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McKnight L, Schultz A, Vidic N, Palmer EE, Jaffe A. Learning to make a difference for chILD: Value creation through network collaboration and team science. Pediatr Pulmonol 2024; 59:2257-2266. [PMID: 36855907 DOI: 10.1002/ppul.26377] [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: 11/01/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.
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Affiliation(s)
- Lauren McKnight
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Nada Vidic
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
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2
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Nicolas-Martinez EC, Robinson O, Pflueger C, Gardner A, Corbett MA, Ritchie T, Kroes T, van Eyk CL, Scheffer IE, Hildebrand MS, Barnier JV, Rousseau V, Genevieve D, Haushalter V, Piton A, Denommé-Pichon AS, Bruel AL, Nambot S, Isidor B, Grigg J, Gonzalez T, Ghedia S, Marchant RG, Bournazos A, Wong WK, Webster RI, Evesson FJ, Jones KJ, Cooper ST, Lister R, Gecz J, Jolly LA. RNA variant assessment using transactivation and transdifferentiation. Am J Hum Genet 2024; 111:1673-1699. [PMID: 39084224 PMCID: PMC11339655 DOI: 10.1016/j.ajhg.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Understanding the impact of splicing and nonsense variants on RNA is crucial for the resolution of variant classification as well as their suitability for precision medicine interventions. This is primarily enabled through RNA studies involving transcriptomics followed by targeted assays using RNA isolated from clinically accessible tissues (CATs) such as blood or skin of affected individuals. Insufficient disease gene expression in CATs does however pose a major barrier to RNA based investigations, which we show is relevant to 1,436 Mendelian disease genes. We term these "silent" Mendelian genes (SMGs), the largest portion (36%) of which are associated with neurological disorders. We developed two approaches to induce SMG expression in human dermal fibroblasts (HDFs) to overcome this limitation, including CRISPR-activation-based gene transactivation and fibroblast-to-neuron transdifferentiation. Initial transactivation screens involving 40 SMGs stimulated our development of a highly multiplexed transactivation system culminating in the 6- to 90,000-fold induction of expression of 20/20 (100%) SMGs tested in HDFs. Transdifferentiation of HDFs directly to neurons led to expression of 193/516 (37.4%) of SMGs implicated in neurological disease. The magnitude and isoform diversity of SMG expression following either transactivation or transdifferentiation was comparable to clinically relevant tissues. We apply transdifferentiation and/or gene transactivation combined with short- and long-read RNA sequencing to investigate the impact that variants in USH2A, SCN1A, DMD, and PAK3 have on RNA using HDFs derived from affected individuals. Transactivation and transdifferentiation represent rapid, scalable functional genomic solutions to investigate variants impacting SMGs in the patient cell and genomic context.
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Affiliation(s)
- Emmylou C Nicolas-Martinez
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Olivia Robinson
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Christian Pflueger
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; Australian Research Council Centre of Excellence in Plant Energy Biology, School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Alison Gardner
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mark A Corbett
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Tarin Ritchie
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Thessa Kroes
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Clare L van Eyk
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia; Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC 3052, Australia; The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Jean-Vianney Barnier
- Institut des Neurosciences Paris-Saclay, UMR 9197, CNRS, Université Paris-Saclay, Saclay, France
| | - Véronique Rousseau
- Institut des Neurosciences Paris-Saclay, UMR 9197, CNRS, Université Paris-Saclay, Saclay, France
| | - David Genevieve
- Montpellier University, Inserm U1183, Reference Center for Rare Diseases Developmental Anomaly and Malformative Syndromes, Genetics Department, Montpellier Hospital, Montpellier, France
| | - Virginie Haushalter
- Genetic Diagnosis Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Amélie Piton
- Genetic Diagnosis Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Anne-Sophie Denommé-Pichon
