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Thomas J, Keels J, Calzone KA, Badzek L, Dewell S, Patch C, Tonkin ET, Dwyer AA. Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012-2022). Genes (Basel) 2023; 14:2013. [PMID: 38002957 PMCID: PMC10671121 DOI: 10.3390/genes14112013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
In the 20 years since the initial sequencing of the human genome, genomics has become increasingly relevant to nursing. We sought to chart the current state of genomics in nursing by conducting a systematic scoping review of the literature in four databases (2012-2022). The included articles were categorized according to the Cochrane Collaboration outcome domains/sub-domains, and thematic analysis was employed to identify key topical areas to summarize the state of the science. Of 8532 retrieved articles, we identified 232 eligible articles. The articles primarily reported descriptive studies from the United States and other high-income countries (191/232, 82%). More than half (126/232, 54.3%) aligned with the "healthcare provider oriented outcomes" outcome domain. Three times as many articles related to the "knowledge and understanding" sub-domain compared to the "consultation process" subdomain (96 vs. 30). Five key areas of focus were identified, including "nursing practice" (50/126, 40%), "genetic counseling and screening" (29/126, 23%), "specialist nursing" (21/126, 17%), "nurse preparatory education" (17/126, 13%), and "pharmacogenomics" (9/126, 7%). Only 42/126 (33%) articles reported interventional studies. To further integrate genomics into nursing, study findings indicate there is a need to move beyond descriptive work on knowledge and understanding to focus on interventional studies and implementation of genomics into nursing practice.
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Affiliation(s)
- Joanne Thomas
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
| | - Jordan Keels
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
| | - Kathleen A. Calzone
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- National Institutes of Health, National Cancer Institute, Center for Cancer Research, Genetics Branch, Bethesda, MD 20892, USA
| | - Laurie Badzek
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Ross and Carol Nese College of Nursing, Penn State University, University Park, PA 16802, USA
| | - Sarah Dewell
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- School of Nursing, Thompson Rivers University, Kamloops, BC V2C 0C8, Canada
| | - Christine Patch
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
- Engagement and Society, Wellcome Connecting Science, Hinxton CB10 1RQ, UK
| | - Emma T. Tonkin
- Genomics Policy Unit, Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02476, USA;
- Global Genomics Nursing Alliance (G2NA), Pontypridd CF37 1DL, UK; (K.A.C.); (L.B.); (S.D.); (C.P.)
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Cicali EJ, Wiisanen K. The importance of phenoconversion when using the CYP2D6 genotype in clinical practice. Pharmacogenomics 2022; 23:749-752. [PMID: 36102178 PMCID: PMC9490503 DOI: 10.2217/pgs-2022-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Tweetable abstract Clinical phenoconversion needs to be incorporated when interpreting and applying CYP2D6 results in clinical care. This article describes how this can be performed either manually or by utilizing online tools and resources. #Phenoconversion #Pharmacogenomics.
