1
|
Colver A, McConachie H, Le Couteur A, Dovey-Pearce G, Mann KD, McDonagh JE, Pearce MS, Vale L, Merrick H, Parr JR. A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions. BMC Med 2018; 16:111. [PMID: 30032726 PMCID: PMC6055340 DOI: 10.1186/s12916-018-1102-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/18/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Most evidence about what works in transitional care comes from small studies in single clinical specialties. We tested the hypothesis that exposures to nine recommended features of transitional healthcare were associated with better outcomes for young people with long-term conditions during transition from child-centred to adult-oriented health services. METHODS This is a longitudinal, observational cohort study in UK secondary care including 374 young people, aged 14-18.9 years at recruitment, with type 1 diabetes (n = 150), cerebral palsy (n = 106) or autism spectrum disorder with an associated mental health problem (n = 118). All were pre-transfer and without significant learning disability. We approached all young people attending five paediatric diabetes centres, all young people with autism spectrum disorder attending four mental health centres, and randomly selected young people from two population-based cerebral palsy registers. Participants received four home research visits, 1 year apart and 274 participants (73%) completed follow-up. Outcome measures were Warwick Edinburgh Mental Wellbeing Scale, Mind the Gap Scale (satisfaction with services), Rotterdam Transition Profile (Participation) and Autonomy in Appointments. RESULTS Exposure to recommended features was 61% for 'coordinated team', 53% for 'age-banded clinic', 48% for 'holistic life-skills training', 42% for 'promotion of health self-efficacy', 40% for 'meeting the adult team before transfer', 34% for 'appropriate parent involvement' and less than 30% for 'written transition plan', 'key worker' and 'transition manager for clinical team'. Three features were strongly associated with improved outcomes. (1) 'Appropriate parent involvement', example association with Wellbeing (b = 4.5, 95% CI 2.0-7.0, p = 0.001); (2) 'Promotion of health self-efficacy', example association with Satisfaction with Services (b = - 0.5, 95% CI - 0.9 to - 0.2, p = 0.006); (3) 'Meeting the adult team before transfer', example associations with Participation (arranging services and aids) (odds ratio 5.2, 95% CI 2.1-12.8, p < 0.001) and with Autonomy in Appointments (average 1.7 points higher, 95% CI 0.8-2.6, p < 0.001). There was slightly less recruitment of participants from areas with greater socioeconomic deprivation, though not with respect to family composition. CONCLUSIONS Three features of transitional care were associated with improved outcomes. Results are likely to be generalisable because participants had three very different conditions, attending services at many UK sites. Results are relevant for clinicians as well as for commissioners and managers of health services. The challenge of introducing these three features across child and adult healthcare services, and the effects of doing so, should be assessed.
Collapse
Affiliation(s)
- A Colver
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. .,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
| | - H McConachie
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - A Le Couteur
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Newcastle upon Tyne, NE3 3XT, UK
| | - G Dovey-Pearce
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - K D Mann
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J E McDonagh
- Centre for Musculoskeletal Research and Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
| | - M S Pearce
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - L Vale
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - H Merrick
- Institute of Health & Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - J R Parr
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Newcastle upon Tyne, NE3 3XT, UK.,Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.,Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | | |
Collapse
|
2
|
Gray S, Cheetham T, McConachie H, Mann KD, Parr JR, Pearce MS, Colver A. A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well-being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services. Diabet Med 2018; 35:1216-1222. [PMID: 29852520 PMCID: PMC6099219 DOI: 10.1111/dme.13698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
AIM We hypothesized that participant well-being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care. METHODS Some 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well-being (Warwick-Edinburgh Mental Well-being Scale; WEMWBS) were captured. Change in HbA1c , episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4. RESULTS Mean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a 'satisfactory' and 76 a 'suboptimal' clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups. CONCLUSIONS The well-being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho-educational interventions can improve the clinical course is a research priority.
