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Misra S, Shukla AK. Teplizumab: type 1 diabetes mellitus preventable? Eur J Clin Pharmacol 2023; 79:609-616. [PMID: 37004543 DOI: 10.1007/s00228-023-03474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune condition driven by T lymphocytes that specifically declines the function of beta cells of pancreas. Immunological treatments aim to stop this decline in β-cell function thus preventing TIDM. Although TIDM occur at any age, it is one of the most common chronic disorders in children. T1DM accounts for 5 to 10% of all cases of diabetes amounting 21-42 million affected persons. Teplizumab is a novel drug recently approved by the US FDA for the treatment of T1DM. This drug reduces abnormal glucose tolerance who are at high risk for developing T1DM and have antibodies suggesting an immunological attack on their pancreas. A 14-day infusion of the drug prevents T cells' attack of the insulin-producing cells of the pancreas. Adverse events due to teplizumab reported so far mild and of limited duration. This review gives an overview of the preclinical and clinical research on teplizumab for their role in new-onset T1DM.
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Affiliation(s)
- Saurav Misra
- Department of Pharmacology, Kalpana Chawla Government Medical College, Karnal, Haryana, India.
| | - Ajay Kumar Shukla
- Department of Pharmacology, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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2
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Nightingale R, Kirk S, Swallow V, McHugh GA. Supporting the parent-to-child transfer of self-management responsibility for chronic kidney disease: A qualitative study. Health Expect 2023; 26:683-692. [PMID: 36562551 PMCID: PMC10010075 DOI: 10.1111/hex.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As children with long-term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self-management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self-management responsibility and parents to relinquish control. METHODS A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13-17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. FINDINGS Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self-management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child- or family-centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. CONCLUSION This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child- and family-centred care, and how HCPs can adopt personalized, strengths-based approaches to help ensure the support that families receive is tailored to their individual needs. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery.
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Affiliation(s)
- Ruth Nightingale
- Language and Cognition Department, UCL Division of Psychology and Language Science, University College London, London, UK
| | - Sue Kirk
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Gretl A McHugh
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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3
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Gauci J, Bloomfield J, Lawn S, Towns S, Hobbs A, Steinbeck K. A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: a study protocol. Trials 2022; 23:850. [PMID: 36199075 PMCID: PMC9532816 DOI: 10.1186/s13063-022-06740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management support is increasingly viewed as an integral part of chronic condition management in adolescence. It is well recognized that markers of chronic illness control deteriorate during adolescence. Due to the increasing prevalence of long-term chronic health conditions in childhood and improved survival rates of previously life-limiting conditions in children and adolescents, significant numbers of adolescents are having to manage their chronic condition effectively as they transition to adult health care. Therapy adherence has been identified as a major challenge for young people living with a chronic condition such as cystic fibrosis, diabetes, or asthma requiring long-term pharmacological therapy and/or lifestyle modifications. Most systematic reviews on self-management interventions address adult populations. Very few intervention studies are directed at adolescents with a chronic condition who are transitioning to adult health services. This protocol describes a prospective randomized controlled trial of a standardized self-management intervention program delivered to adolescents aged 15-18 years prior to their transfer to adult care. This study has been designed to provide evidence regarding self-management programs for adolescents and is the first study to use the Flinders Program with this important, under-researched age group. METHODS A randomized controlled trial is used to investigate the effectiveness of a modified adolescent-friendly version of an adult self-management program. This program is directed at improving self-management in an adolescent cohort 15-18 years of age with a chronic condition being treated in a specialist pediatric hospital. Participants will be randomized to either usual care or the modified Flinders Program plus usual care. Data collection will include measures of specific illness control, unscheduled hospital admissions, and questionnaires to record self-management competencies, quality of life, self-efficacy, and outcome measures specific to the chronic condition at baseline, 3 months, 6 months, and 12 months after delivery. DISCUSSION This study will provide a better understanding of the elements required for effective self-management programs in adolescents with a chronic condition and address some important knowledge gaps in current literature. The study will be carried out in collaboration with the Discipline of Behavioural Health at Flinders University, Adelaide, Australia, in order to inform the development of an adolescent version of the successful and validated Flinders Program™. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12621000390886). Registered on April 8, 2021.
