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Vogel AP, Sobanska A, Gupta A, Vasco G, Grobe-Einsler M, Summa S, Borel S. Quantitative Speech Assessment in Ataxia-Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Markers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1128-1134. [PMID: 37897626 PMCID: PMC11102369 DOI: 10.1007/s12311-023-01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
Dysarthria is a common and debilitating symptom of many neurodegenerative diseases, including those resulting in ataxia. Changes to speech lead to significant reductions in quality of life, impacting the speaker in most daily activities. Recognition of its importance as an objective outcome measure in clinical trials for ataxia is growing. Its viability as an endpoint across the disease spectrum (i.e. pre-symptomatic onwards) means that trials can recruit ambulant individuals and later-stage individuals who are often excluded because of difficulty completing lower limb tasks. Here we discuss the key considerations for speech testing in clinical trials including hardware selection, suitability of tasks and their role in protocols for trials and propose a core set of tasks for speech testing in clinical trials. Test batteries could include forms suitable for remote short, sensitive and easy to use, with norms available in several languages. The use of artificial intelligence also could improve accuracy and automaticity of analytical pipelines in clinic and trials.
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Affiliation(s)
- Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia.
- Division of Translational Genomics of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Tübingen, Germany.
- Redenlab Inc., Melbourne, Australia.
| | - Anna Sobanska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anoopum Gupta
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gessica Vasco
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Susanna Summa
- Bambino Gesù Children's Hospital, IRCCS, 00050, Rome, Italy
| | - Stephanie Borel
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, F-75013, Paris, France
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2
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Bhalla D, Sati S, Basel D, Karody V. A novel termination site in a case of Stüve-Wiedemann syndrome: case report and review of literature. Front Pediatr 2024; 12:1341841. [PMID: 38628360 PMCID: PMC11018973 DOI: 10.3389/fped.2024.1341841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Stüve-Wiedemann syndrome (SWS) is a rare autosomal recessive disorder that is characterized by bowing of long bones, dysautonomia, temperature dysregulation, swallowing and feeding difficulties, and frequent respiratory infections. Respiratory distress and hyperthermic events are the leading causes of early neonatal death, and most patients are not expected to survive past infancy. Here, we report on the survival of a 5-year-old male with SWS, discussing his case presentation, providing a brief clinical course, and discussing the outcome. This case adds to the literature surrounding rare instances of childhood survivors of SWS and raises awareness for this syndrome to facilitate an earlier recognition, intervention, and genetic counseling for the families, thereby improving understanding of this disease and the health outcomes for the children affected by this condition.
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Affiliation(s)
- Deepali Bhalla
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sunil Sati
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Donald Basel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Vijender Karody
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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3
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Feng S, Rcheulishvili N, Jiang X, Zhu P, Pan X, Wei M, Wang PG, Ji Y, Papukashvili D. A review on Gaucher disease: therapeutic potential of β-glucocerebrosidase-targeted mRNA/saRNA approach. Int J Biol Sci 2024; 20:2111-2129. [PMID: 38617529 PMCID: PMC11008270 DOI: 10.7150/ijbs.87741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Gaucher disease (GD), a rare hereditary lysosomal storage disorder, occurs due to a deficiency in the enzyme β-glucocerebrosidase (GCase). This deficiency leads to the buildup of substrate glucosylceramide (GlcCer) in macrophages, eventually resulting in various complications. Among its three types, GD2 is particularly severe with neurological involvements. Current treatments, such as enzyme replacement therapy (ERT), are not effective for GD2 and GD3 due to their inability to cross the blood-brain barrier (BBB). Other treatment approaches, such as gene or chaperone therapies are still in experimental stages. Additionally, GD treatments are costly and can have certain side effects. The successful use of messenger RNA (mRNA)-based vaccines for COVID-19 in 2020 has sparked interest in nucleic acid-based therapies. Remarkably, mRNA technology also offers a novel approach for protein replacement purposes. Additionally, self-amplifying RNA (saRNA) technology shows promise, potentially producing more protein at lower doses. This review aims to explore the potential of a cost-effective mRNA/saRNA-based approach for GD therapy. The use of GCase-mRNA/saRNA as a protein replacement therapy could offer a new and promising direction for improving the quality of life and extending the lifespan of individuals with GD.
