Transition Program Research Articles

Defining the gaps in transitional care to adulthood for patients in paediatric surgical specialties: a scoping review protocol

IntroductionTransitioning patients from their paediatric centres to adulthood is an important subject for many of these patients living with different chronic pathologies. There are few studies that assess its effectiveness...

Shooting for the STARS: Implementing an Evidence-Based Program to Meet the End of Treatment Needs of Childhood Cancer Survivors and Their Families.

Background: The end of treatment (EOT) is a significant time point along the childhood cancer treatment-survivorship continuum, and is recognized as a time when childhood cancer survivors (CCS) and their families experience significant vulnerability and stress. There is a call by families and healthcare professionals alike for standardized, comprehensive EOT services to successfully navigate through this transition period and better cope with posttreatment medical, physical, and social-emotional issues. Method: A multidisciplinary team of pediatric oncology health care professionals developed and implemented a two-session psychoeducational program to address these EOT needs. To evaluate the Shooting for the STARS (Survivors Tackling All Roadblocks Successfully) EOT Transition Program, a pretest-posttest repeated measures design was utilized. A convenience sample of 47 parents/caregivers and 29 CCS completed surveys before, during, and after the EOT services were received. Analysis of relationships and changes over time was conducted using Spearman-ranked correlations and Friedman tests, a nonparametric repeated measures analysis of variance. Results: All respondents reported program satisfaction, with 94.7% feeling somewhat or very prepared for ending treatment. Participants' distress levels tended to decrease over time. Parent/caregiver-reported levels of CCS' anxiety, fatigue, pain interference, and physical mobility significantly improved over the time period during which families participated in the Shooting for the STARS Program. Discussion: This nurse-led, evidence-based program was determined to be feasible and acceptable. It may contribute to improved health-related quality of life and decrease distress over time.

A nurse-led coaching intervention with home telemonitoring for patients with heart failure: Protocol for a feasibility randomized clinical trial

Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation.We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT.

Effects of a 10-week footstrike transition programme on tibial stress fracture probability; a randomized controlled intervention using finite element and probabilistic modelling

Introduction: The aim of this study was to undertake a randomized control trial examining the effects of a 10-week footstrike transition program on tibial stress fracture risk compared to control. Material and methods: Twenty habitual rearfoot strike runners were randomly assigned to either footstrike or control groups. The footstrike group undertook a graduated 10-week program which allowed them to convert their habitual rearfoot strike pattern, whereas the control group maintained their normal training regime without any alterations to their strike pattern. Running biomechanics were collected using an eight-camera motion capture system, and ground reaction forces using a force plate. Tibial strains were quantified using finite element modelling and stress fracture probability calculated via probabilistic modelling over 100 days of running. The primary outcome: tibial stress fracture probability, and secondary outcomes: running biomechanics, muscle forces, joint contact forces, and tibial strain indices were measured at baseline and after 10 weeks. Results: Intention-to-treat analyses revealed no significant alterations in the primary outcome (Footstrike: baseline = 12.82% & 10-weeks = 10.82%, Control: baseline = 15.43% & 10-weeks = 13.39%) between arms. However, alterations in the strike index (Footstrike: baseline = 21.79% & 10-weeks = 65.74%, Control: baseline = 13.61% & 10-weeks = 12.41%) and the loading rate (Footstrike: baseline = 165.85BW/s & 10-weeks = 100.01 BW/s, Control: baseline = 170.13 BW/s & 10-weeks = 197.87 BW/s) were significantly greater in the footstrike group compared to the control one. Conclusion: This trial concludes that the footstrike intervention adopted in this study was not effective in mediating improvements in tibial stress fracture risk, although future intervention trials could examine the efficacy of footstrike modification on other musculoskeletal injuries in runners.

The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery

BackgroundThe aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery. MethodsThis study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention. ResultsThe results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001). ConclusionThe H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery. Implications to practiceThe results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.

Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations.

The effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs. To identify barriers and facilitators to developing partnerships between hospitals and CBOs to facilitate care transitions for patients with SUDs. Qualitative study using semi structured interviews conducted between November 2022-August 2023. Staff and providers from hospitals affiliated with four safety-net health systems (n=21), and leaders and staff from the CBOs with which they had established partnerships (n=5). Interview questions focused on barriers and facilitators to implementing TOPs, developing partnerships with CBOs, and successfully transitioning SUD patients from hospital settings to CBOs. We identified four key barriers to establishing transition partnerships: policy and philosophical differences between organizations, ineffective communication, limited trust, and a lack of connectivity between data systems. We also identified three facilitators to partnership development: strategies focused on building partnership quality, strategic staffing, and organizing partnership processes. Our findings demonstrate that while multiple barriers to developing hospital-CBO partnerships exist, stakeholders can adopt implementation strategies that mitigate these challenges such as using mediators, cross-hiring, and focusing on mutually beneficial services, even within resource-limited safety-net settings. Policymakers and health system leaders who wish to optimize TOPs in their facilities should focus on adopting implementation strategies to support transition partnerships such as inadequate data collection and sharing systems.

A Cross-Sectional Study of Disparities in Healthcare Transition in Cerebral Palsy.

Background: Cerebral palsy (CP) is the most common physical disability among children, affecting their lifespan. While CP is typically nonprogressive, symptoms can worsen over time. With advancements in healthcare, more children with CP are reaching adulthood, creating a greater demand for adult care. However, a significant lack of adult healthcare providers exists, as CP is predominantly considered a pediatric condition. This study compares the transition experiences of children with CP compared to those with other developmental disabilities (DDs) and typically developing children (TDC). Methods: This study utilizes cross-sectional data from the National Survey of Children's Health (NSCH) from 2016-2020, including 71,973 respondents aged 12-17. Children were categorized into three groups: CP (n = 263), DD (n = 9460), and TDC (n = 36,053). The analysis focused on the receipt of transition services and identified demographic and socioeconomic factors influencing these services. Results: Only 9.7% of children with CP received necessary transition services, compared to 19.7% of children with DDs and 19.0% of TDC. Older age, female sex, non-Hispanic white ethnicity, and higher household income were significant predictors of receiving transition services. Children with CP were less likely to have private time with healthcare providers and receive skills development assistance compared to other groups. Conclusions: The findings highlight disparities and critical needs for targeted interventions and structured transition programs to improve the transition from pediatric to adult healthcare for children with CP. Addressing disparities in service receipt and ensuring coordinated, continuous care are essential for improving outcomes for children with CP.

Feasibility of BrainSTORM, a Traumatic Brain Injury Transitional Care Intervention.

To investigate the feasibility, acceptability, and clinical outcome measures of a transitional care intervention for patients with traumatic brain injury (TBI) and their family caregivers. Inpatient and outpatient rehabilitation at a level I trauma center in the Southeastern United States. Patients (ages 18-75) diagnosed with moderate to severe TBI, receiving rehabilitation, and their family caregivers. Quasi-experimental, single-arm, single-center feasibility study with pre- and post-test design. Participants completed a 4-month transitional care program involving monthly education and social support. Feasibility of enrollment, data collection, intervention completion rates, and intervention acceptability. Clinical outcome measures included patient quality of life (QOL) (12-Item Short Form Health Survey (SF-12), primary outcome) and patient and caregiver self-efficacy (Self-Efficacy for Management of Chronic Conditions Scale). Eleven dyads and 1 monad enrolled (N=23, 12 patients, 11 caregivers). All completed baseline data; 91.3% (n=21, 11 patients, 10 caregivers) completed 2-month (intervention midpoint) data; and 86% (n=20, 11 patients, 9 caregivers) completed 4-month (intervention endpoint) data. The intervention completion rate was 91.67%. Participants engaged in a mean of 2.17 (SD=1.34) monthly educational webinars and 2.42 (SD=1.51) social support groups during the intervention period. Approximately 70% of participants (n=16, 9 patients, 7 caregivers) completed acceptability data, indicating positive intervention experiences (patients: mean 9.44/10 [SD=1.01]; caregivers: mean 9.57/10 [SD=0.79]). Patient QOL scores did not statistically improve over time; however, patient self-efficacy scores did statistically significantly improve from baseline (mean=7.03, SD=1.53; P =.0197) to intervention end point (4months) (mean=8.35, SD=1.71). Brain Injury Support To Optimize Recovering Minds (BrainSTORM) is a promising new TBI transitional care intervention that has potential to enhance care standards for patients with TBI and their family caregivers. Further research is needed to determine its efficacy.

Cadherin Expression Profiles Define Glioblastoma Differentiation and Patient Prognosis.

