Nurse-led epilepsy follow-up clinic in India: is it feasible and acceptable to patients? A pilot study

Employment among people with epilepsy in Hong Kong

BACKGROUND

People with epilepsy (PWE) face difficulties in employment. Hong Kong depends heavily on tertiary industry and enjoys a low unemployment rate. However, there have been rare reports on employment of PWE in Hong Kong. We aimed at (1) investigating the employment status among PWE; (2) correlating demographic and clinical factors with employment status of PWE; and (3) describing the self-perceived impact of epilepsy on employment and their correlations with employment status.

METHOD

This was a single center cross-sectional study conducted in 2019. Adult with epilepsy but without intellectual disability of year age 16-65 were recruited. Homemakers and retired persons were excluded. A questionnaire with two parts was given to each patient. The first part focused on objective data about employment. The second part focused on self-perception on the impact of epilepsy on employment. Responders expressed their opinions in 5-point Likert scale. Clinical data were retrieved from the computerized medical record system for interpretation.

RESULTS

A total of 138 PWE were recruited. Unemployment rate among the PWE was 33%, which was much higher than the general population. Low education levels, drug-resistant epilepsy, psychiatric comorbidities, and high Charlson Comorbidity Index were correlated to unemployment in PWE. Unemployed respondents significantly more tend to regard that lack of education, stigma of epilepsy, and seizure frequency were main hurdles in employment.

CONCLUSIONS

Unemployment is a severe social problem among PWE in Hong Kong. Various objective clinical and demographic factors correlated with unemployment. Work beliefs of a patient may also correlate with the employment status.

Safety and feasibility of an intensive epilepsy nurse-based treatment course

PURPOSE

To determine safety, feasibility and patient satisfaction of an epilepsy nurse-based treatment course with frequent contacts and changes of anti-epileptic treatment provided by supervised anti-epileptic drug (AED) prescribing epilepsy nurses.

METHODS

Regular prescheduled clinical contacts with a neurologist to adjust AED treatment were largely substituted by on-demand contacts with epilepsy nurses with the delegated right to adapt AED within predefined limits. To secure safety, electronic medical files of patients with 6 or more contacts with epilepsy nurses were retrospectively analysed for clinical characteristics, safety measures and seizure frequency before/after the intensive treatment course and patients were asked to complete a questionnaire about treatment satisfaction.

RESULTS

Between January 1^st 2016 and 31^st December 2018, 2721 patients were treated by epilepsy nurses (2561 ambulatory controls, 8690 phone contacts). 617 patients received an intensive treatment course (six or more contacts in the observation period, range: 6-65) with an average length of 24.3 months. The average number of AED tried was 3.4. In patients with ongoing seizures (n = 310), 165 (53.2 %) reported an improvement of seizure frequency by 50 % or more. Seizure frequency fell from 4.4 to 2.4 days with seizures/months (p < 0.001). The epilepsy-related hospitalization rate was 0.86/patient; 27 episodes with status epilepticus occurred in 21 patients, three hospitalizations were due to severe side effects. There were no fatal complications. No hospitalization was related to the intensive treatment course by prescribing epilepsy nurses. The overall patients' satisfaction was high.

CONCLUSION

Intensive epilepsy treatment facilitated by epilepsy nurses was safe and associated with high patient accept and improvement of seizure frequency.

The Effect of Comprehensive Video-Assisted Epilepsy Education on Drug Adherence and Self-Care in People with Epilepsy

Background  Epilepsy is a chronic neurological disorder which needs proper drug adherence and follow-up care to control the recurrent seizure events as one of the most common reasons for “breakthrough” seizures is nonadherence to antiepileptic drugs. In addition to usual therapeutic management, patients are encouraged to involve in epilepsy self-management by understanding the nature of the disease and its control measures to prevent the complications.

Methods  A single group experimental design (pretest–posttest) was conducted to evaluate the effect of comprehensive video-assisted teaching program on self-care efficacy and level of knowledge of patients with epilepsy. Data was collected by direct interview with Epilepsy Self-Management Scale and epilepsy knowledge questionnaire. A video-assisted teaching covering all aspects of epilepsy was given on the day of pretest. At the interval of 3 months, the level of drug adherence, self-care, and knowledge level were assessed.

Results  Majority of the study participants (47.1%) belonged to the age group between 19 and 30 years, 54.3% participants were male, majority of them (70%) had tonic-clonic seizure, and 40% of them reported the onset of seizures as above 20 years. Eighty-seven percent of participants had no family history of seizures or epilepsy. Note that 38.6% of the participants had at least one seizure episode/month. Majority of the caregivers were either parents (41.4%) or spouse (48.6%). The study revealed that, following video-assisted teaching, the proportion of participants with adequate knowledge has increased from 14 to 64.3%. Similarly, the percentage of participants who had good drug adherence increased from 52 to 65% and no participant had poor drug adherence. Participants who had high level of self-care increased from 71.4 to 88.6%.

Conclusion  To overcome the poor drug adherence-related complications, people with epilepsy are to be personally educated adequately to increase the factual information about the condition and their self-care practices.

Professional practice models for nurses in low-income countries: an integrative review

BACKGROUND

Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries.

METHODS

An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH).

RESULTS

Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs.

CONCLUSIONS

Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

Telemedicine for epilepsy support in resource-poor settings

The Problem: Epilepsy is a common disease worldwide causing significant physical and social disability. It is one of the most treatable neurological diseases. Yet, in rural, poorer countries like much of India and Nepal, most people with epilepsy are not undergoing any treatment often because they cannot access doctors.

Conventional Approaches: It is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details, however, have been put forward about how that might be achieved.

Thinking Differently: Untreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found.

Telemedicine Approaches: Telemedicine might contribute to two steps – diagnosis and review. A tool that enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity, and specificity for the diagnosis. There are a number of ways in which the use of phone review or short messaging service can improve management.

Conclusion: Telemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.