Transition Program Research Articles

Exploring the impact of the mentoring new nurses for transition and empowerment program led by clinical nurse educators in South Korea: A mixed-methods study

Background“New nurses” are those with less than a year of work experience at a hospital. To address the challenges of new nurses caused by their limited experience, the Mentoring New Nurses for Transition and Empowerment Program (MNTEP) was designed based on the Stress-Appraisal-Coping Model of Lazarus and Folkman. ObjectivesThis study aimed to explore the impact of the MNTEP, in which clinical nurse educators teach stress-coping strategies, on the clinical transition of new nurses in South Korea. DesignThis study used a mixed-methods design with a pretest-posttest non-equivalent comparison group and focus group interviews (FGIs). SettingsThe research was conducted at a hospital in South Korea. ParticipantsThe intervention and comparison groups comprised 30 and 28 new nurses, respectively. Also, 12 MNTEP participants were subjected to three separate FGIs. MethodsTo comprehensively assess the program's effects, quantitative data were collected through self-report surveys, while qualitative data were obtained from March 2022 to March 2023 using semi-structured interviews that allowed for open-ended responses. ResultsThere were significant differences in mean self-efficacy scores (t = 2.45, p = 0.017) and perceived social support from clinical nurse educators (F = 4.51, p = 0.038) between the intervention and comparison groups. Additionally, significant changes were observed in the field adaptation pre-test and post-test scores within the intervention group (t = −3.12, p = 0.004). However, there was no statistically significant difference between the groups in terms of active and passive coping strategies. FGIs yielded two main themes: (1) gaining positive energy through empowerment and solidarity; and (2) clinical nurse educators sharing strategies for improved role adaptation and capacity building. ConclusionsMNTEP led by clinical nurse educators positively influenced new nurses' self-efficacy and facilitated their transition to clinical settings. These findings underscore the importance of mentorship programs and clinical nurse educators.

Nationwide Survey on Transitional Care for Patients With Childhood-Onset Cardiomyopathy in Japan.

Background: Individuals transitioning into adulthood require age-appropriate medical care and delegation of decision-making authority from their parents to the patients themselves. Although there have been multiple observational and interventional studies on transitional care for patients with congenital heart disease (CHD) in the cardiovascular field, transitional care specific to childhood-onset cardiomyopathy (CM) remains unaddressed. Methods and Results: A nationwide questionnaire-based survey was performed in the pediatric cardiology departments of 151 facilities in Japan. Responses were obtained from 100 (66%) facilities with low transfer rates (<5%) for childhood-onset CM cases. The comparison between CHD-transferring and non-CHD-transferring facilities revealed a significantly higher transfer rate (83.9%) for childhood-onset CM cases in the CHD-transferring facilities (P<0.001). Regarding the transition programs, 72 (72%) facilities do not offer any programs for CM, while most (92%) facilities recognize its necessity. Finally, only 19 (19%) facilities provided a transition program, 10 of which were CHD based. Conclusions: To the best of our knowledge, this is the first study to demonstrate the poor transition/transfer care status of patients with childhood-onset CM in Japan. The transfer rate of CMs was lower than that of CHDs, and transition programs were less available. Referring to the system established for CHD could help develop a successful transitional care system for CM.

Supporting children and families with opportunity gaps: educators’ perspectives of a summer kindergarten transition program

ABSTRACT Effective transitions to kindergarten engage families and ease children into new environments. Countdown to Kindergarten (CTK), a program in a southeastern U.S. state that serves more than 1,000 children each year and is grounded in Bronfenbrenner’s ecological systems theory, partners kindergarten teachers and families to facilitate effective transitions for those who often experience opportunity gaps. Research partners surveyed 238 CTK educators (98% of participating educators). Educators indicated that CTK had a positive impact on increasing family awareness of school expectations, promoting smooth transitions, and developing positive relationships between teachers and families. The perceived quality of CTK and parent investment in CTK significantly predicted educators’ belief that CTK exceeded its goals of enhancing connections between the blended systems in which children interact. The model provides curricular approaches, activities, and materials for six sessions prior to kindergarten entry that can be replicated to better serve children and families in need.

First Year Students’ Perceptions of the Transition to University: The Role of Informational, Instrumental, and Emotional Support

First Year Students’ Perceptions of the Transition to University: The Role of Informational, Instrumental, and Emotional Support

Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan.

Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.

Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand.