Cadherins are cell-cell adhesion proteins which have been strongly implicated in cancer invasion, dissemination and metastasis capacity; thus, they are key players in the epithelial-to-mesenchymal transition (EMT) program. However, their role in glioblastoma (GBM), a primary central nervous system aggressive tumor, remains to be clarified. N-, E- and P-cadherin expression was analyzed on a large series of GBMs, characterized with clinical, imaging and neuropathological parameters, as well as with patients' survival data. In addition, cadherins' expression was studied in match-recurrent cases. Using TCGA data, cadherin expression profiles were also evaluated according to GBM transcription subtypes. N-cadherin expression was observed in 81.5% of GBM, followed by E-cadherin in 31% and P-cadherin in 20.8%. Upon tumor recurrence, P-cadherin was the only significantly upregulated cadherin compared with the primary tumor, being positive in 65.8% of the cases. Actually, P-cadherin gain was observed in 51.4% of matched primary-recurrent cases. Cadherins' co-expression was also explored. Interestingly, E- and N-cadherin co-expression identified a GBM subgroup with frequent epithelial differentiation and a significant survival benefit. On the other hand, subgroups with P-cadherin expression carried the worse prognosis. P- and N-cadherin co-expression correlated with the presence of a mesenchymal phenotype. Expressions of isolated P-cadherin or E- and P-cadherin co-expression were associated with imaging characteristics of aggressiveness, to highly heterogeneous tumors, an d to worse patient survival. Classical cadherins co-expression subgroups present consistent clinical, imaging, neuropathological and survival differences, which probably reflect different states of an EMT-like program in GBM.

Kindergarten readiness: associations with a summer transition program and teacher/school level factors

ABSTRACT Transition to kindergarten is an important developmental milestone for children and families. This study explored factors associated with kindergarten readiness focusing on the impact of a summer kindergarten transition program. A mixed-method design was employed, and the qualitative data from interviews with 16 randomly selected kindergarten teachers and the quantitative data of assessment scores of 320 kindergarteners were analyzed. Compared with children who were eligible but did not participate in the transition program, those who participated in the program had significantly more family engagement and stronger home-school relations. Smaller class sizes were associated with children’s higher readiness scores in both academic achievement and social-emotional development. Larger school enrollment was associated with children’s higher readiness scores in academic achievement, more family engagement, and stronger home-school relations. Higher school poverty was associated with children’s lower readiness scores in social-emotional development. The findings can be used to inform program development and policymaking.

In the Name of My Father: The Personalization of Government in Nigerian Politics, 1999-2023

The study examines the implications of the roles of class, godfatherism, and personalization of government for Nigeria’s political development and nation-building. The research method employed was the qualitative analytical method which involved content analysis of relevant documentary data on the subject. The approach adopted was also thematic. The research findings indicate that because of the “unending” transition to civil rule, most politicians avoided the transition because they are not certain if the military will hand over power to civilian, and they lacked the money to compete with the political entrepreneurs. These gave room for political entrepreneurs or ‘money bags’ to dominate the transition programme. The principle of party supremacy shortly lost its meaning as campaign organizations took over from party secretariats. And the party’s manifesto or programme lost its meaning to the personal ‘greed’ or ambitions of the political entrepreneurs, who also positioned their children to power through various means, including inheritance of political legacies, strategic alliances, and leveraging financial resources. The attitude of these godfathers impacted negatively on good governance. It also reduces the legitimacy of government and voids the electoral value of the citizens.

A scoping review of hospital to home transitional care programmes for stroke survivors.

The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors. Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke. A scoping review. Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023. Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria. This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home. This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them. PRISMA checklist for scoping reviews. No patient or public contribution was part of this study.

Does transition theory matter? A descriptive study of a transition program in Australia based on Duchscher’s Stages of Transition Theory and Transition Shock Model.

