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Fremion E, Morrison-Jacobus M, Castillo J, Castillo H, Ostermaier K. A chronic care model for spina bifida transition. J Pediatr Rehabil Med 2017; 10:243-247. [PMID: 29125512 DOI: 10.3233/prm-170451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing comprehensive transition care for adolescents and young adults with spina bifida (AYASB) requires a structured approach to addressing chronic condition management, self-management, care coordination, and health care navigation that is adaptable to the various levels of cognitive ability, physical function, and family/community environments within the population. This commentary (1) highlights AYASB transition program needs identified in the literature and within a local community, (2) analyzes advantages and limitations of published AYASB transition care models in addressing these needs, (3) demonstrates how a spina bifida (SB) transition clinic used the Chronic Care Model (CCM) to develop a comprehensive AYASB transition program, and (4) examines the potential feasibility in adapting this model to other SB clinics. A SB-specific transition clinic based on the CCM model facilitates the complex chronic care management and transition planning for AYASB. Further study is needed to evaluate health care outcomes using the CCM for SB transition.
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Affiliation(s)
- Ellen Fremion
- Center for Transition Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Spina Bifida Transition Clinic, Houston, TX, USA
| | | | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Ostermaier
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Cooper J, Chisolm D, McLeod DJ. Sociodemographic Characteristics, Health Literacy, and Care Compliance in Families With Spina Bifida. Glob Pediatr Health 2017; 4:2333794X17745765. [PMID: 29238738 PMCID: PMC5721963 DOI: 10.1177/2333794x17745765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/08/2017] [Indexed: 12/29/2022] Open
Abstract
Children with spina bifida experience varying rates of disease complications and health system overutilization. Data on sociodemographics, urinary tract infection, clean intermittent catheterization, and health system utilization were collected from caregiver-patient dyads. Newest Vital Sign (NVS) and Brief Health Literacy Screen (BRIEF) were administered to evaluate health literacy (HL). In total, 105 dyads completed enrolment with 24.8% versus 12.4% of caregivers scoring poor/marginal on the NVS and BRIEF, respectively. Nearly half on clean intermittent catheterization missed a catheterization over the previous week. Medicaid insurance, parental education, and household income predicted HL (P < .01). Over the preceding 5 years, 68.5% visited our hospital's emergency department. Eighteen (25%) visited the emergency department >6 times and 12 incurred charges over $50 000. Caregivers of children who missed ≥4 catheterizations per week had lower NVS scores (P = .03). Children with spina bifida represent high utilizers, and consideration of sociodemographic and HL differences is necessary when tailoring care plans.
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Trinh A, Wong P, Sakthivel A, Fahey MC, Hennel S, Brown J, Strauss BJ, Ebeling PR, Fuller PJ, Milat F. Fat-Bone Interactions in Adults With Spina Bifida. J Endocr Soc 2017; 1:1301-1311. [PMID: 29264455 PMCID: PMC5686646 DOI: 10.1210/js.2017-00258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022] Open
Abstract
Context: Spina bifida (SB) can lead to changes in body composition and bone mineral density (BMD) through diminished ambulation, renal impairment, and anticonvulsant medication. With increased life expectancy, diseases such as obesity and osteoporosis are emerging comorbidities in SB, with limited data to guide management. Objective: To examine the relationship between cardiometabolic factors, body composition, BMD, and minimal trauma fractures (MTFs) in adults with SB. Design: Retrospective cross-sectional study. Setting and Participants: Forty-nine adults with SB (median age, 32.7 years; interquartile range, 22.6 to 39.0) who had undergone dual-energy x-ray absorptiometry imaging at a single tertiary hospital from 2004 to 2015. Results: The mean body mass index was 31.7 ± 7.5 kg/m2; 26 (53.1%) were obese. Using age- and sex-matched fat percentiles from the National Health and Nutrition Examination Survey III, 62.5% had a total body percentage fat greater than the 95th percentile. Low bone mass (defined as a Z-score of ≤−2.0) was present in 21.9% at the L1 vertebra and in 35.1% at the femoral neck. Ten (20.4%) had a history of MTFs. A BMD or Z-score at L1, femoral neck, or total body site did not correlate with the occurrence of MTF. Fat mass was significantly and positively associated with BMD after adjustment for age, sex, and height and accounted for 18.6% of the variance in BMD (P = 0.005). The prevalence of metabolic comorbidities, such as hypertension (20.4%) and obstructive sleep apnea (16.3%), was high. Conclusions: Obesity and low BMD are common in young adults with SB. An increased fat mass correlated significantly with BMD. The prevalence of metabolic complications in patients with SB is increased and deserves further study.
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Affiliation(s)
- Anne Trinh
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Phillip Wong
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Anuradha Sakthivel
- Department of General Medicine and Endocrinology, Eastern Health, Melbourne, Victoria 3168, Australia
| | - Michael C Fahey
- Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia
| | - Sabine Hennel
- Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia
| | - Justin Brown
- Department of Paediatrics, Monash Health, Melbourne, Victoria 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia
| | - Boyd J Strauss
- Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.,Department of Medicine, Monash University, Melbourne, Victoria 3168, Australia
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Abstract
OBJECTIVE To determine feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and its effects on psychosocial and medical outcomes. DESIGN In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. RESULTS Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. CONCLUSION Use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.
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Liptak GS, Robinson LM, Davidson PW, Dziorny A, Lavalley R, Flaherty MG, Dosa NP. Life course health and healthcare utilization among adults with spina bifida. Dev Med Child Neurol 2016; 58:714-20. [PMID: 26526690 DOI: 10.1111/dmcn.12952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the prevalence of organ system disorders and describe healthcare utilization among adults with spina bifida at a regional clinic. METHOD This study was a structured chart review using the Rochester Health Status Survey-IV. 65 males, 57 females aged 16 to 59 years were seen at the Spina Bifida Center of Central New York between January 2007 and December 2008 (annual hospitalization rate was 15 out of 100). RESULTS Hospitalizations and acute outpatient visits were associated with having shunted hydrocephalus, whereas visits to the emergency department were associated with having a decubitus ulcer. Logistic regression models revealed that older adults made proportionately fewer visits to primary care providers than younger adults (odds ratio 0.919; p=0.02). Yet for every 1-year increase in age, the odds of being hospitalized increased by 5% (odds ratio 1.051; p=0.03). INTERPRETATION Adults with spina bifida have multiple organ-system disorders. They have greater difficulty accessing services, and utilize emergency and inpatient healthcare at higher rates than the general population. In the future, adults with spina bifida will require access to more medical care and preventive services if they are to have optimal health, well-being, and functioning.
