Transitioning the Adolescent with IBD from Pediatric to Adult Care: A Review of the Literature

The incidence of inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), has increased in pediatric populations over the last decade. Patients diagnosed during childhood often survive well into adulthood, and therefore their healthcare requires transfer to an adult gastroenterologist, usually at age 18 years. Transition has been defined in the literature as the “purposeful planned movement of adolescents and young adults with chronic conditions from child-centered to adult-oriented health care systems” (Blum et al., 1993). The purpose of this review is to establish the current state of knowledge regarding the transition from pediatric to adult care in IBD. This review highlights that developmentally appropriate transitional care is now recognized as a healthcare priority and thoughtful targeted intervention is needed.

Download Full-text

Transition from child-centered to adult health-care systems for adolescents with chronic conditions

Journal of Adolescent Health ◽

10.1016/1054-139x(93)90143-d ◽

1993 ◽

Vol 14 (7) ◽

pp. 570-576 ◽

Cited By ~ 749

Author(s):

Robert WM. Blum ◽

Dale Garell ◽

Christopher H. Hodgman ◽

Timothy W. Jorissen ◽

Nancy A. Okinow ◽

...

Keyword(s):

Health Care ◽

Chronic Conditions ◽

Health Care Systems ◽

Adult Health ◽

Child Centered ◽

Care Systems ◽

Adult Health Care

Download Full-text

An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care

Journal of Pediatric Epilepsy ◽

10.1055/s-0040-1716825 ◽

2020 ◽

Vol 09 (04) ◽

pp. 106-113

Author(s):

Ysabeau Bernard-Willis ◽

Emily De Oliveira ◽

Shaheen E Lakhan

Keyword(s):

Health Management ◽

Digital Health ◽

Health Care Systems ◽

Well Being ◽

Pediatric Care ◽

Medical Mistrust ◽

Patient Portals ◽

Language Therapy ◽

Adult Care ◽

Care Systems

AbstractChildren with epilepsy often have impairments in cognitive and behavioral functioning which may hinder socio-occupational well-being as they reach adulthood. Adolescents with epilepsy have the added worry of health problems while starting the transition from family-centered pediatric care into largely autonomous adult care. If this transition is not appropriately planned and resourced, it may result in medical mistrust, nonadherence, and worsening biopsychosocial health as an adult. In recent years, there has been increased availability of digital health solutions that may be used during this stark change in care and treating teams. The digital health landscape includes a wide variety of technologies meant to address challenges faced by patients, caregivers, medical professionals, and health care systems. These technologies include mobile health products and wearable devices (e.g., seizure monitors and trackers, smartphone passive data collection), digital therapeutics (e.g., cognitive/behavioral health management; digital speech–language therapy), telehealth services (e.g., teleneurology visits), and health information technology (e.g., electronic medical records with patient portals). Such digital health solutions may empower patients in their journey toward optimal brain health during the vulnerable period of pediatric to adult care transition. Further research is needed to validate and measure their impact on clinical outcomes, health economics, and quality of life.

Download Full-text

Comprehensive Review of Cardiovascular Involvement in COVID-19

AACN Advanced Critical Care ◽

10.4037/aacnacc2021302 ◽

2021 ◽

pp. e1-e19

Author(s):

Ruff Joseph Macale Cajanding

Keyword(s):

Cardiac Involvement ◽

Health Care Systems ◽

The Body ◽

Cardiac Pathology ◽

Current State ◽

Global Pandemic ◽

Cardiovascular Involvement ◽

Disease Causation ◽

Care Systems ◽

Clinically Significant

COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.

Download Full-text

Adult Care in Cystic Fibrosis

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0039-3400289 ◽

2019 ◽

Vol 40 (06) ◽

pp. 857-868 ◽

Cited By ~ 4

Author(s):

J. Stuart Elborn

Keyword(s):

Health Care ◽

Cystic Fibrosis ◽

Care Delivery ◽

Health Care Systems ◽

Well Being ◽

Models Of Care ◽

Adult Care ◽

Care Systems ◽

Expanding Population ◽

Almost All

AbstractCystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidity and almost all the mortality of CF occur in adults and will increasingly follow this pattern even with new effective modulator therapies. Maintaining good quality of life including social functioning and maximizing survival for adults are the key priorities. This requires a highly knowledgeable and adaptable multidisciplinary team, which, though focused on maintaining lung health, requires an increasing range of other disciplines and specialties to maximize well-being. Changes in health care systems will require current models of care to adapt to provide care for the large number of adult patients. With increasing survival and age, many are likely to have both CF morbidities and additional diseases of aging. New models are needed for health care delivery for this expanding population with complex medical conditions.

