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Title: CSER-MedSeq      
citations:
24645908
25341114
25714468
25642274
description:
Whole genome sequencing (WGS) and whole exome sequencing (WES) services are currently available to and being utilized by physicians and their patients in both research and clinical settings, and recently to anyone in the general public via direct-to-consumer companies. But the widespread availability and use of WGS and WES in the practice of clinical medicine is imminent. In the very near future, sequencing of individual genomes will be inexpensive and ubiquitous, and patients will be looking to the medical establishment for interpretations, insight and advice to improve their health. Developing standards and procedures for the use of WGS information in clinical medicine is an urgent need, but there are numerous obstacles related to integrity and storage of WGS data, interpretation and responsible clinical integration. The MedSeq Project is an exploratory trial of WGS in clinical medicine. At the conclusion of this study, we will have helped create innovative protocols and novel outcome measures that can be applied safely in future large-scale multi-site randomized clinical trials with larger numbers of physicians from broad specialties and with more economically and ethnically diverse patients. Together with our colleagues from across the nation through the U01 consortium formed as a result of this funding from the NIH, we will have invented a process of implementation and evaluation whereby the fruits of the Human Genome Project can be applied for the first time to the daily practice of medicine for the betterment of human health. The objectives of the MedSeq Project are to: Recruit, consent and enroll 2 study groups: 10 primary care physicians and 100 of their healthy middle-aged patients 10 cardiologists and 100 of their patients with cardiomyopathy. Randomize each study group to receive standard of care versus standard of care plus WGS. Monitor the entire protocol for subject safety. Only half the enrolled patients were selected for sequencing. Fifty subjects were selected from the primary care cohort and fifty were selected from the cardiomyopathy cohort. Whole genome sequencing was performed at 30x coverage in Illumina's CLIA-certified laboratory on these 100 individuals. Generate and optimize an algorithm for interpreting WGS data covering the spectrum of human genetic variation, in terms of both previously reported and novel variants likely to influence the health of patients. Create patient reports and provide an interface for communicating clinically relevant genomic information to practicing physicians. Describe physicians' and patients' attitudes toward, and preferences for, the disclosure of WGS results at the start of the study. Evaluate physicians' experiences with receiving and interpreting patients' genetic test results and how they communicate these results to their patients. Explore how patients respond to and use WGS results by administering validated scales of psychological impact, personal utility, and behavioral responses, as well as economic and health outcomes. Although we do not have a large enough sample size for statistical comparisons of outcomes, we will conduct exploratory comparisons: Exploratory Hypotheses: Patients who receive WGS results will show equivalent levels of distress compared to patients who receive family history only. Patients with higher genetic literacy and better understanding will report greater satisfaction and less decisional regret. Patients who receive WGS will (a) be more likely to change health behaviors and (b) utilize more health care resources than those who do not receive WGS.
Identifier:
phs000958.v1.p1
accesstypes:
download
enclave
landingpage: http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000958.v1.p1
authentication: simpleLogin
none
authorization:
none
duaIndividual
name:
Cardiomyopathies
Cardiomyopathy, Dilated
Cardiomyopathy, Hypertrophic
affiliations:
Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
name:
Robert C. Green, MD, MPH
roles:
Principal Investigator
affiliations:
National Human Genome Research Institute, Nationa lnstitutes of Health, Bethesda, MD, USA
name:
HG006500
roles:
Funding Source
performedBy:
TitleNameInstitute Principal InvestigatorRobert C. Green, MD, MPHDivision of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Funding SourceHG006500National Human Genome Research Institute, Nationa lnstitutes of Health, Bethesda, MD, USA
downloadURL: https://dbgap.ncbi.nlm.nih.gov/aa/wga.cgi?page=DUC&view_pdf&stacc=phs000958.v1.p1
Identifier:
phs000958.v1.p1_policy
name:
Data Use Certificate
Identifier:
1
name:
General Research Use
alternateIdentifiers:
yes
selectionCriteria:

Patients:

Primary Care Patients:

Inclusion criteria:

  • Generally healthy (as defined by the primary care provider and exclusion criteria) adult patients at Brigham and Women's Hospital (BWH)
  • Ages 40-65
  • All patients must be fluent in English

Exclusion criteria:

  • Patients who do not meet the above criteria
  • Patients with a progressive debilitating illness
  • Patients with untreated clinical anxiety or depression (as measured by a Hospital Anxiety and Depression Scale (HADS) score ≥ 14 on the anxiety subscale or ≥ 16 on the depression subscale)
  • Patients with cardiovascular disease (including Long QT syndrome, arrhythmia, atrial fibrillation, abdominal aortic aneurysm, etc.)
  • Patients with type 2 diabetes
  • Patients with clotting disorders
  • Patients who are pregnant or patients whose spouses/significant others are pregnant

Cardiology Patients:

Inclusion criteria: Patients in the Partners Healthcare System or patients seen at Boston Children's Hospital (BCH) who are 18 years or older with a diagnosis of hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM) who previously had or who are candidates for targeted genetic testing through routine clinical practices within Partners or at BCH. All patients must be fluent in English.

Exclusion criteria: Patients who do not meet the above criteria. Patients with a progressive debilitating illness. Patients who are pregnant or patients whose spouses/significant others are pregnant. Patients with untreated clinical anxiety or depression as measured by a score of ≥ 14 on the anxiety subscale of the HADS or a score of ≥ 16 on the depression subscale of the HADS.

types:
Case-Control
dateReleased:
07-18-2015
version:
phs000958.v1.p1
dateModified:
09-18-2015
abbreviation:
NHGRI
name:
National Human Genome Research Institute
ID:
0
name:
dbGaP

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