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Fishman LN, Ding J. Optimizing the Transition and Transfer of Care in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:629-644. [PMID: 37543405 DOI: 10.1016/j.gtc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Health care transition from pediatric to adult care has been identified as a priority in the field of medicine, especially for those with chronic illnesses such as inflammatory bowel disease (IBD). Although there is no universally accepted model of preparing the pediatric patient for transfer to adult care, transition care is best accomplished in a structured and consistent manner. The authors highlight concepts for optimizing the transition of care for patients with IBD, which include setting expectations throughout adolescence with the gradual nurturing of self-management skills, preparing and assessing of readiness for transfer, and enacting a successful transfer to adult care.
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Affiliation(s)
- Laurie N Fishman
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Julia Ding
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
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Fishman LN, Shanske S, McKenna KD. Putting the Good in Goodbye: The Pediatrician's Role in Framing a Positive Transition to Adult Care. Clin Pediatr (Phila) 2022; 61:669-673. [PMID: 35678061 DOI: 10.1177/00099228221102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laurie N Fishman
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan Shanske
- Department of Social Work, Boston Children's Hospital, Boston, MA, USA.,BRIDGES Adult Transition Program, Boston Children's Hospital, Boston, MA, USA
| | - Kristine D McKenna
- Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Rajanala S, Wilson JK, Mitchell PD, Garvey KC, Fishman LN. Contrasting Social Media Use Between Young Adults With Inflammatory Bowel Disease and Type 1 Diabetes: Cross-sectional Study. JMIR Pediatr Parent 2022; 5:e34466. [PMID: 35139484 PMCID: PMC9086877 DOI: 10.2196/34466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Social media is used by young adult patients for social connection and self-identification. OBJECTIVE This study aims to compare the social media habits of young adults with inflammatory bowel disease (IBD) and type 1 diabetes (T1D). METHODS This is a cross-sectional study of subjects from Boston Children's Hospital outpatient IBD and diabetes clinics. Patients above 18 years of age were invited to complete a brief anonymous survey, which asked about the various ways they use several social media platforms. RESULTS Responses were received from 108 patients (92.5% response rate), evenly split across disease type. We found that 83% of participants spent at least 30 minutes per day on social media, most commonly on Instagram and Facebook. Although the content varied based on the platform, patients with IBD posted or shared content related to their disease significantly less than those with T1D (23% vs 38%, P=.02). Among Instagram users, patients with IBD were less likely to engage with support groups (22% vs 56%, P=.04). Among Twitter users, patients with IBD were less likely to seek disease information (77% vs 29%, P=.005). Among Facebook users, patients with IBD were less likely to post about research and clinical trials (31% vs 65%, P=.04) or for information seeking (49% vs 87%, P=.003). Patients with IBD were also less likely to share their diagnosis with friends or family in person. CONCLUSIONS Young adults with IBD were less willing to share their diagnosis and post about or explore the disease on social media compared to those with T1D. This could lead to a sense of isolation and should be further explored.
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Affiliation(s)
- Susruthi Rajanala
- Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Jennifer K Wilson
- Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard University, Boston, MA, United States
| | - Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Laurie N Fishman
- Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
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Plevinsky JM, Maddux MH, Fishman LN, Kahn SA, Greenley RN. Perceived effect of pediatric inflammatory bowel diseases on academics, college planning, and college adjustment. J Am Coll Health 2022; 70:940-947. [PMID: 32643555 DOI: 10.1080/07448481.2020.1781869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/30/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveTo examine the relationship between perceived effect of inflammatory bowel diseases (IBD) on high school academics and college planning on college adjustment. Participants: Participants (N = 97) were college students with IBD. Methods: Participants completed an online survey including the Student Adaptation to College Questionnaire and study-developed questions assessing the perceived impact of their diagnosis on their high school academics and college planning. Results: Most participants reported average college adjustment across domains, except personal-emotional adjustment with 47% of participants falling within the very low to low ranges. Nearly half reported IBD impacted their choice of college (49%). The impact of IBD on college planning was most consistently associated with domains of college adjustment. Conclusions: IBD severely impacts college planning, decision-making, and adjustment in college-bound youth. Perceiving that having a chronic illness impacts college planning may result in greater difficulty with academic adjustment, attachment to the institution, and social adjustment during college.
