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Xiao L, Amin R, Nonoyama ML. Long-term mechanical ventilation and transitions in care: A narrative review. Chron Respir Dis 2023; 20:14799731231176301. [PMID: 37170874 PMCID: PMC10184211 DOI: 10.1177/14799731231176301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population who go through several transitions over their lifetime. This paper describes three transitions: 1) institution/hospital to community/home, 2) pediatric to adult care, and 3) active treatment to end-of-life for ventilator-assisted individuals (VAIs). METHODS A narrative review based on literature and the author's collective practical and research experience. Four online databases were searched for relevant articles. A manual search for additional articles was completed and the results are summarized. RESULTS Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems. CONCLUSIONS For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mika Laura Nonoyama
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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2
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Ernst G, Szczepanski R, Lange K, Staab D, Thyen U, Menrath I. Two-Year Follow-Up of a Transition-Specific Education Program for Young People With Chronic Conditions. J Adolesc Health 2022; 71:344-350. [PMID: 35545464 DOI: 10.1016/j.jadohealth.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/18/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The transition to adulthood is a challenging process for young people (YP) with chronic conditions. Patient education can help to prepare them for autonomous disease management and transfer to adult healthcare services. In a previous controlled study, participation in the youth-specific group education program ModuS-T immediately improved transition-specific knowledge, competencies, and patient activation of YP with various chronic conditions. To evaluate whether these effects are long lasting, we questioned YP from the intervention group (IG) and the control group (CG; no program) 2 years after participation. METHODS Standardized questionnaires were used to assess YP's transition-specific knowledge, competencies, patient activation, health-related quality of life, and medical care status at baseline and 2 years later. Repeated measurement covariance analyses were used for statistical testing. RESULTS A total of 181 YP (109 IG, 72 CG) completed the questionnaires (60% of previous interviewees; mean age 20 years, 46% female). Compared to the CG, the IG reported significant improvements in transition-specific knowledge, competencies, and patient activation (p < .001) and lower parents' responsibility for their condition (p = .004). The proportion of YP who had already transferred to adult health care was nearly the same (54% IG/56% CG), but the CG was more likely to lose access to medical care (6% IG/14% CG). There were no effects on health-related quality of life. DISCUSSION The 1.5-day ModuS-T program has long-lasting positive effects on knowledge and competencies relevant for the transition of YP. Transition-specific patient education programs close an important care gap and should be integrated into standard care.
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Affiliation(s)
- Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany.
| | | | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Doris Staab
- Department of Pediatric Pulmonology and Immunology, Charité, Berlin, Germany
| | - Ute Thyen
- Department of Pediatrics, Luebeck University, Luebeck, Germany
| | - Ingo Menrath
- Department of Pediatrics, Luebeck University, Luebeck, Germany
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3
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Transition of Care Barriers in Pediatric Patients With Anorectal Malformation. Dis Colon Rectum 2022; 65:955-957. [PMID: 35535807 DOI: 10.1097/dcr.0000000000002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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4
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Collins R, Singh B, Payne DN, Bharat C, Noffsinger W, Dhaliwal SS, O'Dea C, Mulrennan S. Effect of transfer from a pediatric to adult cystic fibrosis center on clinical status and hospital attendance. Pediatr Pulmonol 2021; 56:2029-2035. [PMID: 33793092 DOI: 10.1002/ppul.25398] [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: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022]
Abstract
AIM Transfer from pediatric to adult services could lead to clinical deterioration, few studies have examined this. We sought to examine the clinical impact of a structured individualized transition and transfer process in patients with cystic fibrosis (CF). METHODS Medical records of all patients with CF in Western Australia who transferred from a pediatric center (Princess Margaret Hospital for Children) to an adult CF center (Sir Charles Gairdner Hospital) between 2008 and 2012 were reviewed. Data were extracted for 2 years before and after transfer. The number of CF outpatient visits, inpatient days, and home intravenous antibiotic therapy (HIVT) days were recorded at yearly intervals before and after transfer. Sputum culture results at transfer were collected. All respiratory function and anthropometric data over the 4 years were extracted. RESULTS Forty-two patients with CF were transferred between 2008 and 2012. The mean age at transfer was 18.9 years (range 17-22). Compared to 1-year pre-transfer, the frequency of outpatient visits at 1- and 2-year post-transfer increased. After transfer, there was no change in BMI, HIVT days, or inpatient days, and no acceleration in the expected decline in FEV1. CONCLUSION This study found that transfer from a pediatric to an adult CF center using a structured, individualized transition and transfer process was not associated with accelerated clinical deterioration.
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Affiliation(s)
- Rachel Collins
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research Institute, Perth, Western Australia, Australia.,School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | | | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - William Noffsinger
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Christopher O'Dea
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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5
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Bourgeois G, Magne F, Nove Josserand R, Durupt S, Durieu I, Reix P, Reynaud Q. A formalized transition program for cystic fibrosis: A 10-year retrospective analysis of 97 patients in Lyon. Pediatr Pulmonol 2021; 56:2000-2006. [PMID: 33751837 DOI: 10.1002/ppul.25364] [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: 07/10/2020] [Revised: 01/06/2021] [Accepted: 01/22/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The prognosis of people diagnosed with cystic fibrosis (CF) has dramatically improved over the past decade in France, largely due to advances in CF care management, including an emphasis on chronic maintenance medications. Currently, the majority of French CF patients are adults, which means that they went through a transition process from receiving care at a pediatric CF center to receiving care at an adult CF center. To determine the impact of the transfer on clinical evolution, we report the transition procedure of our CF center in Lyon. MATERIALS AND METHODS From January 2006 to December 2016, 97 CF patients underwent a standardized process of transitioning from the pediatric to the adult CF center in Lyon. We compared the clinical evolution of these patients during three periods, starting the year before transition and ending the year after transition. Clinical data taken into account were forced expiratory volume in 1 s (FEV1 in liters), body mass index (BMI in kg/m2 ), pulmonary colonization, number of antibiotic courses, number of days of hospitalization per year, and outpatient visits per year. RESULTS No significant differences were observed between respiratory and nutritional status, respiratory microbiome, number of antibiotic courses, or number of hospitalizations or visits when comparing the threeperiods of observation around transition (the year before, the first year after, and the second year after transfer). CONCLUSION The standardized transition procedure used in Lyon is associated with the clinical stability of our CF patients.
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Affiliation(s)
- Gaelle Bourgeois
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France
| | - Fanny Magne
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France
| | - Raphaele Nove Josserand
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France
| | - Stephane Durupt
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France
| | - Isabelle Durieu
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France.,Équipe d'Accueil Health Services and Performance Research, Université de Lyon, Lyon, France
| | - Philippe Reix
- Service de pneumologie pédiatrique et CRCM enfant, Hôpital Femme Mère Enfant, Hospices civils de Lyon, Bron, Lyon, France
| | - Quitterie Reynaud
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, Pierre Bénite, Lyon, France.,Équipe d'Accueil Health Services and Performance Research, Université de Lyon, Lyon, France
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6
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Jarvis SW, Roberts D, Flemming K, Richardson G, Fraser LK. Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review. Pediatr Res 2021; 90:1120-1131. [PMID: 33654285 PMCID: PMC8671088 DOI: 10.1038/s41390-021-01396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and Social Science Citation Index were searched. Studies published in English since 1990 including individuals with any life-limiting condition post- and pre-transition and reporting a health or social care use outcome were included. Data were extracted and quality assessed by one reviewer with 30% checked by an independent reviewer. RESULTS Nineteen papers (18 studies) met the inclusion criteria. There was evidence for both increases and decreases (post- versus pre-transition) in outpatient attendance, inpatient admissions, inpatient bed days and health service costs; for increases in Emergency Department visits and for decreases in individuals receiving physiotherapy. CONCLUSIONS Evidence for changes in healthcare use post- versus pre-transition is mixed and conflicting, although there is evidence for an increase in Emergency Department visits and a reduction in access to physiotherapy. More high-quality research is needed to better link changes in care to the transition. IMPACT Evidence for changes in healthcare use associated with transition to adult services is conflicting. Emergency Department visits increase and access to physiotherapy decreases at transition. There are marked differences between care patterns in the United States and Canada.
