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Rubinstein YR, Robinson PN, Gahl WA, Avillach P, Baynam G, Cederroth H, Goodwin RM, Groft SC, Hansson MG, Harris NL, Huser V, Mascalzoni D, McMurry JA, Might M, Nellaker C, Mons B, Paltoo DN, Pevsner J, Posada M, Rockett-Frase AP, Roos M, Rubinstein TB, Taruscio D, van Enckevort E, Haendel MA. The case for open science: rare diseases. JAMIA Open 2020; 3:472-486. [PMID: 33426479 PMCID: PMC7660964 DOI: 10.1093/jamiaopen/ooaa030] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/30/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
The premise of Open Science is that research and medical management will progress faster if data and knowledge are openly shared. The value of Open Science is nowhere more important and appreciated than in the rare disease (RD) community. Research into RDs has been limited by insufficient patient data and resources, a paucity of trained disease experts, and lack of therapeutics, leading to long delays in diagnosis and treatment. These issues can be ameliorated by following the principles and practices of sharing that are intrinsic to Open Science. Here, we describe how the RD community has adopted the core pillars of Open Science, adding new initiatives to promote care and research for RD patients and, ultimately, for all of medicine. We also present recommendations that can advance Open Science more globally.
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Affiliation(s)
- Yaffa R Rubinstein
- Special Volunteer in the Office of Strategic Initiatives, National Library of Medicine, Bethesda, Maryland, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - William A Gahl
- Undiagnosed Diseases Program and Office of the Clinical Director, National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies and Telethon Kids Institute, Perth, Australia
| | | | - Rebecca M Goodwin
- Department of Health and Human Services, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen C Groft
- NCATS, National Institutes of Health, Bethesda, Maryland, USA
| | - Mats G Hansson
- Center for Research Ethics and Bioethics, Uppsala Universitet, Uppsala, Sweden
| | - Nomi L Harris
- Department of Environmental Genomics & System Biology, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Vojtech Huser
- Department of Health and Human Services, NCBI, National Institutes of Health, Bethesda, Maryland, USA
| | - Deborah Mascalzoni
- Center for Research Ethics and Bioethics, Uppsala University, Sweden and EURAC Research, Bolzano, Italy
| | - Julie A McMurry
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
| | - Matthew Might
- Hugh Kaul Precision Medicine Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christoffer Nellaker
- Nuffield Department of Women's and Reproductive Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Barend Mons
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Dina N Paltoo
- Department of Health and Human Services, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan Pevsner
- Department of Neurology, Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Manuel Posada
- Rare Diseases Research Institute & CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Marco Roos
- Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Tamar B Rubinstein
- Children Hospital at Montefiore/Albert Einstein College of Medicine—Pediatrics, Bronx, New York, USA
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Esther van Enckevort
- Department of Genetics, University Medical Center Groningen, University of Groningen, Leiden, Netherlands
| | - Melissa A Haendel
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon, USA
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2
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Soraru J, Isbel N, Wong G, Coates PT, Mantha M, Abraham A, Juneja R, Hsu D, Brown F, Bose B, Mudge D, Carroll R, Kausman J, Hughes P, Barbour T, Durkan A, Mount P, Lee D, Larkins N, Ranganathan D, Lim WH. Baseline characteristics of patients with atypical haemolytic uraemic syndrome (aHUS): The Australian cohort in a global aHUS registry. Nephrology (Carlton) 2020; 25:683-690. [PMID: 32378251 DOI: 10.1111/nep.13722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 11/27/2022]
Abstract
AIMS To describe the baseline characteristics and treatment of Australian patients diagnosed with atypical haemolytic uraemic syndrome (aHUS) reported to the Global aHUS Registry. METHODS Descriptive analysis of the Australian cohort with aHUS (n = 106) was undertaken for demographics, disease characteristics and prior treatment with eculizumab; comparing with the global cohort (n = 1688) for certain pre-specified disease characteristics. RESULTS In Australia, almost two-thirds of patients diagnosed with aHUS were female and over 80% of patients were Caucasians, with similar proportions reported in the global cohort. Less than 6% of patients in the Australia and global cohorts were reported to have a history of autoimmune disease (4% vs 2%, respectively; P = .21) or cancer (5% vs 5%, respectively; P = .93), conditions that have been associated with secondary HUS. In the Australian cohort, 26% had received a kidney transplant and 68% of patients had received eculizumab. Kidneys were the most common organ involvement, followed by gastrointestinal tract (26%) and cardiovascular system (19%), with 35% of patients reported to have had at least two organs involved within 6 months prior to baseline visit or entry into the registry. Complement factor H was the most common pathogenic complement gene variant in the Australian patients. CONCLUSION Data from the aHUS registry confirms and defines region-specific disease characteristics among a selected group of Australian children and adults with aHUS reported to the registry. Ongoing and more inclusive data will provide further information about temporal trends and treatment outcomes, representing a unique opportunity for clinicians and researchers to further develop knowledge surrounding this rare disease.
