1
|
Chow AJ, Saad A, Al‐Baldawi Z, Iverson R, Skidmore B, Jordan I, Pallone N, Smith M, Chakraborty P, Brehaut J, Cohen E, Dyack S, Gillis J, Goobie S, Greenberg CR, Hayeems R, Hutton B, Inbar‐Feigenberg M, Jain‐Ghai S, Khangura S, MacKenzie JJ, Mitchell JJ, Moazin Z, Nicholls SG, Pender A, Prasad C, Schulze A, Siriwardena K, Sparkes RN, Speechley KN, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, Van Karnebeek C, Walia JS, Wilson K, Potter BK. Family-centred care interventions for children with chronic conditions: A scoping review. Health Expect 2024; 27:e13897. [PMID: 39102737 PMCID: PMC10837485 DOI: 10.1111/hex.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Children with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family-centred care need information about the characteristics of existing interventions, their development and the domains of family-centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family-centred interventions designed to improve experiences with care for children with chronic conditions. METHODS We searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7-20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family-centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full-text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family-centred care. RESULTS Our search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed-methods studies (n = 9 each). The most frequently addressed domains of family-centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30). CONCLUSION This review, which identified 61 unique interventions aimed at improving family-centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high-needs population. PATIENT OR PUBLIC CONTRIBUTION This study was co-developed with three patient partner co-investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co-investigators contributed to this study at all stages, from conceptualization to dissemination.
Collapse
Affiliation(s)
- Andrea J. Chow
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ammar Saad
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Zobaida Al‐Baldawi
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ryan Iverson
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | | | | | - Maureen Smith
- Canadian Organization for Rare DisordersOttawaOntarioCanada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern OntarioOttawaOntarioCanada
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Jamie Brehaut
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Eyal Cohen
- Department of PediatricsUniversity of Toronto/Hospital for Sick ChildrenTorontoOntarioCanada
| | - Sarah Dyack
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Sharan Goobie
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | - Cheryl R. Greenberg
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Robin Hayeems
- Child Health Evaluative SciencesUniversity of Toronto/Hospital for Sick ChildrenTorontoOntarioCanada
| | - Brian Hutton
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Michal Inbar‐Feigenberg
- Division of Clinical & Metabolic GeneticsHospital for Sick ChildrenTorontoOntarioCanada
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Shailly Jain‐Ghai
- Department of Medical GeneticsUniversity of AlbertaEdmontonAlbertaCanada
| | - Sara Khangura
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Jennifer J. MacKenzie
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
- Department of MedicineQueen's UniversityKingstonOntarioCanada
| | | | - Zeinab Moazin
- Newborn Screening Ontario, Children's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Stuart G. Nicholls
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Amy Pender
- McMaster Children's HospitalHamiltonOntarioCanada
| | - Chitra Prasad
- Department of PediatricsWestern UniversityLondonOntarioCanada
| | - Andreas Schulze
- Department of Biochemistry and Department of PediatricsUniversity of TorontoTorontoOntarioCanada
- Clinical and Metabolic GeneticsHospital for Sick ChildrenTorontoOntarioCanada
| | - Komudi Siriwardena
- Department of Medical GeneticsUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Kathy N. Speechley
- Departments of Pediatrics and Epidemiology and BiostatisticsWestern UniversityLondonOntarioCanada
| | | | - Monica Taljaard
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | | | | | - Clara Van Karnebeek
- Departments of Pediatrics and Human GeneticsEmma Center for Personalized Medicine, Amsterdam UMCAmsterdamThe Netherlands
| | | | - Kumanan Wilson
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
| | - Beth K. Potter
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| |
Collapse
|
2
|
Iverson R, Taljaard M, Geraghty MT, Pugliese M, Tingley K, Coyle D, Kronick JB, Wilson K, Austin V, Brunel-Guitton C, Buhas D, Butcher NJ, Chan AKJ, Dyack S, Goobie S, Greenberg CR, Jain-Ghai S, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mhanni A, Mitchell JJ, Nagy L, Offringa M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Tapscott K, Trakadis Y, Turner L, Van Karnebeek C, Vandersteen A, Walia JS, Wilson BJ, Yu AC, Potter BK, Chakraborty P. Assessing the quality and value of metabolic chart data for capturing core outcomes for pediatric medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. BMC Pediatr 2024; 24:37. [PMID: 38216926 PMCID: PMC10787451 DOI: 10.1186/s12887-023-04393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Generating rigorous evidence to inform care for rare diseases requires reliable, sustainable, and longitudinal measurement of priority outcomes. Having developed a core outcome set for pediatric medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, we aimed to assess the feasibility of prospective measurement of these core outcomes during routine metabolic clinic visits. METHODS We used existing cohort data abstracted from charts of 124 children diagnosed with MCAD deficiency who participated in a Canadian study which collected data from birth to a maximum of 11 years of age to investigate the frequency of clinic visits and quality of metabolic chart data for selected outcomes. We recorded all opportunities to collect outcomes from the medical chart as a function of visit rate to the metabolic clinic, by treatment centre and by child age. We applied a data quality framework to evaluate data based on completeness, conformance, and plausibility for four core MCAD outcomes: emergency department use, fasting time, metabolic decompensation, and death. RESULTS The frequency of metabolic clinic visits decreased with increasing age, from a rate of 2.8 visits per child per year (95% confidence interval, 2.3-3.3) among infants 2 to 6 months, to 1.0 visit per child per year (95% confidence interval, 0.9-1.2) among those ≥ 5 years of age. Rates of emergency department visits followed anticipated trends by child age. Supplemental findings suggested that some emergency visits occur outside of the metabolic care treatment centre but are not captured. Recommended fasting times were updated relatively infrequently in patients' metabolic charts. Episodes of metabolic decompensation were identifiable but required an operational definition based on acute manifestations most commonly recorded in the metabolic chart. Deaths occurred rarely in these patients and quality of mortality data was not evaluated. CONCLUSIONS Opportunities to record core outcomes at the metabolic clinic occur at least annually for children with MCAD deficiency. Methods to comprehensively capture emergency care received at outside institutions are needed. To reduce substantial heterogeneous recording of core outcome across treatment centres, improved documentation standards are required for recording of recommended fasting times and a consensus definition for metabolic decompensations needs to be developed and implemented.
Collapse
Affiliation(s)
- Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Michael T Geraghty
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Valerie Austin
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | | | | | - Nancy J Butcher
- The Hospital for Sick Children Research Institute/University of Toronto, Toronto, Canada
| | - Alicia K J Chan
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | - Sarah Dyack
- IWK Health Centre/Dalhousie University, Halifax, Canada
| | - Sharan Goobie
- IWK Health Centre/Dalhousie University, Halifax, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg/University of Manitoba, Winnipeg, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | | | - Natalya Karp
- London Health Sciences Centre/Western University, London, Canada
| | | | - Erica Langley
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Matthew Lines
- Hamilton Health Sciences Centre/McMaster University, Hamilton, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jennifer MacKenzie
- McMaster Children's Hospital, Hamilton, Canada
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Bruno Maranda
- CIUSSSE-CHUS, Université de Sherbrooke, Sherbrooke, Canada, Sherbrooke, Canada
| | | | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg/University of Manitoba, Winnipeg, Canada
| | | | - Laura Nagy
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Martin Offringa
- The Hospital for Sick Children Research Institute/University of Toronto, Toronto, Canada
| | - Amy Pender
- McMaster Children's Hospital, Hamilton, Canada
| | | | - Chitra Prasad
- London Health Sciences Centre/Western University, London, Canada
| | - Suzanne Ratko
- London Health Sciences Centre/Western University, London, Canada
| | - Ramona Salvarinova
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
| | - Andreas Schulze
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta/Stollery Children's Hospital, Edmonton, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital/University of Calgary, Calgary, Canada
| | | | - Kendra Tapscott
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
| | | | - Lesley Turner
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital/University of British Columbia, Vancouver, Canada
- Emma Center for Personalized Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Jagdeep S Walia
- Kingston Health Sciences/Queen's University, Kingston, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital/Memorial University, St John's, Canada
| | - Andrea C Yu
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Newborn Screening Ontario, Ottawa, Canada.
