During the entry examination, leg ulcers were present in 2.5% of 2,075 patients 10 years of age and older with sickle cell disease who entered into the Cooperative Study of Sickle Cell Disease (CSSCD) between 1979 and 1986. Prevalence rates were highest among patients with sickle cell anemia and sickle cell anemia with thalassemia genotypes. Among sickle cell anemia patients free of ulcers at entry, the overall incidence was 5.73 per 100 person years in those having associated alpha-thalassemia and 9.97 for those without. Among sickle cell anemia patients with two alpha genes, the estimated incidence of leg ulcers is 2.38 per 100 person years and 6.12 per 100 person years among sickle cell anemia patients with three alpha genes (P less than .05). In both groups, the incidence was highest among those patients over 20 years of age and considerably higher among males than females (P less than .001). Leg ulcers were nonexistent in patients with sickle beta plus thalassemia and sickle hemoglobin C disease. Low steady-state hemoglobin is associated with a higher incidence of ulcer formation (P less than .0001) in sickle cell anemia patients. The protective effect of hemoglobin F is apparent at all levels of total hemoglobin among sickle cell anemia patients and those with associated alpha-thalassemia.

When health systems in a geographic area share data, they are better able to recognize patterns of overuse, and address them properly. This study demonstrated that a collaborative 90-day intervention identifying super-utilizers reduced the monthly rate of 9-1-1 calls, ED visits, and hospital admissions.

Objective: A multidisciplinary team from a US midwestern urban medical centre developed written patient education materials for a group education programme designed to prepare adolescents and emerging adults with sickle cell disease for transition to adult care. We evaluated the literacy levels of these materials and demonstrate how to revise the patient education materials to meet literacy standards. Method: Six tools were used to evaluate literacy levels of the patient education materials. Based on the literacy level scores of the materials, including readability, grade level, understandability and actionability, recommendations and revisions were made to improve literacy levels. The revised materials were again assessed using the same six tools. Results: Initial literacy levels of the patient education materials were higher than recommended standards. Adjustments were made to meet literacy standards. Not all standards were met. Conclusion: Patient education materials should conform as much as possible to recommended literacy standards for optimum understandability. However, not all patient education materials can fully meet all evidence-based literacy standards. Recommendations for evaluating literacy standards when creating or providing previously developed patient education materials are discussed. Extra efforts to achieve acceptable literacy standards are recommended when medically complex educational materials are necessary.

Background: The transition of adolescents and emerging adults (AEA) from pediatric to adult care is often challenging. This is especially true for those with sickle cell disease (SCD) because transition coincides with a time period of rapidly increasing mortality risk. Gaps in knowledge and lack of appropriate communication skills can contribute to this risk. Many SCD AEA do not know which variant of SCD they have, cannot explain their relevant medical history, do not understand or take ownership over requesting prescription refills, and do not have the skillset to navigate health insurance. Additionally, pain is an invisible complication that cannot be objectively measured and requires communication skills. Many patients lack the necessary communication skills to effectively articulate their pain to healthcare providers. To address the transition needs of individuals with SCD, our team adapted and developed an innovative group healthcare model based on the core components of the well-established Centering® healthcare model. We produced a group healthcare curriculum entitled Our Hands, Our Health based on these gaps in knowledge. At each session, the 8-10 patients in the group will have a one-on-one visit with their hematologist and then meet with the entire group for 60 minutes of health education through group discussions led by two facilitators using interactive activities, games, and role-plays. Patients form relationships with other members of the group and with the co-facilitators as they collaboratively discuss and generate health education strategies. Methods: Using a constant comparative technique, we reviewed the core components of the Centering® model and systematically integrated these into the Our Hands, Our Heath program. The health education content reflects the needs of all AEA as well as the unique healthcare needs of AEA with sickle cell disease as they prepare to transition to adult care. Next, we completed a 6-session feasibility and acceptability study with four participants who met monthly. Then, we expanded the program from 6 to 10 sessions and conducted a full-scale pilot meeting every other month (n=13). Direct observations of sessions, debriefings, and interviews with participants and co-facilitators were used to evaluate the model. Results: Participants and co-facilitators enthusiastically embraced the Centering-based group care model. The feasibility participants (n=4) stated that they preferred group care to individual care. From the pilot, there was only one participant who did not like meeting in a group; all others (n=9) reported that they enjoyed group meetings and preferred getting their care this way. Three participants were lost to follow-up due to moving (n=2) and full-time employment (n=1). After the 4th session, six participants reported feeling more prepared for transition. Participants described the value of shared experiences and appreciated the engaging learning environment. Participants felt group meetings offered a supportive environment allowing them to develop relationships with peers who can relate, as well as with their healthcare provider, who was a co-facilitator. They were comfortable asking questions for clarification and liked being able to have in-depth discussions. Co-facilitators reported that it was more efficient to convey health education material in groups than repeating things to each patient one by one and observed participants in group care had an increased understanding of the health education messages. Some structural changes included securing a room larger, how patients were checked in and checked out, how vital signs were taken, and the hiring of a phlebotomist. Conclusions: The Centering-based group care model was feasible and acceptable by participants and co-facilitators. In addition to patient-focused assessments, we suggest including provider satisfaction and perceived quality of care measures. Sustainability is an important consideration and a costs/benefits analysis is needed. Based on our developmental research, a Centering-based group care model appears to offer a promising strategy to increase health education and will facilitate a successful transition from pediatric to adult care. Our long-term goal is to test the efficacy of such a model. Disclosures No relevant conflicts of interest to declare.

Advisement programs, a part of the total guidance service provided by many secondary schools, involve the entire teaching staff and provide personalized guidance services to all secondary students (7–12) in the following areas: program planning, self‐assessment, school offerings awareness, parent relations and conferences, feedback evaluation, decision‐making skills, career planning and preparation, and school and community issues. Advisement enhances counseling and offers counselors the opportunity to practice their specialized skills more fully. The Ferguson‐Florissant advisement program, described in this article, emphasizes positive change in students' attitudes toward themselves and school.