Balanced information about Down syndrome: what is essential?

The purpose of this study was to explore the perspectives of genetic counselors and parents of children with Down syndrome to define essential information for the initial discussion of a new diagnosis. We compared information given in both prenatal and postnatal settings, and also aimed to distinguish differences between the informational needs of parents and the information genetic counselors provide. Online surveys were distributed to members of the National Down Syndrome Congress, National Down Syndrome Society, and National Society of Genetic Counselors. Participants included 993 parents of children with Down syndrome and 389 genetic counselors. Participants rated 100 informational features about Down syndrome as Essential, Important, or Not Too Important for inclusion in the first discussion of the diagnosis. Responses identified 34 essential informational items for the initial discussion of Down syndrome, including clinical features, developmental abilities, a range of prognostications, and informational resources. Healthcare providers should consider incorporating these items in their initial discussion of a diagnosis in both prenatal and postnatal settings. Statistically significant differences between parent and genetic counselor responses illustrate that information is valued differently and that parents appreciate information about the abilities and potential of people with Down syndrome, as opposed to clinical details. Balancing clinical information with other aspects of the condition, as well as a better understanding of the information parents consider most important, may enable healthcare professionals to more effectively satisfy families' informational needs following a new diagnosis of Down syndrome.

Practice guidelines for communicating a prenatal or postnatal diagnosis of Down syndrome: recommendations of the national society of genetic counselors.

Down syndrome is one of the most common conditions encountered in the genetics clinic. Due to improvements in healthcare, educational opportunities, and community inclusion over the past 30 years, the life expectancy and quality of life for individuals with Down syndrome have significantly improved. As prenatal screening and diagnostic techniques have become more enhanced and widely available, genetic counselors can expect to frequently provide information and support following a new diagnosis of Down syndrome. This guideline was written for genetic counselors and other healthcare providers regarding the communication of a diagnosis of Down syndrome to ensure that families are consistently given up-to-date and balanced information about the condition, delivered in a supportive and respectful manner.

Algorithm for the early diagnosis and treatment of patients with cross reactive immunologic material-negative classic infantile pompe disease: a step towards improving the efficacy of ERT.

OBJECTIVE: Although enzyme replacement therapy (ERT) is a highly effective therapy, CRIM-negative (CN) infantile Pompe disease (IPD) patients typically mount a strong immune response which abrogates the efficacy of ERT, resulting in clinical decline and death. This study was designed to demonstrate that immune tolerance induction (ITI) prevents or diminishes the development of antibody titers, resulting in a better clinical outcome compared to CN IPD patients treated with ERT monotherapy. METHODS: We evaluated the safety, efficacy and feasibility of a clinical algorithm designed to accurately identify CN IPD patients and minimize delays between CRIM status determination and initiation of an ITI regimen (combination of rituximab, methotrexate and IVIG) concurrent with ERT. Clinical and laboratory data including measures of efficacy analysis for response to ERT were analyzed and compared to CN IPD patients treated with ERT monotherapy. RESULTS: Seven CN IPD patients were identified and started on the ITI regimen concurrent with ERT. Median time from diagnosis of CN status to commencement of ERT and ITI was 0.5 months (range: 0.1-1.6 months). At baseline, all patients had significant cardiomyopathy and all but one required respiratory support. The ITI regimen was safely tolerated in all seven cases. Four patients never seroconverted and remained antibody-free. One patient died from respiratory failure. Two patients required another course of the ITI regimen. In addition to their clinical improvement, the antibody titers observed in these patients were much lower than those seen in ERT monotherapy treated CN patients. CONCLUSIONS: The ITI regimen appears safe and efficacious and holds promise in altering the natural history of CN IPD by increasing ERT efficacy. An algorithm such as this substantiates the benefits of accelerated diagnosis and management of CN IPD patients, thus, further supporting the importance of early identification and treatment initiation with newborn screening for IPD.

Información equilibrada sobre el síndrome de Down: ¿Qué es lo esencial? / No disponible

El artículo explora las perspectivas de los consejeros genéticos y de los padres para establecer un consenso general sobre cuál puede ser la información esencial que se debe suministrar a los padres en esa entrevista clave en la que se expone el síndrome de Down, sea en el diagnóstico prenatal o postnatal. Se comparan las perspectivas sobre la información suministrada en ambas situaciones de diagnóstico prenatal y postnatal, y trata de distinguir entre las necesidades informativas de los padres y la información que los consejeros genéticos ofrecen. Muestra treinta y cuatro puntos que pueden ser considerados como esenciales, sobre los que puede existir un consenso, si bien la importancia de cada punto varía en función del origen: padre o consejero genético (AU)

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Información equilibrada sobre el síndrome de Down: ¿Qué es lo esencial? / No disponible

El objeto de este estudio fue explorar las perspectivas de los consejeros genéticos y de los padres de niños con síndrome de Down, para establecer cuál ha de ser la información esencial en una exposición inicial ante un nuevo diagnóstico. Comparamos la información proporcionada en situaciones prenatales y postnatales, e intentamos también distinguir las diferencias entre las necesidades informativas de los padres y la información que ofrecen los consejeros genéticos. Se distribuyeron encuestas on line a miembros del National Down Syndrome Congress, National Down Syndrome Society, y National Sciety of Genetic Counselors. Participaron 993 padres y 389 consejeros genéticos. Los participantes clasificaron 100 aspectos informativos sobre el síndrome de Down como Esenciales, Importantes o No Demasiado Importantes como elementos o temas a incluir en la conversación o entrevista en el momento del diagnóstico. Las respuestas identificaron 34 ítems informativos como esenciales en esa primera discusión sobre el con síndrome de Down, lo que incluía características clínicas, habilidades del desarrollo, todo un espectro de datos pronósticos, y fuentes informativas. El personal sanitario debería considerar el incorporar estos temas en su conversación inicial sobre el diagnóstico, sea prenatal o postnatal. Hubo diferencias estadísticamente significativas entre las respuestas de los padres y de los consejeros genéticos, lo que ilustra que la información es valorada de manera diferente, y que los padres aprecian la información sobre las habilidades y el potencial de las personas con síndrome de Down más que los detalles clínicos. Equilibrar la información clínica con otros aspectos sobre el con síndrome de Down, así como comprender mejor la información que los padres consideran más relevante ante un nuevo diagnóstico, hará que el personal sanitario satisfaga las necesidades informativas de las familias de forma más eficiente (AU)

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