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Noble AJ, Robinson A, Snape D, Marson AG. 'Epileptic', 'epileptic person' or 'person with epilepsy'? Bringing quantitative and qualitative evidence on the views of UK patients and carers to the terminology debate. Epilepsy Behav 2017; 67:20-27. [PMID: 28086189 DOI: 10.1016/j.yebeh.2016.10.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022]
Abstract
How to refer to someone with epilepsy is a divisive topic. Arguments for and against different approaches, including traditional adjective labels, disability-first labels, and person-first terms have been presented. The preferences of those with epilepsy and their family and friends have, though, never been determined. This study provides this information for the first time. Via epilepsy interest groups and organizations in the UK and Republic of Ireland, 638 patients and 333 significant others completed an online survey. Three distinct phrases were presented: "They're epileptic" (traditional label), "They're an epileptic person" (disability-first) and "That person has epilepsy" (person-first). Participants identified which they preferred and explained their choices. Patients' median age was 39, with 69% having experienced seizures in the prior 12months. Significant others were typically parents. Most (86.7%) patients and significant others (93.4%) favored the person-first term. Traditional and disability-first terms were "Disliked"/"Strongly disliked". Regression found it was not possible to reliably distinguish between participants favoring the different terms on the basis of demographics. Qualitative analysis of answers to open-ended questions, however, revealed most favored person-first terminology as by not including the word 'epileptic' and by affirming personhood before disability, it was felt to less likely restrict a listener's expectations or evoke the condition's negative association. It was also considered to suggest the person being referred to might have some mastery over their condition. The findings indicate consensus amongst these key stakeholders others for the use of person-first terminology in English. A truly informed debate on the topic can now begin.
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Sherratt FC, Snape D, Goodacre S, Jackson M, Pearson M, Marson AG, Noble AJ. Paramedics' views on their seizure management learning needs: a qualitative study in England. BMJ Open 2017; 7:e014024. [PMID: 28069626 PMCID: PMC5237774 DOI: 10.1136/bmjopen-2016-014024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at scene or by using alternative care pathways. Most though are transported to ED. One factor that helps explain this is paramedics can have low confidence in managing seizures. OBJECTIVES With a view to ultimately developing additional seizure management training for practicing paramedics, we explored their learning needs, delivery preferences and potential drivers and barriers to uptake and effectiveness. DESIGN AND SETTING Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed. PARTICIPANTS A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics. RESULTS Participants said seizure management was neglected within basic and postregistration paramedic training. Most welcomed additional learning opportunities and identified gaps in knowledge. This included how to differentiate between seizure types and patients that do and do not need ED. Practical, interactive e-learning was deemed the most preferable delivery format. To allow paramedics to fully implement any increase in skill resulting from training, organisational and structural changes were said to be needed. This includes not penalising paramedics for likely spending longer on scene. CONCLUSIONS This study provides the first evidence on the learning needs and preferences of paramedics regarding seizures. It can be used to inform the development of a bespoke training programme for paramedics. Future research should develop and then assess the benefit such training has on paramedic confidence and on the quality of care they offer to seizure patients.
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Noble AJ, Snape D, Goodacre S, Jackson M, Sherratt FC, Pearson M, Marson A. Qualitative study of paramedics' experiences of managing seizures: a national perspective from England. BMJ Open 2016; 6:e014022. [PMID: 28186950 PMCID: PMC5128771 DOI: 10.1136/bmjopen-2016-014022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The UK ambulance service is expected to now manage more patients in the community and avoid unnecessary transportations to hospital emergency departments (ED). Most people it attends who have experienced seizures have established epilepsy, have experienced uncomplicated seizures and so do not require the full facilities of an ED. Despite this, most are transported there. To understand why, we explored paramedics' experiences of managing seizures. DESIGN AND SETTING Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed. PARTICIPANTS A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics. RESULTS Participants' confirmed how most seizure patients attended to do not clinically require an ED. They explained, however, that a number of factors influence their care decisions and create a momentum for these patients to still be taken. Of particular importance was the lack of access paramedics have to background medical information on patients. This, and the limited seizure training paramedics receive, meant paramedics often cannot interpret with confidence the normality of a seizure presentation and so transport patients out of precaution. The restricted time paramedics are expected to spend 'on scene' due to the way the ambulance services' performance is measured and that are few alternative care pathways which can be used for seizure patients also made conveyance likely. CONCLUSIONS Paramedics are working within a system that does not currently facilitate non-conveyance of seizure patients. Organisational, structural, professional and educational factors impact care decisions and means transportation to ED remains the default option. Improving paramedics access to medical histories, their seizure management training and developing performance measures for the service that incentivise care that is cost-effective for all of the health service might reduce unnecessary conveyances to ED.
