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Vernon-Roberts A, Chan P, Christensen B, Havrlant R, Giles E, Williams AJ. Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand. Inflamm Bowel Dis 2024:izae087. [PMID: 38701328 DOI: 10.1093/ibd/izae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The incidence of pediatric inflammatory bowel disease (IBD) is rising, and there is an increasing need to support adolescents when they transition to adult care. Evidence supports the use of a structured transition process but there is great variation across Australasia. The study aim was to develop evidence and expert opinion-based consensus statements to guide transitional care services in IBD. METHODS A modified UCLA-RAND methodology was employed to develop consensus statements. An IBD expert steering committee was formed and a systematic literature review was conducted to guide the drafting of consensus statements. A multidisciplinary group was formed comprising 16 participants (clinicians, nurses, surgeons, psychologists), who anonymously voted on the appropriateness and necessity of the consensus statements using Likert scales (1 = lowest, 9 = highest) with a median ≥7 required for inclusion. Patient support groups, including direct input from young people with IBD, informed the final recommendations. RESULTS Fourteen consensus statements were devised with key recommendations including use of a structured transition program and transition coordinator, mental health and transition readiness assessment, key adolescent discussion topics, allied health involvement, age for transition, and recommendations for clinical communication and handover, with individualized patient considerations. Each statement reached median ≥8 for appropriateness, and ≥7 for necessity, in the first voting round, and the results were discussed in an online meeting to refine statements. CONCLUSIONS A multidisciplinary group devised consensus statements to optimize pediatric to adult transitional care for adolescents with IBD. These guidelines should support improved and standardized delivery of IBD transitional care within Australasia.
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Affiliation(s)
| | - Patrick Chan
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rachael Havrlant
- Transition Care Network, Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Edward Giles
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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2
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Wolfson S, Patel D, Toto E, Khlevner J, Santucci NR. "An urgent need for transition of care programs for adolescents and young adults with neurogastroenterology and motility disorders". J Pediatr Gastroenterol Nutr 2024. [PMID: 38623964 DOI: 10.1002/jpn3.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
Transition of Care for Adolescents and Young Adults (AYA) with Neurogastroenterology & Motility (NGM) Disorders.
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Affiliation(s)
- Sharon Wolfson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dhiren Patel
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Erin Toto
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Neha R Santucci
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Choukair D, Patry C, Lehmann R, Treiber D, Hoffmann GF, Grasemann C, Bruck N, Berner R, Burgard P, Lorenz HM, Tönshoff B. Resource utilization and costs of transitioning from pediatric to adult care for patients with chronic autoinflammatory and autoimmune disorders. Pediatr Rheumatol Online J 2024; 22:28. [PMID: 38395977 PMCID: PMC10885380 DOI: 10.1186/s12969-024-00963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A structured transition of adolescents and young adults with chronic autoinflammatory and autoimmune disorders from the pediatric to the adult health care system is important. To date, data on the time, processes, outcome, resources required for the necessary components of the transition process and the associated costs are lacking. METHODS Evaluation of resource use and costs in a prospective cohort study of 58 adolescents with chronic autoinflammatory and autoimmune disorders, for the key elements of a structured transition pathway including (i) compilation of a summary of patient history, (ii) assessment of patients' disease-related knowledge and needs, (iii) required education and counseling sessions, (iv) and a transfer appointment of the patient with the current pediatric and the future adult rheumatologist. RESULTS Forty-nine of 58 enrolled patients (84.5%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process to the final transfer consultation was 315 ± 147 days. Transfer consultations were performed in 49 patients, including 10 patients jointly with the future adult rheumatologist. Most consultations were performed by the multidisciplinary team with a median of three team members and lasted 65.5 ± 21.3 min. The cumulative cost of all consultation and education sessions performed including the transfer appointment was 283 ± 164 Euro per patient. In addition, the cost of coordinating the transition process was 57.3 ± 15.4 Euro. CONCLUSIONS A structured transition pathway for patients with chronic autoinflammatory and autoimmune disorders is resource and time consuming and should be adequately funded.
