1
|
Mann L, VanLooy L. The impact of amplification on quality of life in women with Turner syndrome. Orphanet J Rare Dis 2024; 19:119. [PMID: 38481335 PMCID: PMC10938653 DOI: 10.1186/s13023-024-03122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Individuals with Turner syndrome (TS, ORPHA 881) experience barriers in communication throughout life as they navigate both early conductive, and progressive sensorineural hearing loss amid other healthcare needs. Hearing loss is self-identified as one of the largest unmet healthcare needs. PURPOSE The purpose of this study was to investigate the impact of treatment for hearing loss on communication confidence and quality of life measures for individuals with TS. RESEARCH DESIGN We employed a prospective cross-sectional study design that included both online survey data and audiometric data for a subset of participants. STUDY SAMPLE We recruited 179 adults with TS at the Turner Syndrome Society of the United States (TSSUS) Conference, and through a variety of regional TS organizations' social media platforms. Audiological data was collected onsite at the conference for a subset of 67 participants; 8 of which who were followed after receiving subsequent treatment with hearing aids. DATA COLLECTION AND ANALYSIS The online survey design included demographic questions, the Communication Confidence Profile (CCP), and the RAND 36-Item Health Survey 1.0. Audiometric data included tympanometry, puretone air, and puretone bone conduction thresholds. Descriptive statistics, parametric, and non-parametric tests were used to analyze both survey and audiometric data. RESULTS 74% of participants had a self-reported diagnosis of hearing loss, of which 61% were previously recommended amplification. Only 38% of participants reported using hearing aids. For those participants who wore hearing aids, Total CCP Score, 'Confidence in Ability to Hear Under Various Conditions', and 'Energy/Vitality' metrics were significantly greater than those with untreated hearing loss warranting a hearing aid. Collectively, Total CCP Score and 'Confidence in Ability to Hear Under Various Conditions' increased significantly when participants were fit with hearing aids. CONCLUSION The results support previous data where hearing loss is a self-identified healthcare concern among women with Turner syndrome, yet many fail to receive appropriate hearing evaluation or treatment. Additionally, the use of hearing aids may improve communication confidence and quality of life in women with Turner syndrome. Furthermore, this study confirms the need for long-term audiological care and monitoring in women with Turner syndrome.
Collapse
Affiliation(s)
- Lauren Mann
- University of Kansas Medical Center, 3901 Rainbow Blvd MS 3047, 66160, Kansas City, KS, USA.
| | - Lindsey VanLooy
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Karam PE, Hamad L, Elsherif M, Kreidieh K, Nakouzi G, El Asmar K, Kabakian-Khasholian T, Curi DA, Yazbek SN. Genetic literacy among primary care physicians in a resource-constrained setting. BMC MEDICAL EDUCATION 2024; 24:140. [PMID: 38350948 PMCID: PMC10863164 DOI: 10.1186/s12909-024-05110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Genetic literacy among primary healthcare providers is crucial for appropriate patient care with the advances in genetic and genomic medicine. Studies from high-income countries highlight the lack of knowledge in genetics and the need to develop curricula for continuing professional development of non-geneticists. Scarce data is available from resource-constrained countries in Middle East and North Africa. Lebanon is a small country in this region characterized by high rates of consanguinity and genetic disorders like several surrounding countries, such as Jordan, Syria, and Turkey. METHODS The primary aim of this study assessed the genetic literacy, self-perceived and actual knowledge as well as practices among primary care providers in Lebanon. The secondary aim identified their educational needs and proposed evidence-based continuing education programs. A cross-sectional survey-based study, using a self-administered questionnaire, was conducted targeting physicians from Family Medicine, Obstetrics and Gynecology, and Pediatrics. The questionnaire was divided into five sections: demographics, familiarity with genetic tests, self-reported and actual knowledge, genetic practices, and educational needs. Statistics were performed using SPSS v24. The Chi-square test was used for independent variables. Differences between mean scores were measured using paired sample t-tests for groups of two levels and one-way ANOVA for more than two. Multiple linear regression was used to study the variables associated with the knowledge score while controlling for other variables. RESULTS The survey included 123 physicians. They were mostly familiar with karyotype as first-tier genetic test. Although 38% perceived their knowledge as good, only 6% scored as such in knowledge assessment. A better knowledge score was observed in academic institutions as well as in urban settings (p<0.05). One third never ordered any genetic testing, mostly due to poor knowledge. Almost all (98%) were ready to attend continuing professional development sessions in genetics. CONCLUSION Our findings show the need to improve genetic literacy among healthcare frontliners, focusing on remote regions and nonacademic centers in Lebanon, a model for other resource-constrained country in the Middle East and North Africa region. This study advances recommendations for evidence-based genetic continuing education programs and highlighted the role of that the few genetic specialists can play in their successful implementation.
