1
|
Goselink RJ, Eklund A, Olsson I, Hallböök T, Malmgren K, Reilly C. Transitioning from paediatric to adult care in epilepsy: A qualitative study of adolescent experiences. Seizure 2024; 119:92-97. [PMID: 38820675 DOI: 10.1016/j.seizure.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE Transition into adulthood and adult medical care is an important step in the life of young people with epilepsy. We aimed to gain a better insight into the lived experience of the transition to adulthood and adult medical care in epilepsy in Sweden, to improve future transitional care. METHODS A cross-sectional observational study with digital focus-group meetings and interviews with young people with epilepsy (16-22 years, n = 37) prior to, or after the transfer to adult care, or their primary caregivers if they had intellectual disability. We used reflexive thematic analysis to analyse the experiences and expectations on the transition to adulthood and adult medical care. RESULTS The results of the thematic analysis included four key areas during transition to adulthood and adult care for young persons with epilepsy: (I) worries on coming changes and future, (II) transfers are not smooth and adult care is less integrated, (III) epilepsy is part of a bigger picture, and (IV) parental roles change. In those with intellectual disability, parents experienced a stressful process and had to increase their efforts to coordinate all care contacts in adult care. Here, epilepsy was often experienced as a minor part of a more complex disease picture, where neurodevelopmental issues were often the primary concern. SIGNIFICANCE Transition in epilepsy is often complex due to the large burden of co-occurring disease, specifically intellectual disability and neuropsychiatric diagnoses. Transfer to adult care is experienced as unplanned and participants experience uncertainty, indicating a need for an improved transition process. As effective interventions are known in other chronic diseases, future studies should focus on the evaluation of how these approaches can be feasible and effective in young people with epilepsy.
Collapse
Affiliation(s)
- Rianne Jm Goselink
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Anna Eklund
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Colin Reilly
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden; Member of the ERN EpiCARE, Gothenburg, Sweden; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| |
Collapse
|
2
|
Abildgaard Hansen O, Clemensen J, Beier CP, Pors Klinting G, Smith AC, Kaas Larsen M. Being an adolescent with epilepsy during the transition from pediatric to adult hospital care: A qualitative descriptive study. Epilepsy Behav 2024; 155:109780. [PMID: 38640727 DOI: 10.1016/j.yebeh.2024.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The transition from pediatric to adult care is challenging for adolescent patients despite numerous recommendations in recent decades. However, the perspective of the patients is sparsely investigated. AIM To explore the experiences and needs of adolescents with epilepsy (AWE) during the transition from pediatric to adult hospital care. METHODS We conducted 15 semi-structured interviews with AWEs aged 13-20 years and 10 h of field observations of consultations. Interviews were audio-recorded, transcribed, anonymized, and entered into NVivo (version 12, QSR International) with the transcribed field notes. Data were analyzed using systematic text condensation. RESULTS Three themes were identified: (1) Navigating epilepsy in everyday life; (2) The difficult balance between concealment and openness about epilepsy; and (3) Being seen as an individual and not an illness. AWEs' needs in transition are closely associated with their experiences and perceptions of illness, treatment, consultations, and seizures. Notably, AWEs reveal a significant concern about being overlooked beyond their medical condition in appointments. CONCLUSIONS This study highlights the vulnerability and challenges of AWEs transitioning to adult care. Overall, AWEs seek understanding, acceptance, and autonomy in managing their epilepsy and transitioning to adult care. Their experiences underscore the importance of holistic support and communication in healthcare settings. A concerted effort from healthcare professionals (HCP) is necessary to foster the recognition of AWEs as individuals with distinct personalities, needs, and capabilities.
Collapse
Affiliation(s)
- Ole Abildgaard Hansen
- Department of Neurology, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark.
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | | | - Anthony C Smith
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | - Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Zulfiqar Ali Q, Marques P, Patel P, Carrizosa J, Nabbout R, Andrade DM. Transition in epilepsy - A pilot study with patients in and outside of academic centers. Epilepsy Behav 2024; 151:109624. [PMID: 38219605 DOI: 10.1016/j.yebeh.2024.109624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
RATIONALE Epilepsy is a complex condition and seizures are only one part of this disease. The move from pediatric to adult healthcare system proves difficult for many adolescents with epilepsy and their families. The challenges increase when patients have epilepsies associated with intellectual and/or developmental disabilities, autism spectrum disorder, and motor disorders. Knowledge and system gaps may exist between the two systems, adding to the challenges. The main goal of this study is to understand the perception of patients with epilepsy and their families who were preparing to move from pediatric to adult healthcare system or had already moved. METHODS A survey was distributed to patients/caregivers of patients with epilepsy through patient support groups in North America and in-person through the 2019 Epilepsy Awareness Day at Disneyland. Patients were required to be 12 years or older at the time of the survey and were divided into two groups: those between 12 and 17 years and those 18 years or older. Caregivers answered on behalf of patients who were unable to respond (e.g., intellectual disability). Major components of the survey included demographics, epilepsy details, quality and access to care received in pediatric and adult years, and questions regarding transition and readiness. RESULTS Responses were received from 58 patients/caregivers of patients with epilepsy from Canada and the United States. In group A (patients between 12 and 17 years), none of the 17-year-old patients were spoken to about transition. Patients (caregivers) with epilepsy and intellectual and/or developmental disabilities (IDD) had less time to discuss important things during the transition/transfer phase than patients with normal intelligence. Finally, there was a statistically significant difference observed in access to specialty care reported in the adult years, compared to the years in the pediatric system. In the group B (patients 18 years and older) a) 35 % still visit their family doctor for epilepsy related treatment despite the majority being on 2 or more antiseizure medications (ASMs); b) 27 % of patients in this group were still being followed by their pediatric neurologist; c) one patient received care only through visits to the emergency department; d) only 4 % felt that they received clear instructions during transfer of care such as knowing the name of the adult healthcare practitioner and/or the name of the care institution they were being transferred to. CONCLUSIONS This study highlights the lack of appropriate transition to adult healthcare system (AHCS) amongst an unselected group of patients with epilepsy in Canada and United States. An overwhelming majority of patients followed in the community and in academy centers were simply "transferred" to an adult health practitioner, or they remained under the care of pediatricians. Finally, most patients lack access to significant social and medical support after moving to the AHCS.