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Affiliation(s)
- Jacqueline Soraru
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nicole Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Patrick Toby Coates
- Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Murty Mantha
- Department of Nephrology, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Abu Abraham
- Department of Nephrology and Renal Transplant, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rajiv Juneja
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Danny Hsu
- Department of Haematology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Fiona Brown
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Bhadran Bose
- Department of Nephrology, Nepean Hospital, Blue Mountains, New South Wales, Australia
| | - David Mudge
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robert Carroll
- Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua Kausman
- Department of Nephrology and Renal Transplantation, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter Hughes
- Department of Nephrology and Transplantation, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Barbour
- Department of Nephrology and Transplantation, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anne Durkan
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter Mount
- Department of Nephrology, Austin Health, Melbourne, Australia
| | - Darren Lee
- Department of Renal Medicine, Eastern Health Clinical School, Monash University Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Larkins
- Department of Nephrology and Hypertension, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Dwarakanathan Ranganathan
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, School of Medicine, Griffith University, Mount Gravatt, Queensland, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Multi-Method Patient-Engagement Approach: A Case Example from a PCORI-Funded Training Project. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:277-280. [PMID: 30390238 DOI: 10.1007/s40271-018-0341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lacaze P, Millis N, Fookes M, Zurynski Y, Jaffe A, Bellgard M, Winship I, McNeil J, Bittles AH. Rare disease registries: a call to action. Intern Med J 2018; 47:1075-1079. [PMID: 28891182 DOI: 10.1111/imj.13528] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 01/18/2023]
Abstract
When registries collect accurate clinical data over time, they can act as fundamental support structures for patients and their families and powerful cost-effective instruments to support clinical trials and translational research to improve quality of care, quality of life and survival. Registries are critical for rare diseases (RD) with low prevalence and propensity for variation in treatment and outcomes. Rare Voices Australia is leading a call for action to the research and clinical community to prioritise RD data collection and develop an integrated RD Registry strategy for Australia. Financial, operational and governance challenges exist for establishing and maintaining RD registries. As a multidisciplinary team whose interests converge on RD, we highlight the need for the establishment of an Australian RD Registry Alliance. This 'umbrella' organisation will: (i) bring together existing RD registries across Australia; (ii) establish National RD Registry Standards to support interoperability and cohesion across registries; (iii) develop strategies to attract sustainable funding from government and other sources to maximise the utility of existing RD registries and support the development of new RD registries. The most important role for the Alliance would be to use the RD registries for translational research to address current knowledge gaps about RD and to improve the care for the over 1.4 million Australians estimated to live with RD.
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Affiliation(s)
- Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicole Millis
- Rare Voices Australia Ltd, Melbourne, Victoria, Australia
| | - Megan Fookes
- Rare Voices Australia Ltd, Melbourne, Victoria, Australia
| | - Yvonne Zurynski
- Paediatrics and Child Health, Children's Hospital, Sydney, New South Wales, Australia.,Australian Paediatric Surveillance Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Matthew Bellgard
- Centre for Comparative Genomics (CCG), Murdoch University, Perth, Western Australia, Australia
| | - Ingrid Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alan H Bittles
- Centre for Comparative Genomics (CCG), Murdoch University, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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5
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Wideman TH, Miller J, Bostick G, Thomas A, Bussières A. Advancing Pain Education in Canadian Physiotherapy Programmes: Results of a Consensus-Generating Workshop. Physiother Can 2018; 70:24-33. [PMID: 29434415 DOI: 10.3138/ptc.2016-57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This article reports on a national stakeholder workshop that focused on advancing pain education in physiotherapy programmes across Canada. Methods: Workshop participants included national leaders from the following stakeholder groups: people living with pain; physiotherapy students and recent graduates; pain educators; physiotherapy programme administrators; and representatives from the Canadian Alliance of Physiotherapy Regulators, Physiotherapy Education Accreditation Canada, Canadian Physiotherapy Association, and Physiotherapy Practice Profile project. During the workshop, barriers to, facilitators of, and strategies for advancing pain education were discussed, and a stakeholder-endorsed consensus statement was generated. The workshop was recorded, and data were thematically analyzed. Results: Participants identified important barriers and facilitators associated with the field of pain, standards and regulatory processes, physiotherapy programmes, and physiotherapy students and people living with pain. Strategies for advancing pain education included integrating pain competencies into standards and regulatory policy, encouraging the development of best teaching practices, partnering with people living with pain, building awareness, and setting goals and assessing clear outcomes. The consensus statement highlighted the central importance of pain education for physiotherapists and the need for a reference standard to guide its implementation in the Canadian context. Conclusion: This was the first initiative to specifically explore national stakeholders' perceptions of pain education. The workshop outcomes provide a strong mandate and direction for advancing pain education across Canadian physiotherapy programmes.