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Affiliation(s)
- Stuart W. Jarvis
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
| | - Daniel Roberts
- grid.413991.70000 0004 0641 6082Leeds Children’s Hospital, Leeds, UK
| | - Kate Flemming
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Lorna K. Fraser
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
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7
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Willis E, McDonagh JE. Shifting the mindset-adolescent and young adult rheumatology in transition. THE LANCET. RHEUMATOLOGY 2020; 2:e236-e244. [PMID: 38268158 DOI: 10.1016/s2665-9913(19)30163-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 01/26/2024]
Abstract
Almost 30 years have passed since publication of the first reports acknowledging the crucial importance of transitional care for adolescents and young adults with chronic disease, but universal implementation has yet to be achieved. Progress has undoubtedly been made, with increasing evidence for best practice in transitional care. However, translation of research and guidance into clinical practice continues to be challenging. Neuroscience advances in understanding the changes occurring in the adolescent brain demand that the third phase of transition (ie, post-transfer to adult services) is given further attention, with recognition that transfer itself is not the end of the transition process. The complex, often unwieldy health systems delivering care must also be considered. Paediatric and adult rheumatology practitioners need to collaborate not only with each other, but also with practitioners in other disciplines, specialties, and agencies, to plan and commission rheumatology services that are responsive to adolescents and young adults. A shift in approach from focusing on health transition towards developmentally appropriate health care has the potential to improve the care provided during this vulnerable life stage, increasing the likelihood of continuing engagement of patients in their own health care into adulthood and thereby improving health outcomes.
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Affiliation(s)
- Emily Willis
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK; Versus Arthritis Centre for Epidemiology, and Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK.
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8
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Louagé A, Knoop C, Hanssens L. Impact de la période de transition de l’enfance à l’âge adulte dans la mucoviscidose. Rev Mal Respir 2020; 37:235-242. [DOI: 10.1016/j.rmr.2019.11.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
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9
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Dale CM, Carbone S, Amin R, Amaria K, Varadi R, Goldstein RS, Rose L. A transition program to adult health services for teenagers receiving long-term home mechanical ventilation: A longitudinal qualitative study. Pediatr Pulmonol 2020; 55:771-779. [PMID: 31971666 DOI: 10.1002/ppul.24657] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/09/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Adolescents receiving long-term home mechanical ventilation (HMV) who survive into adulthood must transition to adult health care services. Lack of transition readiness is reported to result in poor health outcomes. The objective of this study is to explore longitudinally the pediatric-to-adult health care transition experience involving a transition program for adolescents receiving HMV including transition readiness, barriers, facilitators, and modifiable features. DESIGN A prospective qualitative longitudinal interview study of adolescent and family caregiver dyads recruited through a pediatric-to-adult HMV transition program jointly established by two collaborating health centers: The Hospital for Sick Children and West Park Healthcare Centre in Toronto, Canada. Eligible dyads were interviewed at three time points: pretransition, transition, and 12-months posttransition. Interviews were transcribed verbatim and analyzed using directed content analysis methods. RESULTS Ventilator-assisted adolescents (VAAs) and caregiver participants perceived a lack of transition readiness in their ability to manage health communication and coordination across multiple adult providers. Transition facilitators included early transition discussion, opportunities for VAAs to speak directly with HMV providers during appointments, receipt of print informational materials regarding adult services, and a joint pediatric-adult team handover meeting. Modifiable transition barriers included lack of other specialist referrals, insufficient information about adult homecare service funding, and limited involvement of family doctors. Unresolved transition barriers resulted in perceptions of service fragmentation. CONCLUSIONS Although the pediatric-to-adult HMV transition program conferred benefits service fragmentation was perceived. Transition barriers may be overcome through early planning and staged transition with all specialists, community providers, and the family and adolescent working in collaboration.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sarah Carbone
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Khushnuma Amaria
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Robert Varadi
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, York, Canada.,Department of Medicine and Physical Therapy, University of Toronto, Toronto, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Sunnybrook Research Institute, King's College London, London, UK.,Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, University of Toronto, Toronto, Canada.,Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Canada
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10
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Hart LC, Patel-Nguyen SV, Merkley MG, Jonas DE. An Evidence Map for Interventions Addressing Transition from Pediatric to Adult Care: A Systematic Review of Systematic Reviews. J Pediatr Nurs 2019; 48:18-34. [PMID: 31220801 DOI: 10.1016/j.pedn.2019.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
Abstract
PROBLEM Adolescents and young adults with chronic illnesses continue to face barriers as they transition from pediatric to adult care. An evidence map can help to identify gaps in the transition literature to determine targets for future research. ELIGIBILITY CRITERIA We searched PubMed, CINAHL, PsycInfo, and Cochrane for systematic reviews published through February 2018. Eligible reviews included at least one comparative study testing a youth-focused intervention for improving transition with at least one quantitative health-related outcome reported. SAMPLE We identified 431 unique reviews in our search, and 37 reviews (containing 71 eligible primary studies) met inclusion criteria. RESULTS Most reviews (20 of 37) summarized some aspect of transition across diagnoses. Type 1 diabetes was the most common diagnosis studied (7 of 37 reviews and 24 of 71 primary studies). Only 14 of 71 primary studies focused on care after transfer to adult care. CONCLUSIONS The literature on interventions to improve transition to adult care has focused on a limited number of diagnoses, most commonly Type 1 diabetes. Common pediatric conditions, such as asthma, have not been studied with regard to transition. Efforts have been mainly targeted on transition preparation, with less focus on transition needs after transfer to adult care. IMPLICATIONS There is a need for transition research focused on common pediatric conditions and transition needs after transfer to adult care.
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Affiliation(s)
- Laura C Hart
- Nationwide Children's Hospital, Columbus, OH, United States of America; The Ohio State University College of Medicine, Departments of Pediatrics and Medicine, United States of America; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America.
| | | | | | - Daniel E Jonas
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America; University of North Carolina at Chapel Hill, Department of Medicine, United States of America.
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11
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Welsner M, Sutharsan S, Taube C, Olivier M, Mellies U, Stehling F. Changes in Clinical Markers During A Short-Term Transfer Program of Adult Cystic Fibrosis Patients from Pediatric to Adult Care. Open Respir Med J 2019; 13:11-18. [PMID: 31908684 PMCID: PMC6918541 DOI: 10.2174/1874306401913010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Transition from child-oriented to adult-oriented health care in Cystic Fibrosis (CF) has become more important over recent decades as the survival of people with this disease has increased. The transition process usually begins in adolescence, with full transfer completed in early adulthood. Objective: This study investigated the impact of a short-term transfer program on clinical markers in an adult CF cohort still being managed by pediatricians. Methods: Clinically relevant data from the year before (T-1), the time of Transfer (T) and the year after the transfer (T+1) were analysed retrospectively. Results: 39 patients (median age 29.0 years; 64% male) were transferred between February and December 2016. Lung function had declined significantly in the year before transfer (in % predicted: Forced Expiratory Volume in 1 second (FEV), 62.8 vs. 57.7, p <0.05; Forced Vital Capacity (FVC), 79.9 vs. 71.1, p<0.05), but remained stable in the year after transfer (in % predicted: FEV: 56.3; FVC 68.2). BMI was stable over the whole observational period. There was no relevant change in chronic lung infection with P. aeruginosa, Methicillin-Resistant Staphylococcus aureus (MRSA) and Burkholderia sp. during the observation period. The number of patient contacts increased significantly in the year after versus the year before transfer (inpatient: 1.51 vs. 2.51, p<0.05; outpatient: 2.67 vs. 3.41, p<0.05). Conclusions: Our data show that, within the framework of a structured transfer process, it is possible to transfer a large number of adult CF patients, outside a classic transition program, from a pediatric to an adult CF center in a short period of time, without any relevant changes in clinical markers and, stability.
