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de Hosson M, De Groote K, Hecke AV, De Wolf D, Vandekerckhove K, Mosquera LM, Panzer J, Logghe K, Mels S, Demulier L, Campens L, Goossens E, De Backer J. Evaluation of a nurse-led multi-component transition program for adolescents with congenital heart disease. PATIENT EDUCATION AND COUNSELING 2024; 118:108028. [PMID: 37879284 DOI: 10.1016/j.pec.2023.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the transition program for adolescents with congenital heart disease (CHD) 'Transition With a Heart' (TWAH) on disease-related knowledge, quality of life (QoL), transition experiences, and gaps in follow-up. METHODS A study with pre-posttest and control group (post-test) using consecutive sampling, including adolescents with moderate to severely complex CHD, without intellectual disability, aged≥ 12 y, and parents. After weighting, t-tests were performed. A multivariable regression analysis explored the outcomes' determinants. RESULTS In the intervention group, 28 adolescents and 25 parents were included, and 53 adolescents and 18 parents as controls. Adolescents' knowledge significantly increased after completing TWAH (from 59.8% to 75.7%;p < 0.01). Their knowledge was positively correlated with TWAH (β = +13.3;p < 0.01). Adolescents' transition experiences were also positively related to TWAH (general experience: β = +5.5;p < 0.01; transfer satisfaction: β = +0.8; p < 0.01). Adolescents' QoL was mainly determined by CHD complexity and not by TWAH. No one showed gaps in follow-up. TWAH was not associated with parents' transition experiences. CONCLUSION Implementing TWAH substantially improved adolescents' disease-related knowledge and transition experiences. PRACTICE IMPLICATIONS The results regarding transition experiences need to be confirmed by further research. The TWAH design with the person-tailored educational program, skills training, and the transition coordinator can be used in settings with other chronic diseases.
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Affiliation(s)
- Michèle de Hosson
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium.
| | - Katya De Groote
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Ann Van Hecke
- Ghent University - Faculty of Medicine and Health Sciences - Department of Public Health and Primary Care - University Center for Nursing and Midwifery, Ghent, Belgium; Ghent University Hospital, Staff nursing department, Ghent, Belgium
| | - Daniël De Wolf
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | | | | | - Joseph Panzer
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Karen Logghe
- Ghent University Hospital, Department of Pedicatric Cardiology, Ghent, Belgium
| | - Saskia Mels
- Ghent University Hospital, Department of Pediatric Psychology, Ghent, Belgium
| | - Laurent Demulier
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Laurence Campens
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
| | - Eva Goossens
- University of Antwerp - Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, Antwerp, Belgium; KU Leuven - Department of Public Health and Primary Care, Leuven, Belgium
| | - Julie De Backer
- Ghent University Hospital, Department of Adult Congenital Heart Disease, Ghent, Belgium
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Moons P. Empowering the Future: Transitioning to Adulthood With Congenital Heart Disease. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:237-239. [PMID: 37970219 PMCID: PMC10642125 DOI: 10.1016/j.cjcpc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Zhang QL, Lin SH, Lin WH, Chen Q, Cao H. The effect of applying telehealth education to home care of infants after congenital heart disease surgery. Int J Qual Health Care 2023; 35:6947076. [PMID: 36537207 DOI: 10.1093/intqhc/mzac102] [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: 03/31/2022] [Revised: 11/15/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of applying telehealth education to home care of infants after congenital heart disease (CHD) surgery. METHODS A prospective randomized controlled study was conducted from July 2020 to February 2021 in Fujian Children's Hospital to compare the home care condition of infants after CHD surgery between the intervention group and the control group. RESULTS At 3 months after discharge, parents' caring ability and CHD knowledge in the intervention group were significantly better than those in the control group and were significantly improved compared with those at discharge time (P < 0.05). The parental care burden in the intervention group was significantly lower than that in the control group and was significantly lower than that at discharge time (P < 0.05). During the follow-up period, the rate of loss of follow-up and complications in the intervention group were significantly lower than those in the control group (P < 0.05). CONCLUSION Telehealth education via WeChat can effectively improve the knowledge of disease and home care ability of parents of infants after CHD surgery and reduce their home care burden, which can effectively reduce the incidence of complications and lost to follow-up rate after discharge.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Wen-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
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Endo S, Higuchi M, Hotta N. The association between the social adaptive skills of school-aged children with congenital heart disease and mothers' decision factors for providing disease explanations in Japan: a cross-sectional study. CHILD HEALTH NURSING RESEARCH 2022; 28:187-196. [PMID: 35953068 PMCID: PMC9371799 DOI: 10.4094/chnr.2022.28.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose This study aimed to clarify the factors related to mothers' decisions to provide disease explanations to their children, investigate the associations between those factors and social adaptive skills, and examine support relative to children's growth and development. Methods Data were collected from anonymous, self-administered questionnaires answered by 71 mothers of outpatient school-aged children with congenital heart disease. The questionnaire items included characteristics of mothers and children, decision factors for providing disease explanations, and children's social adaptive skills (Asahide-Shiki social adaptive skills test). Factor analysis was performed on the decision factors, and multiple regression analysis was performed to examine the association between the identified factors and each social adaptive skill. Results The decision factors for providing disease explanations were the mother's explanation ability, the receptive capability of the child, and the child's interest and literacy regarding the explanation. Multiple regression analysis showed that language and social life skills were significantly associated with the child's receptive capability, and language and daily life skills were significantly associated with the child's interest and literacy regarding the explanation. Conclusion Improving children's language, social life, and daily life skills may enhance their receptive capability and literacy regarding explanations of their disease.
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Affiliation(s)
- Shinsaku Endo
- Associate Professor, Graduate School of Nursing, Nagoya City University, Nagoya, Aichi, Japan
- Corresponding author Shinsaku Endo Graduate School of Nursing, Nagoya City University, 1 Kawasumi Mizuho-cho Mizuhorr-ku, Nagoya 467-8601, Japan TEL: +82-52-853-8049 FAX: +82-52-853-8049 E-MAIL:
| | - Michiyo Higuchi
- Professor, Graduate School of Nursing, Nagoya City University, Nagoya, Aichi, Japan
| | - Noriko Hotta
- Professor Emeritus, Nagoya City University, Nagoya, Aichi, Japan
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Na I, Van Bulck L, Rassart J, Goossens E, Luyckx K, Van De Bruaene A, Moons P. Absence from work or school in young adults with congenital heart disease: is illness identity associated with absenteeism? Eur J Cardiovasc Nurs 2022; 21:491-498. [PMID: 34864976 DOI: 10.1093/eurjcn/zvab117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/17/2023]
Abstract
AIMS Absence from work or school in patients with congenital heart disease (CHD) is an understudied domain. Illness identity, which is the degree to which a chronic illness is integrated into one's identity, could be hypothesized to be a predictor for absenteeism. This study determined the proportion of young adults with CHD absent from work or school and examined if illness identity dimensions were related to absenteeism. METHODS AND RESULTS In a cross-sectional study, we included 255 patients with CHD. Data on absence from work or school over the past 12 months were obtained using self-report. The Illness Identity Questionnaire was used, which comprises four illness identity dimensions: rejection, engulfment, acceptance, and enrichment. Linear models with doubly robust estimations were computed after groups were balanced using propensity weighting. Absence from work/school occurred in 69% of young adults with CHD. Absence because of CHD specifically was present in 15% of the patients. Engulfment was significantly related to both all-cause absence and absence for CHD reasons. CONCLUSIONS Patients who strongly define themselves in terms of their heart disease were more likely to be absent from work or school than those who did not. If this finding can be confirmed in future research, it has the potential to be a target for intervention to influence work/school absence.
