Rounding@Iowa Podcast: “Challenges in Transitioning Seriously Ill Patients from Pediatric to Adult Systems of Care”

I listened to the Rounding@Iowa podcast of February 11, 2025, “Challenges in Transitioning Seriously Ill Patients from Pediatric to Adult Systems of Care.”

94: Microbiome – Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Ganesan and Mangalam, as they discuss what is known about the microbiome, its relation to disease and how we can promote a healthy microbiome. Episode Transcript CE Credit Available Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Sukirth Ganesan, DDS, PhD, MPH Centennial Research Associate Professor Director of the Advanced Education Program in Periodontics University of Iowa College of Denistry and Dental Clinics Ashutosh Mangalam, PhD Professor of Pathology Interdisciplinary Graduate Program in Molecular Medicine University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources: Shahi SK, Ghimire S, Jensen SN, Lehman PC, Rux AG, Sinha S, Borcherding N, Tanas MR, Gibson-Corley KN, Ganesan SM, Karandikar NJ, Mangalam AK. IL-17A deficiency in HLA-DR3 transgenic mice enriches beneficial Prevotella species in gut to promote Tregs and reduce CNS autoimmunity. Microbiome. 2026 Jun 29;14(1):176. doi: 10.1186/s40168-026-02394-w. PMID: 42374500 Lehman PC, Ghimire S, Price JD, Ramer-Tait AE, Mangalam AK. (2023) Diet-microbiome-immune interplay in multiple sclerosis: Understanding the impact of phytoestrogen metabolizing gut bacteria. Eur J Immunol. Nov; 53(11):e2250236. DOI: 10.1002/eji.202250236. PMID: 37673213. Mendoza-Leon MJ, Mangalam AK, Regaldiz A, Gonzalez-Madrid E, Rangel-Ramirez MA, Alvarez-Mardonez OA, Vallejos OP, Mendez C, Bueno SM, Melo-Gonzalez F, Duarte Y, Opazo MC, Kalergis AM, Riedel CA. (2023) Gut microbiota short-chain fatty acids and their impact on the host thyroid function and diseases. Front Endocrinol (Lausanne). Jun 30; 14:1192216. DOI: 10.3389/fendo.2023.119226. PMID: 37455925. PMCID: PMC10349397.

This was a very interesting presentation about the challenges of helping persons with life-limiting conditions (for example, hemophilia, cystic fibrosis, sickle cell anemia and more) transition from pediatric to adult systems of care. Most of the discussion was about the difficulty in finding doctors who would be willing and able to assume care of patients who had survived to adulthood who had been previously seen in pediatrics throughout childhood.

I listened very carefully to the whole podcast, waiting to hear about what the role of mental health care professionals would be in this kind of transition. There was no mention of it, not even after one of the presenters described a patient who was starting to have hallucinations.

My role as a consulting psychiatrist in a general hospital was mainly to see those with chronic diseases who were being treated by colleagues during a bout of cystic fibrosis or sickle cell crisis. I remember they were young adults, struggling with emotional distress and disruptive behavior.

I was surprised at the lack of discussion about the role of mental health assessments, diagnoses, and treatment including psychotherapy during transitions from pediatric to adult health care. Not that I would have had much to offer other than questions about how mental health professionals could be helpful regarding transitions—but I think they would have not been out of place.

I took a quick look at the resources provided. One of them was a University of Iowa website, the Iowa Center for Disabilities and Development: Transition to Adulthood Clinic For Teens and Young Adult Ages 14-30. Even here, the role of a psychologist was to evaluate learning problems.

One of the discussants mentioned a program called Got Transition, which has a very comprehensive website. There was a section for Special Populations and a list of resources and research when I searched the site using the term “mental health.” It was hard to find a section specific to the population under discussion in the podcast. On the other hand, it was very comprehensive.

In this podcast, discussants talked about the importance of a team approach to transitions. I wonder if there’s a place on the team for psychiatry.

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