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Devaux F, Fonteyne C, Deriez M, Lambotte I. [Crossed perspectives on pediatrics to adult health care transition in Belgium]. Med Sci (Paris) 2023; 39:137-144. [PMID: 36799748 DOI: 10.1051/medsci/2023017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
In Belgium, there is not yet a standardized procedure for supporting the transition of patients with chronic diseases from pediatrics to adult health care. However, the field increasingly calls for the development of multidisciplinary landmarks. By crossing perspectives of a pediatrician, two psychologists and an ethicist, we propose the key elements of a successful transition: 1. Start preparing for the transition early; 2. Promote the patient's knowledge, know-how and interpersonal skills; 3. Improve continuity of care and collaboration between patient, family, healthcare teams, patient associations and families; 4. Support parents; 5. Improve the skills of healthcare teams in the specificities of adolescent medicine; 6. Individualize the transition, respecting each person's pace and uniqueness; 7. Develop an interdisciplinary approach of the transition; 8. Develop collaboration with public authorities, national and international experts; 9. Develop research on this emerging field of study.
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Affiliation(s)
- Franck Devaux
- Éthicien, président du comité d'éthique, coordinateur de la fonction maladies rares et maître de conférences, Université libre de Bruxelles (ULB), Hôpital universitaire de Bruxelles (HUB), Hôpital universitaire des enfants Reine Fabiola (HUDERF), Belgique
| | - Christine Fonteyne
- Cheffe de clinique, unité ressource douleur et équipe mobile de soins palliatifs pédiatriques, Université libre de Bruxelles (ULB), Hôpital universitaire de Bruxelles (HUB), Hôpital universitaire des enfants Reine Fabiola (HUDERF), Belgique
| | - Marie Deriez
- Psychologue clinicienne, Université libre de Bruxelles (ULB), Hôpital universitaire de Bruxelles (HUB), Hôpital universitaire des enfants Reine Fabiola (HUDERF), Belgique
| | - Isabelle Lambotte
- Psychologue clinicienne PhD, cheffe du service de psychologie secteur infanto-juvénile, Université libre de Bruxelles (ULB), Hôpital universitaire de Bruxelles (HUB), Hôpital Universitaire des enfants Reine Fabiola (HUDERF), Belgique
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Collins R, Singh B, Payne DN, Bharat C, Noffsinger W, Dhaliwal SS, O'Dea C, Mulrennan S. Effect of transfer from a pediatric to adult cystic fibrosis center on clinical status and hospital attendance. Pediatr Pulmonol 2021; 56:2029-2035. [PMID: 33793092 DOI: 10.1002/ppul.25398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022]
Abstract
AIM Transfer from pediatric to adult services could lead to clinical deterioration, few studies have examined this. We sought to examine the clinical impact of a structured individualized transition and transfer process in patients with cystic fibrosis (CF). METHODS Medical records of all patients with CF in Western Australia who transferred from a pediatric center (Princess Margaret Hospital for Children) to an adult CF center (Sir Charles Gairdner Hospital) between 2008 and 2012 were reviewed. Data were extracted for 2 years before and after transfer. The number of CF outpatient visits, inpatient days, and home intravenous antibiotic therapy (HIVT) days were recorded at yearly intervals before and after transfer. Sputum culture results at transfer were collected. All respiratory function and anthropometric data over the 4 years were extracted. RESULTS Forty-two patients with CF were transferred between 2008 and 2012. The mean age at transfer was 18.9 years (range 17-22). Compared to 1-year pre-transfer, the frequency of outpatient visits at 1- and 2-year post-transfer increased. After transfer, there was no change in BMI, HIVT days, or inpatient days, and no acceleration in the expected decline in FEV1. CONCLUSION This study found that transfer from a pediatric to an adult CF center using a structured, individualized transition and transfer process was not associated with accelerated clinical deterioration.