Collapse
Affiliation(s)
- Quratulain Zulfiqar Ali
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada
| | - Paula Marques
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada; Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Puja Patel
- Isabelle Rapin Division of Child Neurology, The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Jaime Carrizosa
- Department of Pediatrics, Child Neurology Service, University of Antioquia, Mapeo Genético Research Group, Medellín, Colombia
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Hôpital Universitaire Necker-Enfants Malades, APHP, Member of EPICARE, Institut Imagine, Université Paris Cité, Paris, France
| | - Danielle M Andrade
- Adult Genetic Epilepsy Program, Toronto Western Hospital, Krembil Brain Institute, Toronto, Canada; Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| |
Collapse
|
4
|
Vacca M, Fernandes M, Veronese L, Ballesio A, Cerminara C, Galasso C, Mazzone L, Lombardo C, Mercuri NB, Liguori C. Clinical, Sociodemographic, and Psychological Factors Associated with Transition Readiness in Patients with Epilepsy. Brain Sci 2023; 14:21. [PMID: 38248236 PMCID: PMC10813513 DOI: 10.3390/brainsci14010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The transition to adult care for patients with epilepsy is a complicated clinical issue associated with adverse outcomes, including non-adherence to treatment, dropout of medical care, and worse prognosis. Moreover, youngsters with epilepsy are notably prone to emotional, psychological, and social difficulties during the transition to adulthood. Transition needs depend on the type of epilepsy and the epileptic syndrome, as well as on the presence of co-morbidities. Having a structured transition program in place is essential to reduce poor health consequences. A key strategy to optimize outcomes involves the use of transition readiness and associated factors assessment to implement the recognition of vulnerability and protective aspects, knowledge, and skills of these patients and their parents. Therefore, this study aims to provide a comprehensive framework of clinical and psychosocial aspects associated with the transition from pediatric to adult medical care of patients with epilepsy. METHODS Measures examining different aspects of transition readiness and associated clinical, socio-demographic, psychological, and emotional factors were administered to 13 patients with epilepsy (Mage = 22.92, SD = 6.56) with (n = 6) or without (n = 7) rare diseases, and a respective parent (Mage = 56.63, SD = 7.36). RESULTS patients showed fewer problems in tracking health issues, appointment keeping, and pharmacological adherence as well as low mood symptoms and moderate resiliency. Moreover, they referred to a low quality of sleep. Notably, parents of patients with rare diseases reported a lower quality of sleep as compared to the other group of parents. CONCLUSIONS Increasing awareness around transition readiness is essential to promote self-management skills of patients with epilepsy and their parents. Anticipating the period of transition could be beneficial, especially to prevent problematic sleep patterns and promote independence in health care management. Parents of patients with epilepsy and rare diseases should be monitored for their mental status which can affect patients' well-being.
Collapse
Affiliation(s)
- Mariacarolina Vacca
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
| | - Lorenzo Veronese
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Caterina Cerminara
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Cinzia Galasso
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Luigi Mazzone
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Hospital, Viale Oxford 81, 00133 Rome, Italy;
| | - Caterina Lombardo
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (A.B.); (C.L.)
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Epilepsy Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy; (M.F.); (L.V.); (C.G.); (L.M.); (N.B.M.)
- Epilepsy Center, Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| |
Collapse
|
5
|
Pringsheim T, Batla A, Shalash A, Sahu JK, Cosentino C, Ebrahimi‐Fakhari D, Friedman J, Lin J, Mink J, Munchau A, Munoz D, Nardocci N, Perez‐Dueñas B, Sardar Z, Triki C, Ben‐Pazi H, Silveira‐Moriyama L, Troncoso‐Schifferli M, Hoshino K, Dale RC, Fung VS, Kurian MA, Roze E. Transitional Care for Young People with Movement Disorders: Consensus-Based Recommendations from the MDS Task Force on Pediatrics. Mov Disord Clin Pract 2023; 10:748-755. [PMID: 37205244 PMCID: PMC10186998 DOI: 10.1002/mdc3.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 05/21/2023] Open
Abstract
Background The International Parkinson and Movement Disorders Society (MDS) set up a working group on pediatric movement disorders (MDS Task Force on Pediatrics) to generate recommendations to guide the transition process from pediatrics to adult health care systems in patients with childhood-onset movement disorders. Methods To develop recommendations for transitional care for childhood onset movement disorders, we used a formal consensus development process, using a multi-round, web-based Delphi survey. The Delphi survey was based on the results of the scoping review of the literature and the results of a survey of MDS members on transition practices. Through iterative discussions, we generated the recommendations included in the survey. The MDS Task Force on Pediatrics were the voting members for the Delphi survey. The task force members comprise 23 child and adult neurologists with expertise in the field of movement disorders and from all regions of the world. Results Fifteen recommendations divided across four different areas were made pertaining to: (1) team composition and structure, (2) planning and readiness, (3) goals of care, and (4) administration and research. All recommendations achieved consensus with a median score of 7 or greater. Conclusion Recommendations on providing transitional care for patients with childhood onset movement disorders are provided. Nevertheless several challenges remain in the implementation of these recommendations, related to health infrastructure and the distribution of health resources, and the availability of knowledgeable and interested practitioners. Research on the influence of transitional care programs on outcomes in childhood onset movement disorders is much needed.
Collapse
Affiliation(s)
- Tamara Pringsheim
- Department of Clinical NeurosciencesPsychiatry, Pediatrics and Community Health Sciences, University of CalgaryCalgaryABCanada
| | - Amit Batla
- Department of Clinical and Movement NeuroscienceUCL Queen Square Institute of NeurologyLondonUK
| | - Ali Shalash
- Department of NeurologyFaculty of medicine, Ain Shams UniveristyCairoEgypt
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Postgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Carlos Cosentino
- Department of Neurodegenerative DiseasesInstituto Nacional de Ciencias Neurologicas and School of Medicine, Universidad Nacional Mayor de San MarcosLimaPeru
| | | | - Jennifer Friedman
- Departments of Neurosciences and PediatricsUC San DiegoSan DiegoCAUSA
| | - Jean‐Pierre Lin
- Children's Neurosciences, Complex Motor Disorders Service (CMDS)Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), and Women and Children's Health Institute Faculty of Life Sciences & Medicine, Kings Health Partners, King's College LondonLondonUK
| | - Jonathan Mink
- Department of NeurologyUniversity of RochesterRochesterNYUSA
| | - Alexander Munchau
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| | - Daniela Munoz
- Department of Paediatric NeurologySan Borja Arriaran Hospital. University of ChileSantiagoChile
| | - Nardo Nardocci
- Pediatric Neuroscience DepartmentFondazione IRCCS Istituto Neurologico “C Besta”MilanItaly
| | - Belen Perez‐Dueñas
- Department of Pediatric NeurologyHospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona. Centre for Biomedical Research of Rare Diseases (CIBERER), ISCIIIMadridSpain
| | - Zomer Sardar
- FCPS, Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNYUSA
| | - Chahnez Triki
- Department of child neurologyHedi Chaker Hospital, LR10ES15, Sfax Medical School, University of Sfax TunisiaSfaxTunisia
| | | | | | | | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for ChildrenTokyoJapan
| | - Russell C. Dale
- Children's Hospital at Westmead Clinical School, University of SydneySydneyNSWAustralia
| | - Victor S.C. Fung
- Movement Disorders Unit, Department of NeurologyWestmead Hospital & Sydney Medical School, University of SydneySydneyNSWAustralia
| | - Manju A. Kurian
- Developmental NeurosciencesZayed Centre for Research into Rare Disease in Children, GOS‐Institute of Child Health, UCLLondonUK
| | - Emmanuel Roze
- Sorbonne UniversityParis Brain Institute, Assistance Publique—Hôpitaux de Paris, DMU NeurosciencesParisFrance
| |
Collapse
|
6
|
Goselink RJM, Olsson I, Malmgren K, Reilly C. Transition to adult care in epilepsy: A systematic review. Seizure 2022; 101:52-59. [PMID: 35901664 DOI: 10.1016/j.seizure.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
The transfer from paediatric to adult care can be a complex process in children with epilepsy. Inadequate care during this phase can affect long-term medical and psychosocial outcomes. The aim of this study was to review studies on transitional care from paediatric to adult healthcare for young persons with epilepsy in order to synthesize evidence for best practice. We undertook a systematic review following PRISMA guidelines and employed narrative synthesis. A total of 36 articles were included, of which 11 were interventional studies and 25 observational studies. Study quality was rated as 'good' for only four studies. Interventions included joint or multidisciplinary clinics, education (patient and health professional education) and extended service provision (Saturday clinics, peer-groups). All studies observed a positive effect experienced by the participants, regardless of intervention type. Observational studies showed that transition plans/programmes are asked for but frequently not existing or not adapted to subgroups with intellectual disability or other neurodevelopmental conditions. The results of this systematic review on transitional care in epilepsy suggest that a planned transition process likely enhances medical and psychosocial outcomes for young people with epilepsy, but the body of evidence is limited and there are significant gaps in knowledge of what efficacious transition constitutes. More studies are needed employing qualitative and quantitative methods to further explore the needs of young people with epilepsy and their families but also robust study designs to investigate the impact of interventions on medical and psychosocial outcomes.