Collapse
Affiliation(s)
- S. Gray
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - T. Cheetham
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Institute of Genetic MedicineNewcastle upon TyneUK
| | - H. McConachie
- Institute of Health and SocietyNewcastle upon TyneUK
| | - K. D. Mann
- Institute of Health and SocietyNewcastle upon TyneUK
| | - J. R. Parr
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - M. S. Pearce
- Institute of Health and SocietyNewcastle upon TyneUK
| | - A. Colver
- Institute of Health and SocietyNewcastle upon TyneUK
- Northumbria Healthcare NHS Foundation TrustNorth ShieldsUK
| |
Collapse
|
3
|
Colver A, Pearse R, Watson RM, Fay M, Rapley T, Mann KD, Le Couteur A, Parr JR, McConachie H. How well do services for young people with long term conditions deliver features proposed to improve transition? BMC Health Serv Res 2018; 18:337. [PMID: 29739396 PMCID: PMC5941647 DOI: 10.1186/s12913-018-3168-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For young people with long-term conditions, transition from child to adult-oriented health services is a critical period which, if not managed well, may lead to poor outcomes. There are features of transition services which guidance and research suggest improve outcomes. We studied nine such features, calling them 'proposed beneficial features': age-banded clinic; meet adult team before transfer; promotion of health self-efficacy; written transition plan; appropriate parent involvement; key worker; coordinated team; holistic life-skills training; transition manager for clinical team. We aimed to describe the extent to which service providers offer these nine features, and to compare this with young people's reported experience of them. METHODS A longitudinal, mixed methods study followed 374 young people as their care moved from child to adult health services. Participants had type 1 diabetes, cerebral palsy or autism spectrum disorder with additional mental health difficulties. Data are reported from the first two visits, one year apart. RESULTS Three hundred four (81.3%) of the young people took part in the second visit (128 with diabetes, 91 with autism, 85 with cerebral palsy). Overall, the nine proposed beneficial features of transition services were poorly provided. Fewer than half of services stated they provided an age-banded clinic, written transition plan, transition manager for clinical team, a protocol for promotion of health self-efficacy, or holistic life-skills training. To varying degrees, young people reported that they had not experienced the features which services said they provided. For instance, the agreement for written transition plan, holistic life-skills training and key worker, was 30, 43 and 49% respectively. Agreement was better for appropriate parent involvement, age-banded clinic, promotion of health self-efficacy and coordinated team at 77, 77, 80 and 69% respectively. Variation in the meaning of the features as experienced by young people and families was evident from qualitative interviews and observations. CONCLUSIONS UK services provide only some of the nine proposed beneficial features for supporting healthcare transition of young people with long term conditions. Observational studies or trials which examine the influence of features of transition services on outcomes should ensure that the experiences of young people and families are captured, and not rely on service specifications.
Collapse
Affiliation(s)
- A Colver
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK. .,Northumbria Healthcare NHS Foundation Trust, North Shields, NE29 8NH, UK.
| | - R Pearse
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - R M Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - M Fay
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - T Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.,Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - K D Mann
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - A Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.,Centre for Neurorehabilitation and Neuropsychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, NE6 4QD, UK
| | - J R Parr
- Centre for Neurorehabilitation and Neuropsychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, NE6 4QD, UK.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - H McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | | |
Collapse
|
4
|
Goodwin J, Lecouturier J, Crombie S, Smith J, Basu A, Colver A, Kolehmainen N, Parr JR, Howel D, McColl E, Roberts A, Miller K, Cadwgan J. Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy. Child Care Health Dev 2018; 44:203-211. [PMID: 29168216 DOI: 10.1111/cch.12540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/06/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Although the rationale for standing frame use and the associated challenges have been described, little attention has been given to the users' experiences. The aim of the current study was to explore young people's positive and negative experiences, and attitudes regarding standing frame use. METHODS Framework analysis informed an open exploration of young people's opinions of standing frames. Using semistructured interviews, 12 young people with cerebral palsy (6 female) were interviewed, providing the data set for transcription and thematic analysis. FINDINGS The first theme "attitudes to standing frames" describes the young people's understanding of why they use standing frames. Although standing frames can be painful, some young people believe they should be endured to improve their body structure and function. There were mixed views about the impact standing frames have socially, with some young people feeling excluded from their peers, and others feeling as though standing frames helped them "fit in." Some young people are not offered a choice about how and when they use their standing frame. The second theme "challenges of standing frame use" highlights the issues with standing frame use such as manual handling, interference from siblings, and the lack of aesthetically pleasing standing frame designs. CONCLUSIONS Young people report benefits related to choice, pain relief, and participation but can also cause pain, discomfort, and reduced independence and participation. Healthcare professionals should have open, informative conversations about potential benefits and challenges of standing frames on all aspects of the young people's lives, including participation and activity.
