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Sen K, DiSabella MT, Harmon J, Strelzik JA, Gropman AL. Gaps in Neurogenetics Education During Child Neurology Residency: Results of a National Survey. J Child Neurol 2022; 37:702-706. [PMID: 35656773 DOI: 10.1177/08830738221106896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The practice of child neurology has changed significantly in the past two decades as we have integrated genetic testing into our standard of care to achieve precise diagnoses and to guide management of many childhood neurological conditions. Despite this paradigm shift, there appears to be a gap in both clinical exposure to neurogenetic disorders and education provided to residents in ordering and interpreting genetic testing. We therefore conducted a national survey for child neurology trainees in all programs across the United States to delineate their perception of the adequacy of current training and didactics in genetic/neurogenetic disorders. The results revealed knowledge gaps related to ordering and interpreting genetic testing, managing acute metabolic emergencies, and identifying resources for referral of patients to clinical trials. Responders considered their current curriculum in neurogenetics to be insufficient and voted favorably for an educational platform using recorded lectures and interactive sessions.
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Affiliation(s)
- Kuntal Sen
- Division of Neurogenetics and Developmental Pediatrics, 8404Children's National Hospital, Washington DC, USA
| | - Marc T DiSabella
- Division of Neurology, 8404Children's National Hospital, Washington DC, USA
| | - Jennifer Harmon
- Rare Disease Institute; 8404Children's National Hospital, Washington DC, USA
| | - Jeffrey A Strelzik
- Division of Neurology, 8404Children's National Hospital, Washington DC, USA
| | - Andrea L Gropman
- Division of Neurogenetics and Developmental Pediatrics, 8404Children's National Hospital, Washington DC, USA
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Domínguez-Carral J, López-Pisón J, Macaya A, Bueno Campaña M, García-Pérez MA, Natera-de Benito D. Genetic testing among Spanish pediatric neurologists: Knowledge, attitudes and practices. Eur J Med Genet 2016; 60:124-129. [PMID: 27890788 DOI: 10.1016/j.ejmg.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/16/2016] [Accepted: 11/22/2016] [Indexed: 01/01/2023]
Abstract
Advances in genetic testing applied to child neurology have enabled the development of genetic tests with greater sensitivity in elucidating an etiologic diagnosis for common neurological conditions. The objective of the current study was to examine child neurologists' perspectives and insights into genetic testing. We surveyed 118 Spanish child neurologists, exploring their knowledge, attitudes, and practices concerning genetic tests. All of them had requested at least one genetic test in the past six months. Global developmental delay or intellectual disability in absence of a strong specific etiologic suspicion and autism spectrum disorders were the disorders for which genetic testing was most frequently requested. The most commonly requested genetic test was CGH-array. Overall, child neurologist perception of readiness for making genetic-related decisions was not bad, although many would like to have a greater support from geneticists and were interested in increasing the time dedicated to genetics within their continuing education program. These data have important implications for future practice, research, and education.
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Affiliation(s)
- J Domínguez-Carral
- Department of Pediatrics, Hospital Universitario de Torrejón, Madrid, Spain
| | - J López-Pisón
- Department of Pediatric Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Macaya
- Department of Pediatric Neurology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - M Bueno Campaña
- Department of Pediatrics, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - M A García-Pérez
- Department of Pediatrics, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - D Natera-de Benito
- Department of Pediatrics, Hospital Universitario de Fuenlabrada, Madrid, Spain.
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van Nimwegen KJM, Schieving JH, Willemsen MAAP, Veltman JA, van der Burg S, van der Wilt GJ, Grutters JPC. The diagnostic pathway in complex paediatric neurology: a cost analysis. Eur J Paediatr Neurol 2015; 19:233-9. [PMID: 25604808 DOI: 10.1016/j.ejpn.2014.12.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The diagnostic trajectory of complex paediatric neurology may be long, burdensome, and expensive while its diagnostic yield is frequently modest. Improvement in this trajectory is desirable and might be achieved by innovations such as whole exome sequencing. In order to explore the consequences of implementing them, it is important to map the current pathway. To that end, this study assessed the healthcare resource use and associated costs in this diagnostic trajectory in the Netherlands. METHODS Fifty patients presenting with complex paediatric neurological disorders of a suspected genetic origin were included between September 2011 and March 2012. Data on their healthcare resource utilization were collected from the hospital medical charts. Unit prices were obtained from the Dutch Healthcare Authority, the Dutch Healthcare Insurance Board, and the financial administration of the hospital. Bootstrap simulations were performed to determine mean quantities and costs. RESULTS The mean duration of the diagnostic trajectory was 40 months. A diagnosis was established in 6% of the patients. On average, patients made 16 physician visits, underwent four imaging and two neurophysiologic tests, and had eight genetic and 16 other tests. Mean bootstrapped costs per patient amounted to €12,475, of which 43% was for genetic tests (€5,321) and 25% for hospital visits (€3,112). CONCLUSION Currently, the diagnostic trajectories of paediatric patients who have complex neurological disease with a strong suspected genetic component are lengthy, resource-intensive, and low-yield. The data from this study provide a backdrop against which the introduction of novel techniques such as whole exome sequencing should be evaluated.
