Clinical significance of CYP2D6 polymorphisms and tamoxifen in women with breast cancer

Tamoxifen has been used as adjuvant hormonal therapy for estrogen receptor positive breast cancer for over 30 years and is also widely used for the treatment of metastatic breast cancer. Tamoxifen is metabolized to its more active form by cytochrome P450 2D6 (CYP2D6); decreases in CYP2D6 activity, either by inactivating polymorphisms or drug interactions, can reduce concentrations of tamoxifen's active metabolites. Clinical studies demonstrate that breast cancer patients treated with adjuvant tamoxifen who have decreased CYP2D6 due to genetic polymorphisms or drug interactions may have an increased risk of recurrence and reductions in disease-free survival. Pharmacogenetic testing is currently available to predict CYP2D6 phenotypes and individualize tamoxifen therapy.

Inservice education: career development for South Australian nurses

Inservice education is mandatory for the development of a skilled workforce and a planned rational program is required to ensure that labourforce requirements are met in specific areas of practice. The South Australian Health Commission (SAHC) has endorsed a Career Development Model for Nursing Practice which among other things will assist in the planning and implementation of inservice education in South Australia (SA). The model is based on the principles of advancement, competency and diversity and reflects the Dreyfus Model of skill acquisition adapted to nursing by the American nurse theorist Patricia Benner.