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Beghini M, Pichler M, Tinnefeld FC, Metz M, Möslinger D, Konstantopoulou V, Spenger J, Kautzky-Willer A, Frommlet F, Scherer T, Hufgard-Leitner M. Poor adherence during adolescence is a risk factor for becoming lost-to-follow-up in patients with phenylketonuria. Mol Genet Metab Rep 2024; 39:101087. [PMID: 38766496 PMCID: PMC11101879 DOI: 10.1016/j.ymgmr.2024.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose A high rate of lost to follow-up (LTFU) in patients with phenylketonuria (PKU) represents a main challenge. In this study, we investigated potential risk factors for becoming LTFU related to adolescence as a critical period of life. Methods We retrospectively analyzed longitudinal data collected from 1993 to 2019 of patients diagnosed with classic PKU that were followed at our center during adolescence (14-18 y) and at least once in adulthood (>18 y). Patients who interrupted their contact with our center after the 18th birthday for at least 2 years were classified as LTFU. We performed a multivariate regression analysis to investigate following potential risk factors for becoming LTFU in adult life: sex, dietary compliance during adolescence assessed through the mean of the annual medians of phenylalanine plasma values, average number of contacts with the center during adolescence and age at first visit after the 18th birthday. Results 93 patients (52 males, 41 females) were included in the study. 58% became LTFU during adulthood. The mean age at the last visit before becoming LTFU was 26.2 ± 5.1 years. In the multivariate Cox regression analysis we found that poor dietary compliance during adolescence was significantly associated with a higher risk of becoming LTFU during adulthood (p-value = 0.028). Discussion Adult patients who displayed poor treatment adherence during adolescence should be identified and carefully monitored to prevent loss of contact.
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Affiliation(s)
- Marianna Beghini
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Maximilian Pichler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Fiona Carolina Tinnefeld
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Matthäus Metz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorothea Möslinger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Vassiliki Konstantopoulou
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Johannes Spenger
- University Children's Hospital, Salzburger Landeskliniken (SALK) and Paracelsus Medical University (PMU), 5020 Salzburg, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Florian Frommlet
- Center for Medical Data Science (Institute of Medical Statistics), Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Miriam Hufgard-Leitner
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Bulut FD, Seydaoğlu G, Kor D, Kılavuz S, Boz A, Önenli Mungan N. Perspectives of adult patients with lysosomal storage diseases on the transition from pediatric to adult healthcare in Turkey. Arch Pediatr 2023; 30:450-454. [PMID: 37331832 DOI: 10.1016/j.arcped.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
AIM In many countries, adult clinics specifically dedicated to adult patients with lysosomal storage diseases (LSDs) do not exist. In Turkey, these patients are managed either by pediatric metabolic specialists or adult physicians who do not specifically specialize in LSDs. In this study, we aimed to identify the unmet clinical needs of these adult patients and their suggestions. METHODS The focus group participants were 24 adult LSD patients. Interviews were conducted in person. RESULTS A total of 23 LSD patients and parents of a patient with mucopolysaccharidosis type-3b with intellectual deficit were interviewed, with 84.6% of patients diagnosed after the age of 18 years and 18% of patients diagnosed before the age of 18 years desiring management by adult physicians. Patients with particular physical characteristics or severe intellectual deficit declined the transition. Patients reported structural problems in the hospital and social problems associated with pediatric clinics. They made suggestions to facilitate the possible transition. CONCLUSION With improved care, more patients with LSDs survive into adulthood or receive the diagnosis in adulthood. Children with chronic diseases need to transition to the care of adult physicians when they reach adulthood. Thus, there is an increasing need for adult physicians to manage these patients. In this study, most LSD patients accepted a well-planned and organized transition. Problems were related to stigmatization and social isolation in the pediatric clinic or adult issues with which pediatricians are not familiar. There is a need for adult metabolic physicians. Thus, health authorities should adopt necessary regulations for training of physicians in this field.