| |
Collapse
|
3
|
Palermo TM, Lalloo C, Zhou C, Dampier C, Zempsky W, Badawy SM, Bakshi N, Ko YJ, Nishat F, Stinson JN. A cognitive-behavioral digital health intervention for sickle cell disease pain in adolescents: a randomized, controlled, multicenter trial. Pain 2024; 165:164-176. [PMID: 37733479 PMCID: PMC10723646 DOI: 10.1097/j.pain.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Severe acute and chronic pain are the most common complications of sickle cell disease (SCD). Pain results in disability, psychosocial distress, repeated clinic visits/hospitalizations, and significant healthcare costs. Psychosocial pain interventions that teach cognitive and behavioral strategies for managing pain have been effective in other adolescent populations when delivered in person or through digital technologies. Our aim was to conduct a multisite, randomized, controlled trial to improve pain and coping in youth aged 12 to 18 years with SCD using a digital cognitive-behavioral therapy program (iCanCope with Sickle Cell Disease; iCC-SCD) vs Education control. We enrolled 137 participants (ages 12-18 years, 59% female) and analyzed 111 adolescents (107 caregivers), 54 randomized to Education control and 57 randomized to iCC-SCD. Ninety-two percent of youth completed posttreatment assessments and 88% completed 6-month follow-up. There was a significant effect of treatment group (iCC-SCD vs Education) on reduction in average pain intensity from baseline to 6-month follow-up (b = -1.32, P = 0.009, 95% CI [-2.29, -0.34], d = 0.50), and for the number of days with pain, adolescents in the iCC-SCD group demonstrated fewer pain days compared with the Education group at 6-month follow-up (incident rate ratio = 0.63, P = 0.006, 95% CI [0.30, 0.95], d = 0.53). Treatment effects were also found for coping attempts, momentary mood, and fatigue. Several secondary outcomes did not change with intervention, including anxiety, depression, pain interference, and global impression of change. Future studies are needed to identify effective implementation strategies to bring evidence-based cognitive-behavioral therapy for sickle cell pain to SCD clinics and communities.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Carlton Dampier
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - William Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
| | - Sherif M. Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Yeon Joo Ko
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Rothuizen-Lindenschot M, Graff MJL, de Boer L, de Groot IJM, Nijhuis-van der Sanden MWG, Steultjens EMJ, Koene S. Using PRPP-Assessment for measuring change in everyday activities by home-based videos: An exploratory case series study in children with multiple disabilities. Aust Occup Ther J 2023; 70:644-660. [PMID: 37365675 DOI: 10.1111/1440-1630.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Currently, paediatric health care aims to use a child-centred tailor-made approach. In order to design tailored occupational therapy, the implementation of personalised occupation-based measurements that guide and evaluate goal setting and are responsive to change is necessary. PURPOSE Primarily, this study explored the potential of the Perceive, Recall, Plan, and Perform (PRPP) assessment to measure the change in the performance of children with multiple disabilities. As a secondary evaluation, the feasibility of the PRPP-Intervention in a home-based program to enable activities was described. The overall aim is to show the potential of the PRPP-Assessment as an outcome measure to use as a base for designing tailor-made person-centred care. METHODS An exploratory longitudinal multiple case series mixed-methods design was used. The PRPP-Assessment, scored by multiple raters, was conducted based on parent-provided videos. The assessed activities were chosen by the child and/or parents. Responsiveness was evaluated by hypotheses formulated a priori and by comparing measured change with change on concurrent measures: Goal Attainment Scaling (GAS) and Canadian Occupational Performance Measure (COPM). Over a 6-week period, children and their parents (or caregivers) participated in an online home-based video coaching program where parents were coached in the implementation of the training, based on the PRPP-Intervention, by paediatric occupational therapists on a weekly basis. The feasibility of the intervention was explored using semi-structured interviews with children, parents, and the treating occupational therapists and was analysed by directed content analysis. RESULTS Three out of 17 eligible children agreed to participate and completed post-intervention measurement, of which two completed the intervention. Quantitative results showed that eight out of nine activities improved on the PRPP-Assessment and the COPM, and nine improved on the GAS. In total, 13 out of 15 hypotheses for responsiveness were accepted. Participants experienced the intervention as successful and acceptable. Facilitators and concerns over demand, implementation, practicality, integration, and adaptation were shared. CONCLUSION The PRPP-Assessment showed the potential to measure change in a heterogeneous group of children. The results indicated a positive tendency for the intervention and also provide directions for further development.
Collapse
Affiliation(s)
- Marieke Rothuizen-Lindenschot
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Department of Occupational Therapy, HAN University of Applied Sciences, Nijmegen, Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maud J L Graff
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lonneke de Boer
- Department of Paediatrics, Radboud Center for Mitochondrial Medicine, Nijmegen, Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther M J Steultjens
- Department of Occupational Therapy, HAN University of Applied Sciences, Nijmegen, Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Saskia Koene
- Department of Paediatrics, Radboud Center for Mitochondrial Medicine, Nijmegen, Netherlands
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
5
|
Acupuncture Case Registry Study: Rationale, Implementations, and Achievements. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3860231. [DOI: 10.1155/2022/3860231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022]
Abstract
The acupuncture case registry study is focusing on acupuncture therapy data from patient cases. The main objective is to collect real-world data and integrate clinically meaningful outcome evaluation indicators to uncover and evaluate real-world acupuncture efficacy and safety, explore factors affecting acupuncture efficacy, and provide real-world evidence to complement RCTs. Since the International Acupuncture Case Registry data collection system’s establishment in 2017, 16 projects have been underway, including two acupuncture specialty therapies and 15 diseases. Data from 3404 patients included extensive information on the diagnosis and treatment of acupuncture and the evaluation of its efficacy. In order to serve as a guide for future studies, this article discusses the value of and rationale for establishing acupuncture case registry studies, how to distinguish them from patient registries, and crucial techniques for implementing registry studies in terms of applications, patient recruitment, costakeholder collaboration, data collection and management, study quality control, and ethics.
Collapse
|
6
|
Beck M, Ramaswami U, Hernberg-Ståhl E, Hughes DA, Kampmann C, Mehta AB, Nicholls K, Niu DM, Pintos-Morell G, Reisin R, West ML, Schenk J, Anagnostopoulou C, Botha J, Giugliani R. Twenty years of the Fabry Outcome Survey (FOS): insights, achievements, and lessons learned from a global patient registry. Orphanet J Rare Dis 2022; 17:238. [PMID: 35725623 PMCID: PMC9208147 DOI: 10.1186/s13023-022-02392-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patient registries provide long-term, real-world evidence that aids the understanding of the natural history and progression of disease, and the effects of treatment on large patient populations with rare diseases. The year 2021 marks the 20th anniversary of the Fabry Outcome Survey (FOS), an international, multicenter, observational registry (NCT03289065). The primary aims of FOS are to broaden the understanding of Fabry disease (FD), an X-linked lysosomal storage disorder, and to improve the clinical management of affected patients. Here, we review the history of FOS and the analyses and publications disseminated from the registry, and we discuss the contributions FOS studies have made in understanding FD. Results FOS was initiated in April 2001 and, as of January 2021, 4484 patients with a confirmed diagnosis and patient informed consent have been enrolled from 144 centers across 26 countries. Data from FOS have been published in nearly 60 manuscripts on a wide variety of topics relevant to FD. Analyses of FOS data have investigated the long-term effectiveness and safety of enzyme replacement therapy (ERT) with agalsidase alfa and its effects on morbidity and mortality, as well as the benefits of prompt and early treatment with agalsidase alfa on the progression of cardiomyopathy and the decline in renal function associated with FD. Based on analyses of FOS data, ERT with agalsidase alfa has also been shown to improve additional signs and symptoms of FD experienced by patients. FOS data analyses have provided a better understanding of the natural history of FD and the specific populations of women, children, and the elderly, and have provided practical tools for the study of FD. FOS has also provided methodology and criteria for assessing disease severity which contributed to the continuous development of medical practice in FD and has largely improved our understanding of the challenges and needs of long-term data collection in rare diseases, aiding in future rare disease real-world evidence studies. Conclusion FOS over the last 20 years has substantially increased the scientific knowledge around improved patient management of FD and continues to expand our understanding of this rare disease.
Collapse
Affiliation(s)
- Michael Beck
- SphinCS GmbH, Institute Clinical Science LSD, Hochheim, Germany
| | - Uma Ramaswami
- Lysosomal Disorders Unit, Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, University College London, London, UK.
| | | | - Derralynn A Hughes
- Lysosomal Disorders Unit, Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, University College London, London, UK
| | - Christoph Kampmann
- Johannes Gutenberg School of Medicine, University of Mainz, Mainz, Germany
| | - Atul B Mehta
- Department of Haematology, University College London, London, UK
| | - Kathleen Nicholls
- The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Dau-Ming Niu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Guillem Pintos-Morell
- Reference Centre for Hereditary Metabolic Disorders (MetabERN), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ricardo Reisin
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Michael L West
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jörn Schenk
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Jaco Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Roberto Giugliani
- Department of Genetics, UFRGS, Medical Genetics Service, HCPA, Porto Alegre, Brazil
| |
Collapse
|
7
|
Chow AJ, Pugliese M, Tessier LA, Chakraborty P, Iverson R, Coyle D, Kronick JB, Wilson K, Hayeems R, Al-Hertani W, Inbar-Feigenberg M, Jain-Ghai S, Laberge AM, Little J, Mitchell JJ, Prasad C, Siriwardena K, Sparkes R, Speechley KN, Stockler S, Trakadis Y, Walia JS, Wilson BJ, Potter BK. Family Experiences with Care for Children with Inherited Metabolic Diseases in Canada: A Cross-Sectional Survey. THE PATIENT 2022; 15:171-185. [PMID: 34282509 PMCID: PMC8289623 DOI: 10.1007/s40271-021-00538-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Children with inherited metabolic diseases often require complex and highly specialized care. Patient and family-centered care can improve health outcomes that are important to families. This study aimed to examine experiences of family caregivers (parents/guardians) of children diagnosed with inherited metabolic diseases with healthcare to inform strategies to improve those experiences. METHODS A cross-sectional mailed survey was conducted of family caregivers recruited from an ongoing cohort study. Participants rated their healthcare experiences during their child's visits to five types of healthcare settings common for inherited metabolic diseases: the metabolic clinic, the emergency department, hospital inpatient units, the blood laboratory, and the pharmacy. Participants provided narrative descriptions of any memorable negative or positive experiences. RESULTS There were 248 respondents (response rate 49%). Caregivers were generally very or somewhat satisfied with the care provided at each care setting. Appropriate treatment, provider knowledge, provider communication, and care coordination were deemed essential aspects of satisfaction with care by the majority of participants across many settings. Memorable negative experiences were reported by 8-22% of participants, varying by setting. Among participants who reported memorable negative experiences, contributing factors included providers' demeanor, lack of communication, lack of involvement of the family, and disregard of an emergency protocol letter provided by the family. CONCLUSIONS While caregivers' satisfaction with care for children with inherited metabolic diseases was high, we identified gaps in family-centered care and factors contributing to negative experiences that are important to consider in the future development of strategies to improve pediatric care for inherited metabolic diseases.
