Adult Team Research Articles

Transition from pediatric to adult care system in patients with complex epilepsies: Necker model for transition evaluated on 70 consecutive patients.

Complex epilepsies such as epileptic and developmental encephalopathies require multidisciplinary care throughout life. A coordinated transition program is therefore essential to provide optimal support for patients leaving pediatric for adult care. The aim of this study is to describe and evaluate our transition program for complex epilepsies, focusing on the last step in this program, that is, the multidisciplinary transition day hospital (MTDH). We performed a retrospective observational study including patients with complex epilepsies who underwent the full steps of the transition program at Necker-Enfants Malades Hospital between May 2021 and June 2023, with a follow-up until February 2024. We described the cohort and detailed the interventions performed during the MTDH including medical, medicosocial, educational, daily life abilities, and laboratory and imaging assessments with the participation of one member of the adult team. We evaluated two indicators of our program: (1) the "adult first clinic attendance rate," defined by the percentage of patients attending their first adult clinic; and (2) the "return rate," defined by the percentage of patients who requested a pediatric encounter after their transfer. Our cohort included 70 patients with a mean age of 19.1 years (interquartile range = 16.3-19.5). Eighty percent had an epilepsy syndrome diagnosis; 72.8% were treated with three or more antiseizure medications. All patients had their appointment at the adult clinic within 6 months of the day hospital, and only two families requested a pediatric encounter after the transfer. The transition program is key for an optimal transfer of patients with complex epilepsies to adult care. It requires a comprehensive multidisciplinary approach and provides a complete summary of the medical record. Our program secures a smooth landing in adult care and is a promising model to better manage the challenging transition process, especially in patients with complex epilepsy.

Determining Validity and Reliability of an In-Field Performance Analysis System for Swimming

To permit the collection of quantitative data on start, turn and clean swimming performances in any swimming pool, the aims of the present study were to (1) validate a mobile in-field performance analysis system (PAS) against the Kistler starting block equipped with force plates and synchronized to a 2D camera system (KiSwim, Kistler, Winterthur, Switzerland), (2) assess the PAS’s interrater reliability and (3) provide percentiles as reference values for elite junior and adult swimmers. Members of the Swiss junior and adult national swimming teams including medalists at Olympic Games, World and European Championships volunteered for the present study (n = 47; age: 17 ± 4 [range: 13–29] years; World Aquatics Points: 747 ± 100 [range: 527–994]). All start and turn trials were video-recorded and analyzed using two methods: PAS and KiSwim. The PAS involves one fixed view camera recording overwater start footage and a sport action camera that is moved underwater along the side of the pool perpendicular to the swimming lane on a 1.55 m long monostand. From a total of 25 parameters determined with the PAS, 16 are also measurable with the KiSwim, of which 7 parameters showed satisfactory validity (r = 0.95–1.00, p < 0.001, %-difference < 1%). Interrater reliability was determined for all 25 parameters of the PAS and reliability was accepted for 21 of those start, turn and swimming parameters (ICC = 0.78–1.00). The percentiles for all valid and reliable parameters provide reference values for assessment of start, turn and swimming performance for junior and adult national team swimmers. The in-field PAS provides a mobile method to assess start, turn and clean swimming performance with high validity and reliability. The analysis template and manual included in the present article aid the practical application of the PAS in research and development projects as well as academic works.

Older people in the world of esport: a qualitative study.

The inclusion of older players in the gaming world is growing rapidly, leading to the emergence of specific categories for them at major esport events. The aim of this study is to analyze the psychological issues faced by older people when engaging with the competitive context of esport. The study was conducted in 2021 within the French association Silver Geek, which offers digital workshops using Nintendo Wii consoles to older people living in retirement homes and organizes annual amateur competitions between teams of older adults. This qualitative study involved 16 participants (eight women, eight men) aged 63 to 97 years. Semi-structured interviews were used to explore the motivations, emotional well-being, and social impact of esport on older people. The results show that older people who participate in esport are motivated by the discovery and mastery of new game skills, as well as the pleasure of performance through social comparison. All experience a psychological well-being that translates into intense positive emotions. Moreover, the esport context, whether during the pre-competition workshops or the competitions themselves, proved to be a strong vector for positive social relationships, especially with the young e-sports coaches. However, this activity had little impact on existing family relationships. This study highlights the potential of esport as a recreational activity to promote mental health and social integration in older adults. The challenge for future research is to identify the levers that will enable this activity to become a true medium for intergenerational communication.

