Evidence For Best Practice Research Articles

Clinical updates on phantom limb pain.

Most patients with amputation (up to 80%) suffer from phantom limb pain postsurgery. These are often multimorbid patients who also have multiple risk factors for the development of chronic pain from a pain medicine perspective. Surgical removal of the body part and sectioning of peripheral nerves result in a lack of afferent feedback, followed by neuroplastic changes in the sensorimotor cortex. The experience of severe pain, peripheral, spinal, and cortical sensitization mechanisms, and changes in the body scheme contribute to chronic phantom limb pain. Psychosocial factors may also affect the course and the severity of the pain. Modern amputation medicine is an interdisciplinary responsibility. This review aims to provide an interdisciplinary overview of recent evidence-based and clinical knowledge. The scientific evidence for best practice is weak and contrasted by various clinical reports describing the polypragmatic use of drugs and interventional techniques. Approaches to restore the body scheme and integration of sensorimotor input are of importance. Modern techniques, including apps and virtual reality, offer an exciting supplement to already established approaches based on mirror therapy. Targeted prosthesis care helps to obtain or restore limb function and at the same time plays an important role reshaping the body scheme. Consequent prevention and treatment of severe postoperative pain and early integration of pharmacological and nonpharmacological interventions are required to reduce severe phantom limb pain. To obtain or restore body function, foresighted surgical planning and technique as well as an appropriate interdisciplinary management is needed.

Electroacupuncture for alleviation of phantom limb pain

Phantom limb pain is clinically defined as the perception of pain or discomfort in a limb that no longer exists. Most amputees will experience phantom limb pain, which is associated with a low health-related quality of life. Phantom limb pain represents an important challenge in finding an effective therapy. The scientific evidence for best practice is weak, and is characterized by various clinical reports describing the pragmatic use of drugs and interventional techniques. Recent approaches to restore the sensory motor input have shown promise. One such technique is electroacupuncture. We report here a case study of a male in his 30s who sustained severe injuries, including a high transfemoral amputation, as a result of being hit by a car. An electroacupuncture treatment protocol was used. Over the course of 3 months, electroacupuncture alleviated the patient’s phantom limb pain, minimized his use of drugs, and improved his sleep and quality of life. The effect of electroacupuncture treatment lasted for 3–4 months, and successful top-up treatment maintained his pain relief. The results are in line with a study comparing massage and electroacupuncture in patients with spinal cord injury with neurogenic pain; a limited number of patients treated with electroacupuncture were significantly alleviated of their pain for months. This case report suggests that electroacupuncture may be useful in patients with phantom limb pain.LAY ABSTRACTSince phantom limb pain was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies has increased every year. Although many hypotheses have been proposed regarding the mechanisms of pain and many treatments approaches tried, there is a lack of successful treatments to induce long-term pain relief, improve sleep and quality of life in patients with phantom limb pain. A novel treatment approach used in patients with spinal cord injury pain is electroacupuncture. This case report used a long-term electroacupuncture protocol in a patient with phantom limb pain.

Enhancing translational team effectiveness: The Wisconsin Interventions in Team Science framework for translating empirically informed strategies into evidence-based interventions.

Achieving the clinical, public health, economic, and policy benefits of translational science requires the integration and application of findings across biomedical, clinical, and behavioral science and health policy, and thus, collaboration across experts in these areas. To do so, translational teams need the skills, knowledge, and attitudes to mitigate challenges and build on strengths of cross-disciplinary collaboration. Though these competencies are not innate to teams, they can be built through the implementation of effective strategies and interventions. The Science of Team Science (SciTS) has contributed robust theories and evidence of empirically-informed strategies and best practices to enhance collaboration. Yet the field lacks methodological approaches to rigorously translate those strategies into evidence-based interventions to improve collaborative translational research. Here, we apply lessons from Implementation Science and Human-Centered Design & Engineering to describe the Wisconsin Interventions in Team Science (WITS) framework, a process for translating established team science strategies into evidence-based interventions to bolster translational team effectiveness. To illustrate our use of WITS, we describe how University of Wisconsin's Institute for Clinical and Translational Research translated the existing Collaboration Planning framework into a robust, scalable, replicable intervention. We conclude with recommendations for future SciTS research to refine and test the framework.

