Transitioning adolescents and young adults with spina bifida to adult healthcare: initial findings from a model program.

PURPOSE: The Spina Bifida Transition Project (SBTP) was developed by partners from pediatric and adult health care settings using existing best practice information in an effort to transition adolescents to adult health care providers. The purpose of this manuscript is to present the results of an initial evaluation of the SBTP from the adolescent/young adult (AYA) and family perspective. DESIGN AND METHODS: Qualitative evaluation data were obtained from telephone interviews with 40 individuals (24 AYA and 16 parents representing 28 families) two-three weeks after initial adult clinic visits using a semi-structured interview guide. FINDINGS: Interview analysis yielded six overall themes: Positive experience, Developing Trust, Unexpected Benefits, Communication, Potential Worries, and Suggestions for Improvement. The study supported both the effectiveness of the SBTP as well as patient desire for earlier initiation of transition activities CONCLUSION AND CLINICAL RELEVANCE: SBTP is well-received by participants and their parents and may be useful model for other chronic health conditions.

Transitioning adolescents and young adults with a chronic health condition to adult healthcare - an exemplar program.

Pediatric specialists have successfully improved the longevity and quality of life of many children with chronic health conditions. As these children reach adolescence and young adulthood, the scope of their concomitant medical problems often include those typically seen in older patients. As a result, these individuals need continuing quality health care in focused adult healthcare facilities. This article describes the effective partnership between pediatric and adult healthcare providers to create and implement an exemplar Spina Bifida Transition Program. The processes, strategies and tools discussed are likely to be useful to other healthcare professionals interested in developing pediatric to adult transition programs for adolescents and young adults with chronic health conditions.

Protocol management of late-stage pressure ulcers: a 5-year retrospective study of 101 consecutive patients with 179 ulcers.

BACKGROUND: Despite a 12 to 82 percent pressure ulcer recurrence rate, no standard protocol exists for postoperative management. The authors reviewed a single surgeon's experience using a standard protocol: surgery and immediate reconstruction regardless of nutrition, intraoperative bone culture guiding postoperative antibiotic use, and hospital admission for 3 weeks of flat bedrest before graduated sitting. METHODS: A 5-year retrospective chart review was performed on consecutive surgically treated pressure ulcers. A search of billing records identified 101 patients with 179 ulcers. Data abstracted included demographics, comorbidities, location and stage of ulcers, treatment history with outcomes, and laboratory data. RESULTS: Seventy-nine percent of the patients were men with a mean age of 49.4 years. Of 179 ulcers, 49.7 percent were ischial, 26.8 percent were sacral, and 19 percent were trochanteric; 87.7 percent of ulcers were stage 4. Primary closure was performed on 45.8 percent; others underwent flap closure. There was no correlation between positive bone cultures and recurrence or complications. The overall recurrence rate was 16.8 percent at a mean period of 435.9 days. New ulcer occurrence was 14.5 percent and the complication rate was 17.3 percent. Admission prealbumin and albumin did not correlate with recurrence or complication. Mean follow-up was 629 days. CONCLUSIONS: A standard clinical pathway for pressure ulcer treatment improves long-term outcomes; the authors' protocol's validity is supported by low recurrence and complication rates. Nutritional data do not predict outcome. Intraoperative bone cultures are the most valid method of diagnosing osteomyelitis; results should not delay definitive treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

_ 2009 review and revisions of the international standards for the neurological classification of spinal cord injury.

The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) were recently reviewed by the ASIA's Education and Standards Committees, in collaboration with the International Spinal Cord Society's Education Committee. Available educational materials for the ISNCSCI were also reviewed. The last citable reference for the ISNCSCI's methodology is the ISNCSCI Reference Manual, published in 2003 by ASIA. The Standards Committee recommended that the numerous items that were revised should be published and a precedent established for a routine published review of the ISNCSCI. The Standards Committee also noted that, although the 2008 reprint pocket booklet is current, the reference manual should be revised after proposals to modify/revise the ASIA Impairment Scale (AIS as modified from Frankel) are considered. In addition, the Standards Committee adopted a process for thorough and transparent review of requests to revise the ISNCSCI.