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Genetic counseling in Korean health care system (유전상담의 제도적인 고찰)

  • Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.4 no.1
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    • pp.1-5
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    • 2007
  • Unprecedented amount of genetic information being generated from the result of Human Genome Project (HGP) and advances in genetic research is already forcing changes in the paradigm of health and disease. The ultimate goal of genetic medicine is to use genetic information and technology to develop new ways of treatment or even prevention of the disease on an individual level for 'personalized medicine'. Genetics is play ing an increasingly important role in the diagnosis, monitoring and management of common multifactorial diseases in addition to rare single-gene disorders. While wide range of genetic testing have provided benefits to patients and family, uncertainties surrounding test interpretation, the current lack of available medical options for the diseases, and risks for discrimination and social stigmatization may remain to be resolved. However an increasing number of genetic tests are becoming commercially available, including direct to consumer genetic testing, yet public is often unaw are of their clinical and social implications. The personal nature of information generated by a genetic test, its power to affect major life decisions and family members, and its potential misuse raise important ethical considerations. Therefore appropriate genetic counseling is needed for patient to be informed with the benefits, limitations and risks of genetic tests, prior to informed consent for the tests. Physician also should be familiar with the legal and ethical issues involved in genetic testing to tell patients how w ell a particular genetic risk factor relates with likelihood of disease, and be able to provide appropriate genetic counseling. Genetic counseling become a mandatory requirement as global standard for many genetic testing such as prenatal diagnosis, presymtomatic DNA diagnostic tests and cancer susceptibility gene test for familial cancer syndrome. In oder to meet the challenge of genetic medicine of 21 century in korean health care system, professional education program and certification board for medical genetics specialist including non-MD genetic counselors should be addressed by medical society and regulatory policy of national health insurance reimbursement for genetic counseling to be in place to promote the implementation of clinical genetic service including genetic counseling for proper genetic testing.

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Challenge of Personalized Medicine in the Genomic Era (유전의료시대의 "맞춤의학")

  • Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.5 no.2
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    • pp.89-93
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    • 2008
  • "Personalized medicine," the goal of which is to provide better clinical care by applying patient's own genomic information to their health care is a global challenge for the $21^{st}$ century "genomic era." This is especially true in Korea, where provisions for clinical genetic services are inadequate for the existing demand, let alone future demands. Genomics-based knowledge and tools make it possible to approach each patient as a unique biological individual, which has led to a paradigm-shift in medical practice, giving it more of a predictive focus as compared with current treatment oriented approach. With recent advancements in genomics, many genetic tests, such as susceptibility genetic tests, have been developed for both rare single gene diseases and more common multifactorial diseases. Indeed, genetic tests for presymtomatic individuals and genetic tests for drug response have become widely available, and personalized medicine will face the challenge of assisting patients who use such tests to make appropriate and wise use of genetic risk assessment. A major challenge of genomic medicine lies in understanding and communicating disease risk in order to facilitate and support patients and their families in making informed decisions. Establishment of a health care system with provisions for genetic counseling as an integral part of health care service, in addition to genomic literacy of health care providers, is vital to meet this growing challenge. Realization of the promise of personalized medicine in the era of genomics for improvement of health care is dependent on further development of next generation sequencing technology and affordable sequencing test costs. Also necessary will be policy development concerning the ethical, legal and social issues of genomic medicine and an educated and ready medical community with clinical practice guidelines for genetic counseling and genetic testing.