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Affiliation(s)
- Jill M Plevinsky
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michele H Maddux
- Department of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Laurie N Fishman
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel N Greenley
- Department of Clinical Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Shanske S, Bond J, Ross A, Dykeman B, Fishman LN. Validation of the RAISE (Readiness Assessment of Independence for Specialty Encounters) Tool: Provider-Based Transition Evaluation. J Pediatr Nurs 2021; 59:103-109. [PMID: 33845322 DOI: 10.1016/j.pedn.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to establish content validity of a developmentally based assessment tool of readiness for medical independence for specialty providers. DESIGN AND METHODS The validation process used expert panel evaluation to assess the items believed to measure the desired content in the nine age-based scales within the RAISE (Readiness Assessment of Independence for Specialty Encounters) tool. Experts in child development and transition rated items on relevance, clarity and developmental appropriateness via electronic survey. Statistical analyses included calculation of interrater agreement (IRA), content validity indices (CVIs), and factorial validity indices (FVI). RESULTS A total of 135 items were rated by 36 experts. Mean I-CVIs for 123 items across nine developmental scales met criteria for retention, ranging from 0.76 (threshold) to 1.00 (excellent). Mean I-CVIs for all 25 items across the five psychosocial stressor scales met criteria for retention, ranging from 0.92 to 1.00 (excellent). CONCLUSIONS Findings from the current content validation study suggest that items on the revised RAISE tool are relevant, clear, and developmentally-appropriate as rated by experts in the fields of child development and transition. The tool, consisting of age based scales (ages birth-2, 3-4, 5-6, 7-8, 9-11, 12-13, 14-15, 16-17, 18-21), is shown to have content validity of the retained items meeting criteria. PRACTICE IMPLICATIONS With content validity of the RAISE tool established by experts, this developmentally based assessment tool can be integrated into practice to assist providers in educating patients around skills of medical independence which could improve transition outcomes.
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Affiliation(s)
- Susan Shanske
- Department of Social Work, Boston Children's Hospital, Boston, MA, USA.
| | - Judy Bond
- Department of Social Work, Boston Children's Hospital, Boston, MA, USA
| | - Abigail Ross
- Department of Social Work, Boston Children's Hospital, Boston, MA, USA; Fordham University Graduate School of Social Service, New York, NY, USA
| | - Blair Dykeman
- Institutional Centers for Clinical and Translational Research, Boston, MA, USA
| | - Laurie N Fishman
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
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Levy S, Tennermann N, Marin AC, Wiseblatt A, Shrier LA, Garvey K, Dedeoglu F, Fishman LN, Weitzman ER. Safety Protocols for Adolescent Substance Use Research in Clinical Settings. J Adolesc Health 2021; 68:999-1005. [PMID: 32994123 DOI: 10.1016/j.jadohealth.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Research involving adolescent risk behaviors must balance data confidentiality with participant safety when risky behaviors are revealed. This report details a safety protocol and reports the experience of two contemporaneous studies that used it with variant safety thresholds. METHODS We developed a safety protocol for research with adolescent patients and used it in two concurrent studies of adolescent patients, aged 14-18 years. Study "PC" recruited participants from a primary care adolescent medical clinic (N = 490), and Study "SP" recruited participants from subspecialty pediatric clinics (N = 434); both studies involved a similar self-administered assessment of health behaviors. The protocol sets thresholds for clinical intervention (positive safety flags) for past 3-month heavy alcohol consumption (Study PC: 10 or more drinks and Study SP: "binge-"level drinking), illicit drug use other than marijuana and alcohol in combination with a substance other than marijuana, and sets a positive screen for depression. We examined the rates of positive safety flags in both protocol settings, used significance testing to describe demographic differences between participants with and without positive flags in both studies, and described clinician experiences with protocol implementation. RESULTS In studies PC/SP, .6%/8.8% of participants were flagged for heavy alcohol consumption, respectively; .2%/0% for illicit drug use, 2.2%/.7% for combination substance use, and 14.9%/4.8% for depression. Some clinicians found managing positive flags challenging, although both studies completed recruitment on time and without serious adverse events. CONCLUSIONS The protocol was feasible in clinical settings. The findings and experiences documented in this report could be useful for future protocols.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Nicole Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Aria Wiseblatt
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Lydia A Shrier
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Katharine Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Laurie N Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Shapiro JM, El-Serag HB, Gandle C, Peacock C, Denson LA, Fishman LN, Hernaez R, Hou JK. Recommendations for Successful Transition of Adolescents With Inflammatory Bowel Diseases to Adult Care. Clin Gastroenterol Hepatol 2020; 18:276-289.e2. [PMID: 31077824 DOI: 10.1016/j.cgh.2019.04.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
Adolescents and young adults diagnosed with inflammatory bowel diseases (IBDs) in pediatric care are vulnerable during their transition to adult care. There are 6 core elements of transition from pediatric to adult IBD care. We identified gaps in this transition and make recommendations for clinical practice and research. There have been few studies of transition policy (core element 1) or studies that tracked and monitored patients through the transition (core element 2). Several studies have assessed transition readiness (core element 3), but instruments for assessment were not validated using important outcomes such as disease control, health care use, adherence, quality of life, or continuity of care. There have been no studies of best practices for transition planning (core element 4), including how to best educate patients and facilitate gradual shifts in responsibility. A small number of longitudinal studies have investigated transfer of care (core element 5), but these were conducted outside of the United States; these studies found mixed results in short- and intermediate-term outcomes after transition completion (core element 6). We discuss what is known about the transition from pediatric to adult care for IBD, make recommendations to improve this process, and identify areas for additional research.