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Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | | | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Aslı Boz
- Çukurova University, Biostatistics Department, Adana, Turkey
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Casado E, Gómez-Alonso C, Pintos-Morell G, Bou-Torrent R, Barreda-Bonis AC, Torregrosa JV, Broseta-Monzó JJ, Arango-Sancho P, Chocrón-de-Benzaquen S, Olmedilla-Ishishi Y, Soler-López B. Transition of patients with metabolic bone disease from paediatric to adult healthcare services: current situation and proposals for improvement. Orphanet J Rare Dis 2023; 18:245. [PMID: 37644568 PMCID: PMC10463506 DOI: 10.1186/s13023-023-02856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There are currently no models for the transition of patients with metabolic bone diseases (MBDs) from paediatric to adult care. The aim of this project was to analyse information on the experience of physicians in the transition of these patients in Spain, and to draw up consensus recommendations with the specialists involved in their treatment and follow-up. METHODS The project was carried out by a group of experts in MBDs and included a systematic review of the literature for the identification of critical points in the transition process. This was used to develop a questionnaire with a total of 48 questions that would determine the degree of consensus on: (a) the rationale for a transition programme and the optimal time for the patient to start the transition process; (b) transition models and plans; (c) the information that should be specified in the transition plan; and (d) the documentation to be created and the training required. Recommendations and a practical algorithm were developed using the findings. The project was endorsed by eight scientific societies. RESULTS A total of 86 physicians from 53 Spanish hospitals participated. Consensus was reached on 45 of the 48 statements. There was no agreement that the age of 12 years was an appropriate and feasible point at which to initiate the transition in patients with MBD, nor that a gradual transition model could reasonably be implemented in their own hospital. According to the participants, the main barriers for successful transition in Spain today are lack of resources and lack of coordination between paediatric and adult units. CONCLUSIONS The TEAM Project gives an overview of the transition of paediatric MBD patients to adult care in Spain and provides practical recommendations for its implementation.
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Affiliation(s)
- Enrique Casado
- Rheumatology Department, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Carlos Gómez-Alonso
- Bone and Mineral Metabolism Clinical Management Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Guillem Pintos-Morell
- Hereditary Metabolic Diseases, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rosa Bou-Torrent
- Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - José Vicente Torregrosa
- Department of Nephrology and Renal Transplant, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Pedro Arango-Sancho
- Department of Paediatric Nephrology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | | | - Begoña Soler-López
- Medical Department, E-C-BIO, S.L., c/Rosa de Lima, 1, Edificio ALBA, Office 016, 28230, Las Rozas, Madrid, Spain.
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Ibrahim MS, Gold JI, Woodall A, Yilmaz BS, Gissen P, Stepien KM. Diagnostic and Management Issues in Patients with Late-Onset Ornithine Transcarbamylase Deficiency. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1368. [PMID: 37628367 PMCID: PMC10453542 DOI: 10.3390/children10081368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Ornithine transcarbamylase deficiency (OTCD) is the most common inherited disorder of the urea cycle and, in general, is transmitted as an X-linked recessive trait. Defects in the OTC gene cause an impairment in ureagenesis, resulting in hyperammonemia, which is a direct cause of brain damage and death. Patients with late-onset OTCD can develop symptoms from infancy to later childhood, adolescence or adulthood. Clinical manifestations of adults with OTCD vary in acuity. Clinical symptoms can be aggravated by metabolic stressors or the presence of a catabolic state, or due to increased demands upon the urea. A prompt diagnosis and relevant biochemical and genetic investigations allow the rapid introduction of the right treatment and prevent long-term complications and mortality. This narrative review outlines challenges in diagnosing and managing patients with late-onset OTCD.
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Affiliation(s)
- Majitha Seyed Ibrahim
- Department of Chemical Pathology, Teaching Hospital Batticaloa, Batticaloa 30000, Sri Lanka
| | - Jessica I. Gold
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Alison Woodall
- Adult Inherited Metabolic Diseases, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
| | - Berna Seker Yilmaz
- Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, UK
| | - Paul Gissen
- Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, UK
- Department of Paediatric Metabolic Medicine, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK
- National Institute of Health Research, Great Ormond Street Biomedical Research Centre, London WC1N 1EH, UK
| | - Karolina M. Stepien
- Adult Inherited Metabolic Diseases, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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Wicker C, Cano A, Decostre V, Froissart R, Maillot F, Perry A, Petit F, Voillot C, Wahbi K, Wenz J, Laforêt P, Labrune P. French recommendations for the management of glycogen storage disease type III. Eur J Med Res 2023; 28:253. [PMID: 37488624 PMCID: PMC10364360 DOI: 10.1186/s40001-023-01212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/05/2023] [Indexed: 07/26/2023] Open
Abstract
The aim of the Protocole National De Diagnostic et de Soins/French National Protocol for Diagnosis and Healthcare (PNDS) is to provide advice for health professionals on the optimum care provision and pathway for patients with glycogen storage disease type III (GSD III).The protocol aims at providing tools that make the diagnosis, defining the severity and different damages of the disease by detailing tests and explorations required for monitoring and diagnosis, better understanding the different aspects of the treatment, defining the modalities and organisation of the monitoring. This is a practical tool, to which health care professionals can refer. PNDS cannot, however, predict all specific cases, comorbidities, therapeutic particularities or hospital care protocols, and does not seek to serve as a substitute for the individual responsibility of the physician in front of his/her patient.
