Family Medicine

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World Book of Family Medicine – European Edition 2015 Several IT supporting systems (ITSS) have been developed to integrate all elements of familygram. Some of them are oriented to pedigree profiling and offer a standardized system for pedigree storage. Other pedigree oriented ITSS are particularly intended for epidemiologists in the sense that they allow customized automatic drawing of large numbers of pedigrees and remote and distributed consultation of pedigrees. Some other pedigree ITSS fully integrate risk analysis and support for industry standard databases and are designed for genetic counsellors and work with genetic marker data, enable haplotyping and allow exports to a range of linking analysis packages. Family tree programmes enable construction of family trees, offering an ability to import data from other genealogy programmes. Attractive charts and reports in a variety of formats can be drawn and the photos, audio, and video files can be added to the tree. Graphical genotyping package ITSS combines genetic map data and locus data to display graphical genotypes. Data can be viewed by individual or by linkage group, and sorted on markers. Statistics are calculated, and simultaneous filtering/selection on multiple linkage groups are made possible. However, gathering, filtering and inputting data is always a doctor’s task, while ITSS only manages inputted data. If the inputted data are more complete, the output and suggested course is more comprehensive. Future challenge: a personalized medicine In the future, medicine will become more and more focused on personalized approach to the patient. Personalized health care (PHC) is a strategic approach to medicine that is individualized, predictive, preventive, and is based on an individual’s specific profile. People subject to increased risk because of their family history are among the most appropriate candidates for genetic profiling to find possible new biomarkers. Biomarkers can help in better understanding of the disease, prediction of its onset and development. Such genomic approach can help to evaluate co-morbidity of selected chronic diseases horizontally and connect them with family history. This shall help to reveal new horizons of genomics in chronic diseases. Such processes should be supported by an IT centralised vendor-neutral clinical data repository with support for realtime transactional health data storage, query, retrieval and exchange. This is structured data set for the validation of the decision support model, efficiency calculations and bio-informatic studies. Views on personalized medicine can vary according to standpoint: for patients, it offers access to life or better quality of life; researchers see potential in their own areas of specialization; for pharmaceutical industry it offers the hope of developing more effective medicines as understanding of specific diseases advances; a physician sees a new way of treating a patient; for society, it may be perceived as offering scope for an overall improvement in healthcare – or a new cost. It will be possible for patients and professionals to discuss options only if a common language and conceptual understanding of genetic and protein signatures and pathophysiology of the disease are available for both – taking account of the individual patient’s psychological make-up (educational level, mental state, and attitudes to risk). Additionally, ethical standards must be evaluated taking into account the specifics of PM and creating an infrastructure in which genetic information is available in a regulated context. To conclude, familygram opens the pathway to PM which is entering medical care. However no one, not even ITSS, can replace the family physician and its fundamental role in assessing the health of each individual within the context of family, society and socio-economic aspects and to communicate with the patient on his/her personal level. Take home messages Familygram is an important tool for assessing every patient in the content of his/her family. Family history enables detection of risk factors and presents a gateway to medical genetics. IT supporting systems (ITSS) have been developed to integrate all elements of familygram. Medicine is becoming focused on a personalized approach to patient in the near future. Nobody can replace the family physician and its fundamental role in assessing the health of each individual. Original abstract http://www.woncaeurope.org/content/295-family-profile-and-familygram-99 244
References World Book of Family Medicine – European Edition 2015 Yoon PW, Scheuner MT, Peterson-Oehlke KL, Gwinn M, Faucett A et al. (2002) Can family history be used as a tool for public health and preventive medicine? Genet Med 4: 304-310. doi:10.1097/00125817-200207000-00009. PubMed: 12172397 Klemenc-Ketis Z, Peterlin B (2013) Family History as a Predictor for Disease Risk in Healthy Individuals: A Cross-Sectional Study in Slovenia. PLoS ONE 8(11): e80333. doi:10.1371/journal.pone.0080333 McCarthy, J. J. (2014), Driving personalized medicine forward: the who, what, when, and how of educating the health-care workforce. Molecular Genetics & Genomic Medicine. doi: 10.1002/mgg3.113 Burnette R, Simmons LA, Snyderman R. Personalized Health Care as a Pathway for the Adoption of Genomic Medicine. J. Pers. Med. 2012, 2, 232-240; doi:10.3390/jpm2040232 Cesuroglu T, van Ommen B, Malats N, Sudbrak R, Lehrach H, Brand A. Public health perspective: from personalized medicine to personal health. Pers Med 2012; 9(2): 115-119). Rich EC, Burke W, Heaton CJ et al. Reconsidering the Family History in Primary Care. J Gen Intern Med 2004;19:273–280. Wonca Europe. An Anthology of Useful Family Assessment Tools http://www.woncaeurope.org/content/anthology-useful-family-assessment-tools European Alliance for Personalised Medicine. Integrating Personalised Medicine into EU strategy. EAPM Annual Conference Report Bibliotheque Solvay and the European Parliament; Brussels, 2014. 245
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Family Medicine

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