Physicians’ knowledge on specific rare diseases and its associated factors: a national cross-sectional study from China

Caregivers' experiences and challenges of the diagnostic odyssey in Dravet syndrome

BACKGROUND

Although the genetic background of Dravet syndrome (DS) has been determined and is clearly described, and genetics tests that support a clinical diagnosis are available, DS diagnosis is often based on the clinical assessment alone, which may lead to a late or missed diagnosis. This study explores experiences of caregivers' of persons with DS with the diagnostic odyssey and their perception of its consequences for DS patients.

RESULTS

106 family caregivers connected with the Association for People with Severe Refractory Epilepsy DRAVET.PL completed an anonymised, self-administered, computer-assisted online survey on parents' experiences of the diagnostic journey conducted from March to June 2024. Although 96.2% of DS parents reported that their children experienced initial symptoms in the first year of life, 58.4% indicated that it took more than a year before DS was diagnosed and 72.7% reported that their DS child received at least one misdiagnosis. While 6.6% of patients were diagnosed by the first doctor consulted, 65.1% had to consult between two and four specialists and 22.8% consulted more than five specialists. 19.8% of parents confirmed that they sought diagnosis abroad. 58.4% of DS parents suggested that delayed diagnosis was harmful to their children's health. Many believed that it resulted in taking unnecessary or inappropriate medications (67%), hospitalisations (32.1%), or medical interventions (15.1%). Many parents reported problems with accessing genetic counselling and psychological support.

CONCLUSIONS

Since DS parents report the multifaceted and protracted diagnostic journey in their children, underscoring the duration of the diagnostic process, numerous misdiagnoses and the number of healthcare professionals involved in achieving the confirmed DS diagnosis, this study highlights the need for widespread access to genetic testing, which usually concludes the diagnostic odyssey and is crucial for managing the proper treatment plan for DS patients. It also shows the need to increase general practitioners' awareness of the developmental and epileptic encephalopathy (DEE) and the creation of more rapid and transparent referral procedures for children with DEE.

Effects of continuing medical education on emergency trainees' rare disease knowledge and attitude: a single-center study

BACKGROUND

Rare diseases (RDs) affect 10% of the global population but have inadequate medical resources. Early detection and treatment are crucial, yet many emergency physicians lack awareness of RDs. This study aims to evaluate the effects of continuing medical education (CME) on the knowledge and attitude of emergency physicians.

METHODS

This retrospective study was conducted from April to June 2023, involving 218 Chinese emergency physicians. The online questionnaire consisted of four groups and 30 questions, covering demographic data, knowledge, and attitudes regarding RDs. Respondents were divided into two groups based on their recent CME training experience with RDs.

RESULTS

Two hundred and eighteen emergency physicians completed the questionnaire, of which 108 received RD CME training and 110 did not receive RD CME training. Most respondents (98.2%) felt their knowledge about RDs was insufficient. The CME training group showed increased awareness of RD incidence (p = 0.047) and improved case analysis after training, but only slight improvement in knowledge of RD professional websites. Among the CME training group, CME was identified as the most prominent avenue for acquiring knowledge about RDs, with 72 respondents (66.7%, p < 0.001). In contrast, in the non-training group, clinical work was identified as the primary source of learning, with 47 respondents (42.7%, p < 0.001).

CONCLUSION

Emergency physicians generally lacked knowledge about rare diseases. CME training can improve their awareness and knowledge of RDs.

A qualitative exploration of the lived experience of mothers caring for a child with narcolepsy

STUDY OBJECTIVES

Parents/carers of a child with narcolepsy are often required to become experts in narcolepsy and navigate health care, education, and welfare systems on behalf of their child. Managing pediatric narcolepsy is complex and challenges the child and the entire family, yet few studies have explored carers' experiences.

METHODS

Twenty mothers (50% had a child with narcolepsy < 18 years at the time of interview; 85% narcolepsy with cataplexy) participated in a 1:1 semistructured interview. Participation from fathers was sought; however, none were recruited. A multidisciplinary team of researchers/clinicians analyzed interview transcripts using thematic analysis.

