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Issue 7 | September 2023

Welcome from Vicky, Annette and Jo

Welcome to our first Autumn edition of the East Genomic Medical Service Alliance (GMSA) Nursing and Midwifery Newsletter. We hope you enjoyed the summer and that you feel rested and re-energised if you managed to get away for a break.


In this edition, we focus on genomic testing for fetal anomalies with a likely genetic cause, or the R21 genomic test. Please share this newsletter with colleagues and encourage them to sign up to receive it here.

Vicky Carr 

East GMSA Nurse Lead
Cambridge University Hospitals

Annette Breen

East GMSA Nurse Lead

Nottingham University Hospitals

Joanne Hargrave

East GMSA Midwife Lead

Norfolk and Norwich University Hopsitals

The R21 Testing Pathway

Meet Dr Katarzyna (Kasia) Gajewska- Knapik. Kasia is Prenatal Care Lead for the East Genomic Medicine Service Alliance (GMSA). She is also Consultant Obstetrician and Subspecialist in Fetomaternal Medicine at Cambridge University Hospitals NHS Foundation Trust.


What is the R21 genomic test?

The R21 genomic test (rapid prenatal exome sequencing) is undertaken on samples from chorionic villi (CVS) or amniocentesis in cases where it has not been possible to reach a prenatal genetic diagnosis through QF-PCR or chromosomal microarray. R21 evaluates a nationally agreed panel of genes known to cause certain fetal anomalies, listed in the NHS national genomic test directory for rare and inherited disease. Trio testing (i.e. fetus and both parents) is recommended to increase the likelihood of obtaining an informative R21 result.


What are the eligibility criteria for the R21 testing pathway?

R21 testing can be requested in a pregnancy where:

  • Multiple fetal anomalies were detected through ultrasound or MRI, and / or
  • Findings suggest an underlying monogenic condition, and
  • A molecular diagnosis will inform management of the pregnancy and the baby in the neonatal period.

A multidisciplinary team including clinical genetics, clinical scientists from the R21 testing laboratory, fetal medicine specialists and paediatric specialists review these cases to decide whether they are eligible for R21 testing.

 

Further information is available at R21 GeNotes.


Where are the samples tested?

There are two laboratories which perform R21 testing: the North Thames Genomics Laboratory Hub at Great Ormond Street Hospital, where R21 samples from the East GMSA are tested, and the Central and South Genomics Laboratory Hub at Birmingham Women’s and Children’s NHS Foundation Trust.


Does the East GMSA have any fetomaternal pathway genomic workstreams?

Yes, we are working on a transformation project to coordinate implementing changes across services in the region, with a particular focus on improving equity of access to the R21 testing pathway.  Hear more about this from Lauren below.

     
Meet Lauren Capacchione. Lauren is the Senior Midwifery Project Lead - Feto Maternal Medicine, at East GMSA.

Lauren is also the Deputy Fetal Medicine Midwife at East and North Hertfordshire NHS Trust.

What is your role?

I am the senior midwifery project lead for the East GMSA transformation project aiming to improve equity of access to prenatal genomic sequencing in the region. 


The project primarily involved a thematic analysis arising from a self-reporting questionnaire sent out to all the maternity units within the East GMSA catchment. This information was then used to map how services are delivered across the region and identify areas for development and improvement. All the project outputs aim to support clinicians with different ‘touch points’ of the pathway to improve the equity of access.


How did you become the Project Lead with the GMSA?

I have worked as a midwife for 16 years in various roles and settings. I had reached a point in my career where I was ready for a new challenge and completed the MSc in Genomic Medicine at Cambridge University, which was fully funded by Health Education England. On completion of this course, I started to work as a fetal medicine midwife within my local NHS Trust. When the opportunity arose to support the East GMSA with the transformation project I applied for the post and was successful.


What is the most challenging thing about your job?

Definitely sticking to the scope of the project!  There are so many interlinking issues across maternity and fetal medicine services. But it's important to focus on the improving access to genomic sequencing aspect of fetal medicine services.


What is the most rewarding thing about your job? 

Being able to develop and share resources with fellow clinicians, supporting them to provide the very best care to patients and whilst improving the equity of access to genomic sequencing within fetal medicine.

     
Meet Fleur Murray Gilbertson, Lead Fetal Medicine Midwife at Cambridge University Hospitals NHS Foundation Trust .

What is your role?

