Genomics and breast cancer screening Many women fear the risk of developing breast cancer, and some women have increased fear because of their family history. Thankfully, the study of genetics has brought forth tools to better identify women at risk. An understanding of genetics and cancer has led to genetic testing protocols which enable at-risk women to take preventative action through medication, surgery, and intensive screenings. These protocols not only have the potential to prevent cancer but also lead to early detection. Appropriate screening for women at risk for genetic breast cancer is essential for patient care. These screenings include specific risk assessment tests, genetic counseling, and genetic testing. To provide the best possible care for patients, providers must have a basic understanding of cancer, genetics, screening tests, genetic testing, and available prevention measures.

Health care system changes supporting the development of the nurse practitioner role in Tanzania Background and purpose: Accessibility to health care services remains a global challenge, and this has affected the quality of services delivered. This has affected the quality of health care services. Poor accessibility to health care services in Tanzania has hindered the achievements of health care system goals. The development of the nurse practitioner (NP) role has not yet received enough attention to resolve current existing and emerging problems facing the Tanzanian health care system. This study assessed the health care system changes that support the development of the NP role in Tanzania. Methods: A descriptive, cross-sectional study design was used to collect quantitative data. Purposive and convenience sampling techniques were used to collect data from 237 health care providers using a semi-structured questionnaire. Data were entered into SPSS version 20 and analyzed using descriptive statistics and Chi-square test for independence (Pearson Chi-square, χ2). Conclusions: Although the government of Tanzania has made some improvements in access to health care services, the rural health care facilities still suffer from an extreme shortage of skilled health care providers. This has forced the government to allow medical attendants to treat patients when they are not licensed to do so. The development of the NP role should be able to address the shortage of skilled health care providers in rural health care facilities. Implications for practice: The development of the NP role will improve the accessibility to health care services in rural primary health care facilities.

Use of PHQ-9 and pharmacogenetic testing in clinical practice Background: This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy. Local Problem: According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001). Methods and Interventions: Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data. Results: The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug–gene interactions. Medications with significant drug–gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug–gene interactions. Conclusions: Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug–gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.

Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity Background and purpose: Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting. Methods: A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire–Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed. Conclusions: More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74). Implications for practice: The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.

Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity No abstract available

Comparison of two cohorts of medically at-risk adolescents engaging in substance use (cancer survivors and asthmatics): Clinical predictors for monitoring care Background and purpose: Medically at-risk adolescents differ in their perception of severity and are vulnerable to substance use because of effects on their medical regimen. The intent in comparing two cohorts, adolescent survivors of cancer and teens with asthma, is to provide clinical predictors to help in monitoring those needing help with substance use decision making. Methods: Baseline data were obtained from two randomized controlled trials for a decision-making program of research for medically at-risk adolescents. Multivariate analyses were used to identify clinical predictors for poor decision making as well as lifetime and current substance use (smoking, alcohol use, and marijuana use). Conclusions: Predictors for both cohorts for lifetime and current substance use were increasing age and risk motivation. A significant predictor for both cohorts for poor decision making related to substance use was risk motivation, measured as a more positive attitude for engaging in substance use. Negative modeling by peers and family members had an impact on teen survivors' decision making; but, this was not clear for teens with asthma. Implications for practice: Research is needed comparing other medically at-risk adolescents to determine which cohorts on the substance use spectrum are less resilient to peer and parent modeling, have unrealistic views of their decision-making skills, and need close monitoring and guidance.

Thematic analysis of nurse practitioners use of clinical decision support tools and clinical mobile apps for prescriptive purposes Background and purpose: An obstacle to clinical implementation of precision medicine is the absence of easily accessible peer-reviewed, comprehensive clinical practice guidelines. Therefore, an easily accessible format is needed to propel the adoption of these guidelines by healthcare providers. An understanding of the process providers take to prescribe medications will inform development of clinical decision support tools, specifically related to precision medicine. Successful use of mobile applications will depend on the buy-in from healthcare providers. The purpose of this study was to assess perceptions of trustworthiness surrounding clinical decision support tools and mobile applications through interviews with nurse practitioners. Methods: A descriptive, qualitative research design was used. A sample of 10 nurse practitioners who actively prescribe medication was used within the study. Conclusions: The participants mentioned both negative and positive attitudes regarding these prescribing techniques. Overall four themes emerged from this thematic analysis: the use of pharmacists to help with current prescribing practices, reliance on the EMR as a clinical decision support tool, lack of mobile app use in clinical practice, but the desire to have these resources if they were affordable and reliable. Implications for practice: The participants were aware of the use of mobile apps for clinical decision support, but the adoption of these tools was limited due to the perceived lack of affordability and reliability. Therefore, to overcome these barriers to adoption of a mobile app related to precision medicine, affordability and transparent construction of an app grounded in credible sources must be developed.

Text messaging as an intervention for weight loss in emerging adults Background and purpose: Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI. Methods: Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss–related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks. Conclusions: Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups. Implications for practice: Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message–based interventions.

Role of ultrafast-acting insulin analogues in the management of diabetes To control both fasting and prandial plasma glucose levels in people with diabetes, insulin therapy must mimic “normal” physiological insulin secretion as much as possible. This is achieved with a long-acting insulin injected once or twice daily and a bolus of insulin injected before every meal. Prandial (bolus) insulin can either be regular human insulin (RHI) or a rapid-acting insulin analogue (RAIA). Although the efficacy of RHI has been established over approximately 35 years of clinical use, RAIAs offer several clinical advantages over RHI, namely that they have been engineered with a reduced tendency to aggregate as hexamers, which allows for rapid dissociation and absorption after a subcutaneous injection. Conventional RAIAs include insulin lispro, insulin aspart, and insulin glulisine. The more recently developed fast-acting insulin aspart (faster aspart) is an ultrafast-acting mealtime insulin that contains the conventional insulin aspart in a new formulation with the excipients niacinamide and L-arginine to achieve faster insulin absorption than RHI and the conventional insulin aspart formulation. This article reviews the clinical evidence supporting the use of RAIAs as part of a basal–bolus regimen in patients with diabetes, with a focus on new formulations whose pharmacological profiles more closely mimic the endogenous prandial insulin secretion pattern that is seen in individuals without diabetes. This review also provides a clinical perspective to help guide health care professionals in the use of RAIAs.