Outcomes of adolescent children with severe cardiogenic shock referred for extracorporeal membrane oxygenation: insight from collaboration of adult shock team and paediatric cardiac critical care.

Adolescents with severe cardiogenic shock can present to both paediatric and adult centres. We present six adolescent children who had extracorporeal membrane oxygenation consultation fast-tracked with clinical care input from the adult multidisciplinary team, including interhospital transfers on extracorporeal membrane oxygenation. After recovery on conventional cardiogenic shock care or extracorporeal membrane oxygenation, or bridge to transplant, all had favourable neurologic outcome.

Policy brief of the Belgian Europe’s Beating Cancer Plan mirror group: children, adolescents and young adults with cancer

Children and Adolescents and Young Adults with cancer represent a young population with specific needs, which need to be addressed in a patient- and cancer-driven way. There is an urgent need to support and extend the ongoing initiatives in Belgium. First, multidisciplinary care programmes dedicated to children need to be reviewed, and those for Adolescents and Young Adults need to be developed with close collaboration between paediatric and adult oncology and haematology teams. This needs to be done considering the entire patient journey; from cancer prevention, diagnosis, treatment, rehabilitation, follow-up of late effects, transition pathways between paediatric and adult wards, and palliative care. Second, national haemato/oncology precision programmes adapted to this young population with rare cancers, including infrastructure to manage cancer gene predisposition in CAYAs with cancers and their relatives, needs to be developed. This multi-level plan aims to ensure improved outcome with high quality of care for the young population with cancer in Belgium in line with Europe’s Beating Cancer Plan initiatives.

"Look at You Having Fun With Your Markers in Here!": Child Life Specialists' Countering of Infantilizating Narratives in Adult Oncology.

Child life specialists are clinically trained and educated healthcare professionals who work in both healthcare environments and the community to address the needs of ill children and their families. However, child life specialists have previously reported potential for their role, responsibilities, and scope of practice to be misunderstood by their clinical colleagues. Using a narrative methodology, this paper presents the composite narrative of Diane, whose story encompasses the stories of the four child life specialists working in adult oncology environments in Ontario, Canada. Diane's narrative is a counter-story, which counters common assumptions, beliefs, and attitudes about child life specialists. Through spending significant time narrating the multitude of tasks that are encompassed within her scope of care, Diane reaffirms her identity as a valuable member of an interprofessional adult oncology team and counters infantilizing assumptions that she is merely a babysitter or child entertainer. Her story highlights how, while the introduction of child life specialists to adult healthcare environments is new, the work they do is of great benefit to families and their children. The lack of understanding from clinical colleagues of the role of child life specialists, however, hinders not only the development of relationships between colleagues, but also the care for these families.

Visual Mapping of Operating Theater Team Dynamics and Communication for Reflexive Feedback and Surgical Practice Optimization.

Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices. Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics. Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data. Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.

Transition from child to adult health services for young people with cerebral palsy in Ireland; implications from a mixed-methods study

Background Poor transition from child- to adult-oriented healthcare may lead to negative outcomes and dissatisfaction with services in adulthood. The aim of the study was to examine how transition is provided to and experienced by young people with CP in Ireland. This report provides integrated quantitative and qualitative findings and implications based on the totality of knowledge generated. Methods A convergent parallel mixed-methods study was conducted. Data were collected from people with CP aged 16-22 years, parents, and health professionals using surveys and semi-structured interviews, informed by a framework of nine key transition practices. Quantitative and qualitative findings were integrated at the interpretation stage of the research using integration through joint displays. Implications were developed through discussions with health professionals, young people, and parents. Results Surveys were completed by 75 young people/parents and 108 health professionals. Interviews were conducted with 13 young people, 14 parents, and 27 health professionals. There was complementarity between quantitative and qualitative findings indicating lack of a named worker, limited information provision, insufficient self-management support, no opportunity to meet the adult team, limited contact with the GP, and no opportunity for attending formal life skills training. There was dissonance between quantitative and qualitative findings regarding appropriate level of parental involvement. There was silence between quantitative and qualitative findings for promotion of health self-efficacy and senior manager responsible for transition, with quantitative findings indicating these were not present for most young people, but qualitative findings not describing these practices Conclusion Implications of integrated findings include the need for a standardised transition pathway, intentional actions to enable parents and young people to adapt to changing roles, provision of information in a collaborative and phased approach, a common understanding of self-management between young people, parents and health professionals, and the need to involve adults’ services and GPs in transition.