Collapse
Affiliation(s)
- Rianne J M Goselink
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, SE-413 45, Sweden.
| | - Colin Reilly
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, United Kingdom.
| |
Collapse
|
7
|
Jung SY, Yu SW, Lee KS, Yi YY, Kang JW. Transition from pediatric to adult care among patients with epilepsy: Cross-sectional surveys of experts and patients in Korea. Epilepsia Open 2022; 7:452-461. [PMID: 35766448 PMCID: PMC9436304 DOI: 10.1002/epi4.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Many pediatric patients with epilepsy require treatment beyond the pediatric age. These patients require transition to an adult epilepsy center. Currently, many centers worldwide run epilepsy transition programs. However, a standardized protocol does not exist in Korea. The basic data required to establish a transition program are also unavailable. We aimed to assess the status and perceptions of patients and epilepsy care providers on transition. Methods To assess the status of epilepsy transition, we retrospectively collected data from patients with epilepsy older than 18 years who visited our pediatric epilepsy clinic between March 1990 and July 2019. To assess the perception of transition, we surveyed patients, parents, pediatric neurologists (PN), and adult epileptologists (AE). Results In a retrospective chart review, 39 of 267 (14.6%) patients visited the adult epilepsy clinic after consulting a pediatric neurologist, and three patients returned to the pediatric center. The average patient age at transition was 23.29 ± 5.10 years. A total of 94 patients or their guardians and 100 experts participated in the survey. About half of the patients or guardians (44.7%) did not want to transition and emotional dependence was the commonest reason. Most patients (52.1%) thought that the appropriate age of transition was above 20 years. PNs had greater concerns about patients' compliance than AEs. Regarding the age of transition, AEs believed that a younger age (18 years) was more appropriate than PNs (20 years). Significance This study describes difficulties in the transition from pediatric to adult epilepsy centers without appropriate support. There were differences in perspectives among patients, parents, and adult and pediatric epilepsy care providers. This study can assist in creating a standardized protocol in Korea.
Collapse
Affiliation(s)
- Seung Yeon Jung
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woo Yu
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Keon Su Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon Young Yi
- Department of Pediatrics, Hallym University and Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea.,Department of Pediatrics and Medical Science, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, Korea
| |
Collapse
|
8
|
Bauer J, Kösel E, Henkel AG, Spinner CD, Kolisch R. [Integrated care concepts and multidisciplinary process chains in a radiological context]. Radiologe 2022; 62:331-342. [PMID: 35201396 DOI: 10.1007/s00117-022-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Modern patient-centered and cost-efficient care concepts in hospitals require the mapping of multidisciplinary process chains into clinical pathways. Clinical decision support systems and operations research methods use algorithms to classify patients into homogeneous groups and to model a complete clinical pathway for scheduling individual procedures. An improvement of the economic situation of the care facility can be achieved through improved resource utilization, reduced patient waiting times and a shortening of the length of stay. The interdisciplinary use of centrally stored interoperable information and comprehensive care management via information technology (IT) services lay the foundation for the dissolution of traditional IT system architectures in medicine and the development of flexibly integrable modern system platforms. New IT approaches such as the semantically standardized definition of procedures and resource properties, the use of clinical decision support systems and the use of service-oriented system architectures form the basis for the deep integration of radiology services into comprehensive interdisciplinary care concepts.
Collapse
Affiliation(s)
- J Bauer
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - E Kösel
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A G Henkel
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C D Spinner
- Abteilung Informationstechnologie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - R Kolisch
- Lehrstuhl für Operations Management, Fakultät für Wirtschaftswissenschaften, Technische Universität München, München, Deutschland
| |
Collapse
|
9
|
Edelstein OE. Attitudes and beliefs of medicine and social work students about medical cannabis use for epilepsy. Epilepsy Behav 2022; 127:108522. [PMID: 34999501 DOI: 10.1016/j.yebeh.2021.108522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/28/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022]
Abstract
The current study sought: (i) to explore whether health profession students possess formal medical cannabis (MC) education, feel prepared to answer questions about MC, and perceive it as an effective therapy for epilepsy; (ii) to assess students' attitudes and beliefs about MC use; and (iii) to explore the associations between students' background characteristics, MC-related attitudes and beliefs regarding its effectiveness for epilepsy. A sample of 310 students (141 from medicine and 169 from social work) voluntarily participated in the anonymous online survey. The vast majority (92.5%) indicated they had no formal education about MC, and only 11.2 % reported being prepared to answer clients' MC-related questions. Participants reported favorable beliefs about MC benefits, the need for training, and recreational marijuana use legalization. Less supportive attitudes were reported regarding MC risks. Prior cannabis use (e.g., self-use, friends, or family) and individuals from a secular background were associated with more positive beliefs about MC benefits and its legalization for recreational purposes. Prior recreational cannabis use [OR=1.541] and having friends who recreationally use the substance [OR=1.891] were associated with the belief that MC is an effective therapy for epilepsy. These findings indicate an urgent need for students' MC education to provide future physicians and social workers with MC-related capacities. Development of curricula and training programs in Israel are encouraged.
Collapse
Affiliation(s)
- Offer E Edelstein
- Ben-Gurion University of the Negev, The Spitzer Department of Social Work, Beer-Sheva 841050, Israel.
| |
Collapse
|
10
|
Lanteigne A, Genest M, Racine E. The evaluation of pediatric-adult transition programs: What place for human flourishing? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
11
|
Oguni H, Ito S, Nishikawa A, Otani Y, Nagata S. Transition from pediatric to adult care in a Japanese cohort of childhood-onset epilepsy: prevalence of epileptic syndromes and complexity in the transition. Seizure 2021; 88:1-6. [PMID: 33773226 DOI: 10.1016/j.seizure.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022] Open
Abstract
AIM We retrospectively examined patients with childhood-onset epilepsy who transitioned from pediatric to adult care to reveal the clinical characteristics and evaluate the complexity of transitioning. METHODS The subjects were 220 patients (89 males, 131 females) who had been treated at our pediatric epilepsy clinic and had transferred to adult care between 2014 and 2018 without attending a transition clinic or program. The demographic data of the patients were retrospectively analyzed. RESULTS The ages at transition ranged from 15 to 54 years (median: 27 years old). There were 91 patients with focal epilepsies (FEs) and 129 patients with generalized epilepsies [genetic generalized epilepsy (GGE) n = 30, generalized epilepsy of various etiologies (GEv) n = 99]. A most frequent epileptic syndrome was temporal lobe epilepsy followed by frontal lobe epilepsy in FEs, GTCS only followed by juvenile myoclonic epilepsy in GGE and Lennox-Gastaut syndrome followed by Dravet syndrome in GEv. At the age of transition, a total of 77 of the 96 patients with developmental and epileptic encephalopathies (DEE) had pharmacoresistant seizures, which was positively correlated with a late transition age (P≤0.05). More than monthly seizures and greater than moderate disabilities were noted in 45% and 55% of the patients, respectively. CONCLUSION The patients with childhood-onset epilepsy transitioned to adult care from the hospital-based pediatric epilepsy clinic were characterized by generalized>focal epilepsy, a frequent complication of DEE, more than monthly seizures, and worse than moderate intellectual disabilities. The complication of DEE made a smooth transition difficult and delayed the transition age.