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Affiliation(s)
- Jordan M Shapiro
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
| | - Hashem B El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Cassandra Gandle
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cynthia Peacock
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laurie N Fishman
- Division of Pediatric Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Ruben Hernaez
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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Marchioni Beery RM, Li E, Fishman LN. Impact of pediatric inflammatory bowel disease diagnosis on exercise and sports participation: Patient and parent perspectives. World J Gastroenterol 2019; 25:4493-4501. [PMID: 31496627 PMCID: PMC6710172 DOI: 10.3748/wjg.v25.i31.4493] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) may limit physical activity due to intestinal or extraintestinal manifestations, fatigue, or exercise perception. We sought to evaluate the influence of IBD diagnosis on exercise and sports participation in a pediatric population. We compared patient-reported and parent-reported perspectives.
AIM To evaluate the influence of IBD diagnosis on exercise and sports participation in a pediatric population.
METHODS Consecutive IBD outpatients (aged 10-18 years) and their parents completed parallel voluntary surveys. A validated, patient-reported functional activity scale, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was used to assess children’s activity levels.
RESULTS There were 149 completed surveys (75% response rate) with mean participant age of 16.5 years [standard deviation (SD) = 4.0] and mean age at IBD diagnosis of 11.8 years (SD = 3.4). Most patients (77%) were diagnosed within 12 mo of symptom onset. Current athletic participation was reported in 65% across 65 sports. Participation was greatest before (40%) rather than after (32%) IBD diagnosis, with no reported change in 28%. IBD negatively impacted play/performance in 45% but did not change play/performance in 44%. IBD treatment improved patients’ desire to exercise (70%) and subjective capacity for aerobic exercise (72%). Patients and parents agreed that IBD subjects demonstrate normal capacity for aerobic exercise (0.40, 95%CI: 0.22-0.58) and that treatment improved both participatory desire (0.33, 95%CI: 0.12-0.54) and capacity for aerobic exercise (0.52, 95%CI: 0.31-0.71). Almost all (99%) viewed exercise as healthy, and most encouraged its practice. IBD patients demonstrated normal mean HSS Pedi-FABS scores.
CONCLUSION After pediatric IBD diagnosis, most patients continue exercise and sports, with mean activity levels comparable to American youth. Treatment positively impacts participatory desire and aerobic capacity. Patients favor the role of exercise in IBD.
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Affiliation(s)
- Renée M Marchioni Beery
- Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL 33612, United States
| | - Enju Li
- Institutional Center of Clinical and Translational Research, Boston Children’s Hospital, Boston, MA 02115, United States
| | - Laurie N Fishman
- Division of Gastroenterology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
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Clerx EM, Silvester J, Leffler D, DeGroote M, Fishman LN. Sequence of acquisition of self-management skills to follow a gluten-free diet by adults with celiac disease. Dig Liver Dis 2019; 51:1096-1100. [PMID: 30872088 PMCID: PMC6682428 DOI: 10.1016/j.dld.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/27/2019] [Accepted: 02/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Celiac disease (CD) treatment is lifelong adherence to a gluten-free diet (GFD), requiring mastery of numerous skills to maintain health. AIMS To assess the rate of self-management skill acquisition following diagnosis, and the influence of demographic factors on this rate. METHODS Patients attending a celiac center were invited to complete an anonymous survey which reported demographic information and time for mastery of self-management skills relevant to CD. RESULTS Completed surveys were returned by 137 patients (79% female). Most participants reported mastering skills that involved identifying gluten-containing versus gluten-free foods within 6 months. Explaining CD and GFD to others required 1-2 years. Identifying gluten in medications and supplements required 3-5 years. Traveling internationally with GFD adherence required more than five years to learn. Demographic factors were not associated with the rate of acquisition. CONCLUSIONS This is the first description of a timeline for relevant skill acquisition following diagnosis for CD. A sequence emerges, with most patients learning skills relevant to home, then social settings, then the workplace, and, finally, unfamiliar settings. Awareness of this progression of mastery, and particular recognition of difficult skills will allow physicians and dietitians to provide CD patients with targeted education and resources to facilitate adherence.
