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Padley N, Moubayed D, Lanteigne A, Ouimet F, Clermont MJ, Fournier A, Racine E. Transition from Paediatric to adult health services: Aspirations and practices of human flourishing. Int J Qual Stud Health Well-being 2023; 18:2278904. [PMID: 37994797 PMCID: PMC11000676 DOI: 10.1080/17482631.2023.2278904] [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] [Received: 02/13/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths. METHODS Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing. RESULTS 54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy). DISCUSSION AND CONCLUSION The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.
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Affiliation(s)
- Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Dina Moubayed
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amélie Lanteigne
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Marie-José Clermont
- Département de pédiatrie, CHU Sainte-Justine, Montréal, Québec, Canada
- Département de pédiatrie, Université de Montréal, Montréal, QC, Canada
| | - Anne Fournier
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, QC, Canada
- Department of Medicine (Division of Experimental Medicine), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, 3801 Rue University, Montréal, QC, Canada
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Morsa M. [History and challenges of the transition from pediatrics to adult care]. SOINS. PEDIATRIE, PUERICULTURE 2023; 44:12-15. [PMID: 37980154 DOI: 10.1016/j.spp.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Transition from pediatrics to adult care involves a growing number of young people living with chronic health conditions. Now a field of study and practice, transition has been built up in successive stages, the nature of which informs us about its evolution and current issues.
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Affiliation(s)
- Maxime Morsa
- Département de psychologie, unité de recherche adaptation, résilience et changement (ARCh), université de Liège, place des Orateurs, 1-B33, 4000 Liège, Belgique.
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3
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Alderson E, Lally S, Campbell M. Transition for adolescents with learning disabilities and an immunodeficiency. Front Immunol 2023; 14:1211872. [PMID: 37781398 PMCID: PMC10533907 DOI: 10.3389/fimmu.2023.1211872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Many adolescents with immunodeficiency are diagnosed with a comorbid learning disability. The process of transition from paediatric to adult healthcare for these individuals occurs with a range of additional challenges. Due to the lack research available on immunodeficiency specifically, this article addresses a number of recommendations from the research undertaken with individuals with other chronic health conditions and learning disability. The research suggests that for individuals with learning disabilities autonomy and independence needs to be acknowledged despite their perceived need for increased input from parents and medical professionals. Instead, medical professionals could prioritise their relationship with the adolescent patient by ensuring communication needs are met and that a sense of continuity between paediatric and adult services is maintained. Families can be supported through psychological interventions which provide skills to allow family members to empower their young adult with a learning disability. Specific tools to help the transition process run more smoothly are also recommended and have proven to be effective in other parts of the world.
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Affiliation(s)
- Eliška Alderson
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom
| | - Sarah Lally
- Acute Liaison – Learning Disabilities, Royal Free Hospital, London, United Kingdom
| | - Mari Campbell
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom
- University College London (UCL) Institute of Immunity & Transplantation, London, United Kingdom
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4
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Lara-Macaraeg BR, Cardinal A, Bermejo BG. Transition readiness of adolescents to adult health care. Front Pediatr 2023; 11:1204019. [PMID: 37587976 PMCID: PMC10426738 DOI: 10.3389/fped.2023.1204019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Background Transition in health care is a process wherein adolescents gradually prepare for and shift towards care in the adult system. An initial assessment of the readiness of these adolescents is fundamental in providing appropriate health services for them. This paper aims to determine the readiness of adolescent patients towards transitioning to adult care. Methods This is a prospective cross-sectional study utilizing an interviewer-guided modified Transition Readiness Assessment Questionnaire (TRAQ). Sixty-three adolescents ages 15 to 18 years seen in the Pediatric Outpatient Department (OPD) of a tertiary hospital in Baguio City from July 1 to October 31, 2020 were enrolled. Frequency and percentages were used to describe the demographic data; while mean score and standard deviation determined readiness based on a Likert scale. One-way ANOVA was utilized to determine association between factors and readiness to transition. Results For all domains of TRAQ, the mean score was 3.64, implying that they are not yet ready to transition. 49.2% belong to General Pediatrics. 44.4% belong to the Igorot ethnic groups. Most are still in High school, and majority of their parents finished High School level. Furthermore, the P-values were more than 0.05 for all variables suggesting no association between readiness to transition and the identified factors in this study. Discussion This study showed that adolescents who had both acute and chronic illnesses, were not yet ready to transition. Provision of a platform for assisting the adolescents in their assumption of bigger roles/responsibilities for their own health care is necessary to ensure proper transitioning to adult health care.