Download Full-text

Development of Multimorbidity Over Time: An Analysis of Belgium Primary Care Data Using Markov Chains and Weighted Association Rule Mining

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa278 ◽

2020 ◽

Author(s):

Xi Shi ◽

Gorana Nikolic ◽

Gijs Van Pottelbergh ◽

Marjan van den Akker ◽

Rein Vos ◽

...

Keyword(s):

Health Care ◽

Markov Chains ◽

Association Rule ◽

Chronic Conditions ◽

Association Rule Mining ◽

Musculoskeletal Diseases ◽

Current Knowledge ◽

Health Care Systems ◽

Rule Mining ◽

Care Systems

Abstract Background The prevalence of multimorbidity is increasing in recent years, and patients with multimorbidity often have a decrease in quality of life and require more health care. The aim of this study was to explore the evolution of multimorbidity taking the sequence of diseases into consideration. Methods We used a Belgian database collected by extracting coded parameters and more than 100 chronic conditions from the Electronic Health Records of general practitioners to study patients older than 40 years with multiple diagnoses between 1991 and 2015 (N = 65 939). We applied Markov chains to estimate the probability of developing another condition in the next state after a diagnosis. The results of Weighted Association Rule Mining (WARM) allow us to show strong associations among multiple conditions. Results About 66.9% of the selected patients had multimorbidity. Conditions with high prevalence, such as hypertension and depressive disorder, were likely to occur after the diagnosis of most conditions. Patterns in several disease groups were apparent based on the results of both Markov chain and WARM, such as musculoskeletal diseases and psychological diseases. Psychological diseases were frequently followed by irritable bowel syndrome. Conclusions Our study used Markov chains and WARM for the first time to provide a comprehensive view of the relations among 103 chronic conditions, taking sequential chronology into consideration. Some strong associations among specific conditions were detected and the results were consistent with current knowledge in literature, meaning the approaches were valid to be used on larger data sets, such as National Health care Systems or private insurers.

Download Full-text

Development and Implementation of a Person-Centered, Technology-Enhanced Care Model For Managing Chronic Conditions: Cohort Study (Preprint)

10.2196/preprints.11082 ◽

2018 ◽

Author(s):

Curtis L Petersen ◽

William B Weeks ◽

Olof Norin ◽

James N Weinstein

Keyword(s):

Health Care ◽

Chronic Conditions ◽

Chronic Condition ◽

Health Care Systems ◽

Health Care Expenditures ◽

Health Behavior Change ◽

Care Model ◽

Health Technologies ◽

Care Systems ◽

Per Capita

BACKGROUND Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems. OBJECTIVE The purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition. METHODS At Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures. RESULTS Participants averaged 41 years of age; 72.70% (2104/2894) were female and 12.99% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls. CONCLUSIONS The technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.

Download Full-text

Worldwide Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: An International Survey

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa202 ◽

2020 ◽

Cited By ~ 1

Author(s):

