1
|
Harrison DJ, Uzark K, Gauvreau K, Yu S, Lowery R, Yetman AT, Cramer J, Rudd N, Cohen S, Gurvitz M. Transition readiness in congenital heart disease: Are teens and young adults getting the recommended information? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2021.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
2
|
Brennan M, Uveges MK. Ethical Issues in the Care of Emerging Adults in Pediatric Intensive Care Units. AACN Adv Crit Care 2021; 32:219-226. [PMID: 34161968 DOI: 10.4037/aacnacc2021949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary Brennan
- Mary Brennan is a Registered Nurse, Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| |
Collapse
|
3
|
Uzark K, Afton K, Yu S, Lowery R, Smith C, Norris MD. Transition Readiness in Adolescents and Young Adults with Heart Disease: Can We Improve Quality of Life? J Pediatr 2019; 212:73-78. [PMID: 31182220 DOI: 10.1016/j.jpeds.2019.04.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We previously reported common knowledge deficits and lack of transition readiness in 13- 25-year-olds with congenital or acquired heart disease. The aims of this study were to re-evaluate transition readiness in this cohort at follow-up and to examine the relationship between changes in transition readiness and quality of life (QOL). STUDY DESIGN In this prospective cohort study, patients completed the Transition Readiness Assessment and the Pediatric Quality of Life Inventory using an e-tablet, web-based format at a routine follow-up visit. Changes from initial to follow-up scores were evaluated. RESULTS Sixty-five percent of patients (106 of 164) completed follow-up assessments at a median age of 18.7 years (IQR, 16.5-21.2 years) at a median follow-up of 1 year. The average perceived knowledge deficit score (percent of items with no knowledge) at follow-up was 18.0 ± 15.2%, which decreased from 24.7 ± 16.5% (P < .0001). On a 100-point scale, the mean score for self-efficacy increased from 71.4 ± 17.0 to 76.7 ± 18.2 (P = .0004) and for self-management increased from 47.9 ± 18.4 to 52.0 ± 20.7 (P = .004). Although physical QOL did not change, the mean psychosocial QOL score increased significantly (P = .02). A decrease in the knowledge deficit score at follow-up was significantly associated with an increased psychosocial QOL score (P = .03). An increase in the self-efficacy score was associated with an increase in psychosocial QOL score (P = .04), especially social QOL (P = .02). CONCLUSIONS Although deficits in knowledge and self-management skills persist, transition readiness assessment and recognition of deficits can improve transition readiness with improved psychosocial QOL.
Collapse
Affiliation(s)
- Karen Uzark
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI; Department of Cardiac Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, MI.
| | - Katherine Afton
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Sunkyung Yu
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Ray Lowery
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Cynthia Smith
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Mark D Norris
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| |
Collapse
|
4
|
Abstract
Purpose of the Review The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. Recent Findings With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers. Summary The effective build of an ACHD program requires measured escalation in management of ACHD complexity matched with cultivation of key resources and clinical services ranging from congenital cardiac surgery and interventional cardiology to acquired heart disease as well as partnerships with non-cardiac specialists. By reframing ACHD care as a shared goal between patients, providers, hospitals, pharmaceutical and device industry, and payers, a potent business model can be built around the developing ACHD program to facilitate acquisition of these key resources.
Collapse
|
5
|
|
6
|
Bare I, Crawford J, Pon K, Farida N, Dehghani P. Frequency and Consequences of Influenza Vaccination in Adults With Congenital Heart Disease. Am J Cardiol 2018; 121:491-494. [PMID: 29310808 DOI: 10.1016/j.amjcard.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
Immunization against influenza is a critical, but perhaps underappreciated prevention of morbidity and mortality in the cardiac population. The purpose of the present study is to examine influenza vaccination rates in adults with congenital heart disease (ACHD). A secondary purpose is to explore whether there is an association between demographic, medical, and behavioral variables and receipt of the influenza vaccination. Of the 183 consecutive ACHD patients who were contacted, 123 responded to our telephone survey. Mean age was 38.4 ± 14.7, with the most common type of lesion complexity being moderate (65.3%), followed by simple (21.0%) and severe (13.7%). Overall, 53 respondents reported undergoing influenza vaccination in the previous season. Fifty-two percent of all subjects claimed they were notified of the benefits of vaccination by their physician. Univariate analysis revealed that older age (p = 0.006), female gender (p = 0.027), perceived susceptibility to influenza illness (p <0.001), perceived severity of the influenza illness (p <0.001), perceived benefits of the influenza vaccination (p <0.001), side effects from previous immunization (p = 0.006), and physician recommendation (p = 0.008) were predictors of receipt of influenza vaccination. On multivariate analyses, however, only side effects from previous immunization was a predictor (odds ratio = 0.34 [95% confidence interval 0.13 to 0.91]), whereas physician recommendation was numerically, but not statistically, significant (odds ratio 2.01 [95% confidence interval 0.85 to 4.78]). Our study demonstrated that less than 50% of ACHD population receives influenza vaccination. We believe educating both the patients about the side effects of vaccination and the physicians about their role in counseling ACHD patients will increase the vaccination rates in this high-risk population.