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Affiliation(s)
- Inwon Na
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jessica Rassart
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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6
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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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Abstract
INTRODUCTION With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review. METHODS A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian. RESULTS From the cohort of 95 patients, 285 "obese clinical encounters" were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms "obese" or "obesity" (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%). CONCLUSIONS Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.
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Moons P, Bratt EL, De Backer J, Goossens E, Hornung T, Tutarel O, Zühlke L, Araujo JJ, Callus E, Gabriel H, Shahid N, Sliwa K, Verstappen A, Yang HL, Thomet C. Transition to adulthood and transfer to adult care of adolescents with congenital heart disease: a global consensus statement of the ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP), the ESC Working Group on Adult Congenital Heart Disease (WG ACHD), the Association for European Paediatric and Congenital Cardiology (AEPC), the Pan-African Society of Cardiology (PASCAR), the Asia-Pacific Pediatric Cardiac Society (APPCS), the Inter-American Society of Cardiology (IASC), the Cardiac Society of Australia and New Zealand (CSANZ), the International Society for Adult Congenital Heart Disease (ISACHD), the World Heart Federation (WHF), the European Congenital Heart Disease Organisation (ECHDO), and the Global Alliance for Rheumatic and Congenital Hearts (Global ARCH). Eur Heart J 2021; 42:4213-4223. [PMID: 34198319 PMCID: PMC8560210 DOI: 10.1093/eurheartj/ehab388] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
The vast majority of children with congenital heart disease (CHD) in high-income countries survive into adulthood. Further, paediatric cardiac services have expanded in middle-income countries. Both evolutions have resulted in an increasing number of CHD survivors. Expert care across the life span is necessitated. In adolescence, patients transition from being a dependent child to an independent adult. They are also advised to transfer from paediatrics to adult care. There is no universal consensus regarding how transitional care should be provided and how the transfer should be organized. This is even more challenging in countries with low resources. This consensus document describes issues and practices of transition and transfer of adolescents with CHD, accounting for different possibilities in high-, middle-, and low-income countries. Transitional care ought to be provided to all adolescents with CHD, taking into consideration the available resources. When reaching adulthood, patients ought to be transferred to adult care facilities/providers capable of managing their needs, and systems have to be in place to make sure that continuity of high-quality care is ensured after leaving paediatric cardiology.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, South Africa.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP)
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Gothenburg, Sweden.,Association for European Paediatric and Congenital Cardiology (AEPC)
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,ESC Working Group on Adult Congenital Heart Disease (WG ACHD)
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP).,Association for European Paediatric and Congenital Cardiology (AEPC).,Research Foundation Flanders (FWO), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Tim Hornung
- Paediatric and Congenital Cardiology Service, Starship Children's Hospital, Auckland, New Zealand.,Cardiac Society of Australia and New Zealand (CSANZ)
| | - Oktay Tutarel
- ESC Working Group on Adult Congenital Heart Disease (WG ACHD).,Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Liesl Zühlke
- Department of Paediatrics and Child Health, University of Cape Town, South Africa.,Division of Paediatric Cardiology, Red Cross War Memorial Childreńs Hospital, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Pan-African Society of Cardiology (PASCAR)
| | - John Jairo Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Medellin, Colombia.,Inter-American Society of Cardiology (IASC)
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,European Congenital Heart Disease Organisation (ECHDO)
| | - Harald Gabriel
- ESC Working Group on Adult Congenital Heart Disease (WG ACHD).,Department of Cardiology, Medical University of Vienna, Austria
| | - Nauman Shahid
- Global Alliance for Rheumatic and Congenital Hearts (Global ARCH)
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa.,CHI, Faculty of Health Sciences, University of Cape Town, South Africa.,World Heart Federation (WHF)
| | - Amy Verstappen
- Global Alliance for Rheumatic and Congenital Hearts (Global ARCH)
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Asia-Pacific Pediatric Cardiac Society (APPCS)
| | - Corina Thomet
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP).,Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Switzerland.,International Society for Adult Congenital Heart Disease (ISACHD)
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Akiyama N, Ochiai R, Hokosaki T, Nitta M, Nakano Y, Watanabe S, Nakashima R, Enomoto J, Watabe S. Objective and Personalized Assessment of Disease-Related Knowledge Among Patients With Congenital Heart Disease - Development and Validation of the Japanese Version of the Leuven Knowledge Questionnaire for Congenital Heart Disease. Circ Rep 2021; 3:604-614. [PMID: 34703938 PMCID: PMC8492402 DOI: 10.1253/circrep.cr-21-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Disease understanding in patients with congenital heart disease is important in transitional and lifelong care. This study aimed to develop the Japanese version of the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD) and identify factors associated with disease-related knowledge. Methods and Results: After confirming the content and face validity of the scale, a questionnaire including the LKQCHD was distributed to 59 eligible patients aged >16 years attending a university hospital. For the 58 participants who responded (30 males, 28 females; median age 22 years), the mean (±SD) LKQCHD total score was 53.7±15.4, with mean (±SD) scores for each domain as follows: Disease and Treatment, 68.3±19.7; Preventing Complications, 45.8±19.0; Physical Activity, 74.1±34.1; Sex and Heredity, 37.9±35.4; and Contraception and Pregnancy, 40.2±29.1. Regarding known-groups validity, we found a positive correlation between the LKQCHD score and age (ρ=0.268, P=0.042), and a significantly low LKQCHD score in the moderate/severe disease group (η2=0.131, P=0.021). Regarding convergent validity, the LKQCHD score was positively correlated with the total and subscale scores of the Resilience Assessment Tool (r=0.213 [P=0.109] and r=0.405 [P=0.002], respectively). Conclusions: We confirmed the validity of the Japanese version of the LKQCHD, concluding that patient education regarding long-term complications, prevention methods, heredity, pregnancy, and childbirth is needed.