The incidence of pediatric inflammatory bowel disease (IBD) is rising, and there is an increasing need to support adolescents when they transition to adult care. Evidence supports the use of a structured transition process but there is great variation across Australasia. The study aim was to develop evidence and expert opinion-based consensus statements to guide transitional care services in IBD. A modified UCLA-RAND methodology was employed to develop consensus statements. An IBD expert steering committee was formed and a systematic literature review was conducted to guide the drafting of consensus statements. A multidisciplinary group was formed comprising 16 participants (clinicians, nurses, surgeons, psychologists), who anonymously voted on the appropriateness and necessity of the consensus statements using Likert scales (1 = lowest, 9 = highest) with a median ≥7 required for inclusion. Patient support groups, including direct input from young people with IBD, informed the final recommendations. Fourteen consensus statements were devised with key recommendations including use of a structured transition program and transition coordinator, mental health and transition readiness assessment, key adolescent discussion topics, allied health involvement, age for transition, and recommendations for clinical communication and handover, with individualized patient considerations. Each statement reached median ≥8 for appropriateness, and ≥7 for necessity, in the first voting round, and the results were discussed in an online meeting to refine statements. A multidisciplinary group devised consensus statements to optimize pediatric to adult transitional care for adolescents with IBD. These guidelines should support improved and standardized delivery of IBD transitional care within Australasia.

Tracing Tumor Heterogeneity of Pleomorphic Carcinoma of the Lung

IntroductionPulmonary pleomorphic carcinoma (PPC) is an aggressive and highly heterogeneous NSCLC whose underlying biology is still poorly understood. MethodsA total of 42 tumor areas from 20 patients with PPC were microdissected, including 39 primary tumors and three metastases, and the histologically distinct components were subjected to whole exome sequencing separately. We further performed in silico analysis of microdissected bulk RNA sequencing and methylation data of 28 samples from 14 patients with PPC. We validated our findings using immunohistochemistry. ResultsThe epithelial and the sarcomatoid components of PPCs shared a large number of genomic alterations. Most mutations in cancer driver genes were clonal and truncal between the two components of PPCs suggesting a common ancestor. The high number of alterations in the RTK-RAS pathway suggests that it plays an important role in the evolution of PPC. The metastases morphologically and genetically resembled the epithelial or the sarcomatoid components of the tumor.The transcriptomic and epigenetic profiles of the sarcomatoid components of PPCs with matched squamous-like or adenocarcinoma-like components differed from each other, and they shared more similarities to their matched epithelial components. NCAM1/CD56 was preferentially expressed in the sarcomatoid component of squamous-like PPCs, whereas CDH1/E-Cadherin expression was down-regulated in the sarcomatoid component of most PPCs. ConclusionLung adenocarcinoma-like PPCs are mainly driven by RTK-RAS signaling, whereas epithelial-mesenchymal transition programs as highlighted by increased NCAM1 and decreased CDH1 expression govern the epithelial-sarcomatoid transition between the clonally related tumor components. Several alterations in PPCs pinpoint therapeutic opportunities.

E-Learning Instructional Management For Students with Intellectual Disabilities

Online teaching is inevitable during the COVID-19 pandemic as schools and educational institutions globally are forced to close. This sudden paradigm shift from the traditional classroom to remote online teaching has disrupted the education system in general. The study aims to examine the e-learning practices of a school-to-work transition program using TPACK Framework for students with intellectual disabilities (IDs). An in-depth study was conducted with 25 students with IDs on the process of curriculum design, technology setup, as well as roles of all stakeholders. Findings show the importance of collaborative support with clear roles and planning are essential to achieve effective management in online and individualized learning. This paper highlights the challenges and problems encountered by both teachers and students. Practical guidelines, processes, and teaching strategies of the e-learning system are proposed for the betterment of e-learning management of teaching and delivery.

Atypical heat shock transcription factor HSF5 is critical for male meiotic prophase under non-stress conditions.

Meiotic prophase progression is differently regulated in males and females. In males, pachytene transition during meiotic prophase is accompanied by robust alteration in gene expression. However, how gene expression is regulated differently to ensure meiotic prophase completion in males remains elusive. Herein, we identify HSF5 as a male germ cell-specific heat shock transcription factor (HSF) for meiotic prophase progression. Genetic analyzes and single-cell RNA-sequencing demonstrate that HSF5 is essential for progression beyond the pachytene stage under non-stress conditions rather than heat stress. Chromatin binding analysis in vivo and DNA-binding assays in vitro suggest that HSF5 binds to promoters in a subset of genes associated with chromatin organization. HSF5 recognizes a DNA motif different from typical heat shock elements recognized by other canonical HSFs. This study suggests that HSF5 is an atypical HSF that is required for the gene expression program for pachytene transition during meiotic prophase in males.