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Affiliation(s)
- Daniela Choukair
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
- Center for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christian Patry
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ronny Lehmann
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Dorothea Treiber
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Center for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Corinna Grasemann
- Department of Pediatrics, St-Josef Hospital Bochum and Center for Rare Diseases, Ruhr-University, Bochum, Germany
| | - Normi Bruck
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Burgard
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Oncology, Hematology and Rheumatology (Internal Medicine V), Heidelberg University Hospital, Heildelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Choukair D, Rieger S, Bethe D, Treiber D, Hoffmann GF, Grasemann C, Burgard P, Beimler J, Mittnacht J, Tönshoff B. Resource use and costs of transitioning from pediatric to adult care for patients with chronic kidney disease. Pediatr Nephrol 2024; 39:251-260. [PMID: 37464057 PMCID: PMC10673743 DOI: 10.1007/s00467-023-06075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The structured transition of adolescents and young adults with chronic kidney disease (CKD) from pediatric to adult care is important, but data on the time and resources required for the necessary components of the transition process and the associated costs are lacking. METHODS In a prospective single-center cohort study of 52 patients with pre-transplant CKD (CKD stage 1, n = 10; stage 2, n = 6; stage 3, n = 5; stage 4 and 5, 1 patient each) or kidney transplant recipients (KTR), resource use and costs were evaluated for the key elements of a structured transition pathway, including (i) assessment of patients' disease-related knowledge and needs, (ii) required education and counseling sessions, and (iii) compiling an epicrisis and a transfer appointment of the patient with the current pediatric and the future adult nephrologist. RESULTS Forty-four of 52 enrolled patients (84.6%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process until the final transfer consultation was 514 ± 204 days. The process was significantly longer for KTR (624 ± 150 [range, 307-819] days) than for patients with pre-transplant CKD (365 ± 172 [range, 1-693] days; P < 0.0001). The cumulative costs of all counseling and education sessions performed including the transfer appointment were 763 ± 473 Euro; it was significantly higher in KTR (966 ± 457 Euro) than in patients with pre-transplant CKD (470 ± 320 Euro; P < 0.0001). CONCLUSIONS A structured transition pathway for patients with CKD is resource and time-consuming due to the complexity of the disease and should be sufficiently funded. A higher-resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Daniela Choukair
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.
- Center for Rare Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Susanne Rieger
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Bethe
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Dorothea Treiber
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
- Center for Rare Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Corinna Grasemann
- Department of Pediatrics, St-Josef Hospital Bochum and Center for Rare Diseases, Ruhr-University Bochum, Bochum, Germany
| | - Peter Burgard
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Jörg Beimler
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Janna Mittnacht
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
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Giouleme O, Koutsoumourakis A, Katsoula A, Katsaros M, Soufleris K, Vasilaki K, Xinias I. Barriers to and requirements for a successful transition in inflammatory bowel disease from pediatric to adult care in Greece. Ann Gastroenterol 2023; 36:541-548. [PMID: 37664230 PMCID: PMC10433259 DOI: 10.20524/aog.2023.0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background The incidence of pediatric-onset inflammatory bowel disease (IBD) is rising, while the relapsing and often severe nature of IBD, and its impact on emotional and pubertal development and social maturation underline the need for a successful transition from pediatric to adult care. Methods A web-based survey was distributed via the Hellenic Group for the Study of IBD, the Hellenic Society of Gastroenterology Department of North Greece, and the Hellenic Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Results The questionnaire was answered by 98 individuals (78 adult and 20 pediatric gastroenterologists, out of 357 and 30, respectively). The response rate was 25.3%. A higher response rate was found among pediatric (66.6%) vs. adult gastroenterologists 21.8% (P<0.001). Pediatric gastroenterologists believed that the appropriate age for transition was either 16-17 or 17-18 years, whereas 59% of the adult gastroenterologists chose the age group of 16-17 years. Both adult and pediatric gastroenterologists stated that the most significant initiators for a successful transition process were cognitive maturity and patients' ability to manage their disease independently. The lack of communication and collaboration between pediatric and adult gastroenterologists was the main barrier to the transition process, as identified by adult gastroenterologists (27.7%). In contrast, 43.5% of pediatric gastroenterologists suggested that differences in the follow up of patients with IBD between pediatric and adult clinics were the main restrictions. Conclusion These results highlight the need for a transitional education program for pediatric IBD patients, and the importance of improving collaboration among adult and pediatric gastroenterologists.