Collapse
Affiliation(s)
- Pascale E Karam
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Elsherif
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghunwa Nakouzi
- Hudson Alpha Clinical Services Lab, LLC, Huntsville, AL, USA
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dany Assaf Curi
- Department of Pediatrics, Division of Hematology and Oncology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Soha N Yazbek
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
3
|
Wang A, Little ID, Carter D, Pham S, Piper M, Ramírez-Renta GM, Telaak S, Gunter C. Provider-reported experiences, barriers, and perspectives on genetic testing as part of autism diagnosis. PLoS One 2024; 19:e0296942. [PMID: 38315653 PMCID: PMC10843127 DOI: 10.1371/journal.pone.0296942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Several professional organizations recommend conducting genetic testing as part of the autism diagnosis process, as it can provide additional information and benefits for autistic people and their families. However, there is disagreement among autism communities about whether genetic testing reflects autistic people's best interests. In practice, rates of clinical genetic testing for autism are much lower than diagnoses, creating a large gap between clinical guidelines and real clinical encounters. To investigate one potential source of this gap, we interviewed 14 healthcare providers about the autism diagnostic process and their actions related to autism genetic testing. We recruited a sample of primarily Ph.D. level-psychologists and analyzed our qualitative data using a five-step framework analysis method. Participants generally had positive or mixed views of genetic testing in autism. They described their current experiences of implementation of genetic testing, including that they did not often find it changed their clinical practice. Only some providers recommended it to everyone receiving an autism diagnosis. They also listed factors which discourage families from getting testing, including high costs, families feeling overwhelmed, other support needs taking priority, and ethical implications. Notably, providers highlighted a trend of referring patients to research genetic testing rather than clinical testing, which may provide a cheaper and easier alternative but is not likely to return results to participants. Finally, participants felt they needed more training in genetics and listed specific topics of uncertainty. Our research highlights a need to further educate clinicians in the uses and limitations of genetic testing for autism and suggests content areas of focus for genetics educators.
Collapse
Affiliation(s)
- Amy Wang
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, Maryland, United States of America
| | - India D. Little
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, Maryland, United States of America
| | - Dennis Carter
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, United States of America
| | - Stephanie Pham
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, United States of America
| | - Madeline Piper
- Johns Hopkins University and National Institutes of Health, Genetic Counseling Training Program, Baltimore, Maryland, United States of America
| | - Gabriela M. Ramírez-Renta
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, Maryland, United States of America
| | - Sydney Telaak
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, Maryland, United States of America
| | - Chris Gunter
- National Human Genome Research Institute, Social and Behavioral Research Branch, Bethesda, Maryland, United States of America
- National Human Genome Research Institute, Bethesda, Maryland, United States of America
| |
Collapse
|
4
|
Lane AS, Lynch KE, Arnold M, Dar-Nimrod I, Morandini J, Gawronski SA, Griffiths PE. The undue influence of genetic information on senior medical students' treatment decisions. BMC MEDICAL EDUCATION 2023; 23:938. [PMID: 38066555 PMCID: PMC10709879 DOI: 10.1186/s12909-023-04895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Knowledge of the genetic basis of health conditions can influence how the public perceives their own and others' health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making. METHODS Senior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 - a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students' responses. RESULTS Management recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students' good understanding of the common non-deterministic nature of genes, such as HLADQ2. CONCLUSION Differences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students' decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.
Collapse
Affiliation(s)
- Andrew Stuart Lane
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Kate E Lynch
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Department of History and Philosophy of Science, The University of Melbourne, Victoria, 3010, Australia
| | - Mark Arnold
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Western New South Wales Health District, Dubbo, NSW, 2830, Australia
| | - Ilan Dar-Nimrod
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - James Morandini
- School of Psychology, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Stefan A Gawronski
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
- School of History of Philosophy of Science, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Paul E Griffiths
- Department of Philosophy, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, 2006, Australia
| |
Collapse
|
5
|
Arshad M, Trepanier A, Hashmi SS, Naeem R, Mehmood S, Ashfaq M. Medical students' self-perceived knowledge and clinical comfort with genetics in Pakistan. J Genet Couns 2023. [PMID: 37960989 DOI: 10.1002/jgc4.1828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
Pakistan has a high rate of genetic disorders and neonatal mortality concurrent with noted lack of genetic counselors and geneticists. To meet the needs of the patient population, the responsibility of providing clinical genetic services falls on general and specialty physicians. However, their education regarding these essential services is not standardized in medical school curricula nor has it ever been evaluated. The purpose of this work is to describe the self-perceived knowledge, clinical comfort, and perspectives of Pakistani medical students toward their medical genetics' education. A web-based survey was distributed electronically to medical schools around the country. The survey comprised of four sections: (1) participant demographics, (2) self-perceived medical genetics knowledge, (3) level of comfort in applying genetic knowledge and skills, and (4) attitudes toward medical genetics education. Descriptive statistics and a one-way analysis of variance were used for data analysis. Medical students in years 3, 4, and 5 (n = 473) from 25 medical schools participated in this research representing medical education in four Pakistani provinces. Most medical students reported "minimal" to "basic" knowledge of genetic testing methodology (64.7%), cancer genetics (64.9%), prenatal genetic testing (63.02%), and treatment strategies for genetic disease (72.9%). A plurality of students (37%) reported they were uncomfortable with interpreting and communicating genetic test results to patients. Medical students also expressed dissatisfaction with their medical genetics (40%) and genetic counselors training (42%). The self-perceived knowledge and clinical comfort with genetics among Pakistani medical students was limited, especially regarding genetic testing. A significant portion (74.5%) expressed desire for additional genetics education during medical school to aid in their role as future physicians. It is important for physicians-in-training to have a solid understanding of genetic concepts, technologies, and genetic counseling to best support their patients. As endorsed by the participating medical students, this study supports inclusion of more robust genetics' education into Pakistan's medical school curricula.