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Affiliation(s)
- Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children´s Hospital, University of Duisburg-Essen, Essen, Germany
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12
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Cochrane Database Syst Rev 2019; 5:CD012578. [PMID: 31119726 PMCID: PMC6531890 DOI: 10.1002/14651858.cd012578.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS Two authors independently reviewed papers identified in the searches. MAIN RESULTS No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.
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Affiliation(s)
- Helen Malone
- Trinity College DublinSchool of Nursing & Midwifery24 D’Olier Street, College GreenDublin 2Ireland
| | - Susan Biggar
- Australian Health Practitioner Regulation Agency (AHPRA)111 Burke Street, Level 7MelbourneAustraliaVIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, CrumlinDepartment of Respiratory MedicineDublinIreland12
| | - Zai Edworthy
- Temple Street Children's University HospitalDepartment of PsychologyTemple StreetDublinIrelandDO1 YC67
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
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13
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Crowley EM, Bosslet GT, Khan B, Ciccarelli M, Brown CD. Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care. Pediatr Pulmonol 2018; 53:735-740. [PMID: 29611352 PMCID: PMC6487197 DOI: 10.1002/ppul.23997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study evaluates the roles of medical and social complexity in health care use outcomes in cystic fibrosis (CF) after transfer from pediatric to adult care. METHODS Retrospective cohort design included patients with CF who were transitioned into adult care at Indiana University from 2005 to 2015. Predictor variables included demographic and comorbidity data, age at transition, treatment complexity score (TCS), and an objective scoring measure of their social complexity (Bob's Level of Social Support, BLSS). Outcome variables included outpatient visit rates and hospitalization rates. Pearson's correlations and linear regression were used to analyze the data. RESULTS The median age of the patients (N = 133) at the time of transition was 20 (IQR 19-23) years. The mean FEV1 % predicted at transition was 69 ± 24%. TCS correlated with outpatient visit rates (r = 0.3, P = 0.003), as well as hospitalization rates (r = 0.4, P < 0.001); while the BLSS only correlated with hospitalization rates (r = 0.7, P < 0.001). After adjusting for covariates, the strongest predictors of post-transfer hospitalizations are BLSS (P < 0.0001) and pre-transfer hospitalization rate (P < 0.0001). CONCLUSION Greater treatment complexity is associated with greater healthcare utilization overall, while greater social complexity is associated with increased hospitalizations (but not outpatient visits). Screening young adults for social complexity may identify high-risk subpopulations and allow for patient centered interventions to support them and prevent avoidable health care use.
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Affiliation(s)
- Erin M Crowley
- Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gabriel T Bosslet
- Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Babar Khan
- Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ciccarelli
- Department of Internal Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cynthia D Brown
- Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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14
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The Evolving Cystic Fibrosis Microbiome: A Comparative Cohort Study Spanning 16 Years. Ann Am Thorac Soc 2018; 14:1288-1297. [PMID: 28541746 DOI: 10.1513/annalsats.201609-668oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The cystic fibrosis (CF) airways are infected with a diverse polymicrobial community. OBJECTIVES Understanding how changes in the CF microbiome have occurred over time, similar to the observed changes in the prevalence of cultured pathogens, is key in understanding the microbiome's role in disease. METHODS Drawing from a prospectively collected and maintained sputum biobank, we identified 45 patients with sputum samples collected between the ages of 18 and 21 years in three successive cohorts of adults transitioning to our CF clinic: A (1997-2000), B (2004-2007), and C (2010-2013). Patient demographics, clinical status, and medications were collected from detailed chart review. Microbial communities were assessed by Ilumina MiSeq sequencing of the variable 3 (V3) region of the 16S rDNA. RESULTS The three cohorts were similar with respect to baseline demographics. There was a trend toward improved health and use of disease-modifying therapies in each successive cohort. Shannon diversity increased in the most recent cohort, suggesting an increase in the diversity of organisms between cohorts. Furthermore, the proportion of samples with Pseudomonas-dominated communities decreased over time, whereas Streptococcus increased. Although β-diversity was associated with transition cohort, the greatest predictor of diversity remained lung function. Furthermore, core microbiome constituents were preserved across cohorts. CONCLUSIONS Modest changes in the composition and structure of the microbiome of three successive cohorts of young adults with CF were observed, occurring in parallel with successive improvements in clinical status. Importantly, however, the core microbiome constituents were preserved across cohorts.
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15
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Menrath I, Ernst G, Szczepanski R, Lange K, Bomba F, Staab D, Muehlan H, Thyen U. Effectiveness of a generic transition-oriented patient education program in a multicenter, prospective and controlled study. JOURNAL OF TRANSITION MEDICINE 2018. [DOI: 10.1515/jtm-2018-0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractObjectivesFor young people (YP) with a chronic condition growing up is a challenging process. This stage of life is associated with a higher risk for non-adherence, insufficient disease control, acute deteriorations and irregular consultations. Patient education programs can support YP cope with the independent disease management and the transition into adulthood. However, there is a lack of transition-oriented patient education programs for most chronic conditions. In this study, an existing generic transition-oriented education program was expanded by a module for parents and evaluated in a multicenter study all over Germany.MethodsYP with chronic conditions and their parents were quasi-randomized into a control group (CG) and an intervention group (IG). The IG took part in the 1.5-day standardized education program ModuS-T while the CG received treatment as usual. The education program was designed as a compact workshop in a group setting for youth (15–24 years) and their parents. The education program contained youth specific topics such as the transfer to adult care, the influence of disease on the daily life of YP, and other important issues like detachment from parents, occupational career, intimate relationships and family planning. The parent module dealt with the topics transition from child-centered to adult health services, and supporting children to become adults. The program focused on improving competencies relevant for transition and self-management skills of the families. Satisfaction with the program, transition-specific knowledge, transition competencies, patient activation and health-related quality of life (HRQoL) were measured at baseline and after 4 weeks.ResultsA total of 300 YP (overall mean age 17.6 years; 47% female; IG = 166, CG = 134) with 12 different conditions and their parents participated in 37 transition programs. The participants were highly satisfied with the program. The program significantly affected transition-specific knowledge, transition competence and patient activation (p < 0.001). There were no effects on HRQoL.ConclusionThe generic transition-oriented education program empowers YP with chronic conditions and their parents in the transition process. Due to a modular approach, the program is successful in a variety of chronic conditions.
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Affiliation(s)
- Ingo Menrath
- University of Luebeck, Department of Pediatrics, Luebeck, Germany
| | - Gundula Ernst
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
| | | | - Karin Lange
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
| | - Franziska Bomba
- University of Luebeck, Department of Pediatrics, Luebeck, Germany
| | - Doris Staab
- Charité, Department of Pediatric Pulmonology and Immunology, Berlin, Germany
| | - Holger Muehlan
- Ernst-Moritz-Arndt-University of Greifswald, Department Health and Prevention, Institute of Psychology, Greifswald, Germany
| | - Ute Thyen
- University of Luebeck, Department of Pediatrics, Luebeck, Germany
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16
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Halbeisen F, Hogg C, Alanin MC, Bukowy-Bieryllo Z, Dasi F, Duncan J, Friend A, Goutaki M, Jackson C, Keenan V, Harris A, Hirst RA, Latzin P, Marsh G, Nielsen K, Norris D, Pellicer D, Reula A, Rubbo B, Rumman N, Shoemark A, Walker WT, Kuehni CE, Lucas JS. Proceedings of the 2nd BEAT-PCD conference and 3rd PCD training school: part 1. BMC Proc 2018; 12:1. [PMID: 29630684 PMCID: PMC5841193 DOI: 10.1186/s12919-018-0098-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare heterogenous condition that causes progressive suppurative lung disease, chronic rhinosinusitis, chronic otitis media, infertility and abnormal situs. 'Better Experimental Approaches to Treat Primary Ciliary Dyskinesia' (BEAT-PCD) is a network of scientists and clinicians coordinating research from basic science through to clinical care with the intention of developing treatments and diagnostics that lead to improved long-term outcomes for patients. BEAT-PCD activities are supported by EU funded COST Action (BM1407). The second BEAT-PCD conference, and third PCD training school were held jointly in April 2017 in Valencia, Spain. Presentations and workshops focussed on advancing the knowledge and skills relating to PCD in: basic science, epidemiology, diagnostic testing, clinical management and clinical trials. The multidisciplinary conference provided an interactive platform for exchanging ideas through a program of lectures, poster presentations, breakout sessions and workshops. Three working groups met to plan consensus statements. Progress with BEAT-PCD projects was shared and new collaborations were fostered. In this report, we summarize the meeting, highlighting developments made during the meeting.