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Affiliation(s)
- Olga Giouleme
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Gastroenterology and Hepatology Division Medical School, Aristotle University of Thessaloniki (Olga Giouleme, Anastasia Katsoula, Marios Katsaros)
| | - Anastasios Koutsoumourakis
- Endoscopy Unit, First Department of Internal Medicine, Papageorgiou General Hospital (Anastasios Koutsoumourakis)
| | - Anastasia Katsoula
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Gastroenterology and Hepatology Division Medical School, Aristotle University of Thessaloniki (Olga Giouleme, Anastasia Katsoula, Marios Katsaros)
| | - Marios Katsaros
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Gastroenterology and Hepatology Division Medical School, Aristotle University of Thessaloniki (Olga Giouleme, Anastasia Katsoula, Marios Katsaros)
| | | | - Konstantina Vasilaki
- Third Pediatric Department, Hippokration General Hospital, Aristotle University School of Medicine (Konstantina Vasilaki, Ioannis Xinias), Thessaloniki, Greece
| | - Ioannis Xinias
- Third Pediatric Department, Hippokration General Hospital, Aristotle University School of Medicine (Konstantina Vasilaki, Ioannis Xinias), Thessaloniki, Greece
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Rubín de Célix C, Martín-de-Carpi J, Pujol-Muncunill G, Palomino LM, Velasco Rodríguez-Belvís M, Martín-Masot R, Navas-López VM, Ricart E, Casanova MJ, Rodríguez-Martínez A, Leo-Carnerero E, Alcaraz A, Mañosa M, Hernández V, Cobelas Cobelas MC, Sánchez C, Menchén L, Mesonero F, Barreiro-De Acosta M, Martinón-Torres N, Tejido Sandoval C, Rendo Vázquez A, Corsino P, Vicente R, Hernández-Camba A, Alberto Alonso JR, Alonso-Abreu I, Castro Millán AM, Peries Reverter L, Castro B, Fernández-Salgado E, Busto Cuiñas MM, Benítez JM, Madero L, Clemente F, Riestra S, Jiménez-Treviño S, Boscá-Watts M, Crehuá-Gaudiza E, Calvo Moya M, Huguet JM, Largo-Blanco EM, González Vives L, Plaza R, Guerra I, Barrio J, Escartín L, Alfambra E, Cruz N, Muñoz MC, Muñoz Pino MG, Van Domselaar M, Botella B, Monfort Miquel D, Rodríguez Grau MC, De La Mano A, Ber Y, Calvo Iñiguez M, Martínez-Pérez TDJ, Chaparro M, Gisbert JP. Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU and SEGHNP. J Clin Med 2023; 12:4813. [PMID: 37510928 PMCID: PMC10381381 DOI: 10.3390/jcm12144813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.
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Affiliation(s)
- Cristina Rubín de Célix
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Laura María Palomino
- Paediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | | | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Alejandro Rodríguez-Martínez
- Paediatric Gastroenterology, Hepatology and Nutrition, UGC de Pediatría, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | | | - Alba Alcaraz
- Department of Paediatric Gastroenterology, Nutrition and Hepatology, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain
| | - Miriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 08916 Badalona, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, SERGAS, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | | | - César Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Hospital General Universitario Gregorio Marañón, 28018 Madrid, Spain
| | - Luis Menchén
- Gastroenterology Department-CEIMI, Hospital General Universitario Gregorio Marañón, Departamento de Medicina, Universidad Complutense de Madrid, 28018 Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Manuel Barreiro-De Acosta
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Nazareth Martinón-Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Coral Tejido Sandoval
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Alicia Rendo Vázquez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Pilar Corsino
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Raquel Vicente
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Alejandro Hernández-Camba
- Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - José Ramón Alberto Alonso
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - I Alonso-Abreu
- Gastroenterology Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Ana María Castro Millán
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Laia Peries Reverter
- Gastroenterology Department, Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Estela Fernández-Salgado
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - M Mercedes Busto Cuiñas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, 14004 Córdoba, Spain
| | - Lucía Madero
- Gastroenterology Department, Hospital Universitario de Alicante, Instituto de Investigación Sanitaria y Biomedica (ISABIAL), 03010 Alicante, Spain
| | - Fernando Clemente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Alicante, 03010 Alicante, Spain
| | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Santiago Jiménez-Treviño
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maia Boscá-Watts
- Gastroenterology Department, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Marta Calvo Moya
- Inflammatory Bowel Disease Unit, Department of Gastroenterology and Hepatology, Hospital Puerta de Hierro, 28222 Madrid, Spain
| | - José María Huguet
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Ester-María Largo-Blanco
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Leticia González Vives
- Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Rocío Plaza
- Gastroenterology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Josefa Barrio
- Paediatric Gastroenterology Unit, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Laura Escartín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Erika Alfambra
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Noelia Cruz
- Gastroenterology Department, Hospital Doctor José Molina Orosa, 35500 Las Palmas, Spain
| | - M Carmen Muñoz
- Gastroenterology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | | | | | - Belén Botella
- Gastroenterology Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - David Monfort Miquel
- Gastroenterology Department, Centro Consorci Sanitari Terrassa, 08227 Terrassa, Spain
| | | | - Agustín De La Mano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Henares, 28822 Madrid, Spain
| | - Yolanda Ber