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Affiliation(s)
- Rachel Collins
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research Institute, Perth, Western Australia, Australia.,School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | | | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - William Noffsinger
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Christopher O'Dea
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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Smoothing the transition of adolescents with CF from pediatric to adult care: Pre-transfer needs. Arch Pediatr 2021; 28:257-263. [PMID: 33863608 DOI: 10.1016/j.arcped.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 09/24/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The "SAFETIM need" study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center. METHODS This was a prospective, observational, multicenter study conducted between July 2017 and December 2018, involving the three CF centers of a regional network in southeastern France. Each adolescent registered with the center and his or her parents were interviewed individually, on the same day, during the 6 months leading up to transfer. They participated in semi-structured interviews during one of their routine consultations at the CF center. The interview manual, based on literature reviews and targeting national recommendations, was tested and validated by the national CF therapeutic education group (GETheM). All interviews were transcribed and checked by two different people, and analyzed by two researchers individually. The results were classified by topic according to content categorization. RESULTS Overall, 43 adolescents and 41 parents were interviewed, respectively, who were followed up by CF centers: 14% (n=6) in a mixed CF center (pediatric and adult); 19% (n=8) and 67% (n=29), respectively, in two different pediatric CF centers. Adolescents were between 16 and 19 years old. For adolescents, the average interview time was 5.11min. (standard deviation [SD]: 3.8min; minimum: 2.53min; maximum: 17.14min). For parents, the average interview time was 7.99min (SD: 3.56min, minimum: 3.43min; maximum: 22.50min). DISCUSSION Our study enquired only about the preparation and organization of the transfer. We identified three areas of actions matching the needs of adolescents and parents before transfer. The first one is to anticipate team change to prepare follow-up in their future CF center: acquire new skills, consider the future CF center according to the adolescent's curriculum, be involved in the transition process. The second area is to accompany the upcoming change. The care team could help by providing information and support during the start of teenagers' transition toward autonomy. And parents were aware that the CF center change will reverse roles. They must provide their own knowledge and manage the ambivalence of this as well as letting go. The third one is to announce the transition process and functioning of the future adult CF center, because the transition would require time to find their place (patients and parents) with the new team. CONCLUSION The "SAFETIM needs" pre-transfer study results show that we can identify the main criteria to be developed and strengthened, to promote a smooth, high-quality transition from pediatric to adult CF care for patients in France. For most patients, the transition cannot be prepared at the last minute. Caregivers need to develop specific skills in adolescent and young adult care and follow-up. Each team must consider the transition as a normal part of the patient care cycle. While it must be structured, some flexibility must be allowed so as to give everyone the chance to be prepared and to personalize the care.
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Colinart-Thomas M, Noël V, Roques G, Gordes-Grosjean S, Abely M, Pluchart C. [From pediatric care to adult medicine: Transition of sickle cell patients, a French monocentric study]. Arch Pediatr 2018. [PMID: 29530458 DOI: 10.1016/j.arcped.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sickle cell disease, a hemoglobin disorder with autosomal recessive transmission, is one of the most common genetic diseases screened in France. Thanks to early management, 95% of sickle cell patients reach adulthood and require transition from pediatric care to adult care. Through a retrospective study of records from serious sickle cell patients over 17 years old, followed in the hematology-oncology pediatric unit of Reims University Hospital Center in France, we analyzed transition conditions, compared pediatric and adult management, and proposed a plan for transition care. As of 1 January 2016, out of 19 sickle cell patients meeting the inclusion criteria, 12 had made the transition from pediatric care to adult medicine. Among the transition group, the transition was proposed by the pediatrician in 92% of cases. The average age of transition was 19.4 years. The time between receiving the information and the last pediatric visit was 2.4 months. Seven out of the 12 patients were informed of their transition during the last pediatric visit. The age of the first adult visit was 20.3 years. There was no alternate or joint consultation. The treatments prescribed during the last pediatric visit were not modified during the first adult visit. The average number of hospitalizations per patient was 2.7 in pediatric care and 3.4 in adult care with a median value of 2 in both groups. Three out of 12 patients died, the average age of death being 26.7 years. Transition is an important milestone in chronic disease patients. More than age, the maturity of the patient must be taken into account. The transition to the adult structure requires early preparation in the teenage years and investment of the adolescent and his family as well as investment of pediatric and adult caregivers. This study points out the need to establish a transition plan within our hospital in collaboration with adult physicians. Continuity of care is necessary to increase the quality of managing patients and cannot be done without a close relationship between pediatric specialists and adult physicians.