Charles N Bernstein ◽

Siew C Ng ◽

Rupa Banerjee ◽

Flavio Steinwurz ◽

Bo Shen ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Task Force ◽

Health Care Systems ◽

Underlying Disease ◽

Virus Spread ◽

The World ◽

Management Guidance ◽

Care Systems ◽

Inflammatory Bowel

Abstract Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable to COVID-19 either because of their underlying disease or its management. Guidance has been presented on the management of persons with IBD in the time of this pandemic by different groups. We aimed to determine how gastroenterologists around the world were approaching the management of IBD. Methods Members of the World Gastroenterology Organization (WGO) IBD Task Force contacted colleagues in countries largely beyond North America and Europe, inviting them to review the WGO website for IBD and COVID-19 introduction, with links to guideline documents, and then to respond to 9 ancillary open-ended management questions. Results Fifty-two gastroenterologists from 33 countries across 6 continents completed the survey (April 14 to May 16, 2020). They were all adhering for the most part to published guidelines on IBD management in the COVID-19 era. Some differences and reductions in services related to access, and some related to approach within their communities in terms of limiting virus spread. In particular, most gastroenterologists reduced in-person clinics (43 of 52), limited steroid use (47 of 51), limited elective endoscopy (45 of 52), and limited elective surgeries (48 of 51). If a patient was diagnosed with COVID-19, immunomodulatory therapy was mostly held. Conclusions In most countries, the COVID-19 pandemic significantly altered the approach to persons with IBD. The few exceptions were mostly based on low burden of COVID-19 in individual communities. Regardless of resources or health care systems, gastroenterologists around the world took a similar approach to the management of IBD.

Download Full-text

Shock in the Setting of Diamond-Blackfan Anemia Relapse

Case Reports in Cardiology ◽

10.1155/2021/6623119 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Metri Haddaden ◽

Samir Husami ◽

Modar Alom ◽

Yifan Pang ◽

Zaid Imam ◽

...

Keyword(s):

Early Recognition ◽

Health Care Systems ◽

Knowledge Bases ◽

Adult Care ◽

Congenital Diseases ◽

Diamond Blackfan Anemia ◽

Care Systems ◽

Lost To Follow Up ◽

New Strategies

Adult intensivists have increasing exposure to individuals with congenital diseases surviving into adulthood. Solid knowledge bases and early recognition of the possible sequelae of congenital disorders are crucial in caring for these patients. We present a challenging case of shock and relapse of Diamond-Blackfan anemia in a 42-year-old man lost to follow-up for 18 years and highlighted the importance of healthcare transitions into adulthood and the challenges faced by health care systems to develop new strategies successfully transitioning complex pediatric patients to adult care.

Download Full-text

SARS-CoV-2 and the Possible Connection to ERs, ACE2 and RAGE: Focus on Susceptibility Factors

10.20944/preprints202005.0178.v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Roberta Sessa Stilhano ◽

Angelica Jardim Costa ◽

Michelle Sayuri Nishino ◽

Shahin Shams ◽

Cynthia Silva Bartolomeo ◽

...

Keyword(s):

Health Care Systems ◽

Critical Role ◽

The Elderly ◽

Receptor Expression ◽

Viral Receptor ◽

Current State ◽

Susceptibility Factors ◽

Care Systems ◽

Male Patients ◽

Host Infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has provoked major stresses on the health care systems of several countries, and caused the death of more than a quarter of a million people globally, mainly in the elderly population with pre-existing pathologies. Previous studies with coronavirus (SARS-CoV) point to gender differences in infection and disease progression with increased susceptibility in male patients, indicating that estrogens may be associated with physiological protection against the coronavirus. Therefore, the objectives of this work are threefold. First, we aim to summarize the SARS-CoV-2 infection pathway and the roles both the virus and patient play in COVID-19 (Coronavirus disease 2019) progression, clinical symptomology, and mortality. Second, we detail the effect estrogen has on viral infection and host infection response, including its role in both the regulation of key viral receptor expression and the mediation of inflammatory activity. Finally, we describe how ERs (estrogen receptors) and RAGE (receptor for advanced glycation end-products) play a critical role in metabolic pathways, which we envisage could maintain a close interplay with SARS-CoV and COVID-19 mortality rates, despite a current lack of research directly determining how. Taken together, we present the current state of the field regarding SARS-CoV-2 research and illuminate where research is needed to better define the role both estrogen and metabolic comorbidities have in the COVID-19 disease state, which can be key in screening potential therapeutic options as the search for effective treatments continue.

Download Full-text

Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients

Inflammatory Intestinal Diseases ◽

10.1159/000520522 ◽

2021 ◽

pp. 1-9

Author(s):

Jesús K. Yamamoto-Furusho ◽

Norma N. Parra-Holguín

Keyword(s):

Health Care ◽

Health Care System ◽

Associated Factors ◽

Health Care Systems ◽

Diagnostic Delay ◽

Private Health Care ◽

The Public ◽

Care Systems ◽

Inflammatory Bowel ◽

Care System

Introduction: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors. Methods: This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time >1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of p ≤ 0.05 was taken as significant. Results: The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course >2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (p = 0.00001). Conclusions: We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.

Download Full-text