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Noble AJ, Marson AG. Which outcomes should we measure in adult epilepsy trials? The views of people with epilepsy and informal carers. Epilepsy Behav 2016; 59:105-10. [PMID: 27123531 DOI: 10.1016/j.yebeh.2016.01.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/30/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE So that informed treatment decisions can be made, clinical trials need to evaluate treatments against domains that are important to people with epilepsy (PWE), their carers, and clinicians. Health professionals have identified domains of importance to them via the International League Against Epilepsy's Commission on Outcome Measurement (COME). However, patients and carers have not been systematically asked. METHODS Via the membership of the British Epilepsy Association, we recruited and surveyed 352 PWE and 263 of their informal carers. They were presented with 10 outcome domains (including the 5 identified by COME) and asked to rate their importance using a 9-point Likert scale. They were also asked to identify any additional domains of importance. RESULTS The patients' mean age was 49years, the median number of years since diagnosis was 20, and 65% had experienced seizures in the prior 12months. Most carers were the spouse or parent. Patients' and carers' mean ratings indicated that their outcome priorities were similar, as were those of patients who had and had not experienced recent seizures. There was consensus among patients that 6 domains were of critical importance. These included the 5 identified by COME (namely, and in order of importance, the effects of the treatment on "Seizure severity", "Seizure frequency", "Quality of life", "Cognitive function", and "Adverse events"), as well as one additional domain ("Independence/need for support"). There was consensus among carers that the 5 COME domains were also critically important. They, however, identified 3 further domains as critically important. These were the effects of the treatment on patient "Depression", "Anxiety", and "Independence/need for support". CONCLUSIONS Our study found some overlap between the priorities of PWE, carers, and health professionals. They, however, highlight additional areas of importance to patients and carers. Our results could inform a core outcome set for epilepsy that represents the domains that should be reported as a minimum by all trials. This could promote trials which produce meaningful results and consistency in measurement and reporting.
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Noble AJ, Marson AG. Should we stop saying "epileptic"? A comparison of the effect of the terms "epileptic" and "person with epilepsy". Epilepsy Behav 2016; 59:21-7. [PMID: 27084979 DOI: 10.1016/j.yebeh.2016.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The advantages and disadvantages of using "epileptic" as a noun to describe someone with epilepsy have long been debated. Recent high-profile recommendations have stated that the term should not be used, including in English, as it perpetuates stigma. This decision was largely informed by a Brazilian Global Campaign Against Epilepsy study that reported experimental evidence indicating that, with students, the label evokes more negative attitudes than "person with epilepsy". The generalizability of this effect to different countries/cultures, and thus the justification for the recommendations, has never been tested. METHODS We replicated the Brazilian study in the UK, in English, while also addressing methodological limitations. It was powered to detect the effects reported by the Brazilian study, with 234 students completing a survey regarding epilepsy attitudes. Half were randomized to Group 1 and half to Group 2. In Group 1, patients were referred to as "people/person with epilepsy" within the attitudinal measures, while in Group 2 they were referred to as "epileptic/s". Measures included translations of the questions used in the Brazilian study and the Attitudes and Beliefs about Living with Epilepsy scale. Participants' epilepsy familiarity and knowledge were also assessed. RESULTS The two groups were comparable in characteristics. A comparison of their responses to the attitude measures revealed no statistically significant or meaningful differences. CONCLUSIONS In this English replication, the word "epileptic" did not provoke more negative attitudes. This suggests that the effect reported by the Brazilian study might be culturally dependent. Methodological limitations to that study might also be relevant. Our results have implications for the global debate about how negative attitudes towards epilepsy might be addressed. Simply not saying "epileptic" may not promote the positive attitudes towards epilepsy that had been expected. To know how to best refer to those with epilepsy, evidence on the preferences of those actually living with epilepsy is needed.