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Affiliation(s)
- Jaunna Gauci
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Annabelle Hobbs
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Steinbeck
- Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
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4
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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5
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Deep Learning for Type 1 Diabetes Mellitus Diagnosis Using Infrared Quantum Cascade Laser Spectroscopy. MATERIALS 2022; 15:ma15092984. [PMID: 35591319 PMCID: PMC9099836 DOI: 10.3390/ma15092984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 12/05/2022]
Abstract
An estimated 10.5% of the world’s population aged 20–79 years are currently living with diabetes in 2021. An urgent task is to develop a non-invasive express-diagnostics of diabetes with high accuracy. Type 1 diabetes mellitus (T1DM) diagnostic method based on infrared laser spectroscopy of human exhaled breath is described. A quantum cascade laser emitting in a pulsed mode with a peak power of up to 150 mW in the spectral range of 5.3–12.8 μm and Herriot multipass gas cell with an optical path length of 76 m were used. We propose a method for collecting and drying an exhaled human air sample and have measured 1200 infrared exhaled breath spectra from 60 healthy volunteers (the control group) and 60 volunteers with confirmed T1DM (the target group). A 1-D convolutional neural network for the classification of healthy and T1DM volunteers with an accuracy of 99.7%, recall 99.6% and AUC score 99.9% was used. The demonstrated results require clarification on a larger dataset and series of clinical studies and, further, the method can be implemented in routine medical practice.
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Smith BM, Sharma R, Das A, Aboumatar H, Pitts SI, Day J, Holzhauer K, Bass E, Bennett WL. Patient and family engagement strategies for children and adolescents with chronic diseases: A review of systematic reviews. PATIENT EDUCATION AND COUNSELING 2021; 104:2213-2223. [PMID: 33678498 DOI: 10.1016/j.pec.2021.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. We aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature. METHODS We searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years). Strategies were categorized by direct patient care, health system, and community policy levels. We excluded reviews if interventions were unidirectional or without comparison. RESULTS We identified 25 systematic reviews. Twenty-two evaluated direct patient care, with 14 (279 unique studies) exclusively in pediatrics and 8 (24 unique studies) that included pediatric results with adults. Three reviews (9 unique studies) evaluated health system strategies. Direct patient care reviews focused on self-management support (n = 16) and shared decisionmaking (n = 6). Asthma was the most frequently evaluated condition (n = 14). CONCLUSIONS AND PRACTICE IMPLICATIONS Engagement strategies for children and adolescents with chronic disease are focused on direct patient care, particularly for asthma. More research is needed to address engagement for broader populations, expanded outcomes, and at health system and community levels.
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Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Ritu Sharma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Asar Das
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hanan Aboumatar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Samantha I Pitts
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Katherine Holzhauer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Gauci J, Bloomfield J, Lawn S, Towns S, Steinbeck K. Effectiveness of self-management programmes for adolescents with a chronic illness: A systematic review. J Adv Nurs 2021; 77:3585-3599. [PMID: 33630315 DOI: 10.1111/jan.14801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
AIM To assess what is known about the effectiveness of face-to-face self-management programmes designed specifically for adolescents (10-19 years) with a chronic illness. DESIGN A systematic review and synthesis without meta-analysis (SWiM). DATA SOURCES Six international web-based reference libraries were searched with a date range of 1946 to July 2020. REVIEW METHOD The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria. RESULTS Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted. CONCLUSIONS There is a limited body of evidence on the effectiveness of self-management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self-management programmes to guide the development of future programmes. IMPACT It is crucial for adolescents with a chronic illness to develop independence and the self-management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self-management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self-management skills as they assume responsibility for their own healthcare.
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Affiliation(s)
- Jaunna Gauci
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Katharine Steinbeck
- Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
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The comparison of efficacy and safety between different doses of empagliflozin in insulin-treated type 1 diabetes mellitus patients: a systematic review and meta-analysis protocol. J Diabetes Metab Disord 2020; 19:545-550. [PMID: 32550206 DOI: 10.1007/s40200-020-00544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
Objectives The proposed review aims to compare the efficacy and safety profile of empagliflozin 25 mg with its lower dosages and placebo, respectively, in insulin-treated type 1 diabetes mellitus (T1DM) patients. Methods Double-blinded randomized controlled trials comparing the above outcomes will be searched primarily in three electronic databases (PubMed, Embase, and Scopus) and eligible trials will be included in the proposed review. Then, from the trials recruited in the review, data of the study design, participants, interventions compared, and outcomes of interest will be extracted. Subsequently, the trials' risk of bias will be assessed using the Cochrane Collaboration's tool. The meta-analysis will be conducted with a fixed-effect or a random-effect model to estimate the mean differences (weighted or standardized) and risk ratios for the efficacy and safety-related comparable outcome data, respectively. Statistical heterogeneity will be assessed by the p-value of chi-squared statistics and I2 statistics and explained by subgroup analysis and meta-regression. Publication bias will be assessed by funnel plots and Egger's test. The sensitivity analysis will repeat the meta-analysis for respective outcomes using assumptions alternative to that used in the preliminary meta-analysis and by dropping each study at a time. Results A narrative reporting will ensue if a meta-analytic comparison is not possible. Conclusions Based on the contemporary literature, the proposed review will synthesize the evidence on how the efficacy and safety profile of high dose empagliflozin varies with its lower doses and placebo, respectively, in insulin-treated T1DM patients.