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Affiliation(s)
- Camille Wicker
- Maladies métaboliques et hépatiques pédiatriques, CHRU Hautepierre, 1 Avenue Molière, 67200, Strasbourg, France
| | - Aline Cano
- Centre de Référence des Maladies Héréditaires du Métabolisme- CHU La Timone Enfants, 264 rue Saint-Pierre, 13385, Marseille cedex 5, France
| | - Valérie Decostre
- Institut de myologie, Groupe Hospitalier Pitié-Salpêtrière, APHP. Université Paris Sorbonne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Roseline Froissart
- Centre de Biologie et pathologie Est, maladies héréditaires du métabolisme, HFME, 59, Boulevard Pinel, 69677, Bron Cedex, France
| | - François Maillot
- Médecine Interne, Centre Référence Maladies Métaboliques, hôpital Bretonneau, 2 boulevard Tonnelé, 37044, Tours cedex 9, France
| | - Ariane Perry
- Pédiatrie, Centre de Référence Maladies Héréditaires du Métabolisme Hépatique, Hôpital Antoine Béclère, APHP Université Paris-Saclay, 92141, Clamart Cedex, France
| | - François Petit
- Laboratoire de génétique, Hôpital Antoine Béclère, APHP. Université Paris-Saclay, 92141, Clamart Cedex, France
| | - Catherine Voillot
- Pédiatrie, Centre de Référence Maladies Héréditaires du Métabolisme Hépatique, Hôpital Antoine Béclère, APHP Université Paris-Saclay, 92141, Clamart Cedex, France
| | - Karim Wahbi
- Service de cardiologie - Hôpital Cochin, APHP. Université Paris Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Joëlle Wenz
- Service d'hépatologie et transplantation hépatique pédiatriques, hôpital Bicêtre, APHP. Université Paris-Saclay, 94276, Le Kremlin Bicêtre Cedex, France
| | - Pascal Laforêt
- Neurologie, Centre de Référence Maladies Neuromusculaires Nord/Est/Ile de France Hôpital Raymond Poincaré, AP-HP, Université Paris Saclay, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Philippe Labrune
- Pédiatrie, Centre de Référence Maladies Héréditaires du Métabolisme Hépatique, Hôpital Antoine Béclère, APHP Université Paris-Saclay, 92141, Clamart Cedex, France.
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Ladha FA, Le Mons C, Craigen WJ, Magoulas PL, Marom R, Lewis AM. Barriers to a successful healthcare transition for individuals with urea cycle disorders. Mol Genet Metab 2023; 139:107609. [PMID: 37245377 DOI: 10.1016/j.ymgme.2023.107609] [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: 04/03/2023] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Abstract
The pediatric to adult healthcare transition (HCT) is a process for individuals with chronic health conditions to gradually shift from a pediatric to an adult-oriented care system. Autonomy and self-management skills required for an individual's HCT readiness can be evaluated through the transition readiness assessment questionnaire (TRAQ). Despite general HCT preparation guidelines, little is known about the HCT experience of individuals with a urea cycle disorder (UCD). This is the first study to report the parent or guardian perception of the HCT process in children with a UCD by investigating the stages of transition readiness and transition outcome. We identify barriers to HCT readiness and planning, along with deficiencies in transition outcome for individuals with a UCD. For children that received special education services compared to those that did not, significantly lower transition readiness scores were identified in the total TRAQ score (p = 0.03) and in the domains of tracking health issues (p = 0.02), talking with providers (p = 0.03), and managing daily activities (p = 0.01). There was a lack of HCT preparation as most subjects did not have a HCT discussion with their healthcare provider before age 26. Deficiencies in HCT outcome are demonstrated by individuals with a UCD reporting delays in needed medical care and dissatisfaction with their healthcare services. Considerations for facilitating a successful HCT for individuals with a UCD include providing individualized education, appointing a transition coordinator, allowing flexibility in HCT timing, and ensuring that the individual recognizes concerning UCD symptoms and knows when to seek medical care.