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Affiliation(s)
- Gregory S Liptak
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Laura M Robinson
- The School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Philip W Davidson
- The School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Adam Dziorny
- The School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Rebecca Lavalley
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | | | - Nienke P Dosa
- State University of New York Upstate Medical University, Syracuse, NY, USA
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Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System. Arch Phys Med Rehabil 2016; 97:1969-1978. [PMID: 27311718 DOI: 10.1016/j.apmr.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability. DESIGN Nonrandomized, noncontrolled cohort study; 2 years of enrollment. SETTING Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system. PARTICIPANTS Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention. INTERVENTIONS Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives. MAIN OUTCOME MEASURES Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost. RESULTS Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment. CONCLUSIONS Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.
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Carrasco A, Vemulakonda VM. Managing adult urinary incontinence from the congenitally incompetent bladder outlet. Curr Opin Urol 2016; 26:351-6. [PMID: 27096718 DOI: 10.1097/mou.0000000000000296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Treatment of urinary incontinence in adult patients with congenital incompetent bladder outlet (exstrophy-epispadias complex, cloacal anomalies, or neurogenic bladder secondary to myelomeningocele) is a challenging surgical problem. In this review article, we summarize and highlight recent studies in the management of incontinence in this patient population. RECENT FINDINGS The literature regarding management of urinary incontinence in this patient population is scarce. Injection of bulking agents to the bladder neck, artificial/autologous slings, artificial urinary sphincters, bladder neck reconstruction, bladder neck closure, or a combination of these are the cornerstone of management. Augmentation cystoplasty is a major adjunct procedure that can help increase continence rate and success of surgery in select patients. The level of evidence on bladder neck procedures for this patient population is low because of significant limitations, including small sample, heterogeneity of primary diagnosis/surgical techniques, variable definitions of continence, and the retrospective nature of most studies in this field. SUMMARY Standard options for treatment of urinary incontinence in the congenitally incompetent bladder outlet procedure remain unchanged. There is no single reproducible procedure to accomplish the goal of renal preservation and continence in these patients, and often patients require multiple procedures to achieve continence. Most importantly, the pediatric and adult urologist should continue to work toward achieving a well tolerated and efficient transition of care. There is a need to standardize data acquisition and reporting of outcomes. Although randomized control studies would be ideal, because of the small number of patients with these conditions, this may not be practical. Collaboration and continued discussion among experts in the field is needed to gain a better understanding of the optimal management strategy in this growing patient population.
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Affiliation(s)
- Alonso Carrasco
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, USA
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Abstract
The population of patients with congenital genitourinary disorders has unique healthcare demands that require an additional interpersonal and medical skillset. Adults with congenital neurogenic bladder may have complex urinary anatomy, abnormal bladder function and atypical voiding mechanisms. While initial surgery and care of these patients is typically managed by a pediatric urologist, growth and development into adulthood necessitates transition of care to an adult care team. Failure of transition to adult care has been demonstrated to result in lower quality healthcare and increased risk of developing preventable complications.
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Affiliation(s)
- Christopher J Loftus
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Hadley M Wood
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
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Aguilera AM, Wood DL, Keeley C, James HE, Aldana PR. Young adults with spina bifida transitioned to a medical home: a survey of medical care in Jacksonville, Florida. J Neurosurg Pediatr 2016; 17:203-207. [PMID: 26496631 DOI: 10.3171/2015.7.peds14694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study's purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children's Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.
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Affiliation(s)
| | - David L Wood
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; and
| | - Cortney Keeley
- Division of Community and Societal Pediatrics, Department of Pediatrics, and
| | - Hector E James
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Philipp R Aldana
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
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Parmanto B, Pramana G, Yu DX, Fairman AD, Dicianno BE. Development of mHealth system for supporting self-management and remote consultation of skincare. BMC Med Inform Decis Mak 2015; 15:114. [PMID: 26714452 PMCID: PMC4696204 DOI: 10.1186/s12911-015-0237-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 12/16/2015] [Indexed: 01/21/2023] Open
Abstract
Background Individuals with spina bifida (SB) are vulnerable to chronic skin complications such as wounds on the buttocks and lower extremities. Most of these complications can be prevented with adherence to self-care routines. We have developed a mobile health (mHealth) system for supporting self-care and management of skin problems called SkinCare as part of an mHealth suite called iMHere (interactive Mobile Health and Rehabilitation). The objective of this research is to develop an innovative mHealth system to support self-skincare tasks, skin condition monitoring, adherence to self-care regimens, skincare consultation, and secure two-way communications between patients and clinicians. Methods In order to support self-skincare tasks, the SkinCare app requires three main functions: (1) self-care task schedule and reminders, (2) skin condition monitoring and communications that include imaging, information about the skin problem, and consultation with clinician, and (3) secure two-way messaging between the patient and clinician (wellness coordinator). The SkinCare system we have developed consists of the SkinCare app, a clinician portal, and a two-way communication protocol connecting the two. The SkinCare system is one component of a more comprehensive system to support a wellness program for individuals with SB. Results The SkinCare app has several features that include reminders to perform daily skin checks as well as the ability to report skin breakdown and injury, which uses a combination of skin images and descriptions. The SkinCare app provides reminders to visually inspect one’s skin as a preventative measure, often termed a “skin check.” The data is sent to the portal where clinicians can monitor patients’ conditions. Using the two-way communication, clinicians can receive pictures of the skin conditions, track progress in healing over time, and provide instructions for how to best care for the wound. Conclusions The system was capable of supporting self-care and adherence to regimen, monitoring adherence, and supporting clinician engagement with patients, as well as testing its feasibility in a long-term implementation. The study shows the feasibility of a long-term implementation of skincare mHealth systems to support self-care and two-way interactions between patients and clinicians.
