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Barry JN, Moses JD, Kim SC. A Clinician's Guide To Effectively Transitioning and Transferring Care For Pediatric Patients With Inflammatory Bowel Diseases From The Pediatric To Adult Gastroenterologist. Curr Gastroenterol Rep 2024:10.1007/s11894-024-00936-6. [PMID: 39009946 DOI: 10.1007/s11894-024-00936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Transition of care for pediatric patients with inflammatory bowel diseases (IBD) is a continuous, dynamic process that takes place over several years with a coordinated approach executed by a multidisciplinary team. We review the concepts, tools, and research in effective transitioning and transfer of care for adolescent/young adult patients with IBD. RECENT FINDINGS Given the constraints within the healthcare system, effective transitioning can be challenging to implement in everyday clinical practice. Different barriers include resources and expertise in effective transitioning by pediatric and adult gastroenterology healthcare providers and the impact of non-gastrointestinal issues facing young adult patients who are learning to manage and coordinate all aspects of their medical care and health maintenance. Factors that facilitate successful care transitioning and transfer include structured transitioning programs, utilization of validated transition checklists, and IBD medical summaries. Proactive transitioning by pediatric gastroenterologists in partnership with their emerging young adult patients with IBD leads to better clinical and psychosocial outcomes and ultimately, effective transfer of care to adult gastroenterology. By utilizing utilize comprehensive transition assessment tools and medical summaries in partnership with their patients, pediatric and adult gastroenterology teams can better prepare patients as they transfer to independent care and health maintenance.
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Affiliation(s)
- Jessica N Barry
- Cleveland Clinic, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland, OH, USA
| | - Jonathan D Moses
- Stanford Medicine Children's Health Division of Gastroenterology, Hepatology, and Nutrition, Palo Alto, CA, USA
| | - Sandra C Kim
- Cleveland Clinic, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland, OH, USA.
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Nardone OM, Martinelli M, de Sire R, Calabrese G, Caiazzo A, Testa A, Rispo A, Miele E, La Mantia A, D’Alessandro E, Fioretti MT, Limansky L, Ferrante M, Di Luna I, Staiano A, Castiglione F. Time to grow up: readiness associated with improved clinical outcomes in pediatric inflammatory bowel disease patients undergoing transition. Therap Adv Gastroenterol 2024; 17:17562848241241234. [PMID: 38827647 PMCID: PMC11143856 DOI: 10.1177/17562848241241234] [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: 08/23/2023] [Accepted: 03/06/2024] [Indexed: 06/04/2024] Open
Abstract
Background The transition from pediatric to adult healthcare in individuals with inflammatory bowel disease (IBD) poses significant challenges mainly due to the high burden of IBD during adolescence, a critical period of psychosocial development. So far, there are few longitudinal data linking transition readiness to long-term disease outcomes. Objective We aimed to assess patients' readiness to transition and its impact on clinical outcomes, quality of life, and adherence to therapy. Design An observational, prospective study was conducted in a tertiary adult and pediatric center, including adolescents aged ⩾17 years with a diagnosis of IBD, who underwent a 'structured transition' program including two joint adult-pediatric visits. Methods Transition readiness skills were assessed with the Transition Readiness Assessment Questionnaire (TRAQ). All patients completed the TRAQ at the time of recruitment, which occurred during the initial joint adult-pediatric visit, to determine those deemed ready for transition versus those not ready. The Morisky Medication Adherence Scale and the 36-Item Short Form Health Survey Questionnaire (SF-36) were also completed at baseline and after 12 months. Clinical outcomes were collected at the 12-month follow-up. Results In all, 80 patients were enrolled who had transitioned through a structured transition clinic and completed 12 months of follow-up. In total, 54 patients were ready for the transition, with a mean TRAQ = 3.2 ± 0.5. The number of clinical relapses and hospitalizations at 12 months was lower in ready compared to not-ready patients (p = 0.004 and p = 0.04, respectively). SF-36 did not differ between ready and not-ready patients and pre- and post-transition clinics (p > 0.05). Based on the receiver operating characteristic curve, a TRAQ cutoff ⩾3.16 could predict medication adherence with a sensibility of 77%, a specificity of 82%, and an AUC of 0.81 (0.71-0.91; p < 0.001). Conclusion Patients ready for transition had better outcomes at 12 months compared to those who were not ready. Therefore, readiness assessment tools should be integrated into transition management to ensure that interventions are targeted, patient-centered, and responsive to individuals' changing needs.