Collapse
Affiliation(s)
- Hirokazu Oguni
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Epilepsy Center, TMG Asaka Medical Center, 1340-1 Mizonuma, Asaka-city, Saitama, 351-0023, Japan.
| | - Susumu Ito
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Aiko Nishikawa
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yui Otani
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Satoru Nagata
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| |
Collapse
|
12
|
Andreoli A, Klingbeil C. Implementing Pediatric Transition Education Initiative During Inpatient Admissions in the Epilepsy Monitoring Unit. J Pediatr Nurs 2021; 57:50-55. [PMID: 33242830 DOI: 10.1016/j.pedn.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adolescents with epilepsy are a population with unique needs when addressing transition to adult care. Scheduled, non-emergent admissions to the Epilepsy Monitoring Unit (EMU) have not yet been utilized to improve transition education. METHODS The overarching goal of this evidence-based practice project was to explore opportunities to enhance the transition education patients and families receive in the clinic setting by leveraging scheduled inpatient admissions for EEG monitoring to provide structured transition education. Twenty-one Neurology Clinic providers were surveyed about their perspectives on the transition process. Thirty-five adolescent patients (12-20 years old) received a pre-test regarding their condition, health maintenance and disease management, and a subsequent post-test measuring knowledge retention after education with a provider. Documentation in the electronic health record (EHR) using an institution created transition flowsheet and a standardized template was used to communicate through the EHR with the primary neurology team. FINDINGS The effectiveness of the intervention was supported as 100% of patients demonstrated increased knowledge after transition education. Providers' knowledge and support of transition efforts increased regarding tools and guidelines for transition of adolescents to adult care. DISCUSSION These results support the feasibility of providing transition education in the EMU with shared responsibility between inpatient and ambulatory providers. IMPLICATIONS FOR PRACTICE Improved use of the transition flowsheet in the EMU and by ambulatory setting providers will enhance the process of transition. Discussion of self-management with adolescent patients during all phases of health care will encourage independence and promote successful transition to adult health care.
Collapse
Affiliation(s)
- Ashley Andreoli
- Medical College of Wisconsin, Children's Wisconsin, WI, United States of America.
| | - Carol Klingbeil
- University of Wisconsin Milwaukee, WI, United States of America.
| |
Collapse
|
13
|
Cui C, Li SZ, Zheng XL, Cheng WJ, Ting W. Participation in healthcare behavior by adolescents with epilepsy and factors that influence it during the transition period: A cross-sectional study in China. Epilepsy Behav 2020; 113:107576. [PMID: 33232895 DOI: 10.1016/j.yebeh.2020.107576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Given the importance of adolescents' participation in the care of their chronic diseases during their transitional period in the healthcare system, the present study investigated the degree of participation in healthcare behavior by Chinese adolescents with chronic epilepsy and identified factors that should be addressed by health interventions. METHODS The study used a convenience sample of 1238 adolescent patients with epilepsy, who were hospitalized in 17 tertiary A-level children or maternal and child specialty hospitals in China between January 2017 and March 2020. Several scales were used to measure their degree of participation in healthcare behavior and the factors that influence it. Data collection was conducted after uniform training of the investigators. The adolescents who met the inclusion and exclusion criteria could scan the QR code of the questionnaire via a mobile phone. RESULTS The age of the participants ranged from 12.2 to 17.8 years (mean 14.2 years), and the sample had a male-to-female ratio of 1.25:1. The patients' average total score of participation in healthcare behavior was 125.58 (SD = 12.25), which was lower than the norm for China. Their scores on the six dimensions of participation were highest for information interaction, followed in descending order by medical decision-making, treatment and care, appeal, diagnosis and treatment decision-making, and questioning supervision. Multiple linear regression found significant associations between health-care participation and five personal and disease variables (gender, age, course of disease, number of comorbid diseases, type of family structure), self-efficacy, and coping styles (cognitive-palliative and acceptance), which explained 52.1% of the variance in patients' total scores on participating in healthcare behavior. CONCLUSIONS The participation of young Chinese patients with epilepsy in transitional healthcare behavior needs to be improved. Participation was positively associated with being female, a longer course of disease, fewer comorbidities, and living in a nuclear family. Patients who used cognitive-palliative and acceptance coping styles and those who had higher self-efficacy also had significantly higher levels of participation in healthcare behavior. The study provides useful reference points for adolescents with chronic disease to participate in healthcare programs, in order to achieve a smooth transition from childhood to adulthood.
Collapse
Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Shuang-Zi Li
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xian-Lan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Ting
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
14
|
McGovern E, Pringsheim T, Medina A, Cosentino C, Shalash A, Sardar Z, Fung VSC, Kurian MA, Roze E. Transitional Care for Young People with Neurological Disorders: A Scoping Review with A Focus on Patients with Movement Disorders. Mov Disord 2020; 36:1316-1324. [PMID: 33200525 DOI: 10.1002/mds.28381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
Childhood-onset movement disorders represent a heterogenous group of conditions. Given the complexity of these disorders, the transition of care from pediatric to adult medicine is an important consideration. We performed a scoping review of the literature on transitional care in chronic neurological disease, exploring key transitional issues and proposed transitional care models. Our aim was to describe the current knowledge and gaps about the transition process of young adults with chronic neurological disorders, paying special attention to childhood onset movement disorders. A total of 64 articles were included in the qualitative synthesis; 56 articles reported on transitional care issues, and 8 articles reported on transitional care models. Only 2 articles included patients with movement disorders. The following 4 main transitional issues were identified following synthesis of the available literature: (1) inadequate preparation for the transition process, (2) inappropriate and inconsistent transition practices, (3) inadequate adult services, and (4) heightened emotional response surrounding transition. Of the reported transitional care models, multidisciplinary ambulatory care was the most common approach. In studies evaluating patient-related outcomes, positive health, educational, and vocational outcomes were found. The available literature provides insights on issues that can arise during transition that should be addressed to improve patient and caregiver comfort and satisfaction with care. Further research is needed to evaluate how transitional care programs affect outcomes and their cost effectiveness. More studies are required to determine the needs and outcomes specific to patients with childhood onset movement disorders. © 2020 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Eavan McGovern
- Dublin Neurological Institute, Mater University Hospital, Dublin, Ireland
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alex Medina
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Zomer Sardar
- Department of Neurology, Mayo Hospital, Lahore, Pakistan
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Emmanuel Roze
- Department of Neurology, Salpêtrière Hospital, Sorbonne University and Assistance Publique - Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
15
|
Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
Collapse
Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
| |
Collapse
|
16
|
Schraegle WA, Young SR, Rettig EK, Payne AR, Wilson JK, Wedberg-Sivam EA, Titus JB. Improving Transitional Services for Adolescents and Young Adults with Epilepsy and Intellectual Disability. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe transition from pediatric to adult health care systems is challenging for many adolescents with epilepsy and their families, and those challenges are compounded for adolescents with comorbid intellectual disabilities and epilepsy (ID-E). Many traditional transition pathways to adult care are inadequate, as they fail to address important considerations unique to the ID-E population or are absent entirely. Poor organization of care during critical transition periods increases the risks of sudden unexpected death in epilepsy, suboptimal seizure control, inadequate management of comorbidities, and poor psychological and social outcomes. The literature lacks systematic studies on effective transition programs for this population. The present review provides an overview of the main themes important in care transitions for the ID-E population: (1) precise diagnosis and management of seizures; (2) mental health and medical comorbidities affecting care; (3) accessing behavioral, habilitative, legal, financial, and community resources; and (4) caretaker support. We propose a specific framework which includes targeted recommendations of minimum care standards for youth with ID-E transitioning to adult care.