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Affiliation(s)
- Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Ont
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal
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Young A, Menon D, Street J, Al-Hertani W, Stafinski T. Exploring patient and family involvement in the lifecycle of an orphan drug: a scoping review. Orphanet J Rare Dis 2017; 12:188. [PMID: 29273068 PMCID: PMC5741909 DOI: 10.1186/s13023-017-0738-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i.e., orphan drug lifecycle). METHODS A scoping review was conducted using methods outlined by Arksey and O'Malley. To validate the findings from the literature and identify any additional opportunities that were missed, a consultative webinar was conducted with members of the Patient and Caregiver Liaison Group of a Canadian research network. RESULTS Existing and proposed opportunities for involving patients, families, and patient organizations were reported throughout the orphan drug lifecycle and fell into 12 themes: research outside of clinical trials; clinical trials; patient reported outcomes measures; patient registries and biorepositories; education; advocacy and awareness; conferences and workshops; patient care and support; patient organization development; regulatory decision-making; and reimbursement decision-making. Existing opportunities were not described in sufficient detail to allow for the level of involvement to be assessed. Additionally, no information on the impact of involvement within specific opportunities was found. Based on feedback from patients and families, documentation of existing opportunities within Canada is poor. CONCLUSIONS Opportunities for patient, family, and patient organization involvement exist throughout the orphan drug lifecycle. However, based on the information found, it is not possible to determine which opportunities would be most effective at each stage.
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Affiliation(s)
- Andrea Young
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Jackie Street
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Walla Al-Hertani
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB Canada
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7
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Baynam G, Bauskis A, Pachter N, Schofield L, Verhoef H, Palmer RL, Kung S, Helmholz P, Ridout M, Walker CE, Hawkins A, Goldblatt J, Weeramanthri TS, Dawkins HJS, Molster CM. 3-Dimensional Facial Analysis-Facing Precision Public Health. Front Public Health 2017; 5:31. [PMID: 28443272 PMCID: PMC5385440 DOI: 10.3389/fpubh.2017.00031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/14/2017] [Indexed: 11/13/2022] Open
Abstract
Precision public health is a new field driven by technological advances that enable more precise descriptions and analyses of individuals and population groups, with a view to improving the overall health of populations. This promises to lead to more precise clinical and public health practices, across the continuum of prevention, screening, diagnosis, and treatment. A phenotype is the set of observable characteristics of an individual resulting from the interaction of a genotype with the environment. Precision (deep) phenotyping applies innovative technologies to exhaustively and more precisely examine the discrete components of a phenotype and goes beyond the information usually included in medical charts. This form of phenotyping is a critical component of more precise diagnostic capability and 3-dimensional facial analysis (3DFA) is a key technological enabler in this domain. In this paper, we examine the potential of 3DFA as a public health tool, by viewing it against the 10 essential public health services of the “public health wheel,” developed by the US Centers for Disease Control. This provides an illustrative framework to gage current and emergent applications of genomic technologies for implementing precision public health.