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Cousins S, Ridsdale L, Goldstein LH, Noble AJ, Moorey S, Seed P. A pilot study of cognitive behavioural therapy and relaxation for migraine headache: a randomised controlled trial. J Neurol 2015; 262:2764-72. [PMID: 26477023 PMCID: PMC4655008 DOI: 10.1007/s00415-015-7916-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Abstract
Headache is being viewed more commonly in a biopsychosocial framework, which introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy and relaxation. No such treatments have been trialled in the UK. We conducted a randomised controlled pilot trial, comparing a brief guided self-help CBT and relaxation treatment with standard medical care (SMC), in a UK NHS setting. Participants were recruited from specialist headache clinics across London. Participants were randomised to receive either treatment or standard medical care. Our objective was to provide design information necessary for a future definitive trial of the SHE treatment, including, recruitment/retention rates, acceptability of randomisation, treatment fidelity and estimations of mean and variances of outcome measures. From the initial 275 patients identified, 73 were randomised. There was no difference in drop-out rates between SMC and treatment groups. Of the 36 participants randomised to receive treatment, 72 % attended all sessions. Findings show that a future definitive trial of the SHE treatment is feasible, with small modifications of protocol, within a UK NHS context.
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Noble AJ. Unplanned hospital use by people with epilepsy: A lever by which to bring about increased self-management support? Epilepsy Behav 2015; 51:57-9. [PMID: 26262933 DOI: 10.1016/j.yebeh.2015.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/11/2015] [Indexed: 11/17/2022]
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Noble AJ, Marson AG, Tudur-Smith C, Morgan M, Hughes DA, Goodacre S, Ridsdale L. 'Seizure First Aid Training' for people with epilepsy who attend emergency departments, and their family and friends: study protocol for intervention development and a pilot randomised controlled trial. BMJ Open 2015; 5:e009040. [PMID: 26209121 PMCID: PMC4521519 DOI: 10.1136/bmjopen-2015-009040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/30/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION People with chronic epilepsy (PWE) often make costly but clinically unnecessary emergency department (ED) visits. Offering them and their carers a self-management intervention that improves confidence and ability to manage seizures may lead to fewer visits. As no such intervention currently exists, we describe a project to develop and pilot one. METHODS AND ANALYSIS To develop the intervention, an existing group-based seizure management course that has been offered by the Epilepsy Society within the voluntary sector to a broader audience will be adapted. Feedback from PWE, carers and representatives from the main groups caring for PWE will help refine the course so that it addresses the needs of ED attendees. Its behaviour change potential will also be optimised. A pilot randomised controlled trial will then be completed. 80 PWE aged ≥16 who have visited the ED in the prior 12 months on ≥2 occasions, along with one of their family members or friends, will be recruited from three NHS EDs. Dyads will be randomised to receive the intervention or treatment as usual alone. The proposed primary outcome is ED use in the 12 months following randomisation. For the pilot, this will be measured using routine hospital data. Secondary outcomes will be measured by patients and carers completing questionnaires 3, 6 and 12 months postrandomisation. Rates of recruitment, retention and unblinding will be calculated, along with the ED event rate in the control group and an estimate of the intervention's effect on the outcome measures. ETHICS AND DISSEMINATION Ethical approval: NRES Committee North West-Liverpool East (Reference number 15/NW/0225). The project's findings will provide robust evidence on the acceptability of seizure management training and on the optimal design of a future definitive trial. The findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN13 871 327.
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Magill N, Ridsdale L, Goldstein LH, McCrone P, Morgan M, Noble AJ, Baker G, Richardson M, Taylor S, Landau S. Self-management education for adults with poorly controlled epilepsy (SMILE (UK)): statistical, economic and qualitative analysis plan for a randomised controlled trial. Trials 2015; 16:269. [PMID: 26068449 PMCID: PMC4488108 DOI: 10.1186/s13063-015-0788-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a need to test the effectiveness of new educational interventions for people with poorly controlled epilepsy. The SMILE (self-management education for adults with poorly controlled epilepsy) trial evaluates a complex service intervention that involves a 2-day self-management course with the aim of improving quality of life and clinical outcomes. This article describes the statistical, economic, and qualitative analysis plan for the trial. METHODS AND DESIGN SMILE is a pragmatic, parallel design, two-arm, multi-centre randomised controlled superiority trial of a group-based interactive course compared with treatment as usual for people who have experienced two or more seizures in the past 12 months. RESULTS A summary of the objectives and design of the trial are reported as well as the manner in which the data will be summarised and inferentially analysed. This includes the type of modelling that will be employed for each of the primary and secondary outcomes and the methods by which the assumptions of these models will be checked. Strategies are described for handling clustering of outcome data, missing observations, and treatment non-compliance. CONCLUSION This update to the previously published trial protocol provides a description of the trial analysis which is transparent and specified before any outcome data are available. It also provides guidance to those planning the analysis of similar trials. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389; date assigned: 27 March 2013.
