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Robinson PD, Jayasuriya G, Haggie S, Uluer AZ, Gaffin JM, Fleming L. Issues affecting young people with asthma through the transition period to adult care. Paediatr Respir Rev 2022; 41:30-39. [PMID: 34686436 DOI: 10.1016/j.prrv.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022]
Abstract
Asthma is among the most common medical conditions affecting children and young people, with adolescence a recognised period of increased risk, overrepresented in analyses examining recent increasing asthma mortality rates. Asthma may change significantly during this period and management also occurs in the context of patients seeking increased autonomy and self-governance whilst navigating increasing academic and social demands. A number of disease factors can destabilise asthma during adolescence including: increased rates of anaphylaxis, anxiety, depression, obesity, and, in females, an emerging resistance to corticosteroids and the pro-inflammatory effects of oestrogen. Patient factors such as smoking, vaping, poor symptom recognition, treatment non-adherence and variable engagement with health services contribute to difficult to treat asthma. Significant deficiencies in the current approach to transition have been identified by a recent EAACI task force, and subsequent asthma-specific recommendations, published in 2020 provide an important framework moving forward. As with other chronic conditions, effective transition programmes plan ahead, engage with adolescents and their families to identify the patients' management priorities and the current challenges they are experiencing with treatment. Transition needs may vary significantly across asthma patients and for more complex asthma may include dedicated transition clinics involving multidisciplinary care requiring input including, amongst others, allergy and immunology, psychological medicine, respiratory physicians and scientists and nurse specialists. Across different global regions, barriers to treatment may vary but need to be elicited and an individualised approach taken to optimising asthma care which is sustainable within the local adult healthcare system.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Dept of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart Haggie
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Department of Paediatrics, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Ahmet Z Uluer
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College, London UK; Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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Rajendran D, Beazley J, Bright P. Shared decision making by United Kingdom osteopathic students: an observational study using the OPTION-12 instrument. Chiropr Man Therap 2019; 27:42. [PMID: 31516693 PMCID: PMC6727529 DOI: 10.1186/s12998-019-0260-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background At the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner. Despite external pressures, studies indicate that SDM remains poorly practised across a variety of healthcare professions. The degree of SDM engagement within United Kingdom osteopathic undergraduate teaching clinics is currently unknown. Methods In 2014 we used the reliable and validated OPTION-12 (O12) instrument to calculate a score that reflected the degree of SDM utility in one United Kingdom Osteopathic Educational Institute’s teaching clinic. We also aimed to compare these scores with those previously obtained for physiotherapists working within the United Kingdom’s National Health Service. Student-patient initial and follow-up encounters were audio recorded, transcribed and scored using the O12. Comparisons between the following O12 scores were performed: the Osteopathic Educational Institute’s 4th and 3rd year students; the Osteopathic Educational Institute’s student’s initial and follow-up patient encounters; the Osteopathic Educational Institute’s students and National Health Service physiotherapists. Results We analysed 35.5 h of transcribed data from 30 student-patient encounters (7 initial: 23 follow-up). An O12 score of 0.6% (range 0–10.4%) was calculated. No significant differences were found between year groups or encounter types. Significant differences were found compared to National Health Service physiotherapist (score = 24.4%): (U = 144, z = 4.25, p < 0.0005); although both scores are below the 60% threshold for competent SDM behaviour. Conclusions Undergraduate osteopaths did not appear to engage in competent SDM behaviours, implying traditional and paternalistic styles of decision making that align with results from other manual therapy professions. Students in this study did not practise competent SDM behaviours. Effective educational strategies are required to ensure SDM behaviours reach competent levels.
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Affiliation(s)
- Dévan Rajendran
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
| | - Jane Beazley
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
| | - Philip Bright
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
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Kaur S, Singh V. Asthma and Medicines - Long-Term Side-Effects, Monitoring and Dose Titration. Indian J Pediatr 2018; 85:748-756. [PMID: 29306991 DOI: 10.1007/s12098-017-2553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/22/2017] [Indexed: 01/30/2023]
Abstract
Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential component of comprehensive asthma management programme. Monitoring includes not only assessment of asthma control but also checking for adherence to treatment, technique of inhaler device use, associated co-morbities, if any, and potential environmental exposure. Various tools - both subjective and objective - are available for assessment of asthma control. However, evidence for their optimum use in different settings and patient groups is lacking and monitoring has to be customized depending on available resources and individual patient characteristics. Patient education is an important component of long-term asthma therapy. The ultimate aim is to achieve optimum asthma control i.e., achieve and maintain control of clinical symptoms, decrease future risk to patients (risk of exacerbations, progressive loss of lung function and development of fixed airflow obstruction, adverse effects of medications) and enabling the child to lead a life without restrictions, at lowest possible dose of drugs. This article reviews the side-effects of medications used for long-term management of asthma and discusses current literature on asthma monitoring and dose titration in pediatric population to help the asthma therapist not only prescribe the drugs rationally but also help the family make right choices for treatment.
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Affiliation(s)
- Satnam Kaur
- Department of Pediatrics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
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van den Wijngaart LS, Roukema J, Merkus PJFM. Respiratory disease and respiratory physiology: putting lung function into perspective: paediatric asthma. Respirology 2015; 20:379-88. [PMID: 25645369 DOI: 10.1111/resp.12480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/03/2014] [Accepted: 08/03/2014] [Indexed: 01/27/2023]
Abstract
Dealing with paediatric asthma in daily practice, we are mostly interested in the airway function: the hallmark of asthma is the variability of airway patency. Various pulmonary function tests (PFT) can be used to quantify airway caliber in asthmatic children. The choice of the test is based on the developmental age of the child, knowledge of the diagnosis/underlying pathophysiology, clinical questions and reasoning, and treatment. PFT is performed to monitor the severity of asthma and the response to therapy, but can also be used as a diagnostic tool, and to study growth and development of the lungs and airways. This review aims to provide clinicians an overview of the differences in assessing PFT in infants and preschool children compared with older cooperative children, which tests are feasible in infants and young children, the limitations of and usefulness of these tests, and of their interpretation in these age groups.
