Dan Wood Consultant in Adolescent and Reconstructive Urology University College London Hospitals Honorary Consultant Urologist Great Ormond Street

 Some definitions  What does transition mean?  ‘C’ing the issues  Other issues DW UCLH

 Latin  Adolescere  (to) grow  Presents Challenges DW UCLH

“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

Friday November 7 th 2008 Tranisition clinic - GOSH DW UCLH

Change consultation

 Different environment  New personnel  Information loss  Different medical approach  Potential for conflicting messages DW UCLH

 Building for the rest of your life  Regular checks  Baseline  New team members  Watch for problems  ?Need for travel??? DW UCLH

Change consultation confidentiality

 Parents in vs. parents out  New issues  Embarrassment  We have to look to build a trust  They will grow up DW UCLH

Change consent consultation confidentiality

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

 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 DW UCLH

Change concordance consent consultation confidentiality

 With freedom comes responsibility  Some have difficulty with this  Unsafe?  Difficult  Usually finite DW UCLH

Change conjugation concordance consent consultation confidentiality

 Permission  Ability  Fertility  Concerns DW UCLH

Change conjugation concordance consent consultation conflict confidentiality

 With me  With you  With others  With themselves DW UCLH

 Listen  Understand  Explain  Give time  Re-Explain  Empower DW UCLH

 Future surgery  Continence  Other diseases  Children (1/70 – 1/100)  Historical comparison DW UCLH

 Several studies – 45 ladies 49 deliveries  May need Caesarian section  All likely to need shared care  Prolapse is a problem but treatable DW UCLH

 Regular reviews  Good communication with GPs  Follow-up bloods  Scans  Expertise  Outcomes - ?database DW UCLH

 Some definitions  What does transition mean?  ‘C’ing the issues  Other issues DW UCLH

Any Questions? DW UCLH