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Kiphuth IC, Utz KS, Noble AJ, Köhrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Stroke 2014; 45:3360-6. [PMID: 25278556 DOI: 10.1161/strokeaha.113.004459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE A transient ischemic attack (TIA) involves temporary neurological symptoms but leaves a patient symptom-free. Patients are faced with an increased risk for future stroke, and the manifestation of the TIA itself might be experienced as traumatizing. We aimed to investigate the prevalence of posttraumatic stress disorder (PTSD) after TIA and its relation to patients' psychosocial outcome. METHODS Patients with TIA were prospectively studied, and 3 months after the diagnosis, PTSD, anxiety, depression, quality of life, coping strategies, and medical knowledge were assessed via self-rating instruments. RESULTS Of 211 patients with TIA, data of 108 patients were complete and only those are reported. Thirty-two (29.6%) patients were classified as having PTSD. This rate is 10× as high as in the general German population. Patients with TIA with PTSD were more likely to show signs of anxiety and depression. PTSD was associated with the use of maladaptive coping strategies, subjectively rated high stroke risk, as well as with younger age. Finally, PTSD and anxiety were associated with decreased mental quality of life. CONCLUSIONS The experience of TIA increases the risk for PTSD and associated anxiety, depression, and reduced mental quality of life. Because a maladaptive coping style and a subjectively overestimated stroke risk seem to play a crucial role in this adverse progression, the training of adaptive coping strategies and cautious briefing about the realistic stroke risk associated with TIA might be a promising approach. Despite the great loss of patients to follow-up, the results indicate that PTSD after TIA requires increased attention.
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Noble AJ, Lacerda AF. Intracellular Interaction of Spherical Antimicrobial Nanoparticles of Silver on Freshwater Protozoan Euglena gracilis. ACTA ACUST UNITED AC 2014. [DOI: 10.1166/jamr.2014.1209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kralj-Hans I, Goldstein LH, Noble AJ, Landau S, Magill N, McCrone P, Baker G, Morgan M, Richardson M, Taylor S, Ridsdale L. Self-Management education for adults with poorly controlled epILEpsy (SMILE (UK)): a randomised controlled trial protocol. BMC Neurol 2014; 14:69. [PMID: 24694207 PMCID: PMC3976555 DOI: 10.1186/1471-2377-14-69] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Teaching people with epilepsy to identify and manage seizure triggers, implement strategies to remember to take antiepileptic drugs, implement precautions to minimize risks during seizures, tell others what to do during a seizure and learn what to do during recovery may lead to better self-management. No teaching programme exists for adults with epilepsy in the United Kingdom although a number of surveys have shown patients want more information. METHODS/DESIGN This is a multicentre, pragmatic, parallel group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of a two-day Self-Management education for epILEpsy (SMILE (UK)), which was originally developed in Germany (MOSES).Four hundred and twenty eight adult patients who attended specialist epilepsy outpatient clinics at 15 NHS participating sites in the previous 12 months, and who fulfil other eligibility criteria will be randomised to receive the intervention (SMILE (UK) course with treatment as usual- TAU) or to have TAU only (control). The primary outcome is the effect on patient reported quality of life (QoL). Secondary outcomes are seizure frequency and psychological distress (anxiety and depression), perceived impact of epilepsy, adherence to medication, management of adverse effects from medication, and improved self-efficacy in management (mastery/control) of epilepsy.Within the trial there will be a nested qualitative study to explore users' views of the intervention, including barriers to participation and the perceived benefits of the intervention. The cost-effectiveness of the intervention will also be assessed. DISCUSSION This study will provide quantitative and qualitative evidence of the impact of a structured self management programme on quality of life and other aspects of clinical and cost effectiveness in adults with poorly controlled epilepsy. TRIAL REGISTRATION Current Controlled Trials: ISRCTN57937389.