Transition to Adulthood in Pediatric Palliative Care: A Narrative Review.

Pediatric palliative care (PPC) is defined as "the active care of the child's body, quality of life, mind and spirit, also giving support to the family". PPC should be established once a diagnosis of life-limiting or life-threatening disease is reached and should continue as long as necessary. Therefore, pediatric palliative care (PPC) can continue for years, also given the improved care approaches for children with life-limiting or life-threatening diseases. Over time, the child may grow to become a young adult, and when this happens, the transition to adult healthcare services must be undertaken. This article discusses possible interventions, fostering an efficient transition from pediatric to adult palliative care. A narrative review presents issues, experiences, and existing programs. A "Perspectives" section presents opinions and proposals by the authors. The transition process is not limited to a change from pediatric to adult services. Rather, it includes the entire process of the development of the child and requires interdisciplinary management with proper planning and collaboration among professionals of pediatric and adult teams.

A Clinician's Guide To Effectively Transitioning and Transferring Care For Pediatric Patients With Inflammatory Bowel Diseases From The Pediatric To Adult Gastroenterologist.

Transition of care for pediatric patients with inflammatory bowel diseases (IBD) is a continuous, dynamic process that takes place over several years with a coordinated approach executed by a multidisciplinary team. We review the concepts, tools, and research in effective transitioning and transfer of care for adolescent/young adult patients with IBD. Given the constraints within the healthcare system, effective transitioning can be challenging to implement in everyday clinical practice. Different barriers include resources and expertise in effective transitioning by pediatric and adult gastroenterology healthcare providers and the impact of non-gastrointestinal issues facing young adult patients who are learning to manage and coordinate all aspects of their medical care and health maintenance. Factors that facilitate successful care transitioning and transfer include structured transitioning programs, utilization of validated transition checklists, and IBD medical summaries. Proactive transitioning by pediatric gastroenterologists in partnership with their emerging young adult patients with IBD leads to better clinical and psychosocial outcomes and ultimately, effective transfer of care to adult gastroenterology. By utilizing utilize comprehensive transition assessment tools and medical summaries in partnership with their patients, pediatric and adult gastroenterology teams can better prepare patients as they transfer to independent care and health maintenance.

Normal hip strength and range of motion values in youth and adult female national football teams: Data from 504 assessments

ObjectivesTo determine normal hip adduction- and abduction strength and range of motion (ROM) values for youth and adult female national team football players, and evaluate if increasing age, playing position and leg dominance were associated with these strength and ROM values. DesignCohort study. SettingNational football center. Participants344 unique asymptomatic female football players. Main outcome measuresHip internal/external rotation (°), Bent Knee Fall Out test (cm), hip adduction/abduction strength(N) and ratio, and normalised hip adduction/abduction torque (Nm/kg). ResultsA total of 504 assessments were performed. A total of 107 players underwent two (n = 67), three (n = 27) or four (n = 13) assessments. Mean peak hip adduction strength was 39% greater in 20 + Y old players 170 (±53 N) than in 13Y old players 122 (±28 N). Normalised hip adduction torque was 9% greater: 2.5 (±0.8Nm/kg) versus 2.3 (±0.5Nm/kg). A positive association between age and all strength measurements was found, while a negative association between age and hip external rotation and total hip rotation was found. No clinically relevant differences were found for the associations between playing position, leg dominance and hip strength- and ROM values. ConclusionNormal values for hip strength and range of motion in youth and adult female national football players are presented that can be used as clinical reference values.

