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Heera S, Beattie K, Punthakee Z, DiRezze B, Herrington J, Cellucci T, Heale L, Matsos M, Gorter JW, Batthish M. The TRUST Study-TRansition US Together: Evaluating the Impact of a Parent- and Adolescent-Centered Transition Toolkit on Transition Readiness in Patients with Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. CHILDREN (BASEL, SWITZERLAND) 2024; 11:881. [PMID: 39062330 PMCID: PMC11276097 DOI: 10.3390/children11070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Adolescents with chronic rheumatic disease must increasingly take on more responsibility for disease management from parents as they transition from pediatric to adult care. Yet, there are limited resources to inform and support parents about transition. Here, we evaluate the impact of a Transition Toolkit, geared towards parents and adolescents, on transition readiness, and explore the potential impact of parent-adolescent communication. METHODS A prospective cohort study of youths aged 14-18 years old and their parents was performed. Participant demographics, disease characteristics, transition readiness scores (Transition-Q, max 100), and parent-adolescent communication scores (PACS, max 100) were collected at enrollment (when the Transition Toolkit was shared with adolescents and their parents. Generalized estimating equation (GEE) analyses determined the influence of the Toolkit on transition readiness and explored the role of parent-adolescent communication quality. Subgroup analyses were conducted by sex. RESULTS A total of 21 patients were included; 19 completed one post-intervention Transition-Q and 16 completed two. Transition-Q scores increased over time and the rate of increase doubled after the Toolkit was shared (β = 7.8, p < 0.05, and β = 15.5, p < 0.05, respectively). CONCLUSION Transition readiness improved at each follow-up, the greatest increase was seen after the Toolkit was shared. Parent-adolescent communication quality did not appear to impact changes in transition readiness.
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Affiliation(s)
- Simran Heera
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
| | - Karen Beattie
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada (M.M.)
| | - Briano DiRezze
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Julie Herrington
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada; (S.H.); (B.D.); (J.H.)
| | - Tania Cellucci
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Liane Heale
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
| | - Mark Matsos
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada (M.M.)
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Michelle Batthish
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (K.B.); (T.C.); (L.H.); (J.W.G.)
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Plascevic J, Shah S, Tan YW. Transitional Care in Anorectal Malformation and Hirschsprung's Disease: A Systematic Review of Challenges and Solutions. J Pediatr Surg 2024; 59:1019-1027. [PMID: 37996349 DOI: 10.1016/j.jpedsurg.2023.10.066] [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: 08/31/2023] [Revised: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The literature on transitional care in anorectal malformation (ARM) and Hirschsprung's disease (HD) is diverse and heterogeneous. There is a lack of standards and guidelines specific to transitional care in these conditions. We aim to establish and systematically categorize challenges and solutions related to colorectal transition care. METHODS Systematic review of qualitative studies from MEDLINE, EMBASE, PubMed and Scopus databases (2008-2022) was conducted to identify the challenges and solutions of healthcare transition specific to ARM and HD. Thematic analyses are reported with reference to patient, healthcare provider and healthcare system. RESULTS Sixteen studies from 234 unique articles were included. Fourteen themes related to challenges and solutions, each, are identified. Most challenges identified are patient related. The key challenges pertain to: (1) patient's lack of understanding of their disorder, resulting in over-reliance on the pediatric surgical team and reluctance towards transitioning to adult services; (2) a lack of education and awareness among adult colorectal surgeons in caring for pediatric colorectal conditions and inadequate communication between pediatric and adult teams; and (3) a lack of structured transition program and joint-clinic to meet the needs of the transitioning patients. The key solutions are: (1) fostering young adult patient's autonomy and independence; (2) conducting joint pediatric-adult transition clinics; and (3) ensuring a structured and coordinated transition program is available using a standardized guideline. CONCLUSION A comprehensive framework related to barriers and solutions for pediatric colorectal transition is established to help benchmark care quality of transitional care services. LEVEL OF EVIDENCE IV. TYPE OF STUDY Systematic review without meta-analysis.
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Affiliation(s)
- Josip Plascevic
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, United Kingdom; Faculty of Medicine, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom
| | - Shaneel Shah
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, United Kingdom
| | - Yew-Wei Tan
- Paediatric Surgery, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, United Kingdom; Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Furuie K, Kuraoka S, Ban H, Hidaka Y, Nagata H, Tamura H, Nagano K, Kawano T, Furuse A, Nakazato H, Nakamura K. Ongoing impacts of childhood-onset glomerular diseases during young adulthood. Pediatr Nephrol 2024; 39:1791-1799. [PMID: 38110662 PMCID: PMC11026251 DOI: 10.1007/s00467-023-06250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Childhood-onset glomerular disease often requires ongoing treatment and follow-up into adulthood. However, few studies have analyzed the associated impact and distress experienced by patients with this condition during the transition from childhood to adolescence and adulthood. METHODS At three facilities, we recruited patients who developed idiopathic nephrotic syndrome or IgA nephropathy during childhood and were at least 18 years old at the time of study entry. Among them, a questionnaire-based survey was administered to patients who consented to participate, and the results were analyzed in conjunction with clinical information. RESULTS Data from a total of 38 patients were analyzed. Of these patients, 15 had idiopathic nephrotic syndrome and 23 had IgA nephropathy. The age of transition from pediatrics to the adult medicine department was correlated with the number of recurrences. Many patients also reported being significantly affected by exercise restrictions and physical decline associated with their diseases and medications. Various impacts, including distress, affected decision-making regarding higher education, with patients engaging in higher education at a significantly higher rate compared with the regional average (66.7% vs. 46.9%, p = 0.028). CONCLUSION We analyzed the impact of childhood-onset glomerular disease and distress during the transition period from pediatric to adult care. This study highlighted the significant impact of medications and exercise restrictions on patients' decisions regarding higher education. Future prospective studies will be needed to examine patients' distress in more detail and establish management approaches to enhance patient quality of life.