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Noble AJ, McCrone P, Seed PT, Goldstein LH, Ridsdale L. Clinical- and cost-effectiveness of a nurse led self-management intervention to reduce emergency visits by people with epilepsy. PLoS One 2014; 9:e90789. [PMID: 24603669 PMCID: PMC3948384 DOI: 10.1371/journal.pone.0090789] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 02/03/2014] [Indexed: 11/18/2022] Open
Abstract
People with chronic epilepsy (PWE) often make costly, and clinically unnecessary emergency department (ED) visits. Some do it frequently. No studies have examined interventions to reduce them. An intervention delivered by an epilepsy nurse specialist (ENS) might reduce visits. The rationale is it may optimize patients' self-management skills and knowledge of appropriate ED use. We examined such an intervention's clinical- and cost-effectiveness. Eighty-five adults with epilepsy were recruited from three London EDs with similar catchment populations. Forty-one PWE recruited from two EDs received treatment-as-usual (TAU) and formed the comparison group. The remaining 44 PWE were recruited from the ED of a hospital that had implemented a new ENS service for PWE attending ED. These participants formed the intervention group. They were offered 2 one-to-one sessions with an ENS, plus TAU. Participants completed questionnaires on health service use and psychosocial well-being at baseline, 6- and 12-month follow-up. Covariates were identified and adjustments made. Sixty-nine (81%) participants were retained at follow-up. No significant effect of the intervention on ED visits at 12 months or on other outcomes was found. However, due to less time as inpatients, the average service cost for intervention participants over follow-up was less than for TAU participants' (adjusted difference £558, 95% CI, -£2409, £648). Covariates most predictive of subsequent ED visits were patients' baseline feelings of stigmatization due to epilepsy and low confidence in managing epilepsy. The intervention did not lead to a reduction in ED use, but did not cost more, partly because those receiving the intervention had shorter hospital admissions. Our findings on long-term ED predictors clarifies what causes ED use, and suggests that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency-savings generated.
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Covey J, Noble AJ, Schenk T. Family and friends' fears of recurrence: impact on the patient's recovery after subarachnoid hemorrhage. J Neurosurg 2013; 119:948-54. [DOI: 10.3171/2013.5.jns121688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with subarachnoid hemorrhage (SAH) and their close friends and family may be excessively fearful that the patient will have a recurrence, and such fears could play a critical role in the poor recovery shown by many patients The authors examined whether these fears could account for significant variance in psychosocial outcomes.
Methods
The authors prospectively studied a sample of 69 patients with SAH alongside their spouse, other family member, and/or close friend identified as their significant other (SO). The patient/SO pairs were assessed at 13 months postictus for their fears of recurrence and for health-related quality of life on the 8 domains of the 36-Item Short Form Health Survey.
Results
The SOs were found to be significantly more fearful of SAH recurrence than the patients. The SO's fears also explained unique variance in the patient's recovery on 4 of the 36-Item Short Form Health Survey domains over and above the patient's own fears, demographic and/or neurological variables, and the patient's history of psychiatric or neurological problems. The domains affected reflected activity-based and functional aspects of the patient's quality of life as opposed to more general characteristics of their emotional well-being or physical health state.
Conclusions
The patient's recovery may be compromised if their spouse, close family, and/or friends are excessively fearful about their suffering a recurrence. Perhaps the SO's fears cause them to be overprotective of the patient and to restrict their day-to-day activities. Attention must therefore be given to the experience of having a loved one suffer from an SAH, and alleviating the caregiver's fears could help to promote a better outcome for the patient.
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Noble AJ, Morgan M, Virdi C, Ridsdale L. A nurse-led self-management intervention for people who attend emergency departments with epilepsy: the patients’ view. J Neurol 2012; 260:1022-30. [DOI: 10.1007/s00415-012-6749-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022]
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Noble AJ, Goldstein LH, Seed P, Glucksman E, Ridsdale L. Characteristics of people with epilepsy who attend emergency departments: Prospective study of metropolitan hospital attendees. Epilepsia 2012; 53:1820-8. [DOI: 10.1111/j.1528-1167.2012.03586.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Noble AJ, Baisch S, Covey J, Mukerji N, Nath F, Schenk T. Subarachnoid hemorrhage patients' fears of recurrence are related to the presence of posttraumatic stress disorder. Neurosurgery 2012; 69:323-32; discussion 332-3. [PMID: 21415779 DOI: 10.1227/neu.0b013e318216047e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) patients illustrate a chronic fear of recurrence. A third of patients develop posttraumatic stress disorder (PTSD) after SAH, and PTSD after other conditions is associated with a more negative outlook on life. OBJECTIVE We examined whether recurrence fears are related to PTSD and whether this is associated with the patients making more negative health appraisals. We also examined the helpfulness of current treatments. METHODS Two SAH samples were generated. Sample 1 (n = 82) was assessed 13 months after ictus for PTSD, cognition, fear of recurrence, and beliefs concerning future health. Sample 2 (n = 60) was assessed 18 months after ictus for PTSD and to determine how much current treatments increased their confidence about not having another SAH. RESULTS Thirty-four percent of sample 1 had PTSD. Although clinically and cognitively comparable, PTSD patients feared recurrence more and were comparatively more pessimistic about their chances of further SAH. Thirty-six percent of sample 2 had PTSD. These most fearful patients reported finding current treatments the least helpful. CONCLUSION Fear of recurrence after SAH is related to PTSD. Participants with PTSD were more pessimistic about their future health. Treatment for PTSD could alleviate fears of SAH recurrence and promote better outcome.