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Affiliation(s)
- Gareth Baynam
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA, Australia.,Western Australian Register of Developmental Anomalies, Perth, WA, Australia.,Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Spatial Sciences, Department of Science and Engineering, Curtin University, Perth, WA, Australia
| | - Alicia Bauskis
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Lyn Schofield
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA, Australia.,Centre for Comparative Genomics, Murdoch University, Perth, WA, Australia
| | - Hedwig Verhoef
- Cooperative Research Centre for Spatial Information, Perth, WA, Australia
| | - Richard L Palmer
- School of Spatial Sciences, Curtin University, Perth, WA, Australia
| | - Stefanie Kung
- School of Spatial Sciences, Curtin University, Perth, WA, Australia
| | - Petra Helmholz
- School of Spatial Sciences, Curtin University, Perth, WA, Australia
| | - Michael Ridout
- School of Spatial Sciences, Curtin University, Perth, WA, Australia
| | - Caroline E Walker
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Anne Hawkins
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Jack Goldblatt
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Tarun S Weeramanthri
- Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Hugh J S Dawkins
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia.,Centre for Comparative Genomics, Murdoch University, Perth, WA, Australia.,Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, WA, Australia
| | - Caron M Molster
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, WA, Australia
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Bellgard MI, Napier KR, Bittles AH, Szer J, Fletcher S, Zeps N, Hunter AA, Goldblatt J. Design of a framework for the deployment of collaborative independent rare disease-centric registries: Gaucher disease registry model. Blood Cells Mol Dis 2017; 68:232-238. [PMID: 28190666 PMCID: PMC5729019 DOI: 10.1016/j.bcmd.2017.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/20/2022]
Abstract
Orphan drug clinical trials often are adversely affected by a lack of high quality treatment efficacy data that can be reliably compared across large patient cohorts derived from multiple governmental and country jurisdictions. It is critical that these patient data be captured with limited corporate involvement. For some time, there have been calls to develop collaborative, non-proprietary, patient-centric registries for post-market surveillance of aspects related to orphan drug efficacy. There is an urgent need for the development and sustainable deployment of these ‘independent’ registries that can capture comprehensive clinical, genetic and therapeutic information on patients with rare diseases. We therefore extended an open-source registry platform, the Rare Disease Registry Framework (RDRF) to establish an Independent Rare Disease Registry (IRDR). We engaged with an established rare disease community for Gaucher disease to determine system requirements, methods of data capture, consent, and reporting. A non-proprietary IRDR model is presented that can serve as autonomous data repository, but more importantly ensures that the relevant data can be made available to appropriate stakeholders in a secure, timely and efficient manner to improve clinical decision-making and the lives of those with a rare disease.
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Affiliation(s)
- Matthew I Bellgard
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia; Western Australian Neuroscience Research Institute, Nedlands, Western Australia, Australia; Convenor of the Australian Bioinformatics Facility, Bioplatforms Australia, Macquarie University, North Ryde, New South Wales, Australia.
| | - Kathryn R Napier
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia.
| | - Alan H Bittles
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Jeffrey Szer
- Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Sue Fletcher
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia; Western Australian Neuroscience Research Institute, Nedlands, Western Australia, Australia.
| | - Nikolajs Zeps
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia.
| | - Adam A Hunter
- Centre for Comparative Genomics, Murdoch University, Murdoch, Western Australia, Australia.
| | - Jack Goldblatt
- Genetic Services & Familial Cancer Program of Western Australia, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
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Improved Diagnosis and Care for Rare Diseases through Implementation of Precision Public Health Framework. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:55-94. [PMID: 29214566 DOI: 10.1007/978-3-319-67144-4_4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Public health relies on technologies to produce and analyse data, as well as effectively develop and implement policies and practices. An example is the public health practice of epidemiology, which relies on computational technology to monitor the health status of populations, identify disadvantaged or at risk population groups and thereby inform health policy and priority setting. Critical to achieving health improvements for the underserved population of people living with rare diseases is early diagnosis and best care. In the rare diseases field, the vast majority of diseases are caused by destructive but previously difficult to identify protein-coding gene mutations. The reduction in cost of genetic testing and advances in the clinical use of genome sequencing, data science and imaging are converging to provide more precise understandings of the 'person-time-place' triad. That is: who is affected (people); when the disease is occurring (time); and where the disease is occurring (place). Consequently we are witnessing a paradigm shift in public health policy and practice towards 'precision public health'.Patient and stakeholder engagement has informed the need for a national public health policy framework for rare diseases. The engagement approach in different countries has produced highly comparable outcomes and objectives. Knowledge and experience sharing across the international rare diseases networks and partnerships has informed the development of the Western Australian Rare Diseases Strategic Framework 2015-2018 (RD Framework) and Australian government health briefings on the need for a National plan.The RD Framework is guiding the translation of genomic and other technologies into the Western Australian health system, leading to greater precision in diagnostic pathways and care, and is an example of how a precision public health framework can improve health outcomes for the rare diseases population.Five vignettes are used to illustrate how policy decisions provide the scaffolding for translation of new genomics knowledge, and catalyze transformative change in delivery of clinical services. The vignettes presented here are from an Australian perspective and are not intended to be comprehensive, but rather to provide insights into how a new and emerging 'precision public health' paradigm can improve the experiences of patients living with rare diseases, their caregivers and families.The conclusion is that genomic public health is informed by the individual and family needs, and the population health imperatives of an early and accurate diagnosis; which is the portal to best practice care. Knowledge sharing is critical for public health policy development and improving the lives of people living with rare diseases.