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Affiliation(s)
- Keishiro Furuie
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan.
| | - Hideki Ban
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Yuko Hidaka
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Hiroko Nagata
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Hiroshi Tamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Koji Nagano
- Department of Pediatrics, Kumamoto Chuo Hospital, Kumamoto City, Japan
| | - Tomoyasu Kawano
- Department of Pediatrics, Kumamoto Chuo Hospital, Kumamoto City, Japan
| | - Akio Furuse
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto City, Japan
| | - Hitoshi Nakazato
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, 860-8556, Japan
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Mejía González MA, Quijada Morales P, Escobar MÁ, Juárez Guerrero A, Seoane-Reula ME. Navigating the transition of care in patients with inborn errors of immunity: a single-center's descriptive experience. Front Immunol 2023; 14:1263349. [PMID: 37854610 PMCID: PMC10579936 DOI: 10.3389/fimmu.2023.1263349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
The transition from pediatric to adult care is a critical milestone in managing children, especially in those with complex chronic conditions. It involves ensuring the patient and family adapt correctly to the new phase, maintaining continuity of ongoing treatments, and establishing an appropriate follow-up plan with specialists. Patients with Inborn error of immunity (IEI), formerly known as Primary Immune Disorders (PID) are part of a group of disorders characterized by alterations in the proper functioning of the immune system; as the diagnostic and treatment tools for these entities progress, life expectancy increases, and new needs emerge. These children have special needs during the transition. Particularly important in the group of children with PID and syndromic features, who often present multiple chronic medical conditions. In these cases, transition planning is a significant challenge, involving not only the patients and their families but also a wide range of specialists. To achieve this, a multidisciplinary transition team should be established between the pediatric specialists and the adult consultants, designing a circuit in which communication is essential. As few transition care guidelines in the field of PID are available, and to our knowledge, there is no specific information available regarding patients with PID associated with syndromic features, we share our experience in this issue as a Primary Immunodeficiencies Unit that is a National Reference Center for PID, and propose a guide to achieve an adequate and successful transition to adulthood in these patients, especially in those with associated syndromic features.
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Affiliation(s)
- María Alejandra Mejía González
- Immunology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Quijada Morales
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Ángeles Escobar
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Day-care Hospital of Immunology, Department of Nursing of Day-care Hospital, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Juárez Guerrero
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Elena Seoane-Reula
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medical Advisor of the Spanish Association of Primary Immunodeficiencies (AEDIP), Madrid, Spain
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Chan CM, Abdul Latiff AH, Noh LM, Ismail IH, Abd Hamid IJ, Liew WK, Zhong Y, Suratannon N, Nantanee R, Santos-Ocampo FJ, Castor MAR, Nguyen-Ngoc-Quynh L, Van Nguyen AT, Thuc HT, Tuan NM, Muktiarti D, Amalia R, Chean S, Try L, Ali A. Transition practice for primary immunodeficiency diseases in Southeast Asia: a regional survey. Front Immunol 2023; 14:1209315. [PMID: 37529038 PMCID: PMC10390097 DOI: 10.3389/fimmu.2023.1209315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction With increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians' opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries. Methods We adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries. Results Regionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer. Discussion and conclusion Our study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.
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Affiliation(s)
- Chee Mun Chan
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Research Center, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia (UKM) Specialist Children’s Hospital, Kuala Lumpur, Malaysia
| | | | - Lokman Mohd Noh
- Malaysian Patient Organization for Primary Immunodeficiencies (MYPOPI), Shah Alam, Selangor, Malaysia
| | - Intan Hakimah Ismail
- Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Intan Juliana Abd Hamid
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Woei Kang Liew
- Rheumatology and Immunology Service, Department of Pediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Youjia Zhong
- Department of Pediatrics, Yong Loo Lin School of Medicine, Kent Ridge, National University of Singapore, Kent Ridge Country, Singapore
| | - Narissara Suratannon
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rapisa Nantanee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Mary Anne R. Castor
- Division of Allergy and Immunology, Department of Pediatrics, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Anh Thi Van Nguyen
- Allergy - Immunology - Rheumatology Department , National Children’s Hospital, Hanoi, Vietnam
| | - Huyen Thanh Thuc
- Allergy and Clinical Immunology Center, Vinmec International Hospital, Hanoi, Vietnam
| | - Nguyen Minh Tuan
- Department of Paediatrics, Children’s Hospital 1, Ho Chi Minh, Vietnam
| | - Dina Muktiarti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizqi Amalia
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sophâl Chean
- Department of Pediatric Hemato-Immunology, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Lytheang Try
- Department of Pediatric Hemato-Immunology, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Research Center, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia (UKM) Specialist Children’s Hospital, Kuala Lumpur, Malaysia
- Institute of IR4.0, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- Infection and Immunology Health and Advanced Medicine Cluster, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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