- CRMRs "Anomalies du Développement et syndromes malformatifs" et "Déficiences Intellectuelles de causes rares", Centre de Génétique, CHU Dijon, Dijon, France; INSERM UMR1231, GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Ange-Line Bruel
- CRMRs "Anomalies du Développement et syndromes malformatifs" et "Déficiences Intellectuelles de causes rares", Centre de Génétique, CHU Dijon, Dijon, France; INSERM UMR1231, GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Sophie Nambot
- CRMRs "Anomalies du Développement et syndromes malformatifs" et "Déficiences Intellectuelles de causes rares", Centre de Génétique, CHU Dijon, Dijon, France; INSERM UMR1231, GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Bertrand Isidor
- CRMRs "Anomalies du Développement et syndromes malformatifs" et "Déficiences Intellectuelles de causes rares", Centre de Génétique, CHU Dijon, Dijon, France; INSERM UMR1231, GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - John Grigg
- Speciality of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Tina Gonzalez
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Sondhya Ghedia
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Rhett G Marchant
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
| | - Adam Bournazos
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Children's Medical Research Institute, Westmead, NSW 2145, Australia
| | - Wui-Kwan Wong
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Children's Medical Research Institute, Westmead, NSW 2145, Australia; Department of Paediatric Neurology, Children's Hospital at Westmead, Sydney, NSW 2000, Australia
| | - Richard I Webster
- Department of Paediatric Neurology, Children's Hospital at Westmead, Sydney, NSW 2000, Australia
| | - Frances J Evesson
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia; Children's Medical Research Institute, Westmead, NSW 2145, Australia
| | - Kristi J Jones
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Children's Medical Research Institute, Westmead, NSW 2145, Australia; Department of Clinical Genetics, Children's Hospital at Westmead, Sydney, NSW 2000, Australia
| | - Sandra T Cooper
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia; Children's Medical Research Institute, Westmead, NSW 2145, Australia
| | - Ryan Lister
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia; Australian Research Council Centre of Excellence in Plant Energy Biology, School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Jozef Gecz
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia.
| | - Lachlan A Jolly
- The Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia; School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia.
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3
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Nevin SM, Le Marne FA, Beavis E, Macintosh R, Palmer EE, Sachdev R, Nunn K, Bye A. Psychosocial experiences of clinicians providing care for children with severe neurological impairment. Dev Med Child Neurol 2024. [PMID: 38837791 DOI: 10.1111/dmcn.15987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
AIM To investigate clinicians' psychosocial experiences navigating interdisciplinary care for children with severe neurological impairment (SNI), for example children with a developmental epileptic encephalopathy; secondarily, to identify preferences for future interventions to support clinicians caring for children with SNI. METHOD We conducted a qualitative descriptive study with interdisciplinary clinicians by using a purposeful sampling recruitment strategy. Twenty-four participants with expertise caring for children with SNI completed in-depth, semi-structured interviews. We transcribed the interviews, de-identified them, and performed inductive thematic analysis. RESULTS Thematic analysis elicited interrelated themes. Clinicians experienced immense professional barriers providing patient-centred care across fragmented healthcare contexts. Physical, emotional, and psychological impacts were attributed to inadequate reflective practice training and a paucity of integrated resources to support clinicians over time. Multipronged strategies were prioritized by clinicians, incorporating psychoeducation, interdisciplinary peer mentorship, and psychological resources to build reflective practice skills for clinicians providing complex care in an advancing era of medicine. INTERPRETATION This study provides novel and in-depth insight into clinicians' experiences navigating care for children with SNI. The results will be used to inform future integrated and multipronged co-developed resources tailored for clinicians, on the basis of their recommendations.