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Affiliation(s)
- Emily J Cicali
- Department of Pharmacotherapy & Translational Research, University of Florida, College of Pharmacy, Gainesville, FL 32608, USA
- Center for Pharmacogenomics & Precision Medicine, University of Florida, College of Pharmacy, Gainesville, FL 32608, USA
| | - Kristin Wiisanen
- Department of Pharmacotherapy & Translational Research, University of Florida, College of Pharmacy, Gainesville, FL 32608, USA
- Center for Pharmacogenomics & Precision Medicine, University of Florida, College of Pharmacy, Gainesville, FL 32608, USA
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Daniels H, Jones KH, Heys S, Ford DV. Exploring the Use of Genomic and Routinely Collected Data: Narrative Literature Review and Interview Study. J Med Internet Res 2021; 23:e15739. [PMID: 34559060 PMCID: PMC8501405 DOI: 10.2196/15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/01/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Advancing the use of genomic data with routinely collected health data holds great promise for health care and research. Increasing the use of these data is a high priority to understand and address the causes of disease. Objective This study aims to provide an outline of the use of genomic data alongside routinely collected data in health research to date. As this field prepares to move forward, it is important to take stock of the current state of play in order to highlight new avenues for development, identify challenges, and ensure that adequate data governance models are in place for safe and socially acceptable progress. Methods We conducted a literature review to draw information from past studies that have used genomic and routinely collected data and conducted interviews with individuals who use these data for health research. We collected data on the following: the rationale of using genomic data in conjunction with routinely collected data, types of genomic and routinely collected data used, data sources, project approvals, governance and access models, and challenges encountered. Results The main purpose of using genomic and routinely collected data was to conduct genome-wide and phenome-wide association studies. Routine data sources included electronic health records, disease and death registries, health insurance systems, and deprivation indices. The types of genomic data included polygenic risk scores, single nucleotide polymorphisms, and measures of genetic activity, and biobanks generally provided these data. Although the literature search showed that biobanks released data to researchers, the case studies revealed a growing tendency for use within a data safe haven. Challenges of working with these data revolved around data collection, data storage, technical, and data privacy issues. Conclusions Using genomic and routinely collected data holds great promise for progressing health research. Several challenges are involved, particularly in terms of privacy. Overcoming these barriers will ensure that the use of these data to progress health research can be exploited to its full potential.
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Affiliation(s)
- Helen Daniels
- Population Data Science, Swansea University, Swansea, United Kingdom
| | | | - Sharon Heys
- Population Data Science, Swansea University, Swansea, United Kingdom
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Cicali EJ, Elchynski AL, Cook KJ, Houder JT, Thomas CD, Smith DM, Elsey A, Johnson JA, Cavallari LH, Wiisanen K. How to Integrate CYP2D6 Phenoconversion Into Clinical Pharmacogenetics: A Tutorial. Clin Pharmacol Ther 2021; 110:677-687. [PMID: 34231197 PMCID: PMC8404400 DOI: 10.1002/cpt.2354] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 01/26/2023]
Abstract
CYP2D6 genotype is increasingly being integrated into practice to guide prescribing of certain medications. The CYP2D6 drug metabolizing enzyme is susceptible to inhibition by concomitant drugs, which can lead to a clinical phenotype that is different from the genotype-based phenotype, a process referred to as phenoconversion. Phenoconversion is highly prevalent but not widely integrated into practice because of either limited experience on how to integrate or lack of knowledge that it has occurred. We built a calculator tool to help clinicians integrate a standardized method of assessing CYP2D6 phenoconversion into practice. During tool-building, we identified several clinical factors that need to be considered when implementing CYP2D6 phenoconversion into clinical practice. This tutorial shares the steps that the University of Florida Health Precision Medicine Program took to build the calculator tool and identified clinical factors to consider when implementing CYP2D6 phenoconversion in clinical practice.
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Affiliation(s)
- Emily J. Cicali
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
| | - Amanda L. Elchynski
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
| | - Kelsey J. Cook
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Jacksonville, Florida, USA
- Nemours Children’s Specialty Care, Jacksonville, FL, USA
| | - John T. Houder
- Dean’s Office, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Cameron D. Thomas
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
| | - D. Max Smith
- MedStar Health, Columbia, Maryland
- Georgetown University Medical Center, Washington, DC
| | - Amanda Elsey
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA
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Jeiziner C, Suter K, Wernli U, Barbarino JM, Gong L, Whirl-Carrillo M, Klein TE, Szucs TD, Hersberger KE, Meyer zu Schwabedissen HE. Pharmacogenetic information in Swiss drug labels - a systematic analysis. THE PHARMACOGENOMICS JOURNAL 2021; 21:423-434. [PMID: 33070160 PMCID: PMC8292148 DOI: 10.1038/s41397-020-00195-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Abstract
Implementation of pharmacogenetics (PGx) and individualization of drug therapy is supposed to obviate adverse drug reactions or therapy failure. Health care professionals (HCPs) use drug labels (DLs) as reliable information about drugs. We analyzed the Swiss DLs to give an overview on the currently available PGx instructions. We screened 4306 DLs applying natural language processing focusing on drug metabolism (pharmacokinetics) and we assigned PGx levels following the classification system of PharmGKB. From 5979 hits, 2564 were classified as PGx-relevant affecting 167 substances. 55% (n = 93) were classified as "actionable PGx". Frequently, PGx information appeared in the pharmacokinetics section and in DLs of the anatomic group "nervous system". Unstandardized wording, appearance of PGx information in different sections and unclear instructions challenge HCPs to identify and interpret PGx information and translate it into practice. HCPs need harmonization and standardization of PGx information in DLs to personalize drug therapies and tailor pharmaceutical care.