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10
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Pelentsov LJ, Fielder AL, Laws TA, Esterman AJ. The supportive care needs of parents with a child with a rare disease: results of an online survey. BMC FAMILY PRACTICE 2016; 17:88. [PMID: 27439905 PMCID: PMC4955113 DOI: 10.1186/s12875-016-0488-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
Background Parents caring for a child affected by a rare disease have unmet needs, the origins of which are complex and varied. Our aim was to determine the supportive care needs of parents caring for a child with a rare disease. Methods An online survey was developed consisting of 45 questions (108 items) and separated into six domains. The survey included questions about perceived level of satisfaction with receiving care, experiences and needs of providing daily care, the impacts of disease on relationships, the emotional and psychological burdens of disease, and parents overall satisfaction with the support received. Results Three-hundred and one parents from Australia and New Zealand completed the survey; 91 % (n = 275/301) were mothers, with 132 distinct rare diseases being reported. Fifty-four percent (n = 140/259) of parents were dissatisfied with health professionals’ level of knowledge and awareness of disease; 71 % (n = 130/183) of parents felt they received less support compared to other parents. Information regarding present (60 %, n = 146/240) and future services (72 %, n = 174/240) available for their child were considered important. Almost half of parents (45 %, n = 106/236) struggled financially, 38 % (n = 99/236) reduced their working hours and 34 % (n = 79/236) ceased paid employment. Forty-two percent (n = 99/223) of parents had no access to a disease specific support group, and 58 % (n = 134/230) stated that their number of friends had reduced since the birth of their child; 75 % (n = 173/230) had no contact with other parents with a child with a similar disease, and 46 % (n = 106/230) reported feeling socially isolated and desperately lonely. Most frequent emotions expressed by parents in the week prior to completing the survey were anxiety and fear (53 %, n = 119/223), anger and frustration (46 %, n = 103/223) and uncertainty (39 %, n = 88/223). Conclusion This study is the first to develop an online survey specifically for use with parents to investigate their supportive care needs across a large and diverse group of rare diseases. The findings highlight that parents with a child with a rare disease have common unmet needs regardless of what disease their child has. Such information may allow health providers to improve child outcomes through improving parental supportive care.