Objective: Explore the impact of transition program policy directives grounded in foundational elements of transition theory. Background: Within fast-track health service environments nurse leaders remain committed to improving transition programs that support wellbeing and retain new graduate nurses. Duchscher’s Stages of Transition Theory and Transition Shock model was the framework chosen by the health service nurse leaders to implement in the clinical environment, however, implementing elements can be problematic without sufficient support and clear policy directives. Study Design and methods: Descriptive study using multiple methods in one major national health service that incorporates a number of private (eight) and public (four) hospitals across Australia. Online surveys were distributed to new graduate nurses at one, five and eleven months into the initial transition year. The survey tool was a synthesised adaptation of the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework. At the end of the transition year telephone interviews were conducted with the Nurse Managers who were responsible for implementing transition programs policies and processes. Resulting data were summarised using descriptive statistics for quantitative data and a thematic analysis for qualitative data. Results: 158 new graduate nurses returned the online survey and eight Nurse Managers participated in the telephone interviews. As a whole the new graduate registered nurses described feeling accepted during their transition and expressed feeling comfortable when approaching senior staff. They managed challenges of shift work and took time for self-care. The clear majority (88%) of participants reported no plans to leave the profession. Nurse Managers were able, in most clinical areas, to apply transition program policy and directives and enable the implementation of Duchscher’s Stages of Transition as the framework for the transition support initiatives. Retention of new graduates on their wards at the end of the program was determined to be a positive outcome for Nurse Managers. Discussion: A carefully structured Graduate Nurse Transition Program founded on sound theoretically grounded ideology alongside integrated policy directives guided the Nurse Managers implementation of Duchscher’s Stages of Transition Theory and Transition Shock model into practice. Additionally, a dedicated Graduate Nurse Coordinator role with a manageable ratio of graduate nurses was an important component included in the transition program at each participating hospital as it facilitated support of both graduates and Nurse Managers. These positions should be costed into any Graduate Nurse Transition Program. An interesting finding was the consistency in smaller units that were unable to provide or mobilise preceptors for the required allocated mirrored shifts and it was felt this workload management issue impacted the success of graduate transition nurse programs on those units. Conclusions: Implementing policy directives grounded in foundational elements of Duchscher’s Stages of Transition theory and Transition Shock model delivered consistent experiences for new graduate nurses across one major health service that incorporates a number of hospitals across Australia. Data suggested some practical challenges to program implementation for Nurse Managers, including unit/ward size, staffing, and varying levels of understanding of preceptor roles. Implications for research, policy, practice: Introducing formal policy directives that are grounded in strong theoretical frameworks of professional role transition, agreed to and funded by health service nurse leaders are important in guiding a consistent approach across health services in the implementation of evidence-based Graduate Nurse Transition Programs. What is already known about the topic? Duchscher’s foundational research on the Stages of Transition theory and Transition Shock model is applied to inform Graduate Nurse Transition Programs on an international level. There is a current workforce shortage within Australia and internationally. The importance of retention of newly graduated nurses has become a focus for health care services implementing supportive transition programs to prevent new graduates from leaving the profession in the first year. What this paper adds The inclusion of specific policy directives based on Duchscher’s Stages of Transition theory and Transition Shock model provides clear direction to Nurse Managers related to the required implementation steps and time frames to be met during the transition year. Additional Graduate Nurse Coordinator positions, with a manageable ratio of New Graduate Registered Nurses (NGRNs), are important supports for both graduates and Nursing Managers to meet policy directives. Additional positions should be costed within transition programs. Provides additional evidence that well supported newly graduated nurses are likely to remain within the health service.

Spatiotemporal heterogeneity of LMOD1 expression summarizes two modes of cell communication in colorectal cancer

Cellular communication (CC) influences tumor development by mediating intercellular junctions between cells. However, the role and underlying mechanisms of CC in malignant transformation remain unknown. Here, we investigated the spatiotemporal heterogeneity of CC molecular expression during malignant transformation. It was found that although both tight junctions (TJs) and gap junctions (GJs) were involved in maintaining the tumor microenvironment (TME), they exhibited opposite characteristics. Mechanistically, for epithelial cells (parenchymal component), the expression of TJ molecules consistently decreased during normal-cancer transformation and is a potential oncogenic factor. For fibroblasts (mesenchymal component), the expression of GJs consistently increased during normal-cancer transformation and is a potential oncogenic factor. In addition, the molecular profiles of TJs and GJs were used to stratify colorectal cancer (CRC) patients, where subtypes characterized by high GJ levels and low TJ levels exhibited enhanced mesenchymal signals. Importantly, we propose that leiomodin 1 (LMOD1) is biphasic, with features of both TJs and GJs. LMOD1 not only promotes the activation of cancer-associated fibroblasts (CAFs) but also inhibits the Epithelial–mesenchymal transition (EMT) program in cancer cells. In conclusion, these findings demonstrate the molecular heterogeneity of CC and provide new insights into further understanding of TME heterogeneity.Graphical

Transitional care for older persons with need of geriatric rehabilitation nursing interventions

BackgroundThe literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured.ObjectiveThis study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs.MethodsThis is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out.ResultsThe triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. ConclusionsIt is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.