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Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Public Health, AOU ‘Federico II’ of Naples, Via Pansini 5, Naples 80131, Italy
| | - Massimo Martinelli
- Section of Pediatrics, Department of Translational Medical Science, University Federico II of Naples, Naples, Italy
| | - Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Giulio Calabrese
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Caiazzo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Erasmo Miele
- Section of Pediatrics, Department of Translational Medical Science, University Federico II of Naples, Naples, Italy
| | - Alessia La Mantia
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Ermelinda D’Alessandro
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Maria Teresa Fioretti
- Section of Pediatrics, Department of Translational Medical Science, University Federico II of Naples, Naples, Italy
| | - Lara Limansky
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Mario Ferrante
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Imma Di Luna
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Castiglione F, Scarallo L, Nardone OM, Aloi M, Alvisi P, Armuzzi A, Arrigo S, Bodini G, Calabrese E, Ceccarelli L, Fries W, Marseglia A, Martinelli M, Milla M, Orlando A, Rispo A, Rizzello F, Romano C, Caprioli F, Lionetti P. Transition care in patients with IBD: The pediatric and the adult gastroenterologist's perspective. Results from a national survey. Dig Liver Dis 2024; 56:802-809. [PMID: 38072745 DOI: 10.1016/j.dld.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Transition is a crucial process in the care of IBD patients, although it remains largely heterogeneous. AIMS To provide an overview of the transition process in Italy and to investigate the perspective of the paediatric and adult physicians. METHODS An online survey was developed by the Italian Group for Inflammatory Bowel Diseases (IG-IBD) and the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition (SIGENP). RESULTS 104 physicians (62 paediatric and 42 adult gastroenterologists) participated to the survey. The disease status was ranked with the highest priority among the key elements of the transition process. The age of the patient was perceived with a higher priority by paediatric gastroenterologists than by adult ones (p < 0.01). In most cases, the transition was organized through one or more joint meetings. Only less than 25 % of responders reported to involve other professions during transition. The struggle in leaving paediatric setting was perceived as the main obstacle to an effective transition process. Paediatric IBD gastroenterologists ranked the struggle in leaving the paediatric setting and the attending physician as higher critical point than adult gastroenterologists. CONCLUSIONS The current survey provided a snapshot of the IBD transition process in Italy. The present findings highlight the need to embed transitional care in healthcare policy.
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Affiliation(s)
- Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer IRCCS children's Hospital, Florence, Italy; Department NEUROFARBA, University of Florence, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Public Health, University Federico II of Naples
| | - Marina Aloi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, 40133 Bologna, Italy
| | | | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genova, Genova, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Linda Ceccarelli
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010, Pisa, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, Dept. of Clinical and Experimental Medicine, University of Messina, Messina; Italy
| | - Antonio Marseglia
- Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Antonio Rispo
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; DIMEC, University of Bologna, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer IRCCS children's Hospital, Florence, Italy; Department NEUROFARBA, University of Florence, Italy.
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Rubín de Célix C, Martín-de-Carpi J, Pujol-Muncunill G, Palomino LM, Velasco Rodríguez-Belvís M, Martín-Masot R, Navas-López VM, Ricart E, Casanova MJ, Rodríguez-Martínez A, Leo-Carnerero E, Alcaraz A, Mañosa M, Hernández V, Cobelas Cobelas MC, Sánchez C, Menchén L, Mesonero F, Barreiro-De Acosta M, Martinón-Torres N, Tejido Sandoval C, Rendo Vázquez A, Corsino P, Vicente R, Hernández-Camba A, Alberto Alonso JR, Alonso-Abreu I, Castro Millán AM, Peries Reverter L, Castro B, Fernández-Salgado E, Busto Cuiñas MM, Benítez JM, Madero L, Clemente F, Riestra S, Jiménez-Treviño S, Boscá-Watts M, Crehuá-Gaudiza E, Calvo Moya M, Huguet JM, Largo-Blanco EM, González Vives L, Plaza R, Guerra I, Barrio J, Escartín L, Alfambra E, Cruz N, Muñoz MC, Muñoz Pino MG, Van Domselaar M, Botella B, Monfort Miquel D, Rodríguez Grau MC, De La Mano A, Ber Y, Calvo Iñiguez M, Martínez-Pérez TDJ, Chaparro M, Gisbert JP. Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU and SEGHNP. J Clin Med 2023; 12:4813. [PMID: 37510928 PMCID: PMC10381381 DOI: 10.3390/jcm12144813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.
