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                <text>Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review</text>
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                <text> Jarvis SW; Roberts D; Flemming K; Richardson G; Fraser LK</text>
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                <text>Background: Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services.</text>
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                <text>Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).</text>
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                <text>Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review</text>
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                <text>2021</text>
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                <text>Jarvis SW; Roberts D; Flemming K; Richardson G; Fraser LK</text>
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                <text>Background: Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services. Method(s): MEDLINE, EMBASE, CINAHL, PsychINFO and Social Science Citation Index were searched. Studies published in English since 1990 including individuals with any life-limiting condition post- and pre-transition and reporting a health or social care use outcome were included. Data were extracted and quality assessed by one reviewer with 30% checked by an independent reviewer. Result(s): Nineteen papers (18 studies) met the inclusion criteria. There was evidence for both increases and decreases (post- versus pre-transition) in outpatient attendance, inpatient admissions, inpatient bed days and health service costs; for increases in Emergency Department visits and for decreases in individuals receiving physiotherapy. Conclusion(s): Evidence for changes in healthcare use post- versus pre-transition is mixed and conflicting, although there is evidence for an increase in Emergency Department visits and a reduction in access to physiotherapy. More high-quality research is needed to better link changes in care to the transition. Impact: Evidence for changes in healthcare use associated with transition to adult services is conflicting.Emergency Department visits increase and access to physiotherapy decreases at transition.There are marked differences between care patterns in the United States and Canada. Copyright © 2021, The Author(s).</text>
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                <text>Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).</text>
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                <text>Place of death of children and young adults with a life-limiting condition in England: a retrospective cohort study</text>
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                <text>children; young adult; epidemiology; mortality; palliative care</text>
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                <text> Gibson-Smith D; Jarvis SW; Fraser LK</text>
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                <text>Objective To assess trends in place of death for children with a life-limiting condition and the factors associated with death at home or hospice rather than hospital. Design Observational cohort study using linked routinely collected data. Setting England. Patients Children aged 0–25 years who died between 2003 and 2017. Main outcome measures Place of death: hospital, hospice, home. Multivariable multinomial logistic regression models. Results 39 349 children died: 73% occurred in hospital, 6% in hospice and 16% at home. In the multivariable models compared with dying in a hospital: neonates were less likely, and those aged 1–10 years more likely, than those aged 28 days to &lt;1 year to die in hospice. Children from all ethnic minority groups were significantly less likely to die in hospice, as were those in the most deprived group (RR 0.8, 95% CI 0.7 to 0.9). Those who died from 2008 were more likely than those who died earlier to die in a hospice.Children with cancer (RR 4.4, 95% CI 3.8 to 5.1), neurological (RR 2.0, 95% CI 1.7 to 2.3) or metabolic (RR 3.7, 95% CI 3.0 to 4.6) diagnoses were more likely than those with a congenital diagnosis to die in a hospice.Similar patterns were seen for clinical/demographic factors associated with home versus hospital deaths. Conclusions Most children with a life-limiting condition continue to die in the hospital setting. Further research on preferences for place of death is needed especially in children with conditions other than cancer. Paediatric palliative care services should be funded adequately to enable equal access across all settings, diagnostic groups and geographical regions.</text>
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                <text>&lt;a href="http://doi.org/10.1136/archdischild-2020-319700" target="_blank" rel="noreferrer noopener"&gt;10.1136/archdischild-2020-319700&lt;/a&gt;</text>
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                <text>Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).</text>
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