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Hald M, Carlsen K, Wewer V. Transition of Adolescents with Inflammatory Bowel Disease-Are the Pediatric Teams up to the Task? Children (Basel) 2021; 8:900. [PMID: 34682165 PMCID: PMC8534990 DOI: 10.3390/children8100900] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
Our aim was to describe the challenges of the transition process of adolescents with inflammatory bowel disease (IBD), as seen from a pediatric-care perspective, to clarify the key obstacles and propose how to move forward. Semi-structured individual interviews of pediatric gastroenterologists and nurses were analyzed and interpreted according to the principles of social science. It is a challenge for the pediatric team to continuously match, support, and gently guide the ever-changing adolescent patient. All adolescent patients should be offered guidance regardless of their starting point, and specific individual needs should be taken into consideration. Adolescents burdened by psychosocial challenges require extra support. Early and continued interdisciplinary effort is essential. Collaboration with the parents must be continuously adapted to prepare them for their new roles and responsibilities. The shift from the pediatric family-focused approach to the individualistic approach of the Adult Gastroenterology Department signifies a fundamental change. Equipping adolescents with disease-management skills remains a comprehensive task. The following crucial questions remain: Who is capable of performing the transition? Who can dedicate the necessary resources for performing the transition? A transition center led by both pediatricians and adult gastroenterologists in an interdisciplinary setting that includes transition-trained persons may be the solution.
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Ternov NK, Vestergaard T, Hölmich LR, Karmisholt K, Wagenblast AL, Klyver H, Hald M, Schøllhammer L, Konge L, Chakera AH. Reliable test of clinicians' mastery in skin cancer diagnostics. Arch Dermatol Res 2020; 313:235-243. [PMID: 32596742 DOI: 10.1007/s00403-020-02097-8] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.
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Affiliation(s)
- Niels Kvorning Ternov
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark. .,Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark. .,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - T Vestergaard
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - L Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - K Karmisholt
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A L Wagenblast
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - H Klyver
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Hald
- Department of Dermatology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - L Schøllhammer
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - A H Chakera
- Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Malham M, Jakobsen C, Paerregaard A, Hald M, Virta L, Kolho KL, Wewer V. Letter: suicide risk among adult inflammatory bowel disease patients. Authors' reply. Aliment Pharmacol Ther 2020; 51:1214-1215. [PMID: 32424916 DOI: 10.1111/apt.15733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Affiliation(s)
- Mikkel Malham
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Jakobsen
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Paerregaard
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mette Hald
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lauri Virta
- The Research Department, The Social Insurance Institution, Turku, Finland
| | - Kaija-Leena Kolho
- Children´s Hospital and University of Helsinki, Helsinki, Finland.,Tampere University, Tampere, Finland
| | - Vibeke Wewer
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
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Malham M, Jakobsen C, Hald M, Paerregaard A, Virta LJ, Kolho KL, Wewer V. Editorial: suicide and IBD-a call to action. Authors' reply. Aliment Pharmacol Ther 2019; 50:106-107. [PMID: 31184387 DOI: 10.1111/apt.15318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/24/2022]
Affiliation(s)
- Mikkel Malham
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Jakobsen
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark.,The Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mette Hald
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Paerregaard
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lauri J Virta
- The Research Department, The Social Insurance Institution, Turku, Finland
| | - Kaija-Leena Kolho
- The Paediatric Department, Tampere University Hospital and Tampere University, Tampere, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Vibeke Wewer
- The Paediatric Department, Copenhagen University Hospital, Hvidovre, Denmark
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Carlsen K, Hald M, Dubinsky MC, Keefer L, Wewer V. A Personalized eHealth Transition Concept for Adolescents With Inflammatory Bowel Disease: Design of Intervention. JMIR Pediatr Parent 2019; 2:e12258. [PMID: 31518331 PMCID: PMC6715343 DOI: 10.2196/12258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/19/2018] [Revised: 02/27/2019] [Accepted: 03/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transfer from pediatric to adult care is a crucial period for adolescents with inflammatory bowel disease (IBD). OBJECTIVE Our aim was to develop a personalized transition-transfer concept including relevant tools in an established eHealth (electronic health) program. METHODS Required transition skills and validated patient-reported outcome measures (PROMs) were identified via bibliographic search and clinical experience and were implemented into an existing eHealth program. RESULTS The following skills were identified: disease knowledge, social life, disease management, and making well-informed, health-related decisions. The PROMs included the following: self-efficacy (the IBD Self-Efficacy Scale-Adolescents), resilience (the 10-item Connor-Davidson Resilience Scale), response to stress (the Child Self-Report Responses to Stress-IBD), and self-management and health care transition skills (the Self-Management and Transition to Adulthood with Treatment questionnaire). Starting at age 14, the patient will be offered a 1-hour annual transition consultation with an IBD-specialized nurse. The consultation will be based on the results of the PROMs and will focus on the patient's difficulties. Patients will complete the PROMs on the eHealth program at home, allowing nurses and patients to prepare for the meeting. Symptom scores and medication will be filled out on the eHealth program to support disease self-management. The consultation will be a topic-centered dialogue with practical exercises. During routine outpatient visits with the provider, parents will be left out of half of the consultation when the patient is 16 years old; at 17 years old, the parents will not be present. At the transfer consultation, the pediatric provider, the adult gastroenterologist, the pediatric nurse, the patient, and the parents will be present to ensure a proper transfer. CONCLUSIONS We have conducted a personalized eHealth transition concept consisting of basic elements that measure, train, and monitor the patients' transition readiness. The concept can be implemented and adjusted to local conditions.
