Transition of gastroenterological patients from paediatric to adult care: A position statement by the Italian Societies of Gastroenterology.

In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood.

Effectiveness of a toll-free telephone hotline for children and adolescents with type 1 diabetes. A 5-year study.

In 1995 we introduced a 24-h 7-day-a-week toll-free telephone service and specific guidelines to help the patients at home to reduce the risk of diabetic ketoacidosis (DKA) progression during intercurrent illnesses. Five years later we analysed the calls received at this emergency telephone hotline service (ETHS). From 1 January 1996 to 31 December 2001 a total of 9.125 calls was recorded (5.1 +/- 4.2 calls per day), but only 24% of them were veritable hot-line calls and were received from 767 patients or parents resulting in a mean of 2.5 +/- 0.8 calls per patient or parent. Fifty-nine percent of these users called from outside Parma's area. Their mean age (7.8 +/- 4.2 years) and duration of diabetes (2.8 +/- 1.2 years) were significantly lower (p < 0.001) and shorter (p < 0.001) compared to those (12.8 +/- 2.9 and 4.9 +/- 3.2 years respectively) found in the population which called for no-emergency reasons. Twenty-two percent of the veritable hot-line calls were received on saturdays and sundays or holidays, in the morning (25%), in the evening (59%) or during the night (16%). Telephone care has been finally demonstrated to be an useful way to provide a continuous support for patients and their families in the management of diabetes in some critical situations. ETHS helps them to achieve and maintain a better metabolic control and to avoid DKA during acute intercurrent illness and consequently hospital admissions.