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Affiliation(s)
- M Colinart-Thomas
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - V Noël
- Service de médecine interne, maladies infectieuses et immunologie clinique, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - G Roques
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Gordes-Grosjean
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Abely
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - C Pluchart
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Eluri S, Book WM, Kodroff E, Strobel MJ, Gebhart JH, Jones PD, Menard-Katcher P, Ferris ME, Dellon ES. Lack of Knowledge and Low Readiness for Health Care Transition in Eosinophilic Esophagitis and Eosinophilic Gastroenteritis. J Pediatr Gastroenterol Nutr 2017; 65. [PMID: 28644350 PMCID: PMC5360549 DOI: 10.1097/mpg.0000000000001415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A growing population of adolescents/young adults with eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE) will need to transition from pediatric to adult health providers. Measuring health care transition (HCT) readiness is critical, but no studies have evaluated this process in EoE/EGE. We determined the scope and predictors of HCT knowledge in patients and parents with EoE/EGE and measured HCT readiness in adolescents/young adults. METHODS We conducted an online survey of patients 13 years or older and parents of patients with EoE/EGE who were diagnosed when 25 years or younger. Parents answered questions regarding their children and their own knowledge of HCT. HCT readiness was assessed in adolescents/young adults aged 13 to 25 years with the Self-Management and Transition to Adulthood with Rx Questionnaire (a 6-domain self-report tool) with a score range of 0 to 90. RESULTS Four hundred fifty participants completed the survey: 205 patients and 245 parents. Included in the analysis (those diagnosed with EoE/EGE at age 25 years or younger) were 75 of 205 patients and children of 245 parent respondents. Overall, 78% (n = 52) of the patients and 76% (n = 187) of parents had no HCT knowledge. Mean HCT readiness score in adolescents/young adults (n = 50) was 30.4 ± 11.3 with higher scores in domains of provider communication and engagement during appointments. Mean parent-reported (n = 123) score was 35.6 ± 9.7 with higher scores in medication management and disease knowledge. CONCLUSIONS There was a significant deficit in HCT knowledge, and HCT readiness scores were lower than other chronic health conditions. HCT preparation and readiness assessments should become a priority for adolescents/young adults with EoE/EGE and their parents.
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Affiliation(s)
- Swathi Eluri
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wendy M. Book
- American Partnership for Eosinophilic Disorders, Atlanta, GA
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Disease, Cincinnati, OH
| | - Mary Jo Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, GA
| | - Jessica H. Gebhart
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patricia D. Jones
- Department of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL
| | - Paul Menard-Katcher
- Department of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Maria E. Ferris
- Pediatric Nephrology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Evan S. Dellon
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Juvenile systemic lupus erythematosus (JSLE) represents 15—20% of all SLE cases. The leading presenting symptoms of JSLE are constitutional and not specific such as fatigue, headache, weight loss or mood swings. They are also encountered in healthy adolescents, which explains frequent diagnosis delay. The frequency of irreversible damage is high in JSLE and involves especially the renal, musculoskeletal and neuropsychiatric systems. Although the overall prognosis has markedly improved, thanks to earlier diagnosis and new therapeutic approaches, cardiovascular, hematological events and chronic renal failure remain severe, and constitute the main disease-related causes of death. Treatment is based on hydroxycloroquine and corticosteroids. Immunosuppressive agents must be discussed to decrease the duration of corticosteroids use. New drugs and monoclonal antibodies targeting B-cells and B-cell related cytokines are being evaluated with encouraging results. Management of JSLE has to challenge three objectives: controlling disease progression, obtaining patient's adherence to treatment, and preventing consequences of medication side effects on growth, puberty, development and fertility. Patients' quality of life and psychosocial development have also to be taken into account, as well as the organization of a successful transition from paediatric to adult care. Lupus (2007) 16, 606—612.