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Affiliation(s)
- Suzanne M Nevin
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Fleur A Le Marne
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia
- Department of Neurology, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Rebecca Macintosh
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Elizabeth E Palmer
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Rani Sachdev
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine Sydney, Children's Hospital Network, Sydney, NSW, Australia
| | - Ann Bye
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Sydney, NSW, Australia
- Department of Neurology, Sydney Children's Hospital Network, Randwick, NSW, Australia
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Nguyen CQ, Kariyawasam DST, Ngai TSJ, Nguyen J, Alba‐Concepcion K, Grattan SE, Palmer EE, Hetherington K, Wakefield CE, Dale RC, Woolfenden S, Mohammad S, Farrar MA. 'High hopes for treatment': Australian stakeholder perspectives of the clinical translation of advanced neurotherapeutics for rare neurological diseases. Health Expect 2024; 27:e14063. [PMID: 38711219 PMCID: PMC11074375 DOI: 10.1111/hex.14063] [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: 04/12/2023] [Revised: 03/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Advanced therapies offer unprecedented opportunities for treating rare neurological disorders (RNDs) in children. However, health literacy, perceptions and understanding of novel therapies need elucidation across the RND community. This study explored healthcare professionals' and carers' perspectives of advanced therapies in childhood-onset RNDs. METHODS In this mixed-methodology cross-sectional study, 20 healthcare professionals (clinicians, genetic counsellors and scientists) and 20 carers completed qualitative semistructured interviews and custom-designed surveys. Carers undertook validated psychosocial questionnaires. Thematic and quantitative data analysis followed. RESULTS Participants described high positive interest in advanced therapies, but low knowledge of, and access to, reliable information. The substantial 'therapeutic gap' and 'therapeutic odyssey' common to RNDs were recognised in five key themes: (i) unmet need and urgency for access; (ii) seeking information; (iii) access, equity and sustainability; (iv) a multidisciplinary and integrated approach to care and support and (v) difficult decision-making. Participants were motivated to intensify RND clinical trial activity and access to advanced therapies; however, concerns around informed consent, first-in-human trials and clinical trial procedures were evident. There was high-risk tolerance despite substantial uncertainties and knowledge gaps. RNDs with high mortality, increased functional burdens and no alternative therapies were consistently prioritised for the development of advanced therapies. However, little consensus existed on prioritisation to treatment access. CONCLUSIONS This study highlights the need to increase clinician and health system readiness for the clinical translation of advanced therapeutics for RNDs. Co-development and use of educational and psychosocial resources to support clinical decision-making, set therapeutic expectations and promotion of equitable, effective and safe delivery of advanced therapies are essential. PATIENT OR PUBLIC CONTRIBUTION Participant insights into the psychosocial burden and information need to enhance the delivery of care in this formative study are informing ongoing partnerships with families, including co-production and dissemination of psychoeducational resources featuring their voices hosted on the Sydney Children's Hospitals Network website SCHN Brain-Aid Resources.
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Affiliation(s)
- Christina Q. Nguyen
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
| | - Didu S. T. Kariyawasam
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Tsz Shun Jason Ngai
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
| | - James Nguyen
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
| | - Kristine Alba‐Concepcion
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Sarah E. Grattan
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Elizabeth E. Palmer
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Centre for Clinical GeneticsSydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Kate Hetherington
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Behavioural Science UnitKids Cancer Centre, Sydney Children's HospitalSydneyNew South WalesAustralia
| | - Claire E. Wakefield
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Behavioural Science UnitKids Cancer Centre, Sydney Children's HospitalSydneyNew South WalesAustralia
| | - Russell C. Dale
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
- Children's Hospital Westmead Clinical SchoolFaculty of Medicine and Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia
| | - Sue Woolfenden
- Children's Hospital Westmead Clinical SchoolFaculty of Medicine and Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia
- Population Child Health Research GroupUniversity of New South WalesSydneyNew South WalesAustralia
- Sydney Institute for Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Shekeeb Mohammad
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
- Children's Hospital Westmead Clinical SchoolFaculty of Medicine and Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia
| | - Michelle A. Farrar
- Discipline of Paediatrics and Child HealthUniversity of New South Wales Medicine and HealthSydneyNew South WalesAustralia
- Department of NeurologySydney Children's Hospital NetworkSydneyNew South WalesAustralia
