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James S, Cudizio L, Ng SM, Lyons S, Maruthur NM, Araszkiewicz A, Gomber A, Snoek F, Toft E, Weissberg-Benchell J, de Beaufort C. Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals' experiences and perceptions. Diabetes Res Clin Pract 2024; 214:111768. [PMID: 38971378 DOI: 10.1016/j.diabres.2024.111768] [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: 04/05/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Youth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals' (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. METHODS Data were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. RESULTS Respondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer. Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). CONCLUSION HCPs' experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, Petrie, University of Melbourne, Parkville, and Western Sydney University, Campbelltown, Australia.
| | | | - Sze May Ng
- Edge Hill University, Liverpool, and Mersey and West Lancashire Teaching Hospitals National Health Service Trust, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Lyons
- Baylor College of Medicine, Houston, United States
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, United States
| | | | | | - Frank Snoek
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Toft
- Karolinska Institute, Solna, and Ersta Hospital, Stokholm, Sweden
| | | | - Carine de Beaufort
- University of Luxembourg, Luxembourg, and Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Gale J, Varndell W, James S, Perry L. Unscheduled emergency department presentations with diabetes: Identifying high risk characteristics. Australas Emerg Care 2023; 26:205-210. [PMID: 36528482 DOI: 10.1016/j.auec.2022.12.001] [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: 04/29/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Unscheduled emergency department (ED) presentation by patients with diabetes has seldom been examined. This study aimed to determine the frequency and associated characteristics of presentations in this population. METHODS Using a prospective cross-sectional design, data were collected from patients with diabetes presenting and/or admitted to a tertiary metropolitan hospital in New South Wales, Australia (December 2016-September 2017). A screening interview including brief measures of cognitive and executive function, and clinical details from healthcare records were utilised; details around unscheduled presentations within 90 days were extracted. Independent associations with ED presentation were determined. RESULTS Unscheduled ED presentations were common; 35.4% had at least one within 90 days, and for 20.1% this occurred within 28 days. The screening tool contributed little towards identifying risk of unscheduled presentation. Those attending any community or outpatient follow-up appointment within the first 28 (OR 0.42, 95% CI 0.23-0.76; p = 0.004) or 90 days (OR 0.25; 0.13-0.47; p < 0.001) from the index presentation were less likely to present within that same period. CONCLUSIONS Findings indicated the magnitude of unscheduled ED presentation, care complexity and the value of targeted and timely follow-up. Alternative service support may help maintain and improve diabetes self-management and will require effectiveness and cost-effectiveness evaluation.
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Affiliation(s)
- Julie Gale
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wayne Varndell
- Prince of Wales Hospital, Randwick, New South Wales, Australia; University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Steven James
- University of the Sunshine Coast, Petrie, Queensland, Australia; University of Melbourne, Parkville, Victoria, Australia.
| | - Lin Perry
- Prince of Wales Hospital, Randwick, New South Wales, Australia; University of Technology Sydney, Ultimo, New South Wales, Australia
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James S, Lowe J, Perry L. New opportunities to improve diabetes healthcare. Int J Nurs Pract 2023; 29:e13137. [PMID: 36724902 DOI: 10.1111/ijn.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Steven James
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia.,Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Julia Lowe
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Hansen BS, Dysvik E. Expanding the theoretical understanding in Advanced Practice Nursing: Framing the future. Nurs Forum 2022; 57:1593-1598. [PMID: 36352468 PMCID: PMC10098484 DOI: 10.1111/nuf.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
AIM We aimed to discuss the importance of the integration of nursing theories in advanced nursing to meet future demands. BACKGROUND Nursing studies reporting a lack of professional care have increased in recent years and indicate a global complex socioecological problem. The lack of a clear theoretical understanding in education, research and practice makes Advanced Practice Nursing invisible and vulnerable. DESIGN A theoretical paper was selected to stimulate vital reflexion and debate about the importance of theory integration. METHODS The selection of nursing theories represents the position of some theorists based on our experiences with national and international research and personal leadership in a master's degree program. IMPLICATIONS FOR NURSES For nurses to continue to make a difference in the lives of their patients, practitioners, and researchers need to practice and expand theoretical understanding within their fields. This would enable them to be visible and at the forefront of the wider changes in health care owing to their central position and connection to health organizations. CONCLUSION Nursing theories are essential to the continuing evolution of the discipline of nursing. Postgraduate programs in nursing and research must be encouraged to use and further develop nursing theories to facilitate the advancement of nursing care in education, research, and practice.