Single case experiment evaluating the effectiveness of an adapted cognitive behavioural therapy intervention for an older adult with a fear of falling

Aim:A single case experiment was carried out for a 77-year-old woman who was referred to the older adult community mental health team for support with anxiety related to a fear of falling.Method:An AB design was implemented, using an adapted cognitive behavioural therapy graded exposure intervention to target her anxiety and fear of falling.Results:There was an overall reduction in the client’s anxiety and an increase in her activity levels.Conclusion:The adapted intervention resulted in decreased anxiety, psychological distress, and a fear of falling and an increase in the frequency of her walking.Consent:The client was provided with information about the purpose of the write up for this case study. She kindly provided informed written consent for the case study to be published within an academic journal. Some demographic details have been amended to protect her identity.

Conditionally Discharged Restricted Patients in a General Adult Community Mental Health Setting

AbstractLittle is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study, the authors evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures. Supervision in the community is time‐ and resource‐intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training and joint working opportunity with forensic services to ensure safe quality care.

Transition from pediatric to adult care in patients with chronic intestinal failure on home parenteral nutrition: How to do it right?

BackgroundLife expectancy of children with chronic intestinal failure (CIF) on home parenteral nutrition has greatly improved. Children are now able to grow into adulthood which requires transfer from pediatric to adult health care. A guideline for structured transition is lacking and the demand for a more standardized care for this patient group is necessary. Therefore, we investigated the perceptions of health care professionals from various disciplines working in this specific field, concerning effective interventions regarding transition to adult health care. AimTo create a standardized protocol which provides practical guidance for health care professionals in order to bridge the gap between pediatric and adult health care and to facilitate successful transition of children with chronic intestinal failure. MethodsA survey consisting of 20 interventions for transition was sent out to members of the Intestinal Failure working group of European Reference Network for Rare Inherited Congenital (gastrointestinal and digestive) Anomalies (ERNICA) and the Network of Intestinal Failure and Intestinal Transplant in Europe (NITE) group - European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) healthcare professionals in 48 medical centers in various countries. Next to 20 interventions, an open-ended question to fill in any other suggestion with respect to most effective intervention was included. Interventions scoring higher than 80% by the participants were included in the protocol. Interventions scoring between 50% and 80% and other own suggestions were discussed during a consensus meeting and included when consensus, defined as unanimous agreement, was reached. Interventions scoring as effective by < 50% of participants were excluded directly. ResultsA total of 80 healthcare professionals from 33 medical centers (participation rate 69%) participated. The protocol consisted of modifiable components expected to be targets of interventions. The most important key outcomes of the survey were: 1) assessment of patient’s transition readiness and provision of knowledge to the patient by the pediatric team, 2) involvement of parents in the transition process, and 3) collaboration between the pediatric and adult chronic intestinal failure team. In addition it is advised that the transition process should start 1 to 2 years before transfer. A nurse specialist working in both services should form a bridge. All interventions must be tailor-made and based on the maturity of the patient. ConclusionThis study provides a protocol describing transition of children with chronic intestinal failure from pediatric to adult care. This international protocol will serve as practical guidance for pediatric chronic intestinal failure which will provide a more structured, optimal transition process. It is advised to use this protocol as a formal checklist that can be placed in the patient’s chart to review and track the transition process by CIF team members. Future research investigating transition readiness of CIF patients is needed.

A Quality Improvement Project to Investigate How Addenbrooke's Cognitive Examination-III (ACE-III) Training Improves the Accuracy of ACE-III Scoring in an Older Adult Community Mental Health Team

A Quality Improvement Project to Investigate How Addenbrooke's Cognitive Examination-III (ACE-III) Training Improves the Accuracy of ACE-III Scoring in an Older Adult Community Mental Health Team

Quality Improvement Project: Lithium Monitoring in an Older Adult Community Mental Health Team

Quality Improvement Project: Lithium Monitoring in an Older Adult Community Mental Health Team

Comparing locomotor intensity indicators in soccer training and competition across contextual factors: a study of replaced coaches in a Portuguese professional 1st league team