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Saxby N, Ford K, Beggs S, Battersby M, Lawn S. Developmentally appropriate supported self-management for children and young people with chronic conditions: A consensus. PATIENT EDUCATION AND COUNSELING 2020; 103:571-581. [PMID: 31611128 DOI: 10.1016/j.pec.2019.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE/S To create a consensus list of self-management definitions, recommendations, and endpoints for children and young people (0-20 years) with chronic conditions. METHODS This study used a Delphi technique. Based on the number of relevant peer-reviewed publications, clinical academics were invited to participate in three survey rounds. Round one contained open-ended and multiple-choice questions eliciting general opinions on self-management. For round two, results were provided to the interdisciplinary expert panel as statements for rating their agreement using a 7-point Likert scale, with consensus predefined as moderately or extremely satisfied by >70% of participants. Statements not meeting consensus were re-presented in round three, with group feedback incorporated. Finalised statements informed creation of the 'Partners in Health: Self-Management Consensus List for Children and Young People'. RESULTS Sixteen clinical academics participated: 12 completed round one; 14 completed round two; and 12 completed round three. Of 101 statements, 90 reached consensus, with statements separated into five developmentally appropriate groups. Statements covered broad self-management and self-management support domains including knowledge, involvement, monitoring/responding to symptoms, transition, impact, lifestyle, and support. Division of responsibility and autonomy were distinct themes. CONCLUSION AND PRACTICE IMPLICATIONS This research provides consensus-based guidance for clinicians providing paediatric self-management support.
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Affiliation(s)
- Nicole Saxby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia; Department of Women's and Children's Services, Royal Hobart Hospital, Hobart, Australia.
| | - Karen Ford
- Centre of Education and Research Nursing and Midwifery, Royal Hobart Hospital, Hobart, Australia; College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Sean Beggs
- Department of Women's and Children's Services, Royal Hobart Hospital, Hobart, Australia; College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
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Saxby N, Beggs S, Battersby M, Lawn S. What are the components of effective chronic condition self-management education interventions for children with asthma, cystic fibrosis, and diabetes? A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:607-622. [PMID: 30471988 DOI: 10.1016/j.pec.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/24/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To articulate the components of educational interventions that help children learn about managing their asthma, cystic fibrosis, or diabetes, relevant to their age/developmental status. METHODS A systematic review of chronic condition self-management (CCSM) educational interventions that included age/developmentally appropriate components, published before 27 January 2018, including evidence level and quality assessments. Teaching approaches were extracted and translated into practical components. RESULTS Twenty education interventions were identified, published across 30 studies. Most studies (n = 20/30) were based on the theories of Piaget and Bandura. Similar teaching approaches were used across conditions, incorporating sequenced curriculum and a variety of active elements. Age/developmentally appropriate interventions resulted in improvements in the CCSM capabilities of children. Outcomes were improved when compared with usual care. For very young children, educational interventions were directed at parents/families. As children reached school age, interventions increasingly became child-focused, promoting autonomy. Integrated play and reinforcement were common. Adolescent interventions placed greater emphasis on communication, problem-solving, and role division. CONCLUSION Eight key components were identified: structured and sequenced curricula; reinforcement; active participation; collaboration; autonomy; feedback; multiple exposures; and, problem-solving. Different components are relevant to specific life stages. PRACTICE IMPLICATIONS Clinicians require age/developmentally appropriate practical education tools to provide effective paediatric health care.
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Affiliation(s)
- Nicole Saxby
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia; Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, GPO Box 1061, Hobart, 7001, Tasmania, Australia.
| | - Sean Beggs
- Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, GPO Box 1061, Hobart, 7001, Tasmania, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia
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