Making use of genes.

Nurses need to understand genetic conditions and, increasingly, genomic health care. Whether a drug such as trastuzumab should be prescribed can depend on the patient's genetic make-up. This article provides expert advice on how nurses can collect relevant information.

Pharmacogenetics of CYP2C19: functional and clinical implications of a new variant CYP2C19*17.

AIMS: Cytochrome P450 2C19 metabolizes many important drugs. In 2006, a variant allele (CYP2C19*17) associated with increased activity was discovered, but its likely clinical significance is controversial. Investigators disagree about the phenotype to be assigned to the two CYP2C19*17 genotypes. The aim of this study was to provide a critical summary, helpful to prescribers. METHODS: We searched MEDLINE for papers on the allele from 2006 and then undertook historical searches through the reference lists of papers retrieved. The relevant information was critically assessed and summarized. RESULTS: CYP2C19*17 was associated with increased enzymic activity. Substrates studied were omeprazole, pantoprazole, escitalopram, sertraline, voriconazole, tamoxifen and clopidogrel. Most studies used pharmacokinetic variables as outcome measure. For clopidogrel, activated by CYP2C19, pharmacodynamic consequences focused on platelet aggregation. While for most pharmacokinetic parameters of the substrates studied the average value was altered, the range of values showed mostly complete overlap for CYP2C19*1/*17 heterozygotes and wild-type homozygotes. Even for CYP2C19*17 homozygotes, the absolute effect was modest compared with the effect of previously identified loss-of-function alleles. In Helicobacter pylori eradication CYP2C19*2 carriage was associated with an altered eradication rate (odds ratio 4.20, 95% confidence interval 1.23, 16.44) relative to the wild-type, but CYP2C19*17 homozygosity was not. Prevalence of the variant allele was typically <5% in Asians and about four times higher in White and African populations. CONCLUSIONS: Assignment of CYP2C19*17 homozygotes as extensive metabolizers rather than ultrarapid metabolizers is adequate. CYP2C19*17 genotyping is unlikely to have clinical utility except for drugs with very narrow therapeutic indices.

Cancer survivorship 2: providing advice and support to those living with and beyond cancer.

The second in this two part unit on cancer survivorship gives practical advice on identifying those with long term and late effects of cancer and its treatment, and providinginformation and support. Part 1 explored why more people are surviving cancer, and how services need to change to meet the needs of this group.

Cancer survivorship. 1: How services need to change for those living with and beyond cancer.

Several factors, including improved healthcare and treatment, have contributed to an enormous increase in the number of people living with and beyond cancer. As a result, an estimated two million people in the UK are classed as cancer survivors. Healthcare providers need to consider how their services can meet the needs of this group, and nurses need to consider their role in their area of practice in terms of supporting those who survive cancer.

Injection systems for two luteinising hormone-releasing hormone agonists: a comparative assessment of administration times and nurses' perceptions.

The aim of this study was to compare the speed of administration (preparation and delivery) and nurses' perceived ease of use and relative safety of two injection systems used to administer luteinising hormone-releasing hormone agonists: a depot system used to administer goserelin acetate ('Zoladex', AstraZeneca) and a vial system used to administer leuprorelin acetate ('Prostap', Wyeth). This was a randomised, crossover study with 82 volunteer nurses (50 pre-registration and 32 post-registration). All nurses were timed in the administration of both systems and all were required to assess the two systems by completing a questionnaire. Results indicate that both pre- and post-registration nurses administered the depot system in less time than the vial system. Overall mean times for administration of the depot system and the vial system were 1.70 and 3.34min, respectively. In questionnaire responses, significantly more nurses thought that the depot system had 'good safety precautions' compared with the vial system (85% versus 40%; P<0.001) and significantly more nurses also expressed a preference for the depot system (58% versus 42%; P=0.036). In conclusion, this study demonstrates that nurses prefer the one-step depot system used to administer goserelin acetate over the vial system used to administer leuprorelin acetate.

Reducing the risks of sharps injuries in health professionals.

Sharps injuries can transmit blood-borne infections and are a serious health risk to nurses and other health professionals. However, there is limited data on the incidence of these injuries in the UK, and low awareness of the risks they pose. New products with enhanced safety features are becoming available but their introduction should be accompanied by education and training to improve practice in relation to sharps and their disposal.

Cancer and older people.

This article considers some causes of cancer, diagnostic assessments and treatment options, as well as some of the myths surrounding the appropriate care of older people with cancer. It stresses the importance of employing the specialist knowledge of gerontological and cancer professionals in caring for the older person with cancer, and emphasises the central role of the nurse in delivering effective care.

Give cancer service framework time to work.

It is fairly obvious that cancer initiatives in the NHS cancer plan will have an impact on other services, but this doesn't have to be a negative one. Some are concerned that the two-week wait from GP to consultation could lead to longer waiting times for those without a malignancy. But could the funding for this and similar initiatives enhance the speed of diagnosis for everyone?