Development of a clinical transition pathway for adolescents in the Netherlands.

AIMS: To explore how young people with juvenile-onset rheumatic and musculoskeletal diseases (jRMDs) and their parent(s) experience care during preparation for the upcoming transfer to adult services, and to develop a clinical transition pathway. METHOD: A survey was conducted with 32 young people aged between 14 and 20 years with jRMDs, and their parents ( n =33), treated at the department of paediatric rheumatology in a tertiary care children's hospital in the Netherlands. RESULTS: More than 30% of young people would have liked to discuss topics such as educational and vocational choices in a clinic, but did not get the opportunity. Preparation for transition was poor as was training in self-management skills. One third of parents had feelings of anxiety about the upcoming transfer. Results from the survey and evidence-based principles of transitional care were used to develop the clinical transition pathway. The pathway focuses on starting transition early, developing self-management skills, joint consultations and supporting parents in giving young people control of their clinical care. CONCLUSION: Care does not currently meet the needs of young people in the process of transition to adult rheumatology services. The clinical transition pathway developed as a result of the study is a tool that may improve this process.

The Rules of the Game Called Psychological Science.

If science were a game, a dominant rule would probably be to collect results that are statistically significant. Several reviews of the psychological literature have shown that around 96% of papers involving the use of null hypothesis significance testing report significant outcomes for their main results but that the typical studies are insufficiently powerful for such a track record. We explain this paradox by showing that the use of several small underpowered samples often represents a more efficient research strategy (in terms of finding p < .05) than does the use of one larger (more powerful) sample. Publication bias and the most efficient strategy lead to inflated effects and high rates of false positives, especially when researchers also resorted to questionable research practices, such as adding participants after intermediate testing. We provide simulations that highlight the severity of such biases in meta-analyses. We consider 13 meta-analyses covering 281 primary studies in various fields of psychology and find indications of biases and/or an excess of significant results in seven. These results highlight the need for sufficiently powerful replications and changes in journal policies.