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Joshi D, Nayagam J, Clay L, Yerlett J, Claridge L, Day J, Ferguson J, Mckie P, Vara R, Pargeter H, Lockyer R, Jones R, Heneghan M, Samyn M. UK guideline on the transition and management of childhood liver diseases in adulthood. Aliment Pharmacol Ther 2024; 59:812-842. [PMID: 38385884 DOI: 10.1111/apt.17904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/15/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Improved outcomes of liver disease in childhood and young adulthood have resulted in an increasing number of young adults (YA) entering adult liver services. The adult hepatologist therefore requires a working knowledge in diseases that arise almost exclusively in children and their complications in adulthood. AIMS To provide adult hepatologists with succinct guidelines on aspects of transitional care in YA relevant to key disease aetiologies encountered in clinical practice. METHODS A systematic literature search was undertaken using the Pubmed, Medline, Web of Knowledge and Cochrane database from 1980 to 2023. MeSH search terms relating to liver diseases ('cholestatic liver diseases', 'biliary atresia', 'metabolic', 'paediatric liver diseases', 'autoimmune liver diseases'), transition to adult care ('transition services', 'young adult services') and adolescent care were used. The quality of evidence and the grading of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS These guidelines deal with the transition of YA and address key aetiologies for the adult hepatologist under the following headings: (1) Models and provision of care; (2) screening and management of mental health disorders; (3) aetiologies; (4) timing and role of liver transplantation; and (5) sexual health and fertility. CONCLUSIONS These are the first nationally developed guidelines on the transition and management of childhood liver diseases in adulthood. They provide a framework upon which to base clinical care, which we envisage will lead to improved outcomes for YA with chronic liver disease.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Jeremy Nayagam
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Clay
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
| | - Jenny Yerlett
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
| | - Lee Claridge
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Jemma Day
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Ferguson
- National Institute for Health Research, Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Paul Mckie
- Department of Social Work, King's College Hospital NHS Foundation Trust, London, UK
| | - Roshni Vara
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
- Evelina London Children's Hospital, London, UK
| | | | | | - Rebecca Jones
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition service, King's College Hospital NHS Foundation Trust, London, UK
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2
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Crawford K, Low JK, Le Page AK, Mulley W, Masterson R, Kausman J, Cook N, Mount P, Manias E. Transition from a renal paediatric clinic to an adult clinic: Perspectives of adolescents and young adults, parents and health professionals. J Child Health Care 2022; 26:531-547. [PMID: 34180271 DOI: 10.1177/13674935211028410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of chronic kidney disease is complex. With disease management being the responsibility of parents in the paediatric renal clinic, the responsibility is gradually shifted to adolescents and young adults during the transition to adult care. This multi-perspective qualitative study aimed to explore the experiences of adolescents and young adults, their parents and health professionals to gain an insight into transitional care. Focussing on the transition process and transfer to adult care, 18 adolescents and young adults and eight mothers participated in individual semi-structured interviews. Additionally, three focus groups were conducted with 20 multidisciplinary health professionals. Data were transcribed verbatim and analysed thematically. Similar responses from adolescents and young adults and mothers included the reluctance to leave the paediatric health service. Mothers found the transition to adult care more challenging than the adolescents and young adults. While health professionals acknowledged that engaging adolescents and young adults in their own care was challenging, they believed parents had an important role in facilitating their child's independence. This study highlights that health professionals in both paediatric and adult health services need to work collaboratively. However, importantly, health professionals need to be mindful that parents require an equal amount of engagement as adolescents and young adults, if not more, to mitigate parental barriers in achieving a successful transfer.