Collapse
|
7
|
Burström Å, Bratt EL, Frenckner B, Nisell M, Hanséus K, Rydberg A, Öjmyr-Joelsson M. Adolescents with congenital heart disease: their opinions about the preparation for transfer to adult care. Eur J Pediatr 2017; 176:881-889. [PMID: 28508990 PMCID: PMC5486562 DOI: 10.1007/s00431-017-2917-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/21/2016] [Accepted: 04/27/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED The aim of the study was to explore what adolescents with congenital heart disease (CHD) view as important in the preparation for the transfer to adult care. We performed interviews in four focus groups with adolescents (14-18 years old) at four university hospitals in Sweden. Data was analysed using qualitative content analysis. The analysis revealed one main category; Becoming a manager of the condition and four subcategories; Sufficient knowledge about the health, Be a participant in the care, Parental support, and Communicate with others about the health. The adolescents' ages differentiated the discussion in the groups. The older adolescents seemed to have more interest in transition planning, information and transfer. The younger described more frustrations about communication and handling the disease. CONCLUSION To become a manager of the CHD in daily life, the adolescents want disease specific knowledge, which should be communicated in a developmentally appropriate way. Adolescents want to participate and be involved in the transition process. They need support and guidance in how to communicate their CHD. Parental support is fundamental but it change over time. Moreover, peer-support is becoming more significant during the transition process. What is Known: • Transition during adolescence and transfer to adult care for adolescents with CHD is complex, and there is a shift in roles. • Adolescents often have poor knowledge and understanding about their heart condition and the consequences. What is New: • Adolescents call for disease specific information regarding health issues of importance for them in daily life. • Communicating the disease with other is a challenge- peer support from other adolescents with CHD could be a facilitator.
Collapse
Affiliation(s)
- Åsa Burström
- Institution for Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Department of Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Ewa-Lena Bratt
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden ,Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Björn Frenckner
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Margret Nisell
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,The Red Cross University College, Stockholm, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Maria Öjmyr-Joelsson
- Institution for Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Uzark K, Smith C, Donohue J, Yu S, Afton K, Norris M, Cotts T. Assessment of Transition Readiness in Adolescents and Young Adults with Heart Disease. J Pediatr 2015; 167:1233-8. [PMID: 26298627 DOI: 10.1016/j.jpeds.2015.07.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 07/10/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate transition readiness, including perceived knowledge deficits, self-efficacy, and self-management behaviors, in 13- to 25-year-olds with congenital heart disease or heart transplant and to examine the relationships between transition readiness assessment, information seeking behavior, and quality of life (QOL). STUDY DESIGN In this cross-sectional study, patients (n = 164) completed the Transition Readiness Assessment and the Pediatric Quality of Life Inventory using an e-tablet, web-based format at a routine clinic visit. RESULTS Median patient age was 18.1 years (range 13.0-25.5). Average perceived knowledge deficit score (% of items with no knowledge) was 25.7% (range 0%-75%). On a 100-point scale, the mean score was 72.0 ± 17.2 for self-efficacy and 49.7 ± 17.5 for self-management. Knowledge deficits were negatively correlated with self-efficacy (r = -0.45, P < .0001) and self-management (r = -0.36, P < .0001). Overall, 66% of patients requested information (73% ≥ 18 years old). Higher psychosocial QOL scores were correlated with lower knowledge deficit scores (r = -0.21, P = .01) and higher perceived self-efficacy scores (r = 0.41, P < .0001). CONCLUSIONS Transition knowledge deficits are common and associated with decreased self-efficacy and self-management skills in adolescents and young adults with heart disease. Greater transition knowledge and perceived self-efficacy are associated with better psychosocial QOL. Routine assessment of transition readiness is recommended to facilitate recognition of deficits and interventions to promote successful transition outcomes.
Collapse
Affiliation(s)
- Karen Uzark
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI; Department of Cardiac Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, MI.
| | - Cynthia Smith
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Janet Donohue
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Sunkyung Yu
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Katherine Afton
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Mark Norris
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| | - Timothy Cotts
- Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, MI
| |
Collapse
|
9
|
Disease-specific knowledge and information preferences of young patients with congenital heart disease. Cardiol Young 2014; 24:321-30. [PMID: 23628281 DOI: 10.1017/s1047951113000413] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS Persons suffering from congenital heart defects require lifelong specialist medical care. Failure to attend cardiological follow-up examinations and risky health behaviour in the transition phase may cause severe medical complications. A good level of disease-specific knowledge enhances compliance. Therefore, the study's aim was to investigate: (a) the level of disease-specific knowledge, (b) information preferences, and (c) sources of information for children, adolescents, and young adults regarding their illness. METHODS AND RESULTS In all, 596 patients, aged 10-30 years, participated in this cross-sectional survey study (response rate: 53%). All patients were already enrolled in the German National Register for Congenital Heart Defects. The main outcome measures included disease-specific knowledge, information preferences, and information sources regarding patients' individual cardiac condition. The patients demonstrated a major knowledge gap concerning their illness and how to live with it. For all three age groups, patients' information needs were unmet on nearly half of the topics of interest. Children's information needs were comparable to those of adolescents and adults concerning several important topics, for example, work/career, sports. Information preferences varied according to age and gender, rather than disease severity. The most important sources of information were physicians (71.0%), family and friends (58.2%), and the Internet (37.5%). CONCLUSION The study revealed substantial knowledge gaps, indicating a need for structured multidisciplinary patient education interventions. These interventions should start as early as in childhood and help patients manage their condition and assume responsibility for their own health, so that the transition phase runs smoothly.
