Hemophilia gene therapy knowledge and perceptions: Results of an international survey

BACKGROUND

Hemophilia gene therapy is a rapidly evolving therapeutic approach in which a number of programs are approaching clinical development completion.

OBJECTIVE

The aim of this study was to evaluate knowledge and perceptions of a variety of health care practitioners and scientists about gene therapy for hemophilia.

METHODS

This survey study was conducted February 1 to 18, 2019. Survey participants were members of the ISTH, European Hemophilia Consortium, European Hematology Association, or European Association for Hemophilia and Allied Disorders with valid email contacts. The online survey consisted of 36 questions covering demographic information, perceptions and knowledge of gene therapy for hemophilia, and educational preferences. Survey results were summarized using descriptive statistics.

RESULTS

Of the 5117 survey recipients, 201 responded from 55 countries (4% response rate). Most respondents (66%) were physicians, and 59% were physicians directly involved in the care of people with hemophilia. Among physician respondents directly involved in hemophilia care, 35% lacked the ability to explain the science of adeno-associated viral gene therapy for hemophilia, and 40% indicated limited ability or lack of comfort answering patient questions about gene therapy for hemophilia based on clinical trial results to date. Overall, 75% of survey respondents answered 10 single-answer knowledge questions correctly, 13% incorrectly, and 12% were unsure of the correct answers.

CONCLUSIONS

This survey highlighted knowledge gaps and educational needs related to gene therapy for hemophilia and, along with other inputs, has informed the development of "Gene Therapy in Hemophilia: An ISTH Education Initiative."

Improving immunization (imm) rates among oncology patients and health care providers (HCP) through a partnership of continuing medical education (CME) and quality improvement (QI) in an NCI-designated comprehensive cancer center

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Background: Onc pts are at increased risk of vaccine (vac)-preventable diseases and suffer worse sequelae. Regulatory requirements demand imm of patients and HCP. There is a large practice gap among clinicians in awareness of imm guidelines, of pt imm status, and of the high risk of transmission from HCP to immunocompromised pt. Methods: From May 2012 to June 2013 the City of Hope CME coordinated a team of MDs, QI specialists, infection control, IT, nursing, and pharmacy in a QI CME initiative to increase the imm rates of pt and HCP by education (ed) to clinicians, pt and families. Multiple ed platforms were used (live CME meetings, web-based content, point of care applications, visual cues, clinician longitudinal self-assessment surveys, systems-based support tools, patient handouts) with emphasis on MD-friendly platforms. Results: >350 HCP participated in CME events (59% MDs, 18% RN). Analysis of ed and clinical outcomes is from 4 areas. (1) Change in HCP attitudes through self-assessment surveys shows an increase in clinician knowledge of types and timing of imm, in use of system-based tools (standard orders, vac computerized manager), and in involvement of pts in imm history and ed. (2) There was an increase of doses of influenza vaccines in pts (Sept-March, 2010-11/ 2011-12/ 2012-13: 1129/1480(31% increase)/1838(24% increase). (3) Respiratory viral testing of pts was done to assess number of confirmed infections. (4) Influenza vac rates of hospital workers improved with the largest increase in the medical staff (65 to 76%). Conclusions: This interdisciplinary CME initiative to improve imm rates among onc pts involved ed activities and system-based changes. Improvements were seen in areas of HCP attitude, performance, and acceptance of their own vac. 24% of the medical staff remain unvaccinated, raising both ethical and compliance challenges to reach the 2020 90% goal of Joint Commission. A gap remains in HCP attitudes regarding their own vac which may not be amenable to analytical-based CME. Use of other decision-making/learning styles is necessary for further progress. CA62505 and Pfizer.

The national learning disabilities postsecondary data bank: an overview

A survey was developed to assess support services, procedures, policies, the proportion of students with learning disabilities (LD), and the factors that affect differences in proportion in a nationally representative sample of postsecondary institutions (PSIs). The factors investigated included general characteristics about the PSI, such as size of the student body and type of PSI. The specific characteristics investigated in regard to LD were admissions procedures, year of initiation of LD support services, type and location of support services, eligibility criteria for services and accommodations, the number of students with LD, and demographic and diagnostic information available. In this article, descriptive data regarding the services, practices, policies, procedures, and proportions are provided. The findings indicated that the proportion of students with LD ranged from .5% to almost 10%. The factors that had a significant impact on the proportion of students with LD were size of the student body, the type of institution, the institution's Carnegie classification, and whether the institution offered graduate degree programs. These findings and their implications are discussed.

Adults with learning disabilities: occupational and social status after college

Forty-nine adults with learning disabilities who had attended a large public university between 1980 and 1992 were interviewed about their current employment and social status. Most of the respondents had adjusted well to the demands and complexities of adulthood. More than 80% of the participants not still in college at the time of the interview were employed, mostly in white collar jobs. Although most of the participants indicated that their learning disabilities affected them at work or in other facets of their life, they typically did not disclose those disabilities when applying for jobs or once employed. The respondents were also socially active and happy with their social life. Keys and barriers to success are examined, and recommendations are made concerning the issue of discrimination in the workplace.

Interleukin-6 (IL-6) gene expression and secretion by cytokine-stimulated human retinal pigment epithelial cells

Retinal and choroidal inflammatory lesions are important causes of visual loss, but the mechanisms regulating intraocular inflammation remain poorly understood. By virtue of its position at the blood-retina barrier, the retinal pigment epithelium (RPE) cells may be critical to the initiation and propagation of ocular inflammation. Previously we showed that cytokine-stimulated RPE cells produce interleukin-8, a well-defined chemotactic factor for neutrophils and lymphocytes. In this study, we found that human RPE cells stimulated by human recombinant interleukin-1-beta (rIL-1 beta) or tumor necrosis factor-alpha (rTNF-alpha) produce interleukin-6 (IL-6). Using a plasmacytoma proliferation assay, significant levels of IL-6 were found in media of RPE cells stimulated with either rIL-1 beta or rTNF-alpha for 4 hr. Progressive accumulation of IL-6 in media overlying stimulated RPE cells occurred over the subsequent 20 hr. IL-1 beta was a significantly more potent stimulator of RPE IL-6 production than TNF-alpha, RPE IL-6 production in response to each of these cytokines was also dose-dependent over a range of 20 pg to 20 ng ml-1. Specific anti IL-6 antibody, but not control immunoglobulin, neutralized RPE-derived IL-6 activity in the plasmacytoma proliferation assays. RPE IL-6 mRNA levels were detectable 1 hr after cytokine stimulation, plateaued within 8 hr in 24-hr assays, and demonstrated dose-dependent kinetics in 6 hr assays. Lipopolysaccharide failed to induce RPE IL-6 mRNA expression or RPE IL-6 production.(ABSTRACT TRUNCATED AT 250 WORDS)