Knowledge and Attitudes of Pharmacogenetics Among Canadian Nurses: Implications for Nursing Education

Pharmacogenetic testing is used to tailor medication recommendations based on an individual\u27s genetic makeup. Increased precision in prescribing medication through the use of genetics leads to a reduction in adverse drug reactions resulting in decreased morbidity and mortality. Due to the noted benefits to patient health outcomes and reduction in healthcare costs, a growing number of Canadian health centers and community pharmacies are beginning to offer pharmacogenetic testing. Previous studies indicate that Canadian nurses have minimal education in genomics; however, there has been an increase in attention to nursing roles in the implementation of genomic health practices in recent years. As the use of pharmacogenetics increases, nurses will be expected to be knowledgeable about pharmacogenetic testing and will play a key role in patient education. Results of previous studies show a low level of knowledge about pharmacogenetic testing among physicians and pharmacists; however, this area of knowledge has not been systematically assessed for nurses. To address this gap, a cross-sectional study was conducted to assess knowledge and attitudes about pharmacogenetics of nurses across Canada. An anonymous online survey was completed by 236 participants, including nursing students (n = 84), registered nurses (n = 144), and nurse practitioners/nurse clinicians (n = 9). Participants represented 9/10 provinces and 2/3 territories across Canada. The majority of the participants (65.9%) lacked formal education in genetics and indicated a fair or poor level of understanding of pharmacogenetic testing in the clinical setting (93%). The mean score for pharmacogenetic knowledge questions was 34.5%, while the mean score for genetics knowledge questions was 61.1%. Despite their self-reported lack of knowledge and understanding, most participants had positive attitudes towards pharmacogenetic testing and recognized its ability to decrease adverse drug reactions and improve clinical efficacy (81.3%). Most participants (73.7%) were interested in educational offerings related to pharmacogenetic testing, particularly web-based courses and seminars/lectures. The results of this study indicate that nurses across Canada may not have the necessary knowledge to support the implementation of pharmacogenetic testing into clinical practice. However, positive attitudes and interest in learning about pharmacogenetics indicate opportunities for the development of educational activities to ensure that Canadian nurses are prepared for upcoming changes that will impact nursing practice. Résumé Les tests pharmacogénétiques sont utilisés pour adapter les recommandations de médicaments en fonction de la constitution génétique d’un individu. Une précision accrue dans la prescription de médicaments grâce à l’utilisation de la génétique conduit à une réduction des effets indésirables des médicaments, ce qui entraîne une diminution de la morbidité et de la mortalité. En raison des avantages constatés pour la santé des patients et de la réduction des coûts des soins de santé, un nombre croissant de centres de santé et de pharmacies communautaires au Canada commencent à offrir des tests pharmacogénétiques. Des études antérieures indiquent que les infirmières au Canada n’ont qu’une formation minimale en génomique; cependant, une attention accrue a été portée aux rôles infirmiers dans la mise en œuvre des pratiques de santé génomique au cours des dernières années. Avec l’augmentation de l’utilisation de la pharmacogénétique, les infirmières devront être bien informées sur les tests pharmacogénétiques et qu’elles jouent un rôle clé dans l’éducation des patients. Les résultats d’études antérieures montrent un faible niveau de connaissances sur les tests pharmacogénétiques chez les médecins et les pharmaciens; cependant, ce domaine de connaissances n’a pas été systématiquement évalué pour les infirmières. Pour combler cette lacune, une étude transversale a été menée pour évaluer les connaissances et les attitudes des infirmières et infirmiers du Canada au sujet de la pharmacogénétique. Un sondage anonyme en ligne a été mené auprès de 236 participantes, incluant des étudiantes en sciences infirmières (n = 84), des infirmières (n = 144) et des infirmières praticiennes/cliniciennes (n = 9). Ces participantes provenaient de neuf des dix provinces et deux des trois territoires. La majorité des participantes (65,9 %) manquaient de formation officielle en génétique et ont indiqué un niveau de compréhension passable ou faible des tests pharmacogénétiques en milieu clinique (93 %). Le résultat moyen aux questions sur les connaissances pharmacogénétiques était de 34,5 %, tandis que le résultat moyen aux questions sur les connaissances en génétique était de 61,1 %. Malgré leur manque de connaissances et de compréhension autodéclaré, la plupart des participantes avaient une attitude positive envers les tests pharmacogénétiques et reconnaissaient leur capacité à réduire les effets indésirables des médicaments et à améliorer l’efficacité clinique (81,3 %). La plupart des participantes (73,7 %) étaient intéressées par les formations offertes liée aux tests pharmacogénétiques, en particulier les cours en ligne et les séminaires/conférences. Les résultats de cette étude indiquent que les infirmières à travers le Canada n’ont peut-être pas les connaissances nécessaires pour soutenir la mise en œuvre de tests pharmacogénétiques dans la pratique clinique. Cependant, les attitudes positives et l’intérêt pour l’apprentissage de la pharmacogénétique indiquent des possibilités d’élaboration d’activités éducatives pour s’assurer que les infirmières canadiennes soient préparées aux changements à venir qui auront une incidence sur leur pratique