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Affiliation(s)
- Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA 15260, USA.
| | - Gede Pramana
- Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Daihua X Yu
- Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Andrea D Fairman
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Perception of secondary conditions in adults with spina bifida and impact on daily life. Disabil Health J 2015; 8:492-8. [DOI: 10.1016/j.dhjo.2015.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 03/13/2015] [Accepted: 03/25/2015] [Indexed: 12/18/2022]
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Loftus C, Wood H. Emerging Concepts in Transitional Care of Congenital Genitourinary Reconstructions. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim S, Ward E, Dicianno BE, Clayton GH, Sawin KJ, Beierwaltes P, Thibadeau J. Factors associated with pressure ulcers in individuals with spina bifida. Arch Phys Med Rehabil 2015; 96:1435-1441.e1. [PMID: 25796136 PMCID: PMC4519375 DOI: 10.1016/j.apmr.2015.02.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/23/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR). DESIGN Unbalanced longitudinal multicenter cohort study. SETTING Nineteen SB clinics. PARTICIPANTS Individuals with SB (N=3153) enrolled in 19 clinic sites that participate in the NSBPR. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pressure ulcer status (yes/no) at the annual visit between 2009 and 2012. RESULTS Of 3153 total participants, 19% (n=603) reported ulcers at their most recent annual clinic visit. Seven factors-level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex-were significantly associated with the presence of pressure ulcers. Of these factors, level of lesion, urinary incontinence, recent surgery, and male sex were included in the final logistic regression model. The 3 adjusting variables-SB type, SB clinic, and age group-were significant in all analyses (all P<.001). CONCLUSIONS By adjusting for SB type, SB clinic, and age group, we found that 7 factors-level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex-were associated with pressure ulcers. Identifying key factors associated with the onset of pressure ulcers can be incorporated into clinical practice in ways that prevent and enhance treatment of pressure ulcers in the population with SB.
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Affiliation(s)
- Sunkyung Kim
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | | | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gerald H Clayton
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO
| | - Kathleen J Sawin
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI
| | - Patricia Beierwaltes
- Children's Hospital of Michigan, Detroit, MI; Wayne State University, Detroit, MI
| | - Judy Thibadeau
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Mann JR, Royer JA, Turk MA, McDermott S, Holland MM, Ozturk OD, Hardin JW, Thibadeau JK. Inpatient and emergency room visits for adolescents and young adults with spina bifida living in South Carolina. PM R 2015; 7:499-511. [PMID: 25511690 PMCID: PMC4469995 DOI: 10.1016/j.pmrj.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/20/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare emergency room (ER) and inpatient hospital (IP) use rates for persons with spina bifida (SB) to peers without SB, when transition from pediatric to adult health care is likely to occur; and to analyze those ER and IP rates by age, race, socioeconomic status, gender, and type of residential area. DESIGN A retrospective cohort study. SETTING Secondary data analysis in South Carolina. PARTICIPANTS We studied individuals who were between 15 and 24 years old and enrolled in the State Health Plan (SHP) or state Medicaid during the 2000-2010 study period. METHODS Individuals with SB were identified using ICD-9 billing codes (741.0, 741.9) in SHP, Medicaid, and hospital uniform billing (UB) data. ER and IP encounters were identified using UB data. Multivariable Generalized Estimating Equation (GEE) Poisson models were estimated to compare rates of ER and IP use among the SB group to the comparison group. MAIN OUTCOME MEASURES Total ER rate and IP rate, in addition to cause-specific rates for ambulatory care sensitive conditions (ACSC) and other condition categories. RESULTS We found higher rates of ER and IP use in persons with SB compared to the control group. Among individuals with SB, young adults (those 20-24 years old) had higher rates of ER use due to all ACSC (P = .023), other ACSC (P = .04), and urinary tract infections (UTI; P = .002) compared to adolescents (those 15-19 years old). CONCLUSIONS Young adulthood is associated with increased ER use overall, as well as in specific condition categories (most notably UTI) in individuals 15-24 years old with SB. This association may be indicative of changing healthcare access as people with SB move from adolescent to adult health care, and/or physiologic changes during the age range studied.
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Affiliation(s)
- Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203(∗).
| | - Julie A Royer
- South Carolina Revenue and Fiscal Affairs Office, Columbia, SC(†)
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Columbia, SC(‡)
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(§)
| | - Margaret M Holland
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(‖)
| | - Orgul D Ozturk
- Department of Economics University of South Carolina Darla Moore School of Business, Columbia, SC(¶)
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(#)
| | - Judy K Thibadeau
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA(∗∗)
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Yu DX, Parmanto B, Dicianno BE, Pramana G. Accessibility of mHealth Self-Care Apps for Individuals with Spina Bifida. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2015; 12:1h. [PMID: 26755902 PMCID: PMC4696094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As the smartphone becomes ubiquitous, mobile health is becoming a viable technology to empower individuals to engage in preventive self-care. An innovative mobile health system called iMHere (Internet Mobile Health and Rehabilitation) has been developed at the University of Pittsburgh to support self-care and adherence to self-care regimens for individuals with spina bifida and other complex conditions who are vulnerable to secondary complications. The goal of this study was to explore the accessibility of iMHere apps for individuals with spina bifida. Six participants were asked to perform tasks in a lab environment. Though all of the participants were satisfied with the iMHere apps and would use them again in the future, their needs and preferences to access and use iMHere apps differed. Personalization that provides the ability for a participant to modify the appearance of content, such as the size of the icons and the color of text, could be an ideal solution to address potential issues and barriers to accessibility. The importance of personalization--and potential strategies--for accessibility are discussed.
