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.     

Melatonin rhythms and pineal structure in a tropical bat, Anoura geoffroyi, that does not use photoperiod to regulate seasonal reproduction

Abstract: It has been hypothesized that pineal structure and function might differ between temperate zone and tropical species of mammals because of lower amplitudes of seasonal change in photoperiod and, in some areas, less seasonal climatic variation. Anoura geoffroyi produce a single offspring in November or December of each year on the Caribbean island of Trinidad, at 10°N latitude in the deep tropics. Previous work has shown that this population lacks reproductive responses to photoperiod, and must be enforcing seasonal breeding using a non-photoperiodic cue. Anoura geoffroyi have a minute, thin, and rod-like pineal gland. Throughout much of its length, the pineal courses irregularly within the ventrolateral wall of the great cerebral vein. This intimate relationship may have functional implications. Despite having a very small pineal gland, this species produced a nocturnal rise in serum melatonin. Serum melatonin levels in most individuals were below or near undetectable levels during the light period and rose to a peak averaging 100 pg/ml in the last third of the dark period. Our results indicate that, although the pineal gland of A. geoffroyi is extremely small, serum melatonin levels are comparable to those of other mammals.     

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.     

Progesterone inhibition in mid-trimester termination of pregnancy: physiological and clinical effects

A double-blind, placebo controlled clinical trial was conducted to assess the clinical and physiological effects of 'epostane', a progesterone synthesis inhibitor, in mid-trimester prostaglandin termination of pregnancy. Mean peripheral progesterone levels had fallen by 74% after 72 h in the patients treated wtih epostane. The mean induction-abortion interval in the treatment group was 490 (SD 271) min, compared with 1432 (SD 640) min in the control group. Intrauterine pressure recording demonstrated increased sensitivity to prostaglandin E2 after epostane treatment but no change in oxytocin sensitivity. The clinical implications of facilitated induction of abortion are discussed.