Maternal loss-of-function of Nlrp2 results in failure of epigenetic reprogramming in mouse oocytes.

NLRP2 belongs to the subcortical maternal complex (SCMC) of mammalian oocytes and preimplantation embryos. This multiprotein complex, encoded by maternal-effect genes, plays a pivotal role in the zygote-to-embryo transition, early embryogenesis, and epigenetic (re)programming. The maternal inactivation of genes encoding SCMC proteins has been linked to infertility and subfertility in mice and humans. However, the underlying molecular mechanisms for the diverse functions of the SCMC, particularly how this cytoplasmic structure influences DNA methylation, which is a nuclear process, are not fully understood. We undertook joint transcriptome and DNA methylome profiling of pre-ovulatory germinal-vesicle oocytes from Nlrp2-null, heterozygous (Het), and wild-type (WT) female mice. We identified numerous differentially expressed genes (DEGs) in Het and Nlrp2-null when compared to WT oocytes. The genes for several crucial factors involved in oocyte transcriptome modulation and epigenetic reprogramming, such as DNMT1, UHRF1, KDM1B and ZFP57 were overexpressed in Het and Nlrp2-null oocytes. Absence or reduction of Nlrp2, did not alter the distinctive global DNA methylation landscape of oocytes, including the bimodal pattern of the oocyte methylome. Additionally, although the methylation profile of germline differentially methylated regions (gDMRs) of imprinted genes was preserved in oocytes of Het and Nlrp2-null mice, we found altered methylation in oocytes of both genotypes at a small percentage of the oocyte-characteristic hyper- and hypomethylated domains. Through a tiling approach, we identified specific DNA methylation differences between the genotypes, with approximately 1.3% of examined tiles exhibiting differential methylation in Het and Nlrp2-null compared to WT oocytes. Surprisingly, considering the well-known correlation between transcription and DNA methylation in developing oocytes, we observed no correlation between gene expression differences and gene-body DNA methylation differences in Nlrp2-null versus WT oocytes or Het versus WT oocytes. We therefore conclude that post-transcriptional changes in the stability of transcripts rather than altered transcription is primarily responsible for transcriptome differences in Nlrp2-null and Het oocytes.

Leveraging User-Friendly Mobile Medical Devices to Facilitate Early Hospital Discharges in a Pediatric Setting: A Randomized Trial Study Protocol.

Mobile technology is increasingly prevalent in healthcare, serving various purposes, including remote health monitoring and patient self-management, which could prove beneficial to early hospital discharges. This study investigates the transitional care program experience facilitating early discharges in a pediatric setting through the use of an easy-to-use mobile medical device (TytoCare™, TytoCare Ltd., Natanya, Israel). This study aims to assess the effectiveness of telehomecare in achieving complete resolution of diseases without readmission, compare the length of stay between intervention and standard care groups, and gather user and professional experiences. A randomized open-label, controlled pilot study enrolled 102 children, randomly assigned to the telehomecare (TELE) group (n = 51, adopting early hospital discharge with continued home monitoring) or the standard-of-care (STAND) group (n = 51). Primary outcomes include complete disease resolution without readmission. Secondary objectives include recording a shorter length of stay in the intervention group. Surveys on user and professional experiences were conducted. A group of 51 children declining telemedicine services (NO-TELE) was also included. In the TELE group, 100% of children achieved complete disease resolution without readmission, with a median duration of stay of 4 days, significantly shorter than the 7 days in the STAND group (p = 0.01). The telemedicine system demonstrated efficient performance and high satisfaction levels. The NO-TELE group showed no significant differences in demographics or digital technology competence. Perceived benefits of telemedicine included time and cost savings, reduced hospital stays, and technology utility and usability. This study demonstrates that user-friendly mobile medical devices effectively facilitate early hospital discharges in a pediatric setting. These devices serve as a bridge between home and hospital, optimizing care pathways.

The Transitioning From Pediatric to Adult Inflammatory Bowel Disease Services: A Qualitative Study of Adolescents and Their Parents.

