Further validation of the Genetic Counseling Self-Efficacy Scale (GCSES): Its relationship with personality characteristics.

Demonstrating validity of a tool for genetic counseling self-efficacy could help determine if this is a useful tool for training outcomes or other purposes in the field. The purpose of the current study was to describe the relationship between genetic counseling self-efficacy, measured by scores on the Genetic Counseling Self-Efficacy Scale (GCSES), personality characteristics, clinical characteristics, and performance on the American Board of Genetic Counselors (ABGC) board certification examination. Genetic counselors, recruited via email through the National Society of Genetic Counselors (NSGC) Student Research Survey Program, completed an online questionnaire that included the GCSES, work locus of control (WLOC) scale, trait subscale of the State-Trait Anxiety Inventory (STAI), and questions related to board examination performance. Higher genetic counseling self-efficacy factor scores for four of six factors were significantly associated with lower WLOC scores indicative of internal locus of control (p's < .05); higher genetic counseling self-efficacy factor scores for all six factors were significantly associated with lower trait anxiety scores (p's < .05). In addition, increased years of experience and providing direct patient care were found to be significantly related to higher scores for all six-factor scores on the GCSES (p's ≤ .05). Multiple linear regression models were performed to assess combined effects of predictor and demographic variables and demonstrated that professional factors were most significantly associated with GCSES factor scores. Findings from the current study provide additional validation for the GCSES and add clarity to the relationships between genetic counseling self-efficacy, personality characteristics, and professional factors. Validation of the GCSES supports the usefulness of this tool as an outcome for genetic counseling training purposes. In addition, the GCSES could be used for self-reflective practice for genetic counselors. Further studies are needed to investigate the relationship between genetic counseling self-efficacy and genetic counselor competency.

Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory.

The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4.6%) were flagged for review for potentially inefficient or inappropriate test ordering. These flagged orders corresponded to a total of 51 cases (1-5 orders for each patient), representing 54 individuals and including 3 sibling pairs. The GC team proposed a modification for each flagged case and the ordering providers approved the proposed change for 49 of 51 cases (96.08%). For the 49 modifications, the cost savings totaled $98,750.64, for an average of $2015.32 saved per modification. This study provides evidence of the significant contribution of genetic counselors in a laboratory setting and demonstrates the benefit of laboratories working with ordering providers to identify the best test for their patients. The review of test orders by a genetic counselor both improves genetic test ordering strategies and decreases the amount of health care dollars spent on genetic testing.

Occurrence of Staphylococcus aureus in swine and swine workplace environments on industrial and antibiotic-free hog operations in North Carolina, USA: A One Health pilot study.

Occupational exposure to swine has been associated with increased Staphylococcus aureus carriage, including antimicrobial-resistant strains, and increased risk of infections. To characterize animal and environmental routes of worker exposure, we optimized methods to identify S. aureus on operations that raise swine in confinement with antibiotics (industrial hog operation: IHO) versus on pasture without antibiotics (antibiotic-free hog operation: AFHO). We associated findings from tested swine and environmental samples with those from personal inhalable air samplers on worker surrogates at one IHO and three AFHOs in North Carolina using a new One Health approach. We determined swine S. aureus carriage status by collecting swab samples from multiple anatomical sites, and we determined environmental positivity for airborne bioaerosols with inhalable and impinger samplers and a single-stage impactor (ambient air) cross-sectionally. All samples were analyzed for S. aureus, and isolates were tested for antimicrobial susceptibility, absence of scn (livestock marker), and spa type. Seventeen of twenty (85%) swine sampled at the one IHO carried S. aureus at >1 anatomical sites compared to none of 30 (0%) swine sampled at the three AFHOs. All S. aureus isolates recovered from IHO swine and air samples were scn negative and spa type t337; almost all isolates (62/63) were multidrug resistant. S. aureus was recovered from eight of 14 (67%) ambient air and two (100%) worker surrogate personal air samples at the one IHO, whereas no S. aureus isolates were recovered from 19 ambient and six personal air samples at the three AFHOs. Personal worker surrogate inhalable sample findings were consistent with both swine and ambient air data, indicating the potential for workplace exposure. IHO swine and the one IHO environment could be a source of potential pathogen exposure to workers, as supported by the detection of multidrug-resistant S. aureus (MDRSA) with livestock-associated spa type t337 among swine, worker surrogate personal air samplers and environmental air samples at the one IHO but none of the three AFHOs sampled in this study. Concurrent sampling of swine, personal swine worker surrogate air, and ambient airborne dust demonstrated that IHO workers may be exposed through both direct (animal contact) and indirect (airborne) routes of transmission. Investigation of the effectiveness of contact and respiratory protections is warranted to prevent IHO worker exposure to multidrug-resistant livestock-associated S. aureus and other pathogens.