Collapse
Affiliation(s)
- William A. Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Stephanie R. Young
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Eman K. Rettig
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Angie R. Payne
- Ascension Seton’s Comprehensive Epilepsy Program, Dell Seton Medical Center at The University of Texas, Austin, Texas, United States
| | - Janet K. Wilson
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| | - Elizabeth A. Wedberg-Sivam
- Ascension Seton’s Comprehensive Epilepsy Program, Dell Seton Medical Center at The University of Texas, Austin, Texas, United States
| | - Jeffrey B. Titus
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
- Comprehensive Pediatric Epilepsy Center, UT Health Austin Pediatric Neurosciences at Dell Children's, Dell Children's Medical Center, Austin, Texas, United States
| |
Collapse
|
17
|
Pilot data and case example of the initial visit in a multidisciplinary transition-age program (TAP). Epilepsy Behav 2020; 111:107242. [PMID: 32629414 DOI: 10.1016/j.yebeh.2020.107242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/25/2020] [Accepted: 06/07/2020] [Indexed: 11/22/2022]
Abstract
The process of transition from pediatric to adult epilepsy care has received increased attention and emphasis in recent literature, particularly related to the assertion that effective transition is likely to lead to improved medical and psychosocial outcomes. However, the majority of current transition literature focuses on the structure of a transition program, with very little research providing relevant clinical data during the transition period and beyond. The current paper attempts to address this gap in the literature by providing pilot data on participants who engaged in the initial visit of a multidisciplinary transition-focused program housed in a level 4 epilepsy center in the Midwest. Pilot data are presented on 28 participants (36% female) who completed the initial transition appointment. All but one participant presented with a positive history for a neurobehavioral comorbidity, the most common of which included anxiety (61%), attention-deficit/hyperactivity disorder (ADHD; 39%) and depression (36%). Seventy-seven percent of participants further identified a current neurobehavioral comorbidity that was impacting their psychosocial functioning. Recommendations provided most frequently involved increased independence with epilepsy management (64%), increased independence with self-care/independent living (82%), psychological intervention (43%), and increased socialization (43%). A case example is also provided to further highlight program process and outcomes of the initial visit. Pilot results emphasize the value of multidisciplinary care involving psychosocial providers to facilitate a smooth transition between pediatric and adult healthcare.
Collapse
|
18
|
Twanow JDE, Maturu S, Khandker N. Pediatric to Adult Epilepsy Transition in Ambulatory Care: Benefits of a Multidisciplinary Epilepsy Transition Clinic. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractChildren with epilepsy comprise 3.2% of the estimated 500,000 youth with special medical needs who move from the pediatric to adult care model annually. These 16,000 children who require transfer each year represent a challenging subset of 470,000 youth living with epilepsy in the United States. Transition and transfer of care are complex and require gradual processes. This period for youth with epilepsy is often associated with inadequate follow-up and increased risk of nonadherence. Furthermore, youth and adults with epilepsy are known to have suboptimal social and emotional outcomes compared with peers, with high rates of under education, underemployment, poverty, and struggles with mental health. The goal of improving social determinants and continuity of care prompted the development of formal epilepsy transition clinics. Multiple clinic models exist, sharing the overarching goal of supporting youth while building self-management skills, tailored to age and developmental level. Early evidence shows that transition discussion leads to statistically significant increases in transfer readiness and self-efficacy in young adults with epilepsy. Our center boasts a 100% attendance rate at our transition and transfer clinic and 78% compliance with follow-up, further demonstrating that patients and families value quality transition programming.
Collapse
Affiliation(s)
- Jaime-Dawn E. Twanow
- Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio, United States
| | - Sarita Maturu
- Division of Epilepsy, Department of Neurology, Nationwide Children’s Hospital, Ohio State University, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Nabil Khandker
- Division of Epilepsy, Department of Neurology, Nationwide Children’s Hospital, Ohio State University, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| |
Collapse
|
19
|
Carrizosa-Moog J, Isaza-Jaramillo S. Perceptions of adult and child neurologists of transition programs in epilepsy in Latin America: A cross-sectional study. Epilepsy Behav 2020; 110:107159. [PMID: 32516745 DOI: 10.1016/j.yebeh.2020.107159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to review the existence and opinion Latin American adult and child neurologists have about the development and function of transition programs in epilepsy. METHODS This was a cross-sectional study. A questionnaire was constructed with sociodemographic variables, knowledge about transition programs, barriers for building up transition programs, and 21 topics regarding the degree of involvement of healthcare providers and carers should have during the transition process. The online questionnaire was sent to 136 Latin American chapter officers registered in the International League Against Epilepsy (ILAE) webpage and to 36 clinicians assisting to the 13th Latin American Summer School on Epilepsy. RESULTS The answer rate was 68% (117/172), and all 19 Latin American countries were represented. Adult neurologists represented 60.7%. Only 16.2% knew of transition programs in epilepsy. The main limitations for transition programs were poor education about transition (76.9%), inflexible healthcare systems (75.2%), absence of financial support (61.5%), need of multidisciplinary teams (59%), and scarce communication between child and adult neurologists (53%). Providers and carers are expected to get involved at a high degree in all 21 presented topics for a transition process. The topics with highest percentage of commitment were violence and carrying weapons (93.2%), mental health (92.3%), alcohol and drugs (91.4%), suicide (90.6%), care of own's disease (90.5%), mortality risk (89.7%), and integral healthcare (92.2%). CONCLUSION Only a few transition programs exist in Latin America. Knowing the benefits of and barriers for transition programs opens the opportunity to move further this strategy in the region considering local specificities. Education, communication skills, team working, and advocacy for adolescents with epilepsy could be initial starting points.
Collapse
Affiliation(s)
- Jaime Carrizosa-Moog
- Child and Adolescent Neurology Service, Department of Pediatrics, Faculty of Medicine, University of Antioquia, Calle 18 B Sur No. 38 - 51, Medellín, Colombia.
| | - Sandra Isaza-Jaramillo
- Adult Neurology Service, Department of Internal Medicine, Faculty of Medicine, University of Antioquia, Cra. 51d # 62-29, Medellín, Colombia.