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Affiliation(s)
- C. Jeiziner
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - K. Suter
- grid.6612.30000 0004 1937 0642European Center of Pharmaceutical Medicine, Faculty of Medicine, University of Basel, Basel, 4056 Switzerland
| | - U. Wernli
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - J. M. Barbarino
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - L. Gong
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - M. Whirl-Carrillo
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - T. E. Klein
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - T. D. Szucs
- grid.6612.30000 0004 1937 0642European Center of Pharmaceutical Medicine, Faculty of Medicine, University of Basel, Basel, 4056 Switzerland
| | - K. E. Hersberger
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - H. E. Meyer zu Schwabedissen
- grid.6612.30000 0004 1937 0642Biopharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, 4056 Switzerland
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Moraes JCD, Nunes FDD, Coeli-Lacchini FB, Miyazaki AHL, Flória-Santos M, Lacchini R. Nurse empowerment through Pharmacogenetics. Rev Lat Am Enfermagem 2020; 28:e3265. [PMID: 32813781 PMCID: PMC7426146 DOI: 10.1590/1518-8345.3415.3265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 02/03/2020] [Indexed: 02/03/2023] Open
Abstract
Objective: to verify the existence of elements that justify the use of pharmacogenetics by the Brazilian nurse. Method: this is a quantitative, cross-sectional, observational, descriptive study, whose final sample was 67 individuals. The participants were healthy at the time of the study and reported a history of previous use and the occurrence of adverse effects by drugs commonly used and metabolized by CYP2C9. We collected 4 mL of venous blood for subsequent DNA extraction by salting out method and genotyping of the CYP2C9*2 and CYP2C9*3 polymorphisms, using Polymerase Chain Reaction in real time using Taqman assays. Results: the use of drugs metabolized by CYP2C9 was frequent (more than 75% of the individuals have already used between 2 or 4 of these drugs). Regarding adverse events, there were 19 perceived symptomatic occurrences associated with drugs metabolized by CYP2C9. The allele frequency of the polymorphism * 2 and * 3 in the population studied was 11.1% and 7.5%, respectively, and there was a coincidence between the presence of alleles of low enzyme activity and the occurrence of adverse effects. Conclusion: there are elements that justify the adoption of pharmacogenetics in the nursing care to reduce the occurrence of adverse reactions to drugs metabolized by CYP2C9.