Collapse
|
10
|
Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country. Cardiol Young 2013; 23:209-18. [PMID: 22717060 DOI: 10.1017/s1047951112000625] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters. MATERIALS AND METHODS The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires. RESULTS The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect. CONCLUSION Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.
Collapse
|
11
|
Rönning H, Nielsen NE, Strömberg A, Thilen U, Swahn E. Development and evaluation of a computer-based educational program for adults with congenitally malformed hearts. Eur J Cardiovasc Nurs 2012; 12:78-86. [DOI: 10.1177/1474515111432999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helén Rönning
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | | | | | | | - Eva Swahn
- Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Abstract
BACKGROUND More than 90% of infants born with congenital heart disease reach adulthood. International medical recommendations outline patient care needs in an effort to optimize patient health. There are, however, limited data focusing on the patient perspective. OBJECTIVES This study investigated adult congenital heart disease patient-reported (1) barriers to medical care, (2) healthcare behaviors, and (3) concerns regarding medical, psychosocial, and lifestyle matters. METHODS In this cross-sectional study, a questionnaire was distributed to all patients who attended a patient education conference. RESULTS There were 123 adult congenital heart disease participants (58% female; mean age, 37 [SD, 13] years). The most common self-reported cardiac diagnoses were tetralogy of Fallot and transposition of the great arteries. Most patients did not report transportation or financial barriers to care, but did report the following: not wanting further surgery even if it was recommended (18%), not liking to think or talk about one's heart (17%), and not understanding doctors' information; 8% of patients inaccurately considered themselves to be "cured." With regard to healthcare behaviors, more than 80% of patients reported annual family physician and dentist visits, but 34% of patients were unaware when to seek urgent medical attention. Patients reported moderate to extreme concern about the following medical topics: heart rhythm problems (82%), infections (74%), and understanding treatment options (71%). Patients most often reported moderate to extreme concern about the following lifestyle and psychosocial topics: physical activity (77%), insurance (72%), assuming increased health responsibility (73%), diet (71%), mental health (60%), and death and dying (57%). CONCLUSIONS This study provides important information about 3 specific areas. First, there are potential barriers to care beyond financial and transportation challenges. Second, many patients require education regarding when to seek urgent medical attention. Third, the concerns of this patient population are not limited to medical information. A patient-centered educational program is recommended.
Collapse
|
13
|
Rönning H, Nielsen NE, Swahn E, Strömberg A. Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts. PATIENT EDUCATION AND COUNSELING 2011; 83:247-251. [PMID: 20634025 DOI: 10.1016/j.pec.2010.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 06/10/2010] [Accepted: 06/12/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Various programmes for adults with congenitally malformed hearts have been developed, but detailed descriptions of content, rationale and goals are often missing. The aim of this study was to describe and make an initial evaluation of a follow-up model for adults with congenitally malformed hearts, focusing on education and psychosocial support by a multidisciplinary team (EPS). METHODS The model is described in steps and evaluated with regards to perceptions of knowledge, anxiety and satisfaction. RESULTS The EPS model included a policlinic visit to the physician/nurse (medical consultation, computer-based and individual education face-to-face as well as psychosocial support) and a 1-month telephone follow-up. Fifty-five adults (mean age 34, 29 women) with the nine most common forms of congenitally malformed hearts participated in the EPS model as well as the 3-months follow-up. Knowledge about congenital heart malformation had increased in 40% of the participants at the 3-months follow-up. CONCLUSION This study describes and evaluates a model that combines a multidisciplinary approach and computer-based education for follow-up of adults with congenitally malformed hearts. The EPS model was found to increase self-estimated knowledge, but further evaluations need to be conducted to prove patient-centred outcomes over time. PRACTICE IMPLICATIONS The model is now ready to be implemented in adults with congenitally malformed hearts.
Collapse
Affiliation(s)
- Helén Rönning
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden.
| | | | | | | |
Collapse
|
14
|
Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM, Graham TP, Gurvitz MZ, Kovacs A, Meadows AK, Reid GJ, Reiss JG, Rosenbaum KN, Sagerman PJ, Saidi A, Schonberg R, Shah S, Tong E, Williams RG. Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues. Circulation 2011; 123:1454-85. [DOI: 10.1161/cir.0b013e3182107c56] [Citation(s) in RCA: 317] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|