- Gastroenterology Department, Hospital de San Jorge, 22004 Huesca, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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7
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Grasemann C, Höppner J, Burgard P, Schündeln MM, Matar N, Müller G, Krude H, Berner R, Lee-Kirsch MA, Hauck F, Wainwright K, Baumgarten S, Atinga J, Bauer JJ, Manka E, Körholz J, Kiewert C, Heinen A, Kretschmer T, Kurth T, Mittnacht J, Schramm C, Klein C, Graessner H, Hiort O, Muntau AC, Grüters A, Hoffmann GF, Choukair D. Transition for adolescents with a rare disease: results of a nationwide German project. Orphanet J Rare Dis 2023; 18:93. [PMID: 37098531 PMCID: PMC10131406 DOI: 10.1186/s13023-023-02698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
PURPOSE The transition process from paediatric/adolescent to adult medical care settings is of utmost importance for the future health of adolescents with chronic diseases and poses even more difficulties in the context of rare diseases (RDs). Paediatric care teams are challenged to deliver adolescent-appropriate information and structures. Here we present a structured transition pathway which is patient-focused and adoptable for different RDs. METHODS The transition pathway for adolescents 16 years and older was developed and implemented as part of a multi-centre study in 10 university hospitals in Germany. Key elements of the pathway included: assessment of patients' disease-related knowledge and needs, training/educational and counselling sessions, a structured epicrisis and a transfer appointment jointly with the paediatric and adult specialist. Specific care coordinators from the participating university hospitals were in charge of organization and coordination of the transition process. RESULTS Of a total of 292 patients, 286 completed the pathway. Deficits in disease-specific knowledge were present in more than 90% of participants. A need for genetic or socio-legal counselling was indicated by > 60%. A mean of 2.1 training sessions per patient were provided over a period of almost 1 year, followed by the transfer to adult care in 267 cases. Twelve patients remained in paediatric care as no adult health care specialist could be identified. Targeted training and counselling resulted in improved disease-specific knowledge and contributed to empowering of patients. CONCLUSION The described transition pathway succeeds to improve health literacy in adolescents with RDs and can be implemented by paediatric care teams in any RD specialty. Patient empowerment was mainly achieved by individualized training and counselling.
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Affiliation(s)
- Corinna Grasemann
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany.
| | - Jakob Höppner
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Peter Burgard
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael M Schündeln
- Department of Paediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nora Matar
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Gabriele Müller
- Centre for Evidence-Based Healthcare, Carl Gustav Carus Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heiko Krude
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhard Berner
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Fabian Hauck
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvana Baumgarten
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janet Atinga
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Jens J Bauer
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Eva Manka
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Julia Körholz
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Cordula Kiewert
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - André Heinen
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tanita Kretschmer
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janna Mittnacht
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Schramm
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Klein
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tübingen, Germany
| | - Olaf Hiort
- Departments of Paediatrics, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annette Grüters
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg F Hoffmann
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
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8
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Dohos D, Váradi A, Farkas N, Erős A, Müller KE, Karoliny A, Gombos E, Nemes É, Vass N, Tárnok A, Hegyi P, Sarlós P. Hungarian Linguistic, Cross-Cultural and Age Adaptation of Transition Specific Questionnaires in Patients with Inflammatory Bowel Disease. Children (Basel) 2023; 10:children10040711. [PMID: 37189959 DOI: 10.3390/children10040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
Objective: In the TRANS-IBD clinical trial, the outcomes are measured with selected validated questionnaires. Cross-cultural and age adaptations of the Self-Efficacy Scale for adolescents and young adults (IBD-SES), the Transition Readiness Assessment Questionnaire (TRAQ), and the Self-Management and Transition Readiness Questionnaire (STARx) were performed. Methods: Linguistic and cultural adaptation was carried out with the usage of reliability coefficients (Cronbach's α coefficients, Spearman's rank correlation), and with confirmatory factor analysis (CFA; root Mean Square Error of Approximation [RMSEA], Comparative Fit Index [CFI], and Tucker-Lewis Index [TLI]). Results: 112 adolescents participated in the study (45.5% male, mean age 17 ± 1.98 years). CFA was acceptable in the IBD-SES and the TRAQ. Internal consistency was acceptable in IBD-SES and good in TRAQ (0.729; 0.865, respectively). Test-retest reliability was good in IBD-SES, but below the acceptable threshold in TRAQ (ρ = 0.819; ρ = 0.034). In STARx tools, RMSEA showed poor fit values, CFI and TLI were below acceptable fit values, and internal consistency was not satisfied (0.415; 0.693, respectively), while test-retest reliabilities were acceptable (ρ = 0.787; ρ = 0.788, respectively). Conclusions: Cross-cultural, age-specific adaptation was successfully completed with IBD-SES and TRAQ. Those are comparable to the original validated versions. The adaption of the STARx tools was not successful.