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Affiliation(s)
| | | | | | | | - Milena Flória-Santos
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Riccardo Lacchini
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Vermehren C, Søgaard Nielsen R, Jørgensen S, Drastrup AM, Westergaard N. Drug Use among Nursing Home Residents in Denmark for Drugs Having Pharmacogenomics Based (PGx) Dosing Guidelines: Potential for Preemptive PGx Testing. J Pers Med 2020; 10:jpm10030078. [PMID: 32752034 PMCID: PMC7565179 DOI: 10.3390/jpm10030078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Polypharmacy is most prevalent among the elderly population and in particular among nursing home residents. The frequency of the use of drugs with pharmacogenomics (PGx)-based dosing guidelines for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were measured among nursing home residents in the Capital Region of Denmark as well as drug-drug interactions. The aim was to evaluate the potential of applying PGx-test as a supportive tool in medication reviews. METHODS Drug use among nursing home residents during 2017-2018 in the Capital Region of Copenhagen, for drugs with PGx-based dosing guidelines available through the PharmGKB website, were measured. Drug-drug interactions were scored in severity by using drug interaction checkers. RESULTS The number of residents using drugs with PGx-based actionable dosing guidelines (AG) were 119 out of 141 residents (84.3%). Of these 119 residents, 87 residents used drugs with AG for CYP2C19, 47 residents for CYP2D6, and 42 residents for SLCO1B1. In addition, 30 residents used two drugs with an AG for CYP2C19, and for CYP2D6, it was only seven residents. The most used drugs with AG were clopidogrel (42), pantoprazole (32), simvastatin (30), metoprolol (25), and citalopram (24). The most frequent drug interactions found with warnings were combinations of proton pump inhibitors and clopidogrel underscoring the potential for phenoconversion. CONCLUSION this study clearly showed that the majority of the nursing home residents were exposed to drugs or drug combinations for which there exist PGx-based AG. This indeed supports the notion of accessing and accounting for not only drug-gene but also drug-drug-gene interactions as a supplement to medication review.
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Affiliation(s)
- Charlotte Vermehren
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; (C.V.); (R.S.N.); (A.M.D.)
- Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - Regitze Søgaard Nielsen
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; (C.V.); (R.S.N.); (A.M.D.)
- Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - Steffen Jørgensen
- Centre for Engineering and Science, Department of Biomedical Laboratory Science, University College Absalon, Parkvej 190, 4700 Naestved, Denmark;
| | - Anne Mette Drastrup
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; (C.V.); (R.S.N.); (A.M.D.)
| | - Niels Westergaard
- Centre for Engineering and Science, Department of Biomedical Laboratory Science, University College Absalon, Parkvej 190, 4700 Naestved, Denmark;
- Correspondence:
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Wen QH, Zhang Z, Cai WK, Lin XQ, He GH. The Associations Between CYP2D6*10 C188T Polymorphism and Pharmacokinetics and Clinical Outcomes of Tramadol: A Systematic Review and Meta-analysis. PAIN MEDICINE 2020; 21:3679-3690. [PMID: 32488232 DOI: 10.1093/pm/pnaa140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractBackgroundTramadol is one of the most extensively used centrally acting synthetic opioid analgesics. Recently, a number of studies have explored the associations of the CYP2D6*10 C188T polymorphism with pharmacokinetic and clinical outcomes of tramadol. However, the results of these previous reports remain controversial. Therefore, a meta-analysis was needed to reach a consensus.MethodsPubMed, EMBASE, and the Cochrane Library were searched to identify eligible studies that explored the influence of the CYP2D6*10 C188T polymorphism on clinical outcomes of tramadol through April 2019. Articles meeting the inclusion criteria were comprehensively reviewed by two independent evaluators. A meta-analysis was performed using Review Manager 5.3.ResultsA total of nine studies involving 809 related subjects were included in this meta-analysis. Significant associations were found between CYP2D6*10 C188T mutation and longer serum tramadol half-lives, larger AUC0-∞, and the slower clearance rate of tramadol. In addition, we also found that CYP2D6*10 C188T had effects on the pharmacokinetic parameters of the metabolite of tramadol, O-desmethyltramadol, by sensitive analysis. Furthermore, CYP2D6*10 C188T polymorphism was associated with higher visual analog scale score, loading dose, and total consumption of tramadol. There was no significant association between CYP2D6*10 C188T polymorphism and postoperative nausea and vomiting.ConclusionsCYP2D6*10 C188T polymorphism had a significant influence on tramadol pharmacokinetics and analgesic effect, but there was insufficient evidence to demonstrate that this polymorphism was associated with incidence of nausea and vomiting.