Optimizing the quality of clinical studies on oral microbiome: A practical guide for planning, performing, and reporting.

With this review, we aim to increase the quality standards for clinical studies with microbiome as an output parameter. We critically address the existing body of evidence for good quality practices in oral microbiome studies based on 16S rRNA gene amplicon sequencing. First, we discuss the usefulness of microbiome profile analyses. Is a microbiome study actually the best approach for answering the research question? This is followed by addressing the criteria for the most appropriate study design, sample size, and the necessary data (study metadata) that should be collected. Next, we evaluate the available evidence for best practices in sample collection, transport, storage, and DNA isolation. Finally, an overview of possible sequencing options (eg, 16S rRNA gene hypervariable regions, sequencing platforms), processing and data interpretation approaches, as well as requirements for meaningful data storage, sharing, and reporting are provided.

Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice.

Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.

Practical Imaging Strategies for Intussusception in Children.

OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.

What, Besides a Lack of Reoffending, Indicates Successful Completion of a Drug Court Program

Drug courts were developed in the United States in the late-1980s as a response to the perceived ineffectiveness of traditional criminal justice responses to drug-related problems. Over the past 20 years drug courts have begun to emerge across the world. In Australia, the model was first adopted in New South Wales in 1999 and continues to gain popularity in most States. Drug court program evaluations routinely focus on recidivism rates as a key indicator of performance; however, this measure does not consider any other components that can result in a successful drug court outcome. This article presents the methodology and analysis of research that sought to determine what other elements of the drug court process are linked to the successful completion of a drug court program. A documentary analysis was conducted of the operation and outcomes of Australian drug courts and thematic analysis of naturalistic observation data from drug court proceedings. The research conclusively identified one overarching theme – “the rehabilitative ideal” – and how it is linked to drug court success. In this vein, the article discusses a number of recommendations on how drug courts can be informed by evidence of best practice to enhance outcomes.

The National Collaborating Centre for Methods and Tools: Supporting evidence-informed decision making

Abstract Background Public health continuously evolves to address an uncertain future, and public health professionals must effectively and efficiently adapt to changes. Evidence-informed decision making (EIDM) is one way to adapt to change. The National Collaborating Centre for Methods and Tools (NCCMT) provides high quality resources, training and mentorship to support the EIDM process through both in-person and distance-based formats. Freely accessible resources including online training opportunities can help public health professionals globally put evidence into practice and be ready to respond to change. Objectives The NCCMT's work is driven by the belief that everyone deserves optimal health and well-being and this can be achieved by using the best available evidence in practice. Our training and education resources include thirteen online learning modules, an EIDM skills assessment, video series, a rapid review guidebook and regular webinars, amongst others. These resources are self-paced and they can be accessed when and where it is most convenient for public health professionals. Results The NCCMT's resources are highly accessed, with over 320, 000 visits to the NCCMT website from around the world from April 2018-March 2019. There were also over 42,000 downloads of knowledge products in the same time period. The NCCMT's resources have been integrated into public health organizations and curriculum in public health postsecondary programs in Canada. We are continuously evolving by engaging our users. We will be launching an updated version of our Learning Centre in April 2020. Conclusions The NCCMT houses useful resources for all public health professionals to learn about finding, understanding, and using evidence. Public health professionals from around the world have used the NCCMT's educational resources to put evidence into practice. The NCCMT is committed to working with global organizations to support them to achieve their EIDM goals. Key messages The NCCMT supports public health professionals to use the best available evidence in practice. The NCCMT offers high quality resources, training and mentorship to public health professionals.