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Affiliation(s)
- I Kone-Paut
- Department of Pediatrics and Pediatric Rheumatology, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
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Malivoir S, Courtillot C, Bachelot A, Chakhtoura Z, Téjédor I, Touraine P. [Therapeutic education programme for patients with chronic endocrine conditions: Transition from paediatric to adult services]. Presse Med 2016; 45:e119-29. [PMID: 27180274 DOI: 10.1016/j.lpm.2015.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/24/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED The purpose of this study is to contribute to better identifying the transition of patients with chronic endocrine conditions from paediatric to adult department. The aim was to specify the means and the competences that must be used by patients and health care teams and which could be help to the best quality care. METHOD We propose group sessions and individual interviews. A thematic analysis of the sessions and the responses to questionnaires have enabled the development of individual educational diagnosis and assess the autonomy of young adolescents. RESULTS Fifty of 214 patients from paediatric services participated to therapeutic education program (TEP) in the last four years. This program is based on the psychic movements of adolescence. One year after the therapeutic education program session, 48 patients came to all the medical consultations and we observed a greater autonomy in adolescent patients. CONCLUSION However, we must improve the modalities for including patients in this "transition program".
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Affiliation(s)
- Sabine Malivoir
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Carine Courtillot
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Anne Bachelot
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Zeina Chakhtoura
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Isabelle Téjédor
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Philippe Touraine
- Hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, centre de référence des maladies endocriniennes rares de la croissance, centre de référence des maladies rares gynécologiques, institut E3M-ICAN, endocrinologie-médecine de la reproduction, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Aimaretti G, Attanasio R, Cannavò S, Nicoletti MC, Castello R, Di Somma C, Garofalo P, Iughetti L, Loche S, Maghnie M, Mazzanti L, Saggese G, Salerno M, Tonini G, Toscano V, Zucchini S, Cappa M. Growth hormone treatment of adolescents with growth hormone deficiency (GHD) during the transition period: results of a survey among adult and paediatric endocrinologists from Italy. Endorsed by SIEDP/ISPED, AME, SIE, SIMA. J Endocrinol Invest 2015; 38:377-82. [PMID: 25362629 DOI: 10.1007/s40618-014-0201-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
Treatment of adolescents with growth hormone deficiency (GHD) during the transition period is a controversial issue. This paper is a contribution from the Italian community of paediatric and adult endocrinologists surveyed in a Delphi panel. The Delphi method is a structured communication technique, originally developed as a systematic, interactive forecasting method that relies on a panel of experts. The experts answer questionnaires in two or more rounds. There was substantial agreement on the definition of the problems associated with the diagnosis and treatment of adolescents with GHD in the transition period, as well as on the identification of the controversial issues which need further studies. There is general consensus on the need of re-testing all isolated idiopathic GHD after at least 30-day withdrawn from treatment, while in patients with multiple pituitary deficiency and low IGF-I levels there is generally no need to re-test. In patients with permanent or confirmed GHD, a starting low rhGH dose (0.01-0.03 mg per day) to be adjusted according to IGF-I concentrations is also widely accepted. For those continuing treatment, the optimal therapeutic schedule to obtain full somatic maturation, normalization of body composition and bone density, cardiovascular function and Quality of Life, need to be evaluated.
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Affiliation(s)
- G Aimaretti
- Diabetology, Metabolic and Endocrinologic diseases, "Maggiore della Carità" Hospital, Novara, Italy
| | - R Attanasio
- Endocrinology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - S Cannavò
- Endocrinological Unit of Clinic-Sperimental Medicine and Surgery Department, University of Messina, Messina, Italy
| | - M C Nicoletti
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
| | - R Castello
- Endocrinology UOC, General Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - C Di Somma
- "Federico II" University of Naples, Naples, Italy
| | - P Garofalo
- UO of Endocrinology, Ospedale Villa Sofia-Cervello, Palermo, Italy
| | - L Iughetti
- Pediatric Clinic, University of Modena, Modena, Italy
| | - S Loche
- Pediatric Endocrinology Service, Ospedale Microcitemico, Cagliari, Italy
| | - M Maghnie
- Department of Pediatrics, University of Genova Pediatric Endocrine Unit, Children's Hospital Giannina Gaslini, IRCCS, Genoa, Italy
| | - L Mazzanti
- Pediatric UO, Programme of Endocrinology, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - G Saggese
- Department of Pediatrics, University of Pisa, Pisa, Italy
| | - M Salerno
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | - G Tonini
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - V Toscano
- II Faculty of Medicine, "La Sapienza", University, Rome, Italy
| | - S Zucchini
- Pediatric UO, Programme of Endocrinology, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - M Cappa
- Endocrinology and Diabetology Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, P.za Sant'Onofrio n. 4, 00165, Rome, Italy.
