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Browsing by Author "Fulton, Cathy R."
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Item Clinical Pharmacogenetics From a Nursing Perspective: Personalizing Drug Therapy(Sigma International Nursing Research Congress, 2019) Fulton, Cathy R.Precision medicine is the approach to patient care that is focused on finding the most appropriate medication based on the interplay between genetic, environmental, and lifestyle factors to improve patient outcomes. With sufficient knowledge and experience, all nurses will become more confident in applying pharmacogenetic results within the clinical context.Item Drug–gene and drug–drug interactions associated with tramadol and codeine therapy in the INGENIOUS trial(Future Medicine, 2019-04) Fulton, Cathy R.; Zang, Yong; Desta, Zeruesenay; Rosenman, Marc B.; Holmes, Ann M.; Decker, Brian S.; Zhang, Yifei; Callaghan, John T.; Pratt, Victoria M.; Levy, Kenneth D.; Gufford, Brandon T.; Dexter, Paul R.; Skaar, Todd C.; Eadon, Michael T.; Medicine, School of MedicineBackground: 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.Item Evaluation of accessibility of open-source EHRs for visually impaired users(AMIA, 2024-01) Moncy, Megha M.; Pilli, Manya; Somasundaram, Manasi; Purkayastha, Saptarshi; Fulton, Cathy R.; Biomedical Engineering and Informatics, Luddy School of Informatics, Computing, and EngineeringThis study investigates the accessibility of open-source electronic health record (EHR) systems for individuals who are visually impaired or blind. Ensuring the accessibility of EHRs to visually impaired users is critical for the diversity, equity, and inclusion of all users. The study used a combination of automated and manual accessibility testing with screen readers to evaluate the accessibility of three widely used open-source EHR systems. We used three popular screen readers - JAWS (Windows), NVDA (Windows), and Apple VoiceOver (OSX) to evaluate accessibility. The evaluation revealed that although each of the three EHR systems was partially accessible, there is room for improvement, particularly regarding keyboard navigation and screen reader compatibility. The study concludes with recommendations for making EHR systems more inclusive for all users and more accessible.Item How Much Time Do Nurse Practitioner Students Spend Seeing Patients in a Clinical Day?(Office of the Vice Chancellor for Research, 2016-04-08) Fulton, Cathy R.; Clark, CarolEducational institutions have the charge of educating nurse practitioner (NP) students with a strong clinical foundation that provides the skills and knowledge needed for practice. The National Organization of Nurse Practitioner Faculties (NONPF) defines clinical practice hours as those hours in which direct patient care is provided to individuals. In 2010, a National Task Force commissioned by NONPF determined it best to maintain the 500 clinical hour requirement to document attainment of the core and population-focused NP competencies. While this requirement is specific, quantifiable, and considered the “gold standard” for educating NP students, the nature and quality of those hours are not well understood. The two-fold purpose of this study was to explore: The characteristics of the clinical hours that family and adult-gerontology primary care NP students logged during practicum courses and what activities students report doing during “down time” when they are not engaged in direct patient care. Secondary data analysis was conducted with 18 family nurse practitioner (FNP) students and 27 adult gerontology primary care nurse practitioner (AGPCNP) students to equal a total of 45 NP students. time study was conducted with 31 FNP and 21 AGPCNP students to equal a total of 52 NP students. The results between the secondary data analysis and the time study were surprising. So what did the NP students spend their clinical hours doing? Did their logged clinical hours match their time study hours? What were the study implications? We look forward to sharing our study results at the Research Day.Item Informatics/health IT implementation in DNP education: Faculty, organizational, and program characteristics for diverse professional roles(IUPUI School of Informatics and Computing, 2020) Fulton, Cathy R.; Hinton Walker, PatriciaNursing informatics/health IT is critical to achieving and measuring patient safety and outcomes as well as key components of graduate nursing education, accreditation and practice. Electronic survey findings (2011) from AACN accredited DNP program directors are compared to a replicated/expanded follow-up survey to further explore informatics/health IT content and experience.Item Organizational and Faculty Determinants Associated with Health Information Technology Adoption in DNP Programs: A Descriptive Study(Office of the Vice Chancellor for Research, 