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Affiliation(s)
- Farah A Ladha
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
| | - Cynthia Le Mons
- National Urea Cycle Disorders Foundation, Pasadena, CA, USA.
| | - William J Craigen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
| | - Pilar L Magoulas
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
| | - Ronit Marom
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
| | - Andrea M Lewis
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA.
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Żuber Z, Kieć-Wilk B, Kałużny Ł, Wierzba J, Tylki-Szymańska A. Diagnosis and Management of Mucopolysaccharidosis Type II (Hunter Syndrome) in Poland. Biomedicines 2023; 11:1668. [PMID: 37371763 DOI: 10.3390/biomedicines11061668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Mucopolysaccharidosis type II (MPS II; also known as Hunter syndrome) is a rare, inherited lysosomal storage disease. The disease is caused by deficiency of the lysosomal enzyme iduronate-2-sulphatase (I2S) due to mutations in the IDS gene, which leads to accumulation of glycosaminoglycans (GAGs). Deficiency of I2S enzyme activity in patients with MPS II leads to progressive lysosomal storage of GAGs in the liver, spleen, heart, bones, joints, and respiratory tract. This process disturbs cellular functioning and leads to multisystemic disease manifestations. Symptoms and their time of onset differ among patients. Diagnosis of MPS II involves assessment of clinical features, biochemical parameters, and molecular characteristics. Life-long enzyme replacement therapy with idursulfase (recombinant human I2S) is the current standard of care. However, an interdisciplinary team of specialists is required to monitor and assess the patient's condition to ensure optimal care. An increasing number of patients with this rare disease reach adulthood and old age. The transition from pediatric care to the adult healthcare system should be planned and carried out according to guidelines to ensure maximum benefit for the patient.
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Affiliation(s)
- Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Beata Kieć-Wilk
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Jolanta Wierzba
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Anna Tylki-Szymańska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, 04-730 Warsaw, Poland
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Genevaz D, Arnoux A, Marcel C, Brassier A, Pichard S, Feillet F, Labarthe F, Chabrol B, Berger M, Lapointe AS, Frigout Y, Héron B, Chatellier G, Belmatoug N. Transition from child to adult health care for patients with lysosomal storage diseases in France: current status and priorities—the TENALYS study, a patient perspective survey. Orphanet J Rare Dis 2022; 17:68. [PMID: 35189927 PMCID: PMC8862388 DOI: 10.1186/s13023-022-02232-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Transition from childhood to adulthood (TCA) is usually difficult in rare, progressive and multisystemic diseases. New treatments and modalities of care for many lysosomal diseases (LD) can increase life expectancy, and a successful TCA can help patient who reach adulthood to avoid disruption to health care. In France, some TCA initiatives have been taken by referral centers but in view of the problems encountered by Vaincre les Maladies Lysosomales (VML), the LD patient association, they seem to be insufficient. The aim of this study is to determine the current state of the TCA process and to identify actions to improve it through interviews with patient families and physicians in LD referral centers. The study is based upon an observational, non-interventional, cross-sectional, national survey which used two anonymous questionnaires. These questionnaires, developed by a scientific committee including representatives from VML and medical specialists in LD, were sent to patients who were receiving care in pediatric departments at age 15 years or older. Questionnaires were also sent to their referral pediatricians.
Results Fifty-four patients were included. Forty-two questionnaires were completed by patients and their corresponding physicians and 12 were completed by physicians only. The majority of the patients (80%) were informed that transfer to adult healthcare would occur, but 52% were informed after their eighteenth birthday. Forty-eight percent indicated that they were informed that a TCA coordinator would be appointed; for 39% the time frame for the transfer was communicated, and 31% were informed of the composition of the adult medical team. Among the actions that patients rated as “important/very important”, and considered to be a priority in their comments, the most frequently cited were the provision of explanatory documents on the TCA (94%), the transmission of the medical file from the pediatric sector to the adult sector (94%) and a joint consultation with both pediatrician and adult unit physician (91%). Physicians were in agreement concerning the primary importance of the last two actions.