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Larivière-Bastien D, Bell E, Majnemer A, Shevell M, Racine E. Perspectives of young adults with cerebral palsy on transitioning from pediatric to adult healthcare systems. Semin Pediatr Neurol 2013; 20:154-9. [PMID: 23948690 DOI: 10.1016/j.spen.2013.06.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transition from pediatric to adult healthcare is a well-established challenge for individuals with neurodevelopmental disorders like cerebral palsy. With regard to ethics, some of the key aspects to explore include the following: if and how individuals feel respected during the transition process; if and how their values and preferences are developed and integrated within transition; and if and how young patients are prepared to participate in decision making (to be autonomous) within the transition. We carried out a qualitative study on 14 young adults with cerebral palsy. Some participants reported positive experiences. However, several tension points were identified, including before the transition (eg, transition envisaged with fear and apprehension); during the transition (eg, lack of cooperation or communication between providers in the pediatric and adult healthcare systems); and after the transition (eg, feelings of abandonment). We discuss the clinical influence and ethical significance of better capturing ethical values within the transition process and preparing young individuals to engage in discussions about their health and disease management.
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Affiliation(s)
- Danaë Larivière-Bastien
- Neuroethics Research Unit, Institut de Recherches Cliniques de Montréal, Montréal, Quebec, Canada
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Racine E, Bell E, Shevell M. Ethics in neurodevelopmental disability. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:243-63. [PMID: 24182383 DOI: 10.1016/b978-0-444-53501-6.00021-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurodevelopmental disabilities, like autism spectrum disorders and cerebral palsy are a common health problem in children. Given the impact of these conditions on children, families, and healthcare and social systems, the care of developmentally challenged children raises questions related to values and ethical principles. We review the common features of neurodevelopmental disorders that help understand the associated ethical questions. We focus on three major areas where ethical questions arise for clinicians and those involved in making decisions for or caring for these children: (1) the principles of decision-making and autonomy as they relate to developmental disability; (2) the issues related to quality of life that have long intersected with developmental disability; and (3) the use of unproven therapies and diagnostics that are particularly controversial given the extent that neurodevelopmental disabilities impact children and their families, yet active treatments options are limited.
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada; Department of Medicine and Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada; Departments of Neurology and Neurosurgery, McGill University, Montreal, Canada.
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11
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Sebastian S, Jenkins H, McCartney S, Ahmad T, Arnott I, Croft N, Russell R, Lindsay JO. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohns Colitis 2012; 6:830-44. [PMID: 22398082 DOI: 10.1016/j.crohns.2012.01.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/24/2011] [Accepted: 01/11/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Preliminary data highlight the importance of appropriate transition for successful transfer of adolescents with IBD from paediatric to adult care. The aim of this study was to identify both the perceived needs of adolescent IBD patients and the barriers to successful transition from the perspective of professionals involved in their care. METHODS A postal questionnaire was distributed to UK adult and paediatric gastroenterologists with an interest in IBD. The questionnaire utilised closed questions as well as ranked items on the importance of the various competencies of adolescents with IBD required for successful transition. RESULTS Response rate of 62% and 49% for paediatric and adult gastroenterologists respectively was achieved. A structured transition service was perceived as very important by 80% paediatric compared to 47% adult gastroenterologists (p=0.001). A higher proportion of adult than paediatric gastroenterologists identified inadequacies in the preparation of adolescents for transfer (79% and 42%, p=0.001). The main areas of perceived deficiency in preparation identified were patient lack of knowledge about the condition and treatment, lack of self advocacy and co-ordination of care. Lack of resources, clinical time, and a critical mass of patients were the factors ranked highest by both groups as barriers to transition care. Both adult (65%) and paediatric gastroenterologists (62%) highlighted suboptimal training in adolescent medicine for adult gastroenterologists. CONCLUSIONS This survey highlights differences in the perception of adult and paediatric gastroenterologists in the management of transition care and perceived competencies for adolescents with IBD. Lack of training and inadequate resources are the main barriers identified for development of a successful transition service.