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Affiliation(s)
- Katrine Carlsen
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Mette Hald
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology and Hepatology, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States
| | - Laurie Keefer
- Division of Gastroenterology, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States
| | - Vibeke Wewer
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
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Petersen A, Johansen J, Hald M. Hand eczema - prognosis and consequences: a 7-year follow-up study. Br J Dermatol 2014; 171:1428-33. [DOI: 10.1111/bjd.13371] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A.H. Petersen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - M. Hald
- Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
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Hald M. Past Climate Change and Perspectives for Archaeological Research: Examples from Norway, Svalbard, and Adjoining Seas. Arctic Anthropology 2009. [DOI: 10.1353/arc.0.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hald M, Agner T, Blands J, Veien N, Laurberg G, Avnstorp C, Menné T, Kaaber K, Kristensen B, Kristensen O, Andersen K, Paulsen E, Thormann J, Sommerlund M, Nielsen N, Johansen J. Clinical severity and prognosis of hand eczema. Br J Dermatol 2009; 160:1229-36. [DOI: 10.1111/j.1365-2133.2009.09139.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hald M, Berg N, Elberling J, Johansen J. Medical consultations in relation to severity of hand eczema in the general population. Br J Dermatol 2008; 158:773-7. [DOI: 10.1111/j.1365-2133.2007.08431.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND The severity of hand eczema is of interest in epidemiological studies. Ideally, as no validated methods of self-assessment exist, a dermatologist should examine all subjects. However, this is very resource intensive. OBJECTIVES To examine if severity grading performed by patients with hand eczema using a self-administered photographic guide was in agreement with the assessment performed by a trained dermatologist. Furthermore, to measure the correlation between the severity of hand eczema expressed on a visual analogue scale (VAS) and the clinical severity assessment, using the photographic guide. METHODS Fifty-three consecutive outpatients with hand eczema were included, a number based on a prestudy statistical calculation. The patients were asked to grade current severity of their hand eczema by choosing one of four groups of photographs representing differing severities of hand eczema. On the same day all patients were examined by an experienced dermatologist, who graded the severity using the same photographic guide. The photographic guide was a modified version of a validated guide for use by physicians. In addition, the patients rated the severity of their hand eczema on a VAS. RESULTS Fifty-one of the respondents completed the full questionnaire. For 37 of the 51 patients (73%) the clinical severity assessments of patient and dermatologist were identical. The measure of agreement, Cohen's kappa coefficient, was 0.61, indicating good inter-rater agreement. The correlation between the dermatologist-rated severity and the corresponding score by the patients on the VAS was only moderate (Spearman's rank correlation coefficient rho = 0.52). CONCLUSIONS The photographic guide for the self-assessment of hand eczema is an easy instrument to use, and for research purposes can be a reliable tool for patients with hand eczema to grade severity. A VAS can only be considered as a mediocre tool for estimation of the dermatologist-rated clinical severity, but should be validated as an independent instrument to assess severity of hand eczema.