Origins Space Telescope: baseline mission concept

The Origins Space Telescope will trace the history of our origins from the time dust and heavy elements permanently altered the cosmic landscape to present-day life. How did galaxies evolve from the earliest galactic systems to those found in the Universe today? How do habitable planets form? How common are life-bearing worlds? To answer these alluring questions, Origins will operate at mid- and far-infrared (IR) wavelengths and offer powerful spectroscopic instruments and sensitivity three orders of magnitude better than that of the Herschel Space Observatory, the largest telescope flown in space to date. We describe the baseline concept for Origins recommended to the 2020 US Decadal Survey in Astronomy and Astrophysics. The baseline design includes a 5.9-m diameter telescope cryocooled to 4.5 K and equipped with three scientific instruments. A mid-infrared instrument (Mid-Infrared Spectrometer and Camera Transit spectrometer) will measure the spectra of transiting exoplanets in the 2.8 to 20  μm wavelength range and offer unprecedented spectrophotometric precision, enabling definitive exoplanet biosignature detections. The far-IR imager polarimeter will be able to survey thousands of square degrees with broadband imaging at 50 and 250  μm. The Origins Survey Spectrometer will cover wavelengths from 25 to 588  μm, making wide-area and deep spectroscopic surveys with spectral resolving power R  ∼  300, and pointed observations at R  ∼  40,000 and 300,000 with selectable instrument modes. Origins was designed to minimize complexity. The architecture is similar to that of the Spitzer Space Telescope and requires very few deployments after launch, while the cryothermal system design leverages James Webb Space Telescope technology and experience. A combination of current-state-of-the-art cryocoolers and next-generation detector technology will enable Origins’ natural background-limited sensitivity

Exploring Literacy and Perceptions of Genomics Among Undergraduate Nursing Students and Faculty: A Mixed Methods Study

As the single largest health care profession in Canada, nurses have a remarkable opportunity to shape the implementation of genomic health care, and will need a solid foundation in genetic and genomic knowledge to do so (Calzone et al., 2010; Canadian Institute for Health Information, 2016). In the early 2000s, a dedicated group of nurse leaders provided recommendations for genetic nursing in Canada (Bottorff et al., 2004). Since that time, the literature and guidelines from Canadian nursing organizations suggest that there has been little progress in the implementation of these recommendations. A mixed-methods explanatory sequential design combining a cross-sectional administration of a survey and thematic analysis of focus group discussion was used to answer the following research questions: Quantitative - How do nursing undergraduate students and faculty perform on the Genomic Nursing Concept Inventory (GNCI)? What individual socio-demographic characteristics and previous experiences with genetics are associated with performance on the GNCI? Qualitative - What barriers and facilitators to the addition of genetic and genomic content into undergraduate nursing curricula are identified by nursing undergraduate students and faculty? Mixed Methods - How do the barriers and facilitators associated with the addition of genetic and genomic knowledge into undergraduate nursing curriculum broaden understanding and provide context for the scores on the GNCI? The average percent correct on the GNCI for the 220 participants was 45%, which is comparable to results of sample US students and faculty. Characteristics associated with higher performance on the GNCI included older age, attending site A, not being female, having taken a genetics course, a previous degree, and having a positive attitude towards nurses learning about genetics. A list of barriers and facilitators was developed, along with eight themes (gaps in understanding; complexity; gaps in curriculum; lack of role models; scope; role; application; and relevance) describing the general sense of becoming “stuck” when discussing integration of genetics into the nursing curriculum. Clear implications emerged from the integration of the quantitative results and qualitative findings, which can be used to focus future research and efforts to advance the inclusion of genetic and genomic knowledge in undergraduate nursing curricula in Canada