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Affiliation(s)
- Lemuel J Pelentsov
- School of Nursing & Midwifery, Division of Health Sciences, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Andrea L Fielder
- Sansom Institute for Health Research and School of Nursing and Midwifery, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Thomas A Laws
- School of Nursing and Midwifery, Faculty of Health, Keele University, Staffordshire, ST5 5BG, UK
| | - Adrian J Esterman
- School of Nursing & Midwifery, Division of Health Sciences, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia.,Australian Institute for Health and Tropical Medicine, James Cook University, Cairns, QLD, Australia
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11
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Hilgers RD, Roes K, Stallard N. Directions for new developments on statistical design and analysis of small population group trials. Orphanet J Rare Dis 2016; 11:78. [PMID: 27301273 PMCID: PMC4908723 DOI: 10.1186/s13023-016-0464-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022] Open
Abstract
Background Most statistical design and analysis methods for clinical trials have been developed and evaluated where at least several hundreds of patients could be recruited. These methods may not be suitable to evaluate therapies if the sample size is unavoidably small, which is usually termed by small populations. The specific sample size cut off, where the standard methods fail, needs to be investigated. In this paper, the authors present their view on new developments for design and analysis of clinical trials in small population groups, where conventional statistical methods may be inappropriate, e.g., because of lack of power or poor adherence to asymptotic approximations due to sample size restrictions. Method Following the EMA/CHMP guideline on clinical trials in small populations, we consider directions for new developments in the area of statistical methodology for design and analysis of small population clinical trials. We relate the findings to the research activities of three projects, Asterix, IDeAl, and InSPiRe, which have received funding since 2013 within the FP7-HEALTH-2013-INNOVATION-1 framework of the EU. As not all aspects of the wide research area of small population clinical trials can be addressed, we focus on areas where we feel advances are needed and feasible. Results The general framework of the EMA/CHMP guideline on small population clinical trials stimulates a number of research areas. These serve as the basis for the three projects, Asterix, IDeAl, and InSPiRe, which use various approaches to develop new statistical methodology for design and analysis of small population clinical trials. Small population clinical trials refer to trials with a limited number of patients. Small populations may result form rare diseases or specific subtypes of more common diseases. New statistical methodology needs to be tailored to these specific situations. Conclusion The main results from the three projects will constitute a useful toolbox for improved design and analysis of small population clinical trials. They address various challenges presented by the EMA/CHMP guideline as well as recent discussions about extrapolation. There is a need for involvement of the patients’ perspective in the planning and conduct of small population clinical trials for a successful therapy evaluation.
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Affiliation(s)
- Ralf-Dieter Hilgers
- Department of Medical Statistics, RWTH Aachen University, Pauwelsstr 30, D-52074, Aachen, Germany.
| | - Kit Roes
- Quality and Patient Safety, Biostatistics, UMC Utrecht, Utrecht, Netherlands
| | - Nigel Stallard
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, UK
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12
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Molster C, Urwin D, Di Pietro L, Fookes M, Petrie D, van der Laan S, Dawkins H. Survey of healthcare experiences of Australian adults living with rare diseases. Orphanet J Rare Dis 2016; 11:30. [PMID: 27012247 PMCID: PMC4806449 DOI: 10.1186/s13023-016-0409-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Few studies have examined whether the healthcare needs of people living with rare diseases are being met. This study explores the experiences of Australian adults living with rare diseases in relation to diagnosis, information provision at the time of diagnosis, use of health and support services and involvement in research on their condition. METHODS The survey respondents are self-selected from the population of Australian residents aged 18 years and over who are living with a rare disease. An online survey was implemented between July-August 2014. Purposive snowballing sampling was used. The results are reported as percentages with significant differences between sub-groups assessed using chi-squared analyses. RESULTS Eight hundred ten responses were obtained from adults living with a rare disease. 92.1% had a confirmed diagnosis, of which 30.0% waited five or more years for a diagnosis, 66.2% had seen three or more doctors to get a diagnosis and 45.9% had received at least one incorrect diagnosis. Almost three quarters (72.1%) received no or not enough information at the time of diagnosis. In the 12 months prior to the survey, over 80% of respondents had used the services of a general practitioner and a medical specialist while around a third had been inpatients at a hospital or had visited an emergency department. Only 15.4% of respondents had ever used paediatric services, 52.8% of these had experienced problems in the transition from paediatric to adult services. Only 20.3% knew of a patient registry for their condition and 24.8% were informed of clinical trials. CONCLUSIONS These findings suggest that not all healthcare needs of people living with rare diseases are being met. Structural changes to Australian healthcare systems may be required to improve the integration and coordination of diagnosis and care. Health professionals may need greater awareness of rare diseases to improve the diagnostic process and support to meet the information requirements of people newly diagnosed with rare diseases. Health service use is likely higher than for the general population and further epidemiological studies are needed on the impact of rare diseases on the healthcare system.