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Affiliation(s)
- Florian Halbeisen
- 1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claire Hogg
- 2Primary Ciliary Dyskinesia Centre, Departments of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Mikkel C Alanin
- 3Department of Otolaryngology - Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zuzanna Bukowy-Bieryllo
- 4Department of Molecular and Clinical Genetics, Institute of Human Genetics Polish Academy of Sciences, Poznań, Poland
| | - Francisco Dasi
- 5Department of Physiology, Faculty of Medicine, Universitat de Valencia, Valencia, Spain.,UCIM Department, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Julie Duncan
- 7Primary Ciliary Dyskinesia Centre, Departments of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Amanda Friend
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Myrofora Goutaki
- 1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claire Jackson
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Victoria Keenan
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amanda Harris
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK
| | - Philipp Latzin
- 10Paediatric Respiratory Medicine, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Gemma Marsh
- 2Primary Ciliary Dyskinesia Centre, Departments of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Kim Nielsen
- 11Danish PCD & chILD Centre, CF Centre Copenhagen Paediatric Pulmonary Service, ERN Accredited for PCD and CF Health Care, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dominic Norris
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell Campus, Oxfordshire, UK
| | - Daniel Pellicer
- 5Department of Physiology, Faculty of Medicine, Universitat de Valencia, Valencia, Spain.,UCIM Department, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Ana Reula
- 5Department of Physiology, Faculty of Medicine, Universitat de Valencia, Valencia, Spain.,UCIM Department, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Bruna Rubbo
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nisreen Rumman
- Pediatric Department, Makassed Hospital, East Jerusalem, Palestine
| | - Amelia Shoemark
- 2Primary Ciliary Dyskinesia Centre, Departments of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK.,14School of Medicine, University of Dundee, Dundee, UK
| | - Woolf T Walker
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claudia E Kuehni
- 1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,10Paediatric Respiratory Medicine, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jane S Lucas
- 8Primary Ciliary Dyskinesia Centre, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Goralski JL, Nasr SZ, Uluer A. Overcoming barriers to a successful transition from pediatric to adult care. Pediatr Pulmonol 2017; 52:S52-S60. [PMID: 28950427 DOI: 10.1002/ppul.23778] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/07/2017] [Indexed: 11/09/2022]
Abstract
As life expectancy for people with cystic fibrosis (CF) has increased dramatically, so has the need for a guided, structured transition from pediatric to adult-focused care. A formalized transition program allows for seamless transfer of patients between providers, helping to ensure continuity of care, and avoid potential declines associated with inconsistent medical care. New CF Center guidelines issued by the CFF strongly recommend that each center establish a transition program for age-appropriate transition to an adult CF clinic. In this article, we explore the remaining barriers to establishing a transition program in a CF Center and offer examples of several successful models. We describe CFF-sponsored and other initiatives that exist to support centers in establishing a transition program and discuss the need for ongoing research in this area.
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Affiliation(s)
- Jennifer L Goralski
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samya Z Nasr
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Ahmet Uluer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Athanazio RA, Silva Filho LVRFD, Vergara AA, Ribeiro AF, Riedi CA, Procianoy EDFA, Adde FV, Reis FJC, Ribeiro JD, Torres LA, Fuccio MBD, Epifanio M, Firmida MDC, Damaceno N, Ludwig-Neto N, Maróstica PJC, Rached SZ, Melo SFDO. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis. ACTA ACUST UNITED AC 2017; 43:219-245. [PMID: 28746534 PMCID: PMC5687954 DOI: 10.1590/s1806-37562017000000065] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Alberto Andrade Vergara
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | | | | | | | - Fabíola Villac Adde
- . Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Francisco José Caldeira Reis
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - José Dirceu Ribeiro
- . Hospital de Clínicas, Universidade Estadual de Campinas, Campinas (SP) Brasil
| | - Lídia Alice Torres
- . Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Marcelo Bicalho de Fuccio
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - Matias Epifanio
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Neiva Damaceno
- . Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo (SP) Brasil
| | - Norberto Ludwig-Neto
- . Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil.,. Serviço de Fibrose Cística e Triagem Neonatal para Fibrose Cística, Secretaria Estadual de Saúde de Santa Catarina, Florianópolis (SC) Brasil
| | - Paulo José Cauduro Maróstica
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil.,. Universidade Federal do Rio Grande do Sul Porto Alegre (RS) Brasil
| | - Samia Zahi Rached
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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19
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Coyne I, Sheehan AM, Heery E, While AE. Improving transition to adult healthcare for young people with cystic fibrosis: A systematic review. J Child Health Care 2017; 21:312-330. [PMID: 29119815 DOI: 10.1177/1367493517712479] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.
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Affiliation(s)
| | | | | | - Alison E While
- 2 Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK
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20
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Transition from children's to adult services for young adults with life-limiting conditions: A realist review of the literature. Int J Nurs Stud 2017; 76:1-27. [PMID: 28898740 DOI: 10.1016/j.ijnurstu.2017.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/16/2017] [Accepted: 06/21/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts. OBJECTIVES To explain how intervention processes interact with contextual factors to help transition from children's to adult services for young adults with life-limiting conditions. DESIGN Systematic realist review of the literature. DATA SOURCES Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers. REVIEW METHODS Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools. RESULTS 78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children's service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders. CONCLUSIONS Early planning, collaboration between children's and adult service providers, and a focus on increasing the young adults' confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents/carers and staff to engage with each other effectively.
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21
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Dale CM, King J, Amin R, Katz S, McKim D, Road J, Rose L. Health transition experiences of Canadian ventilator-assisted adolescents and their family caregivers: A qualitative interview study. Paediatr Child Health 2017; 22:277-281. [PMID: 29479234 DOI: 10.1093/pch/pxx079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose No studies have explored the experiences of Canadian mechanical ventilator-assisted adolescents (VAAs) living at home as they transition from paediatric to adult health providers. A better understanding of the needs of this growing population is essential to provide transition services responsive to VAAs and caregiver-identified needs. Methods We conducted semistructured telephone interviews with adolescents and family caregivers who had recently initiated or completed transition to adult care recruited from three Canadian university-affiliated paediatric home ventilation programs. We analyzed transcripts using a theoretical framework for understanding facilitators and barriers to transition. Results We interviewed 18 individuals representing 14 episodes of paediatric to adult transition. Participants identified early planning, written informational materials and joint paediatric-adult provider-family transition meetings as facilitators of care transition to adult services and providers. Barriers included insufficient information, limited access to interprofessional (nursing and allied health) providers and reduced funding or health services. Barriers resulted in service disruption and a sense of 'medical homelessness'. While most families related a positive transition to a new 'medical home', families caring for VAAs with moderate-to-severe cognitive and/or physical dependence more commonly reported transition difficulties. Conclusions Important opportunities exist to enable improvements in the transition experiences of VAAs and their family caregivers. To maximize service continuity during paediatric to adult transition, future research should focus on transition navigator roles, interprofessional health outreach and the needs of families caring for VAAs with cognitive and physical deficits.
