Genomic medicine: health care issues and the unresolved ethical and social dilemmas

Experience of nurses using the basic nursing science in performing nursing care for patients at RSUD Dr. Soedomo Trenggalek, Indonesia

Introduction: The provision of humanistic and professional nursing care services needs to be carried out comprehensively, and it must cover patients’ bio-psycho-socio-spiritual aspects. This indicates nurses have to integrate all the basic nursing science, including physiology, anatomy, pharmacology, and pathophysiology, while carrying out their duties. This integration helps to provide the best care for their patients, but they often uncertain about the basic science approach to use. Therefore, this study aimsto explore the experience of nurses using basic nursing science in caring for patients with chronic diseases. Design and Methods: In-depth interviews were conducted with 5 nurses working in chronic disease wards for at least 5 years. Each respondent was then interviewed using a self-constructed questionnaire. Results: All respondents agreed that basic nursing science is important in providing quality healthcare services. Furthermore, six themes were identified using the thematic analysis, namely (1) the process of collecting patient data, which was more focused and organized; (2) required for establishing the nursing diagnosis; (3) useful for determining the nursing care plan; (4) it is a basis for implementing nursing actions; (5) provides a basis for monitoring and follow-up; (6) and teamwork between health personnel is more effective. Conclusions: Based on the interview results, nurses need knowledge and skills in basic nursing science while caring for patients with chronic diseases. Furthermore, basic nursing sciences lay the foundation for nurses while assessing patients, diagnosing, planning the care, implementing nursing actions, evaluating patients’ condition, and collaborating with other health personnel.  

Facial Genetics: A Brief Overview

Historically, craniofacial genetic research has understandably focused on identifying the causes of craniofacial anomalies and it has only been within the last 10 years, that there has been a drive to detail the biological basis of normal-range facial variation. This initiative has been facilitated by the availability of low-cost hi-resolution three-dimensional systems which have the ability to capture the facial details of thousands of individuals quickly and accurately. Simultaneous advances in genotyping technology have enabled the exploration of genetic influences on facial phenotypes, both in the present day and across human history. There are several important reasons for exploring the genetics of normal-range variation in facial morphology.     - Disentangling the environmental factors and relative parental biological contributions to heritable traits can help to answer the age-old question "why we look the way that we do?"     - Understanding the etiology of craniofacial anomalies; e.g., unaffected family members of individuals with non-syndromic cleft lip/palate (nsCL/P) have been shown to differ in terms of normal-range facial variation to the general population suggesting an etiological link between facial morphology and nsCL/P.     - Many factors such as ancestry, sex, eye/hair color as well as distinctive facial features (such as, shape of the chin, cheeks, eyes, forehead, lips, and nose) can be identified or estimated using an individual's genetic data, with potential applications in healthcare and forensics.     - Improved understanding of historical selection and adaptation relating to facial phenotypes, for example, skin pigmentation and geographical latitude.     - Highlighting what is known about shared facial traits, medical conditions and genes.

eCHAT for lifestyle and mental health screening in primary care

PURPOSE

Early detection and management of unhealthy behaviors and mental health issues in primary care has the potential to prevent or ameliorate many chronic diseases and increase patients' well-being. This study aimed to assess the feasibility and acceptability of the systematic use of a Web-based eCHAT (electronic Case-finding and Help Assessment Tool) screening patients for problematic drinking, smoking, and other drug use, gambling, exposure to abuse, anxiety, depression, anger control, and physical inactivity, and whether they want help with these issues. Patients self-administered eCHAT on an iPad in the waiting room and received summarized results, including relevant scores and interpretations, which could be by a family physician on the website and in the electronic health record (EHR) at the point of care.

METHODS

We conducted a mixed method feasibility and acceptability study in 2 general practices in Auckland, New Zealand. Participants were consecutive adult patients attending the practice during a 2-week period, as well as all practice staff. Patients completed eCHAT, doctors accessed the summarized reports. Outcome measures were patients' responses to eCHAT, and patients' written and staff recorded interview feedback.

RESULTS

Of the 233 invited patients, 196 (84%) completed eCHAT and received feedback. Domains where patients wanted immediate help were anxiety (9%), depression (7%), physical activity (6%), and smoking (5%), which was not overwhelming for physicians to address. Most patients found the iPad easy to use, and the questions easy to understand and appropriate; they did not object to questions. Feedback from 7 doctors, 2 practice managers, 4 nurses, and 5 receptionists was generally positive. Practices continue to use eCHAT regularly since the research was completed.

CONCLUSIONS

eCHAT is an acceptable and feasible means of systemic screening patients for unhealthy behaviors and negative mood states and is easily integrated into the primary care electronic health record.