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Affiliation(s)
- Dóra Dohos
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, 20 Ifjúság Street, HU-7624 Pécs, Hungary
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
| | - Adrienn Erős
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Katalin Eszter Müller
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
- Department of Family Care Methodology, Faculty of Health Science, Semmelweis University, 17 Vas Street, HU-1088 Budapest, Hungary
| | - Anna Karoliny
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Eszter Gombos
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Éva Nemes
- Department of Pediatrics, Clinical Center, University of Debrecen, 98 Nagyerdei Boulevard, HU-4032 Debrecen, Hungary
| | - Noémi Vass
- Albert Szent-Györgyi Clinical Center of Pediatrics and Child Health Centre, University of Szeged, 14-15, Korányi Street, HU-6725 Szeged, Hungary
| | - András Tárnok
- Department of Pediatrics, Medical School, University of Pécs, 7 József Attila Street, HU-7623 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, 20 Ifjúság Street, HU-7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, 26 Üllői Street, HU-1085 Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, 9 Gaál József Street, HU-1122 Budapest, Hungary
| | - Patrícia Sarlós
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, 13 Ifjúság Street, 7624 Pécs, Hungary
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9
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Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Melekh O, Thormann M, Damm R, Omari J, Pech M, Surov A. Body Composition Predictors of Complicated Crohn's Disease. Dig Dis 2023; 41:589-599. [PMID: 36720207 PMCID: PMC10777712 DOI: 10.1159/000529426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/26/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND High visceral adipose tissue (VAT) and creeping fat (CrF) in Crohn's disease (CD) have been widely recognized. The VAT to subcutaneous adipose tissue (SAT) ratio and sarcopenia have been associated with CD complications. Studies regarding the influence of body composition predictors on CD complications assessed with magnetic resonance enterography (MRE) are scarce. AIM The aim of this study was to assess body composition parameters and CrF in opportunistic MRE as predictors of complicated CD. METHODS This was a retrospective study of 114 patients with inflammatory (n = 54) and complicated (n = 60) CD. The semiautomated assessment of body composition and the qualitative evaluation of CrF were performed. RESULTS Body composition parameters did not differ between both groups regarding the body mass index (p = 0.50), total adipose tissue index (TATI) (p = 0.14), subcutaneous adipose tissue index (SATI) (p = 0.17), visceral adipose tissue index (VATI) (p = 0.33), VAT/SAT ratio (p = 0.77), intramuscular adipose tissue (p = 0.64), skeletal muscle index (p = 0.22), and sarcopenia (p = 0.50). 47 strictures, 18 fistulae, and seven abscesses were identified. Fistulae were more likely to occur in patients with CrF (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.76-14.56; p=<0.001) and high VAT/SAT ratio (OR: 3.82, 95% CI 1.34-10.85; p = 0.01). CONCLUSION Body composition measurements in CD patients displayed no statistically significant difference between the groups of inflammatory and complicated disease. Nonetheless, CD patients stratified in the group of high VAT/SAT ratio and the presence of CrF should be recognized as risk groups for the occurrence of fistulae.
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Affiliation(s)
- Felix Barajas Ordonez
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Radiology Practice, Dessau, Germany
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany
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10
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Nabbijohn AN, Ahola Kohut S. Gastrointestinal Disorders in Adolescents and Young Adults: Preparing for a Smooth Transition to Adult-Centered Care. Gastroenterol Clin North Am 2022; 51:849-865. [PMID: 36376000 DOI: 10.1016/j.gtc.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chronic gastrointestinal disorders are prevalent in youth worldwide. The chronicity of these conditions often results in their persistence into adulthood. Challenges typically faced by young people transitioning to adulthood are often exacerbated in those with chronic gastrointestinal disease. Increased awareness of these challenges among health care professionals and appropriate policies and procedures for health care transition are critical. This article summarizes research on the challenges faced by emerging adults with the gastrointestinal disease during the transition to adult care. Barriers to optimal transitional care and current guidelines are discussed and used to offer practical recommendations for health care professionals working with this population.
