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PubMed2001

[Organizational and medical aspects of transition of juveniles with congenital heart defects to adult cardiology care].

A growing, heterogeneous group of children with congenital heart disease is surviving into adulthood due to advances in medicine. These patients including those with simple and complex congenital heart disease and operated on during childhood are facing long-term complications. Superspecialist care and expertise are required during their life to deal with their unique problems the most common being ventricular failure, arrhythmias, valve and conduit longevity. Teenagers and adolescents disappear from both medical and parental care because of the lack of transition programs. Transition of care from pediatric to adult cardiologists must be organized in each country and must reflect regional history, regional politics and realities. Transition of care requires goodwill from parents, adolescents, pediatric and adult cardiologists. Transition clinics being held jointly by pediatric and adult cardiologists between the age of 16 and 18 years are essential to encourage the adolescents to take charge of their own life and health issues. Adequate information about their heart defect, their operations and their residual lesions may help them understand the implications for the future and improve their compliance. A transition program must include counseling on education, career, endocarditis prophylaxis, insurance and lifestyle issues such as sexuality and reproduction (including anticonception, pregnancy), cardiovascular risk factors and sports activities. Medical reports including operative reports and heart catheterization reports must be transferred to the adult cardiologists. In Switzerland, care of adults with congenital heart disease is based on three levels: 1) primary caregivers including general practiioners, internists and community cardiologists; 2) cardiologists with special commitment and expertise to patients with congenital heart disease who organize regional outpatient clinics; 3) supraregional referral centers with cardiologists trained in pediatric and adult congenital heart disease and experienced in the special needs, problems and management of this unique population. A close collaboration between pediatric and adult cardiologists participating jointly in the care of congenital heart disease patients is very important. An interdisciplinary team offers all non-invasive and invasive facilities for diagnostic and therapeutic procedures in a supraregional referral center. A close collaboration among all physicians is crucial for optimal care and management. Integration of adolescents with congenital heart disease into an adult medical system improves both compliance and quality of care and supports the patient's esteem because many medical aspects and lifestyle issues are completely different from those during childhood.

Adolescent↗
PubMed2004

Experiences of adolescents with cystic fibrosis during their transition from paediatric to adult health care: a qualitative study of young Australian adults.

PURPOSE: Exploring the experiences of Australian adolescents with Cystic Fibrosis (CF) as they made the transition from paediatric to adult care. This often traumatic change of care was examined from the perspective of the two types of care, paediatric and adult, elements of a transition programme if available and psychosocial factors that may affect the transition. METHOD: Focused-in-depth interviews were conducted with six young adults with CF (19-34 years), asking them to describe their experiences during the transition period. RESULTS: Thematic analysis of the transcribed interviews indicated that the four main areas that affected the transition experiences of the participants were paediatric and adult health care, the elements included in the transition programme, and psychosocial factors. CONCLUSIONS: The relationship of the patient with their paediatric doctor, the doctor's attitude towards the transition and the delivery of age-appropriate care appeared to influence the experiences of adolescents as they changed to adult care. Successful elements of a transition programme, if it was offered, were the orientation tours, the provision of information and the presence of a familiar face at adult clinics. Transition experiences of individuals had potential effects on their psychological and physical well-being so that, in order to maximize quality of care, health professionals must be aware of factors which may improve transition experiences.

Adaptation, Psychological↗
PubMed1993

Tutorial: using Microsoft Excel for health care CQI.

The transition from QA to CQI in health care calls for decentralized data collection and analysis in conjunction with the use of personal computers to support CQI team activities. In this article, we discuss recent advances in PC software and hardware technology that make possible revolutionary changes in health care quality data management. We also present detailed examples of how to use Microsoft Excel 4.0 as a single software platform to support commonly used CQI tools and analyses.

Computer Graphics↗
PubMed2005

Transition from pediatric to adult medical care.

Because of recent medical advances, the number of children with chronic medical conditions who survive into adulthood has increased. The transition of care from pediatric to adult specialists and subspecialists has been rarely studied, yet it is an important aspect of care. To define issues in the pediatric patients at the University of Virginia, survey data was collected from adult nephrologists in the state. A total of 105 surveys were mailed to adult providers in Virginia. From 62 responses, 60% of adult providers did not feel completely comfortable caring for a patient with a pediatric-specific diagnosis. To efficiently receive information on new patients, adult providers preferred an abbreviated medical summary or phone call from pediatric providers. Additionally, interviews were conducted with 6 pediatric patients and their families. Patients reported a good grasp of their diagnosis and treatment, expressed an interest in learning chronic-illness coping strategies, and expressed interest in obtaining community-resource information. This study reiterated the need for additional insurance options for this at-risk population. Development of individualized transition plans and transition services are recommended to support young adult patients with chronic medical conditions as they transition into adulthood.

Adolescent↗
PubMed2004

Righting wrong site surgery.

