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Goselink RJM, Olsson I, Malmgren K, Reilly C. Transition to adult care in epilepsy: A systematic review. Seizure 2022; 101:52-59. [PMID: 35901664 DOI: 10.1016/j.seizure.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
The transfer from paediatric to adult care can be a complex process in children with epilepsy. Inadequate care during this phase can affect long-term medical and psychosocial outcomes. The aim of this study was to review studies on transitional care from paediatric to adult healthcare for young persons with epilepsy in order to synthesize evidence for best practice. We undertook a systematic review following PRISMA guidelines and employed narrative synthesis. A total of 36 articles were included, of which 11 were interventional studies and 25 observational studies. Study quality was rated as 'good' for only four studies. Interventions included joint or multidisciplinary clinics, education (patient and health professional education) and extended service provision (Saturday clinics, peer-groups). All studies observed a positive effect experienced by the participants, regardless of intervention type. Observational studies showed that transition plans/programmes are asked for but frequently not existing or not adapted to subgroups with intellectual disability or other neurodevelopmental conditions. The results of this systematic review on transitional care in epilepsy suggest that a planned transition process likely enhances medical and psychosocial outcomes for young people with epilepsy, but the body of evidence is limited and there are significant gaps in knowledge of what efficacious transition constitutes. More studies are needed employing qualitative and quantitative methods to further explore the needs of young people with epilepsy and their families but also robust study designs to investigate the impact of interventions on medical and psychosocial outcomes.
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Affiliation(s)
- Rianne J M Goselink
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ingrid Olsson
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, SE-413 45, Sweden.
| | - Colin Reilly
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neuropaediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden; Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, United Kingdom.
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McGuire MF, Vakulenko-Lagun B, Millis MB, Almakias R, Cole EP, Kim HKW. What is the adult experience of Perthes' disease? : initial findings from an international web-based survey. Bone Jt Open 2022; 3:404-414. [PMID: 35535518 PMCID: PMC9134832 DOI: 10.1302/2633-1462.35.bjo-2021-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Perthes' disease is an uncommon hip disorder with limited data on the long-term outcomes in adulthood. We partnered with community-based foundations and utilized web-based survey methodology to develop the Adult Perthes Survey, which includes demographics, childhood and adult Perthes' disease history, the University of California Los Angeles (UCLA) Activity Scale item, Short Form-36, the Hip disability and Osteoarthritis Outcome Score, and a body pain diagram. Here we investigate the following questions: 1) what is the feasibility of obtaining > 1,000 survey responses from adults who had Perthes' disease using a web-based platform?; and 2) what are the baseline characteristics and demographic composition of our sample? METHODS The survey link was available publicly for 15 months and advertised among support groups. Of 1,505 participants who attempted the Adult Perthes survey, 1,182 completed it with a median timeframe of 11 minutes (IQR 8.633 to 14.72). Participants who dropped out were similar to those who completed the survey on several fixed variables. Participants represented 45 countries including the USA (n = 570; 48%), UK (n = 295; 25%), Australia (n = 133; 11%), and Canada (n = 46; 4%). Of the 1,182 respondents, 58% were female and the mean age was 39 years (SD 12.6). RESULTS Ages at onset of Perthes' disease were < six years (n = 512; 43%), six to seven years (n = 321; 27%), eight to 11 years (n = 261; 22%), and > 11 years (n = 76; 6%), similar to the known age distribution of Perthes' disease. During childhood, 40% (n = 476) of respondents had at least one surgery. Bracing, weightbearing restriction, and absence of any treatment varied significantly between USA and non-USA respondents (p < 0.001, p = 0.002, and p < 0.001, respectively). As adults, 22% (n = 261) had at least one total hip arthroplasty, and 30% (n = 347) had any type of surgery; both more commonly reported among women (p = 0.002). CONCLUSION While there are limitations due to self-sampling, our study shows the feasibility of obtaining a large set of patient-reported data from adults who had childhood Perthes' from multiple countries. Cite this article: Bone Jt Open 2022;3(5):404-414.