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Affiliation(s)
| | - Avegail Cardinal
- Department of Pediatrics, Baguio General Hospital and Medical Center, Baguio, Philippines
| | - Berith Grace Bermejo
- Department of Pediatrics, Baguio General Hospital and Medical Center, Baguio, Philippines
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5
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MacNeill L, Doucet S, Luke A. Caregiver experiences with transitions from pediatric to adult healthcare for children with complex care needs. Child Care Health Dev 2022; 48:800-808. [PMID: 35187705 DOI: 10.1111/cch.12989] [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: 08/06/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caring for a youth with complex care needs (CCN) who is transitioning from paediatric to adult healthcare can produce many challenges. For example, caregivers must often manage their youth's care at home, coordinate care and advocate for their youth. Experiences of fragmented and uncoordinated care often result in caregivers feeling ill-prepared and uncertain about the transition process. The current study explores caregiver experiences with the transition from paediatric to adult healthcare for youth with CCN in a semi-rural Canadian province. METHODS This study used a cross-sectional qualitative descriptive design, involving semi-structured interviews with caregivers of youth with CCN who were preparing for, in the process of, or completed a transition from paediatric to adult healthcare within the province of New Brunswick, Canada. Thematic analysis focused on describing caregiver experiences with the transition from paediatric to adult healthcare. RESULTS Seventeen caregivers completed interviews for this study. Four key themes emerged relating to caregiver experiences with the transition from paediatric to adult healthcare for these youth: (1) lack of caregiver support, (2) lack of continuity of care, (3) need for collaborative care and (4) difficulty navigating transition. CONCLUSION There is a clear need to address the challenges experienced by youth with CCN and their caregivers throughout the transition from paediatric to adult healthcare. An effective transition strategy should involve early and coordinated planning between the paediatric and adult care team; continued communication across the care team throughout the transition process; and coordination among health, education and social services.
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Affiliation(s)
- Lillian MacNeill
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Transition of Chronic Pediatric Nephrological Patients to Adult Care Excluding Patients on Renal Replacement Therapy with Literature Review. CHILDREN 2022; 9:children9070959. [PMID: 35883943 PMCID: PMC9317370 DOI: 10.3390/children9070959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The transition of children with chronic kidney disease to adult care has become a well-handled issue. However, other patients with normal or mildly decreased renal function also requiring further management and transition are neglected. (2) Methods: A questionnaire was sent to patients with kidney pathology, aged 17 years and older.(3) Results: The patients were mostly high-school (55%) or college students (39%), living with their parents (94%). One third did not know how their disease affected their choice of profession and reproductive health. Furthermore, 46% of the respondents did not know who would continue with their care, and 44% still had a primary pediatrician. (4) Conclusions: A review of the literature on the topic was performed and summarized here. Regular education is the key for successful transfer, not only in chronic kidney and transplant patients, but also in others in whom a decline in renal function can be expected in the future.
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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8
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Jefferies M, Peart T, Perrier L, Lauzon A, Munce S. Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review. Front Pediatr 2022; 10:782104. [PMID: 35386256 PMCID: PMC8978581 DOI: 10.3389/fped.2022.782104] [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] [Received: 09/23/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND With current medical advancements, more adolescents with neurodevelopmental disorders are transitioning from child- to adult-centred health care services. Therefore, there is an increasing demand for transitional services to help navigate this transition. Health care transitions can be further complicated by mental health challenges prevalent among individuals with cerebral palsy (CP), spina bifida (SB), and childhood onset acquired brain injury (ABI). Offering evidence-based psychological interventions for these populations may improve overall outcomes during transition period(s) and beyond. The objective of this scoping review is to identify key characteristics of psychological interventions being used to treat the mental health challenges of adolescents and adults with CP, SB, and childhood onset ABI. METHODS Methodological frameworks by Arksey and O'Malley, and Levac and colleagues were used to explore studies published between 2009 and 2019. Included studies were required to be written in English and report on a psychological intervention(s) administered to individuals at least 12 years of age with a diagnosis of CP, SB, or childhood onset ABI. All study designs were included. RESULTS A total of 11 studies were identified. Of these, eight reported psychological interventions for childhood onset ABI, while three reported on CP. No studies reporting on SB were identified. Commonly used interventions included acceptance and commitment therapy (ACT), psychotherapy, and cognitive behavioral therapy (CBT). CONCLUSIONS There are a limited number of studies investigating psychological interventions for individuals with childhood onset ABI and CP, and none for individuals with SB. Further research into effective psychological interventions for these populations will improve mental health outcomes and transitional services.