Collapse
Affiliation(s)
- J Goodwin
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J Lecouturier
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - S Crombie
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Brighton, UK
| | - J Smith
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Basu
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Colver
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - N Kolehmainen
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J R Parr
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Howel
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - E McColl
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - K Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - J Cadwgan
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust (Kings Health Partners), London, UK
| |
Collapse
|
5
|
Goodwin J, Colver A, Basu A, Crombie S, Howel D, Parr JR, McColl E, Kolehmainen N, Roberts A, Lecouturier J, Smith J, Miller K, Cadwgan J. Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy. Child Care Health Dev 2018; 44:195-202. [PMID: 28809057 PMCID: PMC5811781 DOI: 10.1111/cch.12505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/02/2017] [Revised: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use. METHOD Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co-applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK. RESULTS Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child-reported pain. CONCLUSIONS These survey findings provide information from key stakeholders regarding current UK standing frame practice.
Collapse
Affiliation(s)
- J. Goodwin
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Colver
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Basu
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Crombie
- Sussex Community NHS Foundation TrustChailey Clinical ServicesBrightonUK
| | - D. Howel
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. R. Parr
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - E. McColl
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - N. Kolehmainen
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Lecouturier
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. Smith
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - K. Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Cadwgan
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Evelina London Children's HospitalGuys and St Thomas' NHS Foundation Trust (Kings Health Partners) UKLondonUK
| |
Collapse
|
6
|
Gray L, Gibbs J, Jolleff N, Williams J, McConachie H, Parr JR. Variable implementation of good practice recommendations for the assessment and management of UK children with neurodisability. Child Care Health Dev 2015; 41:938-46. [PMID: 26184744 DOI: 10.1111/cch.12272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/12/2015] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. DESIGN Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. RESULTS Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. CONCLUSIONS There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families.
Collapse
Affiliation(s)
- L Gray
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - J Gibbs
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - N Jolleff
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Williams
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
Warnell F, George B, McConachie H, Johnson M, Hardy R, Parr JR. Designing and recruiting to UK autism spectrum disorder research databases: do they include representative children with valid ASD diagnoses? BMJ Open 2015; 5:e008625. [PMID: 26341584 PMCID: PMC4577974 DOI: 10.1136/bmjopen-2015-008625] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES (1) Describe how the Autism Spectrum Database-UK (ASD-UK) was established; (2) investigate the representativeness of the first 1000 children and families who participated, compared to those who chose not to; (3) investigate the reliability of the parent-reported Autism Spectrum Disorder (ASD) diagnoses, and present evidence about the validity of diagnoses, that is, whether children recruited actually have an ASD; (4) present evidence about the representativeness of the ASD-UK children and families, by comparing their characteristics with the first 1000 children and families from the regional Database of children with ASD living in the North East (Dasl(n)e), and children and families identified from epidemiological studies. SETTING Recruitment through a network of 50 UK child health teams and self-referral. PATIENTS Parents/carers with a child with ASD, aged 2-16 years, completed questionnaires about ASD and some gave professionals' reports about their children. RESULTS 1000 families registered with ASD-UK in 30 months. Children of families who participated, and of the 208 who chose not to, were found to be very similar on: gender ratio, year of birth, ASD diagnosis and social deprivation score. The reliability of parent-reported ASD diagnoses of children was very high when compared with clinical reports (over 96%); no database child without ASD was identified. A comparison of gender, ASD diagnosis, age at diagnosis, school placement, learning disability, and deprivation score of children and families from ASD-UK with 1084 children and families from Dasl(n)e, and families from population studies, showed that ASD-UK families are representative of families of children with ASD overall. CONCLUSIONS ASD-UK includes families providing parent-reported data about their child and family, who appear to be broadly representative of UK children with ASD. Families continue to join the databases and more than 3000 families can now be contacted by researchers about UK autism research.