‘I’m praying for a miracle’: characteristics of spiritual statements in paediatric intensive care unit care conferences

ContextSupporting spiritual needs is a well-established aspect of palliative care, but no data exist regarding how physicians engage with patients and families around spirituality during care conferences in paediatric intensive...

Overview and symptom management in heart failure patients eligible for palliative care

Burden symptom in advanced heart failure highly affects quality of life of both patients and caregivers, leading to severe functional limitation and social isolation. Symptoms in the advanced phases of the disease are numerous and often underestimated and undertreated. This negatively affects not only quality of life, but also increases hospitalizations, reduces therapeutic adherence, impairs cardiac function and leads to reduced survival. When symptom control cannot be achieved only with specific cardiologic therapy, optimal care should shift to a combination of life-prolonging and symptom-relief approach, possibly to be initiated as soon as advanced phases are detected. Optimal treatment of severe and invalidating symptoms requires a multi-modal and multi-dimensional approach, as pharmacological therapy represents only a part of a global evaluation that should include spiritual and psycho-social factors, potentially influencing symptom perception. Assessment therefore should rely on multi-modal and multi-dimensional patient-centered score models, such as the Edmonton Symptom Assessment System (ESAS), the Kansas City Cardiomyopathy Questionnaire (KCCQ), or the Integrated Palliative care Outcome Scale (IPOS).Pain, dyspnea, depression, fatigue and less frequent but distressing symptoms, including gastrointestinal disorders (nausea, vomiting, fecal impaction, hiccups), cough, itching, skin xerosis and restless legs syndrome, will be analyzed, and evidence of best palliative practice will be discussed.

Exploration of advanced practice nurses' competencies necessary for achievement of universal health coverage in Jordan.

Given the global shortage of the health workforce and the nature of diseases, strengthening and improving health care systems become a necessity. One of the solutions that is recommended by the literature is to utilize advanced practice nurses (APNs) to accelerate the progress toward the Sustainable Development Goals and universal health coverage (UHC). To delineate APN practice and competencies in relation to UHC and primary care in Jordan from the perspective of nurse administrators, clinical nurse specialist, academics, and policymakers. A descriptive exploratory survey design was utilized to identify APN competencies that are important in achieving UHC. The survey developed by one of the authors (JH) at a PAHO Collaborating Center to delineate APN practice and APN competencies was adapted and utilized. A convenience sample of 94 nurse leaders was recruited from the education sector, nursing associations, councils, and hospitals. The results showed that all four competencies (clinical care; interdisciplinary and patient-centered communication; systems of care; and using evidence for best practice) were rated as agree/strongly agree across all four domains. There was a consensus of participates on dimensions of all competency domains. The current study confirms that the role of APNs is still in its infancy in Jordan. The current study provides nurse educators with baseline information that can be utilized as a framework for APN education programs. The faculty readiness to start new competency-based APN programs or revise the current graduate programs needs to be assessed.

Shift Handover Practices Among Nurses in Medical Wards: A Qualitative Interview Study

Aim: To examine the shift handover practices in various medical wards in Brunei. Objectives were to examine shift handover practices between the nurses and between shifts, to identify supports to enhance handover effectiveness and to identify barriers of effective handover. Background: Handover practices is a routine activity, and ineffective handover practise constitutes a risk to patient safety. Evidence suggests that handover effectiveness is influenced by factors such as through standardised handover practice. Design: A descriptive qualitative study using content analysis. Methods: The study involved a series of individual interviews among a sample of nurses recruited from 6 medical wards in the largest hospital in Brunei. A total of 13 nurses took part in the interview. Data were analysed with qualitative content analysis method. Results: The analysis revealed three broad themes, namely "multiple handover style", "use of handover tool" and "handover distractions". The first theme indicates that there are several handover styles used in the medical wards, which may be related to the cultural and organisational factors. The second theme illustrates the use of a tool in handover practices, and the final themes describe perceived shift handover distractions which could potentially influence the effectiveness of the handover practices. Conclusion: The evidence in the current study suggests that several aspects of the multiple shift handover practices of nurses are not always consistent with best-practice evidence. The results show that nurses need to communicate accurate and concise information, which can be easily understood by both the giver and the recipient to ensure the quality and safety of patient care.

