Y12 Inhibitor Therapy: A Scientific Statement From the American Heart Association.

There is significant variability in the efficacy and safety of oral P2Y12 inhibitors, which are used to prevent ischemic outcomes in common diseases such as coronary and peripheral arterial disease and stroke. Clopidogrel, a prodrug, is the most used oral P2Y12 inhibitor and is activated primarily after being metabolized by a highly polymorphic hepatic cytochrome CYP2C219 enzyme. Loss-of-function genetic variants in CYP2C219 are common, can result in decreased active metabolite levels and increased on-treatment platelet aggregation, and are associated with increased ischemic events on clopidogrel therapy. Such patients can be identified by CYP2C19 genetic testing and can be treated with alternative therapy. Conversely, universal use of potent oral P2Y12 inhibitors such as ticagrelor or prasugrel, which are not dependent on CYP2C19 for activation, has been recommended but can result in increased bleeding. Recent clinical trials and meta-analyses have demonstrated that a precision medicine approach in which loss-of-function carriers are prescribed ticagrelor or prasugrel and noncarriers are prescribed clopidogrel results in reducing ischemic events without increasing bleeding risk. The evidence to date supports CYP2C19 genetic testing before oral P2Y12 inhibitors are prescribed in patients with acute coronary syndromes or percutaneous coronary intervention. Clinical implementation of such genetic testing will depend on among multiple factors: rapid availability of results or adoption of the concept of performing preemptive genetic testing, provision of easy-to-understand results with therapeutic recommendations, and seamless integration in the electronic health record.

Immune Modulating Brevetoxins: Monocyte Cytotoxicity, Apoptosis, and Activation of M1/M2 Response Elements Is Dependent on Reactive Groups.

Brevetoxins are a suite of marine neurotoxins that activate voltage-gated sodium channels (VGSCs) in cell membranes, with toxicity occurring from persistent activation of the channel at high doses. Lower doses, in contrast, have been shown to elicit neuroregeneration. Brevetoxins have thus been proposed as a novel treatment for patients after stroke, when neuron regrowth and repair is critical to recovery. However, findings from environmental exposures indicate that brevetoxins may cause inflammation, thus, there is concern for brevetoxins as a stroke therapy given the potential for neuroinflammation. In this study, we examined the inflammatory properties of several brevetoxin analogs, including those that do and do not bind strongly to VGSCs, as binding has classically indicated toxicity. We found that several analogs are toxic to monocytes, while others are not, and the degree of toxicity is not directly related to VGSC binding. Rather, results indicate that brevetoxins containing aldehyde groups were more likely to cause immunotoxicity, regardless of binding affinity to the VGSC. Our results demonstrate that different brevetoxin family members can elicit a spectrum of apoptosis and necrosis by multiple possible mechanisms of action in monocytes. As such, care should be taken in treating "brevetoxins" as a uniform group, particularly in stroke therapy research.

Student Perspectives: Discussion Boards as Learning Strategies in Online Accelerated Nursing Courses.

BACKGROUND: Discussion boards are frequently used as learning strategies in online nursing courses. Student perceptions of this strategy have not been fully explored. This study aimed to determine student perspectives and preferences of discussion boards as learning strategies in online accelerated nursing courses. METHOD: This mixed-method pilot study described RN-to-Bachelor of Science in Nursing (RN-to-BSN) (n = 27) and Master of Science in Nursing: Nurse Educator (MSN-NE) (n = 37) student perceptions and preferences for discussion boards as learning strategies. RESULTS: Students had an overall positive perception about using discussion boards as learning strategies. RN-to-BSN students preferred a discussion summary over faculty participation. MSN-NE students preferred faculty participation but also found a summary to be helpful. CONCLUSION: A well-designed discussion can enhance student engagement and contribute to successful online learning experiences. Faculty should use a combination of real-time feedback through active participation and provide a discussion summary. Deciding how faculty should engage may depend on the complexity of course content being explored. [J Nurs Educ. 2021;60(7):419-421.].

Nurses' Knowledge and Treatment Beliefs: Use of Complementary and Alternative Medicine for Pain Management.

Purpose: To examine the relationship between nurses' knowledge, attitudes, and beliefs about medicines, in general, and complementary and alternative medicine (CAM) and identify the predictors of referrals for pain management. Method: This descriptive, correlational study utilized an online survey to collect data from direct care nurses at a large medical center in southeastern United States. The online survey consisted of the Complementary and Alternative Medicines and Beliefs Inventory (CAMBI), the Beliefs about Medicine Questionnaire, and four open-ended questions. Referral data were obtained from the Information Management Department at this medical center. Results: Among the 218 nurses who completed the survey (15.12%), majority (85%) supported CAM use, but only 32% reported utilizing CAM therapies with patients. Medical surgical, emergency department, and perioperative nurses scored higher on their CAMBI total score and were more likely to refer for CAM therapies when compared with intensive care unit nurses. Conclusions: Beliefs about CAM specifically were not related to referrals for CAM therapies. This study suggests the need for further education on the nurse's role in CAM usage. Understanding the link between nurses' knowledge, attitudes, and treatment beliefs and their relationship to CAM usage provides direction for future educational interventions.

Implementing a Theoretical Debriefing Model in a Prelicensure BSN Program.

The National League for Nursing and International Nursing Association for Clinical Simulation and Learning stress that debriefing fosters critical reflection and is essential to all educational settings. The call to action for nurse educators is to incorporate theory-based debriefing throughout the curriculum. This article reports on how one school of nursing implemented the theory-based model, Debriefing for Meaningful Learning©, into the prelicensure baccalaureate curriculum.