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Affiliation(s)
- Molly F. McGuire
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
| | | | - Michael B. Millis
- Department of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Roi Almakias
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Earl P. Cole
- Perthes Kids Foundation, Los Angeles, California, USA
| | - Harry K. W. Kim
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A study from the International Perthes Study Group
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
- Department of Statistics, University of Haifa, Haifa, Israel
- Department of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Perthes Kids Foundation, Los Angeles, California, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sadun RE, Covert LT, Lawson EF. Transitioning to Adulthood with a Rheumatic Disease: A Case-Based Approach for Rheumatology Care Teams. Rheum Dis Clin North Am 2021; 48:141-156. [PMID: 34798943 DOI: 10.1016/j.rdc.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Both pediatric and adult rheumatology care teams play a central role in health care transition, the shift from child- and family-centered to adult-oriented health care. Components of transition preparation include readiness assessment, setting self-management goals, and spending time in clinical visits without a parent present. Pediatric providers and families should work together to create a transfer plan, identifying a new adult rheumatology care provider, providing a medical summary before transfer, and anticipating changes in health insurance. For high-risk transfers, direct communication between providers is recommended. Finally, adult rheumatologists need to build rapport with young adults to support future engagement in care.
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Affiliation(s)
- Rebecca E Sadun
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA.
| | - Lauren T Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA
| | - Erica F Lawson
- Department of Pediatrics, Division of Rheumatology, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Sadun RE, Chung RJ, Maslow GR. Transition to Adult Health Care and the Need for a Pregnant Pause. Pediatrics 2019; 143:peds.2019-0541. [PMID: 30971433 DOI: 10.1542/peds.2019-0541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Gary R Maslow
- Pediatrics, and.,Psychiatry, Duke Health, Durham, North Carolina
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Sadun RE, Schanberg LE. Transition and transfer of the patient with paediatric-onset lupus: a practical approach for paediatric and adult rheumatology practices. Lupus Sci Med 2018; 5:e000282. [PMID: 30167316 PMCID: PMC6109813 DOI: 10.1136/lupus-2018-000282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
Abstract
The prevalence of paediatric-onset SLE (pSLE) is estimated at 1million people worldwide and accounts for a significant proportion of SLE morbidity, mortality and cost. Patients with pSLE are especially vulnerable during and immediately following transfer from paediatric to adult rheumatology care, when substantial delays in care and increased disease activity are common. Transition is the process through which adolescents and young adults (AYA) develop the skills needed to succeed in the adult healthcare environment, a process that typically takes several years and may span a patient's time in paediatric and adult clinics. Recommendations for improving transition and transfer for AYA with pSLE include setting expectations of the AYA patient and family concerning transition and transfer, developing AYA's self-management skills, preparing an individualised transition plan that identifies a date for transfer, transferring at a time of medical and social stability, coordinating communication between the paediatric and adult rheumatologists (inclusive of both a medical summary and key social factors), and identifying a transition coordinator as a point person for care transfer and to monitor the AYA's arrival and retention in adult rheumatology care. Of paramount importance is empowering the adult rheumatologist with skills that enhance rapport with AYA patients, engage AYA patients and families in adult care models, promote adherence and encourage ongoing development of self-management skills.