Prática baseada em evidência: um levantamento em profissionais atuantes na área de fisioterapia hospitalar: um estudo transversal

Introdução: A Prática Baseada em Evidências (PBE) consiste em uma combinação entre a experiência do terapeuta, a melhor evidência disponível e a preferência/adaptação do paciente. O fisioterapeuta hospitalar detém conhecimentos sobre procedimentos terapêuticos validados por pesquisas, com comprovação da eficácia de suas técnicas. Sua presença é indispensável em setores como UTI adulto, UTI neonatal e enfermarias. Por se tratar de uma área primordial para a reabilitação de pacientes internados, faz-se necessário identificar se os profissionais, que atuam nos diversos setores do ambiente hospitalar, estão devidamente aptos a oferecer o melhor serviço disponível utilizando os princípios da PBE.Objetivo: Descrever comportamentos, conhecimentos, habilidades, opiniões e barreiras relacionados à PBE reportados por fisioterapeutas hospitalares atuantes em um hospital público estadual de Santa Catarina.Métodos: Foi utilizado um questionário eletrônico adaptado que identificou comportamentos, conhecimentos, habilidades, opiniões e barreiras em PBE reportados pelos participantes.Resultados: A taxa de resposta ao questionário foi de 72,72% (16 respondentes). O meio de atualização profissional mais utilizado foram os artigos científicos (56,3%), sendo a base mais acessada a Scielo (93,8%) seguida da Pubmed (81,3%). Os fisioterapeutas (87,5%) relatam que sabem o significado do termo PBE e procuram implantar a melhor evidência científica na prática clínica (75,0%), auxiliando na qualidade dos serviços de saúde (56,3%). As barreiras mais relatadas foram o idioma dos artigos, a falta da qualidade de evidências, a dificuldade de obter o artigo na íntegra, a falta de tempo, a dificuldade de entendimento dos dados estatísticos, a interpretação dos resultados e a falta de treinamento em PBE.Conclusão: Os fisioterapeutas hospitalares relatam atitudes positivas quanto ao uso da PBE, apresentam interesse em aprofundar seus conhecimentos sobre o tema a fim de utilizar a melhor evidência científica na prática clínica, visando à qualidade no atendimento ao paciente. Por outro lado, algumas barreiras dificultam a implantação da PBE na rotina diária de atendimento.

Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019-A Review.

Tsetse transmitted trypanosomiasis is a fatal disease commonly known as Nagana in cattle and sleeping sickness in humans. The disease threatens food security and has severe economic impact in Africa including most parts of Zambia. The level of effectiveness of commonly used African trypanosomiasis control methods has been reported in several studies. However, there have been no review studies on African trypanosomiasis control and management conducted in the context of One Health. This paper therefore seeks to fill this knowledge gap. A review of studies that have been conducted on African trypanosomiasis in Zambia between 2009 and 2019, with a focus on the control and management of trypanosomiasis was conducted. A total of 2238 articles were screened, with application of the search engines PubMed, PubMed Central and One Search. Out of these articles, 18 matched the required criteria and constituted the basis for the paper. An in-depth analysis of the 18 articles was conducted to identify knowledge gaps and evidence for best practices. Findings from this review provide stakeholders and health workers with a basis for prioritisation of African trypanosomiasis as an important neglected disease in Zambia and for formulation of One Health strategies for better control and/or management of the disease.

The Role of National Registries in Improving Quality of Care and Outcomes for Cardiovascular Disease.