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Affiliation(s)
- Naomi Akiyama
- Department of Nursing, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Ryota Ochiai
- Department of Nursing, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Tatsunori Hokosaki
- Department of Pediatric Cardiology, Yokohama City University Hospital Yokohama Japan
| | - Manabu Nitta
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Yusuke Nakano
- Department of Pediatric Cardiology, Yokohama City University Hospital Yokohama Japan
| | - Shigeo Watanabe
- Department of Pediatric Cardiology, Yokohama City University Hospital Yokohama Japan
| | - Rie Nakashima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama Japan
| | | | - Setsuko Watabe
- Department of Nursing, Yokohama City University Graduate School of Medicine Yokohama Japan
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Cecchetto FH, Bonato GD, Barreto TSM, Riegel F, Pellanda LC. Translation, cross-cultural adaptation, and validation of the Leuven Knowledge Questionnaire for congenital heart disease instrument into Brazilian Portuguese. J Pediatr (Rio J) 2021; 97:402-408. [PMID: 32781036 PMCID: PMC9432303 DOI: 10.1016/j.jped.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To translate the Leuven Knowledge Questionnaire for Congenital Heart Disease into Brazilian Portuguese and to validate its psychometric properties with parents and family caregivers of children with congenital heart disease. METHOD This was a six-step methodological study, including the translation, synthesis, back-translation, evaluation of the version translated by the committee of experts, pre-testing, and validation, for which two pilot tests were used including the think-aloud protocol. The content validity index and the frequency of socioeconomic data were calculated in a statistical programming environment. RESULTS In content validation, the instrument showed good applicability among experts, with average content validity index of 0.8-1, while kappa agreement analysis was between 0.76 to 1; both results were considered adequate for validation. CONCLUSIONS The results suggest reliability among the evaluators, indicating the instrument's accuracy and the possibility of using it to assess the knowledge of parents and family caregivers about congenital heart disease.
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Affiliation(s)
| | - Giuseppe Dick Bonato
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Fernando Riegel
- Universidade Federal de Mato Grosso (UFMT), Campus Universitário do Araguaia, Cuiabá, MT, Brazil
| | - Lúcia Campos Pellanda
- Fundação Universitária de Cardiologia (FUC), Instituto de Cardiologia (IC), Porto Alegre, RS, Brazil.
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11
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project. BMC Health Serv Res 2021; 21:573. [PMID: 34112174 PMCID: PMC8194131 DOI: 10.1186/s12913-021-06567-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background During the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents’ and parents’ experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact. Methods A qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12. Results Experiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents’ prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support. Conclusions Participants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06567-1.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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12
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Etnel JRG, Bons LR, De Heer F, Robbers-Visser D, Van Beynum IM, Straver B, Jongbloed MR, Kiès P, Slieker MG, Van Dijk APJ, Kluin J, Bertels RA, Utens EMWJ, The R, Van Galen E, Mulder BJM, Blom NA, Hazekamp MG, Roos-Hesselink JW, Helbing WA, Bogers AJJC, Takkenberg JJM. Patient information portal for congenital aortic and pulmonary valve disease: a stepped-wedge cluster randomised trial. Open Heart 2021; 8:openhrt-2020-001252. [PMID: 33757975 PMCID: PMC7993296 DOI: 10.1136/openhrt-2020-001252] [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: 02/24/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In response to an increased need for patient information in congenital heart disease, we previously developed an online, evidence-based information portal for patients with congenital aortic and pulmonary valve disease. To assess its effectiveness, a stepped-wedge cluster randomised trial was conducted. METHODS Adult patients and caregivers of paediatric patients with congenital aortic and/or pulmonary valve disease and/or tetralogy of Fallot who visited the outpatient clinic at any of the four participating centres in the Netherlands between 1 March 2016-1 July 2017 were prospectively included. The intervention (information portal) was introduced in the outpatient clinic according to a stepped-wedge randomised design. One month after outpatient clinic visit, each participant completed a questionnaire on disease-specific knowledge, anxiety, depression, mental quality of life, involvement and opinion/attitude concerning patient information and involvement. RESULTS 343 participants were included (221 control, 122 intervention). Cardiac diagnosis (p=0.873), educational level (p=0.153) and sex (p=0.603) were comparable between the two groups. All outcomes were comparable between groups in the intention-to-treat analyses. However, only 51.6% of subjects in the intervention group (n=63) reported actually visiting the portal. Among these subjects (as-treated), disease-specific knowledge (p=0.041) and mental health (p=0.039) were significantly better than in control subjects, while other baseline and outcome variables were comparable. CONCLUSION Even after being invited by their cardiologists, only half of the participants actually visited the information portal. Only in those participants that actually visited the portal, knowledge of disease and mental health were significantly better. This underlines the importance of effective implementation of online evidence-based patient information portals in clinical practice.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frederiek De Heer
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | - Ingrid M Van Beynum
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,De Bascule, Academic Center for Child Psychiatry, Amsterdam, Netherlands
| | | | - Eugene Van Galen
- Patient Association 'Patiëntenvereniging Aangeboren Hartafwijkingen', Maarssen, Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Bektas İ, Kır M, Yıldız K, Genç Z, Bektas M, Ünal N. Symptom Frequency in Children with Congenital Heart Disease and Parental Care Burden in Predicting the Quality of Life of Parents in Turkey. J Pediatr Nurs 2020; 53:e211-e216. [PMID: 32354457 DOI: 10.1016/j.pedn.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This study was conducted to investigate the symptom frequency and parental care burden of the children with congenital heart disease in predicting the quality of life of parents in Turkey. DESIGN AND METHOD The study subjects for the present study included 124 parents whose children were suffering from heart disease. The data for the study were collected from these parents using parent information form, the questionnaire of the frequency of heart disease-related symptoms of the child, the caregiver burden scale, and the quality of life scale. The level by which the heart disease-related symptoms of the child and caregiver burden predicted the quality of life was analyzed using the regression analysis. RESULTS The most common symptoms in children were found to be anorexia, difficulty in activities, palpitations, shortness of breath, weakness, and fatigue. The number of symptoms observed in children and the care burden of the parents were determined to explain 27.1% of the psychological health sub-dimension, 14.4% of the social relations sub-dimension, and 34.9% of the environment sub-dimension. When the variables were examined separately, the number of symptoms was found to significantly predict only social relations sub-dimensions. CONCLUSION Increased number of symptoms increased parental care burden. Increased number of symptoms and care burden of parents reduced the quality of life of parents. PRACTICE IMPLICATIONS Symptom management is one of the important responsibilities of nurses in improving care burden and quality of life for parents of children with heart disease.
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Affiliation(s)
- İlknur Bektas
- Dokuz Eylul University, Faculty of Nursing, Inciraltı, Izmir, Turkey.
| | - Mustafa Kır
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey.
| | - Kaan Yıldız
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Zeynep Genç
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Murat Bektas
- Dokuz Eylul University, Faculty of Nursing, Inciraltı, Izmir, Turkey
| | - Nurettin Ünal
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey.