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Affiliation(s)
- Craig M Dale
- University of Toronto - Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario.,Sunnybrook Health Sciences Centre - TECC Program, Toronto, Ontario
| | - Judy King
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Sherri Katz
- Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Douglas McKim
- Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Jeremy Road
- Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Louise Rose
- University of Toronto - Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario
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22
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Helen Malone
- Trinity College Dublin; School of Nursing & Midwifery; 24 D’Olier Street, College Green Dublin Ireland 2
| | - Susan Biggar
- Health Issues Centre; Consumer Partnerships; 255 Bourke Street Melbourne Victoria Australia VIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, Crumlin; Department of Respiratory Medicine; Dublin Ireland 12
| | - Zai Edworthy
- Temple Street Children's University Hospital; Department of Psychology; Temple Street Dublin Ireland DO1 YC67
| | - Greg Sheaf
- The Library of Trinity College Dublin; College Street Dublin Ireland
| | - Imelda Coyne
- Trinity College Dublin; School of Nursing & Midwifery; 24 D’Olier Street, College Green Dublin Ireland 2
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23
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Wright J, Elwell L, McDonagh JE, Kelly DA, Wray J. "Are these adult doctors gonna know me?" Experiences of transition for young people with a liver transplant. Pediatr Transplant 2016; 20:912-920. [PMID: 27558645 DOI: 10.1111/petr.12777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/03/2023]
Abstract
Excellent survival rates in paediatric LTx have resulted in increasing numbers of young people transferring from paediatric to adult care. Understanding the mechanisms of successful transition is imperative for ensuring good long-term outcomes and developing services for young people. Semi-structured interviews were conducted with 17 young people (10 females; age range: 15.2-25.1 years). Eight were within 1 year of transferring to adult services; nine had transferred. Interviews were analysed using IPA. Analysis revealed two major themes in both pre- and post-transfer groups: "relationships with healthcare professionals" and "continuity of care." Young people experienced difficulty ending relationships with paediatric clinicians and forming new relationships with adult clinicians. They expressed frustrations over a perceived lack of continuity of care after transfer and a fear of the unknown nature of adult services. The importance of a holistic approach to care was emphasized. Interventions are needed to support young people in transition, particularly in ending relationships in paediatric care and forming new relationships in adult care. Young people need help to develop strategies to cope with the different approaches in adult services. Interventions to provide clinicians with skills to communicate and engage with young people are imperative.
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Affiliation(s)
- J Wright
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Elwell
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - J E McDonagh
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - D A Kelly
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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24
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Coyne I, Prizeman G, Sheehan A, Malone H, While AE. An e-health intervention to support the transition of young people with long-term illnesses to adult healthcare services: Design and early use. PATIENT EDUCATION AND COUNSELING 2016; 99:1496-1504. [PMID: 27372524 DOI: 10.1016/j.pec.2016.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/25/2016] [Accepted: 06/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Co-design information and website to support adolescents and young adults with long-term illnesses in their transition to adult healthcare. METHODS A participatory iterative process involving a survey (n=207), twenty-one interviews, six participatory workshops, six video recordings, two advisory groups, and a co-design group to identify needs and preferences for e-health and information provision, was used to develop an appropriate intervention. RESULTS Adolescents and young people expressed preferences for information that was trustworthy, empowering, colorful, easily downloaded online and written using non-patronizing language. They desired video testimonials of experiences from young adults who had transitioned to adult healthcare and wanted advice about becoming more independent, managing their condition, preparing for the transition, and information about medications and the differences between child and adult healthcare. They also wanted information about the location and configuration of adult healthcare, key hospital personnel, and frequently asked questions. CONCLUSION The participatory iterative process led to the development of an online resource specifically tailored to the adolescents and young people's transition needs and information preferences. Preliminary feedback indicates that it is a valued resource. PRACTICE IMPLICATIONS The www.SteppingUP.ie website has the potential to help prepare its target population group for the transition to adult healthcare.
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Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - G Prizeman
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - A Sheehan
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - H Malone
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - A E While
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, United Kingdom.
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Heinzmann-Filho JP, Pinto LA, Marostica PJC, Donadio MVF. Variation in lung function is associated with worse clinical outcomes in cystic fibrosis. J Bras Pneumol 2016; 41:509-15. [PMID: 26785959 PMCID: PMC4723002 DOI: 10.1590/s1806-37562015000000006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/31/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether the variation in lung function over one year is associated with worse clinical outcomes, as well as with a decline in lung function in the following years, in patients with cystic fibrosis (CF). METHODS This was a retrospective study involving CF patients (4-19 years of age), evaluated over a three-year period. We evaluated demographic characteristics, chronic Pseudomonas aeruginosa infection, antibiotic use, hospitalization, six-minute walk distance (6MWD), and lung function. The inclusion criterion was having undergone pulmonary function testing at least three times in the first year and at least once in each of the next two years. RESULTS We evaluated 35 CF patients. The variation in FEV1 in the first year (ΔFEV1) was greater among those who, in the third year, showed reduced FEV1, had a below-average 6MWD, or were hospitalized than among those with normal FEV1, normal 6MWD, or no hospital admissions, in that same year (p < 0.05), although no such difference was found for antibiotic use in the third year. Subjects showing a ΔFEV1 ≥ 10% also showed a greater decline in FEV1 over the two subsequent years (p = 0.04). The ΔFEV1 also showed an inverse correlation with absolute FEV1 in the third year (r = -0.340, p = 0.04) and with the rate of FEV1 decline (r = -0.52, p = 0.001). Linear regression identified ΔFEV1 as a predictor of FEV1 decline (coefficient of determination, 0.27). CONCLUSIONS Significant variation in lung function over one year seems to be associated with a higher subsequent rate of FEV1 decline and worse clinical outcomes in CF patients. Short-term ΔFEV1 might prove useful as a predictor of CF progression in clinical practice.
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Affiliation(s)
- João Paulo Heinzmann-Filho
- Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Araujo Pinto
- Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Rachas A, Lefeuvre D, Meyer L, Faye A, Mahlaoui N, de La Rochebrochard E, Warszawski J, Durieux P. Evaluating Continuity During Transfer to Adult Care: A Systematic Review. Pediatrics 2016; 138:peds.2016-0256. [PMID: 27354452 DOI: 10.1542/peds.2016-0256] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Appropriate outcomes are required to evaluate transition programs' ability to maintain care continuity during the transfer to adult care of youths with a chronic condition. OBJECTIVE To identify the outcomes used to measure care continuity during transfer, and to analyze current evidence regarding the efficacy of transition programs. DATA SOURCES PubMed (1948-2014), Web of Science (1945-2014), Embase (1947-2014), and the reference lists of the studies identified. STUDY SELECTION Screening on titles and abstracts; full-text assessment by 2 reviewers independently. DATA EXTRACTION By 2 reviewers independently, by using a Cochrane form adapted to observational studies, including bias assessment. RESULTS Among the 23 studies retrieved, all but 5 were monocentric, 16 were cohorts (15 retrospective), 6 cross-sectional studies, and 1 randomized trial. The principal disease studied was diabetes (n = 11). We identified 24 indicators relating to 2 main aspects of continuity of care: engagement and retention in adult care. As designed, most studies probably overestimated engagement. A lack of adjustment for confounding factors was the main limitation of the few studies evaluating the efficacy of transition programs. LIMITATIONS The assessment of bias was challenging, due to the heterogeneity and observational nature of the studies. CONCLUSIONS This review highlights the paucity of knowledge about the efficacy of transition programs for ensuring care continuity during the transfer from pediatric to adult care. The outcomes identified are relevant and not specific to a disease. However, the prospective follow-up of patients initially recruited in pediatric care should be encouraged to limit an overestimation of care continuity.