Collapse
Affiliation(s)
- Andrea J Chow
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada
| | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada
| | | | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada
| | - Jonathan B Kronick
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robin Hayeems
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Walla Al-Hertani
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michal Inbar-Feigenberg
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shailly Jain-Ghai
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Anne-Marie Laberge
- Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, QC, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada
| | - John J Mitchell
- McGill University Health Centre, The Montreal Children's Hospital, Montreal, QC, Canada
| | - Chitra Prasad
- Genetics, Metabolism and Paediatrics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Komudi Siriwardena
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Rebecca Sparkes
- University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | | | - Sylvia Stockler
- University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Yannis Trakadis
- McGill University Health Centre, The Montreal Children's Hospital, Montreal, QC, Canada
| | - Jagdeep S Walia
- Medical Genetics, Department of Pediatrics, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Office 207C, Ottawa, ON, K1G 5Z3, Canada.
| |
Collapse
|
8
|
Chow AJ, Iverson R, Lamoureux M, Tingley K, Jordan I, Pallone N, Smith M, Al-Baldawi Z, Chakraborty P, Brehaut J, Chan A, Cohen E, Dyack S, Gillis LJ, Goobie S, Graham ID, Greenberg CR, Grimshaw JM, Hayeems RZ, Jain-Ghai S, Jolly A, Khangura S, MacKenzie JJ, Major N, Mitchell JJ, Nicholls SG, Pender A, Potter M, Prasad C, Prosser LA, Schulze A, Siriwardena K, Sparkes R, Speechley K, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, van Karnebeek C, Walia JS, Wilson BJ, Wilson K, Potter BK. Families' healthcare experiences for children with inherited metabolic diseases: protocol for a mixed methods cohort study. BMJ Open 2022; 12:e055664. [PMID: 35193919 PMCID: PMC8867352 DOI: 10.1136/bmjopen-2021-055664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Children with inherited metabolic diseases (IMDs) often have complex and intensive healthcare needs and their families face challenges in receiving high-quality, family centred health services. Improvement in care requires complex interventions involving multiple components and stakeholders, customised to specific care contexts. This study aims to comprehensively understand the healthcare experiences of children with IMDs and their families across Canada. METHODS AND ANALYSIS A two-stage explanatory sequential mixed methods design will be used. Stage 1: quantitative data on healthcare networks and encounter experiences will be collected from 100 parent/guardians through a care map, 2 baseline questionnaires and 17 weekly diaries over 5-7 months. Care networks will be analysed using social network analysis. Relationships between demographic or clinical variables and ratings of healthcare experiences across a range of family centred care dimensions will be analysed using generalised linear regression. Other quantitative data related to family experiences and healthcare experiences will be summarised descriptively. Ongoing analysis of quantitative data and purposive, maximum variation sampling will inform sample selection for stage 2: a subset of stage 1 participants will participate in one-on-one videoconference interviews to elaborate on the quantitative data regarding care networks and healthcare experiences. Interview data will be analysed thematically. Qualitative and quantitative data will be merged during analysis to arrive at an enhanced understanding of care experiences. Quantitative and qualitative data will be combined and presented narratively using a weaving approach (jointly on a theme-by-theme basis) and visually in a side-by-side joint display. ETHICS AND DISSEMINATION The study protocol and procedures were approved by the Children's Hospital of Eastern Ontario's Research Ethics Board, the University of Ottawa Research Ethics Board and the research ethics boards of each participating study centre. Findings will be published in peer-reviewed journals and presented at scientific conferences.
Collapse
Affiliation(s)
- Andrea J Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Iverson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Pallone
- Patient Partner, Canadian PKU & Allied Disorders Inc, Toronto, Ontario, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| | - Zobaida Al-Baldawi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alicia Chan
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Dyack
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Jane Gillis
- Department of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Sharan Goobie
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cheryl R Greenberg
- Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Jolly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Contagion Consulting Group, Ottawa, Ontario, Canada
| | - Sara Khangura
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer J MacKenzie
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - John J Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andreas Schulze
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Sparkes
- Departments of Medical Genetics and Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kathy Speechley
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Sylvia Stockler
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mari Teitelbaum
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yannis Trakadis
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Clara van Karnebeek
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Jagdeep S Walia
- Medical Genetics, Department of Pediatrics, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Brenda J Wilson
- Faculty of Medicine Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
Collapse
Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Pugliese M, Tingley K, Chow A, Pallone N, Smith M, Chakraborty P, Geraghty MT, Irwin JK, Mitchell JJ, Stockler S, Nicholls SG, Offringa M, Rahman A, Tessier LA, Butcher NJ, Iverson R, Lamoureux M, Clifford TJ, Hutton B, Paik K, Tao J, Skidmore B, Coyle D, Duddy K, Dyack S, Greenberg CR, Jain Ghai S, Karp N, Korngut L, Kronick J, MacKenzie A, MacKenzie J, Maranda B, Potter M, Prasad C, Schulze A, Sparkes R, Taljaard M, Trakadis Y, Walia J, Potter BK. Core Outcome Sets for Medium-Chain Acyl-CoA Dehydrogenase Deficiency and Phenylketonuria. Pediatrics 2021; 148:peds.2020-037747. [PMID: 34266901 DOI: 10.1542/peds.2020-037747] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence to guide treatment of pediatric medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency and phenylketonuria (PKU) is fragmented because of large variability in outcome selection and measurement. Our goal was to develop core outcome sets (COSs) for these diseases to facilitate meaningful future evidence generation and enhance the capacity to compare and synthesize findings across studies. METHODS Parents and/or caregivers, health professionals, and health policy advisors completed a Delphi survey and participated in a consensus workshop to select core outcomes from candidate lists of outcomes for MCAD deficiency and PKU. Delphi participants rated the importance of outcomes on a nine-point scale (1-3: not important, 4-6: important but not critical, 7-9: critical). Candidate outcomes were progressively narrowed down over 3 survey rounds. At the workshop, participants evaluated the remaining candidate outcomes using an adapted nominal technique, open discussion, and voting. After the workshop, we finalized the COSs and recommended measurement instruments for each outcome. RESULTS There were 85, 61, and 53 participants across 3 Delphi rounds, respectively. The candidate core outcome lists were narrowed down to 20 outcomes per disease to be discussed at the consensus workshop. Voting by 18 workshop participants led to COSs composed of 8 and 9 outcomes for MCAD deficiency and PKU, respectively, with measurement recommendations. CONCLUSIONS These are the first known pediatric COSs for MCAD deficiency and PKU. Adoption in future studies will help to ensure best use of limited research resources to ultimately improve care for children with these rare diseases.
Collapse
Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Andrea Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Nicole Pallone
- Patient partner, Canadian Organization for Rare Disorders, Toronto, Canada
| | | | - Pranesh Chakraborty
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.,Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Michael T Geraghty
- Divisions of Medical Genetics and Pediatric Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Julie K Irwin
- Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - John J Mitchell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sylvia Stockler
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stuart G Nicholls
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Martin Offringa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laure A Tessier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Nancy J Butcher
- Department of Pediatrics, Dalhousie University, Halifax, Canada.,Patient partner, Canadian Phenylketonuria & Allied Disorders Inc, Toronto, Canada
| | - Ryan Iverson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Lamoureux
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Tammy J Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Karen Paik
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jessica Tao
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Becky Skidmore
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathleen Duddy
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Sarah Dyack
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | | | - Shailly Jain Ghai
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalya Karp
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Canada
| | - Lawrence Korngut
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Jonathan Kronick
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Alex MacKenzie
- Division of Metabolics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Bruno Maranda
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Murray Potter
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Canada
| | - Chitra Prasad
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Andreas Schulze
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rebecca Sparkes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yannis Trakadis
- Medical Genetics, and Pediatrics, University of Calgary, Calgary, Canada
| | - Jagdeep Walia
- Department of Human Genetics, McGill University, Montreal, Canada
| | | | | |
Collapse
|
11
|
Stockler‐Ipsiroglu S, Potter BK, Yuskiv N, Tingley K, Patterson M, van Karnebeek C. Developments in evidence creation for treatments of inborn errors of metabolism. J Inherit Metab Dis 2021; 44:88-98. [PMID: 32944978 PMCID: PMC7891579 DOI: 10.1002/jimd.12315] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
Inborn errors of metabolism (IEM) represent the first group of genetic disorders, amenable to causal therapies. In addition to traditional medical diet and cofactor treatments, new treatment strategies such as enzyme replacement and small molecule therapies, solid organ transplantation, and cell-and gene-based therapies have become available. Inherent to the rare nature of the single conditions, generating high-quality evidence for these treatments in clinical trials and under real-world conditions has been challenging. Guidelines developed with standardized methodologies have contributed to improve the practice of care and long-term clinical outcomes. Adaptive trial designs allow for changes in sample size, group allocation and trial duration as the trial proceeds. n-of-1 studies may be used in small sample sized when participants are clinically heterogeneous. Multicenter observational and registry-based clinical trials are promoted via international research networks. Core outcome and standard data element sets will enhance comparative analysis of clinical trials and observational studies. Patient-centered outcome-research as well as patient-led research initiatives will further accelerate the development of therapies for IEM.