Inclusive Human Capital—Employment Transition Programme for Adults with Autism at Enabling Academy, Yayasan Gamuda

The case focuses on the Enabling Academy (EA) team within Yayasan Gamuda, the philanthropic arm of Malaysia-based Gamuda Berhad. Gamuda is recognized as one of the largest Malaysian infrastructure companies and has been acknowledged for its pioneering efforts in neurodiversity employment for white-collar positions in Malaysia. EA provided employment training, job matching and job coaching for adults with autism, aiming for sustainable employment. While the programme initially saw success, its outreach remained limited. Gamuda had a goal to disseminate its best practices and encourage other entities to integrate more individuals with autism into their workforce. The team needed to devise strategies for senior management. This case addresses significant issues related to responsible organizational practices, untapped human potential, neurodiversity employment frameworks, workplace diversity and inclusion, and sustainable human resource management. It illustrates the decision-making process of the EA team under the guidance of the company’s leadership. The framing of the case reflects EA’s non-profit status and its preference for a collectivist management approach.

Immune cell senescence and exhaustion promote the occurrence of liver metastasis in colorectal cancer by regulating epithelial-mesenchymal transition.

Liver metastasis (LM) stands as a primary cause of mortality in metastatic colorectal cancer (mCRC), posing a significant impediment to long-term survival benefits from targeted therapy and immunotherapy. However, there is currently a lack of comprehensive investigation into how senescent and exhausted immune cells contribute to LM. We gathered single-cell sequencing data from primary colorectal cancer (pCRC) and their corresponding matched LM tissues from 16 mCRC patients. In this study, we identified senescent and exhausted immune cells, performed enrichment analysis, cell communication, cell trajectory, and cell-based in vitro experiments to validate the results of single-cell multi-omics. This process allowed us to construct a regulatory network explaining the occurrence of LM. Finally, we utilized weighted gene co-expression network analysis (WGCNA) and 12 machine learning algorithms to create prognostic risk model. We identified senescent-like myeloid cells (SMCs) and exhausted T cells (TEXs) as the primary senescent and exhausted immune cells. Our findings indicate that SMCs and TEXs can potentially activate transcription factors downstream via ANGPTL4-SDC1/SDC4, this activation plays a role in regulating the epithelial-mesenchymal transition (EMT) program and facilitates the development of LM, the results of cell-based in vitro experiments have provided confirmation of this conclusion. We also developed and validated a prognostic risk model composed of 12 machine learning algorithms. This study elucidates the potential molecular mechanisms underlying the occurrence of LM from various angles through single-cell multi-omics analysis in CRC. It also constructs a network illustrating the role of senescent or exhausted immune cells in regulating EMT.

Readiness of Special Education Teachers in the Implementation of a Career Transition Programme for Students with Special Educational Needs in Malaysian Island Schools

Readiness of Special Education Teachers in the Implementation of a Career Transition Programme for Students with Special Educational Needs in Malaysian Island Schools

Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study

BackgroundThe increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care.MethodsA descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data.ResultsFive barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers.ConclusionFamily caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.

College student transition program grants

College student transition program grants

Standards of care and educational gaps in adult cystic fibrosis units: a European Respiratory Society survey.

Significant progress in the field of cystic fibrosis (CF) has substantially extended the life expectancy of patients with CF (pwCF). Consequently, the population of adult pwCF has outnumbered paediatric patients in most developed countries. Ageing is a new factor that can contribute to disease complexity and can require adaptation of CF units. Therefore, the necessity for standardised, specialised and multidisciplinary care is imperative. Concerns arise regarding the adequacy of current healthcare, therapeutic and educational offerings. To address these concerns, a multinational survey was conducted to assess the current state of care in specialised multidisciplinary adult and paediatric CF units and identify areas for improvement. Responses were collected from 44 centres providing regular care to CF patients. The survey unveiled considerable disparities in the availability of critical resources, including diagnostic access, supplementary testing, treatment modalities, transplant and transition programmes, and healthcare professionals' training. This study underscores the urgent need to standardise care across these centres in order to minimise disparities in terms of available resources and training with a particular emphasis on adult pwCF who are becoming more numerous and showing different needs with ageing. The changing landscape of CF in adulthood will require constant monitoring to ensure proper adaptation of the current model of care.