| |
Collapse
|
20
|
Hauser WA, Camfield CS, Camfield PR. Can an epilepsy transfer clinic be sustained in the United States? Neurol Clin Pract 2020; 10:274-276. [PMID: 32983606 PMCID: PMC7508335 DOI: 10.1212/cpj.0000000000000785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- W Allen Hauser
- GH Sergievsky Center (WAH), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; and Dalhousie University & IWK Health Center (CSC, PRC), Dalhousie University, Halifax, NS, Canada
| | - Carol S Camfield
- GH Sergievsky Center (WAH), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; and Dalhousie University & IWK Health Center (CSC, PRC), Dalhousie University, Halifax, NS, Canada
| | - Peter R Camfield
- GH Sergievsky Center (WAH), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; and Dalhousie University & IWK Health Center (CSC, PRC), Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
21
|
Gil‐Nagel A, Álvarez Carriles J, Bermejo P, Carreño M, García‐Morales I, García Peñas JJ, López‐González FJ, Ruíz‐Falcó M, Sánchez JC, Tato C. Consensus statement for the management of generalized tonic-clonic seizures in Spain. Acta Neurol Scand 2020; 141:22-32. [PMID: 31529468 DOI: 10.1111/ane.13169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/08/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop recommendations for the management of patients with primary or secondary generalized tonic-clonic seizures (GTCS) based on best evidence and experience. METHODS The Delphi methodology was followed. A multidisciplinary panel of 10 experts was established, who defined the scope, users and preliminary recommendations. Systematic and narrative reviews of the current literature were performed to assess data on the risk of sudden unexpected death in epilepsy and the efficacy and safety of add-on therapy in patients with GTCS. Twenty-five definitive recommendations were generated which were then graded on a scale of 1 (totally disagree) to 10 (totally agree) by the experts and 45 neurologists. Consensus was reached if at least 70% of the participants applied a score of ≥7. Each recommendation was then assigned a level of evidence, a grade of agreement and a grade of recommendation. The entire process was supervised by an expert methodologist. RESULTS Overall, 24 out of 25 recommendations achieved consensus. These included specific recommendations on diagnosis, evaluation and treatment. The recommendations also emphasized the importance of proper psychological evaluation and effective communication between patients and health professionals, and the importance of patient and family education and support. SIGNIFICANCE The recommendations generated by this consensus can be used as a guide for the diagnosis and management of patients with GTCS.
Collapse
Affiliation(s)
| | | | | | - Mar Carreño
- Hospital Clinic de Barcelona Barcelona Spain
| | | | | | | | | | - Juan Carlos Sánchez
- Complejo Hospitalario Universitario Parque Tecnológico de la Salud Granada Spain
| | | |
Collapse
|
22
|
Cui C, Li SZ, Zheng XL, Cheng WJ, Xia Q. Health Assessment of Chinese Adolescents with Epilepsy in the Preparatory Phase of Transition Process from Pediatric to Adulthood:A Single-Center Study Using the Omaha System. J Pediatr Nurs 2019; 49:e2-e7. [PMID: 31229347 DOI: 10.1016/j.pedn.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Epilepsy is one of the most common childhood-onset neurological disorder characterized by both seizures and the related comorbidities. The preparatory phase in transition refers to a dynamic process of identifying and resolving health issues to ensure seamless continuing care from childhood to adulthood. This study identifies the health issues of the preparatory phase in transition from children to adulthood using the Omaha System. METHODS This prospective, single-center study enrolled 86 adolescents with epilepsy in China. The Problem Classification Scheme and Problem Rating Scale for Outcomes of Omaha System were used to evaluate transition-induced health problems. RESULTS These health problems cover all four domains of the problem classification scheme of the Omaha System, and the specific distribution is related to the type of epilepsy. The results of the four-category classification evaluation showed that the most common health problem is health-related behavioral problems (46.1%), followed by psychosocial problems (23.0%), physiological problems (20.6%), and environmental problems (10.3%). The distribution of these health problems in generalized seizures, focal seizures, and generalized-focal seizures are significantly different (P < 0.01). The results of the outcome rating scale showed that 83.4% of the children had minimal knowledge, 84.2% had inconsistently appropriate behaviors, and 86.7% had moderate symptoms. CONCLUSIONS The health problems of patients with epilepsy during the preparatory phase of transition process from pediatric to adulthood should be emphasized. Identification of health problems though the Omaha System can improve management for adolescents with epilepsy, including prevention, nursing care, social support, and therapeutic interventions.
Collapse
Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Shuang-Zi Li
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xian-Lan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Xia
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
23
|
Twito O, Shatzman-Steuerman R, Dror N, Nabriski D, Eliakim A. The "combined team" transition clinic model in endocrinology results in high adherence rates and patient satisfaction. J Pediatr Endocrinol Metab 2019; 32:505-511. [PMID: 31028713 DOI: 10.1515/jpem-2019-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/22/2019] [Indexed: 11/15/2022]
Abstract
Background A structured transition process for young adults with chronic medical conditions from pediatric to adult clinics is strongly promoted. However, the most appropriate transition model has not yet been determined. This study evaluated the effect of a "combined team" Endocrinology Transition Clinic model, including a joint meeting with the patient and pediatric and adult endocrinologists, regarding medical treatment, adherence to follow-up and patient satisfaction with the process. Methods Clinical and demographic data of patients admitted to the Endocrinology Transition Clinic were collected. The clinical impact of the transition meeting was evaluated based on treatment modifications and patient adherence to follow-up. Patient satisfaction was evaluated using a questionnaire. Results From September 2014 through November 2018, 107 patients attended the Endocrinology Transition Clinic, 85.0% were females, mean age 19.7 ± 2.2 years (range 16-29), 97.2% were unmarried. The most common endocrine disorders were obesity (41.1%), Hashimoto's thyroiditis (41.1%) and ovarian hyperandrogenism (38.3%). The Transition Clinic visit modified treatment and/or evaluation for 48 (44.8%) patients. Adherence to follow-up in the adult clinic was 82.9% and was not associated with gender (p = 0.366), ethnicity (p = 0.725), age at transition (p = 0.479) or obesity (p = 0.375). Overall satisfaction reported by 65/85 patients was high (86.8%), although higher among patients who were adherent to follow-up (89.4% vs. 65.6%, p = 0.006). Conclusions The "combined team" transition model in endocrinology requires relatively few resources and has considerable clinical impact, high adherence to follow-up and high patient satisfaction rate. Implementing this model at the interface of pediatric and adult endocrinology units, and possibly in other medical fields, is feasible and efficient.
Collapse
Affiliation(s)
- Orit Twito
- Department of Endocrinology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel.,Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Nitzan Dror
- Pediatric Endocrinology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Dan Nabriski
- Endocrinology, Diabetes and Metabolism Institute, Meir Medical Center, Kfar Saba, Israel
| | - Alon Eliakim
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Pediatric Endocrinology Unit, Meir Medical Center, Kfar Saba, Israel
| |
Collapse
|
24
|
Leeftink AG, Vliegen IMH, Hans EW. Stochastic integer programming for multi-disciplinary outpatient clinic planning. Health Care Manag Sci 2019; 22:53-67. [PMID: 29124483 PMCID: PMC6373312 DOI: 10.1007/s10729-017-9422-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/22/2017] [Indexed: 12/02/2022]
Abstract
Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are jointly optimized. As this currently is an open question in the literature, our research is the first to address this problem. This research is motivated by a Dutch hospital, which uses a multi-disciplinary cancer clinic to communicate the diagnosis and to explain the treatment plan to their patients. Furthermore, also regular patients are seen by the clinicians. All involved clinicians therefore require a blueprint schedule, in which multiple patient types can be scheduled. We design these blueprint schedules by optimizing the patient waiting time, clinician idle time, and clinician overtime. As scheduling decisions at multiple time intervals are involved, and patient routing is stochastic, we model this system as a stochastic integer program. The stochastic integer program is adapted for and solved with a sample average approximation approach. Numerical experiments evaluate the performance of the sample average approximation approach. We test the suitability of the approach for the hospital's problem at hand, compare our results with the current hospital schedules, and present the associated savings. Using this approach, robust blueprint schedules can be found for a multi-disciplinary clinic of the Dutch hospital.
Collapse
Affiliation(s)
- A G Leeftink
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, P.O. Box 217, 7500, AE, Enschede, the Netherlands.
- UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - I M H Vliegen
- Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - E W Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, P.O. Box 217, 7500, AE, Enschede, the Netherlands
| |
Collapse
|
25
|
Mc Govern EM, Maillart E, Bourgninaud M, Manzato E, Guillonnet C, Mochel F, Bourmaleau J, Lubetzki C, Baulac M, Roze E. Making a ‘JUMP’ from paediatric to adult healthcare: A transitional program for young adults with chronic neurological disease. J Neurol Sci 2018; 395:77-83. [DOI: 10.1016/j.jns.2018.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/16/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022]
|
26
|
Development of the transition-age program (TAP): Review of a pilot psychosocial multidisciplinary transition program in a Level 4 epilepsy center. Epilepsy Behav 2018; 89:153-158. [PMID: 30415138 DOI: 10.1016/j.yebeh.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022]
Abstract
Approximately 50% of patients diagnosed with epilepsy in childhood will need treatment in adulthood. Transition from pediatric to adult epilepsy care is challenging, and an unsuccessful transition can have detrimental effects. Researchers emphasize the importance of addressing possible barriers to transition in a multidisciplinary setting. In this paper, we describe a transition program implemented in a Level 4 epilepsy center in the Midwest. This program involves a psychosocial multidisciplinary team including a pediatric neuropsychologist, pediatric psychologist, and social worker who meet jointly with patient and his/her caregiver(s) before and after the transition. The pretransition visit involves assessment of transition readiness, screening for neurobehavioral comorbidities, provision of education regarding epilepsy care during the transition period, goal-setting, and development of a portable summary. The posttransition visit revisits goals and provides additional individualized recommendations and/or referrals for intervention as clinically indicated. The goal of this program is to facilitate a smooth transition from pediatric to adult providers to ensure optimal epilepsy care and quality of life.
Collapse
|
27
|
Burke L, Kirkham J, Arnott J, Gray V, Peak M, Beresford MW. The transition of adolescents with juvenile idiopathic arthritis or epilepsy from paediatric health-care services to adult health-care services: A scoping review of the literature and a synthesis of the evidence. J Child Health Care 2018; 22:332-358. [PMID: 29355024 DOI: 10.1177/1367493517753330] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Young people with long-term health conditions (LTCs) can face challenges when making the transition to adult health services. This paper sought to identify studies that assess and explore transitional care for young people with LTCs. Two conditions were used as exemplars: juvenile idiopathic arthritis (JIA) and epilepsy. A scoping review of the literature was conducted by using search terms to search for papers in English between 2001 and 2016 concerning transitional care on four databases. Qualitative papers were reviewed and synthesized using thematic analysis. Quantitative papers using health outcomes were also synthesized. Twenty-eight papers were selected for review. Despite the wealth of literature concerning aspects of transitional care that are key to a successful transition for young people with JIA or epilepsy, there is a paucity of outcomes that define 'successful' transition and consequently a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services.
Collapse
Affiliation(s)
- Lauren Burke
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jamie Kirkham
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Janine Arnott
- 2 School of Nursing, University of Central Lancashire, Preston, UK
| | - Victoria Gray
- 3 Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- 3 Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | |
Collapse
|
28
|
Geerlings RPJ, Gottmer-Welschen LMC, Machielse JEM, de Louw AJA, Aldenkamp AP. Failed transition to independence in young adults with epilepsy: The role of loneliness. Seizure 2018; 69:207-212. [PMID: 31102826 DOI: 10.1016/j.seizure.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Many young adults with epilepsy are still living with their parents ('failed transition to independence') despite reaching the adult age. This study evaluated patient-related variables and measures of loneliness correlated to 'failed transition to independence' in adults, 25-30 years of age, with (childhood-onset) epilepsy. METHODS Patients with (childhood-onset) epilepsy and 25-30 years of age were recruited from Epilepsy Center Kempenhaeghe. Inclusion criteria were: diagnosis of (childhood-onset) epilepsy, and an (estimated) IQ > 70. Patients were sent one questionnaire and informed consent was obtained from all participants. Questions included the patient's level of functioning and satisfaction on three transitional domains (medical status, educational/vocational status, independence/separation from their parents), satisfaction with their friendships, and the validated De Jong-Gierveld Loneliness Scale. 'Transition to independence' was defined and categorized in a continuum with scores ranging from 0 ('Failed transition') to 4 for all patients. A Bivariate Correlation analysis was used to compute correlations between patient characteristics and failed transition to independence. RESULTS 59 patients were included in the analysis, of which 19 (32.2%) had a failed transition to independence. A statistically significant correlation was found between transition to independence and the social loneliness scale (p = 0.047) and the total loneliness scale (p = 0.04), and for the patients self-reported satisfaction with their independence/separation from parents (p = 0.01) and friendships (p = 0.04). CONCLUSIONS Adults with epilepsy with a failed transition to independence experience loneliness and are not satisfied with their current developmental and social situation.
Collapse
Affiliation(s)
- R P J Geerlings
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Neurology, University Hospital RWTH Aachen, Germany.
| | | | | | - A J A de Louw
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; University of Humanistic Studies, Utrecht, The Netherlands.
| | - A P Aldenkamp
- Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands; Department of Neurology, Maastricht University Hospital, The Netherlands.
| |
Collapse
|
29
|
Zhang-Jiang S, Gorter JW. The use of the Rotterdam Transition Profile: 10 years in review. JOURNAL OF TRANSITION MEDICINE 2018. [DOI: 10.1515/jtm-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe aim of this literature review was to describe the use and utility of the Rotterdam Transition Profile (RTP), as we near the tenth year since its publication in 2008. It is a tool to summarize a youth’s transition process to adulthood by classifying various domains of participation and health care into developmental stages. This review provided a comprehensive synthesis of available knowledge on the RTP by summarizing published and grey literature. Using search terms related to transition, social participation, and questionnaire, a systematic search was conducted for literature up to November 2017 in MEDLINE and Embase databases, and was supplemented with a hand-search using Google Scholar and a general internet search using Google Search. Inclusion criteria were specified to determine the papers selected for review, yielding fifty-five materials for detailed review. Combined analysis of published and grey literature identified nine papers that used some form of the RTP as a measure, 18 materials that cited the RTP or its domains but did not employ it as a measure, and twenty-eight materials that cited the original RTP development and validation paper for information not directly related to the RTP. The literature demonstrated that the RTP seems to be a useful tool to describe and monitor the transition process of adolescents and young adults, in both research and clinical settings. While it has been used with youth of 14–31 years of age across genders and health conditions, more evidence is needed to demonstrate its psychometric properties beyond construct validity in young adults with cerebral palsy.
Collapse
Affiliation(s)
- Sofía Zhang-Jiang
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
30
|
Leeftink AG, Bikker IA, Vliegen IMH, Boucherie RJ. Multi-disciplinary planning in health care: a review. Health Syst (Basingstoke) 2018; 9:95-118. [PMID: 32939255 PMCID: PMC7476549 DOI: 10.1080/20476965.2018.1436909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/30/2018] [Indexed: 12/03/2022] Open
Abstract
Multi-disciplinary planning in health care is an emerging research field that applies to many health care areas with similar underlying planning characteristics. We provide a review of the literature and describe cross-relations between different applications. We identify multiple fields to classify the literature upon. These fields relate to the system characteristics, decision characteristics, and applicability. The relevant papers for each of these fields are discussed, which provides a broad and thorough overview of the present research, and guides readers towards identifying the applicable literature for their research based on the characteristics of their problem. Furthermore, we disclose research gaps and present open challenges for further research.