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Baisch SB, Schenk T, Noble AJ. What is the cause of post-traumatic stress disorder following subarachnoid haemorrhage? Post-ictal events are key. Acta Neurochir (Wien) 2011; 153:913-22. [PMID: 20963450 DOI: 10.1007/s00701-010-0843-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/08/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is common after subarachnoid haemorrhage (SAH) and causes poor outcome. Knowing which SAH events cause the stress leading to PTSD development could allow for their severity, and so the chances of PTSD, to be reduced. The dramatic nature of SAH onset has meant ictal events have been the presumed cause. Frequent loss of consciousness (LOC) at ictus, and presumed resultant amnesia, however, means this might not be correct. We examined two hypotheses for how SAH patients develop PTSD despite frequent LOC. Firstly, has the frequency of amnesia for ictal events subsequent to LOC been overestimated? Secondly, is it the stress of post-ictal events, rather than ictal events, which causes PTSD? METHOD Sixty SAH patients, 18 months post-ictus, were assessed for PTSD, LOC at ictus, memory for ictal events, as well as which aspects of their SAH, ictal and post-ictal, were psychologically stressful. Patients also underwent neuropsychological examination. FINDINGS Of patients, 36.7% had PTSD. Memory overall for ictal events was more common than expected: 50% reported LOC, and only 18% reported no memory. However, memory was not associated with PTSD development. Rather, the key predictor of PTSD was the stress of post-ictal events. The stress of ictal events, cognitive impairment and clinical characteristics were unrelated to PTSD development. Post-ictal events included realizing that their life could have/had changed, that they may have been left with long-term problems, that they could have died and that they had little memory for some SAH events and regaining consciousness. CONCLUSIONS The traumatic quality of an SAH lies in post-ictal events, rather than ictal events. These events are related to the patients' adjustment to the experience of having had an SAH. Reducing the traumatic severity of these events could potentially reduce the likelihood of PTSD in SAH patients and so improve their outcome.
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Noble AJ, Schenk T. Which variables help explain the poor health-related quality of life after subarachnoid hemorrhage? A meta-analysis. Neurosurgery 2010; 66:772-83. [PMID: 20190663 DOI: 10.1227/01.neu.0000367548.63164.b2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Patients with subarachnoid hemorrhage (SAH) are younger than typical stroke patients. Poor psychosocial outcome after SAH therefore leads to a disproportionately high impact on patients, relatives, and society. Addressing this problem requires an understanding of what causes poor psychosocial outcome. Numerous studies have examined potential predictors but produced conflicting results. We aim to resolve this uncertainty about the potential value of individual predictors by conducting a meta-analysis. This approach allows us to quantitatively combine the findings from all relevant studies to identify promising predictors of psychosocial outcome and determine the strength with which those predictors are associated with measures of psychosocial health. METHODS Psychosocial health was measured by health-related quality of life (HRQOL). We included in our analysis those predictors that were most frequently examined in this context, namely patient age, sex, neurologic state at the time of hospital admission, bleed severity, physical disability, cognitive impairment, and time between ictus and psychosocial assessment. RESULTS Only 1 of the traditional variables, physical disability, had any notable affect on HRQOL. Therefore, the cause of most HRQOL impairment after SAH remains unknown. The situation is even worse for mental HRQOL, an area that is often significantly affected in SAH patients. Here, 90% of the variance remains unexplained by traditional predictors. CONCLUSION Studies need to turn to new factors to account for poor patient outcome.