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Affiliation(s)
- Caron Molster
- />Office of Population Health Genomics, Department of Health, Perth, WA Australia
| | - Debra Urwin
- />Office of Population Health Genomics, Department of Health, Perth, WA Australia
| | | | | | | | | | - Hugh Dawkins
- />Office of Population Health Genomics, Department of Health, Perth, WA Australia
- />Centre for Population Health Research, Curtin University of Technology, Bentley, WA Australia
- />School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA Australia
- />Centre for Comparative Genomics, Murdoch University, Murdoch, WA Australia
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13
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Wagner M, Khoury H, Willet J, Rindress D, Goetghebeur M. Can the EVIDEM Framework Tackle Issues Raised by Evaluating Treatments for Rare Diseases: Analysis of Issues and Policies, and Context-Specific Adaptation. PHARMACOECONOMICS 2016; 34:285-301. [PMID: 26547306 PMCID: PMC4766242 DOI: 10.1007/s40273-015-0340-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND The multiplicity of issues, including uncertainty and ethical dilemmas, and policies involved in appraising interventions for rare diseases suggests that multicriteria decision analysis (MCDA) based on a holistic definition of value is uniquely suited for this purpose. The objective of this study was to analyze and further develop a comprehensive MCDA framework (EVIDEM) to address rare disease issues and policies, while maintaining its applicability across disease areas. METHODS Specific issues and policies for rare diseases were identified through literature review. Ethical and methodological foundations of the EVIDEM framework v3.0 were systematically analyzed from the perspective of these issues, and policies and modifications of the framework were performed accordingly to ensure their integration. RESULTS Analysis showed that the framework integrates ethical dilemmas and issues inherent to appraising interventions for rare diseases but required further integration of specific aspects. Modification thus included the addition of subcriteria to further differentiate disease severity, disease-specific treatment outcomes, and economic consequences of interventions for rare diseases. Scoring scales were further developed to include negative scales for all comparative criteria. A methodology was established to incorporate context-specific population priorities and policies, such as those for rare diseases, into the quantitative part of the framework. This design allows making more explicit trade-offs between competing ethical positions of fairness (prioritization of those who are worst off), the goal of benefiting as many people as possible, the imperative to help, and wise use of knowledge and resources. It also allows addressing variability in institutional policies regarding prioritization of specific disease areas, in addition to existing uncertainty analysis available from EVIDEM. CONCLUSION The adapted framework measures value in its widest sense, while being responsive to rare disease issues and policies. It provides an operationalizable platform to integrate values, competing ethical dilemmas, and uncertainty in appraising healthcare interventions.
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Affiliation(s)
- Monika Wagner
- LASER Analytica, 1405 Transcanadienne, Suite 310, Montreal, QC, H9P 2V9, Canada.
| | - Hanane Khoury
- LASER Analytica, 1405 Transcanadienne, Suite 310, Montreal, QC, H9P 2V9, Canada
| | | | - Donna Rindress
- LASER Analytica, 1405 Transcanadienne, Suite 310, Montreal, QC, H9P 2V9, Canada
| | - Mireille Goetghebeur
- LASER Analytica, 1405 Transcanadienne, Suite 310, Montreal, QC, H9P 2V9, Canada
- University of Montreal, School of Public Health, Montreal, QC, Canada
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14
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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.
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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.
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15
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Abstract
BACKGROUND Patients with rare diseases have limited access to useful information to guide treatment decisions. Engagement of patients and other stakeholders in clinical research may help to ensure that research efforts in rare diseases address relevant clinical questions and patient-centered health outcomes. Rare disease organizations may provide an effective means to facilitate patient engagement in research. However, the effectiveness of patient-engagement approaches, particularly for the study of rare diseases, has not been well studied. OBJECTIVES To synthesize evidence about engagement of patients and other stakeholders in research on rare diseases, including the role of rare disease organizations in facilitating patient-centered research. METHODS/RESEARCH DESIGN A systematic review and gray literature search were guided by a technical expert panel composed of patient representatives, clinicians, and researchers. English-language studies that engaged patients or other stakeholders in research on rare diseases or evaluated engagement were included. Studies were assessed on how well key research questions were answered, based on the level of detail describing engagement activities and whether outcomes from engagement were assessed. RESULTS Thirty-five studies were included, although many reported minimal information on engagement. Patients and other stakeholders were most commonly engaged to identify patient-centered research agendas, to select which study outcomes were important to patients, to provide input on study design, and to identify strategies for increasing enrollment in trials. Rare disease organizations mainly helped provide access to patients and communicated research opportunities and findings. They also helped promote collaborative networks and provided financial support for research infrastructures. Although authors reported benefits of engagement and identified changes to their research processes, no empirical assessments of engagement practices and their effectiveness were found. CONCLUSIONS Researchers studying rare diseases can obtain patient input regarding which research questions and health outcomes to study; however, the most effective approaches to engagement have not been well defined.
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