Communication with young people in paediatric and adult endocrine consultations: an intervention development and feasibility study

BACKGROUND

Communication is complex in endocrine care, particularly during transition from paediatric to adult services. The aims of this study were to examine the feasibility of interventions to support young people to interact with clinicians.

METHODS

Development and evaluation of a complex intervention in 2 phases: Pre-intervention observational study; Intervention feasibility study. Purposive sample of recordings of 62 consultations with 58 young people aged 11-25 years with long-term endocrine conditions in two paediatric and two adult endocrine clinics. Proportion of time talked during consultations, number and direction of questions asked; Paediatric Consultation Assessment Tool (PCAT); OPTION shared decision making tool; Medical Information Satisfaction Scale (MISS- 21). Young people were invited to use one or more of: a prompt sheet to help them influence consultation agendas and raise questions; a summary sheet to record key information; and the www.explain.me.uk website.

RESULTS

Nearly two thirds of young people (63%) chose to use at least one communication intervention. Higher ratings for two PCAT items (95% CI 0.0 to 1.1 and 0.1 to 1.7) suggest interventions can support consultation skills. A higher proportion of accompanying persons (83%) than young people (64%) directed questions to clinicians. The proportion of young people asking questions was higher (84%) in the intervention phase than in the observation phase (71%).

CONCLUSIONS

Interventions were acceptable and feasible. The Intervention phase was associated with YP asking more questions, which implies that the availability of interventions could promote interactivity.

Improving acute care for adolescents and young adults on medical admission units: The interventions that matter

It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if "everything is okay?" On each admission, I would be discharged home after a couple of days. We all knew I'd be back again within a month or two.

Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland

OBJECTIVES

The presence of an ectopic posterior pituitary gland (EPP) in childhood is associated with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency. GHD in late adolescence has been defined as a peak GH level <5 microg/l. The aim of this study was to identify the likelihood of persistent GHD in late adolescence in patients with an EPP compared with those with a normally sited posterior pituitary (NPP).

METHODS

In 18 patients with an EPP and 15 patients with an NPP, clinical, biochemical and radiographic data were collected.

RESULTS

In the EPP vs. the NPP group, the change in peak GH levels at the end of growth was less (+0.4[95% confidence interval (CI) - 0.8 to 2.7] vs. +4.1[95%CI + 0.4 to +10.5] microg/l, P-value for ancova = 0.03, after adjustment for age and sex). Using a peak GH level of <5 microg/l as a cut-off for GHD, 66% of EPP subjects compared with 40% of NPP subjects had GHD (P = 0.3). Hundred per cent of EPP subjects had a peak GH level on retesting <10 microg/l, compared with 40% of NPP subjects (P < 0.001).

CONCLUSION

It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic-pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 microg/l, the cut-off for persistent GHD in late adolescence may need to be revised.

Realignment of a smectic-A phase with applied electric field

The realignment of a smectic-A phase contained in a conventional display device (with a mesophase layer approximately 10 &mgr;m thick) in response to an applied electric field has been studied using polarizing microscopy and x-ray diffraction. The initial state of the mesophase was a highly aligned focal conic texture. The applied field created a striated texture with parallel (but not equally spaced) disclination lines which appeared to be created in pairs. The lines seem to grow from disclination "eyes" in the original texture, linking them first in pairs, and then in long chains, as the field is increased. We suggest that the center of each pair of striations corresponds to a disclination wall and that the texture consists of a parallel array of smectic layers arranged in concentric flattened half-cylinders. Previous electro-optic studies of cells of this type have described the striated, field-on texture but appear to have overlooked the role of the defects in the original texture as growth points for the striations. However, there are structural similarities with two related studies where the field-induced disturbance of the mesophase starts with the production of toroidal focal conics-similar to those we propose.

Severe thyroid eye disease associated with primary hypothyroidism and thyroid-associated dermopathy

Four unusual cases of patients are described with severe thyroid eye disease (TED) who presented with primary hypothyroidism and thyroid-associated dermopathy (TAD). All four patients had moderate or severe TED and elevated circulating thyrotropin (TSH) receptor antibodies.