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14
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Ingadottir B, Jaarsma T, Klompstra L, Aidemark J, Askenäs L, Bahat Y, Ben Gal O, Berglund A, Berglund E, Höchsmann C, Plotnik M, Trappenburg JC, Schmidt-Trucksäss A, Strömberg A. Let the games begin: Serious games in prevention and rehabilitation to improve outcomes in patients with cardiovascular disease. Eur J Cardiovasc Nurs 2020; 19:558-560. [PMID: 32538132 DOI: 10.1177/1474515120934058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brynja Ingadottir
- University of Iceland and Landspitali - the National University Hospital of Iceland, Iceland
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Jan Aidemark
- Department of Informatics, Linnaeus University, Sweden
| | - Linda Askenäs
- Department of Informatics, Linnaeus University, Sweden
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Oran Ben Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Aseel Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Erik Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Ingestive Behavior, Weight Management & Health Promotion Laboratory, USA
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel.,Department of Physiology and Pharmacology, Tel Aviv University, Israel
| | - Jaap Ca Trappenburg
- Department of Public Health, Healthcare Innovation and Evaluation and Medical Humanities, Julius Center, The Netherlands
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.,Department of Cardiology, Linköping University, Sweden
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15
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Yang HL, Chang NT, Wang JK, Lu CW, Huang YC, Moons P. Comorbidity as a mediator of depression in adults with congenital heart disease: A population-based cohort study. Eur J Cardiovasc Nurs 2020; 19:732-739. [PMID: 32429700 DOI: 10.1177/1474515120923785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The population of adults with congenital heart disease (CHD) has increased dramatically with a high prevalence of acquired cardiac and non-cardiac comorbidities. However, the relationship among congenital heart disease, physical comorbidities, and psychological health in this population is not well studied. AIMS The purpose of this study was to investigate (a) the association between adult congenital heart disease and the occurrence of depression and (b) whether physical comorbidities mediated the association between congenital heart disease and the occurrence of depression. METHODS This retrospective cohort study was followed from 1 January 2010-31 December 2013, based on the data from the National Health Insurance Research Database 2010 in Taiwan. We used mediation analysis in survival data to assess the mediated effect. The hazard ratios were adjusted by age, sex, area of residence, and estimated propensity scores. RESULTS We recruited 2122 adult congenital heart disease patients and 8488 matched controls. Nearly half of patients diagnosed with simple congenital heart disease, 39.0% had complex congenital heart disease, and 11.2% had unclassified congenital heart disease. Adult congenital heart disease patients had a significantly higher risk of depression than matched controls (adjusted hazard ratio = 1.43 and 1.48, for all and complex congenital heart disease, respectively, p<0.05). Coronary artery disease and chronic obstructive pulmonary disease were the significant comorbidities mediating the relationship between adult congenital heart disease and depression, the proportions mediated by coronary artery disease or chronic obstructive pulmonary disease were 35.5% and 12.9%, respectively. CONCLUSIONS Helping patients to prevent psychological and physical acquired disease is imperative. Coronary artery disease is a potent mediator between congenital heart disease and depression, especially for patients with complex congenital heart disease.
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Affiliation(s)
- Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taiwan
| | - Jou-Kou Wang
- National Taiwan University Children's Hospital, Taiwan
| | - Chun-Wei Lu
- National Taiwan University Children's Hospital, Taiwan
| | - Yong-Chen Huang
- School of Nursing, College of Medicine, National Taiwan University, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
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16
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Empowering Young Persons with Congenital Heart Disease: Using Intervention Mapping to Develop a Transition Program - The STEPSTONES Project. J Pediatr Nurs 2020; 50:e8-e17. [PMID: 31669495 DOI: 10.1016/j.pedn.2019.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Describe the implementation of intervention mapping in the development of a transition program that aims to empower adolescents with congenital heart disease. DESIGN AND METHODS To gain a better understanding of the problem, we conducted a literature review, focus group and individual interviews, and a cross-sectional survey. This information helped us decide on the scope of the intervention, relevant theories, determinants, formulate performance and change objectives and identify adequate evidence-based change methods. Once the transition program had been designed, effectiveness and process evaluation studies were planned. RESULTS Young persons with congenital heart disease have insufficient disease-related knowledge, self-management skills and high parental involvement. The transition program involves three meetings with a trained transition coordinator over a two-and-a-half-year period and targets young persons with congenital heart disease and their parents. The transition coordinators use change techniques such as goal-setting, modeling and active learning in order to target three personal determinants (knowledge, self-efficacy and self-management). CONCLUSIONS The use of intervention mapping may lead to designing interventions tailored to the needs of the targeted population. The transition program described in this paper is currently being evaluated in a hybrid experimental design with simultaneous undertaking of the process evaluation. PRACTICE IMPLICATIONS This transition program can lead to the empowerment of young persons with congenital heart disease and help them in the process of becoming more responsible for their care. If proven effective, it can be implemented for other chronic conditions.
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17
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Svensson MK, Wahlberg A, Gislason GH. Chronic Paradoxes: A Systematic Review of Qualitative Family Perspectives on Living With Congenital Heart Defects. QUALITATIVE HEALTH RESEARCH 2020; 30:119-132. [PMID: 31526075 DOI: 10.1177/1049732319869909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been substantial advances in the diagnostics and treatment of congenital heart defects (CHDs) in recent decades, and this has improved survival significantly. Consequently, there is a growing interest in how CHDs affect the daily lives of children and youth. We examine life with CHDs as a particular kind of living from the perspectives of both children and youth with CHDs and their families through a systematic review of existing qualitative research. Based on a meta-ethnographic analysis of 20 articles (identified through PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from January 7 to 12, 2016), we argue that living with CHDs is characterized by chronic paradoxes arising out of the transitions, normalities, and futures that families have to navigate.