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Effect of Accreditation on Accuracy of Diagnostic Tests in Medical Laboratories

  • Jang, Mi-Ae;Yoon, Young Ahn;Song, Junghan;Kim, Jeong-Ho;Min, Won-Ki;Lee, Ji Sung;Lee, Yong-Wha;Lee, You Kyoung
    • Annals of Laboratory Medicine
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    • v.37 no.3
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    • pp.213-222
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    • 2017
  • Background: Medical laboratories play a central role in health care. Many laboratories are taking a more focused and stringent approach to quality system management. In Korea, laboratory standardization efforts undertaken by the Korean Laboratory Accreditation Program (KLAP) and the Korean External Quality Assessment Scheme (KEQAS) may have facilitated an improvement in laboratory performance, but there are no fundamental studies demonstrating that laboratory standardization is effective. We analyzed the results of the KEQAS to identify significant differences between laboratories with or without KLAP and to determine the impact of laboratory standardization on the accuracy of diagnostic tests. Methods: We analyzed KEQAS participant data on clinical chemistry tests such as albumin, ALT, AST, and glucose from 2010 to 2013. As a statistical parameter to assess performance bias between laboratories, we compared 4-yr variance index score (VIS) between the two groups with or without KLAP. Results: Compared with the group without KLAP, the group with KLAP exhibited significantly lower geometric means of 4-yr VIS for all clinical chemistry tests (P <0.0001); this difference justified a high level of confidence in standardized services provided by accredited laboratories. Confidence intervals for the mean of each test in the two groups (accredited and non-accredited) did not overlap, suggesting that the means of the groups are significantly different. Conclusions: These results confirmed that practice standardization is strongly associated with the accuracy of test results. Our study emphasizes the necessity of establishing a system for standardization of diagnostic testing.

Genetic Counseling in Korean Health Care System (한국 의료제도와 유전상담 서비스의 구축)

  • Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.8 no.2
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    • pp.89-99
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    • 2011
  • Over the years Korean health care system has improved in delivery of quality care to the general population for many areas of the health problems. The system is now being recognized in the world as the most cost effective one. It is covered by the uniform national health insurance policy for which most people in Korea are mandatory policy holders. Genetic counseling service, however, which is well recognized as an integral part of clinical genetics service deals with diagnosis and management of genetic condition as well as genetic information presentation and family support, is yet to be delivered in comprehensive way for the patients and families in need. Two major obstacles in providing genetic counseling service in korean health care system are identified; One is the lack of recognition for the need for genetic counseling service as necessary service by the national health insurance. Genetic counseling consumes a significant time in delivery and the current very low-fee schedule for physician service makes it very difficult to provide meaningful service. Second is the critical shortage of qualified professionals in the field of medical genetics and genetic counseling who can provide the service of genetic counseling in clinical setting. However, recognition and understanding of the fact that the scope and role of genetic counseling is expanding in post genomic era of personalized medicine for delivery of quality health care, will lead to the efforts to overcome obstacles in providing genetic counseling service in korean health care system. Only concerted efforts from health care policy makers of government on clinical genetics service and genetic counseling for establishing adequate reimbursement coverage and professional communities for developing educational program and certification process for professional genetic counselors, are necessary for the delivery of much needed clinical genetic counseling service in Korea.

Clinical Pharmacogenetic Testing and Application: Laboratory Medicine Clinical Practice Guidelines

  • Kim, Sollip;Yun, Yeo-Min;Chae, Hyo-Jin;Cho, Hyun-Jung;Ji, Misuk;Kim, In-Suk;Wee, Kyung-A;Lee, Woochang;Song, Sang Hoon;Woo, Hye In;Lee, Soo-Youn;Chun, Sail
    • Annals of Laboratory Medicine
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    • v.37 no.2
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    • pp.180-193
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    • 2017
  • Pharmacogenetic testing for clinical applications is steadily increasing. Correct and adequate use of pharmacogenetic tests is important to reduce unnecessary medical costs and adverse patient outcomes. This document contains recommended pharmacogenetic testing guidelines for clinical application, interpretation, and result reporting through a literature review and evidence-based expert opinions for the clinical pharmacogenetic testing covered by public medical insurance in Korea. This document aims to improve the utility of pharmacogenetic testing in routine clinical settings.