Collapse
Affiliation(s)
- Sylvia Stockler‐Ipsiroglu
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Beth K. Potter
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Nataliya Yuskiv
- Division of Biochemical Genetics, Department of Pediatrics, and BC Children's Hospital Research InstituteUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kylie Tingley
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Marc Patterson
- Division of Child and Adolescent Neurology, Departments of Neurology Pediatrics and Medical GeneticsMayo Clinic Children's CenterRochesterMinnesotaUSA
| | - Clara van Karnebeek
- Departments of Pediatrics and Clinical GeneticsAmsterdam University Medical CentresAmsterdamThe Netherlands
- Department of PediatricsRadboud University Medical CentreNijmegenThe Netherlands
- Department of PediatricsBC Children's Hospital Research Institute, Centre for Molecular Medicine and TherapeuticsVancouverBritish ColumbiaCanada
| |
Collapse
|
12
|
Qiu T, Wang Y, Dabbous M, Hanna E, Han R, Liang S, Toumi M. Current state of developing advanced therapies for rare diseases in the European Union. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1835640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Tingting Qiu
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Yitong Wang
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Monique Dabbous
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Eve Hanna
- Department of Price, Reimbursement and Market Access, Creativ-ceutical, Paris, France
| | - Ru Han
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Shuyao Liang
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Mondher Toumi
- Department of Public Health, Aix-Marseille University, Marseille, France
| |
Collapse
|
13
|
Bouveret Syndrome: A Systematic Review of Endoscopic Therapy and a Novel Predictive Tool to Aid in Management. J Clin Gastroenterol 2020; 54:758-768. [PMID: 32898384 DOI: 10.1097/mcg.0000000000001221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND GOALS Bouveret syndrome is characterized by gastroduodenal obstruction caused by an impacted gallstone. Current literature recommends endoscopic therapy as the first line of intervention despite significantly lower success rates compared with surgery. The lack of treatment efficacy studies and the paucity of clinical guidelines contribute to current practices being arbitrary. The aim of this systematic review was to identify factors that predict outcomes of endoscopic therapy. Subsequently, a predictive tool was devised to predict the success of endoscopic therapy and recommendations were proposed to improve current management strategies of impacted gallstones in the upper gastrointestinal tract. METHODS A systematic search of PubMed, Medline, Cochrane, and Scopus was performed for articles that contained the terms "Bouveret syndrome," "Bouveret's syndrome," "gallstone" AND "gastric obstruction" and "gallstone" AND "duodenal obstruction" that were published between January 1, 1950 to April 15, 2018. Articles were reviewed by 3 reviewers and raw data collated. χ and Kolmogorov-Smirnov tests were used to test associations between predictors and endoscopic outcomes. A logistic regression model was then used to create a predictive tool which was cross validated. RESULTS Failure of endoscopic therapy is associated with increasing gallstone length (P<0.0001) and impaction in the distal duodenum (P<0.05). Using multiple endoscopic modalities is associated with better success rates (P<0.05). The novel predictive tool predicted success of endoscopic therapy with an area under the receiver operating characteristic score of 0.86 (95% confidence interval: 0.79-0.94). CONCLUSION In Bouveret syndrome, a selective approach to endoscopic therapy can expedite definitive treatment and improve current management strategies.
Collapse
|
14
|
Lanar S, Acquadro C, Seaton J, Savre I, Arnould B. To what degree are orphan drugs patient-centered? A review of the current state of clinical research in rare diseases. Orphanet J Rare Dis 2020; 15:134. [PMID: 32493385 PMCID: PMC7268539 DOI: 10.1186/s13023-020-01400-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the past 30 years, the healthcare industry has increasingly turned its attention to rare diseases. Regulators have emphasized the need for clinical research in this area to be patient-centered. However, there is a lack of evidence concerning whether this need is actually met. In this paper, we aim to address this gap. METHODS First, we describe the state of patient-centricity in clinical research in rare diseases based on a targeted literature review. Second, we discuss recommendations from scientific bodies on patient-reported outcome (PRO) measures in rare diseases. Third, we analyze data collected from EMA's and FDA's websites concerning rare disease labeling claims and data from Clinicaltrials.gov concerning the use of PRO measures in rare disease pivotal trials. Fourth, we perform an exhaustive literature review on the use of PRO measures in the pharmaceutical industry, including all phases of clinical research, observational/registry studies, and instrument development and validation. RESULTS There is limited information on rare disease patient engagement in study design, recruitment, and retention. None of the initiatives describing methods for developing PRO measures in rare diseases provide the clear guidance clinical researchers need. Only 17.4% of orphan drug labels contain a PRO measure. Less than half of pivotal trials in orphan drugs have a PRO measure as a primary or a secondary endpoint. Although the number of publications about PRO measures in rare diseases has risen in the past fifteen years, our results indicate that substantial improvements are needed to achieve patient-centricity. CONCLUSIONS The nature and extent of patient engagement in rare disease research is under-documented. The current paradigm for developing and using PRO measures in clinical research is failing to meet the needs of rare disease patients. Not only are PROs rarely used as high-level endpoints in clinical trials or taken into account in labeling claims, they are also under-researched overall - there are too few measures for the multitude of rare diseases. We call for a clear guidance on patient engagement and suggest a realistic approach to the adaptation of PRO strategy to the specific context of clinical research in rare diseases.
Collapse
Affiliation(s)
- Sally Lanar
- ICON plc, Patient-Centered Outcomes, 27 rue de la Villette, 69003 Lyon, France
| | - Catherine Acquadro
- ICON plc, Patient-Centered Outcomes, 27 rue de la Villette, 69003 Lyon, France
| | - James Seaton
- Seaton Associates, LLC, 9039 Sligo Creek Parkway #1408, Silver Spring, MD 20901 USA
| | - Isabelle Savre
- Mapi Research Trust, 27 rue de la Villette, 69003 Lyon, France
| | - Benoit Arnould
- ICON plc, Patient-Centered Outcomes, 27 rue de la Villette, 69003 Lyon, France
| |
Collapse
|
15
|
Tingley K, Lamoureux M, Pugliese M, Geraghty MT, Kronick JB, Potter BK, Coyle D, Wilson K, Kowalski M, Austin V, Brunel-Guitton C, Buhas D, Chan AKJ, Dyack S, Feigenbaum A, Giezen A, Goobie S, Greenberg CR, Ghai SJ, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mohan C, Mhanni A, Mitchell G, Mitchell JJ, Nagy L, Napier M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Trakadis Y, Turner L, Van Karnebeek C, Vallance H, Vandersteen A, Walia J, Wilson A, Wilson BJ, Yu AC, Yuskiv N, Chakraborty P. Evaluation of the quality of clinical data collection for a pan-Canadian cohort of children affected by inherited metabolic diseases: lessons learned from the Canadian Inherited Metabolic Diseases Research Network. Orphanet J Rare Dis 2020; 15:89. [PMID: 32276663 PMCID: PMC7149838 DOI: 10.1186/s13023-020-01358-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Canadian Inherited Metabolic Diseases Research Network (CIMDRN) is a pan-Canadian practice-based research network of 14 Hereditary Metabolic Disease Treatment Centres and over 50 investigators. CIMDRN aims to develop evidence to improve health outcomes for children with inherited metabolic diseases (IMD). We describe the development of our clinical data collection platform, discuss our data quality management plan, and present the findings to date from our data quality assessment, highlighting key lessons that can serve as a resource for future clinical research initiatives relating to rare diseases. METHODS At participating centres, children born from 2006 to 2015 who were diagnosed with one of 31 targeted IMD were eligible to participate in CIMDRN's clinical research stream. For all participants, we collected a minimum data set that includes information about demographics and diagnosis. For children with five prioritized IMD, we collected longitudinal data including interventions, clinical outcomes, and indicators of disease management. The data quality management plan included: design of user-friendly and intuitive clinical data collection forms; validation measures at point of data entry, designed to minimize data entry errors; regular communications with each CIMDRN site; and routine review of aggregate data. RESULTS As of June 2019, CIMDRN has enrolled 798 participants of whom 764 (96%) have complete minimum data set information. Results from our data quality assessment revealed that potential data quality issues were related to interpretation of definitions of some variables, participants who transferred care across institutions, and the organization of information within the patient charts (e.g., neuropsychological test results). Little information was missing regarding disease ascertainment and diagnosis (e.g., ascertainment method - 0% missing). DISCUSSION Using several data quality management strategies, we have established a comprehensive clinical database that provides information about care and outcomes for Canadian children affected by IMD. We describe quality issues and lessons for consideration in future clinical research initiatives for rare diseases, including accurately accommodating different clinic workflows and balancing comprehensiveness of data collection with available resources. Integrating data collection within clinical care, leveraging electronic medical records, and implementing core outcome sets will be essential for achieving sustainability.
Collapse
Affiliation(s)
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Michael T Geraghty
- University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Jonathan B Kronick
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Doug Coyle
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Kowalski
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Valerie Austin
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Buhas
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Alicia K J Chan
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Dyack
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Feigenbaum
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alette Giezen
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Goobie
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shailly Jain Ghai
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Natalya Karp
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mariya Kozenko
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Erica Langley
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Matthew Lines
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Jennifer MacKenzie
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bruno Maranda
- Le centre hospitalier universitaire Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Connie Mohan
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Grant Mitchell
- Le centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura Nagy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Suzanne Ratko
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ramona Salvarinova
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Schulze
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Yannis Trakadis
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lesley Turner
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hilary Vallance
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jagdeep Walia
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Ashley Wilson
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Andrea C Yu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nataliya Yuskiv
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Ottawa, Ontario, Canada.