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Affiliation(s)
- Cristina Rubín de Célix
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Laura María Palomino
- Paediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | | | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Alejandro Rodríguez-Martínez
- Paediatric Gastroenterology, Hepatology and Nutrition, UGC de Pediatría, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | | | - Alba Alcaraz
- Department of Paediatric Gastroenterology, Nutrition and Hepatology, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain
| | - Miriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 08916 Badalona, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, SERGAS, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | | | - César Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Hospital General Universitario Gregorio Marañón, 28018 Madrid, Spain
| | - Luis Menchén
- Gastroenterology Department-CEIMI, Hospital General Universitario Gregorio Marañón, Departamento de Medicina, Universidad Complutense de Madrid, 28018 Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Manuel Barreiro-De Acosta
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Nazareth Martinón-Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Coral Tejido Sandoval
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Alicia Rendo Vázquez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Pilar Corsino
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Raquel Vicente
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Alejandro Hernández-Camba
- Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - José Ramón Alberto Alonso
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - I Alonso-Abreu
- Gastroenterology Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Ana María Castro Millán
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Laia Peries Reverter
- Gastroenterology Department, Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Estela Fernández-Salgado
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - M Mercedes Busto Cuiñas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, 14004 Córdoba, Spain
| | - Lucía Madero
- Gastroenterology Department, Hospital Universitario de Alicante, Instituto de Investigación Sanitaria y Biomedica (ISABIAL), 03010 Alicante, Spain
| | - Fernando Clemente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Alicante, 03010 Alicante, Spain
| | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Santiago Jiménez-Treviño
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maia Boscá-Watts
- Gastroenterology Department, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Marta Calvo Moya
- Inflammatory Bowel Disease Unit, Department of Gastroenterology and Hepatology, Hospital Puerta de Hierro, 28222 Madrid, Spain
| | - José María Huguet
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Ester-María Largo-Blanco
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Leticia González Vives
- Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Rocío Plaza
- Gastroenterology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Josefa Barrio
- Paediatric Gastroenterology Unit, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Laura Escartín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Erika Alfambra
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Noelia Cruz
- Gastroenterology Department, Hospital Doctor José Molina Orosa, 35500 Las Palmas, Spain
| | - M Carmen Muñoz
- Gastroenterology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | | | | | - Belén Botella
- Gastroenterology Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - David Monfort Miquel
- Gastroenterology Department, Centro Consorci Sanitari Terrassa, 08227 Terrassa, Spain
| | | | - Agustín De La Mano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Henares, 28822 Madrid, Spain
| | - Yolanda Ber
- Gastroenterology Department, Hospital de San Jorge, 22004 Huesca, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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5
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Foster A, Chan JM, Wine E, El-Matary W, Carroll MW, Kroeker KI, deBruyn JC, Seow CH, Lawrence S, Evans K, Kluthe C, Sharifi N, Pears C, Nicol S, Olayinka L, Fu N, Huynh HQ, Bressler B, Bernstein CN, Jacobson K. Transition Readiness in Youth with Inflammatory Bowel Disease. J Pediatr 2023; 258:113403. [PMID: 37019332 DOI: 10.1016/j.jpeds.2023.113403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care. STUDY DESIGN A cross-sectional multicenter study evaluating transition readiness in individuals with IBD 16-19 years old prospectively recruited from 8 Canadian IBD centers using the validated ON Taking Responsibility for Adolescent to Adult Care (ON TRAC) questionnaire. Secondary aims included (1) screening for depression and anxiety using the 8-item Personal Health Questionnaire Depression Scale and The Screen for Child Anxiety Related Emotional Disorders questionnaires, respectively; (2) evaluating the association