2013-04-05) Fulton, Cathy R.Background: Informatics is a key component of graduate nursing education and an accreditation requirement, yet little is documented about the barriers to implementing informatics in Doctor of Nursing Practice curricula. Purpose: The purpose of this descriptive study was to explore: 1) the degree to which the accreditation standard and informatics guidelines have been met across programs; 2) the outcome of the Technology Informatics Guiding Educational Reform Initiative Foundation’s Phase II goals and recommendations as they relate to the Education and Faculty Development Collaborative; 3) the faculty and organizational determinants that lead to actions characteristic of Doctorate of Nursing Practice programs that are required by American Association of Colleges of Nursing to implement Essential IV into their curricula. Method: A survey was sent electronically to 138 Doctor of Nursing Practice program directors as identified on the American Association of Colleges of Nursing website with an 84% response rate. Results: Major findings include a lack of informatics’ certified and/or prepared faculty and a lack of awareness of informatics curricular guidelines. Conclusions: Recommendations for deans and DNP program directors include encouraging interested faculty members to pursue informatics education, using established national informatics curricular competencies, and partnering with educational institutions which do have nursing informatics certified or master’s prepared faculty to improve the development of informatics/health information technology curricula.Item Pharmacogenetics and Practice: Tailoring Prescribing for Safety and Effectiveness(Elsevier, 2018) Fulton, Cathy R.; Swart, Marelize; De Luca, Thomas; Liu, Stephanie N.; Collins, Kimberly S.; Desta, Zeruesenay; Gufford, Brandon T.; Eadon, Michael T.; Medicine, School of MedicineThe promise of pharmacogenomics testing, to find the right medication at the right dose for the right patient at the right time, sits at the heart of precision medicine. Identifying genetic variants that contribute to inter-patient variability in drug disposition and effect allows clinicians to select a more appropriate medication for a patient’s condition by limiting adverse drug events and maximizing beneficial effects. However, as pharmacogenomics is increasingly integrated into prevention-based healthcare, a major obstacle to effective implementation of pharmacogenomics testing is the lack of adequate knowledge of healthcare providers on interpretation of these test results.Item The INGENIOUS Trial: Impact of pharmacogenetic testing on adverse events in a pragmatic clinical trial(Springer Nature, 2023) Eadon, Michael T.; Rosenman, Marc B.; Zhang, Pengyue; Fulton, Cathy R.; Callaghan, John T.; Holmes, Ann M.; Levy, Kenneth D.; Gupta, Samir K.; Haas, David M.; Vuppalanchi, Raj; Benson, Eric A.; Kreutz, Rolf P.; Tillman, Emma M.; Shugg, Tyler; Pierson, Rebecca C.; Gufford, Brandon T.; Pratt, Victoria M.; Zang, Yong; Desta, Zeruesenay; Dexter, Paul R.; Skaar, Todd C.; Medicine, School of MedicineAdverse drug events (ADEs) account for a significant mortality, morbidity, and cost burden. Pharmacogenetic testing has the potential to reduce ADEs and inefficacy. The objective of this INGENIOUS trial (NCT02297126) analysis was to determine whether conducting and reporting pharmacogenetic panel testing impacts ADE frequency. The trial was a pragmatic, randomized controlled clinical trial, adapted as a propensity matched analysis in individuals (N = 2612) receiving a new prescription for one or more of 26 pharmacogenetic-actionable drugs across a community safety-net and academic health system. The intervention was a pharmacogenetic testing panel for 26 drugs with dosage and selection recommendations returned to the health record. The primary outcome was occurrence of ADEs within 1 year, according to modified Common Terminology Criteria for Adverse Events (CTCAE). In the propensity-matched analysis, 16.1% of individuals experienced any ADE within 1-year. Serious ADEs (CTCAE level ≥ 3) occurred in 3.2% of individuals. When combining all 26 drugs, no significant difference was observed between the pharmacogenetic testing and control arms for any ADE (Odds ratio 0.96, 95% CI: 0.78-1.18), serious ADEs (OR: 0.91, 95% CI: 0.58-1.40), or mortality (OR: 0.60, 95% CI: 0.28-1.21). However, sub-group analyses revealed a reduction in serious ADEs and death in individuals who underwent pharmacogenotyping for aripiprazole and serotonin or serotonin-norepinephrine reuptake inhibitors (OR 0.34, 95% CI: 0.12-0.85). In conclusion, no change in overall ADEs was observed after pharmacogenetic testing. However, limitations incurred during INGENIOUS likely affected the results. Future studies may consider preemptive, rather than reactive, pharmacogenetic panel testing.