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Affiliation(s)
- Rebecca E Sadun
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Department of Medicine, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
| | - Laura E Schanberg
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Both P, Ten Holt L, Mous S, Patist J, Rietman A, Dieleman G, Ten Hoopen L, Vergeer M, de Wit MC, Bindels-de Heus K, Moll H, van Eeghen A. Tuberous sclerosis complex: Concerns and needs of patients and parents from the transitional period to adulthood. Epilepsy Behav 2018; 83:13-21. [PMID: 29631156 DOI: 10.1016/j.yebeh.2018.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Transitioning into adulthood and from pediatric services to adult healthcare are both challenging processes for young adults with rare chronic disorders such as tuberous sclerosis complex (TSC) and their parents. Adult healthcare systems are often less family-oriented and lack multidisciplinary care and experience with TSC, which can result in increased health risks and morbidity. Patient-driven data on care needs are necessary to optimize support for this vulnerable patient group. AIM The aim of this study was to explore the concerns and care needs of young adult patients with TSC in medical, psychological, and socioeconomical domains. METHOD A qualitative study was performed using semistructured interviews with 16 patients (median age: 21years; range: 17 to 30) and 12 parents. Concerns and care needs were organized using the International Classification of Functioning, Disability, and Health (ICF). RESULTS Main concerns involved mental and physical health, participation, self-management skills, family planning, and side effects of medications. Patients expressed the need for multidisciplinary care that is well-informed, easily accessible, and focused on the patient as a whole, including his/her family. Parents reported high stress levels. CONCLUSION The current study provides patient-driven information, allowing recommendations to facilitate the (transition of) care for young adults with TSC. In addition to seizures, tumor growth, and TSC-associated neuropsychiatric disorders (TAND), more attention is needed for concerns and care needs specific to the transitional period, participation, and environmental factors. Adult healthcare providers should offer expert multidisciplinary care for adult patients with TSC, including attention for parental stress.
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Affiliation(s)
- Pauline Both
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lyenne Ten Holt
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabine Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joke Patist
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - André Rietman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gwen Dieleman
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leontine Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Menno Vergeer
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Claire de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karen Bindels-de Heus
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte Moll
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Agnies van Eeghen
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands; Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; The Hartekamp Group, Care and Service for People with Intellectual Disabilities, Haarlem, The Netherlands.
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Kelly MS, Thibadeau J, Struwe S, Ramen L, Ouyang L, Routh J. Evaluation of spina bifida transitional care practices in the United States. J Pediatr Rehabil Med 2017; 10:275-281. [PMID: 29125516 PMCID: PMC5896760 DOI: 10.3233/prm-170455] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Recent studies have revealed that the lack of continuity in preparing patients with spina bifida to transition into adult-centered care may have detrimental health consequences. We sought to describe current practices of transitional care services offered at spina bifida clinics in the US. METHODS Survey design followed the validated transitional care survey by the National Cystic Fibrosis center. Survey was amended for spina bifida. Face validity was completed. Survey was distributed to registered clinics via the Spina Bifida Association. Results were analyzed via descriptive means. RESULTS Total of 34 clinics responded. Over 90 characteristics were analyzed per clinic. The concept of transition is discussed with most patients. Most clinics discuss mobility, bowel and bladder management, weight, and education plans consistently. Most do not routinely evaluate their process or discuss insurance coverage changes with patients. Only 30% communicate with the adult providers. Sexuality, pregnancy and reproductive issues are not readily discussed in most clinics. Overall clinics self-rate themselves as a 5/10 in their ability to provide services for their patients during transition. CONCLUSIONS Characteristics of current transitional care services and formal transitional care programs at US clinics show wide variances in what is offered to patients and families.