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Affiliation(s)
- Shunping Feng
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Nino Rcheulishvili
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | | | - Pan Zhu
- Cheerland Biomedicine, Shenzhen, China
| | - Xuehua Pan
- Shenzhen Pengbo Biotech Co. Ltd, Shenzhen, China
| | - Meilan Wei
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Peng George Wang
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Yang Ji
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Dimitri Papukashvili
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
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4
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Walton H, Ng PL, Simpson A, Bloom L, Chitty LS, Fulop NJ, Hunter A, Jones J, Kai J, Kerecuk L, Kokocinska M, Leeson-Beevers K, Parkes S, Ramsay AIG, Sutcliffe A, Taylor C, Morris S. Experiences of coordinated care for people in the UK affected by rare diseases: cross-sectional survey of patients, carers, and healthcare professionals. Orphanet J Rare Dis 2023; 18:364. [PMID: 37996938 PMCID: PMC10668407 DOI: 10.1186/s13023-023-02934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Poorly coordinated care can have major impacts on patients and families affected by rare conditions, with negative physical health, psychosocial and financial consequences. This study aimed to understand how care is coordinated for rare diseases in the United Kingdom. METHODS We undertook a national survey in the UK involving 760 adults affected by rare diseases, 446 parents/carers of people affected by rare diseases, and 251 healthcare professionals who care for people affected by rare diseases. RESULTS Findings suggested that a wide range of patients, parents and carers do not have coordinated care. For example, few participants reported having a care coordinator (12% patients, 14% parents/carers), attending a specialist centre (32% patients, 33% parents/carers) or having a care plan (10% patients, 44% parents/carers). A very small number of patients (2%) and parents/carers (5%) had access to all three-a care coordinator, specialist centre and care plan. Fifty four percent of patients and 33% of parents/carers reported access to none of these. On the other hand, a higher proportion of healthcare professionals reported that families with rare conditions had access to care coordinators (35%), specialist centres (60%) and care plans (40%). CONCLUSIONS Care for families with rare conditions is generally not well coordinated in the UK, with findings indicating limited access to care coordinators, specialist centres and care plans. Better understanding of these issues can inform how care coordination might be improved and embrace the needs and preferences of patients and families affected by rare conditions.
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Affiliation(s)
- Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Pei Li Ng
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Amy Simpson
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Lara Bloom
- The Ehlers-Danlos Society and Academic Affiliate Professor of Practice in Patient Engagement and Global Collaboration (Penn State College of Medicine), Hershey, USA
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Jennifer Jones
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Joe Kai
- Division of Primary Care, Centre for Academic Primary Care, NIHR School for Primary Care Research, University of Nottingham, Floors 13-15, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- NIHR Clinical Research Network West Midlands, Birmingham, UK
| | - Maria Kokocinska
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Sharon Parkes
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alastair Sutcliffe
- UCL and Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christine Taylor
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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5
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Lieschke K, Scott V, Delatycki MB, Lewis S, Munsie M, Tanner C, Corben LA. How Great a Risk Do You Take? A Qualitative Study Exploring Attitudes of Individuals with Friedreich Ataxia Toward Gene Therapy. Hum Gene Ther 2023; 34:1041-1048. [PMID: 37624740 DOI: 10.1089/hum.2023.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Scientists and pharmaceutical companies are working toward delivering gene therapy (GT) for Friedreich ataxia (FRDA). Understanding the views of people with lived experience of FRDA and their parents toward GT is essential to inform trial design and identify potential barriers to participation in clinical trials. The goals of this study were to identify the attitudes toward GT held by individuals with FRDA and parents of individuals with FRDA, and to explore how these may impact future trials for this condition. Audiorecorded, semistructured, qualitative interviews with 19 Australians explored experiences of FRDA, knowledge about clinical trials, views on GT, including risks and benefits, and potential barriers to participation in trials. Participants included thirteen individuals living with FRDA aged between 15-43 years, and six parents of children with FRDA aged 4-12 years of age. Thematic analysis of the interviews identified six main themes. Findings from this study indicate there is strong desire for information regarding GT in FRDA, however the current level of uncertainty around GT makes decision making challenging. The desire to maintain functional status and avoid additional risk of deterioration from an investigational treatment was apparent. Importantly, neurological targets were identified as preferred for GT trials. Further research is required to identify if attitudes and perceptions differ according to geographical location and disease stage.
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Affiliation(s)
- Katherine Lieschke
- Bruce Lefroy Center for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Varlli Scott
- Bruce Lefroy Center for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Martin B Delatycki
- Bruce Lefroy Center for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
| | - Sharon Lewis
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Department of Reproductive Epidemiology, The University of Melbourne, Parkville, Australia
| | - Megan Munsie
- Department of Medicine, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
| | - Claire Tanner
- Department of Sociology, School of Social Sciences, Monash University, Clayton, Australia
| | - Louise A Corben
- Bruce Lefroy Center for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Australia
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6
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Bhushan V, Kumar G, Yadav A, Tripathi S. Psychiatric manifestations of Myhre syndrome: A case report. Indian J Psychiatry 2023; 65:1083-1084. [PMID: 38108059 PMCID: PMC10725206 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_158_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
| | - Gyanendra Kumar
- Department of Psychiatry, IMHH, Agra, Uttar Pradesh, India E-mail:
| | - Arti Yadav
- Department of Psychiatry, IMHH, Agra, Uttar Pradesh, India E-mail:
| | - Sheetal Tripathi
- Department of Psychiatry, IMHH, Agra, Uttar Pradesh, India E-mail:
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7
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Hailemariam T, Demilew E, Manyazewal T, Sisay S. Congenital extrahepatic Portosystemic shunt with hypoplasia of the intrahepatic inferior vena cava: A rare case report. Radiol Case Rep 2023; 18:2750-2753. [PMID: 37334323 PMCID: PMC10275737 DOI: 10.1016/j.radcr.2023.05.042] [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: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
Congenital portosystemic shunt (CPS) is a rare vascular anomaly resulting in diversion of splanchnic or portal blood into the systemic circulation. Other vascular malformations associated with this entity are uncommon. A 4-year-old female child with a diagnosis of acute viral hepatitis had an incidental finding of extrahepatic CPS on a Doppler abdominal ultrasound. Contrast-enhanced computed tomography showed a dilated portal vein having H-type side-to-side communication with a hypoplastic intrahepatic portion of the inferior vena cava and a prominent dilated azygos vein. There was retroaortic left renal vein drained into the IVC which was visualized in its entirety. Echocardiography findings were normal and the patient was discharged after symptomatic treatment that achieved improvement. With the expansion of abdominal imaging, incidental cases of CPS are increasingly being diagnosed in children. Although vascular malformations associated with CPS are rare, early diagnosis of cases helps avoid complications during shunt closure.