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Noble AJ, Schenk T. Psychosocial outcome following subarachnoid haemorrhage: An under-researched problem. ACTA ACUST UNITED AC 2009. [DOI: 10.12968/bjnn.2009.5.8.43598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. Neurosurgery 2009; 63:1095-104; discussion 1004-5. [PMID: 19057321 DOI: 10.1227/01.neu.0000327580.91345.78] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE A subarachnoid hemorrhage reduces patients' quality of life (QoL) in both the short and long term. Neurological problems alone cannot explain this reduction. We examined whether posttraumatic stress disorder (PTSD) and fatigue provide an explanation. METHODS We prospectively studied a representative sample of 105 subarachnoid hemorrhage patients. Patients were examined at approximately 3 and 13 months postictus. Examinations included assessments of PTSD, fatigue, sleep, cognitive and physical outcomes, and QoL. Patients' coping skills were also assessed. Regression analyses identified predictors for QoL and PTSD. RESULTS Thirty-seven percent met the diagnostic criteria for PTSD at both assessment points. This is a fourfold increase compared with the rate of PTSD in the general population. Fatigue in patients was also consistently elevated, higher, in fact, than the notoriously high fatigue level reported for cancer patients undergoing chemotherapy. PTSD was the best predictor for mental QoL, the domain most persistently impaired. It also helped predict physical QoL. Moreover, PTSD was linked to increased sleep problems and may, therefore, have led to fatigue in both the acute and later stages of recovery. To establish the cause of PTSD, a logistic regression was performed. This showed that maladaptive coping was the best predictor of PTSD. CONCLUSION PTSD explains why some subarachnoid hemorrhage patients, despite relatively good clinical outcomes, continue to experience a reduced QoL. Given that maladaptive coping skills seem the main cause of PTSD, teaching patients better coping skills early on might prevent PTSD and QoL reduction.
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Noble AJ, Schenk T. Posttraumatic stress disorder in the family and friends of patients who have suffered spontaneous subarachnoid hemorrhage. J Neurosurg 2008; 109:1027-33. [DOI: 10.3171/jns.2008.109.12.1027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Significant others (SOs), such as spouses and life partners, of patients who have survived subarachnoid hemorrhage (SAH) can experience psychiatric symptoms and psychosocial disability. The cause of such symptoms has not been established. Authors of the present study analyzed whether posttraumatic stress disorder (PTSD) subsequent to a loved one's SAH is a plausible explanation for these symptoms.
Methods
The authors examined a large representative sample of 86 patient/SO pairs 3.5 months postictus. All SOs were evaluated using a diagnostic PTSD measure, and coping skills were assessed. The cognitive, physical, and emotional status of patients was comprehensively examined.
Results
Twenty-six percent of SOs met the diagnostic criteria for PTSD, which represents a 3-fold increase in the rate expected within the general population. To establish the cause of PTSD, a logistic regression was performed, and results of this test showed that the use of maladaptive coping strategies was the best predictor of the disorder. A patient's level of disability held no significant association with the development of PTSD in his or her SO.
Conclusions
The elevated incidence of PTSD in SOs helps to explain why these persons report concerning levels of psychiatric symptomatology and psychosocial disability. Greater attention must be given to an SO's adjustment to the experience of having a loved one suffer an SAH. This need is all the more pertinent given that SOs often act as informal caregivers and that PTSD could interfere with their ability to effectively minister. Because bad coping skills seem to be the main cause of PTSD, teaching SOs better strategies might prevent the disorder and any resulting psychosocial disability.