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| |
Collapse
|
16
|
Lascano-Vaca Y, Ortiz-Prado E, Gomez-Barreno L, Simbaña-Rivera K, Vasconez E, Lister A, Arteaga-Espinosa ME, Perez GF. Clinical, genetic and microbiological characterization of pediatric patients with cystic fibrosis in a public Hospital in Ecuador. BMC Pediatr 2020; 20:111. [PMID: 32143663 PMCID: PMC7060626 DOI: 10.1186/s12887-020-2013-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 02/27/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To carry out a complete clinical, pathological, genetic and microbiological characterization of pediatric patients with molecular confirmed cystic fibrosis (CF) attending the Carlos Andrade Marín Hospital (HCAM) within the study period. METHODS A cross-sectional analysis of the pediatric population with a confirmed diagnosis of CF disease who attended HCAM, one of the largest tertiary-level hospitals in Ecuador, between 2017 and 2018 was performed. All demographic, clinical and genetic variables were obtained from the electronic medical records (EMR) stored by the hospital. RESULTS Forty seven patients with CF were included in the study. Gender distribution was similar between male (48.9%, n = 23) and female patients (51.1%, n = 24). The Tiffeneau-Pinelli index (FEV1/FVC) changed significantly after nine months post-diagnosis (85.55 ± 13.26; p < 0.05). The most common pathogenic genetic variants were F508del, found in 52.78% of the cohort (n = 19); H609R, found in 36.11% (n = 13); g.204099A > C, found in 14.1% (n = 7), followed by G85E and the N1303K with 11.11% (n = 3) each. CONCLUSIONS To our best knowledge, this is the first study exploring the clinical, genetic and bacteriological profile of CF's patients in Ecuador. Within the cohort of patients, an important and unique genetic feature was characterized by the presence of the g.204099A > C and the c.206359C > A homozygous polymorphism as well as the presence of the H609R variant, a mutation only reported among Ecuadorians.
Collapse
Affiliation(s)
- Yazmina Lascano-Vaca
- Pediatric Pneumology Service, Pediatric Unit of the Carlos Andrade Marin Specialties Hospital, Quito, Ecuador
| | - Esteban Ortiz-Prado
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador.
| | - Lenin Gomez-Barreno
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Eduardo Vasconez
- One Health Research Group, Universidad de Las Americas, José Queri and Av. de los Granados, Quito, Ecuador
| | - Alexander Lister
- Faculty of Medicine, University of Southampton, Southampton, England
| | | | - Geovanny F Perez
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
| |
Collapse
|
17
|
Affiliation(s)
- Anushka Patel
- From The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Laurent Billot
- From The George Institute for Global Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
18
|
DiMartino LD, Baumann AA, Hsu LL, Kanter J, Gordeuk VR, Glassberg J, Treadwell MJ, Melvin CL, Telfair J, Klesges LM, King A, Wun T, Shah N, Gibson RW, Hankins JS. The sickle cell disease implementation consortium: Translating evidence-based guidelines into practice for sickle cell disease. Am J Hematol 2018; 93:E391-E395. [PMID: 30203558 PMCID: PMC6503654 DOI: 10.1002/ajh.25282] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Ana A Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Lewis L Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Julie Kanter
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Victor R Gordeuk
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marsha J Treadwell
- University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Telfair
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
| | - Lisa M Klesges
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Allison King
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Ted Wun
- University of California, Davis School of Medicine, Sacramento, California
| | - Nirmish Shah
- Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Robert W Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | |
Collapse
|
19
|
Engagement of Canadian Patients with Rare Diseases and Their Families in the Lifecycle of Therapy: A Qualitative Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:353-359. [PMID: 29299833 DOI: 10.1007/s40271-017-0293-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patient involvement is increasingly recognized as critical to the development, introduction and use (i.e. the lifecycle) of new and effective therapies, particularly those for rare diseases, where natural histories and the impact on patients and families are less well-understood than for common diseases. However, little is known about how patients and families would like to be involved during the lifecycle. OBJECTIVE The aim of this study was to explore ways in which Canadian patients with rare diseases and their families would like to be involved in the lifecycle of therapies and identify their priorities for involvement. METHODS Patients with rare diseases and their families were recruited to participate in two deliberative sessions, during which concepts related to decision-making uncertainty and the technology lifecycle were introduced before eliciting input around ways in which they could be involved. This was followed by a webinar, which was used to further identify opportunities for involvement. The data were then analyzed qualitatively using eclectic coding. RESULTS Patients and families identified opportunities that fell into three goals: (1) incorporation of their 'lived experience' in coverage decision making (i.e. decisions by governments on funding new therapies); (2) improved care for patients; and (3) greater awareness of rare diseases, with the first being a priority. CONCLUSIONS Opportunities for patients and families to contribute their 'lived experience' are needed throughout the orphan drug lifecycle, but the ideal mechanisms for providing this input have yet to be determined.
Collapse
|
20
|
Li D, Mastaglia FL, Fletcher S, Wilton SD. Precision Medicine through Antisense Oligonucleotide-Mediated Exon Skipping. Trends Pharmacol Sci 2018; 39:982-994. [PMID: 30282590 DOI: 10.1016/j.tips.2018.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022]
Abstract
Clinical implementation of two recently approved antisense RNA therapeutics - Exondys51® to treat Duchenne muscular dystrophy (Duchenne MD) and Spinraza® as a treatment for spinal muscular atrophy (SMA) - highlights the therapeutic potential of antisense oligonucleotides (ASOs). As shown in the Duchenne and Becker cases, the identification and specific removal of 'dispensable' exons by exon-skipping ASOs could potentially bypass lethal mutations in other genes and bring clinical benefits to affected individuals carrying amenable mutations. In this review, we discuss the potential of therapeutic alternative splicing, with a particular focus on targeted exon skipping using Duchenne MD as an example, and speculate on new applications for other inherited rare diseases where redundant or dispensable exons may be amenable to exon-skipping ASO intervention as precision medicine.
Collapse
Affiliation(s)
- Dunhui Li
- Centre for Comparative Genomics, Murdoch University, Perth 6050, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, Perth 6000, Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, University of Western Australia, Perth 6000, Australia
| | - Sue Fletcher
- Centre for Comparative Genomics, Murdoch University, Perth 6050, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, Perth 6000, Australia
| | - Steve D Wilton
- Centre for Comparative Genomics, Murdoch University, Perth 6050, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, Perth 6000, Australia.
| |
Collapse
|
21
|
Tingley K, Coyle D, Graham ID, Sikora L, Chakraborty P, Wilson K, Mitchell JJ, Stockler-Ipsiroglu S, Potter BK. Using a meta-narrative literature review and focus groups with key stakeholders to identify perceived challenges and solutions for generating robust evidence on the effectiveness of treatments for rare diseases. Orphanet J Rare Dis 2018; 13:104. [PMID: 29954425 PMCID: PMC6022712 DOI: 10.1186/s13023-018-0851-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION For many rare diseases, strong analytic study designs for evaluating the efficacy and effectiveness of interventions are challenging to implement because of small, geographically dispersed patient populations and underlying clinical heterogeneity. The objective of this study was to integrate perspectives from published literature and key rare disease stakeholders to better understand the perceived challenges and proposed methodological approaches to research on clinical interventions for rare diseases. METHODS We used a meta-narrative literature review and focus group interviews with key rare disease stakeholders to better understand the perceived challenges in generating and synthesizing treatment effectiveness evidence, and to describe various research methods for mitigating these identified challenges. Data from both components of this study were synthesized narratively according to research paradigms that emerged from our data. RESULTS Results from our meta-narrative literature review and focus group interviews revealed three fundamental challenges in generating robust treatment effectiveness evidence for rare diseases: i) limitations in recruiting a sufficient sample size to achieve planned statistical power; ii) inability to account for clinical heterogeneity and assess treatment effects across a clinical spectrum; and iii) reliance on short-term, surrogate outcomes whose clinical relevance is often unclear. We mapped these challenges and associated solutions to three interrelated research paradigms: i) explanatory evidence generation; ii) comparative effectiveness/pragmatic evidence generation; and iii) patient-oriented evidence generation. Within each research paradigm, numerous criticisms and potential solutions have been described with respect to overcoming these challenges from a research study design perspective. CONCLUSIONS Over time, discussions about clinical research for interventions for rare diseases have moved beyond methodological approaches to overcome challenges related to explanatory evidence generation, with increased recognition of the importance of pragmatic and patient-oriented evidence. Future directions for our work include developing a framework to expand current evidence synthesis practices to take into consideration many of the concepts discussed in this paper.
Collapse
Affiliation(s)
- Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON Canada
| | - Pranesh Chakraborty
- Metabolics and Newborn Screening, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
- Newborn Screening Ontario, Ottawa, ON Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - John J. Mitchell
- Department of Pediatrics and Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
| | - Sylvia Stockler-Ipsiroglu
- Division of Biochemical Diseases, BC Children’s Hospital, Vancouver, BC Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - in collaboration with the Canadian Inherited Metabolic Diseases Research Network
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Health Sciences Library, University of Ottawa, Ottawa, ON Canada
- Metabolics and Newborn Screening, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
- Newborn Screening Ontario, Ottawa, ON Canada
- Department of Pediatrics and Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
- Division of Biochemical Diseases, BC Children’s Hospital, Vancouver, BC Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| |
Collapse
|
22
|
Abstract
Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.
Collapse
|
23
|
Affiliation(s)
- Sandra Sirrs
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada.