between depression and anxiety with readiness and disease activity; and (3) subjectively evaluating AYA readiness based on physician and parent assessments. RESULTS In total, 186 participants (139 adolescent, 47 young adult) were enrolled, mean age 17.4 years (SD, 0.87). ON TRAC scores determined that 26.6% of AYAs at pediatric and 40.4% at adult centers reached the threshold of readiness. On multivariable linear regression analysis age was positively (P = .001) and disease remission negatively (P = .03) associated with ON TRAC scores. No statistically significant differences were determined across centers. A significant percentage of AYAs reported moderate-to-severe depression (21.7%) and generalized anxiety (36%); however, neither were significantly associated with ON TRAC scores. Notably, physician and parental assessment of AYA readiness correlated poorly with ON TRAC scores (⍴ = 0.11, ⍴ = 0.24, respectively). CONCLUSIONS Assessment of transition readiness in AYAs with IBD highlighted that a large proportion do not have adequate knowledge or behavior skills needed for transition to adult care. This study infers that readiness assessment tools are essential during transition to identify deficits in knowledge and behavior skills that could be specifically targeted by the youth, caregivers, and multidisciplinary team.
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Affiliation(s)
- Alice Foster
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Justin M Chan
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Eytan Wine
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Wael El-Matary
- Department of Pediatrics, Division of Gastroenterology, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew W Carroll
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Departments of Pediatrics and Community Health Sciences, Division of Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sally Lawrence
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathy Evans
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cheryl Kluthe
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Simone Nicol
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lily Olayinka
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Bressler
- IBD Center of BC, Vancouver, British Columbia, Canada; Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles N Bernstein
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Center and Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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6
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Bay M C, Núñez F P, Quera R, Yarur AJ. Current perspectives on pediatric inflammatory bowel disease focusing on transitional care management. What should we consider? GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:139-147. [PMID: 36243253 DOI: 10.1016/j.gastrohep.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
The prevalence of inflammatory bowel disease (IBD) continues to rise around the globe. Although the percentage of pediatric IBD patients seems to be increasing, rates are surprisingly heterogeneous among different populations. Although the pathogenesis of IBD is believed to be multifactorial, a genetic predisposition may be especially relevant in pediatric-onset IBD. Phenotypic characteristics can also be significantly different when comparing pediatric and adult-onset IBD. Patients that develop the disease at a younger age usually present with more extensive and more aggressive disease and develop complications faster when compared to those that develop it during adulthood. Children with IBD are found to have frequent mood disorders and have a higher risk of developing socio-economic hardship, failing to meet development milestones. Therefore, IBD management should always involve a multidisciplinary team that is not limited to medical providers. Most institutions do not have an established transition protocol and lack the resources and training for transition care. Although there is no consensus on an optimal timing to transition the patient's care to an adult team, it is usually accepted they should be eligible for adult care when most of the key transition points have been met. Management strategies should be tailored to each patient's developmental level and environment. A successful transition can improve the long-term outcomes such as sustained remission, medication adherence, mental health and social and academic performance, while decreasing healthcare utilization. Every institution that manages pediatric IBD patients should have a well-established transition protocol in order to make sure to maintain continuity of care.
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Affiliation(s)
- Constanza Bay M
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paulina Núñez F
- Department of Gastroenterology, Hospital San Juan De Dios, Universidad de Chile, Inflammatory Bowel Disease Programm, Digestive Disease Center, Clínica Universidad de los Andes, Universidad de los Andes, Santiago 7620157, Chile.
