Christina Grant

Condition-related predictors of successful transition from paediatric to adult care among adolescents with Type 1 diabetes.

To describe patient attendance for adult treatment after completion by young people of a structured Diabetes Transition Clinic and to identify the predictors of non‐attendance at adult clinics by young people with Type 1 diabetes transitioning from paediatric care.

Use of Gastrostomy Tubes in Children and Adolescents With Eating Disorders and Related Illnesses

PURPOSE The aim of this case series was to describe five youths with psychiatric illnesses who underwent feeding tube placement as part of their treatment. METHODS The database of a Canadian academic tertiary care eating disorder program was used to identify patients with feeding tubes. RESULTS Five patients with feeding tubes were identified in the database of more than 600 patients. Of the five patients, two had anorexia nervosa and three suffered from food refusal as a result of a psychiatric illness unrelated to body image issues. For each patient, the tube was placed only after standard methods of treatment had failed, including repeated hospitalizations and in two cases, residential treatment. The primary goal of placing the tube was to allow for outpatient management of the patient. In all five cases, the healthy weight was restored, and four of the five patients experienced a significant improvement in independent eating behavior. Four of the five patients were found to have had their tube removed when this article was being written. None of the patients required further hospitalizations and no serious relapses were found to have occurred. CONCLUSION This case series demonstrates that gastrostomy tube feeding can be an effective intervention to allow patients with eating disorders to be treated as outpatients. The limitations of this study include the small study size, the retrospective nature of the study, and the short follow-up after tube removal. Further study is needed to evaluate the psychological effects of enterostomy feeds in patients and their families.

Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder

There is a growing body of literature describing the development, clinical course, and treatment of avoidant/restrictive food intake disorder (ARFID), a diagnostic category introduced in the DSM-5. However, information surrounding complex cases of ARFID involving coexisting medical and/or psychiatric disorders remains scarce. Here we report on two cases of young patients diagnosed concurrently with ARFID and attention deficit hyperactivity disorder (ADHD) who both experienced significant growth restriction following initiation of stimulant medication. The appetite suppressant effect of stimulants exacerbated longstanding avoidant and restrictive eating behaviors resulting in growth restriction and admission to an inpatient eating disorders unit. The implications of ARFID exacerbated by stimulant-treated ADHD are explored, as well as the treatment delivered. These cases suggest that further research is needed to explore management options to counteract the appetite suppression effects of stimulants, while simultaneously addressing attention deficit symptoms and oppositional behavior.

The Integration of a Specialized Eating Disorders Nurse on a General Inpatient Pediatric Unit

Eating disorders (EDs) affect approximately 5% of Canadian adolescents. Patients experiencing acute medical complications of their illness are often treated on a general pediatric ward with mixed populations. Twenty-one health care providers shared their experiences caring for youth with EDs and provided feedback regarding the integration of a specialized ED nurse (ED-RN). Findings suggest that an RN and ED-RN model produces consistent care for ED patients and satisfying therapeutic relationships for nurses. ED-RNs caring for youth with EDs need support from their peers, whereas other nurses need training regarding this population. Suggestions for the integration of specialized RN roles are discussed.

Predictors of Type 1 Diabetes Mellitus Outcomes in Young Adults after Transition from Pediatric Care

Type 1 diabetes (T1D) is a common chronic disease. Poor health outcomes are often noted after transfer to adult health care. It is important to determine the predictors of such outcomes to decrease morbidity and mortality.