Evaluation of the implementation of transition programs for students with intellectual disability in high schools in Saudi Arabia

The purpose of this study is to evaluate the implementation of transition programs for students with intellectual disability served in special high school institutes and self-contained classroom programs in general education high schools, and their challenges. We specifically explore special education teachers’ support for implementing the transition programs for students with intellectual disability in these two settings. Further, this study investigated the differences in teachers’ support for implementing the transition programs based on factors including teachers’ gender, educational level, years of experience, and previous attendance of a course or training program on transition programs. A questionnaire was used to collect data from 249 male and female special education teachers in the cities of Riyadh, Makkah, Al-Ahsa, and Dammam. The results showed that while transition programs are implemented with students with intellectual disability in special high school institutes and self-contained classroom programs in general education high schools there are significant obstacles to their implementation. However, there were no differences in special education teachers’ support for implementing the transition programs based on their demographic characteristics. Implications for supporting and implementing transition programs, developing strategies, enacting laws and regulations, establishing partnerships, and cooperating with community institutions to ensure a successful transition are discussed.

‘I want to scream it from the rooftops now […] there are other pathways’: What young people learned from a co-designed post-secondary transition programme

AbstractThis paper uses the framework of transition as becoming to explore what young people learned from participating in a post-secondary transition program that was co-designed by young people. The 9-week youth participatory action research (YPAR) involved six staff collaborators (SCs) and seven youth collaborators (YCs). Data comprised recordings of weekly group meetings, group interviews, reflections and artefacts such as planning documents, graphic organisers and writing. We discuss the findings using two themes that we identified together as a team of YCs and SCs. The first represents how YCs became aware of and vocalised understandings of life after secondary school as a diverse and fluid process. The second describes and interrogates how YCs became more confident and empowered, showing the importance of critical consciousness, reflection and action in seeking transformation. We conclude that conceptualising transition as becoming enables us to collectively make sense of the diverse ways we co-construct life experiences and directions.

Transition in enuresis patients: Identifying the gaps and opportunities for the future.

Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers. To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder). These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%). We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient.

COCCOS study: Developing a transition program for adolescents with chronic conditions using Experience-Based Co-Design. A study protocol.

During adolescence, adolescents and young adults (AYAs) are expected to transfer their care from the pediatric environment towards an adult-focused setting. To prevent an abrupt transfer of care, it is recommended to provide AYAs with chronic conditions an adequate transition program. The aim of this paper is to describe the study protocol for the development of a transition program for AYAs with common chronic conditions (COCCOS study), using the Experience-Based Co-Design (EBCD) methodology. A qualitative, participatory study is conducted in Flanders (Belgium). Study participants are AYAs (n≥15, 14-25 years old, diagnosed with type 1 diabetes, asthma, or obesity), their families, and healthcare providers (n≥15). The study is composed of eight EBCD stages: clinical site observations, in-depth interviews, trigger film, healthcare providers' feedback event, AYAs' feedback event, joint event, co-design workshops, and a celebration event. Photovoice will take place as a starting point of EBCD. Data will be analyzed using thematic analysis. Data collection has started in January 2023 and is expected to be completed in May 2024. As of August 2023, over 15 clinical site observations have been conducted. A total of 18 AYAs, two parents, six healthcare providers have been enrolled and a total of 20 interviews have been conducted. Advancing transitional care is essential for tackling negative health outcomes. Applying the innovative participatory EBCD methodology will reveal key elements of transitional care for AYAs with common chronic conditions in the development of a person-centered transition program. Study findings will apply key elements of transitional care of AYAs with chronic conditions in the development of an adequate transition program.

Can a mandate be justified by unrealized gains? Evidence from a heating energy transition program in China

Mandatory policies are usually motivated by the desire to correct consumer bias caused by imperfect information or inattention to benefits or costs. However, for consumers whose choices already reflect their true preferences, such policies can lead to a utility loss. Therefore, the policy effects deserve closer scrutiny. Using a large-scale household survey and a choice experiment, this study estimates the welfare effects of a mandatory energy transition program in northern China. Through a discrete choice model, we identify the effect of the mandate on household participation in the transition and simulate the welfare change caused by the mandate. We find that the mandate was not always justified by the unrealized health gains; it may have improved social welfare but at the expense of utility loss for some households, especially for lower-income ones and those in areas with higher transition costs and stricter mandates. These findings shed light on ways to improve the distributional welfare effect when a mandate is adopted, for example, by differentiating policy implementation across income groups and considering both efficiency and equity issues in the long run.