Barriers and characteristics for successful transition to adult healthcare for individuals with cerebral palsy: a systematic review

Abstract

Background: Cerebral palsy (CP) is a common childhood disability. However, these individuals are now living longer lives, participating in adult roles, and seeking healthcare services. The transition from pediatric to adult healthcare for adolescents with CP is a challenging yet significant time. Adolescents experience several barriers during transition.

Objectives: To utilize the environmental and personal dimensions of the ICF model in order to explore barriers when transitioning to adulthood as well as discuss characteristics and physical therapy implications needed to succeed within transition.

Methods: Electronic searching of PubMed, CINAHL, ERIC, Scopus, ProQuest, and the Cochrane Library databases was concluded on January 9, 2019 for studies including transition between pediatric and adult healthcare in individuals diagnosed with CP. Two independent reviewers agreed upon inclusion, eligibility, and quality assessment of each study using the Mixed-Methods Appraisal Tool (MMAT).

Results: Seven studies were included in the systematic review. Results for each study were separated based on the personal and environmental contextual factors of the ICF model and solutions to the barriers were then discussed.

Conclusions: Research has provided proposed solutions to select barriers, however, other barriers have yet to be addressed. More research is needed to address these barriers and provide a model program that can be implemented within the healthcare systems to promote a successful transition for adolescents with CP from pediatric to adult services.     

Lithium treatment of chronic hair pulling

Ten patients with chronic hair pulling received trials of lithium carbonate of 2 to 14 months' duration. Eight patients demonstrated decreased hair pulling and mild to marked hair regrowth. Three responders experienced increased hair pulling subsequent to discontinuation of lithium treatment. Lithium's effect on hair pulling may be related to its observed benefits in treating aggressivity, impulsivity, and mood instability.     

Electrolyte and humoral responses of renal transplant patients to head-out water immersion

Eighteen renal transplant recipients and sixteen volunteers were subjected to the physiological manoeuvre of head-out water immersion, in order to compare changes in electrolyte and humoral responses known to occur in healthy individuals with those arising as a result of renal denervation in the transplant recipients. Although the tubular sodium response to water immersion was normal, tubular potassium excretion was markedly different in the transplant patients. Plasma values of atrial natriuretic factor increased in both groups and showed a close temporal relationship to urinary excretion of cyclic GMP. The attenuation in transplant recipients of the well-documented suppression of plasma renin activity during water immersion was probably due to a combination of factors, namely lack of renal innervation and an increase in circulating ANF. The small but significant increase in the excretion of enzymically active urinary kallikrein observed only in the transplant recipients during immersion still requires explanation.     

Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study

BACKGROUND: There are obvious advantages to increasing donor retention. However, for reasons of blood safety, certain donors may, in fact, be more desirable to retain than others. “Safe” donors are defined as those who provided a blood donation that was negative on all laboratory screening tests and who subsequently reported no behavioral risks in response to an anonymous survey. This study identifies the most important factors affecting the intention of “safe” donors to provide another donation. STUDY DESIGN AND METHODS: An anonymous survey asking about donation history, sexual history, injecting drug use, and recent donation experience was mailed to 50,162 randomly selected allogeneic donors (including directed donors) who gave blood from April through July or from October through December 1993 at one of the five United States blood centers participating in the Retrovirus Epidemiology Donor Study. Before mailing, questionnaires were coded to designate donors with nonreactive laboratory screening tests at their most recent donation. RESULTS: A total of 34,726 donors (69%) responded, with substantially higher response among repeat donors. According to reported intentions only, the vast majority of “safe” donors indicated a high likelihood of donating again within the next 12 months. Only 3.4 percent reported a low likelihood of donating again. A comparison of those likely to return and those unlikely to return reveals significant differences in demographics and in ratings of the donation experience. A higher proportion of those unlikely to return were first-time donors, minority-group donors, and donors with less education. The highest projected loss among “safe” donors was seen for those who gave a fair to poor assessment of their treatment by blood center staff or of their physical well-being during or after donating. CONCLUSION: These data suggest that efforts to improve donors' perceptions of their donation experience, as well as attention to the physical effects of blood donation, may aid in the retention of both repeat and first-time donors.     

Percutaneous drainage of a tuberculous liver abscess

The authors describe the management by percutaneous drainage of a rare solitary tuberculous liver abscess in a 37-year-old woman. Open surgical drainage of such abscesses can be avoided using percutaneous drainage combined with transcatheter infusions of antituberculous agents. For the safe and successful use of this method three criteria must be met: the abscess should be unilocular, there must be a safe access route and a previously sterile compartment must not be contaminated. In addition a small (22 or 23 gauge) needle should be used for the initial puncture.