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Level 4 - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| |
Collapse
|
24
|
Potter BK, Hutton B, Clifford TJ, Pallone N, Smith M, Stockler S, Chakraborty P, Barbeau P, Garritty CM, Pugliese M, Rahman A, Skidmore B, Tessier L, Tingley K, Coyle D, Greenberg CR, Korngut L, MacKenzie A, Mitchell JJ, Nicholls S, Offringa M, Schulze A, Taljaard M. Establishing core outcome sets for phenylketonuria (PKU) and medium-chain Acyl-CoA dehydrogenase (MCAD) deficiency in children: study protocol for systematic reviews and Delphi surveys. Trials 2017; 18:603. [PMID: 29258568 PMCID: PMC5735866 DOI: 10.1186/s13063-017-2327-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Inherited metabolic diseases (IMD) are a large group of rare single-gene disorders that are typically diagnosed early in life. There are important evidence gaps related to the comparative effectiveness of therapies for IMD, which are in part due to challenges in conducting randomized controlled trials (RCTs) for rare diseases. Registry-based RCTs present a unique opportunity to address these challenges provided the registries implement standardized collection of outcomes that are important to patients and their caregivers and to clinical providers and healthcare systems. Currently there is no core outcome set (COS) for studies evaluating interventions for paediatric IMD. This protocol outlines a study that will establish COS for each of two relatively common IMD in children, phenylketonuria (PKU) and medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. METHODS This two-part study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative. Part 1 includes a rapid review and development of an evidence map to identify a comprehensive listing of outcomes reported in past studies of PKU and MCAD deficiency. The review follows established methods for knowledge synthesis, including a comprehensive search strategy, two stages of screening citations against inclusion/exclusion criteria by two reviewers working independently, and extraction of important data elements from eligible studies, including details of the outcomes collected and outcome measurement instruments. The review findings will inform part 2 of our study, a set of Delphi surveys to establish consensus on the highest priority outcomes for each condition. Healthcare providers, families of children with PKU or MCAD deficiency, and health system decision-makers will be invited to participate in two to three rounds of Delphi surveys. The design of the surveys will involve parents of children with IMD who are part of a family advisory forum. DISCUSSION This protocol is a crucial step in developing the capacity to launch RCTs with meaningful outcomes that address comparative effectiveness questions in the field of paediatric IMD. Such trials will contribute high-quality evidence to inform decision-making by patients and their family members, clinicians, and policy-makers.
Collapse
Affiliation(s)
- Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Tammy J. Clifford
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON Canada
| | - Nicole Pallone
- Patient/family partner and Canadian PKU & Allied Disorders Inc, Sparwood, BC Canada
| | - Maureen Smith
- Patient/family partner and Canadian Organization for Rare Disorders, Ottawa, ON Canada
| | - Sylvia Stockler
- BC Children’s Hospital and University of British Columbia, Vancouver, BC Canada
| | - Pranesh Chakraborty
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | | | | | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Alvi Rahman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | | | - Laure Tessier
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
| | | | - Lawrence Korngut
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Alex MacKenzie
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | | | - Stuart Nicholls
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Ontario Child Health SUPPORT Unit (OCHSU), Ottawa, ON Canada
| | - Martin Offringa
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Andreas Schulze
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - In collaboration with the Canadian Inherited Metabolic Diseases Research Network
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Drive, Ottawa, ON K1G 5Z3 Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON Canada
- Patient/family partner and Canadian PKU & Allied Disorders Inc, Sparwood, BC Canada
- Patient/family partner and Canadian Organization for Rare Disorders, Ottawa, ON Canada
- BC Children’s Hospital and University of British Columbia, Vancouver, BC Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- University of Manitoba, Winnipeg, MB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- McGill University Health Centre, Montreal, QC Canada
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- Ontario Child Health SUPPORT Unit (OCHSU), Ottawa, ON Canada
- Hospital for Sick Children and University of Toronto, Toronto, ON Canada
| |
Collapse
|
25
|
Rath A, Salamon V, Peixoto S, Hivert V, Laville M, Segrestin B, Neugebauer EAM, Eikermann M, Bertele V, Garattini S, Wetterslev J, Banzi R, Jakobsen JC, Djurisic S, Kubiak C, Demotes-Mainard J, Gluud C. A systematic literature review of evidence-based clinical practice for rare diseases: what are the perceived and real barriers for improving the evidence and how can they be overcome? Trials 2017; 18:556. [PMID: 29166947 PMCID: PMC5700662 DOI: 10.1186/s13063-017-2287-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Evidence-based clinical practice is challenging in all fields, but poses special barriers in the field of rare diseases. The present paper summarises the main barriers faced by clinical research in rare diseases, and highlights opportunities for improvement. METHODS Systematic literature searches without meta-analyses and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. RESULTS Barriers specific to rare diseases comprise the difficulty to recruit participants because of rarity, scattering of patients, limited knowledge on natural history of diseases, difficulties to achieve accurate diagnosis and identify patients in health information systems, and difficulties choosing clinically relevant outcomes. CONCLUSIONS Evidence-based clinical practice for rare diseases should start by collecting clinical data in databases and registries; defining measurable patient-centred outcomes; and selecting appropriate study designs adapted to small study populations. Rare diseases constitute one of the most paradigmatic fields in which multi-stakeholder engagement, especially from patients, is needed for success. Clinical research infrastructures and expertise networks offer opportunities for establishing evidence-based clinical practice within rare diseases.
Collapse
Affiliation(s)
- Ana Rath
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Valérie Salamon
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Sandra Peixoto
- Orphanet, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Virginie Hivert
- EURORDIS – European Organisation for Rare Diseases, Paris, France
| | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | - Berenice Segrestin
- Centre de Recherche en Nutrition Humaine Rhone-Alpes, Université de Lyon 1, Hospices Civils de Lyon, Groupement Hospitaler Sud, Pierre Benite, France
| | | | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten and Brandenburg Medical School, Neuruppin, Germany
| | - Vittorio Bertele
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rita Banzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Janus C. Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæek, Denmark
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
26
|
Delavan B, Roberts R, Huang R, Bao W, Tong W, Liu Z. Computational drug repositioning for rare diseases in the era of precision medicine. Drug Discov Today 2017; 23:382-394. [PMID: 29055182 DOI: 10.1016/j.drudis.2017.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022]
Abstract
There are tremendous unmet needs in drug development for rare diseases. Computational drug repositioning is a promising approach and has been successfully applied to the development of treatments for diseases. However, how to utilize this knowledge and effectively conduct and implement computational drug repositioning approaches for rare disease therapies is still an open issue. Here, we focus on the means of utilizing accumulated genomic data for accelerating and facilitating drug repositioning for rare diseases. First, we summarize the current genome landscape of rare diseases. Second, we propose several promising bioinformatics approaches and pipelines for computational drug repositioning for rare diseases. Finally, we discuss recent regulatory incentives and other enablers in rare disease drug development and outline the remaining challenges.
Collapse
Affiliation(s)
- Brian Delavan
- National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR 72079, USA; University of Arkansas at Little Rock, Little Rock, AR 72204, USA
| | - Ruth Roberts
- ApconiX, BioHub at Alderley Park, Alderley Edge SK10 4TG, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ruili Huang
- National Center for Advancing Translational Sciences, National Institutes of Health Rockville, MD 20850, USA
| | | | - Weida Tong
- National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Zhichao Liu
- National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR 72079, USA.
| |
Collapse
|
27
|
Aymé S, Bockenhauer D, Day S, Devuyst O, Guay-Woodford LM, Ingelfinger JR, Klein JB, Knoers NVAM, Perrone RD, Roberts J, Schaefer F, Torres VE, Cheung M, Wheeler DC, Winkelmayer WC. Common Elements in Rare Kidney Diseases: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2017; 92:796-808. [PMID: 28938953 PMCID: PMC6685068 DOI: 10.1016/j.kint.2017.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
Abstract
Rare kidney diseases encompass at least 150 different conditions, most of which are inherited. Although individual rare kidney diseases raise specific issues, as a group these rare diseases can have overlapping challenges in diagnosis and treatment. These challenges include small numbers of affected patients, unidentified causes of disease, lack of biomarkers for monitoring disease progression, and need for complex care. To address common clinical and patient issues among rare kidney diseases, the KDIGO Controversies Conference entitled, Common Elements in Rare Kidney Diseases, brought together a panel of multidisciplinary clinical providers and patient advocates to address five central issues for rare kidney diseases. These issues encompassed diagnostic challenges, management of kidney functional decline and progression of chronic kidney disease, challenges in clinical study design, translation of advances in research to clinical care, and provision of practical and integrated patient support. Thus, by a process of consensus, guidance for addressing these challenges was developed and is presented here.