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Affiliation(s)
- Kimberley Crawford
- Monash Nursing and Midwifery, 2541Monash University, Clayton, VIC, Australia
| | - Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 2104Deakin University, Melbourne, VIC, Australia
| | - Amelia K Le Page
- Department of Nephrology, 557360Monash Children's Hospital, Clayton, VIC, Australia
| | - William Mulley
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia.,Department of Medicine, Centre for Inflammatory Diseases, 2541Monash University, Clayton, VIC, Australia
| | - Rosemary Masterson
- Department of Nephrology, 6453The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Joshua Kausman
- Department of Nephrology, 6453Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, 6453Royal Children's Hospital, Melbourne, VIC, Australia
| | - Natasha Cook
- Department of Nephrology, 3805Austin Health, Heidelberg, VIC, Australia
| | - Peter Mount
- Department of Nephrology, 3805Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, Austin Health Faculty of Medicine, Dentistry and Health Sciences, 2281The University of Melbourne, Parkville, VIC, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 2104Deakin University, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, 2281The University of Melbourne, Parkville, VIC, Australia
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Kato TS, Gomi H, Aizawa Y, Kawamura A, Eisen HJ, Hunt SA, Inoue T. Are we ready for building transition programs for heart transplant recipients in Japan? - Knowing the unique background is the first step for discussion. Front Pediatr 2022; 10:935167. [PMID: 36405837 PMCID: PMC9671939 DOI: 10.3389/fped.2022.935167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tomoko S Kato
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Harumi Gomi
- Office of Medical Education and Center for Infectious Diseases, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Howard J Eisen
- Department of Medicine, Division of Cardiology, Penn State Heart and Vascular Institute, Harrisburg, PA, United States
| | - Sharon A Hunt
- Department of Medicine, Division of Cardiology, Stanford University, Stanford, CA, United States
| | - Takamitsu Inoue
- Department of Renal and Urological Surgery, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
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Parfeniuk S, Petrovic K, MacIsaac PL, Cook KA, Rempel GR. Transition readiness measures for adolescents and young adults with chronic health conditions: a systematic review. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractBackgroundTransition from pediatric to adult healthcare for adolescents with chronic health conditions has emerged as a critical period influencing health outcomes. Suitable transition readiness measures are necessary to facilitate effective planning. Currently, there is little consensus about well-validated transition readiness measures. The purpose of this systematic review was to identify best practices in transition readiness measurement for adolescents and young adults with chronic health conditions.Data sourcesAcademic databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, Google Scholar and Athabasca University Library’s Discover.Study selectionArticles were included that discussed the development and psychometric properties of transition readiness measures for adolescents and young adults (11–25 years) with chronic health conditions and/or that utilized a previously developed measure.Data extractionThe primary and secondary reviewers extracted data from the selected articles as per the data extraction tool developed for this review.ResultsForty-eight articles, representing 19 tools, were included in the review. Ten of the tools were disease-specific; nine were disease-neutral. According to the Cohen criteria, eight measures were “well-established assessments”. The Transition Readiness Assessment Questionnaire was deemed the best measure of transition readiness available. The literature search included only articles published in peer-reviewed journals; measures nearing completion or awaiting publication were not included. In addition, only English manuscripts were included, many from North America.ConclusionsDespite national practice guidelines and ongoing policy development, there is slow movement towards achieving a gold standard or best-practice measure of transition readiness.
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Affiliation(s)
| | | | | | | | - Gwen R. Rempel
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB T9S 3A3, Canada, Tel.: +855-833-5699
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Ng VL, Mazariegos GV, Kelly B, Horslen S, McDiarmid SV, Magee JC, Loomes KM, Fischer RT, Sundaram SS, Lai JC, Te HS, Bucuvalas JC. Barriers to ideal outcomes after pediatric liver transplantation. Pediatr Transplant 2019; 23:e13537. [PMID: 31343109 DOI: 10.1111/petr.13537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
Long-term survival for children who undergo LT is now the rule rather than the exception. However, a focus on the outcome of patient or graft survival rates alone provides an incomplete and limited view of life for patients who undergo LT as an infant, child, or teen. The paradigm has now appropriately shifted to opportunities focused on our overarching goals of "surviving and thriving" with long-term allograft health, freedom of complications from long-term immunosuppression, self-reported well-being, and global functional health. Experts within the liver transplant community highlight clinical gaps and potential barriers at each of the pretransplant, intra-operative, early-, medium-, and long-term post-transplant stages toward these broader mandates. Strategies including clinical research, innovation, and quality improvement targeting both traditional as well as PRO are outlined and, if successfully leveraged and conducted, would improve outcomes for recipients of pediatric LT.
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Affiliation(s)
- Vicky Lee Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Beau Kelly
- Division of Surgery, DCI Donor Services, Sacramento, California
| | - Simon Horslen
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Sue V McDiarmid
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - John C Magee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kathleen M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ryan T Fischer
- Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Shikha S Sundaram
- Pediatrics, Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Helen S Te
- Adult Liver Transplant Program, University of Chicago Medicine, Chicago, Illinois
| | - John C Bucuvalas
- Mount Sinai Kravis Childrens Hospital and Recanati/Miller Transplant Institute, New York City, New York
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6
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Pediatric heart transplantation: long-term outcomes. Indian J Thorac Cardiovasc Surg 2019; 36:175-189. [PMID: 33061202 DOI: 10.1007/s12055-019-00820-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022] Open
Abstract
Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed, and over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Short-term outcomes in the most recent era have been excellent resulting in a renewed focus towards medium- and long-term outcomes. This article will review the most up-to-date literature on overall heart transplantation outcomes and specific long-term outcomes including rejection, cardiac allograft vasculopathy, graft failure, infection, renal dysfunction, malignancy, and the need for re-transplantation. The article also explores the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extracorporeal membrane oxygenation, and ventricular assist devices. The article concludes with a look at transition from pediatric to adult care and medication adherence, which are becoming major issues related to long-term outcomes as post-transplant survival increases.