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Affiliation(s)
- Qing-Hua Wen
- Department of Pharmacy, The 920th Hospital of PLA Joint Service Security Forces, Kunming, China
- Department of Pharmacy, Wanzhou Hospital of Traditional Chinese Medicine of Chongqing, Chongqing, China
| | - Zheng Zhang
- Medical Engineering Section, The 306th Hospital of PLA, Beijing, China
| | - Wen-Ke Cai
- Department of Cardio-Thoracic Surgery, The 920th Hospital of PLA Joint Service Security Forces, Kunming, China
| | - Xiao-Qian Lin
- Department of Phase I Clinical Trial, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Gong-Hao He
- Department of Pharmacy, The 920th Hospital of PLA Joint Service Security Forces, Kunming, China
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Cicali EJ, Smith DM, Duong BQ, Kovar LG, Cavallari LH, Johnson JA. A Scoping Review of the Evidence Behind Cytochrome P450 2D6 Isoenzyme Inhibitor Classifications. Clin Pharmacol Ther 2020; 108:116-125. [PMID: 31910286 DOI: 10.1002/cpt.1768] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
The US Food and Drug Administration (FDA) lists 22 medications as clinical inhibitors of cytochrome P450 2D6 isoenzyme, with classifications of strong, moderate, and weak. It is accepted that strong inhibitors result in nearly null enzymatic activity, but reduction caused by moderate and weak inhibitors is less well characterized. The objective was to identify if the classification of currently listed FDA moderate and weak inhibitors is supported by publicly available primary literature. We conducted a literature search and reviewed product labels for area under the plasma concentration-time curve (AUC) fold-changes caused by inhibitors in humans and identified 89 inhibitor-substrate pairs. Observed AUC fold-change of the substrate was used to create an observed inhibitor classification per FDA-defined AUC fold-change thresholds. We then compared the observed inhibitor classification with the classification listed in the FDA Table of Inhibitors. We found 62% of the inhibitors within the pairs matched the listed FDA classification. We explored reasons for discordance and suggest modifications to the FDA table of clinical inhibitors for cimetidine, desvenlafaxine, and fluvoxamine.
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Affiliation(s)
- Emily J Cicali
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - D Max Smith
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Benjamin Q Duong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Lukas G Kovar
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Ahsan T, Urmi NJ, Sajib AA. Heterogeneity in the distribution of 159 drug-response related SNPs in world populations and their genetic relatedness. PLoS One 2020; 15:e0228000. [PMID: 31971968 PMCID: PMC6977754 DOI: 10.1371/journal.pone.0228000] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/03/2020] [Indexed: 12/25/2022] Open
Abstract
Interethnic variability in drug response arises from genetic differences associated with drug metabolism, action and transport. These genetic variations can affect drug efficacy as well as cause adverse drug reactions (ADRs). We retrieved drug-response related single nucleotide polymorphism (SNP) associated data from databases and analyzed to elucidate population specific distribution of 159 drug-response related SNPs in twenty six populations belonging to five super-populations (African, Admixed Americans, East Asian, European and South Asian). Significant interpopulation differences exist in the minor (variant) allele frequencies (MAFs), linkage disequilibrium (LD) and haplotype distributions among these populations. 65 of the drug-response related alleles, which are considered as minor (variant) in global population, are present as the major alleles (frequency ≥0.5) in at least one or more populations. Populations that belong to the same super-population have similar distribution pattern for majority of the variant alleles. These drug response related variant allele frequencies and their pairwise LD measure (r2) can clearly distinguish the populations in a way that correspond to the known evolutionary history of human and current geographic distributions, while D' cannot. The data presented here may aid in identifying drugs that are more appropriate and/or require pharmacogenetic testing in these populations. Our findings emphasize on the importance of distinct, ethnicity-specific clinical guidelines, especially for the African populations, to avoid ADRs and ensure effective drug treatment.