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Affiliation(s)
- Daihua X Yu
- Department of Health Information Management at the University of Pittsburgh School of Health and Rehabilitation Sciences in Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management at the University of Pittsburgh School of Health and Rehabilitation Sciences in Pittsburgh, PA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation at the University of Pittsburgh Medical Center in Pittsburgh, PA
| | - Gede Pramana
- Department of Health Information Management at the University of Pittsburgh School of Health and Rehabilitation Sciences in Pittsburgh, PA
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Myelomeningocele: How we can improve the assessment of the most severe form of spina bifida. Brain Res 2014; 1619:84-90. [PMID: 25498106 DOI: 10.1016/j.brainres.2014.11.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/25/2014] [Indexed: 12/18/2022]
Abstract
Myelomeningocele (MMC) is a devastating spinal cord birth defect, which results in significant life-long disabilities, impaired quality of life, and difficult medical management. The pathological progression of MMC involves failure in neural tube and vertebral arch closure at early gestational ages, followed by subsequent impairment in spinal cord and vertebral growth during fetal development. MMC is irreversible at term. Thus, prenatal therapeutic strategies that interrupt progressive pathological processes offer an appealing approach for treatment of MMC. However, a thorough understanding of pathological progression of MMC is mandatory for appropriate treatment to be rendered. This article is part of a Special Issue entitled SI: Spinal cord injury.
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21st Century Challenges to the Provision of Health Care to Adults With Spina Bifida: A Rehabilitation Approach. Arch Phys Med Rehabil 2014; 95:1601-2. [DOI: 10.1016/j.apmr.2014.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/30/2013] [Accepted: 01/10/2014] [Indexed: 11/21/2022]
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van Nooten FE, Winnette R, Stein R, Kissner M, Schröder A, Jöckel M, Raluy-Callado M, Lambrelli D, Meinhardt M, Wasiak R. Resource utilization and productivity loss in persons with spina bifida—an observational study of patients in a tertiary urology clinic in Germany. Eur J Neurol 2014; 22:53-8. [PMID: 25103893 DOI: 10.1111/ene.12524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE To investigate resource use and burden associated with spina bifida (SB) in Germany. METHODS A questionnaire was used to obtain information on SB-related healthcare resource use and assistive technologies used for the last 1 and 10 years. Individuals with SB were recruited at a tertiary specialist clinic. To participate, persons with SB required the cognitive ability to respond or a caregiver to answer questions on their behalf. They could use personal medical charts or other records to answer. The analyses included assessment of frequency and extent of resource use for both time frames. RESULTS Data on 88 persons with a diagnosis of SB were collected (44% female). During the last year, 88.6% (N = 78) reported at least one visit to a general practitioner's (GP's) office, 77.3% (N = 68) to a urologist and 69.3% (N = 61) to a physiotherapist. The annual average number of visits was 7.6 GP, 3.6 urologist and 65.3 physiotherapist visits. Amongst those hospitalized, a single hospitalization lasted 7.3 days on average, whereas the average annual number of hospital days was 14.8 days. During the previous 10 years, 67.0% (N = 59) of responders used a wheelchair, 64.7% (N = 57) used glasses and 59.1% (N = 52) used orthopaedic shoes, with an average of 2.5, 2.8 and 6.1 new items used, respectively. CONCLUSIONS The results indicate that persons with SB require a substantial amount of interaction with healthcare providers, as well as other healthcare-related resource use, both in the shorter and longer terms.
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Gupta AD, Wright EJ. Transitional Urology: an Evolving Paradigm for Care of the Aging Adolescent. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Royer JA, Hardin JW, McDermott S, Ouyang L, Mann JR, Ozturk OD, Bolen J. Use of state administrative data sources to study adolescents and young adults with rare conditions. J Gen Intern Med 2014; 29 Suppl 3:S732-8. [PMID: 25029984 PMCID: PMC4124125 DOI: 10.1007/s11606-014-2925-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Effective care of young people with rare conditions requires ongoing coordinated medical treatment as well as educational and social support services. However, information on treatment is often lacking due to limited data. South Carolina has a repository of comprehensive health and human service data with which individuals may be tracked across the data systems of multiple state agencies and organizations. OBJECTIVE To develop a method for studying health care of young persons with rare conditions using this repository. METHODS We identified individuals aged 15 to 24 years diagnosed during 2000-2010 with Fragile X syndrome (FXS), spina bifida (SB), or muscular dystrophy (MD) using a series of algorithms. ICD-9-CM codes were used to initially identify the cohort from medical billing data. Demographics, medical care, employment, education, and socioeconomic status data were then extracted from linked administrative sources. RESULTS We identified 1,040 individuals with these rare conditions: 125 with FXS, 695 with SB, and 220 with MD. The vast majority of the cases (95%) were identified in the Medicaid database. Half of the cohort was male, with a higher percentage in the FXS and MD groups. Sixty-two percent of the cohort was enrolled in the last year of high school. Over half of the cohort received support services from the state's disability and special-needs agency; 16% received food assistance. Thirty-eight percent were employed at some point during the study period. Forty-nine individuals with SB and 56 with MD died during the study period. CONCLUSIONS We used a linked statewide data system to study rare conditions. Strengths include the diversity of information, rigorous identification strategies, and access to longitudinal data. Despite limitations inherent to administrative data, we found that linked state data systems are valuable resources for investigating important public health questions on rare conditions.