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Affiliation(s)
- K J M van Nimwegen
- Radboud University Medical Center, Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - J H Schieving
- Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands.
| | - M A A P Willemsen
- Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands.
| | - J A Veltman
- Radboud University Medical Center, Department of Genetics, Nijmegen, The Netherlands.
| | - S van der Burg
- Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, The Netherlands.
| | - G J van der Wilt
- Radboud University Medical Center, Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - J P C Grutters
- Radboud University Medical Center, Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
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Abstract
Hereditary neurological disorders (HNDs) are relatively common in children compared to those occurring in adulthood. Recognising clinical manifestations of HNDs is important for the selection of genetic testing, genetic testing results interpretation, and genetic consultation. Meanwhile, advances in next generation sequencing (NGS) technologies have significantly enabled the discovery of genetic causes of HNDs and also challenge paediatricians on applying genetic investigation. Combination of both clinical information and advanced technologies will enhance the genetic test yields in clinical setting. This review summarises the clinical presentations as well as genetic causes of paediatric neurological disorders in four major areas including movement disorders, neuropsychiatric disorders, neuron peripheral disorders and epilepsy. The aim of this review is to help paediatric neurologists not only to see the clinical features but also the complex genetic aspect of HNDs in order to utilise genetic investigation confidently in their clinical practice. A smooth transition from research based to clinical use of comprehensive genetic testing in HNDs in children could be foreseen in the near future while genetic testing, genetic counselling and genetic data interpretation are in place appropriately.
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Affiliation(s)
- Yue Huang
- 1 Neuroscience Research Australia & the University of New South Wales, NSW, 2031, Australia ; 2 Department of Genetic Medicine, SA Pathology at Women's and Children's Hospital, North Adelaide, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia ; 3 Cytogenetics Department, Western Sydney Genetics Program, Children's Hospital at Westmead, NSW, 2145, Australia ; 4 Department of Neurology, Xiangya Hospital, Central South University & National Laboratory of Medical Genetics of China, Changsha 410000, China
| | - Sui Yu
- 1 Neuroscience Research Australia & the University of New South Wales, NSW, 2031, Australia ; 2 Department of Genetic Medicine, SA Pathology at Women's and Children's Hospital, North Adelaide, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia ; 3 Cytogenetics Department, Western Sydney Genetics Program, Children's Hospital at Westmead, NSW, 2145, Australia ; 4 Department of Neurology, Xiangya Hospital, Central South University & National Laboratory of Medical Genetics of China, Changsha 410000, China
| | - Zhanhe Wu
- 1 Neuroscience Research Australia & the University of New South Wales, NSW, 2031, Australia ; 2 Department of Genetic Medicine, SA Pathology at Women's and Children's Hospital, North Adelaide, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia ; 3 Cytogenetics Department, Western Sydney Genetics Program, Children's Hospital at Westmead, NSW, 2145, Australia ; 4 Department of Neurology, Xiangya Hospital, Central South University & National Laboratory of Medical Genetics of China, Changsha 410000, China
| | - Beisha Tang
- 1 Neuroscience Research Australia & the University of New South Wales, NSW, 2031, Australia ; 2 Department of Genetic Medicine, SA Pathology at Women's and Children's Hospital, North Adelaide, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia ; 3 Cytogenetics Department, Western Sydney Genetics Program, Children's Hospital at Westmead, NSW, 2145, Australia ; 4 Department of Neurology, Xiangya Hospital, Central South University & National Laboratory of Medical Genetics of China, Changsha 410000, China
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