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7
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The genesis of systems of care for transition to adulthood services: emerging models in primary and subspecialty care. Curr Opin Pediatr 2018; 30:303-310. [PMID: 29406441 DOI: 10.1097/mop.0000000000000608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transitioning adolescents and young adults with chronic conditions can be complex. Expert recommendations support a transition process that starts in early adolescence, provides continuous guidance and support and allows for care opportunities with patients and caregivers, with the patient alone and between paediatric and adult providers. As most of the guidance is focused on individual patients, providers and clinical programmes, much less is known about how health systems as a whole might support effective transitions of care. RECENT FINDINGS Many intervention studies focus on the preparation necessary to successfully transition adolescents, young adults and their families to adult care. Although randomized controlled trials of transition interventions are few and standards of care not yet established, promising models are being developed and tested. This review will describe the development and implementation of emerging models of transitional care in primary and subspecialty care, paying special attention to evaluation outcomes that can inform model selection. SUMMARY The emerging models described here highlight the importance of and guidance for invested clinicians and health systems to create effective methods for successful transition. Additional research using rigorous methodology is necessary.
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Murdaugh DL, King TZ, O’toole K. The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care. Child Neuropsychol 2017; 25:131-151. [DOI: 10.1080/09297049.2017.1391949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Donna L. Murdaugh
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Tricia Z. King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Kathleen O’toole
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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9
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Prüfe J, Dierks ML, Bethe D, Oldhafer M, Müther S, Thumfart J, Feldkötter M, Büscher A, Sauerstein K, Hansen M, Pohl M, Drube J, Thiel F, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrod B, Billing H, Staude H, Brunkhorst R, Rusai K, Pape L, Kreuzer M. Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study. BMJ Open 2017; 7:e015593. [PMID: 28606904 PMCID: PMC5734418 DOI: 10.1136/bmjopen-2016-015593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. SETTING In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. RESULTS This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. CONCLUSIONS While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. TRIAL REGISTRATION NUMBER ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).
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Affiliation(s)
- Jenny Prüfe
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Marie-Luise Dierks
- Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Dirk Bethe
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Silvia Müther
- Berliner TransitionsProgramm (BTP), DRK-Kliniken (German Red Cross Hospitals) Berlin Westend, Berlin, Germany
| | - Julia Thumfart
- Department of Paediatric Nephrology, Charité, Berlin, Germany
| | | | - Anja Büscher
- Department of Paediatrics II, Essen University Hospital, Essen, Germany
| | | | - Matthias Hansen
- KfH Centre of Paediatric Nephrology, Clementine Children’s Hospital, Frankfurt, Germany
| | - Martin Pohl
- Department of General Paediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg, Germany
| | - Jens Drube
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Florian Thiel
- University Children’s Hospital Eppendorf, Hamburg, Germany
| | - Susanne Rieger
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike John
- University Children’s Hospital, Jena, Germany
| | - Christina Taylan
- Department of Paediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | | | - Sabine Hollenbach
- KfH Centres of Paediatric Nephrology, St. Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Centres of Paediatric Nephrology, University Hospital of Marburg, Marburg, Germany
| | - Henry Fehrenbach
- KfH Centre of Paediatric Nephrology, Children’s Hospital Memmingen, Memmingen, Germany
| | - Birgitta Kranz
- University Children’s Hospital Münster, Münster, Germany
| | - Carmen Montoya
- KfH Centre of Paediatric Nephrology, University Children’s Hospital, München, Germany
| | | | - Bettina Ruckenbrod
- Children’s Hospital, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Heiko Billing
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Hagen Staude
- University Children’s Hospital, Rostock, Germany
| | - Reinhard Brunkhorst
- KfH Centre of Nephrology, Hospitals of the Hannover Region, Hannover, Germany
| | | | - Lars Pape
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Martin Kreuzer
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Different Demands, Same Goal: Promoting Transition Readiness in Adolescents and Young Adults With and Without Medical Conditions. J Adolesc Health 2017; 60:727-733. [PMID: 28274737 DOI: 10.1016/j.jadohealth.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to examine differences in transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy between a sample of older adolescents and young adults (AYAs) with medical conditions and a sample of healthy peers. Relations among these variables were also examined. METHODS The sample included 494 AYAs (mean age = 19.30 years, standard deviation = 1.33) who reported on their levels of transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy. RESULTS AYAs with medical conditions reported significantly higher levels of transition readiness and self-involvement in completing medical tasks and lower levels of parent involvement in completing medical tasks than healthy peers. Parent involvement in completing medical tasks indirectly related to transition readiness through AYA self-involvement in completing medical tasks for both AYAs with medical conditions and healthy peers. CONCLUSIONS AYAs with medical conditions appear to have greater transition readiness skills and demonstrate more independence in completing medical tasks than healthy peers. For AYAs with medical conditions and healthy peers, transition readiness appears to be enhanced as parents decrease their involvement in completing AYAs' medical tasks and AYAs increase self-involvement in completing these tasks. AYAs with medical conditions, as well as healthy peers, may benefit from programming delivered in primary care, specialty clinic, or educational settings that focuses on increasing AYAs' involvement in and responsibility for managing their health care.