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Affiliation(s)
- Morgan Jefferies
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Taylor Peart
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Andrea Lauzon
- LIFESpan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
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9
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Lanteigne A, Genest M, Racine E. The evaluation of pediatric-adult transition programs: What place for human flourishing? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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10
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Song G, Wang R, Cui Y, Hao CJ, Xia HF, Ma X. Diethylhexyl phthalate induces teratogenic effects through oxidative stress response in a chick embryo model. Toxicol Res (Camb) 2020; 9:622-631. [PMID: 33178422 DOI: 10.1093/toxres/tfaa058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/05/2020] [Accepted: 07/11/2020] [Indexed: 11/14/2022] Open
Abstract
Diethylhexyl phthalate (DEHP) is known as a persistent environmental pollutant. However, the possible effects of DEHP on human neural tube defects (NTDs) remain elusive. We set out to investigate the exposure of DEHP in human and explore the association of DEHP and NTDs. The level of DEHP in maternal urine was measured and analyzed by GC-MS. To further validate the results in human NTDs, chick embryos were used as animal models. Viability, reactive oxygen species (ROS) level, oxidative stress indicators and apoptosis were detected in DEHP-treated chick embryos. Our research revealed that the detection ratio of positive DEHP and its metabolites in maternal urine were observed dramatically higher in NTDs population than that in normal controls (P < 0.01, P < 0.05, respectively). Moreover, DEHP treatment (10-6 M) led to developmental toxicity in chick embryos via accelerating oxidative stress response and cell apoptosis, and changing the level of oxidative stress-related indicators. Moreover, high dose choline (100 μg/μl) could partially restrain the toxicity effects induced by DEHP. Our data collectively imply that the incidence of NTDs may closely associate with DEHP exposure, which disturbs the development of neural tubes by enhancing oxidative stress.
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Affiliation(s)
- Ge Song
- Reproductive and Genetic Center of National Research Institute for Family Planning, Da Hui Si Road, Beijing 100081, China
| | - Rui Wang
- Department of Blood Transfusion, First medical center, Chinese People's Liberation Army General Hospital, Fu Xing Road, Beijing 100853, China
| | - Yi Cui
- Reproductive and Genetic Center of National Research Institute for Family Planning, Da Hui Si Road, Beijing 100081, China
| | - Chan Juan Hao
- Reproductive and Genetic Center of National Research Institute for Family Planning, Da Hui Si Road, Beijing 100081, China
| | - Hong-Fei Xia
- Reproductive and Genetic Center of National Research Institute for Family Planning, Da Hui Si Road, Beijing 100081, China
| | - Xu Ma
- Reproductive and Genetic Center of National Research Institute for Family Planning, Da Hui Si Road, Beijing 100081, China
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11
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Wagner L, Frisch M, Turner-Brown L, Andrews S, Edwards A, Moultrie R, Alvarez Rivas A, Wheeler A, Raspa M. Preferences for the research use of electronic health records among young adults with fragile X syndrome or autism spectrum disorder. Disabil Health J 2020; 13:100927. [PMID: 32360031 PMCID: PMC7541430 DOI: 10.1016/j.dhjo.2020.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health researchers are increasingly using electronic health records (EHRs) to study the health care needs of people with neurodevelopmental disorders (NDDs). However, little is known about the preferences of people with NDDs for sharing EHRs for research. OBJECTIVE To explore preferences for sharing EHRs for research among young adults ages 18-40 who make their own legal decisions and who have autism spectrum disorder (ASD), fragile X syndrome (FXS), or no NDDs. METHODS We conducted a qualitative study with seven focus groups: 2 ASD groups, 3 FXS groups, and 2 no-NDD groups. We asked participants about factors that could affect their willingness to share their EHRs for research: type of organization, type of information, study purpose, duration, contact frequency, return of results, benefits, and risks. We analyzed the qualitative data using directed content analysis. RESULTS Participants with NDDs valued personally relevant and directly beneficial EHR research. Participants with NDDs expressed willingness to share sensitive data if the study was personally relevant. Most participants wanted to receive results, but only participants with FXS indicated it would affect their willingness to participate. Participants were concerned about privacy risks, discrimination, researcher misconduct, and financial conflicts of interest. CONCLUSION This study provides initial evidence suggesting that young adults with NDDs prefer EHR research that is personally relevant, benefits themselves and their communities, and is conducted in the context of trusting, reciprocal participant-researcher relationships. The findings point to the need for researchers to improve the informed consent process and to better engage individuals with NDDs in research.