Towards finding the genes that cause cleft lip in a multifactorial mouse model

Nonsyndromic cleft lip (with or without cleft palate) is one of the most common birth defects. It occurs in approximately one in a thousand live births, although the frequency varies with geographical location, ethnic background and socioeconomic status. Cleft lip is a multifactorial threshold trait whose etiology includes genetic, environmental and chance factors. Despite many studies on human populations, no candidate gene has been shown conclusively to be involved in the risk of developing the defect. There is also no consensus on the role of any specific environmental factors that have been proposed to increase the risk of cleft lip. The "A" strains of inbred mice are the only known mouse strains with nonsyndromic cleft lip. Cleft lip is genetically complex in the "A" strains, thus providing a good model of the human condition. The mouse model used in this study was A/WySn, which has a frequency of cleft lip of 20-30%. Risk of cleft lip in A/WySn is caused by the combined effects of a recessive mutation (clf1), a semi-dominant mutation (Clf2), and a genetic maternal effect. The recessive mutation in the gene clf1 has been mapped to a 2 cM region on mid-distal mouse chromosome 11. A new backcross panel was generated for this project from the initial cross of A/WySn to AXB-4/Pgn. 70 cleft lip embryos were generated, and polymorphic markers were used to look for recombinants between clf1 and the markers, to confirm the boundaries of the clf1 candidate interval and to try to reduce the size of the interval. Five recombinants were found that confirmed the lower breakpoint of the candidate interval. In addition, using new polymorphic markers from within genes, the new panel placed several genes inside or outside the interval. In the second part of this project, the expression of all of the known candidate genes was examined in adult testis tissue and in Day 10-11 embryo heads. The expression of candidate genes was first examined in adult testis tissue, where a variant was seen in the gene Crhr. This gene was then studied in greater detail. Next, because the critical time of lip formation is Day 10 - Day 11 in the mouse, RT-PCR expression of 9 known genes (Arf2, Itgb3, Crhr, Gosr2, Wnt3, Wnt15, Mapt, Myla, Nsf) and 1 putative gene (KIAA1267) in the clf1 candidate interval was examined in embryonic heads from Day 10 and Day 11 embryos. All 9 known genes are expressed at the critical time in development, while the predicted gene is not. In the third part of this project, 6-9 polymorphic markers were used to compare the "A" strain haplotype in the clfl candidate interval with 37 other inbred strains. The data indicate that the "A" strain shares its haplotype with only one other strain, CBA/J. This finding will be useful in confirming a putative clf1 mutation, when found. In the fourth part of this project, one region of the mouse genome was examined for a third locus contributing to the risk of cleft lip in A/WySn. The region was examined in the new backcross panel for non-random segregation of polymorphic markers; however, no evidence of an association with cleft lip was seen.Medicine, Faculty ofMedical Genetics, Department ofGraduat

Relationship Between Psychosocial Distress in Pregnancy and Two Genes Associated With Human Social Interaction: A Pilot Study

Background Prenatal depression, anxiety, and stress (prenatal psychosocial distress) are common, and several environmental risk factors have been implicated in their development. Variation in genes, specifically single nucleotide polymorphisms (SNPs), may explain why some women develop maternal mental health concerns while others do not. Purpose The purpose of this pilot study was to determine the feasibility of completing SNP analyses using whole blood collected prenatally between 2008 and 2011. We examined the association between SNPs in two genes ( FKBP5 and OXTR ) among women with low and high prenatal psychosocial distress. Methods A subset ( N  = 50, 25 high and 25 low prenatal psychosocial distress) of participants was selected from the All Our Families pregnancy cohort. DNA was extracted from maternal blood and used for selected SNP analysis. Participants’ scores on the Edinburgh Prenatal Depression Scale, Spielberger State Anxiety Inventory, and Perceived Stress Scale were used along with demographic variables. Results Genotype distribution was not significantly different between the low and high prenatal psychosocial distress groups for either the FKBP5 or the OXTR SNP ( p  = .699 and p  = .125). After controlling for maternal age and income, women with the GG genotype at the OXTR SNP (rs237885) were statistically less likely to be in the high prenatal psychosocial distress group ( p  = .037). Conclusion OXTR SNP rs237885, maternal age, and lower income were associated with prenatal psychosocial distress. This pilot study demonstrated the feasibility of continuing to a larger study that incorporates additional environmental and genetic information

The Origins Space Telescope: mission concept overview

The Origins Space Telescope (OST) will trace the history of our origins from the time dust and heavy elements permanently altered the cosmic landscape to present-day life. How did the universe evolve in response to its changing ingredients? How common are life-bearing planets? To accomplish its scientific objectives, OST will operate at mid-and far-infrared wavelengths and offer superlative sensitivity and new spectroscopic capabilities. The OST study team will present a scientifically compelling, executable mission concept to the 2020 Decadal Survey in Astrophysics. To understand the concept solution space, our team studied two alternative mission concepts. We report on the study approach and describe both of these concepts, give the rationale for major design decisions, and briefly describe the mission-enabling technology.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The Origins Space Telescope: mission concept overview

The Origins Space Telescope (OST) will trace the history of our origins from the time dust and heavy elements permanently altered the cosmic landscape to present-day life. How did the universe evolve in response to its changing ingredients? How common are life-bearing planets? To accomplish its scientific objectives, OST will operate at mid- and far-infrared wavelengths and offer superlative sensitivity and new spectroscopic capabilities. The OST study team will present a scientifically compelling, executable mission concept to the 2020 Decadal Survey in Astrophysics. To understand the concept solution space, our team studied two alternative mission concepts. We report on the study approach and describe both of these concepts, give the rationale for major design decisions, and briefly describe the mission-enabling technology