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Affiliation(s)
- Emma M. Clerx
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115,Harvard University, 86 Brattle Street, Cambridge MA 02138
| | - Jocelyn Silvester
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115,Celiac Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115,Division of Gastroenterology, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
| | - Daniel Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston MA 02115
| | - Maya DeGroote
- Celiac Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
| | - Laurie N. Fishman
- Division of Gastroenterology, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115
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van der Bent A, Duggan EM, Fishman LN, Dickie BH. Reality check: What happens when patients with anorectal malformations grow up? A pilot study of medical care transition from the adult patient perspective. J Pediatr Surg 2018; 53:1722-1726. [PMID: 29605261 DOI: 10.1016/j.jpedsurg.2018.02.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There has been an increased focus on transition of pediatric and adolescent patients to adult centered care. For patients with rare and complex conditions, such as anorectal malformations (ARM), difficulties are compounded by the absence of structured transition protocols and lack of adult provider expertise. We sought to explore the actual experiences of adult patients with ARM and distinguish if there are factors that influence the ability to achieve satisfactory transition to adult centered medical care. METHODS Patients older than 18years with ARM were identified through a hospital database and social support networks, and invited to participate in an anonymous questionnaire. Patients were asked to describe their transition experience as well as report their demographics, and functional outcomes (bowel and bladder function). RESULTS Twenty-six surveys were completed. Comparison of those respondents (53%) who had transitioned to adult providers to those that had not yet transferred care demonstrated no difference in satisfaction with bowel and bladder function, presence of ostomy, and education level. There was a slight trend for patients with more complex malformations to seek further medical care with adult providers. Of those who transitioned, 67% reported no discussion prior to their transition and 71% received no recommendations for follow-up providers. CONCLUSIONS This pilot project suggests that a significant number of adult patients with ARM lack transition preparation and fail to find adult providers with expertise. Future studies will need to find optimal ways to address these issues. TYPE OF STUDY Survey. Retrospective Study LEVELS OF EVIDENCE: Level II.
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Affiliation(s)
- Annelotte van der Bent
- Department of Pediatric Gastroenterology, VU University Medical Center, Hemonystraat 64-3, 1074, BT, Amsterdam, The Netherlands.
| | - Eileen M Duggan
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
| | - Laurie N Fishman
- Department of Gastroenterology & Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Belinda Hsi Dickie
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
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Szeto W, van der Bent A, Petty CR, Reich J, Farraye F, Fishman LN. Use of Social Media for Health-Related Tasks by Adolescents With Inflammatory Bowel Disease: A Step in the Pathway of Transition. Inflamm Bowel Dis 2018; 24:1114-1122. [PMID: 29788360 PMCID: PMC6093193 DOI: 10.1093/ibd/izy021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Social media is commonly used among the adolescent and young adult population, including those with chronic diseases. For adults, these platforms have been shown to be a major source of health information. Our aims were to explore how youth with inflammatory bowel disease (IBD) use social media for (1) disease information gathering, (2) provider communication, (3) sense of belonging to the IBD community, (4) self-expression around IBD, and (5) disease management/monitoring. METHODS An anonymous and voluntary survey was administered to IBD patients age 12 to 25 years at a single center over 4 months. RESULTS Of 218 patients approached, there were 109 respondents. The mean age of the cohort (SD) was 18 (2.9) years, 65% were male, and 82% had Crohn's disease. Almost all patients accessed the Internet daily, but only 17% reported looking up information about IBD "always" or "often." Less than half (47%) turned to medical websites (WebMD or Crohn's and Colitis Foundation) for information. A small number (16%) connected with other IBD patients. Patients' preferred communication with provider was by e-mail (88%) compared with a phone call to the office (67%) or hospital website/patient portal (52%). Few patients used mobile applications to monitor symptoms (2%) or for medication reminders (9%), although there was professed interest. CONCLUSIONS Adolescents and young adults with IBD are less likely than adults to use social media for health-related activities. They prefer e-mail rather than oral communication between visits, and privacy seems to be less of a concern. Targeted education and skill building may be helpful for this transitioning population.
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Affiliation(s)
- Winnie Szeto
- Department of Internal Medicine, Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts,Address correspondence to: Winnie Szeto, MD, Section of Gastroenterology, Boston Medical Center, 11 Nevins St., Suite 402 Brighton, MA 02135 ()
| | - Annelotte van der Bent
- Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Jason Reich
- Department of Internal Medicine, Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts
| | - Francis Farraye
- Department of Internal Medicine, Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts
| | - Laurie N Fishman
- Inflammatory Bowel Disease Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
Transition is the long process of developing independent self-management skills whereas transfer is the actual move from pediatric to adult-centered provider. Structured anticipated transition works best with timelines of tasks to master and discussion of the stylistic differences between pediatric and adult practices. Disease-specific issues need to be addressed, such as earlier timelines for diet-based therapies, parental support for critical illnesses, and differences in therapeutic strategies.
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Affiliation(s)
- Punyanganie S A de Silva
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Laurie N Fishman
- Division of Pediatric Gastroenterology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Abstract
The authors share twelve practical tips on writing a case that engages learners in active learning and discussion. They first advise that, during the initial preparation of the case, authors should (1) identify the case goals and objectives, and (2) identify the level of the learners. When writing the case, authors should (3) use active and colorful language; (4) use patients' own descriptions rather than medical language; (5) allow the learners to interpret data themselves; (6) allow for natural discovery rather than presenting information chronologically; and (7) be realistic about interruptions in patient care. In addition, case authors should pay attention to methods that enhance discussion by (8) creating barriers to diagnostic or treatment options; (9) promoting questions and discussion over answers; (10) using cues to assure discussion flow and knowledge exploration; and (11) omitting details or inserting informational distractors. Finally, well-crafted questions are essential during the case presentation to engage learners in higher-order thinking; and to (12) stimulate curiosity and reflection.