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Affiliation(s)
- Laura Wagner
- RTI International, Research Triangle Park, NC, United States.
| | - MaryKate Frisch
- University of North Carolina TEACCH Autism Program, Chapel Hill, NC, United States.
| | - Lauren Turner-Brown
- University of North Carolina TEACCH Autism Program, Chapel Hill, NC, United States.
| | - Sara Andrews
- RTI International, Research Triangle Park, NC, United States.
| | - Anne Edwards
- RTI International, Research Triangle Park, NC, United States.
| | | | - Alexandra Alvarez Rivas
- University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC, United States.
| | - Anne Wheeler
- RTI International, Research Triangle Park, NC, United States.
| | - Melissa Raspa
- RTI International, Research Triangle Park, NC, United States.
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12
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Bogossian A, Majnemer A, Racine E. Contextualized Autonomy in Transitional Care for Youth With Neurologic Conditions: The Role of the Pediatric Neurologist. J Child Neurol 2020; 35:536-542. [PMID: 32338583 DOI: 10.1177/0883073820918454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with neurologic conditions experience multiple life transitions. The transfer from pediatric to adult health care systems exemplifies one such complex and multifaceted transition that occurs in parallel with developmental, legal, and social changes that may influence the roles and responsibilities of youth and their caregivers. As a result, ethical situations, questions, and challenges may surface in transition care to which pediatric neurologists may be confronted. In this article, we focus on the topic of autonomy and situations that may arise in transition care in the context of pediatric neurology. Building from a clinical case, we present the concept of contextualized autonomy to work through the questions that arise in the case and propose ways of thinking through those challenging situations in transition care.
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Affiliation(s)
- Aline Bogossian
- School of Social Work, Faculty of Arts and Science, Université de Montréal, Pavillon Lionel-Groulx, Montréal, Quebec, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada.,Montreal Children's Hospital and RI-McGill University Health Centre & Centre for Interdisciplinary Research in Rehabilitation, Montréal, Quebec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Neurology and Neurosurgery, Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, Quebec, Canada
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13
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O'Connell A, Petty J. Preparing young people with complex needs and their families for transition to adult services. Nurs Child Young People 2020; 31:25-31. [PMID: 31468877 DOI: 10.7748/ncyp.2018.e1123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 11/09/2022]
Abstract
Improving survival rates for children and young people with complex health needs requires a robust system for transition to adult services. Effective planning is essential to ensure a smooth transition process that is in the best interests of the young person and their family. This article discusses the needs and requirements for planned and purposeful transition processes to support young people with complex healthcare needs and their families. It considers the preparation of adult services, the team, the young person and their parents in line with an integrated approach and the nurse's role. Recommendations for practice include the necessity for an integrated approach to ensure optimum outcomes and ascertaining the potential value of a nurse-led service in delivering the transition process. A carefully tailored planning strategy should be developed to prepare and support young people with complex health needs through transition.
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Affiliation(s)
| | - Julia Petty
- Children's nursing, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
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14
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Chabrol B, Milh M. Transition from paediatric to adult care in adolescents with neurological diseases and handicap. Rev Neurol (Paris) 2020; 176:37-42. [DOI: 10.1016/j.neurol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/16/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
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15
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Singh N, McDonald PJ. Transitioning in hydrocephalus: Current practices in Canadian Paediatric Neurosurgery centres. Paediatr Child Health 2018; 23:e150-e155. [PMID: 30374224 DOI: 10.1093/pch/pxy016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Advances in perinatal care in the developed world have resulted in more children living into adulthood with complex chronic health conditions. Transition is a process to improve and maximize the functional status of adolescents via the provision of adequate and appropriate health services in adulthood. This process is frequently disjointed, fragmented and inconsistent and inadequate transition increases morbidity, hospital admissions and urgent interventions. Ten thousand children are diagnosed with hydrocephalus annually in North America. Most survive to adulthood yet there are few transitioning programs and little research data on successful programs for this population. Methods An email survey of paediatric neurosurgical centres in Canada was carried out to establish current transition practices and attitudes for adolescents with hydrocephalus. Data were analyzed descriptively. Results Eleven out of 12 centres responded. The age of transition ranged from 16 to 18 years. Four centres have access to a dedicated Adult Hydrocephalus Clinic. Referral practices vary between centres and we highlight inconsistencies in care to this cohort of patients in Canada. There is little satisfaction among neurosurgeons with current transition arrangements in Canada. Several suggestions were made on how to improve this process. Conclusion We recommend research into the needs of patients with hydrocephalus in order to formalize appropriate standards for transitioning patients with a view to developing national guidelines to standardize the transition process. This will require input from patients, families and the wider medical and allied health professional groups.