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Affiliation(s)
- A Natisha Nabbijohn
- Department of Psychology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Sara Ahola Kohut
- Department of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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11
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Bihari A, Olayinka L, Kroeker KI. Outcomes in Patients with Inflammatory Bowel Disease Transitioning from Pediatric to Adult Care: A Scoping Review. J Pediatr Gastroenterol Nutr 2022; 75:423-430. [PMID: 35920854 PMCID: PMC9470050 DOI: 10.1097/mpg.0000000000003581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/08/2022] [Indexed: 12/10/2022]
Abstract
PURPOSE Approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed in childhood and the incidence is increasing. Thus, more patients will transition to adult care in the future. Within the literature, transition readiness has been deemed important to achieving a successful transition; however, it is unclear what outcomes define success. This scoping review aims to summarize the literature on outcomes surrounding transition from pediatric to adult care in patients with IBD. METHODS A scoping review was conducted with the following steps: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarizing, and reporting results, and (6) consultation with an additional researcher. Studies were identified from 5 databases and were included in part if (1) IBD was a disease of interest, (2) referred to transition as the movement and adjustment from pediatric to adult care, and (3) evaluated patient outcomes up to 5 years after first adult appointment and/or defined a successful or unsuccessful transition. RESULTS Twenty-six peer-reviewed studies were included. Four studies defined transition success, while 2 studies defined an unsuccessful transition. Transition outcomes were categorized into these 6 themes: being comfortable in adult care (n = 4); health care utilization (n = 19); disease management (n = 15); knowledge (n = 5); quality of life (n = 6); self-efficacy (n = 7). CONCLUSIONS Most studies evaluated transition outcomes by themes of health care utilization (n = 19) and disease management (n = 15). Future research should focus on engaging patients along with providers in order to create a consensus on indicators of transition success.
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Affiliation(s)
- Allison Bihari
- From the Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lily Olayinka
- From the Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen I. Kroeker
- From the Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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12
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Mollah T, Lee D, Giles E. Impact of a new young adult inflammatory bowel disease transition clinic on patient satisfaction and clinical outcomes. J Paediatr Child Health 2022; 58:1053-1059. [PMID: 35170119 DOI: 10.1111/jpc.15907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023]
Abstract
AIM The transition from paediatric to adult care for patients with inflammatory bowel disease (IBD) is associated with an increased risk of treatment non-adherence, hospitalizations and emergency department (ED) use. We established a new young adult IBD clinic (YAC) in Melbourne to capture this at-risk population. We aimed to assess patient satisfaction as well as clinical outcomes. METHODS All patients who attended the YAC between its inception in November 2016 and November 2018 were recruited to our YAC group, 61 patients in total. A control group was selected from the pre-existing adult clinic (AC) at our service, 34 patients in total. IBD-related ED (IBD-ED) visits were collected for all patients. We compared IBD-ED visits in the 2 years before and after attending the clinic for the first time. Patient satisfaction was assessed using the IBD-Patient Satisfaction Questionnaire. RESULTS There was an overall decrease in IBD-ED visits between the pre-clinic and post-clinic periods in both the YAC (42.9% reduction) and AC (69.2% reduction) (P < 0.001). Patient satisfaction was high amongst both services with YAC patients indicating higher satisfaction with communication (P = 0.015). CONCLUSION There was a reduction in IBD-ED visits in both the YAC and the AC, high patient satisfaction, and statistically higher satisfaction with communication in the YAC. We speculate the importance of a YAC is to capture those patients in the peri-transitional period at risk of being lost to follow-up or not previously referred for specialist care.