I am the Lead Fetal Medicine Midwife in the tertiary Fetal Medicine Service at Cambridge University Hospitals NHS Foundation Trust. I work with 6 consultants and the service is a regional referral centre and sees women from other maternity services across Norfolk, Suffolk, parts of Essex as well as Cambridgeshire.  Most of the women have their CVS at our facility, but a few have had their prenatal diagnosis procedure at their local unit and come to us to discuss the results and their options.  I am responsible for the oversight and triage of referrals to our service, ensuring that women are offered an appointment in a timely manner and that all their information is available for their appointment.  Women are referred to us because of concerns arising from their scan, previous history, or findings from other screening tests during their pregnancy. 


In particular, I see women who are eligible for the R21 testing pathway with the consultant, when their results and / or scan findings are discussed.  There is a lot of technical, detailed information for the woman to take in, so I spend time with the woman afterwards to ensure that she understands the information, so that she can make an informed choice about whether or not to proceed with the testing pathway. If she decides to proceed with testing, we have a full consent discussion based on the Record of Discussion Form and take blood samples from the woman and the baby’s father. This means that everything can be completed at one appointment.  I also liaise with the North Thames Genomics Laboratory at Great Ormond Street Hospital (GOSH) and arrange a Clinic Genetics appointment for the women / couple.    


How did you become a fetal medicine midwife?

When I worked on labour suite, I was always interested in, and drawn to, caring for women who were terminating their pregnancy or had lost their baby for whatever reason, and was interested to discover what had happened to them during their pregnancy.  I started working as a fetal medicine midwife; I reviewed and refreshed the nursing, midwifery, and midwifery support worker roles in my unit after I took up my post. After a few years, I decided that wanted to enhance my knowledge of the subject and completed a genetic counselling post graduate module and went on to study for and complete an MSc degree in Genomic Medicine at Fitzwilliam College, Cambridge University, submitting my dissertation on the psychological effects of screening on pregnancy outcomes. 


What is the most challenging thing about your job?

Dealing with unexpected pregnancy outcomes and fetal demise in a desperately wanted pregnancy.  Genetic test results, whether expected or unexpected that confirm a serious genetic condition.  Scans where the baby has died in utero and very late in pregnancy. Incidental and potentially serious diagnoses, and supporting women to make decisions. 


What is the most rewarding thing about your job?

Many things in fetal medicine have a sad, unhappy ending and I cannot change that outcome. However, I can change the parents’ experience and ensure that they are fully supported and in control of decisions about their pregnancy.  It’s great that women really appreciate our service, and we get many letters and cards saying so. We give hope for future pregnancies and it’s very satisfying to be able to give continuity of care in future pregnancies…and sometimes there is a happy ending!

     
Meet Anita Davis, Information Officer – Family Support, Unique.

Anita is also a Midwife, Surrey and Sussex Healthcare NHS Trust.

What is your role?

As one of the Information Officer’s at Unique, my role is to support families with rare chromosome and specific single gene disorders.  I also provide information to both families and professionals, answer questions, and I can put families in touch with each other, based on their disorder, or symptoms. And it’s great that I’m still in touch with my clinical practice as I work 1 day a week as a midwife at Horsham Hospital.


How did you become  the Information Officer at Unique?

I have worked as a midwife for over 26 years.  While I was working as an antenatal screening midwife at East Surrey Hospital, I completed one of the postgraduate genomics modules at St George’s University of London.  This is where I first heard about Unique.


What is Unique and what does it do?

Unique is a registered charity and relies solely on donations. It receives no government funding. We aim to provide accurate information and support in a user friendly accessible way. We also aim to reduce social isolation for those families affected by a rare chromosome disorder, copy number variant or single gene disorder associated with developmental delay/ learning difficulties and to raise awareness in the public. Unique is for those families where a specific support group doesn’t exist.


What happens when someone contacts Unique?

In the past, families would typically contact us when their child was between 6 months and a year old, when they were delayed reaching milestones.  Now, more families are contacting us during their pregnancy and in the newborn period.


When families first contact us, we find out if they would like to join us as a member.  Just under half of our members live in the UK and the rest live across the globe.  We enter their details on our database and provide them with access to our resources and information e.g. After diagnosis, What’s next? We ask for their genetic information i.e. their specific genetic, chromosome or copy number variant and ask if they would like to be put in touch with other families; sometimes we can match families by age and location.