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Affiliation(s)
- Navneet Singh
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia
| | - Patrick J McDonald
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia.,National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia
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16
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Freeman M, Stewart D, Cunningham CE, Gorter JW. "If I had been given that information back then": An interpretive description exploring the information needs of adults with cerebral palsy looking back on their transition to adulthood. Child Care Health Dev 2018; 44:689-696. [PMID: 29888473 DOI: 10.1111/cch.12579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young people with cerebral palsy (CP) and their families have identified lack of information received during the transition to adulthood as a barrier to successful outcomes. To date, few studies have explored the information needs, preferences, timing, and method of provision from the perspective of individuals with CP. METHOD The methodological approach to this qualitative study was interpretive description. Nine adults living with CP, between the ages of 20 and 40, were purposively recruited in Ontario, Canada, to explore, retrospectively, their information needs during the transition to adulthood. Participants completed a 1-hour interview that explored their experiences seeking and receiving information. Interviews were transcribed verbatim, and data were analysed to create a thematic description of adults' experiences with information. RESULTS Three themes emerged: (a) "Recognizing and supporting information needs," which highlighted the importance of support systems to assist young people in receiving and seeking information throughout the transition; (b) "Getting creative," which highlighted strategies young people use when confronted with environmental barriers when seeking information; and (c) "Gaps and advice for the future," which highlighted the need for real-life opportunities, during the transition to adulthood, to experience some of the responsibilities of adult life. CONCLUSION Clinicians assisting young people with CP need purposefully to foster knowledge and skills during the transition to adulthood. They should be not only providers of information but also enablers of opportunities for immersion in real-life experiences to prepare for adult life. It is important for young people to have the opportunity to discuss challenges and exchange information with their peers.
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Affiliation(s)
- M Freeman
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - D Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - C E Cunningham
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - J W Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Faculty of Health Sciences, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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17
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Bogossian A, Gorter JW, Racine E. Protocol for a scoping review about ethics in transition programmes for adolescents and young adults with neurodisabilities. BMJ Open 2018; 8:e020914. [PMID: 30121595 PMCID: PMC6104787 DOI: 10.1136/bmjopen-2017-020914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION As adolescents with neurodisabilities near adulthood, they and their caregivers will face the challenge of transferring from paediatric to adult healthcare systems. Despite the growing number of programmes designed to support healthcare transitions, little is known about practices that result in positive outcomes or how ethical issues are addressed. The objective of this review is to identify and document the ethical principles that may be embedded in the vision of transitional care programmes and to map ethical issues encountered in transitional care as well as the strategies employed to recognise and address these ethical issues. METHOD AND ANALYSIS We will document hidden and explicit ethical principles and issues from empirical studies on transition programmes for youth with neurodisabilities. An initial framework developed through a content extraction strategy will serve as a point of departure for data analysis and will be iteratively refined through our analytic process and with feedback from our stakeholders, including youth with neurodisabilities and their families. Findings will then be shared in different formats with health and social services professionals, healthcare decision and policymakers. DISSEMINATION Scoping review results will be shared at key conferences and disseminated in peer-reviewed publications as well as plain language summaries with stakeholders and the general public. Opportunities will be sought to discuss this project and its preliminary findings with partners in the paediatric, adult healthcare and rehabilitation communities comprising young people with neurodisabilities, their families, clinicians, programme managers and researchers.
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Affiliation(s)
- Aline Bogossian
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
- Faculté des études supérieures et postdoctorales (Programme de sciences neurologiques), Université de Montréal, Montréal, Quebec, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
- Département de médecine et Département de médecine sociale et préventive (Programmes de bioéthique), Université de Montréal, Montreal, Quebec, Canada
- Division of Experimental Medicine (Biomedical Ethics Unit), Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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18
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Paul M, O’Hara L, Tah P, Street C, Maras A, Ouakil DP, Santosh P, Signorini G, Singh SP, Tuomainen H, McNicholas F. A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services. BMC Med Ethics 2018; 19:73. [PMID: 30021635 PMCID: PMC6052672 DOI: 10.1186/s12910-018-0276-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. METHODS A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. RESULTS Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. CONCLUSIONS There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.