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Affiliation(s)
- Britt Sætre Hansen
- Department of Quality and Health Technology, Faculty of Health Sciences University of Stavanger Stavanger Norway
- The Researcg Group for Nursing and Health Care Sciences Stavanger University Hospital Stavanger Norway
| | - Elin Dysvik
- Faculty of Health Sciences University of Stavanger Stavanger Norway
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James S, Perry L, Lowe J, Harris M, Craig ME. Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry. Pediatr Diabetes 2022; 23:736-741. [PMID: 35561056 DOI: 10.1111/pedi.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self-management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. RESEARCH DESIGN AND METHODS Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were individuals with T1D aged 16-25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. RESULTS Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol); only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B = 0.20; 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B = 0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B = -0.33, -0.45 to -0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B = -0.49, -0.59 to 0.40, p < 0.001). CONCLUSIONS This Australasian study demonstrates widespread and persistent sub-optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, Petrie, Queensland, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Lin Perry
- University of Technology Sydney, School of Nursing and Midwifery, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julia Lowe
- University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Margaret Harris
- University of Newcastle, School of Nursing and Midwifery, New South Wales, Australia
| | - Maria E Craig
- Children's Hospital at Westmead, Endocrinology, Westmead, New South Wales, Australia.,University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, New South Wales, Australia
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Schneiderman JU, Davis JP, Negriff S. Associations Between Psychosocial Functioning and Physical Health in Youth with Maltreatment Experiences. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106080. [PMID: 34211239 PMCID: PMC8240661 DOI: 10.1016/j.childyouth.2021.106080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Childhood maltreatment often results in long-term untoward outcomes, although some individuals demonstrate better psychosocial functioning. Maltreatment is linked with poor physical health outcomes but little is known about how psychosocial functioning is related to physical health. The aims of this study were to: 1) Identify heterogeneity of psychosocial functioning using a latent profile analysis. Positive functioning was measured by both fewer problematic symptoms (depressive, PTSD, anxiety, externalizing behavior, and substance abuse disorder) and the presence of the protective factor of social support; and 2) Explore the relationship between emergent classes of psychosocial functioning and physical health (self-reported illnesses, symptoms, and health status as well as measured overweight/obesity). Participants included a sample of youth with child welfare-documented maltreatment (n=219; mean age 18.3 years; range 15-23 years) at Time 4 (T4) of a longitudinal study. Mean differences or odds ratios were assessed across the health variables between classes. The three resulting classes were labeled: 1) higher support/lower symptoms (60.7%); 2) lower support/higher internalizing symptoms (29.2%); and 3) lower support/higher externalizing/substance abuse symptoms (10%). Youth in the lower/support/higher externalizing/substance abuse symptoms class had a similar high level of internalizing symptoms as the lower support/higher internalizing symptoms class. Youth in the lower support/high externalizing/substance abuse symptoms class had more colds and pain symptoms in the past month and gastrointestinal illnesses in the past year than the higher support/lower symptoms class, and more illnesses, respiratory problems, and gastrointestinal illnesses the last year than the lower support/higher internalizing symptoms class. Overall, functioning class was related to certain health problems which often have a stress component and were more prevalent for youth with more externalizing and substance abuse symptoms.
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Affiliation(s)
- Janet U. Schneiderman
- Corresponding Author: Nursing Department, Suzanne Dworak-Peck School of Social Work; University of Southern California; 669 West 34 Street, Los Angeles, CA, USA 90089-0411; ; 213-821-1338
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work; USC Center for Artificial Intelligence in Society; USC Center for Mindfulness Science; University of Southern California; 669 West 34 Street, Los Angeles, CA, USA 90089-0411
| | - Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California; 100 South Los Robles Avenue, Pasadena, CA USA, 91101-2453
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