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Affiliation(s)
- David A Cohen
- a Department of Internal Medicine, Beth Israel Deaconess Medical Center , Harvard Medical School , Harvard , MA , USA
| | - Lori R Newman
- b Department of Medical Education, Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
| | - Laurie N Fishman
- c Department of Pediatrics, Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
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Kenney LB, Melvin P, Fishman LN, O'Sullivan-Oliveira J, Sawicki GS, Ziniel S, Diller L, Fernandes SM. Transition and transfer of childhood cancer survivors to adult care: A national survey of pediatric oncologists. Pediatr Blood Cancer 2017; 64:346-352. [PMID: 27463688 DOI: 10.1002/pbc.26156] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric oncologists are responsible for ensuring that adolescent and young adult (AYA) childhood cancer survivors have the knowledge and skills necessary to manage their follow-up care in adult healthcare systems. PROCEDURES To describe transition practices and barriers to transfer, we electronically surveyed U.S. Children's Oncology Group members: 507/1449 responded (35%) and 347/507 (68%) met eligibility criteria. RESULTS Of 347 respondents, 50% are male, median years in practice 10 (range 5-22), 37% practice in freestanding children's hospitals. Almost all care for survivors up to age 21 years (96%), 42% care for survivors over age 25 years, and only 16% over age 30 years. While 66% of oncologists reported providing transition education to their patients, very few (8%) reported using standardized transition assessments. The most frequent barriers to transfer were perceived attachment to provider (91%), lack of adult providers with cancer survivor expertise (86%), patient's cognitive delay (81%), or unstable social situation (80%). Oncologists who continue to care for patients older than 25 years are more likely to perceive parents' attachment to provider (P = 0.037) and patients' social situation as barriers to transfer (P = 0.044). Four themes emerged from a content analysis of 75 respondents to the open-ended question inviting comments on transition/transfer practices: desire for flexible transfer criteria; providers as barriers; provider lack of transition knowledge, skills, and resources; and desire for collaboration. CONCLUSIONS Although most pediatric oncologists reported transferring AYA cancer survivors to adult care and providing some transition education, they endorse deficits in transition skills, emotional readiness, and institutional resources.
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Affiliation(s)
- Lisa B Kenney
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | | | | | | | - Sonja Ziniel
- Boston Children's Hospital, Boston, Massachusetts
| | - Lisa Diller
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Susan M Fernandes
- Lucile Packard Children's Hospital at Stanford, Palo Alto, California
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Plevinsky JM, Greenley RN, Fishman LN. Self-management in patients with inflammatory bowel disease: strategies, outcomes, and integration into clinical care. Clin Exp Gastroenterol 2016; 9:259-67. [PMID: 27601930 PMCID: PMC5003515 DOI: 10.2147/ceg.s106302] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Self-management, including medication adherence, is associated with improved health and outcomes for patients with inflammatory bowel disease. The concept of self-management is complex, but can be divided into those aspects that involve the individual patient, those that involve the provider–patient relationship, and those that encompass the social environment. At the individual level, enhancing problem-solving skills and self-efficacy have both been shown to improve self-management tasks, particularly adherence to treatment. However, it is critical to consider these domains from a lifespan perspective because these processes by which self-management can be improved are distinct for children, adolescents, young adults, and adults. A particular emphasis is placed on strategies to improve self-management of older adolescents and young adults as they transition from pediatric to adult providers. The review concludes with recommendations for providers, including rationale and techniques for assessing and promoting patient self-efficacy, encouraging the development of problem-solving skills, improving the patient–provider relationship, and enhancing social support. Providers are encouraged to utilize elements of problem-solving skills training, engage in collaborative relationships with their patients, and offer their patients recommendations for how to increase the quality of their social support networks as ways of increasing overall self-management.
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Affiliation(s)
- Jill M Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Laurie N Fishman
- Department of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Plevinsky JM, Gumidyala AP, Fishman LN. Transition experience of young adults with inflammatory bowel diseases (IBD): a mixed methods study. Child Care Health Dev 2015; 41:755-61. [PMID: 25376979 DOI: 10.1111/cch.12213] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Outcomes following transition can be poor; many young adults are ill prepared to take responsibility for their health care, older adolescents report incomplete understanding of medications, and parents remain largely responsible for their care. Good patient-provider relationships are associated with better adherence; however, the role of the relationship between post-transition patients and their providers has not been explored. The current study aimed to understand transition of young adults with inflammatory bowel diseases (IBD), the impact of the paediatric patient-provider relationship and what determines the adult patient-provider relationship. METHODS This study examined the experience of young adults with Crohn's disease or ulcerative colitis (aged 18-30) after transition. Twenty-nine patients completed a 31-item online survey of their transition experience from paediatric to adult care. Responses were coded quantitatively and qualitatively, and qualitative responses were analysed by two independent raters. RESULTS Positive themes regarding adult providers included independence, autonomy and trust, while negative themes included initial discomfort and confusing logistics. Five of six patients who reported 'terrifying' first visit experiences with their adult providers reported overall positive relationships. The earlier the diagnosis age, the less involved in medical decisions they were as an adult (r = 0.41, P = .03). Those who had a more positive experience with their paediatric providers were more likely to bring up confusion with their adult providers (r = .45, P = .04), and those who had a more positive experience with their adult providers were more likely to endorse collaborative medical decision-making (r = .57, P < .001). CONCLUSIONS Patients diagnosed with IBD at a young age may need extra education and self-management strategies, as they were less likely to exhibit behaviours indicative of a successful transition to adult care. Additionally, transition programme development may benefit from the post-transition perspective across chronic illness populations.