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Affiliation(s)
| | - Judy Thibadeau
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara Struwe
- Spina Bifida Association, Arlington, VA, USA
| | - Lisa Ramen
- Spina Bifida Association, Arlington, VA, USA
| | - Lijing Ouyang
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kam V, Hendershot E, Anderson L, Marjerrison S. Evaluation of a joint adult and pediatric clinic for cancer survivorship care. Pediatr Blood Cancer 2017; 64. [PMID: 28150383 DOI: 10.1002/pbc.26476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/30/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The best model of care for long-term follow-up of survivors of childhood cancer is uncertain. We describe the care experience provided by the joint adult/pediatric AfterCare Clinic at the McMaster Children's Hospital. Secondary outcomes include an evaluation of cancer worry, self-management skills, and loss to follow-up rates. METHODS AfterCare Clinic patients aged 19-29 years were approached for study participation between January and March 2016. Data were collected from a cross-sectional survey, consisting of the Cancer Care Experience Questionnaire (CCEQ), Cancer Worry Scale (CWS), and Self-Management Skills Scale (SMSS). Responses were analyzed using descriptive statistics. RESULTS Seventy-three (40%) patients participated in the survey, 17 (23%) anonymously. Demographic characteristics of the nonanonymous participants were representative of the total clinic cohort. Most respondents were satisfied with the quality of care and anticipatory guidance provided, demonstrated by the CCEQ responses. Respondents had a high degree of cancer worries (mean score 50.6 [±18.4]), but good self-management skills (72.0 [±10.9]). Our 5-year loss to follow-up rate was 3.8%. Sensitivity analyses showed no difference in responses between the total cohort and the nonanonymous participants. CONCLUSIONS This sample of young adult survivors of childhood cancer had a higher degree of cancer worries and higher self-management skills scores than a younger cohort of survivors of childhood cancer in the literature. Given this, along with the positive care experience reported, and the low loss to follow-up rate, the joint adult/pediatric model of survivorship care appears to be meeting the needs of this population.
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Affiliation(s)
- Vicki Kam
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eleanor Hendershot
- Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Loretta Anderson
- Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Stacey Marjerrison
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Kyrana E, Beath S, Gabe S, Small M, Hill S, Basude D, Cosgrove M, Cunningham S, Davies I, Fagbemi A, Flynn D, Holden C, Koglmeier J, Naik S, MacDonald S, Puntis J, Protheroe S. Current practices and experience of transition of young people on long term home parenteral nutrition (PN) to adult services – A perspective from specialist centres. Clin Nutr ESPEN 2016; 14:9-13. [DOI: 10.1016/j.clnesp.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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Ersig AL, Tsalikian E, Coffey J, Williams JK. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management. J Pediatr Nurs 2016; 31:390-6. [PMID: 26831378 DOI: 10.1016/j.pedn.2015.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. DESIGN AND METHODS This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. RESULTS The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. CONCLUSIONS Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. PRACTICE IMPLICATIONS Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, The University of Iowa, Iowa City, IA.
| | - Eva Tsalikian
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
| | - Julie Coffey
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
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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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Abstract
PURPOSE A systematic review of the literature was conducted to identify the level of evidence and to describe the evidence on the transition from pediatric to adult healthcare services among youth with diabetes. BACKGROUND The transition from pediatric to adult healthcare services is an expectation of youth with diabetes; however, little is known to guide policy and procedures on such transitions. DESCRIPTION OF PROJECT The literature was first searched and screened according to predetermined criterion and then evaluated for level of evidence. OUTCOME There were 16 mixed qualitative and/or quantitative studies, 23 quantitative studies, and 2 expert opinion articles reviewed. Most of the evidence was from uncontrolled studies. Youth report challenges in making the transition in services. Delay in seeking adult services and poor clinic attendance are issues for these youth. However, it is unclear if these problems are a result of the transition in services. Several promising transition programs have been evaluated and, overall, are found acceptable and useful by youth. In general, evidence suggests that these programs improve glycemic control. CONCLUSIONS More research is needed in this challenging area to guide policies and procedures. IMPLICATIONS Expert opinion is a guide for policy and procedures at this point in time.
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Affiliation(s)
- Kathleen M Hanna
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA.
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Hanna KM. A framework for the youth with type 1 diabetes during the emerging adulthood transition. Nurs Outlook 2012; 60:401-10. [PMID: 22226223 PMCID: PMC3324668 DOI: 10.1016/j.outlook.2011.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 10/03/2011] [Accepted: 10/30/2011] [Indexed: 10/14/2022]
Abstract
Emerging adulthood, a developmental period from late adolescence to the late twenties, is a critical transition for youths with type 1 diabetes. This article proposes a framework for emerging adults with diabetes during this transitional time, integrating theoretical writings on transitions and emerging adulthood with empirical findings from younger adolescents with diabetes, about whom more is known. Key health, developmental, and behavioral outcomes are proposed, as well as key influential personal and environmental characteristics. Influential transitional events for this age group are also discussed relative to these outcomes and to personal and environmental characteristics. This framework provides a guide for longitudinal studies on the transition to young adulthood among emerging adults with type 1 diabetes. Identifying key times and influential factors will provide information for designing future effective interventions to improve glycemic control and quality of life for these youths as they transition to adulthood.