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Affiliation(s)
- J. A. Royer
- />Division of Research and Statistics, South Carolina Budget and Control Board, 1919 Blanding Street, Columbia, SC 29201 USA
| | - J. W. Hardin
- />Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 800 Sumter Street, Columbia, SC 29208 USA
| | - S. McDermott
- />Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 800 Sumter Street, Columbia, SC 29208 USA
| | - L. Ouyang
- />Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities, Atlanta, GA USA
| | - J. R. Mann
- />Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203 USA
| | - O. D. Ozturk
- />Moore School of Business, Department of Economics, University of South Carolina, Columbia, SC 29208 USA
| | - J. Bolen
- />Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities, Atlanta, GA USA
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Wang HHS, Wiener JS, Ross SS, Routh JC. Emergent care patterns in patients with spina bifida: a case-control study. J Urol 2014; 193:268-73. [PMID: 25016137 DOI: 10.1016/j.juro.2014.06.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Individuals with spina bifida are typically followed closely as outpatients by multidisciplinary teams. However, emergent care of these patients is not well defined. We describe patterns of emergent care in patients with spina bifida and healthy controls. MATERIALS AND METHODS We reviewed Nationwide Emergency Department Sample data from 2006 to 2010. Subjects without spina bifida (controls) were selected from the sample using stratified random sampling and matched to each case by age, gender and treatment year at a 1:4 ratio. Missing emergency department charges were estimated by multiple imputation. Statistical analyses were performed to compare patterns of care among emergency department visits and charges. RESULTS A total of 226,709 patients with spina bifida and 888,774 controls were identified. Mean age was 28.2 years, with 34.6% of patients being younger than 21. Patients with spina bifida were more likely than controls to have public insurance (63.7% vs 35.4%, p <0.001) and to be admitted to the hospital from the emergency department (37.0% vs 9.2%, p <0.001). Urinary tract infections were the single most common acute diagnosis in patients with spina bifida seen emergently (OR 8.7, p <0.001), followed by neurological issues (OR 2.0, p <0.001). Urological issues were responsible for 34% of total emergency department charges. Mean charges per encounter were significantly higher in spina bifida cases vs controls ($2,102 vs $1,650, p <0.001), as were overall charges for patients subsequently admitted from emergent care ($36,356 vs $29,498, p <0.001). CONCLUSIONS Compared to controls, patients with spina bifida presenting emergently are more likely to have urological or neurosurgical problems, to undergo urological or neurosurgical procedures, to be admitted from the emergency department and to incur higher associated charges.
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Affiliation(s)
- Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sherry S Ross
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
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Advances in spina bifida care: from the womb to adulthood. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0046-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Young Adults with Spina Bifida May Have Higher Occurrence of Prehypertension and Hypertension. Am J Phys Med Rehabil 2014; 93:200-6. [DOI: 10.1097/phm.0b013e3182a92b03] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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74
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Economic burden of neural tube defects in Germany. Public Health 2014; 128:274-81. [DOI: 10.1016/j.puhe.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 10/29/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022]
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Young NL, Anselmo LA, Burke TA, McCormick A, Mukherjee S. Youth and young adults with spina bifida: their utilization of physician and hospital services. Arch Phys Med Rehabil 2013; 95:466-71. [PMID: 24095657 DOI: 10.1016/j.apmr.2013.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/06/2013] [Accepted: 09/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe current patterns of health care utilization of youth and young adults who have spina bifida (SB) and provide evidence to guide the development of health care for this growing population. DESIGN We conducted a secondary analysis of health services utilization data from the Canadian Institute for Health Information to determine the rates and patterns of health care utilization, because comprehensive health care has been recognized as critical to positive health outcomes. SETTING Participants were identified from 6 publicly funded children's treatment centers. PARTICIPANTS Health records from youth (n=164; age range, 13.0-17.9y) and adults (n=120; age range, 23.0-32.9y) with SB contributed to this study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The rates of outpatient physician visits and hospital admissions for the youth and adult groups were calculated. The proportion with a "medical home" was also calculated. RESULTS The annual rates of outpatient physician visits per 1000 persons were 8031 for youth and 8524 for adults with SB. These rates were approximately 2.9 and 2.2 times higher, respectively, than for their age-matched peers. On average, 12% of youth and 24% of adults with SB had a medical home. The annual rates of hospital admissions per 1000 persons were 329 for youth and 285 for adults with SB. Rates of admissions were 19.4 and 12.4 times higher, respectively, for these groups than for the general population. CONCLUSIONS It appears that persons with SB are accessing health services more often than their age-matched peers, and few have a medical home. We recommend that seamless medical care be provided to all adults with SB, coordinated by a primary care provider, to facilitate comprehensive care.
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Affiliation(s)
- Nancy L Young
- Evaluating Children's Health Outcomes (ECHO) Research Centre, Laurentian University, Sudbury, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| | - Lianne A Anselmo
- Evaluating Children's Health Outcomes (ECHO) Research Centre, Laurentian University, Sudbury, ON, Canada
| | - Tricia A Burke
- Evaluating Children's Health Outcomes (ECHO) Research Centre, Laurentian University, Sudbury, ON, Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario and Ottawa Children's Treatment Centre, Ottawa, ON, Canada
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Parmanto B, Pramana G, Yu DX, Fairman AD, Dicianno BE, McCue MP. iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions. JMIR Mhealth Uhealth 2013; 1:e10. [PMID: 25100682 PMCID: PMC4114477 DOI: 10.2196/mhealth.2391] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 03/20/2013] [Accepted: 04/27/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. OBJECTIVE The project's goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. METHODS We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. RESULTS There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient's self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients' conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. CONCLUSIONS The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized.
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Affiliation(s)
- Bambang Parmanto
- Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States.
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78
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Madden-Fuentes RJ, McNamara ER, Lloyd JC, Wiener JS, Routh JC, Seed PC, Ross SS. Variation in definitions of urinary tract infections in spina bifida patients: a systematic review. Pediatrics 2013; 132:132-9. [PMID: 23796735 DOI: 10.1542/peds.2013-0557] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes. METHODS Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria. RESULTS We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71). CONCLUSIONS Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.
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Fairman AD, Dicianno BE, Datt N, Garver A, Parmanto B, McCue M. Outcomes of Clinicians, Caregivers, Family Members and Adults with Spina Bifida Regarding Receptivity to use of the iMHere mHealth Solution to Promote Wellness. Int J Telerehabil 2013; 5:3-16. [PMID: 25945209 PMCID: PMC4296836 DOI: 10.5195/ijt.2013.6116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to gather information regarding the receptivity of clinicians, caregivers and family members, and adults with spina bifida (SB) to the use of a mHealth application, iMobile Health and Rehabilitation (iMHere) system. Surveys were administered to end user groups in conjunction with a conference presentation at the Spina Bifida Association's 38th Annual Conference. The survey results were obtained from a total of 107 respondents. Likert scale and qualitative results are provided in consideration of future application of the iMHere system in clinical practice. The results of this survey indicate respondents were receptive and supportive with regard to adopting such a system for personal and professional use. Challenges likely to be encountered in the introduction of the iMHere system are also revealed and discussed.