Conclusion This study provides a basis for the deployment, on the national level, of transition programs which include specific actions that patients view as priorities.
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Hart LC, Díaz-González de Ferris M, Nazareth M, Faldowski RA, Rak E, Hooper SR, Ndugga M, van Tilburg MAL. Evaluation of the TRxANSITION Index-Parent Version for Assessment of Readiness to Transition to Adult Care Among Youth with Chronic Conditions. J Pediatr Nurs 2021; 58:1-8. [PMID: 33278706 DOI: 10.1016/j.pedn.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop and evaluate a parent-proxy measure of youth HCT readiness: the TRxANSITION Index-Parent Version. DESIGN AND METHODS We recruited parents (77% female) and youth (ages 12 to 25) to complete transition readiness measures during outpatient clinic visits. The TRxANSITION Index-Parent Version contains two domains: the Parent Knowledge Domain assessing a parent's knowledge of their youth's illness, and the Parent Proxy Domain, which provides a parental perspective regarding a youth's transition readiness skills. We evaluated the TRxANSITION Index - Parent Version for differences between parent and youth reports of HCT readiness, associations between parent's score and youth's characteristics, and item-category, item-sub-index, and sub-index category correlations. RESULTS Data from 93 parents-youth dyads were analyzed. Parents scored significantly higher than youth in the Parent Knowledge Domain and similarly in the Parent Proxy Domain. Parents of daughters had significantly higher scores in the Parent Knowledge Domain than parents of sons and reported similar scores to Parents of sons in the Parent Proxy Domain. Only the self-management sub-index significantly correlated with youth's age. The sub-index-domain, item-sub-index, and item-domain correlations assessed were generally large in magnitude (r > 0.5). CONCLUSIONS The TRxANSITION Index-Parent Version shows promise as a means of assessing parent knowledge of a youth's illness and may provide an accurate proxy assessment of a youth HCT readiness skills. PRACTICE IMPLICATIONS Obtaining parental perspective on a youth's HCT readiness may provide useful clinical information during the transition process.
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Affiliation(s)
- Laura C Hart
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC, United States of America.
| | - Maria Díaz-González de Ferris
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Meaghan Nazareth
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Richard A Faldowski
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Eniko Rak
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, NC, United States of America
| | - Maggwa Ndugga
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, 231 MacNider Building, NC, United States of America
| | - Miranda A L van Tilburg
- Department of Medicine, University of North Carolina at Chapel Hill, NC, United States of America; College of Pharmacy and Health Sciences, Campbell University, NC, United States of America; School of Social Work, University of Washington, NC, United States of America
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10
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Implementing a Transition Program from Paediatric to Adult Services in Phenylketonuria: Results After Two Years of Follow-Up with an Adult Team. Nutrients 2021; 13:nu13030799. [PMID: 33671057 PMCID: PMC8001271 DOI: 10.3390/nu13030799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
We aimed to report the implementation of a phenylketonuria (PKU) transition program and study the effects of follow-up with an adult team on metabolic control, adherence, and loss of follow-up. Fifty-five PKU patients were analysed in the study periods (SP): 2 years before (SP1) and after the beginning of adult care (SP2). Retrospective data on metabolic control and number of clinic appointments were collected for each SP, and protein intakes were analysed. In SP2, three patients (6%) were lost to follow-up. There was a small but statistically significant increase in median number of annual blood spots from SP1 to SP2: 11 (7–15) vs. 14 (7–20); p = 0.002. Mean ± SD of median blood Phe remained stable (525 ± 248 µmol/L vs. 552 ± 225 µmol/L; p = 0.100); median % of blood Phe < 480 µmol/L decreased (51 (4–96)% vs. 37 (5–85)%; p = 0.041) and median number of clinic appointments increased from SP1 to SP2: (5 (4–6) vs. 11 (8–13); p < 0.001). No significant differences were found regarding any parameter of protein intake. Our results suggest that the implementation of an adult service was successful as impact on metabolic control was limited and attendance remained high. Continuous dietetic care likely contributed to these results by keeping patients in follow-up and committed to treatment.