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11
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Gutierrez-Colina AM, Reed-Knight B, Eaton C, Lee J, Loiselle Rich K, Mee L, Travers C, Blount RL. Transition readiness, adolescent responsibility, and executive functioning among pediatric transplant recipients: Caregivers' perspectives. Pediatr Transplant 2017; 21. [PMID: 28239931 DOI: 10.1111/petr.12898] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/02/2023]
Abstract
This study aimed both to evaluate caregivers' perspectives of EF and transition readiness among adolescent transplant recipients and to examine the indirect effects of adolescent responsibility and parent involvement across domains of EF. Fifty-seven caregivers of adolescent solid organ transplant recipients participated in this study and completed measures of adolescent EF, transition readiness, responsibility in healthcare behavior, and parent involvement. Bootstrapping procedures were used to test indirect effects. Caregiver report of adolescent EF was significantly related to transition readiness among transplant recipients. Significant indirect effects were found for adolescent responsibility but not parent involvement. No significant differences were found between metacognitive and behavioral regulation domains of EF in the association with transition readiness. Assessment of adolescent EF skills may help guide the development of individualized transition readiness guidelines to promote successful gains in self-management abilities as well as eventual transfer to adult medical services.
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Affiliation(s)
| | - Bonney Reed-Knight
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cyd Eaton
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Jennifer Lee
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristin Loiselle Rich
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura Mee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, Athens, GA, USA
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12
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Joshi D, Gupta N, Samyn M, Deheragoda M, Dobbels F, Heneghan MA. The management of childhood liver diseases in adulthood. J Hepatol 2017; 66:631-644. [PMID: 27914924 DOI: 10.1016/j.jhep.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
An increasing number of patients with childhood liver disease survive into adulthood. These young adults are now entering adult services and require ongoing management. Aetiologies can be divided into liver diseases that develop in young adults which present to adult hepatologists i.e., biliary atresia and Alagille syndrome or liver diseases that occur in children/adolescents and adults i.e., autoimmune hepatitis or Wilson's disease. To successfully manage these young adults, a dynamic and responsive transition service is essential. In this review, we aim to describe the successful components of a transition service highlighting the importance of self-management support and a multi-disciplinary approach. We will also review some of the liver specific aetiologies which are unique to young adults, offering an update on pathogenesis, management and outcomes.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK.
| | - Nitika Gupta
- Division of Paediatric Gastroenterology, Emory University School of Medicine, Atlanta, USA
| | - Marianne Samyn
- Institute of Liver Studies, King's College Hospital, London, UK
| | | | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Katholieke Universiteit Leuven, Belgium
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13
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Mendes-Castillo AMC, Bousso RS, Sloand E. The Family Management Styles Framework as A Tool for Tailoring Interventions for Pediatric Transplant Recipients and Their Families: A Case Study. Compr Child Adolesc Nurs 2016. [DOI: 10.1080/24694193.2016.1245364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Elizabeth Sloand
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Fredericks EM, Magee JC, Eder SJ, Sevecke JR, Dore-Stites D, Shieck V, Lopez MJ. Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 2016; 22:150-9. [PMID: 26231289 DOI: 10.1007/s10880-015-9427-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.
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Affiliation(s)
- Emily M Fredericks
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA.
| | - John C Magee
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Sally J Eder
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Jessica R Sevecke
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Dawn Dore-Stites
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Victoria Shieck
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - M James Lopez
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
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15
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van Staa A, Sattoe JNT, Strating MMH. Experiences with and Outcomes of Two Interventions to Maximize Engagement of Chronically Ill Adolescents During Hospital Consultations: A Mixed Methods Study. J Pediatr Nurs 2015. [PMID: 26199096 DOI: 10.1016/j.pedn.2015.05.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Improving patient-provider communication during hospital consultations is advocated to enhance self-management planning and transition readiness of adolescents with chronic conditions. This longitudinal mixed methods study evaluates the implementation and the outcomes of independent split-visit consultations and individual transition plans by 22 hospital teams participating in the Dutch Action Program 'On Your Own Feet Ahead!'. The interventions raised awareness in adolescents and professionals, improved adolescents' display of independent behaviors and led to more discussions about non-medical issues. Successful implementation required a team-based approach and clear explanation to parents and adolescents. Pediatric nurses played a pivotal role in improving transitional care.
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Affiliation(s)
- AnneLoes van Staa
- Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands; Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands; Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands
| | - Mathilde M H Strating
- Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands
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