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Yap NYS, Patil P, Phoenix C, Russell KB, Lewis C, Yates R, Kelsall W. Successful transition for adolescent survivors of CHD: the Cambridge cardiac transition pathway. Cardiol Young 2023; 33:2639-2643. [PMID: 37127728 DOI: 10.1017/s1047951123000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE National standards to ensure effective transition and smooth transfer of adolescents from paediatric to adult services are available but data on successful transition in CHD are limited. The aim of this study is to assess the effectiveness of our transition pathway. METHODS Adolescents with CHD, aged 15-19 years, who attended the joint cardiac transition clinic between 2009 and 2018 were identified from the Patient Administration Systems. Patient attendance at their first adult CHD service appointment at Royal Papworth Hospital was recorded. RESULTS 179 adolescents were seen in the joint cardiac transition clinic in the 9-year study period. The median age of the patients when seen was 16 (range 15-19) years. 145 patients were initially planned for transfer to the Royal Papworth Hospital adult CHD service. Three patients were subsequently excluded and the success of the transfer of care in 142 patients were analysed. 112 (78%) attended their first follow-up in the adult CHD clinic as planned, 28 (20%) attended after reminders were sent out with 5/28 requiring multiple reminders, and only 2 (1.4%) failed to attend. Overall, transfer of care was achieved in 140 (98.6%) patients. CONCLUSION A dedicated joint cardiac transition clinic involving multi-professional medical and nursing teams from paediatric and adult cardiology services appears to achieve high engagement rates with the adult services. This approach allows a 'face' to be put on a named clinician delivering the adult service and should be encouraged.
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Affiliation(s)
- Norah Y S Yap
- Department of Paediatric Cardiology, University Hospital Southampton, Tremona Road, SouthamptonSO16 6YD, England, UK
| | - Parth Patil
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
| | - Carole Phoenix
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, CambridgeCB23 3RE, England, UK
| | - Katie Bradly Russell
- Department of Paediatrics, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
| | - Clive Lewis
- Department of Cardiology, Royal Papworth Hospital, Papworth Everard, CambridgeCB23 3RE, England, UK
| | - Robert Yates
- Department of Cardiology, Great Ormond Street Hospital, Great Ormond Street, LondonWC1N 3JH, England, UK
| | - Wilf Kelsall
- Department of Paediatrics, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, England, UK
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Katz AJ, Lyon S, Farrell AG, Srivastava N, Wilkinson TA, Shew ML. Adolescent Women with Congenital Heart Disease: Self-Reported Reproductive Health Discussions with Health Care Providers. J Pediatr Adolesc Gynecol 2022; 35:299-304. [PMID: 34999230 PMCID: PMC9149112 DOI: 10.1016/j.jpag.2021.12.013] [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: 02/15/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE This study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). DESIGN Data were collected through a one-time survey of AYA women. SETTING Participants were recruited from pediatric cardiology clinics. PARTICIPANTS AYA women with CHD, ages 14-21 (N = 107) INTERVENTIONS: None MAIN OUTCOME MEASURES: Questionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. RESULTS Mean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. CONCLUSIONS AYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.
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Affiliation(s)
- Amy J Katz
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shannon Lyon
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne G Farrell
- Department of Pediatric Cardiology, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Nayan Srivastava
- Department of Pediatric Cardiology, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Tracey A Wilkinson
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marcia L Shew
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Morisaki-Nakamura M, Suzuki S, Kobayashi A, Kita S, Sato I, Iwasaki M, Hirata Y, Sato A, Oka A, Kamibeppu K. Efficacy of a Transitional Support Program Among Adolescent Patients With Childhood-Onset Chronic Diseases: A Randomized Controlled Trial. Front Pediatr 2022; 10:829602. [PMID: 35433550 PMCID: PMC9010051 DOI: 10.3389/fped.2022.829602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
It is recommended that patients with childhood-onset chronic diseases (CCD) be transferred from pediatric to adult healthcare systems when they reach adulthood. Transitional support helps adolescents with CCD transition smoothly. Transition readiness is one of the key concepts to assess the efficacy of transitional support programs. This study aims to investigate the effect of a transitional support program on transition readiness, self-esteem, and independent consciousness among Japanese adolescents with various CCD using a randomized controlled trial. Adolescents with CCD aged 12-18 years participated in a randomized controlled trial evaluating the efficacy of a transitional support program. The patients in the intervention group visited transitional support outpatient clinics twice. They answered questionnaires regarding their disease and future perspectives to healthcare professionals and independently made a short summary of their disease. All the participants answered the questionnaires four times. Eighty patients participated in this study. Among those in the intervention group, transition readiness within one, three, and 6 months after interventions, and self-esteem within 1 month after interventions were higher than that of the control group. The scores on the "dependence on parents" subscale at 6 months after interventions were lower for the intervention group as compared to the control group. This program is expected to help patients transition smoothly from pediatric to adult healthcare systems.
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Affiliation(s)
- Mayumi Morisaki-Nakamura
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seigo Suzuki
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatric Nursing, Tokyo Medical University, Tokyo, Japan
| | - Asuka Kobayashi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Iwasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Sato
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Oka
- Saitama Children’s Medical Center, Saitama, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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López Barreda R, Bernales M, Guerrero A, de la Cuadra JC, Baraona F, Macdonald J. Psychological Well-Being in Adult Patients Suffering From Congenital Heart Disease: A Salutogenic Approach From a Chilean Experience. Qual Manag Health Care 2022; 31:49-51. [PMID: 33470776 DOI: 10.1097/qmh.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rodrigo López Barreda
- Assistant Professor, Department of Anaesthesia, Pontificia Universidad Católica de Chile, Macul, Santiago de Chile
| | - Margarita Bernales
- Assistant Professor, Faculty of Medicine, Pontificia Universidad Católica de Chile, Macul, Santiago de Chile,
| | - Alonso Guerrero
- Research Assistant, School of Medicine, Pontificia Universidad Católica de Chile, Macul, Santiago de Chile
| | | | - Fernando Baraona
- Assistant Professor, Department of Cardiology, Pontificia Universidad Católica de Chile, Macul, Santiago de Chile, Department of Cardiology, Instituto Nacional del Tórax, Santiago, Chile
| | - John Macdonald
- Emeritus Professor and Founding Chair in Primary Health Care, Western Sydney University, Richmond, New South Wales, Australia
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Zentner D, Celermajer DS, Gentles T, d’Udekem Y, Ayer J, Blue GM, Bridgman C, Burchill L, Cheung M, Cordina R, Culnane E, Davis A, du Plessis K, Eagleson K, Finucane K, Frank B, Greenway S, Grigg L, Hardikar W, Hornung T, Hynson J, Iyengar AJ, James P, Justo R, Kalman J, Kasparian N, Le B, Marshall K, Mathew J, McGiffin D, McGuire M, Monagle P, Moore B, Neilsen J, O’Connor B, O’Donnell C, Pflaumer A, Rice K, Sholler G, Skinner JR, Sood S, Ward J, Weintraub R, Wilson T, Wilson W, Winlaw D, Wood A. Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement. Heart Lung Circ 2020; 29:5-39. [DOI: 10.1016/j.hlc.2019.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
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