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Genetic associates/counselors in genetics services.

A survey of US directors of genetic services showed that about 38% of the non-physician professionals providing such are genetic associates/counselors (GAs). Over 90% of GAs appear to be involved in direct human services, rather than in the performance of laboratory procedures or research. Although they wanted GAs to be competent in communication and inter-personal skills, counseling, and community education, employers and potential employers tended to rank a background preparation in and knowledge of psychosocial principles relatively less important than a knowledge of biological principles. The possible consequences of these attitudes are discussed in light of the fact that GAs represent a new profession which is still evolving and struggling to define its professional role in genetic services. Despite some role ambiguities, employers familiar with their work expressed a strong vote of confidence in these professionals.

Evaluation Studies as Topic↗

Assessment of the scientific basis for genetic testing of railroad workers with carpal tunnel syndrome.

In 2000, approximately 20 railroad track workers who filed injury reports or compensation claims for carpal tunnel syndrome were tested by their employer for two genetic traits to determine the work relatedness of the condition. The testing involved deletions, variants, or mutations in the genetic coding for peripheral myelin protein (PMP22) and transthyretin (TTR). This article is an assessment of whether there is a scientific basis for such testing. A review of the scientific literature indicated that neither the scientific basis nor the population validity of the PMP22 or TTR tests for carpal tunnel syndrome were adequately established before use on railroad track workers in 2000. Although ethical and legal issues may predominate in this case, the absence of a compelling scientific basis undermines the decision to conduct the tests.

Carpal Tunnel Syndrome↗

Translating evidence into practice: Developing Canada's first position statement on genomics-informed oncology nursing.

The integration of genomics in oncology care is accelerating in Canada, presenting new opportunities for nurses to improve cancer outcomes through enhanced screening, diagnosis, and targeted therapies. However, nurses have identified that they require policy guidance to clarify their roles and responsibilities as members of interprofessional teams delivering genomic services. In response, the Canadian Nursing and Genomics Initiative, in collaboration with the Canadian Association of Nursing in Oncology/Association Canadienne des Infirmières et Infirmiers en Oncologie, and an interdisciplinary working group developed the first pan-Canadian position statement to guide genomics-informed oncology nursing practice. To support further engagement and use of the position statement, we outline the rationale for developing the position statement and the role of position statements in supporting nursing practice and innovation in genomics-informed oncology nursing. We describe the governance structure and co-design methodology that facilitated its collaborative interdisciplinary development, and how this approach is critical for nursing advocacy, integrated knowledge translation, and ongoing engagement. Finally, we offer recommendations for oncology nurses to translate the position statement into practice changes. This position statement is a preliminary step toward advancing genomics integration in cancer care and ensuring nursing practice remains at the forefront of innovation.

genetics↗

The physician workforce: a medical school dilemma.

Richard Cooper has advanced a projection of a sizable deficit in physicians in the United States, requiring the training of as many as 10,000 additional physicians annually by the year 2025. He questions the ability of U.S. medical schools to "fill the gap." This challenge presents another important dilemma for medical education. Could the applicant pool be enlarged sufficiently to increase qualified applicants? Would medical schools be able to accommodate this increase in students? The impact of these increases could be an ultimate decrease in the quality of health care and the production of physicians who are not current with research findings, particularly in the area of genetics.

Forecasting↗

Child neurology: workforce and practice characteristics.

For more than a decade, reports have indicated that the supply of child neurologists is inadequate to provide care for the growing number of children with acquired and genetic neurological conditions. It is critical to understand how the shortages affect the practice of child neurology, the attitudes of child neurologists, and ability of the field to attract new members. This Issue Brief examines these workforce issues, and profiles the attitudes and practice characteristics of child neurologists and trainees.

Appointments and Schedules↗

Clinicians who provide abortions: the thinning ranks.

Access to abortion services in the United States has become increasingly limited because of a decrease in rural hospital providers and a growing shortage of clinicians willing to offer this service. As of 1988, 83% of United States counties had no identified provider. The deficit in numbers of clinicians stems from the current imbalance between incentives and disincentives. The single most powerful incentive appears to be altruism. On the other hand, disincentives include poor pay, frequent harassment, low prestige, suboptimal working conditions, and tedium. In 1990 a symposium on abortion provision was held, sponsored by the National Abortion Federation and ACOG. Among the remedies suggested by the attendees were increasing the integration of abortion training into the mainstream of residency education, improving the pay and work environments for clinicians, and where feasible expanding the capacity of physician providers by using midlevel practitioners working under physician supervision.

Abortion, Induced↗