Genetic analysis of canine parvovirus vaccine strains in Korea

  • Yang, Dong-Kun;Kim, Byoung-Han;Kim, Yeon-Hee;Lee, Kyung-Woo;Choi, Sung-Suk;Son, Seong-Wan
    • Korean Journal of Veterinary Research
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    • v.49 no.3
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    • pp.243-248
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    • 2009
  • After the original identification of canine parvovirus (CPV) type 2 (CPV-2) in 1978, new antigenic variants such as CPV-2a, CPV-2b and CPV-2c have become widespread in the most countries. In this study, the genetic analysis of canine parvovirus was investigated in a total of 13 CPV vaccines, which have been licensed in Korea since late 1980s, and a field isolate of CPV from a dog with CPV infection clinical symptom. The partial VP2 gene of CPV was amplified and sequenced from 13 vaccine strains and one field isolate. The results showed that of the 13 vaccine strains, 10 strains belong to the CPV-2, 2 strains to CPV-2b, the remaining and one isolate to CPV-2a type, respectively. Several mutations of amino acids were detected at residues of the critical region of the commercial vaccine strains. These data suggest that new type of vaccines containing CPV-2a or CPV-2b/2c type may be required for the better prevention of new CPV infection in dog population in Korea, because CPV-2 contained in most licensed vaccines has been replaced by antigenic variants designated CPV-2a or CPV-2b/c in the worldwide dog population.

National survey for genetic counseling and demands for professional genetic counselor (유전상담과 전문 유전상담사 수요에 대한 전국적인 조사)

  • Chung, Yoon-Sok;Kim, Sook-Ryung;Choi, Ji-Young;Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.4 no.2
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    • pp.167-178
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    • 2007
  • Purpose : The necessity of professional non-MD genetic counselor has been recently emphasized in a medical field. By conducting a national survey on the demands for generic counseling and professional non-MD generic counselor, we can make a long-term master plan to execute the educational program for professional genetic counselors and indeed promote genetic counseling in Korean health care service in a systemic manner. Methods : The survey has been conducted from September 3rd to October 4th of 2007 in a way of e-mail, telephone interview, fax, and direct contacts. It's targets were senior researchers and professors in medical and non-medical institutions, policy makers, research institutions or foundations. The survey questions consist of 16 questionnaires. Results : As a result of survey, 102 of 650 people responded. 80% of respondents indicated that genetic counseling is needed as a health care service and 34% among them considered it as "the most needed". In addition, 77% of the respondents showed that, it is necessary to have a professional non-MD genetic counselor with a master degree or higher in the field of medical genetics and among them 29% thought it as "the most necessary". A 77% of respondents considered that the cost of genetic counseling should be covered by health insurance and among them, 29% answered "strongly agreed". A 56% of respondents chose the answer of "They have a plan to hire the professional non-MD genetic counselor" in their institution, and among them 71% selected "within 5 years" in terms of when to hire. Also, they tend to expect the role of the professional non-MD genetic counselor to be not only "genetic counselor" (60%), but also "researcher" (42%), "educator" (18%) and "clinical laboratory coordinator" (19%). Conclusion : The 102 of 650 people responded to the survey. Based upon the nationwide survey over the needs on genetic counseling in health care service and demands on the professional non-MD genetic counselor, systematic educational program for the genetic counseling, with reimbursement coverage for counseling service by health insurance should be emphasized in development of a master plan.

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Reviewing Articles Related to Recent Advances in Non-invasive Prenatal Testing and Nursing Implications (최신 비침습적 산전 유전 검사(NIPT)의 임상 적용과 간호학적 의미)

