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Transition to adult care

Justyna Rajchert, Monika Rosa, Joanna Pawłowska, Milosz Parczewski, Marta Wawrzynowicz-Syczewska
BACKGROUND Despite excellent transplantation results, there is a vulnerable period of time in the post-transplant management of pediatric liver recipients, which is the time when a child becomes an adolescent. This period of psychological distress influences compliance and may result in premature transplant failure and graft loss. We performed a retrospective review of pediatric liver transplant recipients, transferred to our service for adults, in order to identify key issues associated with transition into the adult care...
October 18, 2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Dan Wood
PURPOSE OF REVIEW: There is increasing recognition of the need for life-long care in patients who have congenital urological anomalies. This study looks at the factors surrounding transition and suggests those, which may improve the success. RECENT FINDINGS: One of the most challenging phases in this care is adolescence. There are the physical and psychological changes that all adolescents go through. Patients need medical surveillance through this time in order to ensure good care and patient safety...
October 5, 2016: Current Opinion in Urology
E Chapman, A Eastman, A Gilmore-Bykovskyi, B Vogelman, A J Kind
Older adults often face poor outcomes when transitioning from hospital to home. Although physicians play a key role in overseeing transitions, there is a lack of practice-based educational programs that prepare resident physicians to manage care transitions of older adults. An educational intervention to provide residents with real-life transitional care practice was therefore developed-Resident-coordinated Transitional Care (RC-TraC). RC-TraC adapted the evidence-based Coordinated-Transitional Care (C-TraC) nurse role for residents, providing opportunities to follow patients during the peri-hospital period without additional costs to the residency program...
October 17, 2016: Gerontology & Geriatrics Education
Jennifer Kirsty Harrison, Azucena Garcia Garrido, Sarah J Rhynas, Gemma Logan, Alasdair M J MacLullich, Juliet MacArthur, Susan Shenkin
BACKGROUND: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. OBJECTIVE: to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. DESIGN AND SETTING: a retrospective cohort study of people admitted to a single large Scottish teaching hospital. SUBJECTS: 100 individuals admitted to the acute hospital from home and discharged to a care home...
October 15, 2016: Age and Ageing
Veronica Gomez-Lobo, Anne-Marie Amies Oelschlager
Disorders (differences) of sexual development encompass a variety of conditions with atypical development of chromosomal, gonadal, or anatomic sex. Three of the most common differences of sex development conditions include congenital adrenal hyperplasia, complete androgen insensitivity, and Turner syndrome. Obstetrician-gynecologists who care for affected individuals in their practice must be familiar with the genetic, endocrine, and anatomic considerations of the most common conditions to provide optimal care...
October 6, 2016: Obstetrics and Gynecology
C Barrett Bowling, Laura Plantinga, Rasheeda K Hall, Anna Mirk, Rebecca Zhang, Nancy Kutner
BACKGROUND AND OBJECTIVES: The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied...
October 12, 2016: Clinical Journal of the American Society of Nephrology: CJASN
(no author information available yet)
BACKGROUND: In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. METHODS: We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level...
October 8, 2016: Lancet
Julien Tap, Muriel Derrien, Hans Törnblom, Rémi Brazeilles, Stéphanie Cools-Portier, Joël Doré, Stine Störsrud, Boris Le Nevé, Lena Öhman, Magnus Simrén
BACKGROUND AND AIMS: We have limited knowledge about the association between the composition of the intestinal microbiota and clinical features of irritable bowel syndrome (IBS). We collected information on the fecal and mucosa-associated microbiota of patients with IBS and evaluated whether these were associated with symptoms. METHODS: We collected fecal and mucosal samples from adult patients who met the Rome III criteria for IBS at secondary or tertiary care outpatient clinics in Sweden, as well as from healthy subjects...
October 7, 2016: Gastroenterology
Rebecca Pleat, Timothy M Cox, T Andrew Burrow, Pilar Giraldo, Ozlem Goker-Alpan, Barry E Rosenbloom, Laura R Croal, Lisa H Underhill, Sebastiaan J M Gaemers, M Judith Peterschmitt
Gaucher disease type 1 is an autosomal recessive disorder caused by deficient activity of the lysosomal enzyme acid β-glucosidase resulting in accumulation of glucosylceramide and clinical manifestations of anemia, thrombocytopenia, hepatosplenomegaly, and skeletal disease. The historic standard of care is intravenous recombinant enzyme therapy with imiglucerase. Eliglustat, an oral substrate reduction therapy, is a first-line treatment for adults with Gaucher disease type 1 who have a compatible CYP2D6-metabolizer phenotype (≈ 95% of patients)...
December 2016: Molecular Genetics and Metabolism Reports
Cathrine Bell, Mette Kjærgaard Nielsen, Mette Asbjoern Neergaard, Mai-Britt Guldin, Anders Bonde Jensen
CONTEXT: Timely recognition of the terminal phase of life will benefit patients and caregivers as it may facilitate advance care planning and support. OBJECTIVES: To investigate the remaining lifetime of patients entering a physician-assessed terminal phase and to analyse variation in remaining lifetime according to diagnosis and socio-demographic factors. METHODS: Danish national health registers were used to establish a prospective cohort, of adult patients formally registered with drug reimbursement due to terminal illness in 2012 and followed until June 2014...