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Affiliation(s)
- Tesfahunegn Hailemariam
- Addis Ababa University, School of Medicine, Department of Radiology, 9080, Addis Ababa, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Endalew Demilew
- Addis Ababa University, School of Medicine, Department of Radiology, 9080, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Samuel Sisay
- Addis Ababa University, School of Medicine, Department of Radiology, 9080, Addis Ababa, Ethiopia
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8
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Peña LDM, Burrage LC, Enns GM, Esplin ED, Harding C, Mendell JR, Niu ZN, Scharfe C, Yu T, Koeberl DD. Contributions from medical geneticists in clinical trials of genetic therapies: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100831. [PMID: 37031408 PMCID: PMC11040261 DOI: 10.1016/j.gim.2023.100831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- Loren D M Peña
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX
| | - Gregory M Enns
- Department of Pediatrics, Stanford University, Stanford, CA
| | | | - Cary Harding
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jerry R Mendell
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Zhiyv Neal Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Curt Scharfe
- Department of Genetics, Yale School of Medicine, New Haven, CT
| | - Timothy Yu
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Dwight D Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University, Durham, NC
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9
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Walton H, Simpson A, Ramsay AIG, Hudson E, Hunter A, Jones J, Ng PL, Leeson-Beevers K, Bloom L, Kai J, Kerecuk L, Kokocinska M, Sutcliffe AG, Morris S, Fulop NJ. Developing a taxonomy of care coordination for people living with rare conditions: a qualitative study. Orphanet J Rare Dis 2022; 17:171. [PMID: 35443702 PMCID: PMC9020422 DOI: 10.1186/s13023-022-02321-w] [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: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Improving care coordination is particularly important for individuals with rare conditions (who may experience multiple inputs into their care, across different providers and settings). To develop and evaluate strategies to potentially improve care coordination, it is necessary to develop a method for organising different ways of coordinating care for rare conditions. Developing a taxonomy would help to describe different ways of coordinating care and in turn facilitate development and evaluation of pre-existing and new models of care coordination for rare conditions. To the authors’ knowledge, no studies have previously developed taxonomies of care coordination for rare conditions. This research aimed to develop and refine a care coordination taxonomy for people with rare conditions. Methods This study had a qualitative design and was conducted in the United Kingdom. To develop a taxonomy, six stages of taxonomy development were followed. We conducted interviews (n = 30 health care professionals/charity representatives/commissioners) and focus groups (n = 4 focus groups, 22 patients/carers with rare/ultra-rare/undiagnosed conditions). Interviews and focus groups were audio-recorded with consent, and professionally transcribed. Findings were analysed using thematic analysis. Themes were used to develop a taxonomy, and to identify which types of coordination may work best in which situations. To refine the taxonomy, we conducted two workshops (n = 12 patients and carers group; n = 15 professional stakeholder group). Results Our taxonomy has six domains, each with different options. The six domains are: (1) Ways of organising care (local, hybrid, national), (2) Ways of organising those involved in care (collaboration between many or all individuals, collaboration between some individuals, a lack of collaborative approach), (3) Responsibility for coordination (administrative support, formal roles and responsibilities, supportive roles and no responsibility), (4) How often appointments and coordination take place (regular, on demand, hybrid), (5) Access to records (full or filtered access), and (6) Mode of care coordination (face-to-face, digital, telephone). Conclusions Findings indicate that there are different ways of coordinating care across the six domains outlined in our taxonomy. This may help to facilitate the development and evaluation of existing and new models of care coordination for people living with rare conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02321-w.
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Affiliation(s)
- Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Amy Simpson
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK.,Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Emma Hudson
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Jennifer Jones
- Genetic Alliance UK, Creative Works, 7 Blackhorse Lane, London, E17 6DS, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | | | - Lara Bloom
- The Ehlers-Danlos Society and Academic of Patient Engagement and Global Collaboration, Penn State College of Medicine, Hershey, USA
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Floors 13-15, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, NIHR CRN West Midlands, Birmingham, UK
| | - Maria Kokocinska
- Birmingham Women's and Children's NHS Foundation Trust, NIHR CRN West Midlands, Birmingham, UK
| | - Alastair G Sutcliffe
- UCL and Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
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