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Affiliation(s)
- Lara S van den Wijngaart
- Department of Pediatrics, Division of Respiratory Medicine, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
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van den Wijngaart LS, Roukema J, Merkus PJFM. The value of spirometry and exercise challenge test to diagnose and monitor children with asthma. Respirol Case Rep 2015; 3:25-8. [PMID: 25802746 PMCID: PMC4364795 DOI: 10.1002/rcr2.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/26/2014] [Accepted: 12/09/2014] [Indexed: 11/23/2022] Open
Abstract
Asthma is defined as a chronic inflammatory disease of the airways with characteristic symptoms including recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It may result in abnormalities of ventilator function, which can be assessed by different pulmonary function tests. In this case report, we present a 15-year-old boy with asthma and illustrate the value and limitations of spirometry and exercise challenge test in daily practice.
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Affiliation(s)
- Lara S van den Wijngaart
- Department of Pediatrics, Division of Respiratory Medicine, Radboud University Medical Centre, Amalia Children's HospitalNijmegen, The Netherlands
- Correspondence, Lara S. van den Wijngaart, Radboud University Medical Centre, Amalia Children's Hospital, PO 9101, Nijmegen 6500 HB, The Netherlands. E-mail:
| | - Jolt Roukema
- Department of Pediatrics, Division of Respiratory Medicine, Radboud University Medical Centre, Amalia Children's HospitalNijmegen, The Netherlands
| | - Peter JFM Merkus
- Department of Pediatrics, Division of Respiratory Medicine, Radboud University Medical Centre, Amalia Children's HospitalNijmegen, The Netherlands
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Dooley JM, Gordon KE, Brna PM, Wood EP, Mohamed IS, MacDonald E, Jackson-Tarlton C. What do patients and families want from a child neurology consultation? J Child Neurol 2014; 29:1699-703. [PMID: 24346316 DOI: 10.1177/0883073813511857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding what patients and their parents want is essential to plan appropriate patient-centered care. Questionnaires were distributed to 500 consecutive children and parents seen for their first pediatric neurology consultation. Both patients and their families answered questions about their expectations of the consultation, their level of worry, and the Penn State Worry Questionnaire. The 5 most important issues for the parents were to get information, to work with the doctor to manage the problem, to have questions answered, to find out what was wrong, and to discuss the impact on the child's life. The children had very similar priorities. The 5 least important concerns for parents were to get a prescription, blood tests, to talk to others with similar problems, to get a radiograph/computed tomography/magnetic resonance imaging (MRI) and to be told nothing is wrong. The pediatric neurologists did well in anticipating these priorities but had more difficulty appreciating parent and patient level of worry.
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Affiliation(s)
- Joseph M Dooley
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kevin E Gordon
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paula M Brna
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ellen P Wood
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ismail S Mohamed
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erin MacDonald
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caitlin Jackson-Tarlton
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
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Koehler U, Hildebrandt O, Nell C, Alakhras R, Nikolaizik W, Weissflog A, Hoehle L, Sohrabi K, Totta L, Gross V. Akustisches Langzeit-Monitoring von Atem- und Lungengeräuschen im Schlaf. SOMNOLOGIE 2014. [DOI: 10.1007/s11818-014-0685-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karnieli-Miller O, Zisman-Ilani Y, Meitar D, Mekori Y. The role of medical schools in promoting social accountability through shared decision-making. Isr J Health Policy Res 2014; 3:26. [PMID: 25075274 PMCID: PMC4114098 DOI: 10.1186/2045-4015-3-26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
Reducing health inequalities and enhancing the social accountability of medical students and physicians is a challenge acknowledged by medical educators and professionals. It is usually perceived as a macro-level, community type intervention. This commentary suggests a different approach, an interpersonal way to decrease inequality and asymmetry in power relations to improve medical decisions and care. Shared decision-making practices are suggested as a model that requires building partnership, bi-directional sharing of information, empowering patients and enhancing tailored health care decisions. To increase the implementation of shared decision-making practices in Israel, an official policy needs to be established to encourage the investment of resources towards helping educators, researchers, and practitioners translate and integrate it into daily practice. Special efforts should be invested in medical education initiatives to train medical students and residents in SDM practices.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Zisman-Ilani
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoseph Mekori
- Dean, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
The adolescent with asthma experiences a period of physical and psychosocial changes that affect their health and well-being. Overall, adolescents with asthma are at increased risk for asthma morbidity and death. Increased rates of depression and anxiety, for the adolescent and their caregivers, can lead to non-adherence to their medical regimens, poor symptom control, and poor treatment outcomes. Contextual factors, such as race, ethnicity, and living situation, affect the prevalence, morbidity, and mortality for the adolescent with asthma. These factors also affect the transition process for adolescents entering adult medical care. An overview is presented of how the adolescent with asthma differs and how healthcare providers can promote effective asthma management and better asthma control.
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Affiliation(s)
- Matthew J Bitsko
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA; Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA.
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Bruce K Rubin
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
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Zullig LL, Shaw RJ, Crowley MJ, Lindquist J, Grambow SC, Peterson E, Shah BR, Bosworth HB. Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circ Cardiovasc Qual Outcomes 2013; 6:619-25. [PMID: 24221839 DOI: 10.1161/circoutcomes.113.000435] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence. METHODS AND RESULTS Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence. CONCLUSIONS Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
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