BACKGROUND: As defined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), wrong site surgery includes wrong side or siteof the body, wrong procedure, and wrong-patient surgeries. Although many health care organizations are implementing guidelines and procedures to decrease the occurrence of wrong site surgery, numerous barriers to their effectiveness have been identified. HUMAN FACTORS ENGINEERING (HFE) ANALYSIS: A human factors system analysis can be used to better understand how elements of a work system combine andinteract to contribute to breakdowns in the system. A case study of wrong site surgery in an outpatient setting illustrates how the different work systtem elements can contribute to the occurrence of a wrong site surgery. In analyzing the care process, it is particularly important to identify the transitions of care, which can be sources of patient safety problems when deficits in communication and information transfer occur (for example, miscommunication, information not transmitted on time, wrong information transmitted, misunderstanding of the information transmitted). RECOMMENDATIONS: After a wrong site surgery, conduct a root cause analysis that uses the work system model and includes a surgery care process analysis similar to the one described in the case study; collaborate with human factors engineers to learn how to apply the work system model; apply the work system model to process analysis; and optimize work systems.

Aged↗
PubMed1999

Follow family-focused care principles.

Making the transition from traditional obstetrics care to single-room maternity care involves changes in the physical facility, cross-education, and new roles. The most important success factor is the staff's response to the change.

Attitude of Health Personnel↗
PubMed2002

Transitions through postacute and long-term care settings: patterns of use and outcomes for a national cohort of elders.

OBJECTIVES: Despite the large number of elders using postacute and long-term care services, there is little information about transitions through different settings or the impact of transitions on elders' health. This gap in knowledge is addressed by analyzing the use of postacute and long-term care settings during a 2-year interval by a nationally representative cohort of elders. METHODS: A 2-year longitudinal record of the use of short-stay hospitals and postacute and long-term care settings was constructed for all respondents to the 1994 National Long Term Care Survey age 65 or older in 1992. Indicators of potential transition problems include emergency room visits, potentially avoidable hospital stays, and return to an institutional setting following discharge to the community. RESULTS: Almost 18% of elders, 4.9 million persons, were admitted to or discharged from a study setting between 1992 and 1994. A sizable number of these elders (22.4%) had subsequent health care use, suggesting a possible transition problem. Transitions from acute care hospitals to paid home care represent 20.8% of all transitions and are followed by relatively high rates of potential problems. CONCLUSIONS: This study provides new information on patterns of postacute and long-term care use and the types of transitions most likely to be followed by potential problems. The results suggest three broad strategies for improving the outcome of transitions through postacute and long-term care settings.

Aged↗
PubMedDate not supplied

Cystic fibrosis: transition from paediatric to adult care.

There is a current caseload of 350 children with cystic fibrosis at the Royal Brompton Hospital, and adult caseload of more than six hundred. Approximately 100 young people aged between 13 and 18 will transfer to adult care during the next five years. The transfer process between services was identified to be in need of review. The initial objectives were to review current practice for young people ready to transfer from paediatric to adult care, and to assess the needs of the professional, patient and caregivers at this time. In June 2000, a new system was introduced to the families, which offered them joint transition consultations with paediatric and adult cystic fibrosis care teams. A hospital-wide standard for transition was approved. In June 2002 an audit of the transition clinic system indicated an improvement in the process of transfer from paediatric to adult care. However, further service development is required to cater for the challenges and individual needs of adolescents.

Adolescent↗
PubMed2000

A new era in home care.

Profound changes in policy and reimbursement are ushering in a new era in home care. The transition from fee-for-service reimbursement to prospective payment/managed care and the mandate for outcomes assessment provide opportunities to expand innovative home care models. The authors describe 3 such models: community-based long-term care (exemplified by PACE, Program of All-inclusive Care for the Elderly), home-based primary care (exemplified by the Veterans Administration Home-Based Primary Care program), and disease management programs (exemplified by Group Health Cooperative of Puget Sound). Professional qualifications for the new era, including certification and graduate education for advanced practice nursing, also are described.

Fee-for-Service Plans↗
PubMed2006

Educate, communicate, anticipate-practical recommendations for transitioning adolescents with IBD to adult health care.

The cyclical nature of chronic illness requires that children with inflammatory bowel disease be transitioned to the adult medical system with as much continuity of care as possible. Transition from pediatric to adult medical care continues to present significant barriers. The philosophy of transition centers on a process, with the actual transfer to adult care as a point along this clinical pathway. Concrete steps can be taken to help patients prepare for new responsibilities. The aim of this review is to propose a clinical and developmental timeline for both patients and their medical team, including specific responsibilities for both, so that the partnership can best promote a successful transition.

Adolescent↗
PubMed2006

Long-term effects of the intensification of the transition between inpatient neurological rehabilitation and home care of stroke patients.