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Affiliation(s)
- Marie Kofod Svensson
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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18
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Moons P, Luyckx K, Kovacs AH, Holbein CE, Thomet C, Budts W, Enomoto J, Sluman MA, Yang HL, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Apers S. Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease. Can J Cardiol 2019; 35:1842-1850. [DOI: 10.1016/j.cjca.2019.07.635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
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19
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Etnel JRG, de Groot JM, El Jabri M, Mesch A, Nobel NA, Bogers AJJC, Takkenberg JJM. Do risk visualizations improve the understanding of numerical risks? A randomized, investigator-blinded general population survey. Int J Med Inform 2019; 135:104005. [PMID: 31901707 DOI: 10.1016/j.ijmedinf.2019.104005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/16/2018] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Risk visualizations are often employed to support risk communication. However, their effectiveness in communication of single absolute risks remains unclear. We investigated the effectiveness of risk visualizations in conveying verbatim knowledge of single absolute risks among the general population. METHODS Randomly sampled members of the general Dutch population completed four basic risk conversions from percentages to natural frequencies and vice versa. By random investigator-blinded allocation, these conversions were supported by either icon arrays, pie charts, bar graphs or no visualization. Verbatim risk knowledge was scored as the number of conversions completed correctly. RESULTS 393 subjects were included. Overall, 60% of respondents answered all four questions correctly. Risk format (percentages vs. natural frequencies, p = 0.677) and risk magnitude (p = 0.532) were not associated with verbatim risk knowledge score. Younger age (p = 0.001) and higher education level (p < 0.001) were independently associated with higher scores. The use of risk visualizations was not associated with higher scores (OR = 1.08; 95% confidence interval: 0.69-1.69; p = 0.745). All three forms of risk visualization were equally ineffective. These findings held when stratifying by risk format, risk magnitude and user preference for a certain form of risk visualization. There were no significant interactions with age or education level. CONCLUSION Risk visualizations did not improve conveyance of verbatim knowledge of single absolute risks, irrespective of age, education level, risk magnitude, risk format and form of risk visualization. Risk visualizations may therefore be less suitable for settings in which detailed conveyance of single absolute risks is the main objective, although their effect on user experience and perception of risk communication and subsequent patient activation and participation remains to be elucidated.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasmin M de Groot
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Moad El Jabri
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anouk Mesch
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nathalie A Nobel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
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20
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Folwaczny M, Bauer F, Grünberg C. Significance of oral health in adult patients with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S377-S387. [PMID: 31737544 PMCID: PMC6837931 DOI: 10.21037/cdt.2018.09.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022]
Abstract
Due to improved diagnosis and treatment life expectancy of patients with congenital heart disease is steadily increasing resulting in a growing portion of adult patients. When entering, adulthood patients commonly show a shift in their specific needs for medical care. Since the treatment is mostly not curative many patients have life-long cardiovascular anomalies, among others, entailing high risk for the development of infective endocarditis. Several oral diseases, i.e., caries, apical periodontitis and periodontitis show a very high overall prevalence. These entities are primarily initiated by bacterial infections. Hence, they cause an inherent risk for bacteremia and subsequently for infective endocarditis in patients with congenital heart disease during professional dental care and various daily activities. Conversely congenital heart disease seems to be inevitably associated with considerable impairment of oral health resulting in a tight interrelation between both entities. Different preventive strategies are available to address the elevated risk for infective endocarditis due to oral diseases in patients with congenital heart disease during professional dental care and routine daily activities. This review delineates the current evidence regarding the issue of oral health in adult patients with congenital heart disease.
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Affiliation(s)
- Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Bauer
- Department of Oral and Maxillofacial Surgery, University of Technology Munich, Munich, Germany
| | - Christina Grünberg
- Department of Oral and Maxillofacial Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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21
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Hollatz S, Wacker-Gussmann A, Wilberg S, Folwaczny M, Neidenbach R, Kaemmerer H, Ewert P, Oberhoffer R. Awareness of oral health in adults with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S281-S291. [PMID: 31737536 DOI: 10.21037/cdt.2019.01.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Poor oral health is known to be a risk factor for infective endocarditis (IE) and acquired cardiovascular disease. Many patients with congenital heart disease (CHD) are at risk for developing IE. Excellent oral health is deemed essential to prevent IE, a potentially life-threatening condition, and therefore is important in adults with congenital heart defects (ACHD). As data on oral heath in ACHD are scarce, the current study aims to assess the prevalence of caries among ACHD and the knowledge of patients about oral health as a risk factor for IE and cardiovascular disease. Methods A cross-sectional study included ACHD who subsequently presented at the German Heart Center Munich. The participants completed a questionnaire assessing oral health and risk awareness. Additionally, as an indicator of caries prevalence, a dentist documented the DMFT index (sum of decayed, missing and filled teeth). Results The median age of the 112 participants was 31.5 (range, 18-77) years. Forty-three patients (38%) were unaware of a correlation between oral health and heart disease. Twelve participants (11%) did not know about poor oral health being a risk factor for cardiovascular diseases. Less than half of the surveyed patients knew the term endocarditis. An additional twelve patients (11%) reported caveats against dental treatment because of their CHD. In twenty-three patients (21%), caries was found at the dentine level. The mean DMFT index, representing caries prevalence, was 7.91 (±6.54). There was no correlation between the Bethesda criteria of CHD and the DMFT index (P=0.69). The DMFT index was higher in patients at high risk for IE (P<0.01). However, this difference in the caries score was mainly due to more extracted and filled teeth in the high-risk patients for IE, whereas the number of decayed teeth did not differ significantly (P=0.09). Conclusions The awareness of the importance of optimized oral health in ACHD needs to be improved.
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Affiliation(s)
- Stefan Hollatz
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Annette Wacker-Gussmann
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Saskia Wilberg
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, München, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, München, Germany
| | - Rhoia Neidenbach
- German Heart Center, Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, München, Germany
| | - Harald Kaemmerer
- German Heart Center, Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, München, Germany
| | - Peter Ewert
- German Heart Center, Department of Pediatric Cardiology and Congenital Heart Disease, Technical University of Munich, München, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, München, Germany
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22
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Holbein CE, Peugh J, Veldtman GR, Apers S, Luyckx K, Kovacs AH, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Health behaviours reported by adults with congenital heart disease across 15 countries. Eur J Prev Cardiol 2019; 27:1077-1087. [DOI: 10.1177/2047487319876231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample. Design This was a cross-sectional observational study. Methods Adults with congenital heart disease ( n = 4028, median age = 32 years, interquartile range 25–42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims. Results Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status. Conclusions Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.