Collapse
Affiliation(s)
- F Warnell
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - B George
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - H McConachie
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - M Johnson
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - R Hardy
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - J R Parr
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
8
|
Parr JR, Jolleff N, Gray L, Gibbs J, Williams J, McConachie H. Twenty years of research shows UK child development team provision still varies widely for children with disability. Child Care Health Dev 2013; 39:903-7. [PMID: 23425219 DOI: 10.1111/cch.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify how services provided by child development teams (CDTs) have changed over 20 years. To what extent have major government initiatives aiming to improve the lives of children with disability and their families been implemented by teams? DESIGN Survey sent to every UK CDT in 2009/2010; comparison with data gathered in 1988 and 1999. RESULTS Ninety-four per cent (225/240) of CDTs responded; data on 242 teams were available from 1999 and 125 teams from 1988. Despite policy recommendations advocating the value of interdisciplinary team working, there was a decline in numbers of professionals working within the CDT multidisciplinary team. One-third of all teams reported a reduction in their funding over the last 5 years. However, specialist clinics provided increased. Teams reported patchy adoption of national initiatives designed to improve provision. Transition services were underdeveloped. CONCLUSIONS This comprehensive survey of UK CDT service provision, as well as national studies of the healthcare experience of families with a disabled child, shows that improvements in provision are required.
Collapse
Affiliation(s)
- J R Parr
- Institute of Neuroscience, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | | |
Collapse
|
9
|
Pickles A, Parr JR, Rutter ML, De Jonge MV, Wallace S, Le Couteur AS, van Engeland H, Wittemeyer K, McConachie H, Roge B, Mantoulan C, Pedersen L, Isager T, Poustka F, Bolte S, Bolton P, Weisblatt E, Green J, Papanikolaou K, Bailey AJ. New Interview and Observation Measures of the Broader Autism Phenotype: Impressions of Interviewee Measure. J Autism Dev Disord 2013; 43:2082-9. [DOI: 10.1007/s10803-013-1810-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
10
|
Parr JR, Buswell CA, Banerjee K, Fairhurst C, Williams J, O'Hare A, Pennington L. Management of drooling in children: a survey of UK paediatricians' clinical practice. Child Care Health Dev 2012; 38:287-91. [PMID: 21392056 DOI: 10.1111/j.1365-2214.2011.01213.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Drooling is common in children with disordered oral-motor control. There is little evidence about the comparative effectiveness of different interventions used to reduce the impact of drooling. Anecdotal reports suggest clinicians' management of drooling varies widely. The aims of this survey were to establish which drooling interventions are currently used, how their effectiveness is monitored and how frequently adverse effects are reported. METHODS 151 UK paediatricians completed a questionnaire about their management of drooling. RESULTS Paediatricians saw one new child with problematic drooling and three follow-up children per month. The most common prescribing pattern was hyoscine first line (84.7%) followed by glycopyrronium bromide second line. The reported rate of adverse effects of medications was lower than expected (median 10% for hyoscine). Very few paediatricians used standardized methods of measuring the medication's effectiveness or adverse effects. CONCLUSION Paediatricians regularly see small numbers of children with problematic drooling. Their clinical management of drooling varies; this is most likely because of a lack of evidence about the most effective approach. Comparative trials of interventions and the development of evidence-based clinical guidelines would improve the management of children's drooling.
Collapse
Affiliation(s)
- J R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Young people with complex healthcare needs (CHNs) face the challenge of transferring from child to adult health services. This study sought to identify successful models of transitional care for young people with CHNs. Three conditions were used as exemplars: cerebral palsy, autism spectrum disorders and diabetes. METHODS Scoping review: using search terms concerning transitional care, four databases were systematically searched for papers published in English between 1980 and April 2010. Additional informal search methods included recommendations from colleagues working with young people with each of the three conditions and making contact with clinical and research teams with expertise in transitional care. Inclusion and exclusion criteria were applied to define the papers selected for review. A separate review of policy documents, adolescent health and transition literature was also undertaken; 10 common summary categories for the components of high-quality services were identified. All papers were coded using a framework analysis which evaluated the data in two ways using the 10 transition categories and four elements of Normalization Process Theory that are important for successful implementation and integration of healthcare interventions. RESULTS Nineteen papers were selected for review. A very limited literature of models of service provision was identified for young people with cerebral palsy and diabetes. No models were identified for young people with autism spectrum disorders. Furthermore most publications were either descriptions of new service provision or time-limited pilot studies with little service evaluation or consideration of key elements of effective implementation. CONCLUSIONS Despite agreement about the importance of effective transitional care, there is a paucity of evidence to inform best practice about both the process of and what constitutes effective transitional care. There is therefore an urgent need for research to evaluate current transitional care practices for young people with CHNs.