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Stepien KM, Kieć-Wilk B, Lampe C, Tangeraas T, Cefalo G, Belmatoug N, Francisco R, Del Toro M, Wagner L, Lauridsen AG, Sestini S, Weinhold N, Hahn A, Montanari C, Rovelli V, Bellettato CM, Paneghetti L, van Lingen C, Scarpa M. Challenges in Transition From Childhood to Adulthood Care in Rare Metabolic Diseases: Results From the First Multi-Center European Survey. Front Med (Lausanne) 2021; 8:652358. [PMID: 33738294 PMCID: PMC7962750 DOI: 10.3389/fmed.2021.652358] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Inherited Metabolic Diseases (IMDs) are rare diseases caused by genetic defects in biochemical pathways. Earlier diagnosis and advances in treatment have improved the life expectancy of IMD patients over the last decades, with the majority of patients now surviving beyond the age of 20. This has created a new challenge: as they grow up, the care of IMD patients' needs to be transferred from metabolic pediatricians to metabolic physicians specialized in treating adults, through a process called “transition.” The purpose of this study was to assess how this transition is managed in Europe: a survey was sent to all 77 centers of the European Reference Network for Hereditary Metabolic Disorders (MetabERN) to collect information and to identify unmet needs regarding the transition process. Data was collected from 63/77 (81%) healthcare providers (HCPs) from 20 EU countries. Responders were mostly metabolic pediatricians; of these, only ~40% have received appropriate training in health issues of adolescent metabolic patients. In most centers (~67%) there is no designated transition coordinator. About 50% of centers provide a written individualized transition protocol, which is standardized in just ~20% of cases. In 77% of centers, pediatricians share a medical summary, transition letter and emergency plan with the adult team and the patient. According to our responders, 11% of patients remain under pediatric care throughout their life. The main challenges identified by HCPs in managing transition are lack of time and shortage of adult metabolic physician positions, while the implementations that are most required for a successful transition include: medical staff dedicated to transition, a transition coordinator, and specific metabolic training for adult physicians. Our study shows that the transition process of IMD patients in Europe is far from standardized and in most cases is inadequate or non-existent. A transition coordinator to facilitate collaboration between the pediatric and adult healthcare teams should be central to any transition program. Standardized operating procedures, together with adequate financial resources and specific training for adult physicians focused on IMDs are the key aspects that must be improved in the rare metabolic field to establish successful transition processes in Europe.
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Affiliation(s)
- Karolina M Stepien
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases and Diabetes, Krakow University Hospital, Krakow, Poland.,Department of Metabolic Diseases, Medical College, Jagiellonian University, Krakow, Poland
| | - Christina Lampe
- Department of Child Neurology, Center for Rare Diseases Giessen (ZSEGI), Justus-Liebig University, Giessen, Germany
| | - Trine Tangeraas
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Graziella Cefalo
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, AP-HP Nord, Beaujon Hospital, Paris University, Clichy, France
| | - Rita Francisco
- Portuguese Association for Congenital Disorders of Glycosylation and other Rare Metabolic Diseases, Lisbon, Portugal
| | - Mireia Del Toro
- Pediatric Neurology Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Leona Wagner
- German-Speaking Self-Help Group for Alkaptonuria (DSAKU) e.V., Stuttgart, Germany
| | - Anne-Grethe Lauridsen
- International Gaucher Alliance, Dursley, United Kingdom.,Gaucher Association Denmark, Holbaek, Denmark
| | - Sylvia Sestini
- Italian Association of Patients With Alkaptonuria (aimAKU), Siena, Italy
| | - Nathalie Weinhold
- Metabolic Unit, Interdisciplinary Centre for Metabolism: Endocrinology, Diabetes and Metabolism (UP) and Children's Hospital, Charité University Hospital Berlin, Berlin, Germany
| | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig University, Giessen, Germany
| | - Chiara Montanari
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Valentina Rovelli
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cinzia M Bellettato
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Laura Paneghetti
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Corine van Lingen
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Maurizio Scarpa
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
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Chabrol B, Milh M. Transition from paediatric to adult care in adolescents with neurological diseases and handicap. Rev Neurol (Paris) 2020; 176:37-42. [DOI: 10.1016/j.neurol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/16/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
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13