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Affiliation(s)
- Christina E Holbein
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, USA
| | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Gruschen R Veldtman
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | - Silke Apers
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven - University of Leuven, Belgium
- UNIBS, University of the Free State, South Africa
| | - Adrienne H Kovacs
- Peter Munk Cardiac Center, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Japan
| | - Maayke A Sluman
- Coronel Institute of Occupational Health, University of Amsterdam, the Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, the Netherlands
| | - Chun-Wei Lu
- Adult Congenital Heart Center, National Taiwan University Children’s Hospital
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Université de Montréal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children’s Hospital, USA
| | | | - Luis Alday
- Division of Cardiology, Hospital de Niños, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Health Sciences, University West, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children’s Hospital, Canada
| | | | | | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University, USA
- Barnes Jewish Heart and Vascular Center, University of Missouri, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center, USA
- Taussig Heart Center, Johns Hopkins School of Medicine, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Folwaczny M, Wilberg S, Bumm C, Hollatz S, Oberhoffer R, Neidenbach RC, Kaemmerer H, Frasheri I. Oral Health in Adults with Congenital Heart Disease. J Clin Med 2019; 8:E1255. [PMID: 31430933 PMCID: PMC6723475 DOI: 10.3390/jcm8081255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/03/2022] Open
Abstract
Oral bacteria and odontogenic oral infections are responsible for a high portion of cases with infective endocarditis. Hence, oral health in patients with congenital heart disease (CHD) gains particular importance. This case-control study compared the oral health status in 112 adults with CHD and 168 healthy control subjects. In addition, the patient group was stratified according to the complexity of the heart defect and the recommendation for antibiotic prophylaxis during invasive dental procedures. Considering caries experience, a significantly lower mean DMFT (decayed missing filled teeth) score (7.91 ± 6.63 vs. 13.6 ± 8.15; p < 0.0001) was found in patients with CHD compared to healthy controls. Healthy controls had a higher average number of decayed teeth (0.33 ± 0.76 vs. 1.76 ± 2.61; p < 0.0001). In female subjects a significant lower relative amount of teeth with apical periodontitis was found among CHD patients (3.4% ± 0.9%) as compared to healthy controls (5.6% ± 1.9%) (p = 0.053). Regarding periodontal health, patients with CHD had lower rate of sulcus bleeding (0.32 ± 0.65 vs. 0.71 ± 0.60; p < 0.0001) and less alveolar bone loss than heart healthy individuals (% root length: multi rooted teeth: 8.97 ± 10.64 vs. 23.22 ± 20.70; p < 0.0001; single rooted teeth: 5.59 ± 6.25 vs. 17.30 ± 17.17; p = 0.003). On the contrary, CHD patients presented with higher amount of plaque in comparison to healthy controls (Quigley & Hein index: 2.22 ± 0.67 vs. 1.25 ± 0.72; p < 0.0001). Based on the current results, it can be concluded that adults with CHD have better oral health than heart healthy individuals.
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Affiliation(s)
- Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany.
| | - Saskia Wilberg
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Caspar Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Stefan Hollatz
- Institute of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, D-80336 Munich, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, D-80336 Munich, Germany
| | - Rhoia Clara Neidenbach
- German Heart Center Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Technical University of Munich, D-80636 Munich, Germany
| | - Harald Kaemmerer
- German Heart Center Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Technical University of Munich, D-80636 Munich, Germany
| | - Iris Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
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Ni ZH, Lv HT, Ding S, Yao WY. Home care experience and nursing needs of caregivers of children undergoing congenital heart disease operations: A qualitative descriptive study. PLoS One 2019; 14:e0213154. [PMID: 30870440 PMCID: PMC6417691 DOI: 10.1371/journal.pone.0213154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 02/16/2019] [Indexed: 12/02/2022] Open
Abstract
Aims and objectives To explore the home care experiences of caregivers taking care of CHD children before and after cardiac surgery. Background Despite the prevalence of congenital heart disease (CHD) in childhood, little is known about the experiences and impacts on the children and their caregivers after CHD diagnosis and surgery. Such knowledge is needed for meaningful support. Design A qualitative descriptive study. Methods Twenty-two caregivers of CHD children undergoing cardiac surgery participated in semi-structured interviews at a University Children’s Hospital in China. Data were collected by an experienced and trained interviewer. Qualitative content analysis was chosen to describe the experiences of the caregivers. Results Caregivers of CHD children experienced significant demands. After the children underwent their CHD operations, the caregivers experienced complex psychological feelings and excessive stress impacting upon theirlives. In addition, caregivers constantly adapted their roles with self-fulfillment in caring activities. Conclusions CHD surgery has a major impact on the emotions and daily lives of children and their caregivers. This study offers a framework for understanding the importance of actively listening to caregivers so coping strategies can be implemented. Relevance to clinical practice Theexperiencesdescribed in this study contribute to a better understanding of the needs of caregivers whose children underwent CHD operations. They also provide valuable information to professional medical care staff that developfuture nursing assessments.
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Affiliation(s)
- Zhi Hong Ni
- Children’s Hospital of Soochow University, Suzhou, China
| | - Hai Tao Lv
- Children’s Hospital of Soochow University, Suzhou, China
- * E-mail: (HTL); (SD)
| | - Sheng Ding
- Children’s Hospital of Soochow University, Suzhou, China
- * E-mail: (HTL); (SD)
| | - Wen Ying Yao
- Children’s Hospital of Soochow University, Suzhou, China
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Acuña Mora M, Sparud-Lundin C, Burström Å, Hanseus K, Rydberg A, Moons P, Bratt EL. Patient empowerment and its correlates in young persons with congenital heart disease. Eur J Cardiovasc Nurs 2019; 18:389-398. [DOI: 10.1177/1474515119835434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this study was to measure the level of empowerment and identify its correlates in young persons with congenital heart disease. Study design: Patients aged 14–18 years with congenital heart disease, and under active follow-up in one of four paediatric cardiology centres in Sweden were invited to participate in a cross-sectional study. A total of 202 young persons returned the questionnaires. Patient empowerment was measured with the Gothenburg Young Persons Empowerment Scale that allows the calculation of total and subscale scores. Univariate and multivariate linear regression analyses were undertaken to analyse possible correlates, including: sex, age, health behaviours, knowledge of congenital heart disease, quality of life, patient-reported health, congenital heart disease complexity, transition readiness and illness perception. Results: The mean empowerment score was 54.6±10.6 (scale of 15–75). Univariate analyses showed that empowerment was associated with age, quality of life, transition readiness, illness perception, health behaviours and patient-reported health (perceived physical appearance, treatment anxiety, cognitive problems and communication issues). However, multivariable linear regression analyses identified that only transition readiness (β=0.28, P<0.001) and communication (β=0.36, P<0.001) had a positive association with patient empowerment. These variables were also significantly associated with the subscale scores of the empowerment scale of knowledge and understanding ( P<0.001), shared decision-making ( P<0.001) and enabling others ( P<0.01). The overall models’ explained variance ranged from 8% to 37%. Conclusion: Patient empowerment was associated with transition readiness and fewer problems communicating. While it is not possible to establish the directionality of the associations, interventions looking to increase empowerment could benefit from using these variables (or measurements) for evaluation purposes.