We have a wide range of family friendly resources and guides covering topics like education, behaviour, communication and many more.   Many were written by a former Unique colleague with the lived experience of caring for a disabled child.


How do Unique’s members get in touch with each other?

If families are interested and would like to be in touch with other families, we can do this, usually by email.   We also have a closed Facebook group just for our members which provides a safe space for them to share concerns, celebrate achievements and ask questions.


We also hold regional face-to-face Family Day events in the UK. This gives families a chance to meet people like themselves, in a non- judgemental space and just be themselves.  We have fun events like face painting and invite the local Clinical and laboratory Genetics Teams so that families have an opportunity to hear from them and ask questions in an informal setting.  


Unique holds a lot of information about families, can researchers and other interested parties have access to it?

Data protection laws and GDPR are applicable to Unique. Our data is stored securely on a protected server.  Unique do not provide any identifiable information to researchers and other interested parties, but sometimes provide anonymised phenotype data.


What is the most challenging thing about your job?

Government spending cuts have impacted health and social care services.  This means that for many of our families, the services that they need either, don’t exist, or there are really long waiting lists.  Some of the waiting times for an initial appointment with Clinical Genetics and CAMHS can be up to several years.


What is the most rewarding thing about your job?

It is so positive to be able to help and give resources to our services users. I am passionate about giving them a “listening ear” and support at a tough time. Some of our members just need someone to talk to and a lot of them are desperate for information about the condition that affects their child and family in an accessible, bite sized type format. We have information and guides for children and families in standard and Easy Read versions.

Genomic BITEs: The R21 Testing Pathway

Our next Genomics BITE session will focus on The R21 Testing Pathway: Genomic testing for fetal anomalies with a likely genetic cause and takes place on Tuesday 26 September, 12.30pm - 1.45pm via MS Teams. You can register for your free place here.


Our previous Nursing and Midwifery Genomics BITE sessions are now available to watch on our YouTube channel:

Is there anything that you would like to see on our Genomics BITE sessions? Please contact Annette Breen and let her know.

Polycystic Kidney Disease work programme

Join our rescheduled fifth and final polycystic kidney disease national workshop on Wednesday 13 September 2023 from 10:00am to 12:30pm via MS Teams to hear about our outputs:

  • Patient stories
  • Infographic which gives an overview of polycystic kidney disease genomic testing across the lifespan
  • Renal GeNotes to support healthcare professionals to make the right genomics decisions at each stage of a clinical pathway
  • Clinical pathway initiative

To register scan the QR code in the above image, download the Outlook calendar invite here or email pauline.simpson@nnuh.nhs.uk

Niche to Necessity Webinar - The Circle of Life

The North East and Yorkshire and North West GMSAs’ Circle of Life webinar from maternity through health visiting and nursing on Tuesday 19 September 2-4pm is open to all health care staff across England. Find out more and book your place here.

Monogenic Diabetes Virtual Training Course

This 2-day virtual course (6 and 7 December 2023) is aimed at Diabetic Specialist Nurses and Midwives, consultants and SpRs to help recognise and treat patients with MODY and other types of monogenic diabetes. Find out more and book your place here.

Education, Training and Resources

The Genomics Education Programme has a wide range of free to access learning and education resources for nurses, midwives and health visitors.  No matter where you are in your leaning journey about genomics, there is something for you to build your knowledge and support your NMC revalidation including:

  • Bite size genomics a series of 10 minute animations and films
  • Genomics 101 a series of 9 short introductory courses, each lasting about 30 minutes for those with a little bit or no knowledge about genomics
  • Taught courses up to Masters level
  • GeNotes help healthcare professionals make the right genomics decisions at each stage of a clinical pathway. GeNotes are in development to provide:
    • In The Clinic information focussed at the point of patient care with clinical scenarios, when to consider genomic testing, what you need to do and the results stage
    • Knowledge Hub accessed via links within ‘In The Clinic’ to external sources and resources and signpost to relevant guidelines, including NICE.

GeNotes are organised into clinical specialities and will be released in a phased manner.  There are currently some Oncology and Fetal and Women’s Health clinical presentations and summaries available to support you in your practice.

Meet the East GMSA Nursing and Midwifery Team

Contact: Melissa Cambell-Kelly, Annette Breen, Vicky Carr, Jo Hargrave or Katy Blakely. We also have a network of LINK Nurses across our 29 Partner Trusts. If would like to know who your local Genomic LINK Nurse is, contact us here.

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