Collapse
Affiliation(s)
- Maheen Arshad
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | - Angela Trepanier
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, Detroit, Michigan, USA
| | - S Shahrukh Hashmi
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Rizwan Naeem
- Albert Einstein College of Medicine, New York City, New York, USA
| | - Saqib Mehmood
- University of Health Sciences, Lahore, Punjab, Pakistan
| | - Myla Ashfaq
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas, USA
| |
Collapse
|
6
|
Kudron EL, Deininger KM, Aquilante CL. Are Graduate Medical Trainees Prepared for the Personalized Genomic Medicine Revolution? Trainee Perspectives at One Institution. J Pers Med 2023; 13:1025. [PMID: 37511638 PMCID: PMC10381337 DOI: 10.3390/jpm13071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Although the use of genomics to inform clinical care is increasing, clinicians feel underprepared to integrate personalized medicine (PM) into care decisions. The educational needs of physician residents and fellows, also known as graduate medical trainees (GMTs), have been overlooked. We administered an anonymous, web-based survey to all GMTs participating in training programs affiliated with our institution to evaluate their knowledge, skills, and attitudes toward PM. Of the 1190 GMTs contacted, 319 (26.8%) returned surveys. Most (88.4%) respondents reported receiving PM education in the past. Although the respondents agreed that knowledge of disease genetics (80.9%) or pharmacogenetics (87.1%) would likely lead to improved clinical outcomes, only 33.2% of the respondents felt sufficiently informed about PM. The respondents who had received PM education in residency and/or fellowship had significantly higher self-reported knowledge, ability, awareness, and adoption of PM than those who had not received this education (p < 0.0001, p < 0.0001, p < 0.0001, and p < 0.01, respectively). Targeted training is needed to improve GMTs' confidence in interpreting and explaining genetic test results. The ideal timing for this education appears to be in residency and/or fellowship rather than in medical school.
Collapse
Affiliation(s)
- Elizabeth L Kudron
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kimberly M Deininger
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Christina L Aquilante
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, USA
| |
Collapse
|
7
|
Little ID, Koehly LM, Gunter C. Understanding changes in genetic literacy over time and in genetic research participants. Am J Hum Genet 2022; 109:2141-2151. [PMID: 36417915 PMCID: PMC9748356 DOI: 10.1016/j.ajhg.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
As genomic and personalized medicine becomes mainstream, assessing and understanding the public's genetic literacy is paramount. Because genetic research drives innovation and involves much of the public, it is equally important to assess its impact on genetic literacy. We designed a survey to assess genetic literacy in three ways (familiarity, knowledge, and skills) and distributed it to two distinct samples: 2,050 members of the general population and 2,023 individuals currently enrolled in a large-scale genetic research study. We compared these data to a similar survey implemented in 2013. The results indicate that familiarity with basic genetic terms in 2021 (M = 5.36 [range 1-7], p < 0.001) and knowledge of genetic concepts in 2021 (M = 9.06 [56.6% correct], p = 0.002) are significantly higher compared to 2013 (familiarity: M = 5.08 [range 1-7]; knowledge: M = 8.72 [54.5% correct]). Those currently enrolled in a genetic study were also significantly more familiar with genetic terms (M = 5.79 [range 1-7], p < 0.001) and more knowledgeable of genetic concepts (M = 10.57 [66.1% correct], p < 0.001), and they scored higher in skills (M = 3.57 [59.5% correct], p < 0.001) than the general population (M = 5.36 [range 1-7]; M = 9.06 [56.6% correct]; M = 2.65 [44.2% correct]). The results suggest that genetic literacy is improving over time, with room for improvement. We conclude that educational interventions are needed to ensure familiarity with and comprehension of basic genetic concepts and suggest further exploration of the impact of genetic research participation on genetic literacy to determine mechanisms for potential interventions.
Collapse
Affiliation(s)
- India D Little
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Chris Gunter
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD 20892, USA; Office of the Director, National Human Genome Research Institute, Bethesda, MD 20892, USA.
| |
Collapse
|
8
|
Dalavaye N. A Response to "Assessing Medical Students' Knowledge of Genetics: Basis for Improving Genetics Curriculum for Future Clinical Practice" [Letter]. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:121-122. [PMID: 35153526 PMCID: PMC8824752 DOI: 10.2147/amep.s356986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
|