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Vaudre G, Sylvain H, Delmas P, Dollfus C, Leverger G. [Consequences and experiences of the transition to adult medicine for young people living with human immunodeficiency virus (HIV)]. Arch Pediatr 2012; 19:786-93. [PMID: 22743171 DOI: 10.1016/j.arcped.2012.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/27/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Continuity of care is a major challenge for young people living with HIV, especially when transitioning from pediatric to adult care. A qualitative study was conducted in an attempt to explore and describe the transitions resulting from this change of care and to identify factors influencing this process. PATIENTS AND METHODS Seven young adults, HIV-infected since childhood, with a median age of 25 years, with more than 2 years of experience since transitioning to adult care, participated in this qualitative research. Data were collected through semi-structured interviews. RESULTS Becoming an adult has depended upon a double change in perception: leaving the cocoon of the pediatric ward made them feel more adult, but entering the adult universe where the disease is more visible and the environment more "cold" and "unfamiliar" made them feel more vulnerable. This "clash of worlds" creates a transformation leading to adulthood, where a relation based on mutual trust remains fundamental for the continuity of care and for pursuing the youth's personal development in the social and affective spheres. CONCLUSION Self-construction on various levels (identity, social, affective) while maintaining regular medical care is the challenge of youth transitioning to adult care. A specific nurse-based consultation could be a useful tool for helping young people through this difficult process.
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Affiliation(s)
- G Vaudre
- Service d'hématologie et d'oncologie pédiatrique, hôpital d'enfants Armand-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Larivière-Bastien D, Racine E. Ethics in health care services for young persons with neurodevelopmental disabilities: a focus on cerebral palsy. J Child Neurol 2011; 26:1221-9. [PMID: 21551372 DOI: 10.1177/0883073811402074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article we review and discuss some of the key ethical and social challenges that young persons with cerebral palsy face in health care delivery. We identify and explain these challenges, some of which are rarely discussed in contemporary medicine and biomedical ethics, partly because they are not considered genuine "ethical" challenges per se. Most of these challenges are heavily shaped by broader social context and institutional practices, which highlights the importance of nonbiological aspects of the care of young persons with cerebral palsy from an ethics standpoint.
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Abstract
Many neurodevelopmental disorders affect early brain development in ways that are still poorly understood; yet, these disorders can place an enormous toll on patients, families, and society as a whole and affect all aspects of daily living for patients and their families. We describe a pragmatic, evidence-based framework for engaging in empiric ethics inquiry for a large consortium of researchers in neurodevelopmental disorders and provide relevant case studies of pragmatic neuroethics. The 3 neurodevelopmental disorders that are at the focus of our research, cerebral palsy (CP), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD), bring unique and intersecting challenges of translating ethically research into clinical care for children and neonates. We identify and discuss challenges related to health care delivery in CP; neonatal neurological decision making; alternative therapies; and identity, integrity, and personhood.