Cardiovascular registries play an integral role in providing real-world data on a number of cardiovascular conditions and allowing measurement of quality metrics across a large cohort of patients. Over the past 35 years, the number of cardiovascular registries has skyrocketed, and their use will only continue to grow as data on novel procedures and devices will need to be collected and analyzed. The American College of Cardiology and Society of Thoracic Surgeons Transcatheter Valve Therapy Registry is just one example of a modern registry that plays a crucial role in collecting data on patients undergoing transcatheter valvular procedures. Through public reporting registries, data can be shared on a hospital and provider level for many quality performance measures. There remains much work to be done on allowing automated data extraction from the electronic medical record directly into registries. No matter how sophisticated and complete a registry is, it can never overcome the problem of treatment selection bias that is inherent in observational data. This review discusses the growth, benefits, and limitations of national registries and their role in developing evidence for best clinical practice, measuring outcomes, providing feedback to clinicians, and improving quality of care.

High-fidelity simulation-based education in pre-registration healthcare programmes: a systematic review of reviews to inform collaborative and interprofessional best practice

ABSTRACT Simulation-based education (SBE) is recognized as an effective interprofessional teaching and learning method. Whilst there is a large volume of research evidence concerning elements of SBE there is a lack of clarity concerning foundational principles of best practice. This is important for educators wishing to utilize high-quality SBE to deliver interprofessional education. The aim of this review is to synthesize review evidence of SBE best practice in a broad range of pre-registration healthcare programs and contextualize findings in light of relevant educational theory. A systematic search of PubMed, Scopus, Medline/Ovid, British Nursing Index, and the Cochrane Library databases was undertaken in February 2020. Data extraction and quality evaluation were undertaken by two authors. Fifteen reviews were included. In addition to identifying barriers and enablers to implementation, three interdependent themes regarding SBE best practice were found: curriculum level integration and planning (curriculum level integration, the opportunity for deliberate repeated practice, distribution, and sequencing); simulation design and delivery (clearly defined learning outcomes and benchmarks, pre-brief, multiple learning strategies, interactivity and individualized learning, feedback, and debrief); and resources (facilitator competency, controlled environments). These themes broadly align with the social constructivist theory of experiential learning whereby structured opportunities to learn via concrete experience, reflective observation, abstract conceptualization, and active experimentation are provided through effective planning, design, and delivery of SBE. Interdependencies suggest that integration of SBE at curriculum-level enables planning and implementation of best practice principles which are associated with effective learning, which also inform and facilitate the availability of adequate simulation resources.

An embedded mixed-methods study highlighted a lack of discussions on retention in clinical trial consultations

ObjectivesThis study investigated trial consultations to identify whether and to what extent discussions of retention are present. Study Design and SettingThis embedded mixed-methods study design included a purposive sample of audio-recorded trial consultations obtained from four sites of a large multicenter UK-based surgical RCT. Study participants included potential trial participants, trial surgeons (TSs), and research nurses (RNs). ResultsForty-four participants were included in this study: potential trial participants (n = 37); TSs (n = 4); and RNs (n = 3). Analysis revealed no discussion of retention across 79% of consultations. Of the remaining 21% where discussions of retention were present, only 3% (maximum) of the conversation related to retention. There was some evidence of good practice, but on the whole the discussions contained inaccuracies about timing and delivery of questionnaires and the right to withdraw often highlighted without providing trial consequences. ConclusionThis study is the first to explore trial consultations for discussions of retention. It suggests that there may be room for improvement within current practice. Further research is required to determine the generalizability of the findings reported to other clinical trials.

P9 Ethnic variability in Post-Mastectomy Breast Reconstruction (PMBR)