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Affiliation(s)
- Kathleen M Hanna
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Lerret SM, Stendahl G. Working together as a team: adolescent transplant recipients and nurse practitioners. Prog Transplant 2012. [PMID: 22548989 DOI: 10.7182/prtr.21.4.v1qu71831k931w47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nurse practitioners are a critical part of the transplant team, enhancing the quality of patient care with their knowledge and skill with respect to disease-specific populations of patients. Adolescent transplant recipients are a vulnerable population and require specific considerations. Nurse practitioners can successfully tailor care to the adolescent developmental stages in order to promote quality of life, adherence to the medical regimen, and successful transition to adult transplant centers and to minimize risk-taking behaviors. Teamwork between the patient's family and the entire transplant team is important to optimize not only the patient's health but also to ensure quality of life after transplant. Adolescents can be especially challenging after transplant, given their complex and evolving psychosocial and cognitive development. Nurse practitioners are in a unique position to be central in adolescents' successful adaptation to their medical condition. Facilitating identification and management of medication-related side effects, awareness of emotional health and quality of life, adherence to the medical regimen, and eventual transition to adult caregivers all remain critically important steps in care that are ideally suited for advance practice leadership.
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Affiliation(s)
- Stacee M Lerret
- Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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Lerret SM, Stendahl G. Working Together as a Team: Adolescent Transplant Recipients and Nurse Practitioners. Prog Transplant 2011; 21:288-93, 298. [DOI: 10.1177/152692481102100406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nurse practitioners are a critical part of the transplant team, enhancing the quality of patient care with their knowledge and skill with respect to disease-specific populations of patients. Adolescent transplant recipients are a vulnerable population and require specific considerations. Nurse practitioners can successfully tailor care to the adolescent developmental stages in order to promote quality of life, adherence to the medical regimen, and successful transition to adult transplant centers and to minimize risk-taking behaviors. Teamwork between the patient's family and the entire transplant team is important to optimize not only the patient's health but also to ensure quality of life after transplant. Adolescents can be especially challenging after transplant, given their complex and evolving psychosocial and cognitive development. Nurse practitioners are in a unique position to be central in adolescents' successful adaptation to their medical condition. Facilitating identification and management of medication-related side effects, awareness of emotional health and quality of life, adherence to the medical regimen, and eventual transition to adult caregivers all remain critically important steps in care that are ideally suited for advance practice leadership.
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Affiliation(s)
- Stacee M. Lerret
- Medical College of Wisconsin (SML), Children's Hospital of Wisconsin (SML, GS), Milwaukee
| | - Gail Stendahl
- Medical College of Wisconsin (SML), Children's Hospital of Wisconsin (SML, GS), Milwaukee
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Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA). Pediatr Nephrol 2011; 26:1753-7. [PMID: 21842231 DOI: 10.1007/s00467-011-1981-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/02/2011] [Indexed: 10/17/2022]
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Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA). Kidney Int 2011; 80:704-7. [PMID: 21832978 DOI: 10.1038/ki.2011.209] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The transfer of young patients from pediatric to adult renal care takes place after a transition process which involves both sides. It is important that it is individualized for each young person, focusing on self-management skills as well as assessing support structures. The consensus statement has been developed by the panel of adult and pediatric nephrologists and endorsed by the councils of both ISN and IPNA. It is hoped that the statement will provide a basis for the development of locally appropriate recommendations for clinical practice.
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Camfield P, Camfield C. Transition to adult care for children with chronic neurological disorders. Ann Neurol 2011; 69:437-44. [DOI: 10.1002/ana.22393] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/02/2011] [Accepted: 02/07/2011] [Indexed: 11/11/2022]
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