This study aims to examine, for each head coach (HC) replaced, the association between training intensity and physical performances obtained in games. Furthermore, the study investigated how contextual factors influence locomotor and mechanical performance association. External load variables were collected using Global Positioning System (GPS) devices across the 4 weeks and 4 games before and after the replacement in a professional adult male soccer team. Six different HC records were analysed (48.8 ± 7.4 years of age; 11.2 ± 3.9 years as an HC) during a three-season span (2020/21–2022/2023). There were marked differences within player variability across the two coaching regimes. Game loads didn't reflect training-related performance, with differences ranging from −71.4% to −9.9%. Players under the outgoing coaches have greater coverage of meters per minute. Meters per minute, distance covered over 18 km/h and high-speed running (all in training) are found to be significant variables influenced by contextual factors. Within-subject and time, training loads did not reflect game-related loads/performances, with starters showing higher deficits (ranging from −79.0 to −14.5). The study suggests that changes in soccer HC can affect players' training intensity and game performance, influenced by various contextual factors and not directly correlated. This type of information might be very suitable to improve training load periodization and programming. For further research avenues, could be the study of the variation of the psychological states of the players at the time of the dismissal and hiring of the HCs, associating them with the physiological performance at the same moments.

Connections between specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder and primary substance use

PurposeThis study aims to use the database of consumers referred to the dual diagnosis shared care service to examine those connections. The Eastern Dual Diagnosis Service, based in Melbourne, Australia, has established a database of consumers with co-occurring mental health disorders and problematic substance use. An examination of mental health and substance-use information obtained over a two-year period in the delivery of dual diagnosis shared care to consumers of mental health services is supporting an improved understanding of substance use and the connections to specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder.Design/methodology/approachThis research uses a quantitative approach to review the prevalence of primary substance use and mental health diagnoses for consumers referred to as dual diagnosis shared care. Reviewed are referrals from adult mental health community and rehabilitation teams operating within a mental health and well-being program between January 2019 and December 2020 inclusive.FindingsOf the 387 clients referred to the specialist dual diagnosis shared care, methamphetamine, alcohol and cannabis are associated with 89.4% of the primary mental health diagnosis (PMHD). The most common PMHDs are schizophrenia, schizoaffective disorder and bipolar disorder. The most common PMHD and substance-use connection was schizophrenia and methamphetamine. Nicotine was reported to be used by 84% of consumers and often occurred in addition to another problematic primary substance.Originality/valueImproved dual diagnosis data collection from a community-based clinical mental health service is increasing understanding of the mental health and substance-use relationship. This is now providing clarity on routes of investigation into co-occurring mental health and problematic substance-use trends and guiding improved integrated treatments within a contemporary mental health setting.

Implementation of a countywide adult suicide review commission: Development, lessons learned, and recommendations.

Fatality review is a public health approach designed to inform efforts to prevent fatalities of a certain kind (e.g., suicide, homicide) or in a specific setting or population (e.g., hospitals, youth). Despite extensive literature on fatality review generally, the literature on suicide review teams specifically is scant. The aim of this paper is to: describe the implementation of a local adult suicide review commission, detail examples of initial outcomes and recommendations developed by the commission, and provide recommendations and/or best practices for how to develop and implement an adult suicide review team. We utilize framing questions from the American Association of Suicidology's psychological autopsy framework. By using these guiding questions in the discussion, members are invited to explore not only the stressors that may have more immediately preceded the suicide event itself, but to situate those stressors in the context of the individual's life course. Several recommendations proposed by our commission have resulted in tangible outcomes and are detailed using Haddon's Matrix as a guiding prevention planning tool. We have highlighted the need to move beyond looking at individual-level help-seeking to focus on structural/systemic issues that result in stress or create unsafe environments for at-risk individuals.

A novel whole-team training programme for adult eating disorder services in England: rationale, development and preliminary evaluation.

In response to recommendations for improving the quality and coordination of care delivered by eating disorder services, a whole-team training programme was commissioned by Health Education England in 2020. This paper describes the development and evaluation of the Eating Disorder Services for Adults (EDSA) whole-team training course, delivered to National Health Service adult eating disorder community teams in England. Course participants (n = 561) in the first two EDSA training cohorts (2021 and 2022) were asked to complete questionnaires at intake and after each session, asking about their views on the training. All course aspects were rated as highly enjoyable, meeting participants' training needs and fostering reflective practice. Thematic analysis identified themes relating to key innovative features of the course and suggestions for improvements. Preliminary evaluation suggests that EDSA is valued by clinicians to enhance their knowledge, skills and ability to improve eating disorder patient care.