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Affiliation(s)
- J M Plevinsky
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - A P Gumidyala
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - L N Fishman
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Cambridge, MA, USA
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Durkin ET, Zurakowski D, Rangel SJ, Lillehei CW, Fishman LN. Passing the baton: The pediatric surgical perspective on transition. J Pediatr Surg 2015; 50:1196-200. [PMID: 25783307 DOI: 10.1016/j.jpedsurg.2014.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/15/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Transition of care from pediatric to adult providers is garnering intense national interest in pediatrics but is largely driven by nonsurgeons. We sought to describe the preferences of pediatric surgeons and their current transition practice patterns for various populations and wondered whether gender, experience, or practice setting affected surgeons' perspectives. METHODS All American Pediatric Surgical Association (APSA) members were surveyed electronically. Responses were voluntary and confidential. RESULTS Survey response rate was 22%. Most surgeons (95%) treated patients up to 22 years of age, and many cared for older patients (23-26 years, 49%; 27-30 years, 25%; 31-40 years, 18%; >40 years, 13%). Developmentally delayed adults comprised a significant portion of this population (54%). Congenital conditions such as Hirschsprung disease (25%), anorectal malformations (22%) and cystic fibrosis (22%) were most commonly reported. About half (52%) of respondents reported institutional limits for age. Lack of qualified adult surgeons was felt to be the greatest barrier to transition (p<0.001). Experience, gender and practice type did not significantly affect opinions of transition. CONCLUSIONS Pediatric surgeons care for adult patients with a variety of surgical conditions, particularly those with developmental delay and congenital anomalies. The perception of a deficit of qualified adult providers warrants further exploration. Understanding the barriers to surgical transition represents a critical step in improving the quality and appropriateness of care transitions.
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Affiliation(s)
- Emily T Durkin
- Pediatric Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI, United States.
| | - David Zurakowski
- Anesthesia and Biostatistics, Boston Children's Hospital, Boston, MA, United States
| | - Shawn J Rangel
- Pediatric Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Craig W Lillehei
- Pediatric Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Laurie N Fishman
- Pediatric Gastroenterology, Boston Children's Hospital, Boston, MA, United States
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18
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O'Sullivan-Oliveira J, Fernandes SM, Borges LF, Fishman LN. Transition of pediatric patients to adult care: an analysis of provider perceptions across discipline and role. Pediatr Nurs 2014; 40:113-142. [PMID: 25134224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The importance of successfully transitioning pediatric patients to adult care is increasingly recognized as more children with chronic diseases are living to adulthood. The aim of this study was to investigate the current state of provider perceptions across disciplines regarding transition of pediatric patients to adult care. Focus groups made up of providers of various roles and experience levels were conducted. A total of six major themes were identified. We conclude that pediatric providers share common concerns about transitioning pediatric patients to adult care. We reinforce many of the issues raised in the literature and also discuss a sense of professional ego that was identified as a barrier to successful transition, which is not widely reported in other studies.
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Fernandes SM, O'Sullivan-Oliveira J, Landzberg MJ, Khairy P, Melvin P, Sawicki GS, Ziniel S, Kenney LB, Garvey KC, Sobota A, O'Brien R, Nigrovic PA, Sharma N, Fishman LN. Transition and transfer of adolescents and young adults with pediatric onset chronic disease: the patient and parent perspective. J Pediatr Rehabil Med 2014; 7:43-51. [PMID: 24919937 PMCID: PMC5727574 DOI: 10.3233/prm-140269] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine patients' and parents' perceptions regarding the delivery of transition education and perceived barriers to transfer to adult oriented care. METHODS A self-report survey was administered to a convenience sample of patients (16-25 years old) with various childhood onset chronic diseases. A similar survey was administered to their parents/guardians. RESULTS A total of 155 patients and 104 parents participated in the study. The mean age of patients was 18.8 ± 2.3 years; 57% were female. Although most patients and parents reported receiving information and training about their medical condition, significant gaps in other aspects of transition education were identified. These included stated deficiencies in education regarding unprotected intercourse, health of future offspring, birth control, pregnancy, illicit drug use, and future career or vocation counseling. Commonly cited barriers to transfer were emotional attachments and lack of adult medicine specialty providers; however, the majority anticipated being ready to transfer to adult oriented care by age 25 years. CONCLUSION There are significant gaps in the delivery of transition education as perceived by patients and their parents. Standardization of transition education may help ensure that patients acquire the knowledge and skills for health care self-management in adulthood and successful transfer to adult oriented care.