| | - Rodrigo Quera
- Inflammatory Bowel Disease Programm, Digestive Disease Center, Clínica Universidad de los Andes, Universidad de los Andes, Santiago 7620157, Chile
| | - Andrés J Yarur
- Cedars-Sinai Medical Center, 8730 Alden Dr. Thalians 2E, Los Angeles, CA 90048, USA
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7
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Michel HK, Boyle B, David J, Donegan A, Drobnic B, Kren C, Maltz RM, McKillop HN, McNicol M, Oates M, Dotson JL. The Pediatric Inflammatory Bowel Disease Medical Home: A Proposed Model. Inflamm Bowel Dis 2022; 28:1420-1429. [PMID: 34562013 DOI: 10.1093/ibd/izab238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 12/09/2022]
Abstract
Care for patients with inflammatory bowel disease (IBD) can be complex and costly. Care delivery models to address these challenges and improve care quality are essential. The patient-centered medical home (PCMH), which was developed in the primary care setting, has recently been applied successfully to the adult IBD population. Following the tenets of the PCMH, this specialty medical home (SMH) emphasizes team-based care that is accessible, comprehensive, patient/family-centered, coordinated, compassionate, and continuous and has demonstrated improved patient outcomes. Children and young adults with IBD have equally complex care needs, with additional challenges not faced by the adult population such as growth, physical and psychosocial development, and transition of care from pediatric to adult providers. Thus, we advocate that the components of the PCMH are equally-if not more-important in caring for the pediatric patient population. In this article, we review what is known about the application of the PCMH model in adult IBD care, describe care delivery within the Center for Pediatric and Adolescent IBD at Nationwide Children's Hospital as an example of a pediatric IBD medical home, and propose a research agenda to further the development and dissemination of comprehensive care delivery for children and adolescents with IBD.
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Affiliation(s)
- Hilary K Michel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Brendan Boyle
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jennie David
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Donegan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Barb Drobnic
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Courtney Kren
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ross M Maltz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,The Center for Microbial Pathogenesis, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hannah N McKillop
- Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan McNicol
- Department of Pharmacy, Nationwide Children's Hospital, Columbus OH, USA
| | - Melanie Oates
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L Dotson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH, USA.,The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
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8
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Phillips MR, Brenner E, Purcell LN, Gulati AS. Pediatric Inflammatory Bowel Disease for General Surgeons. Surg Clin North Am 2022; 102:913-927. [DOI: 10.1016/j.suc.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9
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Fu N, Bollegala N, Jacobson K, Kroeker KI, Frost K, Afif W, El-Matary W, Fowler SA, Griffiths AM, Huynh HQ, Jantchou P, Karimuddin A, Nguyen GC, Otley AR, Pears C, Seow CH, Toulany A, Tersigni C, Tignanelli J, Marshall JK, Boctor M, Hansen T, Pattni C, Wong A, Benchimol EI. Canadian Consensus Statements on the Transition of Adolescents and Young Adults with Inflammatory Bowel Disease from Pediatric to Adult Care: A Collaborative Initiative Between the Canadian IBD Transition Network and Crohn’s and Colitis Canada. J Can Assoc Gastroenterol 2022; 5:105-115. [PMID: 35669843 PMCID: PMC9157291 DOI: 10.1093/jcag/gwab050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives With the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care. Methods Consensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice. Results The Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research. Conclusions These consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.
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Affiliation(s)
- Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natasha Bollegala
- Division of Gastroenterology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Frost
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Wael El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharyle A Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne M Griffiths
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hien Q Huynh
- Division of Pediatric GI Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prévost Jantchou
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Ahmer Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony R Otley
- Division of Pediatric Gastroenterology & Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alene Toulany
- Division of Adolescent Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Tersigni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - John K Marshall
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Monica Boctor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tawnya Hansen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chandni Pattni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric I Benchimol
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Mitrani R, Kohut T, Panganiban J, Carr RM. Transition of Care Model for Pediatric Patients With Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2021; 18:30-36. [PMID: 34484702 PMCID: PMC8405046 DOI: 10.1002/cld.1093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Robert Mitrani
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Taisa Kohut
- Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Jennifer Panganiban
- Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Rotonya M. Carr
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