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Affiliation(s)
- Andrea D Fairman
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nicole Datt
- School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Amanda Garver
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health and Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Abstract
The majority of people with spina bifida in the United States are now older than 18 years of age. Health care delivery for adults with this condition should include routine surveillance for common conditions such as hypertension, hyperlipidemia and cancer. It should also address spina bifida-related complications such as pressure sores, lymphedema, sexual dysfunction and infertility, and hydrocephalus, as well as chiari-related symptoms such as sleep apnea and urologic and renal functioning. Almost all adults with spina bifida benefit from regular followup with specialists in urology, neurosurgery and physiatry. Health care providers for adults with spina bifida should recognize the impact of executive dysfunction and nonverbal learning disability on self management, independent living, and employment in adults with spina bifida.
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81
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Ghani KR, Sammon JD, Karakiewicz PI, Sun M, Bhojani N, Sukumar S, Peabody JO, Menon M, Trinh QD. Trends in surgery for upper urinary tract calculi in the USA using the Nationwide Inpatient Sample: 1999-2009. BJU Int 2013; 112:224-30. [DOI: 10.1111/bju.12059] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Jesse D. Sammon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit; MI
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal; QC; Canada
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal; QC; Canada
| | - Naeem Bhojani
- Department of Urology; Indiana University Health; Methodist Hospital; Indianapolis; IN; USA
| | - Shyam Sukumar
- Vattikuti Urology Institute; Henry Ford Health System; Detroit; MI
| | - James O. Peabody
- Vattikuti Urology Institute; Henry Ford Health System; Detroit; MI
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit; MI
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Jacobson LA, Tarazi RA, McCurdy MD, Schultz S, Levey E, Mahone EM, Zabel TA. The Kennedy Krieger Independence Scales-Spina Bifida Version: a measure of executive components of self-management. Rehabil Psychol 2013; 58:98-105. [PMID: 23438006 PMCID: PMC4154366 DOI: 10.1037/a0031555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Successful implementation of functional self-care skills depends upon adequate executive functioning; however, many scales assessing adaptive skills do not address the inherent executive burden of these tasks. This omission is especially relevant for individuals with spina bifida, for whom medical self-care tasks impose a significant burden requiring initiation and prospective memory. The Kennedy Krieger Independence Scales-Spina Bifida Version (KKIS-SB) is a caregiver-reported measure designed to address this gap; it assesses skills for managing both typical and spina bifida-related daily self-care demands, with a focus on the timely and independent initiation of adaptive skills. RESEARCH METHOD/DESIGN Parents of 100 youth and young adults with spina bifida completed the KKIS-SB. Exploratory factor analysis and Pearson's correlations were used to assess the factor structure, reliability, and construct validity of the KKIS-SB. RESULTS The scale demonstrates excellent internal consistency (Cronbach's alpha = .891). Exploratory factor analysis yielded four factors, explaining 65.1% of the total variance. Two primary subscales were created, initiation of routines and prospective memory, which provide meaningful clinical information regarding management of a variety of typical (e.g., get up on time, complete daily hygiene routines on time) and spina bifida-specific self-care tasks (e.g., begin self-catheterization on time, perform self-examination for pressure sores). CONCLUSIONS/IMPLICATIONS Based upon internal consistency estimates and correlations with measures of similar constructs, initial data suggest good preliminary reliability and validity of the KKIS-SB.
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Affiliation(s)
- Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, 1750 E. Fairmount Avenue, Baltimore, MD 21231, USA.
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Crytzer TM, Dicianno BE, Fairman AD. Effectiveness of an upper extremity exercise device and text message reminders to exercise in adults with spina bifida: a pilot study. Assist Technol 2013; 25:181-93. [PMID: 24620701 PMCID: PMC3955014 DOI: 10.1080/10400435.2012.747572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Obesity, deconditioning, cognitive impairment, and poor exercise tolerance are health issues concerning adults with spina bifida (SB). Our aim is to describe exercise participation and identify motivating tactics and exercise devices that increase participation. In a quasi-experimental randomized crossover design, the GameCycle was compared to a Saratoga Silver I arm ergometer. Personalized free or low-cost text/voice message reminders to exercise were sent. Nineteen young adults with SB were assigned to either the GameCycle or Saratoga exercise group. Within each group, participants were randomized to receive reminders to exercise, or no reminders, then crossed over to the opposite message group after eight weeks. Before and after a 16-week exercise program anthropometric, metabolic, exercise testing and questionnaire data, and recorded participation were collected. Miles traveled by the GameCycle group were significantly higher than the Saratoga exercise groups. No significant differences were found in participation between the message reminder groups. Low participation rates were seen overall. Those using the GameCycle traveled more miles. Barriers to exercise participation may have superseded ability to motivate adults with SB to exercise even with electronic reminders. Support from therapists to combat deconditioning and develop coping skills may be needed.