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Affiliation(s)
- Taha Mollah
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Dongju Lee
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Edward Giles
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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13
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Sturm A, Atreya R, Bettenworth D, Bokemeyer B, Dignaß A, Ehehalt R, Germer C, Grunert PC, Helwig U, Herrlinger K, Kienle P, Kreis ME, Kucharzik T, Langhorst J, Maaser C, Ockenga J, Ott C, Siegmund B, Zeißig S, Stallmach A. Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004. Z Gastroenterol 2022; 60:332-418. [PMID: 35263784 DOI: 10.1055/a-1713-3941] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andreas Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Deutschland
| | | | - Bernd Bokemeyer
- Gastroenterologische Gemeinschaftspraxis Minden, Deutschland
| | - Axel Dignaß
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt am Main, Deutschland
| | | | - Christoph Germer
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Deutschland
| | - Philip C Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
| | - Ulf Helwig
- Internistische Praxengemeinschaft, Oldenburg, Deutschland
| | | | - Peter Kienle
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und Sankt Hedwig-Klinik GmbH, Mannheim, Deutschland
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin, Deutschland
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Deutschland
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum am Bruderwald, Bamberg, Deutschland
| | | | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen Mitte - Gesundheit Nord, Bremen, Deutschland
| | - Claudia Ott
- Gastroenterologie Facharztzentrum, Regensburg, Deutschland
| | - Britta Siegmund
- Medizinische Klinik I, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
| | - Sebastian Zeißig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Deutschland
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
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14
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García-Rodríguez F, Raygoza-Cortez K, Moreno-Hernandez L, García-Pérez R, Garza Lopez LE, Arana-Guajardo AC, Jáquez-Quintana JO, Villarreal-Treviño AV, de la O-Cavazos ME, Rubio-Pérez N. Outcomes of transitional care programs on adolescent chronic inflammatory systemic diseases: systematic review and meta-analyses. Pediatr Rheumatol Online J 2022; 20:15. [PMID: 35177101 PMCID: PMC8851760 DOI: 10.1186/s12969-022-00670-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/22/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with juvenile chronic inflammatory systemic diseases (jCID) are vulnerable to many circumstances when transitioning to adult-centered healthcare; this increases the burden of disease and worsen their quality of life. METHODS MEDLINE, Embase, Web of Science and Scopus were searched from inception to March 16th, 2021. We included observational, randomized controlled trials and quasi-experimental studies that evaluated a transitional care program for adolescents and young adults with jCIDs. We extracted information regarding health-related quality of life, disease activity, drop-out rates, clinical attendance rates, hospital admission rates, disease-related knowledge, surgeries performed, drug toxicity and satisfaction rates. RESULTS Fifteen studies met our inclusion criteria. The implementation of transition programs showed a reduction on hospital admission rates for those with transition program (OR 0.28; 95% CI 0.13 to 0.61; I 2 = 0%; p = 0.97), rates of surgeries performed (OR 0.26; 95% CI 0.12 to 0.59; I 2 = 0%; p = 0.50) and drop-out rates from the adult clinic (OR 0.23; 95% CI 0.12 to 0.46; I 2 = 0%; p = 0.88). No differences were found in other outcomes. CONCLUSION The available body of evidence supports the implementation of transition programs as it could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates.
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Affiliation(s)
- Fernando García-Rodríguez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Karina Raygoza-Cortez
- grid.411455.00000 0001 2203 0321Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, 64460 México
| | - Lesli Moreno-Hernandez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Rodrigo García-Pérez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Leticia Elizabeth Garza Lopez
- grid.411455.00000 0001 2203 0321Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, 64460 México
| | - Ana Cecilia Arana-Guajardo
- Servicio de Reumatología, Instituto de Medicina Interna. Escuela Nacional de Medicina Sistema Tec Salud, Monterrey, Mexico
| | - Joel Omar Jáquez-Quintana
- grid.411455.00000 0001 2203 0321Gastroenterology Service and Department of Internal Medicine, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Ana Victoria Villarreal-Treviño
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, School of Medicine and University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460, Monterrey, Mexico.
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Grossklaus H, Barnett S. Reflection on young adult transitional care in the Boston Children's Hospital Perioperative Care Coordination Clinic. J Pediatr Nurs 2022; 62:184-187. [PMID: 34127344 DOI: 10.1016/j.pedn.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/01/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022]
Abstract
THEORETICAL PRINCIPLES The complexity of pediatric healthcare has increased due to advancement in research and identification of new treatment modalities. With these advancements, life expectancy has increased creating a greater need for young adult transition into adult medical settings and specialty care (Marani et al., 2020). The holistic approach of nursing care is essential in assisting young adults during this transitional period. PHENOMENON ADDRESSED Many pediatric hospitals and subspecialties continue to care for young adults ≥18 years of age that have not transitioned to adult care. In the perioperative care coordination clinic at Boston Children's Hospital, pediatric nurses and advanced practice nurse practitioners provide care to patients from infancy to adulthood, throughout many specialties, to ensure safe perioperative care for a medically complex surgical population. The purpose of this paper is to describe the PCCC young adult care coordination process that provides engaging opportunities for the young adult to advocate for oneself and promote autonomy as they proceed through the stages of transition to adult care. RESEARCH LINKAGES The perioperative care coordination process at Boston Children's Hospital aligns with the Society of Pediatric Nurses position statement that recommended pediatric nurses utilize a framework (Betz, 2017) and Meleis' middle-range theory of Transitions that identified the nursing role during the transitional process (Meleis et al., 2000). A suggestion for future nursing research includes development of a nursing framework that nurses can utilize when supporting young adults during their progression through the steps of transition from pediatric to adult perioperative programs.