Collapse
Affiliation(s)
- R Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Palmer E, Ketteridge C, Parr JR, Baird G, Le Couteur A. Autism spectrum disorder diagnostic assessments: improvements since publication of the National Autism Plan for Children. Arch Dis Child 2011; 96:473-5. [PMID: 20522453 DOI: 10.1136/adc.2009.172825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess in the context of a publically funded healthcare system, change in UK autism spectrum disorder (ASD) clinical diagnostic practice following the recommendations of the National Autism Plan for Children (NAP-C 2003). METHODS In 2007, a questionnaire based on standards from the NAP-C was sent to UK child development teams (CDTs); results were compared with 2001 data from the National Initiative for Autism Screening and Assessment. MAIN FINDINGS Responses were received from 149 of 243 UK CDTs (61%). Most teams used standardised autism diagnostic assessments. There was greater access to members of the multidisciplinary team than in 2001. Only one-third of teams had a defined timescale for completion of assessment; of those teams, about half met the recommended NAP-C target. CONCLUSIONS Since 2001, there has been an improvement in diagnostic services for children with ASD, however, inequalities remain. Providers should continue to improve services in order to deliver timely and comprehensive assessments for children with ASD.
Collapse
Affiliation(s)
- E Palmer
- Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK
| | | | | | | | | |
Collapse
|
14
|
Abstract
Making a diagnosis of transient non-ketotic hyperglycinaemia (tNKH) can be difficult. We report an infant who presented in the neonatal period with symptoms of NKH. Metabolic studies performed on day 2 of life showed raised cerebrospinal fluid (CSF) and plasma glycine, and a CSF:plasma glycine ratio consistent with NKH; however, a liver biopsy performed on day 5 revealed normal liver glycine cleavage system activity. Subsequently, the child's clinical condition improved in the absence of any therapeutic medication. Clinical assessment and developmental follow-up at 5 months, 1 year, and 2 years were age-appropriate. Guidance for the investigation and management of future suspected cases of tNKH is discussed.
Collapse
Affiliation(s)
- T F Lang
- Department of Clinical Biochemistry, the John Radcliffe Hospital, Oxford, UK.
| | | | | | | | | | | |
Collapse
|
15
|
Andrew M, Parr JR, Stacey R, Rosenfeld JV, Hart Y, Pretorius P, Nijhawan S, Zaiwalla Z, McShane MA. Transcallosal resection of hypothalamic hamartoma for gelastic epilepsy. Childs Nerv Syst 2008; 24:275-9. [PMID: 17828541 DOI: 10.1007/s00381-007-0448-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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] [Received: 01/03/2007] [Revised: 06/08/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypothalamic hamartomas (HHs) are commonly associated with severe epilepsy resistant to anticonvulsant therapy. Historically, surgical resection of HHs resulted in considerable morbidity. DISCUSSION Two series of patients who successfully underwent resection using a transcallosal approach have now been published; we report the first UK experience of this technique in a series of five patients with HHs and gelastic epilepsy resistant to anticonvulsant therapy. Patients were assessed pre- and postoperatively for seizure activity, endocrine function, ophthalmology, and neurocognitive function. Two patients had precocious puberty and all had evidence of developmental delay and behavioral problems. Postoperatively, all children experienced at least a 50% reduction in seizure frequency with abolition of major seizure types; one child remains seizure-free. One child developed a mild postoperative right hemiparesis and one developed transient diabetes insipidus. CONCLUSION There were no adverse developmental effects of surgery. Transcallosal resection of HHs ameliorates resistant epilepsy syndromes associated with HH.