October 5, 2016: Journal of Pain and Symptom Management
Karen L Pellegrin, Les Krenk, Sheena Jolson Oakes, Anita Ciarleglio, Joanne Lynn, Terry McInnis, Alistair W Bairos, Lara Gomez, Mercedes Benitez McCrary, Alexandra L Hanlon, Jill Miyamura
OBJECTIVES: To evaluate the association between a system of medication management services provided by specially trained hospital and community pharmacists (Pharm2Pharm) and rates and costs of medication-related hospitalization in older adults. DESIGN: Quasi-experimental interrupted time series design comparing intervention and nonintervention hospitals using a mixed-effects analysis that modeled the intervention as a time-dependent variable. SETTING: Sequential implementation of Pharm2Pharm at six general nonfederal acute care hospitals in Hawaii with more than 50 beds in 2013 and 2014...
October 7, 2016: Journal of the American Geriatrics Society
Parag Goyal, Madeline R Sterling, Ashley N Beecy, John T Ruffino, Sonal S Mehta, Erica C Jones, Mark S Lachs, Evelyn M Horn
OBJECTIVES: Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge. PATIENTS AND METHODS: This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014...
2016: Clinical Interventions in Aging
M Khalid-Raja, K Tzifa
OBJECTIVE: This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. METHODS: A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. RESULTS: Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome...
October 6, 2016: Journal of Laryngology and Otology
Ursula Running Bear, Janette Beals, Douglas K Novins, Spero M Manson
BACKGROUND: Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification). METHODS: The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit...
September 24, 2016: Addictive Behaviors
Benjamin D Elder, Timothy F Witham
Low back pain is highly prevalent, affecting a vast majority of the adult population at some point in their lifetime. Thorough history and physical examination is critically important in evaluating these patients and screening for potentially serious conditions. Imaging should be guided by the history and physical examination, particularly when there is concern for serious conditions and/or a focal neurological deficit present. Adequate treatment of patients with low back pain often requires a multidisciplinary approach, involving several medical specialties...
October 2016: Seminars in Neurology
Alison S Poulton
OBJECTIVES: This paper reviews the importance of transition to adult services for young people with ADHD. METHOD: Different models are described and evidence sought for their effectiveness in clinical practice. RESULTS: Models of care for children with ADHD include specialised mental health services, individual paediatricians and child and adolescent psychiatrists. Although it might be expected that transition would be to equivalent adult teams or specialists, studies have shown that transition may not run smoothly, and the adult services are frequently inadequate...
September 30, 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Gemma Heath, Albert Farre, Karen Shaw
OBJECTIVE: To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services. METHODS: Five databases were systematically searched for qualitative articles examining parents' views and experiences of their child's healthcare transition. Papers were quality assessed and thematically synthesised. RESULTS: Thirty-two papers from six countries, spanning a 17-year period were included...
August 16, 2016: Patient Education and Counseling
Jeanne M Little, Janice A Odiaga, Carla Z Minutti
For adolescents with diabetes, ineffective health care transition to adult health services may result in suboptimal adherence to medical supervision, leading to poor glycemic control, increased diabetes complications, and hospitalization. Despite national recommendations, few youth receive the needed preparation to transition to adult health services. A data transition registry was created at a large Midwest urban academic medical center to identify patients 14 years and older with Type 1 diabetes. Thirty-nine patients with Type 1 diabetes were identified, and 33 were eligible to begin transition planning...
September 29, 2016: Journal of Pediatric Health Care
Jennifer B Oliver, Kiana Kashef, Angela M Bader, Darin J Correll
STUDY OBJECTIVE: Acute postoperative pain may transition to persistent/chronic pain in up to 50% or more of patients after certain surgeries. Despite this concern, it is unclear that patients' preprocedure understanding and expectations are aligned with these potential outcomes. This study was designed to evaluate the extent of this alignment and the potential impact on the quality of risk/benefit discussions before procedures. DESIGN: Prospective survey. SETTING: A large, tertiary care preoperative assessment clinic...
November 2016: Journal of Clinical Anesthesia
Mariela Acuña Mora, Philip Moons, Carina Sparud-Lundin, Ewa-Lena Bratt, Eva Goossens
BACKGROUND: Life-long specialized care is of the utmost importance to safeguard longevity as well as the quality of life in children diagnosed with a chronic condition (CC). Provision of life-long care, however, infers transfers to different settings in line with person's development status. Young people with CC (10-25 years) will transfer care from a pediatric towards an adult-oriented care setting. As a transfer of care is associated with a change of care context, healthcare team, responsibilities, expectations, and roles, patients need to be prepared for this alteration...
September 29, 2016: Systematic Reviews
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