Collapse
Affiliation(s)
- A. G. Leeftink
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
| | - I. A. Bikker
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
- Department of Healthcare Logistics, Sint Maartenskliniek, Nijmegen, Netherlands
| | - I. M. H. Vliegen
- Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - R. J. Boucherie
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
| |
Collapse
|
31
|
Crowley SL, Byrne S, McNulty S, Keating K, Nestor T, Owen Y, O'Rourke D, Lynch B, Shahwan A, King MD. The Temple Star Transitional Model of Care for epilepsy; the outcome of a quality improvement project. Epilepsy Behav 2018; 79:4-8. [PMID: 29223006 DOI: 10.1016/j.yebeh.2017.10.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/03/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim and objective of this study was to assess the knowledge and views of parents on transitional and adolescent care in young adults with epilepsy, and to develop a transitional and adolescent program for epilepsy. METHODS Data were collected from questionnaires completed by parents during focus groups exploring transitional care and inherent issues for young adults, aged 12-18years, with epilepsy. The questionnaire assessed the current knowledge and views of parents of children with epilepsy on transitional care, and following a presentation on "Transition in Epilepsy" (including themes such as self-advocacy, independent healthcare behavior, sexual health, psychosocial support, educational and vocational planning, health and lifestyle issues) assessed feedback on the proposed model of care in transitional and adolescent care. RESULTS Data were collected from 34 parents; the majority of parents, 74% (n=25), wish their children to be transitioned and transferred over to the adult epilepsy sites at the age of 18years. Over 82% (n=28) of parents believe the concept of transition should be introduced between the ages of 12-16years. CONCLUSION This quality improvement initiative identified the need for transitional care to begin at an early age. This study engaged parents in a process to improve adolescent and transitional care for adolescents with epilepsy. This study also highlights the importance of introducing a detailed preparatory phase for a transitional and adolescent care in epilepsy.
Collapse
Affiliation(s)
- Suzanne L Crowley
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland.
| | - Susan Byrne
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Sandra McNulty
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Kim Keating
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Therese Nestor
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Yvonne Owen
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Declan O'Rourke
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Bryan Lynch
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Amre Shahwan
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Mary D King
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland; Academic Centre on Rare Diseases, School of Medicine and Medical Science, University College Dublin, Ireland
| |
Collapse
|
32
|
Kempenhaeghe academic center for epileptology and residential epilepsy care, Heeze, The Netherlands. Epilepsy Behav 2017; 76S:S30-S34. [PMID: 28865882 DOI: 10.1016/j.yebeh.2017.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/21/2022]
|
33
|
Better information sharing and reinforcement of facts needed during transition of young people with epilepsy. Epilepsy Behav 2017; 73:283-284. [PMID: 28587790 DOI: 10.1016/j.yebeh.2017.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 11/21/2022]
|
34
|
Andrade DM, Bassett AS, Bercovici E, Borlot F, Bui E, Camfield P, Clozza GQ, Cohen E, Gofine T, Graves L, Greenaway J, Guttman B, Guttman-Slater M, Hassan A, Henze M, Kaufman M, Lawless B, Lee H, Lindzon L, Lomax LB, McAndrews MP, Menna-Dack D, Minassian BA, Mulligan J, Nabbout R, Nejm T, Secco M, Sellers L, Shapiro M, Slegr M, Smith R, Szatmari P, Tao L, Vogt A, Whiting S, Carter Snead O. Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force. Epilepsia 2017; 58:1502-1517. [PMID: 28681381 DOI: 10.1111/epi.13832] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.
Collapse
Affiliation(s)
- Danielle M Andrade
- Division of Neurology, Epilepsy Transition Program and Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Anne S Bassett
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Eduard Bercovici
- Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Felippe Borlot
- Department of Neurology, Clinical Neurosciences Center University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Esther Bui
- Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Peter Camfield
- Division of Pediatric Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Eyal Cohen
- Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Jon Greenaway
- Erin Oak Kids, Centre for Treatment and Development, Toronto, Ontario, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | | | - Ayman Hassan
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Megan Henze
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Miriam Kaufman
- Division of Adolescent Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Hannah Lee
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lezlee Lindzon
- Epilepsy Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lysa Boissé Lomax
- Division of Neurology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Mary Pat McAndrews
- Division of Neuropsychology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dolly Menna-Dack
- LIFEspan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Berge A Minassian
- Pediatric Epileptologist, Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatric Neurology, University of Texas Southwestern and Dallas Children's Medical Center, Dallas, Texas, U.S.A
| | | | - Rima Nabbout
- Pediatric Neurologist, Centre of Reference Epilepsies Rares, Hospital Necker-Enfants Malades, Paris, France
| | - Tracy Nejm
- Parent Representative, London, Ontario, Canada
| | - Mary Secco
- Strategic Initiatives, Epilepsy Support Centre, London, Ontario, Canada
| | | | - Michelle Shapiro
- Division of Neurology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | | | - Rosie Smith
- Adult Services, Epilepsy Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Leeping Tao
- Surrey Place Centre, Toronto, Ontario, Canada
| | | | - Sharon Whiting
- Division of Pediatric Neurology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - O Carter Snead
- Division of Pediatric Neurology, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Sattoe JNT, Peeters MAC, Hilberink SR, Ista E, van Staa A. Evaluating outpatient transition clinics: a mixed-methods study protocol. BMJ Open 2016; 6:e011926. [PMID: 27566639 PMCID: PMC5013382 DOI: 10.1136/bmjopen-2016-011926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/13/2016] [Accepted: 07/26/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC). METHODS AND ANALYSIS We propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2-4 years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are 'no-show after transfer' (process outcome) and 'experiences and satisfaction with the transfer' (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care. ETHICS The Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246). DISSEMINATION Study results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016-2018).
Collapse
Affiliation(s)
- Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sander R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Erwin Ista
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
36
|
Geerlings RPJ, Aldenkamp AP, Gottmer-Welschen LMC, de Louw AJA. Response to 'Letter to the Editor - Epilepsy transition: Let's start planting the seed' by F. Borlot and D.M. Andrade. Eur J Paediatr Neurol 2016; 20:686-7. [PMID: 27157246 DOI: 10.1016/j.ejpn.2016.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- R P J Geerlings
- Epilepsy Centre Kempenhaeghe, Department of Research & Development, P.O. Box 61, NL-5590 AB Heeze, The Netherlands.
| | - A P Aldenkamp
- Epilepsy Centre Kempenhaeghe, Department of Research & Development, P.O. Box 61, NL-5590 AB Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands; Department of Neurology, Maastricht University Hospital, The Netherlands; Department of Neurology, Ghent University Hospital, Belgium
| | - L M C Gottmer-Welschen
- Epilepsy Centre Kempenhaeghe, Department of Research & Development, P.O. Box 61, NL-5590 AB Heeze, The Netherlands
| | - A J A de Louw
- Epilepsy Centre Kempenhaeghe, Department of Research & Development, P.O. Box 61, NL-5590 AB Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
37
|
Borlot F, Andrade DM. Epilepsy Transition: Let's start planting the seed. Eur J Paediatr Neurol 2016; 20:684-5. [PMID: 27133781 DOI: 10.1016/j.ejpn.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Felippe Borlot
- Division of Neurology, Epilepsy Genetics Program, Toronto Western Hospital & Division of Neurology, Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.
| | - Danielle M Andrade
- Division of Neurology, Epilepsy Genetics Program, Toronto Western Hospital & Division of Neurology, Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|