  • Jun, Myunghee;Shin, Gyeyoung;Hur, Myung Haeng;Choi, Kyung-Sook
    • The Journal of Korean Academic Society of Nursing Education
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    • v.19 no.4
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    • pp.675-683
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    • 2013
  • Purpose: Nineteen articles were analyzed to gather opinions and nursing implications about NIPT recently launched. Methods: Nineteen articles were selected from EBSCO (eBook business collection), Google Scholar, and two Korean academic d-bases with key words 'prenatal screening testing', 'prenatal genetic diagnostic testing', NIPT or 'cell free DNA (cfDNA)'. Authors developed a framework for analyzing the 19 articles including opinions and suggestions for future implications. Results: Eleven articles written by the first author affiliated with medicine or genetics, viewed NIPT as promising because of safety, accuracy, early detectability and cost effectiveness. Articles written by journalists or authors affiliated with history and ethics were concerned with the possible risk of ELSI (ethical, legal, social issues), erratic interpretation of test results, and lack of genetic counseling service. Conclusion: With consideration of Korean clinical, and legal circumstances, not only pregnant women and families but also health professionals must prepare for clinical NIPT implications including updating prenatal genetic testing, counseling services, protecting ELSI and amulticultural team approach.

Novel compound heterozygous mutations of ATM in ataxia-telangiectasia: A case report and calculated prevalence in the Republic of Korea

  • Jang, Min Jeong;Lee, Cha Gon;Kim, Hyun Jung
    • Journal of Genetic Medicine
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    • v.15 no.2
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    • pp.110-114
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    • 2018
  • Ataxia-telangiectasia (AT; OMIM 208900) is a rare autosomal recessive inherited progressive neurodegenerative disorder, with onset in early childhood. AT is caused by homozygous or compound heterozygous mutations in ATM (OMIM 607585) on chromosome 11q22. The average prevalence of the disease is estimated at 1 of 100,000 children worldwide. The prevalence of AT in the Republic of Korea is suggested to be extremely low, with only a few cases genetically confirmed thus far. Herein, we report a 5-year-old Korean boy with clinical features such as progressive gait and truncal ataxia, both ankle spasticity, dysarthria, and mild intellectual disability. The patient was identified as a compound heterozygote with two novel genetic variants: a paternally derived c.5288_5289insGA p.(Tyr1763*) nonsense variant and a maternally derived c.8363A>C p.(His2788Pro) missense variant, as revealed by next-generation sequencing and confirmed by Sanger sequencing. Based on claims data from the Health Insurance Review and Assessment Service Republic of Korea, we calculated the prevalence of AT in the Republic of Korea to be about 0.9 per million individuals, which is similar to the worldwide average. Therefore, we suggest that multi-gene panel sequencing including ATM should be considered early diagnosis.

Xeroderma pigmentosum group A with mutational hot spot (c.390-1G>C in XPA ) in South Korea

  • Choi, Jung Yoon;Yun, Hyung Ho;Lee, Cha Gon
    • Journal of Genetic Medicine
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    • v.13 no.1
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    • pp.20-25
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    • 2016
  • Purpose: Xeroderma pigmentosum (XP) is rare autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet light is deficient. We reported the first molecularly confirmed Korean patient of XP by targeted exome sequencing. The prevalence of XP included all subtype and carrier frequency of XP-A the using public data were estimated for the first time in South Korea. Materials and Methods: We described a 4-year-old Korean girl with clinical diagnosis of XP. We performed targeted exome sequencing in the patient for genetic confirmation considering disease genetic heterogeneity and for differential diagnosis. We verified a carrier frequency of c.390-1G>C in XPA gene known as mutational hot spot using Korean Reference Genome Data Base. We estimated the period prevalence of all subtypes of XP based on claims data of the Health Insurance Review and Assessment Service in South Korea. Results: We identified homozygous splicing mutation of XPA (c.390-1G>C) in the patient. The carrier frequency of risk for XPA (c.390-1G>C) was relatively high 1.608 e-03 (allele count 2/1244). The prevalence of XP in South Korea was 0.3 per million people. Conclusion: We expect that c.390-1G>C is hot spot for the mutation of XPA and possible founder variant in South Korea. However, the prevalence in South Korea was extremely low compared with Western countries and Japan.