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Affiliation(s)
- Heather Grossklaus
- Department of Anesthesiology, Critical Care and Pain Medicine, Perioperative Care Coordination Clinic, USA.
| | - Sheri Barnett
- Department of Anesthesiology, Critical Care and Pain Medicine, Perioperative Care Coordination Clinic, USA.
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Grasemann C, Höppner J, Burgard P, Matar N, Hoffmann GF, Müller G, Berner R, Lee-kirsch M, Wainwright K, Baumgarten S, Weiler-normann C, Choukair D. Ressourcenverbrauch der strukturierten Transition junger Menschen mit seltener Erkrankung aus der Pädiatrie in die Erwachsenenmedizin: Aufwand und Kostenanalyse aus dem Projekt TRANSLATE-NAMSE. Monatsschr Kinderheilkd 2022; 170:29-37. [DOI: 10.1007/s00112-021-01350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yska HAF, Khen-Dunlop N, Lacaille F, Dabbas M. Long-Term Results of Laparoscopic Adjustable Gastric Banding in French adolescents: The Utmost Importance of Follow-Up. J Pediatr Gastroenterol Nutr 2021; 72:906-911. [PMID: 33720097 DOI: 10.1097/mpg.0000000000003092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To investigate the long-term follow-up (FU) and effectivity of laparoscopic adjustable gastric banding (LAGB) in a French adolescent cohort. METHODS We retrospectively analyzed the results of LAGB at our institution. We collected information on FU, adjustable gastric banding (AGB) status, weight-related parameters, and comorbidity at multiple timepoints. RESULTS Fifty-six patients (77% female) with a mean age of 16.5 years and a mean body mass index (BMI) of 45 kg/m2 underwent LAGB over a period of 12 years. The mean postpediatric FU was 23 months. FU decreased progressively from 96% at 3 years to 54% and 29% at 6 and 9 years, respectively. The loss to FU was 39% at last contact. AGB was removed in 17 patients (30%) and 12 patients (21%) underwent a second bariatric procedure. Mean BMI decreased by 11 kg/m2 at last contact (P < 0.001). The prevalence of most comorbidities also decreased significantly after 3 years. The mean excess weight loss (to reach a BMI of 25 kg/m2) was 47% during the first year postsurgery and further increased to 55% at last contact. CONCLUSION Overall, AGB resulted in significant weight loss; however, the increase in heterogeneity suggests that LAGB is more effective in some individuals than in others in the long-term. This study confirmed that LAGB is a valuable bariatric procedure in adolescents, either as a long term-term efficient or bridging method that would be replaced at the time of transition to adult care. The importance of a standardized long-term follow-up should always be emphasized.
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Affiliation(s)
- Hemmo A F Yska
- Hôpital Universitaire Necker - Enfants Malades, Department of Pediatric Gastroenterology-Hepatology-Nutrition
| | - Naziha Khen-Dunlop
- Hôpital Universitaire Necker - Enfants Malades, Department of Pediatric Surgery, Paris, France
| | - Florence Lacaille
- Hôpital Universitaire Necker - Enfants Malades, Department of Pediatric Gastroenterology-Hepatology-Nutrition
| | - Myriam Dabbas
- Hôpital Universitaire Necker - Enfants Malades, Department of Pediatric Gastroenterology-Hepatology-Nutrition
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Nardone OM, Iacucci M, Ghosh S, Castiglione F. Can a transition clinic bridge the gap between paediatric and adult inflammatory bowel disease care models? Dig Liver Dis 2020; 52:516-27. [PMID: 32234418 DOI: 10.1016/j.dld.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Transition care in inflammatory bowel disease is increasingly recognized as challenging given the inherent differences between paediatric and adult health care models, disease characteristics and treatment strategies. Transition is a dynamic process involving adolescents and young adults that are moving from a paediatric to an adult health care setting, and it should be flexible, continually updated and tailored to each patient. The implementation of a transition clinic is essential given the increasing incidence of the paediatric population with inflammatory bowel disease and the lifelong impact of this disease. The key question is when and how to structure transition according to the adolescent's clinical, psycho-social, educational needs and expectations to ensure continuity of care. In the attempt to improve the management of transition in inflammatory bowel disease and address the wide gap between adult and child care, we provide an update of the transition clinic and we propose a "treat to target" approach in transition to facilitate an effective and successful transition programme. In the changing landscape of the treatment of inflammatory bowel disease, further studies are necessary to determine the role of the transition clinic in determining the choice and strategy of therapy and its monitoring and the adoption of newer strategies such as biomarkers guided treating to target.
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