Background Current evidence for best practice indicates breast reconstruction post-mastectomy is associated with greater quality of life and psychological well-being.1 However, rates of reconstruction many not be equivalent across all ethnicities, which contributes to disparities in health outcomes.2 Methods A retrospective review of patients diagnosed with breast cancer between January 1st and December 31st, 2017 at Counties Manukau District Health Board (CMDHB) was performed. Patient demographics, eventual breast cancer treatment, and evidence of whether a reconstruction discussion took place were collected. This data was analysed to assess rates of reconstruction by ethnic group. Results 386 patients were diagnosed with cancer in CMDHB Breast cancer clinic in 2017. Of these women, 190 underwent mastectomy as primary treatment with 30 of these women also receiving reconstruction (either immediate or delayed) giving a reconstruction rate of 15.8%. Indigenous Maori women represented only 10% of the total immediate and delayed reconstructions in CMDHB in 2017. European women comprised 70% of total reconstructions but only represented 50% of all mastectomies. 34.7% of patients receiving mastectomy in 2017 were of Maori or Pasifika ethnicity. Of these patients, only 31.8% of women met eligibility criteria for immediate breast reconstruction at CMDHB (Body Mass Index (BMI) < 35 and non-smoker). There was a statistically significant difference between eligibility in Maori, Pasifika, European and Asian ethnicity groups for post-mastectomy reconstruction at BMI values below 35 (p < 0.05). Conclusion Eligibility rates for post-mastectomy reconstruction are significantly lower (p < 0.05) in Maori and Pasifika women when compared with European and Asian populations. This difference reflects higher smoking rates and higher BMI values in Maori and Pasifika women. Changing eligibility criteria such as having a higher BMI threshold for Maori and Pasifika women may improve access to breast reconstruction in these populations. 1. Cagli B, Cogliandro A, Barone M, Persichetti P. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2014 Apr;133(4):594e–5e2. Schumacher JR, Taylor LJ, Tucholka JL, Poore S, Eggen A, Steiman J, et al. Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors. Ann Surg Oncol. Springer International Publishing; 2017 Aug 1;24(10):3017–23.

Chronic Conditions and Behavioural Change Approaches to Medication Adherence: Rethinking Clinical Guidance and Recommendations.

Patient adherence to medication is an ongoing concern for clinicians, obfuscating treatment efficacy and resulting in wastage of medicine, reduced clinical benefit, and increased mortality. Despite this, procedural guidance on how clinicians should best engage patients regarding their medicine-taking is limited in the United Kingdom. Adherence for chronic conditions is notably complex, requiring clear education, communication, and behavioural shifts to initiate and sustain daily regimens successfully. This article explores current clinician guidance on assuring patient adherence to medication within the National Health Service, comparing it to that provided for healthcare workers in the field of behavioural change. Outlining the inertia of the former and the progress of the latter, we consider what steps should be taken to address this deficit, including greater focus on patient concerns, as well as knowledge translation for healthcare professionals in future adherence research. Current United Kingdom clinical guidance for assuring patient adherence is largely outdated based on inconclusive evidence for best practice. However, efforts to encourage behavioural change in the public health setting demonstrate evidence-based success. Integrating knowledge generated around adherence behaviour and the practical application of adherence and behavioural change research, as well as funding for longer-term studies with a focus on clinical outcomes, may help to solidify the NICE guidance on adherence and further progress the field. This would require close involvement from patient groups and networks informing ethical aspects of study design and clinical implementation.

Shifting the mindset-adolescent and young adult rheumatology in transition.

Almost 30 years have passed since publication of the first reports acknowledging the crucial importance of transitional care for adolescents and young adults with chronic disease, but universal implementation has yet to be achieved. Progress has undoubtedly been made, with increasing evidence for best practice in transitional care. However, translation of research and guidance into clinical practice continues to be challenging. Neuroscience advances in understanding the changes occurring in the adolescent brain demand that the third phase of transition (ie, post-transfer to adult services) is given further attention, with recognition that transfer itself is not the end of the transition process. The complex, often unwieldy health systems delivering care must also be considered. Paediatric and adult rheumatology practitioners need to collaborate not only with each other, but also with practitioners in other disciplines, specialties, and agencies, to plan and commission rheumatology services that are responsive to adolescents and young adults. A shift in approach from focusing on health transition towards developmentally appropriate health care has the potential to improve the care provided during this vulnerable life stage, increasing the likelihood of continuing engagement of patients in their own health care into adulthood and thereby improving health outcomes.