Genetic counselling, familial breast cancer, and the surgeon's responsibility

199 assess the effectiveness of the non-directive genetic counselling service at the Mount Sinai Medical Center in New York City. The preliminary results have been reported previously. Of those families surveyed, 72% responded. Adequate recall of the genetic information was demonstrated by 74% of those responding, and 80% described their counselling experience as favorable. A direct relationship was noted between the degree of satisfaction and whether or not the counsellees received the mode of counselling they preferred, i.e., individual versus team. Sixty-two percent of those counsellees reaching a procreative decision indicated that genetic counselling had influenced their decision making. A significant correlation was noted between the magnitude of the occurrence or recurrence risk and the procreative decisions reached. However, some decisions were modified by the counsellees' subjective interpretation of the burden associated with thel disorder in question. It is concluded that follow-up 0f genetic counselling by questionnaire, together with statistical analysis of the data received, can provide the genetic center with valuable information regarding strengths and weaknesses of the counselling program and can suggest ways to improve the counselling process and thereby enhance its effectiveness.

8) Organization and operation of a home parenteral nutrition program with emphasis on the pharmacist's role GAFFRON, R. E., FLEMING, C. R., BERKNER, S., ET AL. Dept. Pharm., Rochester Methodist Hosp., Rochester, Minn., U.S.A. Mayo Clin. Proc. 55(2), 94-98, 1980 A home parenteral nutrition program was organized at Mayo Clinic-Rochester Methodist Hospital in 1975. To date, 26 patients with chronic malnutrition usually due to either severe short bowel syndrome or extensive Crohn disease have been trained in home parenteral nutrition for a total treatment period of 430 patientmonths. Home parenteral nutrition is an attractive alternative for these patients in that it dramatically improves nutrition, promotes rehabilitation at home, and probably decreases long-term expenses. The numerous medical, psychosocial, and financial problems confronting patients on home parenteral nutrition are managed through a multispecialty team consisting of physicians, pharmacists, nurse, social worker, dietitian, physiatrist, psychiatrist, and business manager. The pharmacist is the person with whom the patient has the most contact during a two-week training period. In addition to patient education, the pharmacist coordinates the transition to home care, offers inservice

FOURTH QUARTER/1980

education on home parenteral nutrition to nurses and house officers, tests and evaluates the equipment, coauthors a training manual, and edits a quarterly newsletter to patients who are on home parenteral nutrition. THE ROLE OF THE HEALTH PROFESSIONAL 9) Genetic counselling, familial breast cancer, and the surgeon's responsibility LYNCH, H. T., ALBANO, W. A., and LYNCH, J. F. Dept. Prev. Med. Publ. Hlth., Creighton Univ. Sch. Med., Omaha, Nebr., U.S.A. Plast. Reconstr. Surg. 66(2), 303-310, 1980 Approximately 20% of 75 consecutive breast cancer patients evaluated in our oncology clinic have shown evidence of familial breast cancer. This determination was made on the basis of association with at least two or more affected first-degree relatives. On a national basis, this would project to about 21,000 patients (and their families) for the year 1979. Seven of these patients, whose families are in various stages of completion of detailed cancer genetic evaluations, have been selected to illustrate the logic utilized for genetic counselling and management. Cardinal aspects of familial breast cancer, including its early age of onset, excess of bilaterality, vertical transmission, and occasional familial association with other varieties of cancer, have been emphasized to depict pragmatic utility for its identification. A hypothetical pedigree, based on extensive clinical experience with familial breast cancer, has been constructed to aid the physician in determining which patients have familial cancer tendencies so that he can then integrate this information for use in genetic counselling and management. The surgeon must be cognizant of the several crucial characteristics of familial breast cancer. When one or more of these features are present in his patient or family or both, appropriate genetic counselling and management should be provided. Therefore, the surgeon must extend his sphere of responsibility to his patient's high-risk relatives.

10) The role of the pediatrician in the adolescent's 9school DUKE, P. M. Dept. Ped., Stanford Univ. Sch. Med., Stanford, Calif., U.S.A. Pediatr. Clin. North Am. 27(1), 163-171, 1980 Pediatricians concerned with their adolescent patients' physical and emotional health have long realized they must look beyond the functioning of teenagers in the family to their interactions with peers and teachers at school. Most physicians have found their involvement