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11
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Johnson LE, Lee MJ, Turner-Moore R, Grinsted Tate LR, Brooks AJ, Tattersall RS, Jones GL, Lobo AJ. Systematic Review of Factors Affecting Transition Readiness Skills in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1049-1059. [PMID: 33252669 DOI: 10.1093/ecco-jcc/jjaa245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease [IBD] diagnosed before adulthood is increasing worldwide. Transition from paediatric to adult health care requires certain skills. The aim of this study was to identify factors affecting these skills. METHODS This review was registered on the PROSPERO database [CRD42019152272]. Inclusion criteria were: 1] studies of factors affecting transition readiness skills in patients with IBD; 2] written in English; 3] published since 1999. MEDLINE, CINAHL, and PsychINFO databases were searched between 1999 and 2019. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Searches identified 822 papers. Sixteen papers were included. Age was positively associated with skills including disease knowledge and performing self-management behaviours [14 studies]. Improvement often occurs at 18; however, skill deficiency may still remain. Increased self-efficacy [confidence] was associated with greater disease knowledge and performing self-management behaviours [three studies]. Self-efficacy was positively correlated with transition duration [two studies] and health-related quality of life [r = 0.57, p <0.001] [one study], negatively correlated with depression [r = -0.57, p <0.001] and anxiety [r = -0.23, p = 0.03] [one study], and was associated with higher education level [two studies] and a family history of IBD [one study]. Females had higher self-management scores [three studies], and greater health care satisfaction was significantly associated with higher knowledge [one study]. Greater transition communication improved knowledge, self-management, and overall transition readiness [two studies]. CONCLUSIONS Potentially modifiable factors have been identified that could be supported in the transitioning IBD population, to improve transition readiness. Identification of those with non-modifiable characteristics associated with poor readiness may aid targeted support.
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Affiliation(s)
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rhys Turner-Moore
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Alenka J Brooks
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children's Hospitals, Sheffield, UK
| | - Georgina L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Alan J Lobo
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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12
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National Trends of Hospitalizations in Cystic Fibrosis Highlight a Need for Pediatric to Adult Transition Clinics. Pancreas 2021; 50:704-709. [PMID: 34016889 DOI: 10.1097/mpa.0000000000001815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We hypothesized that hospitalizations in cystic fibrosis (CF) would reflect the development of age-related comorbidities. METHODS A retrospective analysis was performed using the Nationwide Inpatient Sample (2002-2017). Hospitalizations for which the principal diagnosis was CF were analyzed regarding age at discharge and presence of comorbidities. Trends were assessed for significance using the Cochran-Armitage test. RESULTS The mean age of patients hospitalized for CF increased from 19.7 years in 2002 to 23.0 years in 2017 (P = 0.017). Several comorbidities are more than 10 times more prevalent among adults as compared with children, including congestive heart failure, substance abuse, and chronic kidney disease (P < 0.001). In addition, diabetes with chronic complications was more prevalent in adults than children (10.0% vs 3.9%; P < 0.001), as was hypertension (7.2% vs 1.3%; P < 0.001) and osteoporosis (10.2% vs 1.9%; P < 0.001). More than 65% of CF hospitalizations in 2017 were in individuals older than 18 years. CONCLUSIONS Hospitalizations for adults with CF are increasing, and individuals with CF are developing age-related comorbidities. Providers equipped to manage the health care needs of adults need to be ready and able to care for this unique and growing patient population.
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13
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Shearer JL, Perry S, Lidyard N, Apperson-Hensen C, DeLozier S, Burkhart K, Katz J, Moses J. Evaluating a Standardized Transition of Care Process for Pediatric Inflammatory Bowel Disease Patients. CHILDREN-BASEL 2020; 7:children7120271. [PMID: 33291611 PMCID: PMC7761915 DOI: 10.3390/children7120271] [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: 10/23/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
To reduce lapses in care for pediatric inflammatory bowel disease (IBD) patients approaching adulthood, a health maintenance transition visit (HMV) was developed to supplement standard medical care (SMV). Our aim was to assess the effect of the HMV on transition readiness. A retrospective chart review was conducted at a single center with demographics and clinical data from HMV and SMV visits. Effectiveness of the HMV was assessed by the patient health questionanaire-9 (PHQ-9) and transition readiness assessment questionnaire (TRAQ) scores. A total of 140 patients, 80% Caucasian and 59% male completed an HMV. The mean age was 18 ± 2 years old, and 93% of patients reported inactive or mild disease. Patients who completed at least 1 prior HMV scored significantly higher on the TRAQ when transferring to adult care compared to patients transferred at their first HMV visit (92 vs. 83, p < 0.05). Of patients with no prior depression diagnosis, 36% had a positive screen for depression. A significant relationship was identified between disease status and PHQ-9 (p < 0.05). This study demonstrated a structured HMV increased transition readiness and quantified the significant under-diagnosis of depression in this population, emphasizing the importance of screening. These results indicate depression may affect patients' transition preparedness.