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Affiliation(s)
- Antoine Rachas
- Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France;
| | - Delphine Lefeuvre
- Department of Social Epidemiology, INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Laurence Meyer
- Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France
| | - Albert Faye
- General Pediatrics, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris 7 Denis Diderot University, Sorbonne Paris Cité, Paris, France; INSERM UMR 1123, Paris, France
| | - Nizar Mahlaoui
- French National Reference Center for Primary Immune Deficiencies, and Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades University Hospital, and INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Elise de La Rochebrochard
- Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Institut National d'Etudes Démographiques, Paris, France
| | - Josiane Warszawski
- Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France
| | - Pierre Durieux
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Informatics and Public Health, Georges Pompidou European Hospital, Paris, France; and INSERM Cordeliers Research Center UMRS 872, Paris Descartes University, Paris, France
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Durieu I, Reynaud Q, Nove-Josserand R. [Transition from paediatric to adult cystic fibrosis care centre]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:72-76. [PMID: 26190340 DOI: 10.1016/j.pneumo.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/22/2015] [Accepted: 03/02/2015] [Indexed: 06/04/2023]
Abstract
The number of adolescents and young adults with chronic diseases has increased dramatically over the last decade. This led paediatric teams to organize the transition to adult centres with the aim to ensure the quality of care and prognosis, adherence to survey and treatment. To promote a good work and family life is also a challenge. Several studies have shown the importance of a successful transition in cystic fibrosis (CF) in order to prevent complications and loss monitoring and to improve the perception of patients and their families. In France in 2003, cystic fibrosis centres (CRCM) have been identified and among them of adult CF centres. The regular increase of the adult centre's active file requires improving the transition process. It is necessary to improve the transition process and to prepare the young patient and their family early during adolescence. The process in place should concern the whole aspects of care, i.e., medical, psychological and educational. The transition to adulthood will be successful if it results in a stable state of the disease allowing family and career plans.
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Affiliation(s)
- I Durieu
- Service de médecine interne et pathologie vasculaire, centre de ressources et de compétences mucoviscidose (CRCM), centre hospitalier Lyon-Sud, hospices civils de Lyon, université de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - Q Reynaud
- Service de médecine interne et pathologie vasculaire, centre de ressources et de compétences mucoviscidose (CRCM), centre hospitalier Lyon-Sud, hospices civils de Lyon, université de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - R Nove-Josserand
- Service de médecine interne et pathologie vasculaire, centre de ressources et de compétences mucoviscidose (CRCM), centre hospitalier Lyon-Sud, hospices civils de Lyon, université de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Nagra A, McGinnity PM, Davis N, Salmon AP. Implementing transition: Ready Steady Go. Arch Dis Child Educ Pract Ed 2015; 100:313-20. [PMID: 26063244 PMCID: PMC4680199 DOI: 10.1136/archdischild-2014-307423] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/06/2015] [Indexed: 01/25/2023]
Abstract
There is good evidence that morbidity and mortality increase for young persons (YP) following the move from paediatric to adult services. Studies show that effective transition between paediatric and adult care improves long-term outcomes. Many of the issues faced by young people across subspecialties with a long-term condition are generic. This article sets out some of the obstacles that have delayed the implementation of effective transition. It reports on a successful generic transition programme 'Ready Steady Go' that has been implemented within a large National Health Service teaching hospital in the UK, with secondary and tertiary paediatric services, where it is now established as part of routine care.
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Affiliation(s)
- Arvind Nagra
- Department of Paediatric Nephro-Urology, Southampton Children's Hospital, Southampton, UK
| | - Patricia M McGinnity
- Department of Paediatric Respiratory Medicine, Southampton Children's Hospital, Southampton, UK
| | - Nikki Davis
- Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital, Southampton, UK
| | - Anthony P Salmon
- Department of Adult Congenital Heart Medicine, University Hospitals Southampton, Southampton, UK
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29
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Hergenroeder AC, Wiemann CM, Cohen MB. Current Issues in Transitioning from Pediatric to Adult-Based Care for Youth with Chronic Health Care Needs. J Pediatr 2015; 167:1196-201. [PMID: 26340879 DOI: 10.1016/j.jpeds.2015.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
For over 25 years, with medical advances increasing the lifespan of YYASHCN, we have been aware of the need to improve health care transition to adult-based care services. Barriers to health care transition have been identified and in a number of settings, recognition of the problem and preliminary success has been achieved for pilot programs. Evidence-based solutions to improve health care transition for YYASHCN are needed. There are barriers at the patient, family, pediatric, and adult provider, and insurance system levels that must be overcome.
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Affiliation(s)
| | | | - Mitchell B Cohen
- University of Alabama at Birmingham Children's of Alabama, Birmingham, AL
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Lopez KN, Karlsten M, Bonaduce De Nigris F, King J, Salciccioli K, Jiang A, Marelli A, Kovacs AH, Fordis M, Thompson D. Understanding Age-based Transition Needs: Perspectives from Adolescents and Adults with Congenital Heart Disease. CONGENIT HEART DIS 2015; 10:561-71. [DOI: 10.1111/chd.12283] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Keila N. Lopez
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
- Wiess School of Natural Sciences; Rice University; Houston Tex USA
| | - Melissa Karlsten
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
| | | | - Jason King
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
| | - Katherine Salciccioli
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
| | - Alice Jiang
- Wiess School of Natural Sciences; Rice University; Houston Tex USA
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease; McGill University Health Center; Montreal Canada
| | - Adrienne H. Kovacs
- Congenital Cardiac Centre for Adults, University Health Network; University of Toronto; Toronto Canada
| | - Michael Fordis
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
| | - Deborah Thompson
- Department of Pediatrics, Section of Pediatric Cardiology; Baylor College of Medicine; Houston Tex USA
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31
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McDonagh JE, Gleeson H. Getting transition right for young people with diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers. Inflamm Bowel Dis 2014; 20:2083-91. [PMID: 25137417 PMCID: PMC4328150 DOI: 10.1097/mib.0000000000000136] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. METHODS We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-Ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. RESULTS Participants reported evaluating transition success and failure using health care utilization outcomes (e.g., maintaining continuity with adult providers), health outcomes (e.g., stable symptoms), and quality of life outcomes (e.g., attending school). The patients' level of developmental maturity (i.e., ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e., helicopter parent versus optimally involved parent) and the degree of support by providers (e.g., care coordination) also influenced outcomes. CONCLUSIONS IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care.
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Rutishauser C, Sawyer SM, Ambresin AE. Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care. Eur J Pediatr 2014; 173:1067-74. [PMID: 24610395 DOI: 10.1007/s00431-014-2291-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/07/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.
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Affiliation(s)
- Christoph Rutishauser
- Head Adolescent Medicine Unit, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland,
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Martínez Carrasco C, Cols Roig M, Salcedo Posadas A, Sardon Prado O, Asensio de la Cruz O, Torrent Vernetta A. [Respiratory treatments in neuromuscular disease]. An Pediatr (Barc) 2014; 81:259.e1-9. [PMID: 24890888 DOI: 10.1016/j.anpedi.2014.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022] Open
Abstract
In a previous article, a review was presented of the respiratory pathophysiology of the patient with neuromuscular disease, as well as their clinical evaluation and the major complications causing pulmonary deterioration. This article presents the respiratory treatments required to preserve lung function in neuromuscular disease as long as possible, as well as in special situations (respiratory infections, spinal curvature surgery, etc.). Special emphasis is made on the use of non-invasive ventilation, which is changing the natural history of many of these diseases. The increase in survival and life expectancy of these children means that they can continue their clinical care in adult units. The transition from pediatric care must be an active, timely and progressive process. It may be slightly stressful for the patient before the adaptation to this new environment, with multidisciplinary care always being maintained.