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Aharmim B, Ahmed SN, Amsbaugh JF, Anthony AE, Banar J, Barros N, Beier EW, Bellerive A, Beltran B, Bergevin M, Biller SD, Boudjemline K, Boulay MG, Bowles TJ, Browne MC, Bullard TV, Burritt TH, Cai B, Chan YD, Chauhan D, Chen M, Cleveland BT, Cox-Mobrand GA, Currat CA, Dai X, Deng H, Detwiler J, DiMarco M, Doe PJ, Doucas G, Drouin PL, Duba CA, Duncan FA, Dunford M, Earle ED, Elliott SR, Evans HC, Ewan GT, Farine J, Fergani H, Fleurot F, Ford RJ, Formaggio JA, Fowler MM, Gagnon N, Germani JV, Goldschmidt A, Goon JTM, Graham K, Guillian E, Habib S, Hahn RL, Hallin AL, Hallman ED, Hamian AA, Harper GC, Harvey PJ, Hazama R, Heeger KM, Heintzelman WJ, Heise J, Helmer RL, Henning R, Hime A, Howard C, Howe MA, Huang M, Jagam P, Jamieson B, Jelley NA, Keeter KJ, Klein JR, Kormos LL, Kos M, Krüger A, Kraus C, Krauss CB, Kutter T, Kyba CCM, Lange R, Law J, Lawson IT, Lesko KT, Leslie JR, Loach JC, MacLellan R, Majerus S, Mak HB, Maneira J, Martin R, McBryde K, McCauley N, McDonald AB, McGee S, Mifflin C, Miller GG, Miller ML, Monreal B, Monroe J, Morissette B, Myers A, Nickel BG, Noble AJ, Oblath NS, O'Keeffe HM, Ollerhead RW, Gann GDO, Oser SM, Ott RA, Peeters SJM, Poon AWP, Prior G, Reitzner SD, Rielage K, Robertson BC, Robertson RGH, Rollin E, Schwendener MH, Secrest JA, Seibert SR, Simard O, Simpson JJ, Sinclair L, Skensved P, Smith MWE, Steiger TD, Stonehill LC, Tesić G, Thornewell PM, Tolich N, Tsui T, Tunnell CD, Van Wechel T, Van Berg R, VanDevender BA, Virtue CJ, Walker TJ, Wall BL, Waller D, Tseung HWC, Wendland J, West N, Wilhelmy JB, Wilkerson JF, Wilson JR, Wouters JM, Wright A, Yeh M, Zhang F, Zuber K. Independent measurement of the total active 8B solar neutrino flux using an array of 3He proportional counters at the Sudbury Neutrino Observatory. PHYSICAL REVIEW LETTERS 2008; 101:111301. [PMID: 18851271 DOI: 10.1103/physrevlett.101.111301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Indexed: 05/26/2023]
Abstract
The Sudbury Neutrino Observatory (SNO) used an array of 3He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active (nu_x) 8B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54_-0.31;+0.33(stat)-0.34+0.36(syst)x10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields Deltam2=7.59_-0.21;+0.19x10(-5) eV2 and theta=34.4_-1.2;+1.3 degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.
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Azuelos G, Barnabé-Heider M, Behnke E, Clark K, Di Marco M, Doane P, Feighery W, Genest MH, Gornea R, Guenette R, Kanagalingam S, Krauss C, Leroy C, Lessard L, Levine I, Martin JP, Noble AJ, Noulty R, Shore SN, Wichoski U, Zacek V. Direct dark matter search using large-mass superheated droplet detectors in the PICASSO experiment. RADIATION PROTECTION DOSIMETRY 2006; 120:495-8. [PMID: 16644961 DOI: 10.1093/rpd/nci624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The PICASSO experiment investigates the presence and nature of dark matter in the Universe. The experiment is based on the detection of acoustic signals generated in explosive phase transitions induced by dark matter particles. This technique is an alternative more traditional detection technique like scintillation and ionisation, which are largely employed for dark matter search. One of the main advantages of this technique, besides its sensitivity to very low nuclear recoil energies (few keV), is its excellent background suppression features. A pilot experiment consisting of six superheated droplet detectors (40 g of active mass) is presently taking data at the Sudbury Neutrino Observatory (SNO) at a depth of 2000 m. We discuss the operation, calibration and data acquisition of the experiment and also the ongoing work to increase the sensitivity and the active mass of the detectors.
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Azuelos G, Barnabé-Heider M, Behnke E, Clark K, Di Marco M, Doane P, Feighery W, Genest MH, Gornea R, Guénette R, Kanagalingam S, Krauss C, Leroy C, Lessard L, Levine I, Martin JP, Noble AJ, Noulty R, Shore SN, Wichoski U, Zacek V. Simulation of special bubble detectors for PICASSO. RADIATION PROTECTION DOSIMETRY 2006; 120:499-502. [PMID: 16822778 DOI: 10.1093/rpd/nci666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The PICASSO project is a cold dark matter (CDM) search experiment relying on the superheated droplet technique. The detectors use superheated freon liquid droplets (active material) dispersed and trapped in a polymerised gel. This detection technique is based on the phase transition of superheated droplets at about room temperature and ambient pressure. The phase transition is induced by nuclear recoils when an atomic nucleus in the droplets interacts with incoming subatomic particles. This includes CDM particles candidate as the neutralino (a yet-to-discover particle predicted in extensions of the standard model of particle physics). Simulations performed to understand the detector response to neutrons and alpha particles are presented along with corresponding data obtained at the Montreal Laboratory.
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