Inflammatory bowel disease (IBD) often has its onset during late childhood and adolescence, a time of significant change. Young people may be required to transition from a pediatric to an adult IBD service during this time. The transition from pediatric to adult services can be a high-risk period for poor outcomes for emerging adults with IBD. We seek to understand the concerns of patients and carers during this period. Semi-structured interview and interpretative phenomenological analysis were used to explore the experiences of 16 young persons and 10 of their parents during transition. The narrative analysis reflected the importance of three aspects of transition to the young people and their parents during transition. The process of adjusting to illness, parents letting go, and the young person "growing up" were key themes. In addition to patient needs, parental grief and adjustment may be easily overlooked in the transition period: children who only recently needed intensive parental care and involvement may now be seeking higher degrees of autonomy. These findings indicate a role for including psychological interventions addressing the well-being of parents in transition programs.

A transitional pain management program is associated with reduced opioid dependence after major shoulder surgery

BackgroundOver-prescription of opioids in the United States increases risks of opioid dependence, overdose, and death. Increased perioperative and postoperative opioid use during orthopedic shoulder surgery is a significant risk factor for long term opioid dependence. The authors hypothesized that a multidisciplinary perioperative pain management program (Transitional Pain Service or TPS) for major shoulder surgery would lead to a reduced amount of opioids required postoperatively. MethodsA TPS was implemented at a Veterans Affairs Medical Center focused on non-opioid pain management and cessation support. Opioid consumption during the implementation of the TPS was compared to a historical cohort. All patients undergoing shoulder arthroplasty or rotator cuff repair were included. The primary outcome was the proportion of patients continuing opioid use at 90 days postoperatively. Secondary outcomes included postoperative pain scores, time to opioid cessation, and median opioid tablets consumed at 90-days. A multivariable model was developed to predict total opioid use at 90-days postoperatively. Kaplan Meier curves were calculated for time to opioid cessation. ResultsThe TPS group demonstrated decreased persistent opioid use at 90 days post-discharge (12.6% vs. 28.6%; p=0.018). Independent predictors associated with increased total opioid tablet prescriptions at 90 days included length of stay (β=19.17), anxiety diagnosis (β=37.627), and number of tablets prescribed at discharge (β=1.353). Shoulder arthroplasty surgery (TSA) was associated with decreased 90-day opioid utilization (β= -32.535) when compared to cuff repair (RCR). Median time to cessation was shorter in TSA (6 days) when compared with RCR (8 days). Pain scores were reduced compared to population mean by post-discharge day 2 for TSA and by post-discharge day 7 for RCR. Median number of post-discharge opioid tablets (oxycodone 5 mg) consumed under TPS management was 25 in both RCR and TSA surgery groups (180 MME). Discussion and ConclusionsThis study demonstrates that a TPS reduces the amount of opioid use of patients undergoing shoulder arthroplasty or cuff repair at 90 days when compared with a historical control. Multivariable regression indicated that fewer opioid tablets at discharge was a modifiable factor that may aid in reducing opioid consumption and that anxiety diagnosis, increased length of stay, and cuff repair surgery were other factors independently associated with increased opioid consumption. This data will assist surgeons in counseling patients, setting narcotic use expectations, and minimizing overprescribing. Use of a similar multidisciplinary perioperative pain management program may greatly reduce opioid over prescriptions nationally.

Impacts of the Ban on the Soil-Applied Fumigant Methyl Bromide.

The loss of the soil fumigant methyl bromide (MeBr) and adoption of soil fumigant alternatives has been challenging for farmers, particularly for those crops in which pathogens previously controlled by MeBr have emerged as significant problems, but it has resulted in some unanticipated benefits for the scientific community and the environment. Applauded as one of the most effective environmental agreements to date, the universally accepted Montreal Protocol on Ozone Depleting Substances has had a significant impact on the environment, reducing the release of halogenated compounds from anthropogenic sources enough to mitigate global warming by an estimated 1.1°C by 2021. The funding associated with various MeBr transition programs has increased collaboration across scientific disciplines, commodity groups, industry, and regulatory agencies. Chemical alternatives and improved application strategies, including the development of gas-retentive agricultural films, coupled with sound efficacy data and grower ingenuity have resulted in the sustained production of many of the impacted crops; although there has been some loss of acreage and value, particularly for Florida fumigated crops, for some, value has continued to increase, allowing production to continue. The loss of a single, broad-spectrum tool for pest control has led to a deeper understanding of the specific pest complexes impacting these at-risk crops, as well as the development of new, biologically based management tools for their control while increasing our understanding of the role of the soil microbiome in pest control and crop production.