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Mazzucato M, Visonà Dalla Pozza L, Minichiello C, Manea S, Barbieri S, Toto E, Vianello A, Facchin P. The Epidemiology of Transition into Adulthood of Rare Diseases Patients: Results from a Population-Based Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2212. [PMID: 30309015 PMCID: PMC6210512 DOI: 10.3390/ijerph15102212] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022]
Abstract
Background: Despite the fact that a considerable number of patients diagnosed with childhood-onset rare diseases (RD) survive into adulthood, limited information is available on the epidemiology of this phenomenon, which has a considerable impact both on patients' care and on the health services. This study describes the epidemiology of transition in a population of RD patients, using data from the Veneto Region Rare Diseases Registry (VRRDR), a web-based registry monitoring since 2002 a consistent number of RD in a defined area (4.9 million inhabitants). Methods: Longitudinal cohorts of patients born in the years 1988 to 1998 and enrolled in the VRRDR in their paediatric age were identified. Data referred to this group of patients, experiencing transition from paediatric to adult age during the years 2006⁻2016, are presented. Results: 2153 RD patients (44.1% females and 55.9% males) passed from childhood to adulthood in the study period, corresponding to a 3-fold increase from 2006 to 2016. The majority of these patients was affected by congenital anomalies (32.0%), by hematologic diseases (15.9%), eye disorders (12.1%) and neoplasms (7.9%). RD patients who experienced transition from paediatric age to adulthood represent the 9.2% of adult patients enrolled in the Registry at 31 December 2016. Conclusions: We described a subset of RD young adults experiencing transition into adulthood. The data reported can be considered as minimum values for estimating the size of this increasing population presenting specific transition needs. These figures are valuable for clinicians, patients and health planners. Public policy interventions are needed in order to promote dedicated care transition pathways in the broader framework of health policies devoted to RD.
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Affiliation(s)
- Monica Mazzucato
- Rare Diseases Coordinating Center, Rare Diseases Registry, Veneto Region, 35100 Padua, Italy.
| | | | - Cinzia Minichiello
- Rare Diseases Coordinating Center, Rare Diseases Registry, Veneto Region, 35100 Padua, Italy.
| | - Silvia Manea
- Rare Diseases Coordinating Center, Rare Diseases Registry, Veneto Region, 35100 Padua, Italy.
| | - Sara Barbieri
- Rare Diseases Coordinating Center, Rare Diseases Registry, Veneto Region, 35100 Padua, Italy.
| | - Ema Toto
- Rare Diseases Coordinating Center, Rare Diseases Registry, Veneto Region, 35100 Padua, Italy.
| | - Andrea Vianello
- Department of Women's and Children's Health, University of Padua, 35100 Padua, Italy.
| | - Paola Facchin
- Department of Women's and Children's Health, University of Padua, 35100 Padua, Italy.
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Peron A, Canevini MP, Ghelma F, Di Marco F, Vignoli A. Healthcare transition from childhood to adulthood in Tuberous Sclerosis Complex. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:355-364. [PMID: 30253036 PMCID: PMC6635672 DOI: 10.1002/ajmg.c.31653] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 12/12/2022]
Abstract
Healthcare transition from childhood to adulthood is required to ensure continuity of care of an increasing number of individuals with chronic conditions surviving into adulthood. The transition for patients with tuberous sclerosis complex (TSC) is complicated by the multisystemic nature of this condition, age-dependent manifestations, and high clinical variability and by the presence of intellectual disability in at least half of the individuals. In this article, we address the medical needs regarding each TSC-related manifestation in adulthood, and the services and support required. We review existing models of transition in different chronic conditions, discuss our experience in transitioning from the pediatric to the adult TSC Clinic at our Institution, and propose general rules to follow when establishing a transition program for TSC. Although a generalizable transition model for TSC is likely not feasible for all Institutions, a multidisciplinary TSC clinic is probably the best model, developed in accordance with the resources available and country-specific healthcare systems. Coordination of care and education of the adult team should be always sought regardless of the transition model.
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Affiliation(s)
- Angela Peron
- Department of Health Sciences, Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Maria Paola Canevini
- Department of Health Sciences, Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Filippo Ghelma
- Department of Health Sciences, Disabled Advanced Medical Assistance, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano (Italy), Respiratory Unit ASST-Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Aglaia Vignoli
- Department of Health Sciences, Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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