Collapse
Affiliation(s)
- Ségolène Aymé
- Institut du Cerveau et de la Moelle Épinière, Centre National de la Recherche Scientifique Unite Mixte de Recherche 7225, Institut National de la Santé et de la Recherche Médicale U 1127, Université Pierre et Marie Curie-P6 Unite Mixte de Recherche S 1127, Paris, France
| | - Detlef Bockenhauer
- University College of London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - Simon Day
- Clinical Trials Consulting and Training Limited, Buckingham, UK
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC, USA.
| | - Julie R Ingelfinger
- MassGeneral Hospital for Children at Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jon B Klein
- Division of Nephrology and Hypertension, The University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia Roberts
- Polycystic Kidney Disease Foundation, Kansas City, Missouri, USA
| | - Franz Schaefer
- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes, Brussels, Belgium
| | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
28
|
Jia J, Shi T. Towards efficiency in rare disease research: what is distinctive and important? SCIENCE CHINA-LIFE SCIENCES 2017. [PMID: 28639105 DOI: 10.1007/s11427-017-9099-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Characterized by their low prevalence, rare diseases are often chronically debilitating or life threatening. Despite their low prevalence, the aggregate number of individuals suffering from a rare disease is estimated to be nearly 400 million worldwide. Over the past decades, efforts from researchers, clinicians, and pharmaceutical industries have been focused on both the diagnosis and therapy of rare diseases. However, because of the lack of data and medical records for individual rare diseases and the high cost of orphan drug development, only limited progress has been achieved. In recent years, the rapid development of next-generation sequencing (NGS)-based technologies, as well as the popularity of precision medicine has facilitated a better understanding of rare diseases and their molecular etiology. As a result, molecular subclassification can be identified within each disease more clearly, significantly improving diagnostic accuracy. However, providing appropriate care for patients with rare diseases is still an enormous challenge. In this review, we provide a brief introduction to the challenges of rare disease research and make suggestions on where and how our efforts should be focused.
Collapse
Affiliation(s)
- Jinmeng Jia
- The Center for Bioinformatics and Computational Biology, Shanghai Key Laboratory of Regulatory Biology, the Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, 200241, China
| | - Tieliu Shi
- The Center for Bioinformatics and Computational Biology, Shanghai Key Laboratory of Regulatory Biology, the Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, 200241, China.
| |
Collapse
|
29
|
Bradley LA, Haddow HRM, Palomaki GE. Treatment of mucopolysaccharidosis type II (Hunter syndrome): results from a systematic evidence review. Genet Med 2017. [PMID: 28640238 DOI: 10.1038/gim.2017.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PurposeA pilot systematic evidence review to establish methodology utility in rare genetic diseases, support clinical recommendations, and identify important knowledge gaps.MethodsBroad-based published/gray-literature searches through December 2015 for studies of males with confirmed mucopolysaccharidosis type II (any age, phenotype, genotype, family history) treated with enzyme replacement therapy or hematopoietic stem cell transplantation. Preset inclusion criteria employed for abstract and full document selection, and standardized methods for data extraction and assessment of quality and strength of evidence.ResultsTwelve outcomes reported included benefits of urinary glycosaminoglycan and liver/spleen volume reductions and harms of immunoglobulin G/neutralizing antibody development (moderate strength of evidence). Less clear were benefits of improved 6-minute walk tests, height, early treatment, and harms of other adverse reactions (low strength of evidence). Benefits and harms of other outcomes were unclear (insufficient strength of evidence). Current benefits and harms of hematopoietic stem cell transplantation are unclear, based on dated, low-quality studies. A critical knowledge gap is long-term outcomes. Consensus on selection of critical outcomes and measures is needed to definitively evaluate treatment safety and effectiveness.ConclusionMinor methodology modifications and a focus on critical evidence can reduce review time and resources. Summarized evidence was sufficient to support guidance development and highlight important knowledge gaps.
Collapse
Affiliation(s)
- Linda A Bradley
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
| | | | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
| |
Collapse
|
30
|
Muenzer J, Jones SA, Tylki-Szymańska A, Harmatz P, Mendelsohn NJ, Guffon N, Giugliani R, Burton BK, Scarpa M, Beck M, Jangelind Y, Hernberg-Stahl E, Larsen MP, Pulles T, Whiteman DAH. Ten years of the Hunter Outcome Survey (HOS): insights, achievements, and lessons learned from a global patient registry. Orphanet J Rare Dis 2017; 12:82. [PMID: 28464912 PMCID: PMC5414331 DOI: 10.1186/s13023-017-0635-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/13/2017] [Indexed: 11/18/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II; Hunter syndrome; OMIM 309900) is a rare lysosomal storage disease with progressive multisystem manifestations caused by deficient activity of the enzyme iduronate-2-sulfatase. Disease-specific treatment is available in the form of enzyme replacement therapy with intravenous idursulfase (Elaprase®, Shire). Since 2005, the Hunter Outcome Survey (HOS) has collected real-world, long-term data on the safety and effectiveness of this therapy, as well as the natural history of MPS II. Individuals with a confirmed diagnosis of MPS II who are untreated or who are receiving/have received treatment with idursulfase or bone marrow transplant can be enrolled in HOS. A broad range of disease- and treatment-related information is captured in the registry and, over the past decade, data from more than 1000 patients from 124 clinics in 29 countries have been collected. Evidence generated from HOS has helped to improve our understanding of disease progression in both treated and untreated patients and has extended findings from the formal clinical trials of idursulfase. As a long-term, global, observational registry, various challenges relating to data collection, entry, and analysis have been encountered. These have resulted in changes to the HOS database platform, and novel approaches to maximize the value of the information collected will also be needed in the future. The continued evolution of the registry should help to ensure that HOS provides further insights into the burden of the disease and patient care and management in the coming years.
Collapse
Affiliation(s)
- Joseph Muenzer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Simon A Jones
- Willink Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester and Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Anna Tylki-Szymańska
- Department of Pediatric Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Nancy J Mendelsohn
- Genomic Medicine Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, Division of Genetics, University of Minnesota, Minneapolis, MN, USA
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Bron, France
| | - Roberto Giugliani
- Department of Genetics/UFRGS and INAGEMP, Medical Genetics Service/HCPA, Porto Alegre, Brazil
| | - Barbara K Burton
- Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Maurizio Scarpa
- Rare Disease Centre, Helios Dr Horst Schmidt Clinic, Wiesbaden, Germany.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Michael Beck
- Department of Pediatrics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | | | - Maria Paabøl Larsen
- Shire Human Genetic Therapies, Inc., 300 Shire Way HA100-310, Lexington, MA, 02421, USA.,Present address: Shionogi, Inc., Florham Park, NJ, USA
| | - Tom Pulles
- Shire, Zug, Switzerland.,Present address: Ultragenyx Pharmaceutical, Inc., Basel, Switzerland
| | - David A H Whiteman
- Shire Human Genetic Therapies, Inc., 300 Shire Way HA100-310, Lexington, MA, 02421, USA.
| |
Collapse
|
31
|
Annemans L, Aymé S, Le Cam Y, Facey K, Gunther P, Nicod E, Reni M, Roux JL, Schlander M, Taylor D, Tomino C, Torrent-Farnell J, Upadhyaya S, Hutchings A, Le Dez L. Recommendations from the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL). Orphanet J Rare Dis 2017; 12:50. [PMID: 28283046 PMCID: PMC5345269 DOI: 10.1186/s13023-017-0601-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
Rare diseases are an important public health issue with high unmet need. The introduction of the EU Regulation on orphan medicinal products (OMP) has been successful in stimulating investment in the research and development of OMPs. Despite this advancement, patients do not have universal access to these new medicines. There are many factors that affect OMP uptake, but one of the most important is the difficulty of making pricing and reimbursement (P&R) decisions in rare diseases. Until now, there has been little consensus on the most appropriate assessment criteria, perspective or appraisal process. This paper proposes nine principles to help improve the consistency of OMP P&R assessment in Europe and ensure that value assessment, pricing and funding processes reflect the specificities of rare diseases and contribute to both the sustainability of healthcare systems and the sustainability of innovation in this field. These recommendations are the output of the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL), a collaboration between rare disease experts, patient representatives, academics, health technology assessment (HTA) practitioners, politicians and industry representatives. ORPH-VAL reached its recommendations through careful consideration of existing OMP P&R literature and through a wide consultation with expert stakeholders, including payers, regulators and patients. The principles cover four areas: OMP decision criteria, OMP decision process, OMP sustainable funding systems and European co-ordination. This paper also presents a guide to the core elements of value relevant to OMPs that should be consistently considered in all OMP appraisals. The principles outlined in this paper may be helpful in drawing together an emerging consensus on this topic and identifying areas where consistency in payer approach could be achievable and beneficial. All stakeholders have an obligation to work together to ensure that the promise of OMP's is realised.
Collapse
Affiliation(s)
- Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Ségolène Aymé
- ICM, CNRS UMR 7225––Inserm U 1127––UPMC-P6 UMR S 1127, Paris, France
| | - Yann Le Cam
- EURORDIS-Rare Diseases Europe, Paris, France
| | - Karen Facey
- University of Edinburgh, Edinburgh, Scotland
| | | | - Elena Nicod
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Michele Reni
- IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | | | - Michael Schlander
- Health Economics at the University of Heidelberg, Heidelberg, Germany
- Division of Health Economics at the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Innovation & Valuation in Health Care, Wiesbaden, Germany
| | - David Taylor
- Pharmaceutical and Public Health Policy, University College London (UCL), London, UK
| | - Carlo Tomino
- Clinical Research at IRCSS San Raffaele, Rome, Italy
| | - Josep Torrent-Farnell
- Clinical Pharmacology and Therapeutics, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Lugdivine Le Dez
- European government relations and public policy at Celgene, Brussels, Belgium
| |
Collapse
|
32
|
Woodward L, Johnson S, Walle JV, Beck J, Gasteyger C, Licht C, Ariceta G. An innovative and collaborative partnership between patients with rare disease and industry-supported registries: the Global aHUS Registry. Orphanet J Rare Dis 2016; 11:154. [PMID: 27871301 PMCID: PMC5117495 DOI: 10.1186/s13023-016-0537-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 02/04/2023] Open
Abstract
Background Patients are becoming increasingly involved in research which can promote innovation through novel ideas, support patient-centred actions, and facilitate drug development. For rare diseases, registries that collect data from patients can increase knowledge of the disease’s natural history, evaluate clinical therapies, monitor drug safety, and measure quality of care. The active participation of patients is expected to optimise rare-disease management and improve patient outcomes. However, few reports address the type and frequency of interactions involving patients, and what research input patient groups have. Here, we describe a collaboration between an international group of patient organisations advocating for patients with atypical haemolytic uraemic syndrome (aHUS), the aHUS Alliance, and an international aHUS patient registry (ClinicalTrials.gov NCT01522183). Results The aHUS Registry Scientific Advisory Board (SAB) invited the aHUS Alliance to submit research ideas important to patients with aHUS. This resulted in 24 research suggestions from patients and patient organisations being presented to the SAB. The proposals were classified under seven categories, the most popular of which were understanding factors that cause disease manifestations and learning more about the clinical and psychological/social impact of living with the disease. Subsequently, aHUS Alliance members voted for up to five research priorities. The top priority was: “What are the outcomes of a transplant without eculizumab and what non-kidney damage is likely in patients with aHUS?”. This led directly to the initiation of an ongoing analysis of the data collected in the Registry on patients with kidney transplants. Conclusion This collaboration resulted in several topics proposed by the aHUS Alliance being selected as priority activities for the aHUS Registry, with one new analysis already underway. A clear pathway was established for engagement between a patient advocacy group and an international research network. This should ensure the development of a long-term partnership which clearly benefits both groups.
