Silja Kosolove
44 statements · 1 topic · summaries given as host listed separately
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The young person that you see that is noncompliant, defiant, taking a lot of risks that you do not understand at all, why are they doing that thing to themselves and seem completely invulnerable. are actually on the same time very insecure wondering whether I will ever be loved by someone, whether I will find a profession where I could work and be helpful to others.
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Diabetes
transition is a time in the life of young people that is often related with great anxiety. So if we take it calmer, we might get it better.
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Diabetes
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Silja's statements about Diabetes 44 statements
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Transition of Care - A general overview by Silja Kosolove
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If adolescents are left to survive on their own without structured transition, they will not adhere to care in adult hospitals, their health outcomes will diminish, and many will not survive.
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Abrupt transfer without transition is more expensive due to emergency admissions and unplanned procedures compared to planned care.
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transition is a time in the life of young people that is often related with great anxiety. So if we take it calmer, we might get it better.
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I don't mean to Put down all your clinical expertise, but I'd still say that assessing the clinical situation of the patient is maybe one of the easiest things to do when talking about transition.
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In many countries the age limit from pediatric to adult care has risen and is now most often 18 years.
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Unfortunately, in Finland, the general limit of pediatrics is still 16 years. We're left behind.
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When a 16-year-old is transferred to adult care and engages in risky behavior, adult professionals are mostly not familiar with legal requirements of making child protection notifications.
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Biological development is just one small part of adolescent development; psychological and social changes occur simultaneously.
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The biological development is just one small bit about this, and that's the only bit that medical school really teaches you how to assess
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Adolescents move from concrete thinking where rules apply uniformly to abstract thinking, though they still feel invulnerable ('you can walk in front of a truck and the truck is supposed to stop').
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you're bulletproof yourself. You can walk in front of a truck and the truck is supposed to stop because you were on the pedestrian crossing.
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there's a mess, so to say. In all kindness, I, I don't mean to put down the young people either.
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Illness, nutrition, and stress affect adolescent development and may lead to the developmental conflict being greatest right at the time when young people should leave pediatric care.
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The last bits of the human brain to develop are in the frontal lobe, where planning for the future, problem-solving, and emotional and behavioral control are learned.
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Emotional centers develop earlier than frontal lobe, so young people have 'a car with really nice transmission but no brakes'—the brakes develop later.
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A car, so to say, that has a really, really nice transmission but no brakes. The brakes developed later.
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The young person that you see that is noncompliant, defiant, taking a lot of risks that you do not understand at all, why are they doing that thing to themselves and seem completely invulnerable. are actually on the same time very insecure wondering whether I will ever be loved by someone, whether I will find a profession where I could work and be helpful to others.
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Young people who appear noncompliant, defiant, and risk-taking are simultaneously very insecure, wondering whether they will be loved or find meaningful work.
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Medical follow-up can resemble the relationship young people have with their parents, and as they struggle for autonomy they may rebel against medical care.
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Please don't say that ever to anyone. Please be one of the people who tries to see how that dream could perhaps be made possible.
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all adolescents are first and foremost young people, they are not diabetics. They are not Hirschprung's disease. They are a person who has Hirschprung's, but they are a lot more than just the disease.
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In many studies, both our own and from other centers, quality of life has always been better when judged by young people themselves than when judged by their parents or carers.
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Transfer is simple moving of paper; transition is a process requiring preparation and a welcoming recipient on the other side.
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Transfer is a simple moving on of paper. Sending a person out into the world and saying bye and that's not enough
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The recommended age to meet patients alone for at least part of the appointment is from age 12.
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Treatment advice should be given directly to the patient even if the parent is in the room.
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we turn toward the young person and speak to them and let the mother just listen. I'm saying mother because often it is the mother.
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We discussed leaving the pediatric hospital as a positive thing, just like graduating from school. This is a natural thing that happens. Pediatric hospitals are not for grown-ups.
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There is growing evidence that single days of coaching for transition have very low or no impact.
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There is growing evidence that joint consultations with pediatric and adult teams both present (even via Teams) builds trust and may lead to better outcomes.
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WHO has mapped adolescent medicine training availability in Europe; much of Europe is gray (no response), implying training is not happening.
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I'm not saying we need a special field called adolescent medicine, but I do say that we need special competence to meet these young people
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Great discrepancies in treatment plans between pediatric and adult teams should be built into a more uniform approach; this has been a struggle in liver and kidney transplant patients in Finland.
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The most important attitude professionals working with young people need to show is respect; adolescents are very good at sensing whether you respect them.
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In adult healthcare during the first couple of years after transition, consultations should be more frequent and longer than for other adult patients.
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Talk about it. Raise the issues, show that you are the person who won't blush. Whatever they think is relevant to them.
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Young people need one named contact person for questions between consultations; most times they don't call, so workload concerns are unfounded.
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Continuity of care is the key. There's very strong evidence that you have to take care of the management continuity
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From the perspective of general practice, continuity of care is key, with strong evidence for management continuity, information continuity, and relationship continuity leading to better outcomes.
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It takes a village to raise a child. Well, it definitely takes a whole hospital to manage transition properly.
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The process of transition cannot be on the shoulders of one single person; it must be a holistic approach in the whole hospital so that when that person retires or falls ill, transition continues.
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Summaries Silja gave as host · 2 summaries
Recaps of other experts' statements, not Silja's own clinical position.
Summaries Silja gave as host · Diabetes 2 summaries
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Transition of Care - A general overview by Silja Kosolove
Host summary
Silja Kosolove summarizing a resource: Two Finnish colleagues described that cognitive skills develop logically but psychosocial skills take a dip during teenage years, with the timing and depth of the dip being very individual.
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Host summary
Silja Kosolove summarizing a resource: success is never final... Failure is usually not fatal... It's the courage to continue that counts.
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