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Affiliation(s)
- Susan M Fernandes
- Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Joanne O'Sullivan-Oliveira
- Department of Surgery/Nursing, Boston Children's Hospital, Division of Nursing, Curry College, Boston, MA, USA
| | | | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Patrice Melvin
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA
| | - Gregory S Sawicki
- Department of Medicine, Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Sonja Ziniel
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA
| | - Lisa B Kenney
- Dana-Farber Cancer Institute and Department of Medicine, Division of Hematology and Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Katharine C Garvey
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Amy Sobota
- Department of Medicine, Division of Hematology and Oncology, Boston Medical Center, Boston, MA, USA
| | - Rebecca O'Brien
- Department of Adolescent Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Peter A Nigrovic
- Department of Medicine, Division of Immunology, Boston Children's Hospital and Center for Adults with Pediatric Rheumatic Illness, Brigham and Women's Hospital, Boston, MA, USA
| | - Niraj Sharma
- Department of Medicine, Division of General Medicine, Brigham and Women's Hospital and Department of Medicine, Division of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Laurie N Fishman
- Department of Medicine, Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
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20
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van Groningen J, Ziniel S, Arnold J, Fishman LN. When independent healthcare behaviors develop in adolescents with inflammatory bowel disease. Inflamm Bowel Dis 2012; 18:2310-4. [PMID: 22374585 DOI: 10.1002/ibd.22937] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/11/2012] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with chronic health needs are expected to gradually assume responsibility for health maintenance behavior as they move toward adulthood. We sought to evaluate the influence of factors such as age, duration of disease, and gender by examining the self-reported health behaviors of adolescents with inflammatory bowel disease (IBD). METHODS Confidential voluntary surveys were administered to all IBD outpatients over age 10 during a 4-month period. Questions addressed responsibility for health behaviors such as medication, provider visits, and communication. Likert scales measured the degree of independence: 1 (my parents only) through 3 (parents share equally with me) to 5 (I do it myself). Patient participation during doctor visits was also assessed. RESULTS Of 358 patients approached, 294 (82%) returned completed surveys. Respondents were 51% male and 69% had Crohn's disease. Patients took increasingly active roles, but by ages 19-21 only 45% ordered medication refills, and 50% picked up medication from pharmacy. Only 35% of 19-21-year-olds scheduled appointments and 30% contacted providers between visits if problems arose. Most patients could answer provider questions (55% at age 16-18) but fewer asked questions of the provider (15% at the same age). Males were less likely to order their own prescription refills (P = 0.017) or prepare questions (P = 0.009). Duration of disease did not change skill acquisition. CONCLUSIONS Adolescents develop independence in managing their IBD slowly and many patients ≥ 18 years are still assisted by parents. Focus on specific skill acquisition may help patients with self-management skills expected in adult healthcare.
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21
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Fishman LN, Barendse RM, Hait E, Burdick C, Arnold J. Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition. Clin Pediatr (Phila) 2010; 49:1129-33. [PMID: 20837627 DOI: 10.1177/0009922810379042] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. PATIENTS AND METHODS Adolescents aged 16 to 18 years old in the Children's Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. RESULTS Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). CONCLUSIONS Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.
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Affiliation(s)
- Laurie N Fishman
- Center for Inflammatory Bowel Disease and Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA 02115, USA.
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22
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Lightdale JR, Newburg AR, Mahoney LB, Fredette ME, Fishman LN. Fellow perceptions of training using computer-based endoscopy simulators. Gastrointest Endosc 2010; 72:13-8. [PMID: 20620271 DOI: 10.1016/j.gie.2010.02.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 02/16/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Integrating procedural training by using computer-based endoscopic simulators (CBES) into gastroenterology fellowships may facilitate technical skill development, while posing no additional risk to patients. OBJECTIVE The aim of our study was to survey pediatric gastroenterology fellows about their experiences with and perceptions of CBES as compared with actual procedures, prior to and after exposure to both types of endoscopic learning. DESIGN AND SETTING All first-year trainees at Children's Hospital Boston (2003-2008) were invited to complete a written, pretraining questionnaire and then perform at least 10 each of CBES endoscopies and colonoscopies prior to performing actual procedures. Fellows completed a written, posttraining questionnaire after 4 months. MAIN OUTCOME MEASUREMENTS Survey responses. RESULTS All 25 first-year fellows (12 male, median age 30 years) over the 5-year period participated. Four months into their fellowships, fellows reported simulation to be helpful in increasing procedural skill and confidence. The number of sessions on the simulator was associated with reported increased colonoscopic skill and confidence (P = .032 and P = .007, respectively). All fellows reported it difficult to incorporate CBES into their work schedules. Only 28% of fellows reported performing 20 total CBES procedures, with most simulation sessions reportedly lasting less than 30 minutes. All participants rated faculty instruction with CBES as very helpful. LIMITATIONS This was a single-site study of pediatric trainees and may be limited in generalizability. CONCLUSION A few short sessions with CBES may be perceived as useful for endoscopic skill acquisition by pediatric gastroenterology trainees. Further exploration into how to assimilate CBES into busy gastroenterology training programs may be warranted.