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Temporal trends, practice patterns, and treatment outcomes for infected upper urinary tract stones in the United States. Eur Urol 2012; 64:85-92. [PMID: 23031677 DOI: 10.1016/j.eururo.2012.09.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 09/14/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND The incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal. OBJECTIVE To examine the trends of infected urolithiasis in the United States, the practice patterns of competing treatment modalities, and to compare adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS A weighted estimate of 396385 adult patients hospitalized with infected urolithiasis was extracted from the Nationwide Inpatient Sample, 1999-2009. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time trend analysis examined the incidence of infected urolithiasis and associated sepsis, as well as rates of retrograde ureteral catheterization and percutaneous nephrostomy (PCN) for urgent/emergent decompression. Propensity-score matching compared the rates of adverse outcomes between approaches. RESULTS AND LIMITATIONS Between 1999 and 2009, the incidence of infected urolithiasis in women increased from 15.5 (95% confidence interval [CI], 15.3-15.6) to 27.6 (27.4-27.8)/100 000); men increased from 7.8 (7.7-7.9) to 12.1 (12.0-12.3)/100000. Rates of associated sepsis increased from 6.9% to 8.5% (p=0.013), and severe sepsis increased from 1.7% to 3.2% (p<0.001); mortality rates remained stable at 0.25-0.20% (p=0.150). Among those undergoing immediate decompression, 113 459 (28.6%), PCN utilization decreased from 16.1% to 11.2% (p=0.001), with significant regional variability. In matched analysis, PCN showed higher rates of sepsis (odds ratio [OR]: 1.63; 95% CI, 1.52-1.74), severe sepsis (OR: 2.28; 95% CI, 2.06-2.52), prolonged length of stay (OR: 3.18; 95% CI, 3.01-3.34), elevated hospital charges (OR: 2.71; 95%CI, 2.57-2.85), and mortality (OR: 3.14; 95%CI, 13-4.63). However, observational data preclude the assessment of timing between outcome and intervention, and disease severity. CONCLUSIONS Between 1999 and 2009, women were twice as likely to have infected urolithiasis. Rates of associated sepsis and severe sepsis increased, but mortality rates remained stable. Analysis of competing treatment strategies for immediate decompression demonstrates decreasing utilization of PCN, which showed higher rates of adverse outcomes. These findings should be viewed as preliminary and hypothesis generating, demonstrating the pressing need for further study.
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Fouts DE, Pieper R, Szpakowski S, Pohl H, Knoblach S, Suh MJ, Huang ST, Ljungberg I, Sprague BM, Lucas SK, Torralba M, Nelson KE, Groah SL. Integrated next-generation sequencing of 16S rDNA and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. J Transl Med 2012; 10:174. [PMID: 22929533 PMCID: PMC3511201 DOI: 10.1186/1479-5876-10-174] [Citation(s) in RCA: 317] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/02/2012] [Indexed: 02/07/2023] Open
Abstract
Background Clinical dogma is that healthy urine is sterile and the presence of bacteria with an inflammatory response is indicative of urinary tract infection (UTI). Asymptomatic bacteriuria (ABU) represents the state in which bacteria are present but the inflammatory response is negligible. Differentiating ABU from UTI is diagnostically challenging, but critical because overtreatment of ABU can perpetuate antimicrobial resistance while undertreatment of UTI can result in increased morbidity and mortality. In this study, we describe key characteristics of the healthy and ABU urine microbiomes utilizing 16S rRNA gene (16S rDNA) sequencing and metaproteomics, with the future goal of utilizing this information to personalize the treatment of UTI based on key individual characteristics. Methods A cross-sectional study of 26 healthy controls and 27 healthy subjects at risk for ABU due to spinal cord injury-related neuropathic bladder (NB) was conducted. Of the 27 subjects with NB, 8 voided normally, 8 utilized intermittent catheterization, and 11 utilized indwelling Foley urethral catheterization for bladder drainage. Urine was obtained by clean catch in voiders, or directly from the catheter in subjects utilizing catheters. Urinalysis, urine culture and 16S rDNA sequencing were performed on all samples, with metaproteomic analysis performed on a subsample. Results A total of 589454 quality-filtered 16S rDNA sequence reads were processed through a NextGen 16S rDNA analysis pipeline. Urine microbiomes differ by normal bladder function vs. NB, gender, type of bladder catheter utilized, and duration of NB. The top ten bacterial taxa showing the most relative abundance and change among samples were Lactobacillales, Enterobacteriales, Actinomycetales, Bacillales, Clostridiales, Bacteroidales, Burkholderiales, Pseudomonadales, Bifidobacteriales and Coriobacteriales. Metaproteomics confirmed the 16S rDNA results, and functional human protein-pathogen interactions were noted in subjects where host defenses were initiated. Conclusions Counter to clinical belief, healthy urine is not sterile. The healthy urine microbiome is characterized by a preponderance of Lactobacillales in women and Corynebacterium in men. The presence and duration of NB and method of urinary catheterization alter the healthy urine microbiome. An integrated approach of 16S rDNA sequencing with metaproteomics improves our understanding of healthy urine and facilitates a more personalized approach to prevention and treatment of infection.
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86
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Wilson R, Lewis SA, Dicianno BE. Targeted preventive care may be needed for adults with congenital spine anomalies. PM R 2012; 3:730-8. [PMID: 21871417 DOI: 10.1016/j.pmrj.2011.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 05/06/2011] [Accepted: 05/18/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare hospitalizations caused by spina bifida-sensitive conditions, ambulatory care-sensitive conditions in adults with spina bifida and in the general population, our aim was to provide information about whether preventive health efforts already underway in the hospitalized general population are adequate for preventive care in spina bifida and congenital spine anomalies. DESIGN Retrospective secondary data analysis. PATIENTS (OR PARTICIPANTS) Records of hospitalized individuals who were 18 years of age and older. METHODS Comparison between individuals hospitalized with spina bifida and the general population using data from the California State Inpatient Database from the Healthcare Cost and Utilization Project for 2004 of adults. MAIN OUTCOME MEASUREMENTS Prevalence of spina bifida-sensitive conditions and ambulatory care-sensitive conditions as reason for hospitalization and 30-day readmission. RESULTS As compared with the general population, persons with spina bifida who were hospitalized in 2004 had a significantly greater number of hospitalizations, number of hospitalizations associated with both spina bifida-sensitive conditions and ambulatory care-sensitive conditions, and number of 30-day readmissions. Stratification by age shows that the admissions for spina bifida sensitive conditions were greater in persons with spina bifida than in the general population for all age groups. In contrast, only in the youngest age group did those with spina bifida experience greater hospitalizations for ambulatory care-sensitive conditions. CONCLUSIONS This study provides further evidence that persons with spina bifida have hospitalizations that are beyond what the general population experiences. These conditions may be potentially preventable with appropriate ambulatory care. This group also had a greater risk for readmission within 30 days of discharge from their last hospitalization. More research is needed on the efficacy of programs aimed at prevention of these conditions.