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Affiliation(s)
- Tamim Ahsan
- Department of Genetic Engineering & Biotechnology, Bangabandhu Sheikh Mujibur Rahman Maritime University, Dhaka, Bangladesh
| | | | - Abu Ashfaqur Sajib
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
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Westergaard N, Søgaard Nielsen R, Jørgensen S, Vermehren C. Drug Use in Denmark for Drugs Having Pharmacogenomics (PGx) Based Dosing Guidelines from CPIC or DPWG for CYP2D6 and CYP2C19 Drug-Gene Pairs: Perspectives for Introducing PGx Test to Polypharmacy Patients. J Pers Med 2020; 10:jpm10010003. [PMID: 31963319 PMCID: PMC7151550 DOI: 10.3390/jpm10010003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background: The cytochrome P450 drug metabolizing enzymes CYP2D6 and CYP2C19 are the major targets for pharmacogenomics (PGx) testing and determining for drug response. Clinical dosing guidelines for specific drug-gene interactions (DGI) are publicly available through PharmGKB. The aim of this register study was to map the use of drugs in Denmark for drugs having actionable dosing guidelines (AG) i.e., dosing recommendations different from standard dosing for CYP2D6 or CYP2C19 DGI in terms of consumption. Methods: The Danish Register of Medicinal Product Statistics was the source to retrieve consumption in Defined Daily Dose (DDD) i.e., the assumed average maintenance dose per day for a drug used for its main indication in adults and number of users (2017 data). Clinical dosing guidelines were available from the PharmGKB website. Results: Forty-nine drugs have guidelines corresponding to 14.5% of total sales in DDD. Twenty-eight drugs have AG corresponding to 375.2 million DDD. Pantoprazole, lansoprazole, omeprazole, clopidogrel, and metoprolol constituted fifty-eight percent of the consumption in DDD of drugs having AG. The consumption of antidepressant drugs, opioids, and antipsychotic drugs were 157.0 million DDD; with 441,850 users, 48.9 million DDD; with 427,765 users, and 23.7 million DDD; with 128,935 users, respectively. Age distributions of consumption of drugs and drug combinations, e.g., for sertraline redeemed either alone or in combination with metoprolol and tramadol, are presented. Conclusion: This exploratory register study clearly showed that a large fraction of the Danish population, especially the elderly, are exposed to drugs or drug combinations for which there exist AG related to PGx of CYP2D6 or CYP2C19.
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Affiliation(s)
- Niels Westergaard
- Centre for Engineering and Science, Department of Biomedical Laboratory Science, University College Absalon, Parkvej 190, 4700 Naestved, Denmark;
- Correspondence:
| | - Regitze Søgaard Nielsen
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; (R.S.N.); (C.V.)
- Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - Steffen Jørgensen
- Centre for Engineering and Science, Department of Biomedical Laboratory Science, University College Absalon, Parkvej 190, 4700 Naestved, Denmark;
| | - Charlotte Vermehren
- Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; (R.S.N.); (C.V.)
- Department of Pharmacy, Section for Social and Clinical Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
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12
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Frost DA, Soric MM, Kaiser R, Neugebauer RE. Efficacy of Tramadol for Pain Management in Patients Receiving Strong Cytochrome P450 2D6 Inhibitors. Pharmacotherapy 2019; 39:724-729. [PMID: 31038218 DOI: 10.1002/phar.2269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE Tramadol is metabolized by cytochrome P450 (CYP) 2D6 to form an active metabolite that exhibits its analgesic effect. Medications that inhibit this enzyme are used often in practice, yet the clinical impact of this interaction on the analgesic effects of tramadol has yet to be fully described. The objective was to determine whether a clinically relevant decrease in pain control is observed in patients taking scheduled tramadol concomitantly with a strong CYP2D6 inhibitor. DESIGN Retrospective cohort study. SETTING Large health care system. PATIENTS One hundred fifty-two adult inpatients who received scheduled tramadol for at least 24 hours with (76 patients) or without (76 patients) a strong CYP2D6 inhibitor between January 1, 2012, and February 28, 2017, were included in the analysis. Patients hospitalized for opioid use disorder or those receiving substandard dosing of tramadol were excluded. MEASUREMENTS AND MAIN RESULTS The primary outcome was mean breakthrough opiate consumption in the presence and absence of CYP2D6 inhibitors. Secondary outcomes included mean pain scores, length of hospital stay, tramadol discontinuation rates, and prespecified subgroup analyses based on patient sex, race, and specific CYP2D6 inhibitor administered. Patients receiving concurrent CYP2D6 inhibitors required significantly more breakthrough morphine milligram equivalents per day compared with patients receiving scheduled tramadol without CYP2D6 inhibitors (geometric mean ± SD 18.2 ± 6.3 vs 5.7 ± 6.7 mg morphine milligram equivalents, p<0.001). No significant differences existed between cohorts for mean pain score, length of hospital stay, or tramadol discontinuation rate. CONCLUSION This study demonstrated a clinically relevant decrease in the efficacy of tramadol when used for pain control in patients receiving a strong CYP2D6 inhibitor. These results should encourage clinicians to review medication lists for this interaction and adjust regimens accordingly to ensure adequate pain control.