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Nevin SM, McGill BC, Kelada L, Hilton G, Maack M, Elvidge KL, Farrar MA, Baynam G, Katz NT, Donovan L, Grattan S, Signorelli C, Bhattacharya K, Nunn K, Wakefield CE. The psychosocial impact of childhood dementia on children and their parents: a systematic review. Orphanet J Rare Dis 2023; 18:277. [PMID: 37679855 PMCID: PMC10486052 DOI: 10.1186/s13023-023-02859-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Childhood dementias are a group of rare and ultra-rare paediatric conditions clinically characterised by enduring global decline in central nervous system function, associated with a progressive loss of developmentally acquired skills, quality of life and shortened life expectancy. Traditional research, service development and advocacy efforts have been fragmented due to a focus on individual disorders, or groups classified by specific mechanisms or molecular pathogenesis. There are significant knowledge and clinician skill gaps regarding the shared psychosocial impacts of childhood dementia conditions. This systematic review integrates the existing international evidence of the collective psychosocial experiences of parents of children living with dementia. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched four databases to identify original, peer-reviewed research reporting on the psychosocial impacts of childhood dementia, from the parent perspective. We synthesised the data into three thematic categories: parents' healthcare experiences, psychosocial impacts, and information and support needs. RESULTS Nineteen articles met review criteria, representing 1856 parents. Parents highlighted extensive difficulties connecting with an engaged clinical team and navigating their child's rare, life-limiting, and progressive condition. Psychosocial challenges were manifold and encompassed physical, economic, social, emotional and psychological implications. Access to coordinated healthcare and community-based psychosocial supports was associated with improved parent coping, psychological resilience and reduced psychological isolation. Analysis identified a critical need to prioritize access to integrated family-centred psychosocial supports throughout distinct stages of their child's condition trajectory. CONCLUSION This review will encourage and guide the development of evidence-based and integrated psychosocial resources to optimise quality of life outcomes for of children with dementia and their families.
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Affiliation(s)
- Suzanne M Nevin
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia.
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Brittany C McGill
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Lauren Kelada
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Gail Hilton
- Childhood Dementia Initiative, Sydney, NSW, Australia
| | - Megan Maack
- Childhood Dementia Initiative, Sydney, NSW, Australia
| | | | - Michelle A Farrar
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Gareth Baynam
- Faculty of Health and Medical Sciences, Division of Paediatrics, University of Western Australia, Western Australia, Australia
- Rare Care Centre, Perth Children's Hospital, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Leigh Donovan
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah Grattan
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
| | - Christina Signorelli
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Kaustuv Bhattacharya
- Genetic Metabolic Disorders Service, Sydney Children's Hospitals' Network, Randwick and Westmead, Australia
- Faculty of Medicine and Health, Discipline of Genomics, Sydney University, Westmead, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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6
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Tsitsani P, Katsaras G, Soteriades ES. Barriers to and Facilitators of Providing Care for Adolescents Suffering from Rare Diseases: A Mixed Systematic Review. Pediatr Rep 2023; 15:462-482. [PMID: 37606447 PMCID: PMC10443320 DOI: 10.3390/pediatric15030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
Rare Diseases (RDs) in adolescents are characterized by low frequency and clinical heterogeneity, are chronic and deliberating and demand a multidisciplinary approach as well as costly and specialized treatments. Comprehending patients' and parents' needs through a mixed systematic review is essential for healthcare system planning. This mixed systematic review explored barriers to and facilitators of effective care for adolescents with RDs as perceived by patients and their parents. Three databases (2008-2023) were searched and twenty-five articles were selected and critically appraised with the Mixed Methods Appraisal Tool (MMAT; version 2018). The review followed a convergent integrated approach for data extraction according to Joanna Briggs Institute's (JBI) mixed method systematic review (MMSR) methodology. Subsequent reflexive thematic analysis categorized the barriers and facilitators into five levels (intrapersonal, interpersonal, institutional, community and public policy) following the conceptual framework of the socio-ecological model for healthcare promotion. Barriers on the institutional and public policy level stood out as the most frequently reported, resulting in unmet care needs and frustrating family dynamics. National and regional healthcare policies are rarely actually linked to pragmatic intervention programs with a measurable impact on patients' welfare. Targeted strategies involving primary care infrastructure and personnel for better coordination and management of the disease are discussed.