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Affiliation(s)
- Mariela Acuña Mora
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Belgium
| | | | - Åsa Burström
- Institution for Women’s and Children’s Health, Karolinska Institute, Sweden
- Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Sweden
| | - Katarina Hanseus
- Department of Pediatric Cardiology, Skåne University Hospital, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Belgium
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Sweden
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Motoki H, Yasukochi S, Takigiku K, Takei K, Okamura T, Kimura K, Minamisawa M, Okada A, Saigusa T, Ebisawa S, Seto T, Shoda M, Okada K, Kuwahara K. Establishment of a Healthcare System for Patients With Adult Congenital Heart Disease in Collaboration With Children's Hospital - The Nagano Model. Circ J 2019; 83:424-431. [PMID: 30568052 DOI: 10.1253/circj.cj-18-0705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the best efforts of pediatricians, healthcare for adult patients with congenital heart disease (ACHD) has proven challenging because of the increased numbers. This study presents the process of establishing an ACHD care system as a collaborative effort between Shinshu University Hospital and Nagano Children's Hospital. Methods and Results: Establishing an outpatient clinic for transition, a cooperation agreement for in-patient care between the 2 hospitals, and quality management of diagnostic imaging and educational meetings for adult cardiologists were the 3 major challenges. Of the 99 patients who visited the transition clinic in the children's hospital between May 2014 and December 2016, 3 returned to the pediatrician's clinic. Between June 2013 and December 2017, 273 patients visited the ACHD center in Shinshu University Hospital. Until December 2017, mortality and fatal arrhythmia were noted in 3 and 2 cases, respectively. Catheter ablation for arrhythmia was performed in 12 cases, and 4 cases of pregnancy with moderate/severe ACHD or estimated as high risk were managed with healthy livebirths. Surgical interventions for moderate/severe ACHD were performed in collaboration with the children's hospital or Sakakibara Heart Institute. CONCLUSIONS Patients were successfully transferred to adult cardiology departments. Surgical and nonsurgical interventions for ACHD were provided. Collaboration between adult and pediatric cardiologists assists in the establishment of healthcare systems for ACHD.
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Affiliation(s)
- Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | | | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children's Hospital
| | - Toru Okamura
- Department of Pediatric Cardiovascular Surgery, Nagano Children's Hospital
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuichiro Seto
- Department of Cardiovascular Surgery, Shinshu University School of Medicine
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Kenji Okada
- Department of Cardiovascular Surgery, Shinshu University School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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Etnel JRG, Helbing WA, Roos-Hesselink JW, The R, Bogers AJJC, Takkenberg JJM. Patient and physician view on patient information and decision-making in congenital aortic and pulmonary valve surgery. Open Heart 2018; 5:e000872. [PMID: 30487977 PMCID: PMC6242011 DOI: 10.1136/openhrt-2018-000872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 11/03/2022] Open
Abstract
Background To assess the current state of patient information and decision-making in congenital aortic and pulmonary valve disease, we conducted a survey among patients, parents and physicians. Methods A questionnaire was sent by ground mail to 157 adults and 32 parents of children who previously underwent surgery for congenital aortic or pulmonary valve disease at 0-40 years of age between January 2005 and February 2014 at the Erasmus University Medical Center and to all paediatric and adult congenital cardiologists and congenital cardiac surgeons in the Netherlands (n=88). Results 73 patients/parents (39% response rate, 62 adult patients, 11 parents of paediatric patients) and 35 physicians (40% response rate) responded. Median patient age at the time of surgery was 25.7 years. Basic disease-specific knowledge was adequate in 42% of patients/parents and numeracy was sufficient in 47%. Patients/parents reported that they rely heavily on their physicians for information and often experience difficulty in finding reliable information elsewhere. They lack information on psychosocial aspects of disease (29% of respondents) and risks and benefits of treatment options (26%). They feel less involved in decision-making than they would prefer to be (p=0.014). Decisional conflict at the time of surgery was experienced by 31% of patients/parents. If they had to do it again, 72% of patients/parents would want the same treatment. Quality of life is often impaired due to various valve-related anxieties and lifestyle changes. Physicians reported that they are unable to fully inform and sufficiently involve patients, due to limited patient/parent knowledge and understanding (56%) and limited time during consultations (32%). Patients/parents (98%) and physicians (97%) agree that they should have shared roles in decision-making. Conclusion The substantial shortcomings in our current practice of patient information and decision-making underline the need for innovative solutions, such as careful implementation of patient information tools and shared decision-making in the care path.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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van der Watt R, Pheiffer C, Brown S. The psychosocial themes of children with a congenital heart defect. J Child Adolesc Ment Health 2018; 29:231-244. [PMID: 29240546 DOI: 10.2989/17280583.2017.1405815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children living with a congenital heart defect (CHD) carry the burden of a condition affecting their biological, psychological, and social functioning. Even though the physical heartbeats of these children might be inaudible and defective, their intra- and inter-personal 'stories in sound' need to be heard and understood. The aim of this research study was to explore these 'stories in sound' in children diagnosed with CHD. A qualitative, exploratory, descriptive study using thematic analysis was conducted. Semi-structured interviews were conducted with six boys and three girls between the ages of eight and fourteen years, who were diagnosed with CHD. The developmental psychopathology model (DPM) served as a conceptual framework. Five main themes emerged and were related to (i) the participants' understanding of their cardiac diagnoses; (ii) the participants' perceptions regarding their post-operative cardiac statuses; (iii) the participants' psychological experiences related to their cardiac statuses; (iv) the effects of living with CHD on their social functioning; and (v) a unique relationship to their chronic cardiac condition. Within each of these themes, thirteen subthemes were identified. The article concludes that an age-appropriate understanding of CHD and post-operative cardiac status is important, as children's perceptions have implications for their psychosocial experiences and acceptance of living with CHD. These children need comprehensive support from health care professionals.
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Affiliation(s)
- Ronél van der Watt
- a Department of Psychology , University of the Free State , Bloemfontein , South Africa
| | - Carina Pheiffer
- a Department of Psychology , University of the Free State , Bloemfontein , South Africa
| | - Stephen Brown
- b Pediatric and Child Health , University of the Free State , Bloemfontein , South Africa
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Abstract
Over the past decades, survival of patients with CHD improved significantly, making it a life-cycle disease. Hence, there is a need for a workforce that can take up the care for afflicted individuals in the different phases of the life spectrum. Each life phase is associated with specific challenges. Topics that should receive more attention in clinical care or in CHD research are parenting styles of parents of children, transfer and transition of adolescents, cumulative burden of injury in the brain in adults, and geriatric care for older persons with CHD. Nurses, along with other healthcare professionals, will play a pivotal role in building up expertise in these areas and taking up these challenges.
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Huang HR, Chen CW, Chen CM, Yang HL, Su WJ, Wang JK, Tsai PK. A positive perspective of knowledge, attitude, and practices for health-promoting behaviors of adolescents with congenital heart disease. Eur J Cardiovasc Nurs 2017; 17:217-225. [DOI: 10.1177/1474515117728609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Health-promoting behaviors could serve as a major strategy to optimize long-term outcomes for adolescents with congenital heart disease. The associations assessed from a positive perspective of knowledge, attitudes, and practice model would potentially cultivate health-promoting behaviors during adolescence. Aim: The purpose of this study was to examine the relationships between disease knowledge, resilience, family functioning, and health-promoting behaviors in adolescents with congenital heart disease. Methods: A total of 320 adolescents with congenital heart disease who were aged 12–18 years were recruited from pediatric cardiology outpatient departments, and participated in a cross-sectional survey. The participants completed the Leuven Knowledge Questionnaire for Congenital Heart Disease; Haase Adolescent Resilience in Illness Scale; Family Adaptability, Partnership, Growth, Affection, and Resolve; and Adolescent Health Promotion scales. The collected data were analyzed using descriptive statistics and three multiple regression models. Results: Greater knowledge of prevention of complications and higher resilience had a more powerful effect in enhancing health-promoting behaviors. Having symptoms and moderate or severe family dysfunction were significantly more negatively predictive of health-promoting behaviors than not having symptoms and positive family function. The third model explained 40% of the variance in engaging in health-promoting behaviors among adolescents with congenital heart disease. Conclusion: The findings of this study provide new insights into the role of disease knowledge, resilience, and family functioning in the health-promoting behavior of adolescents with congenital heart disease. Continued efforts are required to plan family care programs that promote the acquisition of sufficient disease knowledge and the development of resilience for adolescents with congenital heart disease.