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Affiliation(s)
- C Martínez Carrasco
- Sección de Neumología Pediátrica, Hospital Universitario La Paz, Madrid, España.
| | - M Cols Roig
- Sección de Neumología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - A Salcedo Posadas
- Sección de Neumología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - O Sardon Prado
- Sección de Neumología Pediátrica, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - O Asensio de la Cruz
- Sección de Neumología Pediátrica, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España
| | - A Torrent Vernetta
- Sección de Neumología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, España
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Okumura MJ, Ong T, Dawson D, Nielson D, Lewis N, Richards M, Brindis CD, Kleinhenz ME. Improving transition from paediatric to adult cystic fibrosis care: programme implementation and evaluation. BMJ Qual Saf 2014; 23 Suppl 1:i64-i72. [PMID: 24415776 DOI: 10.1136/bmjqs-2013-002364] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The paradigm of cystic fibrosis (CF) care has changed as effective therapies extend the lives of patients well into adulthood. Preparing for and maintaining high quality CF care into the adult healthcare setting is critical for prolonged survival. Unfortunately, this transfer process from the paediatric to the adult CF centre is met with a variety of challenges. OBJECTIVE AND METHODS The objective of this quality improvement (QI) project was to develop, implement and evaluate a theory-based programme for transition from paediatric to adult CF care. In a multi-phase process, the paediatric and adult programmes developed a transition curriculum, addressed care standards and standardised patient transfer protocols. We evaluated the impact of this process through staff surveys, review of field notes from QI meetings, tracking transfers and responses of patients to the Transition Readiness Assessment Questionnaire (TRAQ) at the start of the programme and 18 months after initiation. RESULTS The collaboration between the paediatric and adult teams continued through quarterly meetings over the past 4 years. This has provided a forum that sustained our transition programme, harmonised care across CF centres and addressed other needs of our CF centre. Discussion of transition with families in the paediatric centre increased twofold (35% to 73% p<0.001), and resulted in a trend towards improved patient TRAQ self-advocacy scores and decreased in-hospital transfer. CONCLUSIONS We successfully created a curriculum and process for transition from paediatric to adult CF care at our centres. This collaboration shapes the communication between our paediatric and adult CF care teams and enables ongoing feedback among patients, families and providers. The impact of our transition programme on long-term patient morbidity will require future evaluation.
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Affiliation(s)
- Megumi J Okumura
- Division of General Pediatrics, University of California, , San Francisco, California, USA
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Gravelle A, Davidson G, Chilvers M. Cystic fibrosis adolescent transition care in Canada: A snapshot of current practice. Paediatr Child Health 2013; 17:553-6. [PMID: 24294062 DOI: 10.1093/pch/17.10.553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 11/14/2022] Open
Abstract
Cystic fibrosis (CF) adolescent transition is not a new health care issue, yet progress in many areas associated with the transition process has been slow. In Canada, the status of CF transition has not been previously reported. The aim of the present study was to describe the transition from paediatric to adult health care for CF patients in Canada, specifically: availability of adult CF clinic services; average age of transfer from paediatric to adult CF health care; and existing CF transition practices. Results show that access to appropriate adult CF health care in Canada is universal; however, the availability, quantity and quality of CF transition care vary among CF clinics. Over a four-year period, the number of CF clinics using formal transition protocols almost doubled, but more work remains to be performed.
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Affiliation(s)
- Anna Gravelle
- Cystic Fibrosis Clinic, British Columbia Children's Hospital
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37
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Tuchman L, Schwartz M. Health outcomes associated with transition from pediatric to adult cystic fibrosis care. Pediatrics 2013; 132:847-53. [PMID: 24144711 DOI: 10.1542/peds.2013-1463] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Almost half of individuals who have cystic fibrosis (CF) are over 18 years old, thus safely transferring patients from pediatric to adult care is a priority. The purpose of this study is to compare youth transferred from pediatric to adult CF care versus those remaining in pediatric CF care and quantify the relationship between transfer status and health outcomes. METHODS Patients who transferred from pediatric to adult CF care were identified from the CF Foundation Patient Registry from 1997 to 2007. Transferred patients were compared with individuals who have similar baseline characteristics who remained in pediatric care throughout the same time period. The main outcome measures include pulmonary function, nutritional status, care use, and home intravenous antibiotic events per year. A propensity-matched analysis was performed. RESULTS Fifty-eight percent of patients remained in pediatric programs throughout the study period. The mean age at transfer to adult care was 21.2 (1.3) years. In the 2 years after transfer there was a less rapid decline in percent predicted forced expiratory volume in 1 second of 0.78 percentage points per year among transfer-positive patients compared with transfer-negative ones (95% confidence interval; 0.06-1.51); there were no other significant health related changes. CONCLUSIONS The current study contradicts reports of other chronic childhood conditions, in which transfer between the pediatric and adult health system was associated with adverse health outcomes. Further research is needed to explore the long-term relationship between transition practices and health status outcomes to establish a systematic, evidence-based transition process.
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Affiliation(s)
- Lisa Tuchman
- Children's Research Institute, Center for Translational Science, Children's National Medical Center, Washington, DC, 20010.
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Pape L, Lämmermühle J, Oldhafer M, Blume C, Weiss R, Ahlenstiel T. Different models of transition to adult care after pediatric kidney transplantation: a comparative study. Pediatr Transplant 2013; 17:518-24. [PMID: 23730905 DOI: 10.1111/petr.12102] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Abstract
Transition from pediatric to adult care is a critical and difficult step for young people with transplants and for the multidisciplinary team involved. In our retrospective study, we investigated the clinical course in a two-yr period of transition. Data from 66 teenagers were collected one yr before and after their transfer to three different adult care settings: (i) a specialized transition clinic, (ii) a general transplantation clinic, and (iii) a nephrologist. Patient survival rate was 100%. Three patients developed graft loss. GFR development was comparable in the three settings (ΔGFR 1.4 ± 8.7 vs. 3.1 ± 10.6 vs. 0.8 ± 4.4 mL/min/1.73 m2 , p = ns). Immunosuppressive therapy was stable in setting 1, whereas the number of changes increased in setting 2 and even more in setting 3. The percentage of patients with steroids increased from 36% to 38% and 52% in settings 1-3. Patient satisfaction was highest in setting 1 (100% vs. 64% and 78%, p < 0.05). Setting 1 was associated with fewer changes in therapy (13% vs. 91% and 45%, p < 0.05). The use of a specialized transition clinic is associated with fewer changes in medication and care and a higher level of patient satisfaction. This was not associated with a lower increase in GFR one yr after transition. Long-term results are awaited.
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Affiliation(s)
- L Pape
- Department of Pediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
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Begley T. Transition to adult care for young people with long-term conditions. ACTA ACUST UNITED AC 2013; 22:506, 508-11. [DOI: 10.12968/bjon.2013.22.9.506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thelma Begley
- Thelma Begley is Assistant Professor in Children’s Nursing, School of Nursing and Midwifery, Trinity College Dublin
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Abstract
As a testimony to advances in patient care, more individuals with cystic fibrosis are surviving into their adult years than ever before. The clinical epidemiology of this complex multi-organ disease is evolving and has changed dramatically over the past two to three decades. This article discusses the emergence of chronic disease-related co-morbidities such as CF-related diabetes, chronic kidney disease, bone disease, arthropathy, and depression. It also provides an overview of the many challenges confronted by adult CF care providers.
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Affiliation(s)
- Bradley S Quon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medical Center, 1959 NE Pacific St., Campus Box 356522, Seattle, Washington, USA, 98195
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Abstract
The outcome of transition from paediatric to adult care is often judged by what happens after transfer. Young people at the point of transfer are reported to have low levels of knowledge and independence. These observations could be interpreted in one of two ways: either that the transition process before transfer is inadequate or that the transition process needs to continue into young adulthood and therefore adult care. The second interpretation is further supported by brain development continuing into the third decade. There is also growing evidence for the effectiveness of young adult clinics in the process of transition. To optimise transition, adult physicians need not only to work with paediatricians to achieve continuity during transfer, but also to look critically at their service as to how it can be changed to meet the needs of young people. In addition, they need to develop knowledge, skills and attitudes to communicate effectively and address a young person's developmental and health needs.
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Srivastava SA, Elkin SL, Bilton D. The transition of adolescents with chronic respiratory illness to adult care. Paediatr Respir Rev 2012; 13:230-5; quiz 235. [PMID: 23069122 DOI: 10.1016/j.prrv.2012.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical transition aims to safely steer children with chronic illness through adolescence and into adulthood, whilst maintaining optimal management of their underlying medical condition. It is an evolving process with ongoing research and development. Though it has not been proven to prolong life, evidence points to an improved quality of life via greater understanding and management of lifelong illness. The presumption is this will ultimately prevent or delay untimely loss of life and/or complications in those who have been stable throughout childhood. In this article we review the problems associated with adolescence, the current drive towards successful transition and the role of the adult physician in achieving this.