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Affiliation(s)
- Pelagia Tsitsani
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, 2220 Nicosia, Cyprus;
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece;
| | - Georgios Katsaras
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece;
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, 2220 Nicosia, Cyprus;
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7
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Ruseckaite R, Mudunna C, Caruso M, Helwani F, Millis N, Lacaze P, Ahern S. Current state of rare disease registries and databases in Australia: a scoping review. Orphanet J Rare Dis 2023; 18:216. [PMID: 37501152 PMCID: PMC10373259 DOI: 10.1186/s13023-023-02823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Rare diseases (RDs) affect approximately 8% of all people or > 400 million people globally. The Australian Government's National Strategic Action Plan for Rare Diseases has identified the need for a national, coordinated, and systematic approach to the collection and use of RD data, including registries. Rare disease registries (RDRs) are established for epidemiological, quality improvement and research purposes, and they are critical infrastructure for clinical trials. The aim of this scoping review was to review literature on the current state of RDRs in Australia; to describe how they are funded; what data they collect; and their impact on patient outcomes. METHODS We conducted a literature search on MEDLINE, EMBASE, CINAHL and PsychINFO databases, in addition to Google Scholar and grey literature. Dissertations, government reports, randomised control trials, conference proceedings, conference posters and meeting abstracts were also included. Articles were excluded if they did not discuss RDs or if they were written in a language other than English. Studies were assessed on demographic and clinical patient characteristics, procedure or treatment type and health-related quality of life captured by RDRs or databases that have been established to date. RESULTS Seventy-four RDRs were identified; 19 were global registries in which Australians participated, 24 were Australian-only registries, 10 were Australia and New Zealand based, and five were Australian jurisdiction-based registries. Sixteen "umbrella" registries collected data on several different conditions, which included some RDs, and thirteen RDRs stored rare cancer-specific information. Most RDRs and databases captured similar types of information related to patient characteristics, comorbidities and other clinical features, procedure or treatment type and health-related quality of life measures. We found considerable heterogeneity among existing RDRs in Australia, especially with regards to data collection, scope and quality of registries, suggesting a national coordinated approach to RDRs is required. CONCLUSION This scoping review highlights the current state of Australian RDRs, identifying several important gaps and opportunities for improvement through national coordination and increased investment.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Chethana Mudunna
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Marisa Caruso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Falak Helwani
- Rare Voices Australia, VIC, 3194, Melbourne, Australia
| | - Nicole Millis
- Rare Voices Australia, VIC, 3194, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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8
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Teutsch S, Zurynski Y, Eslick GD, Deverell M, Christodoulou J, Leonard H, Dalkeith T, Johnson SLJ, Elliott EJ. Australian children living with rare diseases: health service use and barriers to accessing care. World J Pediatr 2023; 19:701-709. [PMID: 36653598 PMCID: PMC9848027 DOI: 10.1007/s12519-022-00675-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with rare diseases experience challenges at home and school and frequently require multi-disciplinary healthcare. We aimed to determine health service utilization by Australian children with rare diseases and barriers to accessing healthcare. METHODS Parents completed an online survey on health professional and emergency department (ED) presentations, hospitalization, and barriers to accessing services. Potential barriers to service access included residential location (city, regional, remote) and child health-related functioning, determined using a validated, parent-completed measure-of-function tool. RESULTS Parents of 462 children with over 240 rare diseases completed the survey. Compared with the general population, these children were more likely to be hospitalized [odds ratio (OR) = 17.25, 95% confidence interval (CI) = 15.50-19.20] and present to the ED (OR = 4.15, 95% CI = 3.68-4.68) or a family physician (OR = 4.14, 95% CI = 3.72-4.60). Child functional impairment was nil/mild (31%), moderate (48%) or severe (22%). Compared to children with nil/mild impairment, those with severe impairment were more likely to be hospitalized (OR = 13.39, 95% CI = 7.65-23.44) and present to the ED (OR = 11.16, 95% CI = 6.46-19.27). Most children (75%) lived in major cities, but children from regional (OR = 2.78, 95% CI = 1.72-4.55) and remote areas (OR = 9.09, 95% CI = 3.03-25.00) experienced significantly more barriers to healthcare access than children from major cities. Barriers included distance to travel, out-of-pocket costs, and lack of specialist medical and other health services. CONCLUSIONS Children with rare diseases, especially those with severe functional impairment have an enormous impact on health services, and better integrated multidisciplinary services with patient-centered care are needed. Access must be improved for children living in rural and remote settings.