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Affiliation(s)
- Jennifer Lynne Shearer
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; (J.L.S.); (C.A.-H.)
| | - Sharon Perry
- UH/Rainbow Babies Children’s Pediatric Gastroenterology, University Hospitals Cleveland, Cleveland, OH 44106, USA; (S.P.); (N.L.)
| | - Nicole Lidyard
- UH/Rainbow Babies Children’s Pediatric Gastroenterology, University Hospitals Cleveland, Cleveland, OH 44106, USA; (S.P.); (N.L.)
| | - Carolyn Apperson-Hensen
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; (J.L.S.); (C.A.-H.)
| | - Sarah DeLozier
- Center for Clinical Research, University Hospitals Cleveland, Cleveland, OH 44106, USA;
| | - Kimberly Burkhart
- UH/Rainbow Babies and Children’s Pediatric Psychology, University Hospitals Cleveland, Cleveland, OH 44106, USA;
| | - Jeffry Katz
- Division of Gastroenterology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Jonathan Moses
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; (J.L.S.); (C.A.-H.)
- UH/Rainbow Babies Children’s Pediatric Gastroenterology, University Hospitals Cleveland, Cleveland, OH 44106, USA; (S.P.); (N.L.)
- Correspondence: ; Tel.: +1-216-844-1765
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14
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Diamanti A, Capriati T, Lezo A, Spagnuolo MI, Gandullia P, Norsa L, Lacitignola L, Santarpia L, Guglielmi FW, De Francesco A, Pironi L. Moving on: How to switch young people with chronic intestinal failure from pediatric to adult care. a position statement by italian society of gastroenterology and hepatology and nutrition (SIGENP) and italian society of artificial nutrition and metabolism (SINPE). Dig Liver Dis 2020; 52:1131-1136. [PMID: 32868212 DOI: 10.1016/j.dld.2020.07.032] [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: 05/29/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 02/08/2023]
Abstract
In 2019 the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) created a joint panel of experts with the aim of preparing an official statement on transition in Chronic Intestinal Failure (CIF). The transition from pediatric to adult care has a key role in managing all chronic diseases and in optimizing the compliance to care. Thus SIGENP and SINPE, in light of the growing number of patients with IF who need long-term Parenteral Nutrition (PN) and multidisciplinary rehabilitation programs throughout adulthood, shared a common protocol to provide an accurate and timely process of transition from pediatric to adult centers for CIF. The main objectives of the transition process for CIF can be summarized as the so-called "acronym of the 5 M": 1)Motivate independent choices which are characteristics of the adult world; 2)Move towards adult goals (e.g. self-management of his pathology and sexual issues); 3)Maintain the habitual mode of care; 4) Minimize the difficulties involved in the transition process and 5)Modulate the length of the transition so as to fully share with the adult's team the children's peculiarities.
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Affiliation(s)
- Antonella Diamanti
- Artificial Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy (SIGENP).