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Affiliation(s)
- Shelley A Srivastava
- Department of Respiratory Medicine, 5th floor, East Wing, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF.
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Sebastian S, Jenkins H, McCartney S, Ahmad T, Arnott I, Croft N, Russell R, Lindsay JO. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohns Colitis 2012; 6:830-44. [PMID: 22398082 DOI: 10.1016/j.crohns.2012.01.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/24/2011] [Accepted: 01/11/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Preliminary data highlight the importance of appropriate transition for successful transfer of adolescents with IBD from paediatric to adult care. The aim of this study was to identify both the perceived needs of adolescent IBD patients and the barriers to successful transition from the perspective of professionals involved in their care. METHODS A postal questionnaire was distributed to UK adult and paediatric gastroenterologists with an interest in IBD. The questionnaire utilised closed questions as well as ranked items on the importance of the various competencies of adolescents with IBD required for successful transition. RESULTS Response rate of 62% and 49% for paediatric and adult gastroenterologists respectively was achieved. A structured transition service was perceived as very important by 80% paediatric compared to 47% adult gastroenterologists (p=0.001). A higher proportion of adult than paediatric gastroenterologists identified inadequacies in the preparation of adolescents for transfer (79% and 42%, p=0.001). The main areas of perceived deficiency in preparation identified were patient lack of knowledge about the condition and treatment, lack of self advocacy and co-ordination of care. Lack of resources, clinical time, and a critical mass of patients were the factors ranked highest by both groups as barriers to transition care. Both adult (65%) and paediatric gastroenterologists (62%) highlighted suboptimal training in adolescent medicine for adult gastroenterologists. CONCLUSIONS This survey highlights differences in the perception of adult and paediatric gastroenterologists in the management of transition care and perceived competencies for adolescents with IBD. Lack of training and inadequate resources are the main barriers identified for development of a successful transition service.
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Tierney S, Deaton C, Jones A, Oxley H, Biesty J, Kirk S. Liminality and transfer to adult services: a qualitative investigation involving young people with cystic fibrosis. Int J Nurs Stud 2012; 50:738-46. [PMID: 22624956 DOI: 10.1016/j.ijnurstu.2012.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Moving to adult care can be challenging for adolescents with a long-term condition; if not managed well it may result in non-adherence, failure to attend appointments and a decline in health post-transfer. Life expectancy for those with cystic fibrosis has improved considerably in recent decades. This patient group was selected as an exemplar for thinking about the movement of care from paediatric to adult services. OBJECTIVES To explore young people's experience of transferring. DESIGN A qualitative descriptive methodology, involving semi-structured interviews. SETTING One adult cystic fibrosis unit in the United Kingdom. PARTICIPANTS 19 patients (12=male) who had moved to the study site no more than 12 months prior to data collection, which took place between October 2010 and February 2011. METHODS Interviews were conducted face-to-face, by telephone or email. Framework analysis was applied to interview transcripts. RESULTS Data suggested transfer was a period of flux, during which participants progressed from a service that was relatively prescriptive to one that called for autonomy. They appeared to go through three stages during this process: fracturing, acclimatising and integrating. The concept of liminality was used as a lens to explore data. Liminality describes those on the threshold of a new social position and rituals that bring meaning to such change. Rites of passage, such as being visited by a member of the adult team and a first appointment within this new healthcare setting, were important because they allowed for initiation into the workings of the adult unit. However, the absence of certain rituals, including a ceremony marking departure from paediatrics, might hinder progression towards becoming an adult patient. CONCLUSIONS The concept of liminality proved useful for thinking about data. Additional work should explore whether it can be applied to different long-term conditions and if initiation rituals vary across services. Nurses could play a role in preparing adolescents by assessing their readiness to transfer on a regular basis and intervening to address individual needs. This would help with young people's shift from a paediatric to adult identity, hopefully preventing them from experiencing a prolonged liminal state post-transfer.
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Affiliation(s)
- Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Grenet D, Bonnel AS, Dautricourt C, De Miranda S, Foucaud P, Stern M. Passage des adolescents et des jeunes adultes atteints de mucoviscidose en centre adulte. Arch Pediatr 2012; 19 Suppl 1:S33-5. [DOI: 10.1016/s0929-693x(12)71107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- Janet E McDonagh
- Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, UK
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Chryssostalis A, Hubert D, Coste J, Kanaan R, Burgel PR, Desmazes-Dufeu N, Soubrane O, Dusser D, Sogni P. Liver disease in adult patients with cystic fibrosis: a frequent and independent prognostic factor associated with death or lung transplantation. J Hepatol 2011; 55:1377-82. [PMID: 21703187 DOI: 10.1016/j.jhep.2011.03.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Increased life expectancy in patients with cystic fibrosis (CF) allows better knowledge of non-pulmonary complications like liver disease (CFLD). However, few data have been published in large adult cohorts. The aim of this study was to estimate the prevalence and the prognosis of CFLD in adult CF patients. METHODS A retrospective analysis of a monocentric cohort of adult CF patients prospectively followed, at least every year, was performed. CFLD was diagnosed using published composite criteria. If cirrhosis was suspected, upper digestive endoscopy was realized to assess the presence of portal hypertension. RESULTS A cohort of 285 adult CF patients was followed during 4.8 ± 3.6 years. Among them, 90 had CFLD at the beginning of follow-up and 23 a suspicion of cirrhosis. Factors independently associated with liver disease at baseline were history of meconium ileus, pancreatic insufficiency, chronic colonization with Burkholderia cepacia and the number of IV antibiotic courses per year. Nine patients developed liver decompensation during follow-up, all with a suspicion of cirrhosis at baseline. Six patients underwent liver transplantation alone and three patients combined liver and lung transplantation. Factors independently associated with death or lung transplantation at baseline were liver disease, BMI, forced expiratory volume in 1 second and number of IV antibiotic courses per year. CONCLUSIONS CFLD was present at baseline in one third of adult patients with CF with a marked risk of liver decompensation during follow-up. Moreover, CFLD at baseline appears as an independent factor associated with death or lung transplantation.
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Laborde-Castérot H, Donnay C, Chapron J, Burgel PR, Kanaan R, Honoré I, Dusser D, Choudat D, Hubert D. Employment and work disability in adults with cystic fibrosis. J Cyst Fibros 2011; 11:137-43. [PMID: 22104952 DOI: 10.1016/j.jcf.2011.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/11/2011] [Accepted: 10/25/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND As a result of prolonged survival, more patients with cystic fibrosis (CF) participate in the labour force. The aim of this study was to evaluate their education, occupation levels and risk factors for work disability. METHOD 207 patients answered a self-administered questionnaire about their educational level and work status. Independently, medical records were reviewed for illness severity indicators. RESULTS 39 patients (19%) were students, 117 (57%) were in the labour force, 13 (6%) were seeking employment and 38 (18%) were inactive. CF patients had a higher educational level and were more likely to hold skilled jobs and to work part time than the general population. FEV1 and educational level were the strongest predictive factors of disability. CONCLUSION Many CF patients have access to professional life. Their higher educational levels improve the chances of attaining employment, which highlights the need for career counselling. Working part time helps to maintain employment despite declining health.
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Affiliation(s)
- Hervé Laborde-Castérot
- Service de Pathologie Professionnelle, Université Paris Descartes, Sorbonne Paris Cité and Hôpital Cochin, AP-HP, Paris, France
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Schwartz LA, Tuchman LK, Hobbie WL, Ginsberg JP. A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions. Child Care Health Dev 2011; 37:883-95. [PMID: 22007989 DOI: 10.1111/j.1365-2214.2011.01282.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge. OBJECTIVE In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed. METHODS SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic. RESULTS The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients. CONCLUSIONS SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.
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Affiliation(s)
- L A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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