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Affiliation(s)
- Richard Wilson
- MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Mahmood D, Dicianno B, Bellin M. Self-management, preventable conditions and assessment of care among young adults with myelomeningocele. Child Care Health Dev 2011; 37:861-5. [PMID: 22007986 DOI: 10.1111/j.1365-2214.2011.01299.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM In this multicentre cross-sectional study we aimed to identify whether self-management ability and healthcare service delivery factors were related to preventable conditions [urinary tract infections (UTIs), pressure ulcers] and healthcare utilization [emergency room (ER) visits, hospitalizations] specifically in a sample of young adults with myelomeningocele. BACKGROUND Spina bifida is one of the most common congenital birth defects, affecting over 166,000 individuals living in the USA. Participants completed a questionnaire comprised of a self-report measure of healthcare services (Patient Assessment of Chronic Illness Care), recent healthcare utilization and preventable medical conditions. A structured clinical interview [Adolescent Self-Management and Independence Scale 2 (AMIS)] was administered to assess self-management. Multiple linear regression models were run to explore individual and combined effects of the AMIS, Patient Assessment of Chronic Illness Care, condition severity variables (shunted hydrocephalus, lesion level) and demographic factors in explaining variability in ER visits, hospitalizations, UTIs and pressure ulcers. RESULTS Higher number of UTIs were associated with no history of shunting, lower educational levels, higher employment levels and lower AMIS scores (adjusted R(2) = 0.774, P = 0.002). Higher number of ulcers was associated with higher motor level and higher educational level (adjusted R(2) = 0.378, P = 0.017). Higher number of hospitalizations was associated with higher number of wounds and lower AMIS scores (adjusted R(2) = 0.544, P = 0.012). A significant model for ER visits was not identified. CONCLUSIONS Initiatives aimed at improving self-management skills or providing support for skin and bladder care may be warranted for those with high levels of motor impairment or lower educational levels. Better detection of wounds may be seen in those with higher employment levels. Spina bifida is a complex condition, but one whose most prevalent concomitant secondary conditions may be preventable through simple measures that improve self-management and through health educational initiatives targeted to specific patient groups.
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Affiliation(s)
- D Mahmood
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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88
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Abstract
OBJECTIVE In the United States, there are more than 100,000 people with spina bifida. There have been very few studies to date documenting the occurrence of lymphedema in the spina bifida population, despite a case series in 2001 that suggested that the occurrence may be higher than in the general population. Currently, approximately 1 million people have lymphedema in the United States. The purpose of this study was to document the occurrence of lymphedema and associated medical factors in a regional adult spina bifida population. DESIGN A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January 2005 to August 2008 were retrospectively reviewed. Subjects were divided into two groups based on the presence or absence of lymphedema. χ² analyses were used to compare lymphedema groups with respect to history of medical comorbidities and ethnicity. Fisher exact tests were used to compare groups with respect to mobility status and the presence of power wheelchair seat functions. Mann-Whitney U tests were used to compare groups with respect to age, anatomic lesion level, employment level, and income. RESULTS Twenty-two (9.2%) patients had lymphedema. Mean ± SD population age was 35.1 ± 11.1 yrs. Lymphedema was associated with a history of trauma (P = 0.044), cellulitis (P < 0.001), cancer (P = 0.038), obesity (P < 0.001), wounds (P < 0.001), hypertension (P = 0.036), higher lesion level spina bifida (P = 0.049), and mobility status (P = 0.007). Hypertension and obesity were present in 38.3% and 37.5% of the total study population, respectively. CONCLUSIONS This is the first study to document the occurrence of lymphedema in a spina bifida patient population, which was almost 100 times higher than that in the general patient population. We also documented a high occurrence of hypertension and obesity in the total study population. These findings may help guide further prospective studies to more clearly delineate the risk factors for the development of lymphedema and to determine the appropriate therapies. Better screening, prevention and treatment algorithms are needed for hypertension and obesity in the spina bifida population.
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Piatt JH. Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults. J Neurosurg Pediatr 2010; 6:515-25. [PMID: 21121724 DOI: 10.3171/2010.9.peds10266] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. METHODS A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. RESULTS Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. CONCLUSIONS Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.
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Affiliation(s)
- Joseph H Piatt
- Section of Neurosurgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
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Mourtzinos A, Stoffel JT. Management goals for the spina bifida neurogenic bladder: a review from infancy to adulthood. Urol Clin North Am 2010; 37:527-35. [PMID: 20955904 DOI: 10.1016/j.ucl.2010.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with spina bifida require longitudinal urological care as they transition from childhood to adolescence and then to adulthood. Issues important to urological health, such as protection of the upper tracts and prevention of incontinence, need vigilant follow-up throughout the patient's life. As the child ages, additional issues such as sexual functioning also become increasingly important for social integration. Despite this need for regular assessment, many adult patients with spina bifida lose coordinated urological care after leaving specialized pediatric spina bifida clinics. Consequently, urologists frequently encounter an adult patient with spina bifida in practice and they need to understand the basic urological treatment goals and potential complications for this population.
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Affiliation(s)
- Arthur Mourtzinos
- Department of Urology, Lahey Clinic, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, USA
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Abstract
The Life Course Model for patients, families, caregivers, teachers, and clinicians was developed with support by the National Spina Bifida Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, for individuals with spina bifida. The Life Course Model facilitates a developmental approach to assessment and intervention along life's trajectory. This Life Course Model provides information about key developmental milestones for particular age groups, validated assessments that can be performed by clinicians or teachers to determine if milestones have been reached, useful suggestions for intervening in creative ways at each step, and evidence-based references. In this article, the authors introduce the viewpoints of several key clinicians who are involved in the care of individuals with spina bifida and how the Life Course Model can assist them, their patients, and their families in the process of assessment, intervention, collaboration with other clinicians, and follow-up. A case study is used to demonstrate the experience of comprehensive and collaborative management in transitioning a child and his family from infancy to adulthood.
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