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A new era of genetic testing in congenital heart disease: A review. Trends Cardiovasc Med 2021; 32:311-319. [PMID: 33964404 DOI: 10.1016/j.tcm.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/07/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022]
Abstract
Genetic and genomic testing in pediatric CHD is becoming increasingly routine, and can have important psychosocial, clinical and reproductive implications. In this paper we highlight important challenges and considerations when providing genetics consults and testing in pediatric CHD and illustrate the role of a dedicated CHD genetics clinic. Key lessons include that a) a genetic diagnosis can have clinical utility that justifies testing early in life, b) adequate genetic counselling is crucial to ensure families are supported, understand the range of possible results, and are prepared for new or unexpected health information, and c) further integration of the clinical genetics and cardiology workflows will be required to effectively manage the burgeoning information arising from genetic testing. Our experience demonstrates that a dedicated CHD genetics clinic is a valuable addition to a multidisciplinary team providing care to children with CHD.
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Erskine KE, Griffith E, Degroat N, Stolerman M, Silverstein LB, Hidayatallah N, Wasserman D, Paljevic E, Cohen L, Walsh CA, McDonald T, Marion RW, Dolan SM. An interdisciplinary approach to personalized medicine: case studies from a cardiogenetics clinic. Per Med 2013; 10:73-80. [PMID: 24496296 DOI: 10.2217/pme.12.108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the genomic age, the challenges presented by various inherited conditions present a compelling argument for an interdisciplinary model of care. Cardiac arrhythmias with a genetic basis, such as long QT syndrome, require clinicians with expertise in many specialties to address the complex genetic, psychological, ethical and medical issues involved in treatment. The Montefiore-Einstein Center for CardioGenetics has been established to provide personalized, interdisciplinary care for families with a history of sudden cardiac death or an acute cardiac event. Four vignettes of patient care are presented to illustrate the unique capacity of an interdisciplinary model to address genetic, psychological, ethical and medical issues. Because interdisciplinary clinics facilitate collaboration among multiple specialties, they allow for individualized, comprehensive care to be delivered to families who experience complex inherited medical conditions. As the genetic basis of many complex conditions is discovered, the advantages of an interdisciplinary approach for delivering personalized medicine will become more evident.
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Affiliation(s)
- Kathleen E Erskine
- Department of Obstetrics & Gynecology & Women's Health, Division of Reproductive Genetics, Albert Einstein College of Medicine/Montefiore Medical Center, 1695 Eastchester Road, Suite 301, Bronx, NY, USA
| | - Eleanor Griffith
- University OBGYN Associates, Ambulatory Care Center, C1673, UMDNJ, 140 Bergen Street, Newark, NJ 07103, USA
| | - Nicole Degroat
- Department of Obstetrics & Gynecology & Women's Health, Division of Reproductive Genetics, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Mazer 632, Bronx, NY, USA
| | - Marina Stolerman
- Private Practice, 425 E 86th Street, Suite 1A, New York, NY, USA
| | - Louise B Silverstein
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Nadia Hidayatallah
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, USA
| | - David Wasserman
- Center for Ethics at Yeshiva University, 500 W 185th Street, New York, NY, USA
| | - Esma Paljevic
- Pediatric Heart Center, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, USA
| | - Lilian Cohen
- Division of Medical Genetics, Weill Cornell Medical College/New York Presbyterian Hospital, 505 East 70th Street, Helmsley Tower, 3rd Floor, New York, NY, USA
| | - Christine A Walsh
- Pediatric Dysrhythmia Center, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, USA
| | - Thomas McDonald
- Departments of Medicine/Cardiology & Molecular Pharmacology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Forchheimer G35, Bronx, NY, USA
| | - Robert W Marion
- Divisions of Developmental Medicine & Genetics, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, USA
| | - Siobhan M Dolan
- Department of Obstetrics & Gynecology & Women's Health, Division of Reproductive Genetics, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Mazer 634, Bronx, NY 10461 USA
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Mendes A, Chiquelho R, Santos TA, Sousa L. Family matters: examining a multi-family group intervention for women with BRCA mutations in the scope of genetic counselling. J Community Genet 2010; 1:161-8. [PMID: 22460298 DOI: 10.1007/s12687-010-0022-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/24/2010] [Indexed: 11/27/2022] Open
Abstract
The availability of family-centred services for women genetically at-risk for breast and ovarian cancer (BRCA) due to deleterious genetic mutations is still scarce, despite the distress that these women and their families may experience. This study describes a multi-family group intervention for women who tested positive for BRCA mutations and their families. Methods include a time-limited psycho-educational programme involving educational and support components and consisting of four semi-structured multi-family sessions. Three families (a total of nine people) attended the programme in genetic counselling for hereditary cancers at a Portuguese public hospital. A focus group interview was performed 1 month after the last session to assess both the practical and the psychosocial impacts and to collect suggestions from participants. The present paper focuses on the practical aspects of the intervention, its development and its evaluation. Participants reported that the programme is well-structured and that responds to the needs of patients and their families by improving coping skills and medical awareness in the adaptation to genetic illness. Results reinforce the need to integrate psychosocial and family-oriented interventions in genetic counselling, addressing the holistic experience of hereditary disease. Recommendations for enhancing the services available are provided. The multi-family discussion group, combining educative and supportive services with a family focus, can be successfully adapted in genetic counselling protocols.
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Affiliation(s)
- Alvaro Mendes
- Health, Family and Community Research Group, Department of Health Sciences, University of Aveiro, Santiago University Campus, 3810-093, Aveiro, Portugal,
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