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Affiliation(s)
- Jenifer R Lightdale
- Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Hait EJ, Fishman LN, Katzka DA. Clinical scenario--an 18-year-old with acute dysphagia and meat impaction. Clin Gastroenterol Hepatol 2009; 7:721-4. [PMID: 19558987 DOI: 10.1016/j.cgh.2009.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 02/07/2023]
Affiliation(s)
- Elizabeth J Hait
- Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
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Shields HM, Guss D, Somers SC, Kerfoot BP, Mandell BS, Travassos WJ, Ullman SM, Maroo S, Honan JP, Raymond LW, Goldberg EM, Leffler DA, Hayward JN, Pelletier SR, Carbo AR, Fishman LN, Nath BJ, Cohn MA, Hafler JP. A faculty development program to train tutors to be discussion leaders rather than facilitators. Acad Med 2007; 82:486-92. [PMID: 17457073 DOI: 10.1097/acm.0b013e31803eac9f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE During 2003, 2004, and 2005, the role of 70 tutors was changed from that of facilitator to discussion leader, in a preclinical PBL learning course, Gastrointestinal Pathophysiology, by use of three key business school teaching strategies: questions, summaries, and schematics. The purpose of this study was to learn what difference this new approach made. METHOD During each of the three study years, 171 (2003), 167 (2004), and 170 (2005) students were given Likert-scale attitudinal questionnaires to rate whether their tutors encouraged student direction of the tutorials and whether the summaries and closure schematics benefited their learning. Students' overall course evaluations and mean USMLE scores were quantitatively analyzed, pre- and postintervention. A variety of statistical tests were used to assess the statistical significance of means at the confidence level of .05. RESULTS In the third year of the program, student ratings indicated that their tutors were significantly better at encouraging student direction of the tutorials than in the first year (P < .05). The students reported that the tutorial made a more important contribution to their learning (P < .05), and the course objectives were better stated (P = .038) and better met (P = .007). Overall satisfaction with the course also improved significantly (P = .006). Part I gastrointestinal system mean scores of the USMLE showed a statistically significant increase in 2005 compared with 2001 or 2002. CONCLUSIONS The tutor as a discussion leader who questions, summarizes, and uses schematics to illustrate concepts had a significant and positive impact on learning in tutorials, achieving course objectives, improving overall course satisfaction, and increasing a standardized national exam's mean score.
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Affiliation(s)
- Helen M Shields
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Abstract
The cyclical nature of chronic illness requires that children with inflammatory bowel disease be transitioned to the adult medical system with as much continuity of care as possible. Transition from pediatric to adult medical care continues to present significant barriers. The philosophy of transition centers on a process, with the actual transfer to adult care as a point along this clinical pathway. Concrete steps can be taken to help patients prepare for new responsibilities. The aim of this review is to propose a clinical and developmental timeline for both patients and their medical team, including specific responsibilities for both, so that the partnership can best promote a successful transition.
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Affiliation(s)
- Elizabeth Hait
- Center for Inflammatory Bowel Disease, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Abstract
Recent discovery of the two major agents responsible for non-A, non-B hepatitis has led to rapid progress in the diagnosis and prevention of viral hepatitis. Newly implemented vaccine strategies against hepatitis A and hepatitis B are protecting children from infection, and new immunomodulatory therapy with interferon-alpha is being used to eradicate disease in patients chronically infected with hepatitis virus B or C.
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Affiliation(s)
- L N Fishman
- Center for Childhood Liver Disease, Children's Hospital, Boston, Massachusetts, USA
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27
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Fishman LN, Lavine JE. The role of inflammatory mediators on hepatitis B virus surface expression in a transgenic mouse model. Hepatology 1994; 20:762-4. [PMID: 7521320 DOI: 10.1016/0270-9139(94)90117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L N Fishman
- Center for Childhood Liver Disease, Children's Hospital, Boston, Massachusetts
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28
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Affiliation(s)
- L N Fishman
- Center for Childhood Liver Disease, Children's Hospital, Boston, Massachusetts 02115
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Fakhery B, Fishman LN. Sweat gland carcinoma. Report of a case in an unusual location and review of literature. J Maine Med Assoc 1974; 65:80-1. [PMID: 4823258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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