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Affiliation(s)
- Suzy Teutsch
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
| | - Yvonne Zurynski
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Australian Institute of Health Innovation, Center for Healthcare Resilience and Implementation Science, and NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, NSW, Australia
| | - Guy D Eslick
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Marie Deverell
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Government Department of Health Western Australia, Perth, WA, Australia
| | - John Christodoulou
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Murdoch Children's Research Institute and Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Troy Dalkeith
- Genetic Metabolic Disorders Service, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Sandra L J Johnson
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network, Westmead, NSW, Australia
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9
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Robertson EG, Kelada L, Best S, Goranitis I, Grainger N, Le Marne F, Pierce K, Nevin SM, Macintosh R, Beavis E, Sachdev R, Bye A, Palmer EE. Acceptability and feasibility of an online information linker service for caregivers who have a child with genetic epilepsy: a mixed-method pilot study protocol. BMJ Open 2022; 12:e063249. [PMID: 36288836 PMCID: PMC9615979 DOI: 10.1136/bmjopen-2022-063249] [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] [Received: 03/31/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Developmental and epileptic encephalopathies (DEEs) are rare epilepsy conditions that collectively impact 1 in 2000 children. They are highly genetically heterogeneous, resulting in significant barriers to accurate and adequate information for caregivers. This can lead to increased distress and dissatisfaction with the healthcare system. To address this gap, we developed 'GenE Compass' to provide caregivers with the highest-quality possible, understandable and relevant information in response to specific questions about their child's DEE. Using a mixed-method design, we will now pilot GenE Compass to evaluate the acceptability to caregivers and clinicians, feasibility and impact to caregivers. METHODS AND ANALYSIS We will recruit 88 caregivers (estimated final sample of 50 at follow-up) who have a child under 18 years of age with a suspected or confirmed DEE diagnosis. Following consent and a baseline questionnaire (questionnaire 1 (Q1)), participants will be able to submit questions to GenE Compass over a 3-month period. After 3 months, participants will complete a follow-up questionnaire (Q2) and an optional telephone interview to answer the research questions. Primary outcomes are acceptability of GenE Compass and feasibility of delivering the intervention (eg, cost of the intervention, number of questions submitted and time taken to respond to questions). Secondary outcomes include the impact of GenE Compass on caregivers' quality of life, information searching behaviours, perceptions of their child's illness and activation. ETHICS AND DISCUSSION The study protocol (V.2, dated 16 September 2021) has been approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (ETH11277). The results will be disseminated in peer-reviewed journals and at scientific conferences. A lay summary will be disseminated to all participants. TRIAL REGISTRATION NUMBER ACTRN12621001544864.