Collapse
Affiliation(s)
| | - Sally Johnson
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Safepedrug Consortium, Ghent University Hospital, Ghent, Belgium
| | | | | | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Gema Ariceta
- Paediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | | |
Collapse
|
33
|
Javaid MK, Forestier-Zhang L, Watts L, Turner A, Ponte C, Teare H, Gray D, Gray N, Popert R, Hogg J, Barrett J, Pinedo-Villanueva R, Cooper C, Eastell R, Bishop N, Luqmani R, Wordsworth P, Kaye J. The RUDY study platform - a novel approach to patient driven research in rare musculoskeletal diseases. Orphanet J Rare Dis 2016; 11:150. [PMID: 27825362 PMCID: PMC5101709 DOI: 10.1186/s13023-016-0528-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research into rare diseases is becoming more common, with recognition of the significant diagnostic and therapeutic care gaps. Registries are considered a key research methodology to address rare diseases. This report describes the structure of the Rare UK Diseases Study (RUDY) platform that aims to improve research processes and address many of the challenges of carrying out rare musculoskeletal disease research. RUDY is an internet-based platform with online registration, initial verbal consent, online capture of patient reported outcome measures and events within a dynamic consent framework. The database structure, security and governance framework are described. RESULTS There have been 380 participants recruited into RUDY with completed questionnaire rates in excess of 50 %. There has been one withdrawal and two participants have amended their consent options. CONCLUSIONS The strengths of RUDY include low burden for the clinical team, low research administration costs with high participant recruitment and ease of data collection and access. This platform has the potential to be used as the model for other rare diseases globally.
Collapse
Affiliation(s)
- M K Javaid
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,The Botnar Research Centre, NIHR Oxford Musculoskeletal BRU, NDORMS, University of Oxford, Oxford, OX3 7HE, UK.
| | - L Forestier-Zhang
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - L Watts
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Turner
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Ponte
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - H Teare
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Gray
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N Gray
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - R Popert
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Hogg
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Barrett
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - R Pinedo-Villanueva
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Cooper
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - R Eastell
- Academic Unit of Bone Metabolism, Metabolic Bone Centre, Northern General Hospital, Sheffield, UK
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - R Luqmani
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - P Wordsworth
- Oxford NIHR Musculoskeletal Biomedcial Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Kaye
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
34
|
Liu Z, Fang H, Slikker W, Tong W. Potential Reuse of Oncology Drugs in the Treatment of Rare Diseases. Trends Pharmacol Sci 2016; 37:843-857. [DOI: 10.1016/j.tips.2016.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 12/23/2022]
|
35
|
Porrello A, Piergentili RB. Contextualizing the Genes Altered in Bladder Neoplasms in Pediatric andTeen Patients Allows Identifying Two Main Classes of Biological ProcessesInvolved and New Potential Therapeutic Targets. Curr Genomics 2016; 17:33-61. [PMID: 27013923 PMCID: PMC4780474 DOI: 10.2174/1389202916666151014222603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
Research on bladder neoplasms in pediatric and teen patients (BNPTP) has described 21 genes, which are variously involved in this disease and are mostly responsible for deregulated cell proliferation. However, due to the limited number of publications on this subject, it is still unclear what type of relationships there are among these genes and which are the chances that, while having different molecular functions, they i) act as downstream effector genes of well-known pro- or anti- proliferative stimuli and/or interplay with biochemical pathways having oncological relevance or ii) are specific and, possibly, early biomarkers of these pathologies. A Gene Ontology (GO)-based analysis showed that these 21 genes are involved in biological processes, which can be split into two main classes: cell regulation-based and differentiation/development-based. In order to understand the involvement/overlapping with main cancer-related pathways, we performed a meta-analysis dependent on the 189 oncogenic signatures of the Molecular Signatures Database (OSMSD) curated by the Broad Institute. We generated a binary matrix with 53 gene signatures having at least one hit; this analysis i) suggests that some genes of the original list show inconsistencies and might need to be experimentally re- assessed or evaluated as biomarkers (in particular, ACTA2) and ii) allows hypothesizing that important (proto)oncogenes (E2F3, ERBB2/HER2, CCND1, WNT1, and YAP1) and (putative) tumor suppressors (BRCA1, RBBP8/CTIP, and RB1-RBL2/p130) may participate in the onset of this disease or worsen the observed phenotype, thus expanding the list of possible molecular targets for the treatment of BNPTP.
Collapse
Affiliation(s)
- A. Porrello
- Comprehensive Cancer Center (LCCC), University of North Carolina (UNC)-Chapel Hill, Chapel Hill, 27599 NC, USA
| | - R. b Piergentili
- Institute of Molecular Biology and Pathology at CNR (CNR-IBPM); Department of Biology and Biotechnologies, Sapienza – Università di Roma, Italy
| |
Collapse
|
36
|
Pinto D, Martin D, Chenhall R. The involvement of patient organisations in rare disease research: a mixed methods study in Australia. Orphanet J Rare Dis 2016; 11:2. [PMID: 26754025 PMCID: PMC4709899 DOI: 10.1186/s13023-016-0382-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/04/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We report here selected findings from a mixed-methods study investigating the role of Australian rare disease patient organisations (RDPOs) in research. Despite there being many examples of RDPOs that have initiated and supported significant scientific advances, there is little information - and none at all in Australia - about RDPOs generally, and their research-related goals, activities, and experiences. This information is a pre-requisite for understanding what RDPOs bring to research and how their involvement could be strengthened. METHODS We reviewed 112 RDPO websites, conducted an online survey completed by 61 organisational leaders, and interviewed ten leaders and two key informants. Quantitative and qualitative data were analysed using basic descriptive statistics and content analysis, respectively. RESULTS Although most are small volunteer-based groups, more than 90% of the surveyed RDPOs had a goal to promote or support research on the diseases affecting their members. Nearly all (95 %) had undertaken at least one research-related activity - such as providing funding or other support to researchers - in the previous five years. However, RDPO leaders reported considerable challenges in meeting their research goals. Difficulties most frequently identified were insufficient RDPO resources, and a perceived lack of researchers interested in studying their diseases. Other concerns included inadequate RDPO expertise in governing research "investments", and difficulty engaging researchers in the organisation's knowledge and ideas. We discuss these perceived challenges in the light of two systemic issues: the proliferation of and lack of collaboration between RDPOs, and the lack of specific governmental policies and resources supporting rare disease research and patient advocacy in Australia. CONCLUSION This study provides unique information about the experiences of RDPOs generally, rather than experiences retrospectively reported by RDPOs associated with successful research. We describe RDPOs' valuable contributions to research, while also providing insights into the difficulties for small organisations trying to promote research. The study is relevant internationally because of what it tells us about RDPOs; however, we draw attention to specific opportunities in Australia to support RDPOs' involvement in research, for the benefit of current and future generations affected by rare diseases.
Collapse
Affiliation(s)
- Deirdre Pinto
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Dominique Martin
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Richard Chenhall
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| |
Collapse
|
37
|
Singh Ospina N, Maraka S, Montori V, Thompson GB, Young WF. When and how should patients with multiple endocrine neoplasia type 1 be screened for thymic and bronchial carcinoid tumours? Clin Endocrinol (Oxf) 2016; 84:13-6. [PMID: 26562483 DOI: 10.1111/cen.12972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 02/04/2023]
Abstract
Patients with multiple endocrine neoplasia type 1 (MEN1) are commonly evaluated for clinical manifestations of this syndrome with the rationale that early diagnosis and adequate treatment will result in improved survival and quality of life. Thymic and bronchial carcinoid tumours are uncommon but important manifestations of MEN1. Current practice guidelines recommend evaluation with computed tomography or magnetic resonance imaging scan of the chest every 1-2 years to detect these neoplasms. However, the certainty that patients will be better off (increased survival or quality of life) as a result of this case detection strategy is based on evidence at moderate-high risk of bias that yields only imprecise results of indirect relevance to these patients. In order to improve the care that patients with MEN1 receive, co-ordinated efforts from different stakeholders are required so that large, prospective, multicentre studies evaluating patient important outcomes are carried out.
Collapse
Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Victor Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - William F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|