OBJECTIVE: To investigate an intensified transition concept between neurological inpatient rehabilitation and home care for long-term effects on the care situation two and a half years after stroke patients' discharge. DESIGN: Controlled clinical trial allocating patients to intervention group (intensified transition on ward II) or control group (standard transition on ward I); patients were allocated to whichever ward had a vacancy. The last follow-up assessment was carried out on average 31 months after discharge. INTERVENTION: The intensified transition concept consisted of therapeutic weekend care, bedside teaching and structured information for relatives during the second phase of the rehabilitation. SUBJECTS: Seventy-one patients and their family carers were included, of which one case dropped out. Therefore 70 family carers--35 individuals in each group-- were available for assessment at long-term follow-up. DATA COLLECTION: Family carers were asked via telephone whether the patient was still alive and if so, where he or she is living--at home or in a nursing home. STATISTICAL METHODS: Binary logistic regression analysis with the care situation (home care versus institutionalized care or deceased) as dependent variable. RESULTS: Two and a half years after discharge (T3) in the intervention group significantly fewer patients were institutionalized (2 versus 5) or deceased (4 versus 11) (P = 0.010). Multivariate analysis showed that besides a higher functional life quality at discharge and lower patient's age, the participation in the intensified transition programme is the third significant predictor for home care at T3. CONCLUSION: Effects of an intensified transition programme can persist over a long-term period. They can sustain home care by reducing institutionalization and mortality.

Aged↗
PubMed2006

Family caregivers and transition to long-term care.

This study's purpose was to explore family caregivers' experiences while they waited placement of family members with dementia in long-term care and how they coped during this period of waiting and transition. In this exploratory descriptive qualitative study, interviews were conducted with 29 caregivers at entry to the placement wait-list and at 3 to 4-month intervals thereafter. Final interviews, with 15 caregivers, were conducted shortly after admission to long-term care. When "the waiting begins," the themes of crisis as initiator, synchronicity, control, and reciprocity emerged. "After placement" included the themes of deeply bonded relationships, attempting continuity, and sorting out the change. The findings provide new insight into family caregiver experiences during and after placement of a family member with dementia in long-term care. Clinicians must recognize that wherever services are provided, at home before placement or in institutions after placement, family caregivers must be incorporated as full partners in care.

Adaptation, Psychological↗
PubMed2007

Altered protamine expression and diminished spermatogenesis: what is the link?

During the elongating spermatid stage of spermiogenesis, human sperm chromatin undergoes a complex transition in which histones are extensively replaced by protamines in a carefully regulated transition including histone modifications and intermediate and temporary replacement of the histones by sperm-specific transition proteins. The replacement of most histones by protamines 1 and 2 facilitates a high order of chromatin packaging necessary for normal sperm function and may also be necessary for DNA silencing and imprinting changes within the sperm cell. Protamines 1 and 2 are usually expressed in nearly equal quantities, but elevated or diminished protamine 1/protamine 2 ratios are observed in some infertile men and is often associated with severe spermatogenesis defects. Human and animal studies demonstrate that expression of the protamine proteins is uniquely regulated by transcription/translation factors, including storage of the mRNA in ribonucleoprotein (RNP) particles composed of the mRNA, transcription factors and a kinesin molecule necessary for transport of the RNP to the cytoplasm and removal of transcriptional activators from the nucleus. Recent studies indicate that most patients with abnormal protamine protein levels have elevated levels of protamine transcript in the mature sperm cell, indicating a possible defect in transcription or translation. The regulation of protamine expression is unique and includes several possible mechanisms which may be responsible for dysregulation of protamine expression and concurrent broad spectrum defects in spermatogenesis. We suggest two hypotheses: (i) that abnormal protamine expression is indicative of a generalized defect in mRNA storage and/or translation which affects other mRNA transcripts or (ii) that protamines may act as a checkpoint of spermatogenesis.

Animals↗
PubMed1989

Costs associated with ambulatory care and education.

The adoption of an ambulatory care classification system by the Health Care Financing Administration in 1991 may have significant implications for medical education programs in the Department of Veterans Affairs (VA) ambulatory care setting. Presently there is not adequate methodology in the VA to determine costs in ambulatory care and education. (Experience with the VA allocation model suggests that selected characteristics of reimbursement systems are incompatible with educational goals.) Barriers that inhibit the cost-effective delivery of ambulatory care in many VA hospitals must be eliminated so that effective patient care and training care can take place. These barriers include inadequacies of information systems, physical layouts, and staffing. Despite the perception that outpatient care is less costly than inpatient care, the transition from an inpatient-based education model to an ambulatory care model will require an infusion of resources to improve the ambulatory care environment in the VA.

Ambulatory Care↗
PubMed2004

Back to school.

Hospital-based palliative care has been found to decrease the length of stays, ease transitions between care settings and increase patient and family satisfaction.

Critical Illness↗
PubMedDate not supplied

[Primary health care: an analysis of the transition in Anadalucía].

The article develops an analysis of the process of transformation of primary health care in Andalucía (Spain), related to two fundamental aspects. On the one hand, the strategic aspects of reform are analysed, inspiring principles, as well as legislation and administration. So called "central" changes, that is, those that really suppose transformations in the services: geographic distribution, donation, organisation, human resources, etc., are also analyzed. The second aspect approached is an analysis of the situation of the system related to the limitations and malfunctions, important conditioners of the present functioning and immediate future of primary care.

Health Policy↗
PubMed2004

Relocation to a long-term care facility: working with patients and families before, during, and after.

Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.

Adaptation, Psychological↗