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Maladie de Gaucher de type 1 : difficultés pour la transition enfants-adultes. Arch Pediatr 2011; 18:165-9. [DOI: 10.1016/j.arcped.2010.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/02/2010] [Accepted: 11/26/2010] [Indexed: 11/19/2022]
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Mauerhofer A, Akre C, Michaud PA, Suris JC. [Youth-friendly outpatient care]. Arch Pediatr 2009; 16:1151-7. [PMID: 19410439 DOI: 10.1016/j.arcped.2009.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 03/29/2009] [Indexed: 11/26/2022]
Abstract
Ambulatory pediatric and family medicine takes care of adolescent patients, most of whom regularly consult a physician. Consultations with young people involve issues specifically related to their age. Regarding health care systems and physicians, adolescents' expectations vary from those of adults, not so much in terms of the issues discussed but in terms of the priorities that they give to them. Confidential interviews are not always proposed but are highly appreciated, as are certain personal qualities on the part of the caregivers such as honesty, respect, and friendliness. Finally, easy access to care together with the continuity of care are essential. Prevention of risk behaviors by screening and health education is clearly insufficient. This issue could be approached during the consultation through a psychosocial history. This is a good opportunity to discuss sensitive issues that adolescents seldom bring up themselves. More systematic prevention would probably decrease youth morbidity and mortality, which are both closely related to risk behaviors. To meet these expectations and special health care needs, the World Health Organization has developed the concept of youth-friendly health services. This concept can be applied in both a specialized adolescence center and a pediatric or family practice. Youth-friendly services are still rarely evaluated but seem to bring a clear benefit in terms of patient satisfaction and access to care.
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Affiliation(s)
- A Mauerhofer
- Groupe de recherche sur la santé des adolescents, institut universitaire de médecine sociale et préventive, centre hospitalier universitaire de Vaudois, Bugnon 17, 1005 Lausanne, Suisse
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Malbrunot-Wagner AC, Bonnemains C, Troussier F, Darviot E, Chiffoleau M, Person C, Urban T, Giniès JL. Passage de l’enfant à l’adulte : l’exemple d’un centre de ressources et de compétences pour la mucoviscidose. Arch Pediatr 2009; 16:235-42. [DOI: 10.1016/j.arcped.2008.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 10/30/2008] [Accepted: 12/14/2008] [Indexed: 10/21/2022]
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Duguépéroux I, Tamalet A, Sermet-Gaudelus I, Le Bourgeois M, Gérardin M, Desmazes-Dufeu N, Hubert D. Clinical changes of patients with cystic fibrosis during transition from pediatric to adult care. J Adolesc Health 2008; 43:459-65. [PMID: 18848674 DOI: 10.1016/j.jadohealth.2008.03.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 03/10/2008] [Accepted: 03/18/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the clinical changes of adults with cystic fibrosis (CF) during transition from a pediatric to adult CF center. METHODS Data were collected at the time of transfer, 1 year earlier and 1 year later, for all patients in our adult CF center arriving from one of the three pediatric CF centers in Paris between January 2001 and June 2004. RESULTS Sixty-three of the 68 patients (transferred at a median age of 21.0 years) were regularly attending this adult CF center after 1 year and one had died. The mean number of outpatient visits increased in the year after transfer (5.7 vs. 3.8 in the year before, p < .001). The occurrence of clinical events and the rate of bronchial colonization did not change. Pseudomonas aeruginosa was found in about 60% of patients at any time. Pulmonary function declined regularly with no statistically significant difference in the rate of decline between the 2 years of follow-up (FEV 1 was 54.7% predicted at transfer). Nutritional status remained stable (mean body mass index was 19.1 kg/m2). The number and duration of oral and i.v. antibiotic courses did not change, but more patients received them at home (p < .001) and self-administered physiotherapy after transfer (p = .001). The proportion of students decreased from 79.3% to 48.1% (p = .02) and the proportion in the workforce increased from 12.7% to 20.4% after transfer. CONCLUSIONS Patients with CF remained clinically stable during transition and progressively acquired autonomy.