Collapse
Affiliation(s)
- M Andrew
- Department of Paediatric Neurology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
In recent years, understanding of the pathogenesis and clinical presentation of distinct myasthenia subtypes has increased significantly. This article reviews the clinical manifestations of autoimmune myasthenia gravis (including myasthenia associated with anti-muscle-specific kinase antibodies), ocular myasthenia, and antibody negative myasthenia. The following treatments are examined: cholinesterase inhibitors, immunosuppressants, and thymectomy. Inherited congenital myasthenic syndromes (CMS) are now increasingly recognized, and most commonly present during childhood. This article outlines the presynaptic, synaptic basal lamina-associated, and postsynaptic classification of CMS and the clinical presentation and aetiology of individual syndromes. Relevant investigations and treatment options (including the role of pyridostigmine, 3,4-diaminopyridine, fluoxetine, and ephedrine) are discussed.
Collapse
Affiliation(s)
- J R Parr
- University of Oxford Department of Paediatrics, Children's Hospital, Oxford, UK.
| | | |
Collapse
|
17
|
Parr JR, Lamb JA, Bailey AJ, Monaco AP. Response to paper by Molloy et al.: linkage on 21q and 7q in autism subset with regression. Mol Psychiatry 2006; 11:617-9; author reply 619. [PMID: 16801976 DOI: 10.1038/sj.mp.4001833] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Parr JR, Pang K, Mollett A, Zaiwalla Z, Selway R, McCormick D, Jayawant S. Epilepsy responds to vagus nerve stimulation in ring chromosome 20 syndrome. Dev Med Child Neurol 2006; 48:80; author reply 80. [PMID: 16359603 DOI: 10.1017/s0012162206240167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
19
|
Bonora E, Beyer KS, Lamb JA, Parr JR, Klauck SM, Benner A, Paolucci M, Abbott A, Ragoussis I, Poustka A, Bailey AJ, Monaco AP. Analysis of reelin as a candidate gene for autism. Mol Psychiatry 2003; 8:885-92. [PMID: 14515139 DOI: 10.1038/sj.mp.4001310] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Genetic studies indicate that chromosome 7q is likely to contain an autism susceptibility locus (AUTS1). We have followed a positional candidate gene approach to identify relevant gene(s) and report here the analysis of reelin (RELN), a gene located under our peak of linkage. Screening RELN for DNA changes identified novel missense variants absent in a large control group; however, the low frequency of these mutations does not explain the relatively strong linkage results on 7q. Furthermore, analysis of a previously reported triplet repeat polymorphism and intragenic single nucleotide polymorphisms, using the transmission disequilibrium test, provided no evidence for association with autism in IMGSAC and German singleton families. The analysis of RELN suggests that it probably does not play a major role in autism aetiology, although further analysis of several missense mutations is warranted in additional affected individuals.
Collapse
Affiliation(s)
- E Bonora
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND The management of Attention Deficit Disorder with Hyperactivity (ADHD) is controversial and guidance published by the National Institute for Clinical Excellence (NICE) suggests a multidisciplinary approach. METHODS We evaluated the patterns of referral and techniques used in the diagnosis and management of ADHD in Wirral Health Authority by studying the case notes of 391 children diagnosed between 1994 and August 2000. RESULTS The majority of cases were referred from Primary Care and the detected prevalence was 8/1000. Boys were diagnosed more frequently than girls (12 : 1) and the mean age at diagnosis was 8.7 years; girls were more likely to have been diagnosed prior to age 8. The use of behaviour rating questionnaires and school visits as an aid to diagnosis increased during the study period. Management by Child Psychiatry and Community Paediatric services was similar with stimulant medication prescribed in 91% of cases; Child Psychiatry services were more likely to give advice on behaviour management than Paediatric services. Twelve per cent of cases were managed by both services, or in joint Outpatient clinics. Outpatient follow-up was most likely to occur at six monthly intervals and required 1312 appointments per year. CONCLUSIONS This study shows that the management of children with ADHD in Wirral Health Authority is compatible with NICE guidance. Attention Deficit Disorder with Hyperactivity is a significant burden on clinical services and long-term planning is required.
Collapse
Affiliation(s)
- J R Parr
- Department of Paediatrics, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral, UK.
| | | | | |
Collapse
|