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Affiliation(s)
- Moli Paul
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Arden St, Stratford upon Avon, CV34 6NQ UK
| | - Lesley O’Hara
- Saint John of God Research Foundation clg, Stillorgan, Co. Dublin, Republic of Ireland
| | - Priya Tah
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Athanasios Maras
- Yulius Academie, Centrum voor Wetenschappelijk Onderzoek, Innovatie en Opleidingen, Dennenhout 1, 2994 GC Barendrecht, Netherlands
| | - Diane Purper Ouakil
- CHU Montpellier, Médecine Psychologique de l’Enfant et de l’Adolescent (MPEA1), Hôpital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Via Pilastroni 4, 25125 Brescia, Italy
| | | | - Helena Tuomainen
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Fiona McNicholas
- Lucena Clinic Rathgar , Dublin 6, Republic of Ireland
- University College Dublin, Belfield, Dublin 4, Republic of Ireland
- Our Lady’s Children Hospital Crumlin, Dublin 12, Republic of Ireland
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19
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The interface between child/adolescent and adult mental health services: results from a European 28-country survey. Eur Child Adolesc Psychiatry 2018; 27:501-511. [PMID: 29368253 DOI: 10.1007/s00787-018-1112-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/13/2018] [Indexed: 12/14/2022]
Abstract
Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20-30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.
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20
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Wassenberg T, Molero-Luis M, Jeltsch K, Hoffmann GF, Assmann B, Blau N, Garcia-Cazorla A, Artuch R, Pons R, Pearson TS, Leuzzi V, Mastrangelo M, Pearl PL, Lee WT, Kurian MA, Heales S, Flint L, Verbeek M, Willemsen M, Opladen T. Consensus guideline for the diagnosis and treatment of aromatic l-amino acid decarboxylase (AADC) deficiency. Orphanet J Rare Dis 2017; 12:12. [PMID: 28100251 PMCID: PMC5241937 DOI: 10.1186/s13023-016-0522-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023] Open
Abstract
Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare, autosomal recessive neurometabolic disorder that leads to a severe combined deficiency of serotonin, dopamine, norepinephrine and epinephrine. Onset is early in life, and key clinical symptoms are hypotonia, movement disorders (oculogyric crisis, dystonia, and hypokinesia), developmental delay, and autonomic symptoms.In this consensus guideline, representatives of the International Working Group on Neurotransmitter Related Disorders (iNTD) and patient representatives evaluated all available evidence for diagnosis and treatment of AADCD and made recommendations using SIGN and GRADE methodology. In the face of limited definitive evidence, we constructed practical recommendations on clinical diagnosis, laboratory diagnosis, imaging and electroencephalograpy, medical treatments and non-medical treatments. Furthermore, we identified topics for further research. We believe this guideline will improve the care for AADCD patients around the world whilst promoting general awareness of this rare disease.
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Affiliation(s)
- Tessa Wassenberg
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marta Molero-Luis
- Department of Clinical Biochemistry, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Kathrin Jeltsch
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Georg F. Hoffmann
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Birgit Assmann
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Nenad Blau
- Dietmar-Hopp Metabolic Center, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Angeles Garcia-Cazorla
- Department of Child Neurology, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Rafael Artuch
- Department of Clinical Biochemistry, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Roser Pons
- First Department of Pediatrics, Pediatric Neurology Unit, Agia Sofia Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Toni S. Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Vincenco Leuzzi
- Department of Pediatrics and Child Neuropsychiatry, Sapienza Università di Roma, Rome, Italy
| | - Mario Mastrangelo
- Department of Pediatrics and Child Neuropsychiatry, Sapienza Università di Roma, Rome, Italy
| | - Phillip L. Pearl
- Department of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, USA
| | - Wang Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Manju A. Kurian
- Developmental Neurosciences, UCL- Institute of Child Health and Department of Neurology, Great Ormond Street Hospital for Children NHS Foundations Trust, London, UK
| | - Simon Heales
- Laboratory Medicine, Great Ormond Street Hospital and Neurometabolic Unit, National Hospital, London, UK
| | | | - Marcel Verbeek
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department Laboratory Medicine, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Michèl Willemsen
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Thomas Opladen
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
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