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Affiliation(s)
- Derek A Frost
- Department of Pharmacy, University Hospitals Portage Medical Center, Ravenna, Ohio
| | - Mate M Soric
- Department of Pharmacy Practice, Northeast Ohio Medical University College of Pharmacy, Rootstown, Ohio.,Department of Pharmacy, University Hospitals Geauga Medical Center, Chardon, Ohio
| | - Ricky Kaiser
- Northeast Ohio Medical University College of Pharmacy, Rootstown, Ohio
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13
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Fulton CR, Zang Y, Desta Z, Rosenman MB, Holmes AM, Decker BS, Zhang Y, T Callaghan J, Pratt VM, Levy KD, Gufford BT, Dexter PR, Skaar TC, Eadon MT. Drug-gene and drug-drug interactions associated with tramadol and codeine therapy in the INGENIOUS trial. Pharmacogenomics 2019; 20:397-408. [PMID: 30784356 DOI: 10.2217/pgs-2018-0205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Tramadol and codeine are metabolized by CYP2D6 and are subject to drug-gene and drug-drug interactions. Methods: This interim analysis examined prescribing behavior and efficacy in 102 individuals prescribed tramadol or codeine while receiving pharmaco-genotyping as part of the INGENIOUS trial (NCT02297126). Results: Within 60 days of receiving tramadol or codeine, clinicians more frequently prescribed an alternative opioid in ultrarapid and poor metabolizers (odds ratio: 19.0; 95% CI: 2.8-160.4) as compared with normal or indeterminate metabolizers (p = 0.01). After adjusting the CYP2D6 activity score for drug-drug interactions, uncontrolled pain was reported more frequently in individuals with reduced CYP2D6 activity (odds ratio: 0.50; 95% CI: 0.25-0.94). Conclusion: Phenoconversion for drug-drug and drug-gene interactions is an important consideration in pharmacogenomic implementation; drug-drug interactions may obscure the potential benefits of genotyping.