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Affiliation(s)
- Hui-Ru Huang
- Department of Nursing, Fu Jen Catholic University Hospital, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taiwan
| | - Chin-Mi Chen
- Department of Nursing, Fu Jen Catholic University, Taiwan
| | | | - Wen-Jen Su
- Department of Pediatrics, Chang Gung Children’s Hospital, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Pei-Kwei Tsai
- Department of Public Health and Center of Biostatistics, Chang Gung University, Taiwan
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Red Flags for Maltese Adults with Congenital Heart Disease: Poorer Dental Care and Less Sports Participation Compared to Other European Patients-An APPROACH-IS Substudy. Pediatr Cardiol 2017; 38:965-973. [PMID: 28341902 DOI: 10.1007/s00246-017-1604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/18/2017] [Indexed: 12/13/2022]
Abstract
Studies in recent years have explored lifestyle habits and health-risk behaviours in adult congenital heart disease (ACHD) patients when compared to controls. The aim of this study was to investigate differences in lifestyle habits between Maltese and other European ACHD patients. Data on alcohol consumption, cigarette smoking, substance misuse, dental care and physical activity collected in 2013-2015 during "Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study" (APPROACH-IS) were analysed. Responses from 119 Maltese participants were compared to those of 1616 participants from Belgium, France, Italy, Norway, Sweden, Switzerland and the Netherlands. Significantly fewer Maltese patients with simple (Maltese 84.1% vs. European 97.5%, p < 0.001) and moderately complex CHD (Maltese 83.6% vs. European 97.4%, p < 0.001) brushed their teeth daily. Only 67.2% of Maltese with moderately complex disease had dental reviews in the previous year compared to 80.3% of Europeans (p = 0.02). Maltese patients with simple (Maltese 31.8% vs. European 56.1%, p = 0.002) and moderately complex lesions (Maltese 30.0% vs. European 59.2%, p < 0.001) performed less regular sport activities. Comparison by country showed Maltese patients to have significantly poorer tooth brushing and sports participation than patients from any other participating country. Alcohol consumption, cigarette smoking and substance misuse were not significantly different. This study highlights lifestyle aspects that Maltese ACHD patients need to improve on, which might not be evident upon comparing patients to non-CHD controls. These findings should also caution researchers against considering behaviours among patients in one country as necessarily representative of patients on the larger scale.
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Ladouceur M, Calderon J, Traore M, Cheurfi R, Pagnon C, Khraiche D, Bajolle F, Bonnet D. Educational needs of adolescents with congenital heart disease: Impact of a transition intervention programme. Arch Cardiovasc Dis 2017; 110:317-324. [DOI: 10.1016/j.acvd.2017.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/03/2017] [Accepted: 02/11/2017] [Indexed: 11/26/2022]
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33
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Etnel JRG, van Dijk APJ, Kluin J, Bertels RA, Utens EMWJ, van Galen E, Bogers AJJC, Takkenberg JJM. Development of an Online, Evidence-Based Patient Information Portal for Congenital Heart Disease: A Pilot Study. Front Cardiovasc Med 2017; 4:25. [PMID: 28507990 PMCID: PMC5410639 DOI: 10.3389/fcvm.2017.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In response to an increased need for patient information on congenital heart disease in the Netherlands, we initiated a nationwide initiative to develop an online, evidence-based patient information portal, starting with a pilot project aimed at the subgroup of patients with congenital aortic and pulmonary valve disease. METHODS AND RESULTS We developed an information portal that aims to (1) improve patient knowledge and involvement and to subsequently reduce anxiety and decisional conflict and improve mental quality of life and (2) to support physicians in informing and communicating with their patients. The information portal was developed according to the systematic International Patient Decision Aid Standards development process employing Delphi techniques by a multidisciplinary workgroup of pediatric and adult congenital cardiologists, a congenital cardiothoracic surgeon, a psychologist, an epidemiologist, a patient representative, and web and industrial design experts. First, patients and physicians were surveyed and interviewed to assess the current state of patient information and explore their preferences and needs to determine the focus for the development of the information portal. We found that patient knowledge and numeracy are limited, reliable information is scarce, physicians inform patients selectively and patient involvement is suboptimal, and there is a need for more reliable, tailored, and multi-faceted information. Based on the findings of these surveys and interviews, a patient-tailored information portal was designed that presents evidence-based disease- and age-specific medical and psychosocial information about diagnosis, treatment, prognosis, and impact on daily life in a manner that is comprehensible and digestible for patients and that meets the needs expressed by both patients and physicians. The effect of the website on patient outcome is currently being assessed in a multicenter stepped-wedge implementation trial. CONCLUSION The present pilot project succeeded in developing an online, evidence-based information portal that is supported by both patients and physicians. The information portal will be further developed and expanded to include all other major forms of congenital heart disease, translations into other languages, and a public information portal to serve patients' relatives and the general public at large.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,De Bascule, Academic Center for Child Psychiatry, Amsterdam, Netherlands
| | - Eugene van Galen
- Patient Association 'Patiëntenvereniging Aangeboren Hartafwijkingen', Maarssen, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Sillman C, Morin J, Thomet C, Barber D, Mizuno Y, Yang HL, Malpas T, Flocco SF, Finlay C, Chen CW, Balon Y, Fernandes SM. Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD). Int J Cardiol 2016; 229:125-131. [PMID: 28340978 DOI: 10.1016/j.ijcard.2016.10.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. METHODS Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. RESULTS/CONCLUSION The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy.
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Affiliation(s)
- Christina Sillman
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States.
| | - Joanne Morin
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Deena Barber
- Akron Children's Hospital, Akron, OH, United States
| | | | | | - Theresa Malpas
- The Prince Charles Hospital, Adult Congenital Heart Disease Service, Brisbane, Australia
| | - Serena Francesca Flocco
- Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | | | | | - Yvonne Balon
- Peter Lougheed Hospital, Calgary, Alberta, Canada
| | - Susan M Fernandes
- Stanford University, Palo Alto, CA, Departments of Pediatrics and Medicine and Divisions of Pediatric Cardiology and Cardiovascular Medicine, United States
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