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Affiliation(s)
- M Hald
- National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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Hald M, Pedersen JB, Stein PC, Kirpekar F, Jacobsen JP. A comparison of the hairpin stability of the palindromic d(CGCG(A/T)4CGCG) oligonucleotides. Nucleic Acids Res 1995; 23:4576-82. [PMID: 8524645 PMCID: PMC307428 DOI: 10.1093/nar/23.22.4576] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The palindromic deoxyribonucleotides 5'-CGCGA-TATCGCG-3' and 5'-CGCGTTAACGCG-3' have been characterized by 1H NMR spectroscopy. The NMR data identified both B-DNA duplex conformations and hairpin conformations, the latter with loop regions consisting of the four central nucleotides. The resonances of the various conformations were assigned by use of two-dimensional NMR methods. The relative stability of the various conformations was investigated as a function of temperature, ionic strength and nucleotide concentration. The duplexes were found to be stabilized at high ionic strength and at low temperature, while the hairpins were stabilized at low ionic strength and at medium temperature. The thermodynamics of the duplex-hairpin and the hairpin-random coil transitions were examined, and compared to the other two oligonucleotide in the palindromic d(CGCG(A/T)4CGCG) oligonucleotide family. The relative stabilities of the duplex conformations with respect to the random coil conformations are similar for the d(CGCGAATTCGCG), d(CGCGATATCGCG) and d(CGCGTATACGCG) oligonucleotides. The duplex conformation of d(CGCGTTAACGCG) is less stable. The hairpin of d(CGCGTTAACGCG) seems also to be less stable relative to the random coil conformation than in the case of the other oligonucleotides at an equal oligonucleotide concentration. A cruciform intermediate between the duplex and hairpin conformations is suggested to explain some discrepancies observed in this work in case of the d(CGCGTTAACGCG) oligonucleotide. This is similar to what has been reported for the d(CGCGTATACGCG) oligonucleotide.
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Affiliation(s)
- M Hald
- Department of Chemistry, University of Odense, Denmark
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Burgering MJ, Hald M, Boelens R, Breg JN, Kaptein R. Hydrogen exchange studies of the Arc repressor: evidence for a monomeric folding intermediate. Biopolymers 1995; 35:217-26. [PMID: 7696567 DOI: 10.1002/bip.360350210] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The hydrogen exchange rates of the backbone amide and labile side-chain protons of the dimeric Arc repressor have been measured. For the slowly exchanging amides in the alpha-helical regions, these rates show a concentration dependence. To account for this dependence, the role of the monomer-dimer equilibrium was considered. Extrapolating the observed exchange rates to zero dimer concentration provides estimates of these rates in the monomer and shows that they are significantly retarded compared to those of an unfolded polypeptide. This suggests that the monomer is in a structured "molten globule" like state. In particular, the two helices of Arc retain a high degree of their secondary structure and it is proposed that the two amphiphilic helices are packed together with their hydrophobic faces. Evidence for a partially folded structure in the Arc monomer was reported earlier in two other studies [J. L. Silva, C. F. Silveira, A. Correia, Jr., and L. Pontes (1992) Journal of Molecular Biology, Vol. 223, pp. 545-555; X. Peng, J. Jonas, and J. L. Silva (1993) Proceedings of the National Academy of Science USA, Vol. 90, pp. 1776-1780]. By combining the results of these studies and ours, a folding pathway of the dimeric Arc repressor involving four different stages is proposed. Due to the low concentration of Arc repressor in the cell, the protein is present either as a free monomer or it is bound to DNA presumably as a tetramer. Therefore the folding pathway can be regarded as an integral part of the overall DNA binding process.
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Affiliation(s)
- M J Burgering
- Bijvoet Center for Biomolecular Research, Utrecht, The Netherlands
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Abstract
Sodium-23 spin-lattice relaxation rate (the reciprocal relaxation time) measurements have been used to study the intercalation of 9-aminoacridine in calf thymus DNA. The results are analyzed by a two state model based on the counterion condensation theory and a theory for the quadrupolar relaxation of counterions in polyelectrolyte solutions. It is shown that change of the solvent from H2O to D2O has a negligible effect on the intercalation process. Furthermore, an attempt is made to analyze the dependence of the 7Li spin-lattice relation rate on intercalation of 9-aminoacridine in LiDNA. It is shown that both quadrupolar and dipolar mechanisms contribute to the bound 7Li relation rate, and that both these contributions are reduced upon intercalation of 9-aminoacridine.
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Affiliation(s)
- M Hald
- Department of Chemistry, Odense M, Denmark
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