| | - Teresa Capriati
- Artificial Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy (SIGENP)
| | - Antonella Lezo
- Dietetics and Clinical Nutrition Unit, "Città della Salute e della Scienza", Regina Margherita Children's Hospital, Turin, Italy (SIGENP)
| | - Maria Immacolata Spagnuolo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (SIGENP)
| | - Paolo Gandullia
- Gastroenterology Unit, G.Gaslini Institute for Maternal and Child Health, IRCCS, Genova, Italy (SIGENP)
| | - Lorenzo Norsa
- Paediatric, Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy (SIGENP)
| | - Laura Lacitignola
- Department of Neuroscience, Psychology, Pharmacology and Child's Health, University of Florence, Meyer Hospital, Florence, Italy (SIGENP)
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition. University of Naples Federico II, Naples, Italy (SINPE)
| | | | - Antonella De Francesco
- Dietetics and Clinical Nutrition Unit, "Città della Salute e della Scienza", Turin, Italy (SINPE)
| | - Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy(SINPE)
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15
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Can a transition clinic bridge the gap between paediatric and adult inflammatory bowel disease care models? Dig Liver Dis 2020; 52:516-527. [PMID: 32234418 DOI: 10.1016/j.dld.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Transition care in inflammatory bowel disease is increasingly recognized as challenging given the inherent differences between paediatric and adult health care models, disease characteristics and treatment strategies. Transition is a dynamic process involving adolescents and young adults that are moving from a paediatric to an adult health care setting, and it should be flexible, continually updated and tailored to each patient. The implementation of a transition clinic is essential given the increasing incidence of the paediatric population with inflammatory bowel disease and the lifelong impact of this disease. The key question is when and how to structure transition according to the adolescent's clinical, psycho-social, educational needs and expectations to ensure continuity of care. In the attempt to improve the management of transition in inflammatory bowel disease and address the wide gap between adult and child care, we provide an update of the transition clinic and we propose a "treat to target" approach in transition to facilitate an effective and successful transition programme. In the changing landscape of the treatment of inflammatory bowel disease, further studies are necessary to determine the role of the transition clinic in determining the choice and strategy of therapy and its monitoring and the adoption of newer strategies such as biomarkers guided treating to target.
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Intercellular adhesion molecule-1 enhances the therapeutic effects of MSCs in a dextran sulfate sodium-induced colitis models by promoting MSCs homing to murine colons and spleens. Stem Cell Res Ther 2019; 10:267. [PMID: 31443680 PMCID: PMC6708236 DOI: 10.1186/s13287-019-1384-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022] Open
Abstract
Background To investigate the therapeutic effect of intercellular adhesion molecule (ICAM)-1-modified mesenchymal stem cells (MSCs) in a mouse model of inflammatory bowel disease (IBD) induced by dextran sulfate sodium. Methods Primary MSCs and ICAM-1-overexpressing MSCs (C3 cells) were generated in vitro. The IBD mouse model was induced with drinking water containing dextran sulfate sodium for 7 days. For stem cell therapy, mice were randomly assigned to six experimental groups: the control group, IBD group, primary MSC group, C3 group, C3-vector group, and C3-ICAM-1 group. Mice were given a single injection of 1 × 106 primary MSCs or gene-modified MSCs via the tail vein on day 3 of DDS administration. The general conditions of the mice in each group were observed. Additionally, the pathological changes in the colon were observed and scored. Primary MSCs and gene-modified MSCs were stained with the fluorescent dye CM-DIL before injection into the tail vein of mice. The distribution of infused cells in IBD mice was observed in frozen sections. Mechanistically, the polarization of Th1, Th2, Th17, and regulatory T cells (Tregs) in the spleen was determined by flow cytometry. Moreover, the mRNA expression levels of IBD-related immune factors in splenocytes were measured by quantitative PCR. Results A single injection of MSCs promoted general recovery and reduced pathological damage in IBD mice. Additionally, ICAM-1-overexpressing MSCs had stronger therapeutic effects than ICAM-1low MSCs. Furthermore, the in vivo distribution analysis results indicated that a higher number of ICAM-1-overexpressing MSCs homed to the colon and spleen of IBD mice. Moreover, the delivery of ICAM-1 overexpressing MSCs decreased the numbers of Th1 and Th17 cells but increased the number of Tregs in the spleen of IBD mice. The quantitative PCR analysis results revealed that an infusion of ICAM-1-overexpressing MSCs influenced the expression of spleen-derived immune factors by remarkably reducing the mRNA levels of IFN-γ and IL-17A and increasing the mRNA level of Foxp3. Conclusions Our results demonstrate that ICAM-1-modified mesenchymal stem cells (MSCs) remarkably alleviate inflammatory damage in IBD mice by promoting MSC homing to the target and immune organs. The findings suggest that ICAM-1 is required to maintain the therapeutic effects of MSCs in IBD treatment and identified a novel role of ICAM-1 in inflammatory diseases. Electronic supplementary material The online version of this article (10.1186/s13287-019-1384-9) contains supplementary material, which is available to authorized users.
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