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Dabadie A, Troadec F, Heresbach D, Siproudhis L, Pagenault M, Bretagne JF. Transition of patients with inflammatory bowel disease from pediatric to adult care. ACTA ACUST UNITED AC 2008; 32:451-9. [PMID: 18472377 DOI: 10.1016/j.gcb.2008.01.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/08/2008] [Accepted: 01/09/2008] [Indexed: 12/11/2022]
Abstract
AIM This study was designed to ascertain the perception of patients (and their parents) followed-up for inflammatory bowel disease (IBD) concerning the transition from pediatric to adult care. PATIENTS AND METHODS Forty-eight youths with IBD who had transited from pediatric to adult care were surveyed. Their age at transition was 17.9+/-0.9 years. Thirty-four patients (71%) had been referred to a gastroenterologist working in the same hospital and, in 27 cases, after having attended a joint pediatric-adult care visit. RESULTS The response rate was 71%. Twenty-nine patients (85%) and 25 parents (74%) felt they were ready to transit into adult care. Seven patients (22%) and 10 parents (32%) were apprehensive about transition to adult gastroenterology. All patients considered the joint medical visit beneficial in terms of transmitting information from their medical records and 93% considered it beneficial for building confidence in the new gastroenterologist. All parents considered the joint medical visit helpful for building the children's confidence in their new doctor. At the time of the survey, 29 patients (85%) were continuing to be followed-up by the same gastroenterologist. CONCLUSION Effective planning, including a joint medical visit, enabled successful, well-coordinated transition to adult medical-care follow-up.
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Affiliation(s)
- A Dabadie
- Département de médecine de l'enfant et de l'adolescent, CHU hôpital Anne-de-Bretagne, 16, boulevard de Bulgarie, B.P. 900347, 35203 Rennes cedex 2, France.
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Jacquin P, Levine M. Difficultés d’observance dans les maladies chroniques à l’adolescence : comprendre pour agir. Arch Pediatr 2008; 15:89-94. [DOI: 10.1016/j.arcped.2007.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
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Dommergues JP, Gimeno L, Galacteros F. [A pediatrician listening to young adults affected with sickle cell disease]. Arch Pediatr 2007; 14:1115-8. [PMID: 17669637 DOI: 10.1016/j.arcped.2007.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 06/21/2007] [Indexed: 10/23/2022]
Affiliation(s)
- J-P Dommergues
- Département de pédiatrie, hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Tubiana-Rufi N, Lahaie E, Jacquin P, Guitard-Munnich C, Houdan J, du Pasquier L. Le passage des adolescents diabétiques de la pédiatrie à la médecine pour adultes: être ou ne pas être perdu en transit? Arch Pediatr 2007; 14:659-61. [PMID: 17419029 DOI: 10.1016/j.arcped.2007.02.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/19/2022]
Affiliation(s)
- N Tubiana-Rufi
- Service d'endocrinologie-diabétologie, Assistance publique-Hôpitaux de Paris, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Funck-Brentano I, Veber F, Gailhoustet L, Viard JP, Blanche S. [Transition in adult care for HIV perinatally infected adolescents and young adults]. Arch Pediatr 2007; 14:741-3. [PMID: 17416502 DOI: 10.1016/j.arcped.2007.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/29/2022]
Affiliation(s)
- I Funck-Brentano
- Unité d'immunologie et d'hématologie pédiatriques, Assistance publique-Hôpitaux de Paris, hôpital Necker-Enfants-malades, 49, rue de Sèvres, 75743 Paris cedex 15, France
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Tiffreau V, Schill A, Popielarz S, Herbau C, Blanchard A, Thevenon A. La continuité de prise en charge lors de la transition des soins de l'enfant à l'adulte handicapé. ACTA ACUST UNITED AC 2006; 49:652-8. [PMID: 16828521 DOI: 10.1016/j.annrmp.2006.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 06/19/2006] [Indexed: 11/17/2022]
Abstract
Most children born with a chronic health condition or disability are expected to live more than 20 years. Health care is provided for these children in paediatric units until they are 18 years old, and the transition to the adult health care system is difficult because of poor collaboration between specialists and families who sometimes wonder if the adult specialist will be competent, although young disabled people need specialised follow-up. This report discusses U.S. and English models in the transition in health care. Coordination between paediatricians and adult services is necessary. The neuromuscular disorders clinic is cited as an example.
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Affiliation(s)
- V Tiffreau
- Service de médecine physique et de réadaptation, hôpital Swynghedauw, CHRU de Lille, 59037 Lille cedex, France.
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