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Affiliation(s)
- Cathy R Fulton
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Health Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN 46202, USA
| | - Yong Zang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Zeruesenay Desta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Marc B Rosenman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Ann M Holmes
- Richard M Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, IN 46202, USA
| | - Brian S Decker
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yifei Zhang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - John T Callaghan
- Regenstrief Institute for Health Care, Indianapolis, IN 46202, USA
| | - Victoria M Pratt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Kenneth D Levy
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Brandon T Gufford
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Paul R Dexter
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Richard L Roudebush Veteran Affairs Medical Center, Indianapolis, IN 46202, USA
| | - Todd C Skaar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Michael T Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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14
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Smith DM, Weitzel KW, Elsey AR, Langaee T, Gong Y, Wake DT, Duong BQ, Hagen M, Harle CA, Mercado E, Nagoshi Y, Newsom K, Wright A, Rosenberg EI, Starostik P, Clare-Salzler MJ, Schmidt SO, Fillingim RB, Johnson JA, Cavallari LH. CYP2D6-guided opioid therapy improves pain control in CYP2D6 intermediate and poor metabolizers: a pragmatic clinical trial. Genet Med 2019; 21:1842-1850. [PMID: 30670877 PMCID: PMC6650382 DOI: 10.1038/s41436-018-0431-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE CYP2D6 bioactivates codeine and tramadol, with intermediate and poor metabolizers (IMs and PMs) expected to have impaired analgesia. This pragmatic proof-of-concept trial tested the effects of CYP2D6-guided opioid prescribing on pain control. METHODS Participants with chronic pain (94% on an opioid) from seven clinics were enrolled into CYP2D6-guided (n = 235) or usual care (n = 135) arms using a cluster design. CYP2D6 phenotypes were assigned based on genotype and CYP2D6 inhibitor use, with recommendations for opioid prescribing made in the CYP2D6-guided arm. Pain was assessed at baseline and 3 months using PROMIS® measures. RESULTS On stepwise multiple linear regression, the primary outcome of composite pain intensity (composite of current pain and worst and average pain in the past week) among IM/PMs initially prescribed tramadol/codeine (n = 45) had greater improvement in the CYP2D6-guided versus usual care arm (-1.01 ± 1.59 vs. -0.40 ± 1.20; adj P = 0.016); 24% of CYP2D6-guided versus 0% of usual care participants reported ≥30% (clinically meaningful) reduction in the composite outcome. In contrast, among normal metabolizers prescribed tramadol or codeine at baseline, there was no difference in the change in composite pain intensity at 3 months between CYP2D6-guided (-0.61 ± 1.39) and usual care (-0.54 ± 1.69) groups (adj P = 0.540). CONCLUSION These data support the potential benefits of CYP2D6-guided pain management.
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Affiliation(s)
- D Max Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Kristin W Weitzel
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Amanda R Elsey
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Taimour Langaee
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Dyson T Wake
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Benjamin Q Duong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Melanie Hagen
- Division of General Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, IN, USA
| | - Elvira Mercado
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ying Nagoshi
- Division of General Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kimberly Newsom
- University of Florida Health Pathology Laboratories, Gainesville, FL, USA
| | - Ashleigh Wright
- Division of General Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Eric I Rosenberg
- Division of General Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Petr Starostik
- University of Florida Health Pathology Laboratories, Gainesville, FL, USA.,Department of Pathology, Immunology & Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Siegfried O Schmidt
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA.,Department of Community Dentistry and Behavioral Science, College of Dentistry, Gainesville, FL, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA. .,Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA. .,Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA.
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15
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Bigand T, Anderson CL, Roberts ML, Shaw MR, Wilson M. Benefits and adverse effects of cannabis use among adults with persistent pain. Nurs Outlook 2018; 67:223-231. [PMID: 30616866 DOI: 10.1016/j.outlook.2018.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Increasingly, states are legalizing cannabis for recreational use. Improved accessibility may allow adults with pain to use cannabis more liberally. Greater understanding is needed about how adults with pain perceive the effects of cannabis, particularly those who also use opioid analgesics. PURPOSE To examine the perceived effects of cannabis among adults who have been prescribed opioids for persistent pain. METHODS A survey-based study was conducted on 150 adults with persistent pain. Data from two open-ended questions were analyzed using a qualitative descriptive approach and content analysis. FINDINGS Data analysis led to identification of two main categories and five subcategories: (a) cannabis benefits with two subcategories of "physiological" and "mental health"; (b) adverse effects with three subcategories of "physiological," "mental health," and "social and economic concerns." DISCUSSION Both positive and negative effects of cannabis were described. Nursing practice, including open communication with patients, can be guided by patient perspectives surrounding benefits and adverse effects of cannabis use.
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Affiliation(s)
- Teresa Bigand
- College of Nursing, Washington State University, Spokane, WA.
| | | | | | | | - Marian Wilson
- College of Nursing, Washington State University, Spokane, WA
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