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Affiliation(s)
- Eden G Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Lauren Kelada
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Stephanie Best
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - I Goranitis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Grainger
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Fleur Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Kristine Pierce
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Epilepsy Foundation, Melbourne, Victoria, Australia
| | - Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Annie Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
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10
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Kim SY, Lee S, Woo H, Han J, Ko YJ, Shim Y, Park S, Jang SS, Lim BC, Ko JM, Kim KJ, Cho A, Kim H, Hwang H, Choi JE, Kim MJ, Moon J, Seong MW, Park SS, Choi SA, Lee JE, Kwon YS, Sohn YB, Kim JS, Kim WS, Lee YJ, Kwon S, Kim YO, Kook H, Cho YG, Cheon CK, Kang KS, Song MR, Kim YJ, Cha HJ, Choi HJ, Kee Y, Park SG, Baek ST, Choi M, Ryu DS, Chae JH. The Korean undiagnosed diseases program phase I: expansion of the nationwide network and the development of long-term infrastructure. Orphanet J Rare Dis 2022; 17:372. [PMID: 36209187 PMCID: PMC9548182 DOI: 10.1186/s13023-022-02520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phase I of the Korean Undiagnosed Diseases Program (KUDP), performed for 3 years, has been completed. The Phase I program aimed to solve the problem of undiagnosed patients throughout the country and develop infrastructure, including a data management system and functional core laboratory, for long-term translational research. Herein, we share the clinical experiences of the Phase I program and introduce the activities of the functional core laboratory and data management system. RESULTS During the program (2018-2020), 458 patients were enrolled and classified into 3 groups according to the following criteria: (I) those with a specific clinical assessment which can be verified by direct testing (32 patients); (II) those with a disease group with genetic and phenotypic heterogeneity (353 patients); and (III) those with atypical presentations or diseases unknown to date (73 patients). All patients underwent individualized diagnostic processes based on the decision of an expert consortium. Confirmative diagnoses were obtained for 242 patients (52.8%). The diagnostic yield was different for each group: 81.3% for Group I, 53.3% for Group II, and 38.4% for Group III. Diagnoses were made by next-generation sequencing for 204 patients (84.3%) and other genetic testing for 35 patients (14.5%). Three patients (1.2%) were diagnosed with nongenetic disorders. The KUDP functional core laboratory, with a group of experts, organized a streamlined research pipeline covering various resources, including animal models, stem cells, structural modeling and metabolic and biochemical approaches. Regular data review was performed to screen for candidate genes among undiagnosed patients, and six different genes were identified for functional research. We also developed a web-based database system that supports clinical cohort management and provides a matchmaker exchange protocol based on a matchbox, likely to reinforce the nationwide clinical network and further international collaboration. CONCLUSIONS The KUDP evaluated the unmet needs of undiagnosed patients and established infrastructure for a data-sharing system and future functional research. The advancement of the KUDP may lead to sustainable bench-to-bedside research in Korea and contribute to ongoing international collaboration.
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Affiliation(s)
- Soo Yeon Kim
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungbok Lee
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Hyewon Woo
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jiyeon Han
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Young Jun Ko
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Youngkyu Shim
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Soojin Park
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Se Song Jang
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jung Min Ko
- Division of Clinical Genetics, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Anna Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Eun Choi
- Department of Pediatrics, SMG-SNU Boramae Hospital, Seoul, Republic of Korea
| | - Man Jin Kim
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jangsup Moon
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Ah Choi
- Department of Pediatrics, Ehwa Womans University Mokdong Hospital, Ehwa Womans University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Pediatric, Inha University College of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Young Se Kwon
- Department of Pediatric, Inha University College of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Won Seop Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Soonhak Kwon
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young Ok Kim
- Departmentof Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hoon Kook
- Departmentof Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong Gon Cho
- Department of Laboratory Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Chong Kun Cheon
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki-Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Republic of Korea
| | - Mi-Ryoung Song
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Young-Joon Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Hyuk-Jin Cha
- Collage of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Hee-Jung Choi
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yun Kee
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Sung-Gyoo Park
- Collage of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Seung Tae Baek
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Murim Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Jong-Hee Chae
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, National University College of Medicine, 101 Daehakro Jongno-gu, Seoul, 110-744, Republic of Korea.
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