RESULTS

Mothers perceived that most people misunderstood the whole-person impact of narcolepsy, including their child's peers, teachers, and support networks. Narcolepsy had a substantial psychological impact on both the child and the whole family yet was largely unaddressed by health care professionals, leaving mothers unsure of where to turn for help. Most parents described negative experiences with their child's specialist, often perceiving the specialists to lack knowledge specific to narcolepsy. Information about illness trajectory and support services was limited or inaccessible, fueling many mothers' hopes and fears for their child's future. Mothers also frequently described feelings of abandonment by the health care system.

CONCLUSIONS

Our results contextualize the whole-person impact of narcolepsy from the perspective of parents and carers, highlighting the need for proactive inclusion of parents/carers in developing health care policy and practice. It calls for developing tools and resources to capture "well-managed" narcolepsy from the perspective of parents/carers for use in research and clinical practice.

CITATION

Schokman A, Cheung J, Klinner C, et al. A qualitative exploration of the lived experience of mothers caring for a child with narcolepsy. J Clin Sleep Med. 2024;20(5):699-707.

Association of migration status with quality of life among rural and urban adults with rare diseases: A cross-sectional study from China

Background

A considerable proportion of rare disease patients decide to migrate to access a definitive diagnosis or appropriate care, which could affect their quality of life in a long term.

Objective

To compare quality of life (QoL) between migrants and residents and explore the possible mechanism of how migration influence the QoL among rural and urban adults with rare diseases, respectively.

Methods

A cross-sectional study at national level was conducted in a study sample of 1,150 adult patients in China. Migration was defined as being away from one's original place of residence for at least 12 months. Patients who remained in their place of residence in the past 12 months ("resident") were treated as a comparison group for "migrants". Original area of residence (rural vs. urban) for both residents and migrants was used for comparison. The brief version of the World Health Organization Quality of Life instrument was used to measure QoL. Multiple linear regression analyses were adopted to assess the direct association between migration status and QoL after controlling for the confounders that affect QoL. The indirect associations between migration status and QoL, mediated by potential mediators including number of family members living together, individual income, catastrophic health expenditure, and social support, were estimated using the mediation model.

Results

Among the group of rural participants, migration was directly associated with physical QoL (β = 5.07, 95% CI 2.01-8.13) and environmental QoL (3.95, 1.37-6.53), indirectly associated with physical QoL (0.58, 0.05-1.28) and social QoL (0.50, 0.01-1.16) via individual income, and also indirectly associated with environmental QoL (-0.47, -1.12 to -0.50) via tangible support. On the other hand, neither direct nor indirect associations of migration with four domain scores of QoL were significant among the group of urban participants.

Conclusion

Among rural adults with rare diseases, migration was found to have positive direct effect on physical and environmental QoL, positive indirect effect on physical and social QoL through increased individual income, and negative indirect effect on environmental QoL via reduced tangible support. By contrast, neither direct nor indirect associations of migration with QoL were significant among the group of urban participants.

The Application of the GP Model to Manage Controllable Risk Factors in Stroke Patients with Diabetes Can Effectively Improve the Prognosis and Reduce the Recurrence Rate

Objective

The aim of this study is to examine the impacts of general practice model (GP) on prognosis and recurrence of stroke patients with diabetes.

Methods

Ninety patients with stroke combined with diabetes mellitus admitted to our hospital from June 2019 to June 2020 were selected for the study and were randomly and equally divided into 45 cases each in the control and experimental groups for the prospective trial. The patients in the control group received routine treatment while those in the experimental group were treated with GP model. Comparison in treatment effects, patients satisfaction, psychological status, quality of life, glycosylated hemoglobin level, and stroke recurrence was carried out between the two groups.

Results

The experimental group showed markedly better treatment effects (P < 0.05), higher satisfaction degree (P < 0.05), higher HAD (P < 0.05), GQOLI-74 score (P < 0.05), and BI index (P < 0.05), lower level of glycosylated hemoglobin (P < 0.05), and much lower recurrence rate (P < 0.05), as compared to the control group.

Conclusion

The application of the GP model to manage controllable risk factors in stroke patients with diabetes can effectively improve the prognosis and reduce the recurrence rate, which is worthy of clinical application and promotion.