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Transition to adolescence and beyond. Dan Wood Consultant in Adolescent and Reconstructive Urology University College London Hospitals Honorary Consultant Urologist Great Ormond Street. Objectives. Some definitions What does transition mean? ‘ C’ing the issues Other issues.

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transition to adolescence and beyond

Transitionto adolescence and beyond

Dan Wood

Consultant in Adolescent and Reconstructive Urology

University College London Hospitals

Honorary Consultant Urologist

Great Ormond Street

objectives
Objectives
  • Some definitions
  • What does transition mean?
  • ‘C’ing the issues
  • Other issues

DW UCLH

adolescence
Adolescence
  • Latin
  • Adolescere
    • (to) grow
  • Presents Challenges

DW UCLH

slide4

“An increasing number of chronically ill children are surviving into young adulthood. Achieving a seamless transfer is becoming one of the greatest challenges facing both children's and adult services.”

Fiona Smith

Adviser in Children's and Young People's Nursing

Royal College of Nursing

DW UCLH

what do we think

What do we think?

Friday November 7th2008

Tranisition clinic - GOSH

DW UCLH

challenges
Challenges

consultation

Change

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consultation
Consultation
  • Different environment
  • New personnel
  • Information loss
  • Different medical approach
  • Potential for conflicting messages

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consultation1
Consultation
  • Building for the rest of your life
  • Regular checks
  • Baseline
  • New team members
  • Watch for problems
  • ?Need for travel???

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challenges1
Challenges

consultation

confidentiality

Change

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confidentiality
Confidentiality
  • Parents in vs. parents out
  • New issues
  • Embarrassment
  • We have to look to build a trust
  • They will grow up

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challenges2
Challenges

consultation

confidentiality

Change

consent

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consent
Consent
  • No consent is just me
  • All complex decisions need time
  • …and discussion
  • Important role of our CNS
  • Choices – this can be difficult

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consent1
Consent
  • For straight forward procedures – usually no problem
  • Able to sign for themselves
  • May raise issue from the past
  • Should be a process not an event

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challenges3
Challenges

consultation

confidentiality

consent

concordance

Change

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concordance
Concordance
  • With freedom comes responsibility
  • Some have difficulty with this
  • Unsafe?
  • Difficult
  • Usually finite

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challenges4
Challenges

consultation

confidentiality

Change

concordance

consent

conjugation

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conjugation
Conjugation
  • Permission
  • Ability
  • Fertility
  • Concerns

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challenges5
Challenges

consultation

confidentiality

Change

consent

concordance

conjugation

conflict

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conflict
Conflict
  • With me
  • With you
  • With others
  • With themselves

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conflict1
Conflict
  • Listen
  • Understand
  • Explain
  • Give time
  • Re-Explain
  • Empower

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other concerns
Other concerns
  • Future surgery
  • Continence
  • Other diseases
  • Children (1/70 – 1/100)
  • Historical comparison

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obstetrics
Obstetrics
  • Several studies – 45 ladies 49 deliveries
  • May need Caesarian section
  • All likely to need shared care
  • Prolapse is a problem but treatable

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the long term
The long-term
  • Regular reviews
  • Good communication with GPs
  • Follow-up bloods
  • Scans
  • Expertise
  • Outcomes - ?database

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summary
Summary
  • Some definitions
  • What does transition mean?
  • ‘C’ing the issues
  • Other issues

DW UCLH

thank you

Thank you

Any Questions?

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