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Curtin M, Dickerson SS. An Evolutionary Concept Analysis of Precision Medicine, and Its Contribution to a Precision Health Model for Nursing Practice. ANS Adv Nurs Sci 2024; 47:E1-E19. [PMID: 36728719 DOI: 10.1097/ans.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Precision medicine is a new concept that has been routinely encountered in the literature for little more than a decade. With increasing use, it becomes crucial to understand the meaning of this concept as it is applied in various settings. An evolutionary concept analysis was conducted to develop an understanding of the essential features of precision medicine and its use. The analysis led to a comprehensive list of the antecedents, attributes, and consequences of precision medicine in multiple settings. With this understanding, precision medicine becomes part of the broader practice of precision health, an important process proposed by nursing scholars to provide complete, holistic care to our patients. A model for precision health is presented as a framework for care.
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Affiliation(s)
- Martha Curtin
- School of Nursing, University at Buffalo, State University of New York
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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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Rubagumya F, Carson L, Mushonga M, Manirakiza A, Murenzi G, Abdihamid O, Athman A, Mungo C, Booth C, Hammad N. An analysis of the African cancer research ecosystem: tackling disparities. BMJ Glob Health 2023; 8:bmjgh-2022-011338. [PMID: 36792229 PMCID: PMC9933677 DOI: 10.1136/bmjgh-2022-011338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
Disparities in cancer research persist around the world. This is especially true in global health research, where high-income countries (HICs) continue to set global health priorities further creating several imbalances in how research is conducted in low and middle-income countries (LMICs). Cancer research disparities in Africa can be attributed to a vicious cycle of challenges in the research ecosystem ranging from who funds research, where research is conducted, who conducts it, what type of research is conducted and where and how it is disseminated. For example, the funding chasm between HICs and LMICs contributes to inequities and parachutism in cancer research. Breaking the current cancer research model necessitates a thorough examination of why current practices and norms exist and the identification of actionable ways to improve them. The cancer research agenda in Africa should be appropriate for the African nations and continent. Empowering African researchers and ensuring local autonomy are two critical steps in moving cancer research towards this new paradigm.
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Affiliation(s)
- Fidel Rubagumya
- Oncology, Rwanda Military Hospital, Kigali, Rwanda .,Oncology, Queen's University, Kingston, Ontario, Canada.,Research for Development (RD Rwanda), Kigali, Rwanda.,Oncology, University of Rwanda, Kigali, Rwanda
| | - Laura Carson
- Oncology, Queen's University, Kingston, Ontario, Canada
| | - Melinda Mushonga
- Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Gad Murenzi
- Oncology, Rwanda Military Hospital, Kigali, Rwanda,Research for Development (RD Rwanda), Kigali, Rwanda
| | - Omar Abdihamid
- Oncology, Garissa County Referral Hospital, Garissa, Kenya
| | - Abeid Athman
- Oncology, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Chemtai Mungo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
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Underhill-Blazey M, Klehm MR. Genetic Discrimination: The Genetic Information Nondiscrimination Act's Impact on Practice and Research. Clin J Oncol Nurs 2021; 24:135-137. [PMID: 32196007 DOI: 10.1188/20.cjon.135-137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Genetic Information Nondiscrimination Act of 2008 (GINA) provides federal safeguards to prohibit employer or insurance discrimination based on personal or familial genetic information or conditions. Awareness of the implications of genetic testing in individuals and families and of state and federal legislation in place for their protection is an essential component of oncology nursing practice. This article discusses the critical role of the oncology nurse in interacting with and providing information about GINA to patients in a cancer care setting engaged in genetic assessment.
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Freeley M. Current postgraduate training programs and online courses in precision medicine. Expert Rev Mol Diagn 2020; 20:569-574. [PMID: 31875486 DOI: 10.1080/14737159.2020.1709826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Freeley
- School of Biotechnology (Office X225), Dublin City University , Glasnevin, Ireland
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