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Ernawati I, Yasin NM, Setyopranoto I, Ikawati Z. Effect of Mobile Health Applications on Improving Self-Management Knowledge and Seizure Control in Epilepsy Patients: A Scoping Review. Healthc Inform Res 2024; 30:127-139. [PMID: 38755103 PMCID: PMC11098771 DOI: 10.4258/hir.2024.30.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Mobile health app-based interventions are increasingly being developed to support chronic disease management, particularly for epilepsy patients. These interventions focus on managing stress, monitoring drug side effects, providing education, and promoting adherence to medication regimens. Therefore, this scoping review aims to assess how mobile health applications improve epilepsy patients' knowledge and seizure control, and to identify the features of these apps that are frequently used and have proven to be beneficial. METHODS This scoping review was conducted using scientific databases such as ScienceDirect, PubMed, and Google Scholar, adhering to the Joanna Briggs Institute guidelines. The review framework consisted of five steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search included all original articles published in English from 2013 to 2023. RESULTS Among six articles that discussed mobile applications for epilepsy patients, all featured similar functionalities, including education on epilepsy management and seizure monitoring. Four of the articles highlighted behavioral interventions, such as reminder systems, designed to improve medication adherence. The remaining two articles focused on a side-effect reporting system that enabled doctors or health workers to evaluate and regularly monitor adverse effects. CONCLUSIONS This scoping review reveals that mobile health applications employing a combination of educational and behavioral interventions for epilepsy patients significantly improve knowledge about patient self-management and medication adherence. These interventions can prevent seizures, increase awareness, enable better activity planning, improve safety, and reduce the frequency of seizures and side effects of antiepileptic drugs.
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Affiliation(s)
- Iin Ernawati
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
- Akademi Farmasi Surabaya, Surabaya,
Indonesia
| | - Nanang Munif Yasin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
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Biskupiak Z, Ha VV, Rohaj A, Bulaj G. Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases. J Clin Med 2024; 13:403. [PMID: 38256537 PMCID: PMC10816409 DOI: 10.3390/jcm13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.
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Affiliation(s)
- Zack Biskupiak
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Victor Vinh Ha
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84113, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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3
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Er D, Aktaş B. An investigation of stigma and self-management in individuals diagnosed with epilepsy. Epilepsy Behav 2023; 149:109494. [PMID: 37939497 DOI: 10.1016/j.yebeh.2023.109494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/21/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
AIM The complex nature of epilepsy disease confronts individuals with difficulties such as stigma. Stigma has a negative impact, particularly on individuals' coping with the disease. It is important for individuals diagnosed with epilepsy to adopt many self-management behaviors so that they can control these situations. This study aims to measure the stigma and self-management levels of individuals diagnosed with epilepsy and determine the relationship between stigma and self-management. METHODS This descriptive and associational study was conducted in the Neurology Outpatient Clinic of a Training and Research Hospital and 295 patients were included in the sample based on various inclusion criteria such as having a diagnosis of epilepsy for at least six months and not having any psychiatric disorder that would prevent reading and comprehension. Data were collected through the Descriptive Information Form, the Stigma Scale of Epilepsy, and the Epilepsy Self-Management Scale. Data analysis was performed using IBM SPSS Statistics Standard Concurrent User V 26 statistical package program. FINDINGS The Stigma Scale of Epilepsy total mean score was found 60.62 ± 15.40 in individuals diagnosed with epilepsy. The mean scores for the sub-scales were found 7.08 ± 2.20 for the false beliefs sub-scale, 18.86 ± 4.97 for the discrimination sub-scale, 21.64 ± 7.07 for the social isolation sub-scale, 8.46 ± 3.18 for the inadequacy sub-scale, and 5.45 ± 1.41 for the stigma resistance sub-scale. The ESMS total mean score of individuals diagnosed with epilepsy was found to be 140.54 ± 15.33. The mean scores for the ESMS sub-scales were 44.76 ± 4.29 for the medicine management sub-scale, 20.29 ± 5.98 for the information management sub-scale, 30.49 ± 4.80 for the safety management sub-scale, 23.95 ± 4.34 for the seizure management sub-scale, and 21.02 ± 4.65 for lifestyle management sub-scale. A significant and negative relationship was found between the Epilepsy Self-Management Scale (ESMS) and the Stigma Scale of Epilepsy. CONCLUSION This study found that individuals experienced a moderate level of stigma and had high levels of self-management. Stigma was found to decrease with the increase in the self-management level. In this regard, it is recommended to conduct intervention studies to increase self-management levels and reduce stigma for individuals diagnosed with epilepsy.
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Affiliation(s)
- Damla Er
- İzmir Tepecik Education and Research Hospital Neurology Department, İzmir, Turkey.
| | - Betül Aktaş
- İzmir Katip Çelebi University, Faculty of Health Sciences, Department of Public Health Nursing, İzmir, Turkey.
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Min A, Miller WR, Rocha LM, Börner K, Correia RB, Shih PC. Understanding Contexts and Challenges of Information Management for Epilepsy Care. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2023; 2023:328. [PMID: 37786774 PMCID: PMC10544776 DOI: 10.1145/3544548.3580949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common chronic neurological disease. People with epilepsy (PWE) and their caregivers face several challenges related to their epilepsy management, including quality of care, care coordination, side effects, and stigma management. The sociotechnical issues of the information management contexts and challenges for epilepsy care may be mitigated through effective information management. We conducted 4 focus groups with 5 PWE and 7 caregivers to explore how they manage epilepsy-related information and the challenges they encountered. Primary issues include challenges of finding the right information, complexities of tracking and monitoring data, and limited information sharing. We provide a framework that encompasses three attributes - individual epilepsy symptoms and health conditions, information complexity, and circumstantial constraints. We suggest future design implications to mitigate these challenges and improve epilepsy information management and care coordination.
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Affiliation(s)
- Aehong Min
- Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Luis M Rocha
- Binghamton University, Binghamton, New York, USA
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Katy Börner
- Indiana University Bloomington, Bloomington, Indiana, USA
| | - Rion Brattig Correia
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Binghamton University, Binghamton, New York, USA
| | - Patrick C Shih
- Indiana University Bloomington, Bloomington, Indiana, USA
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Cui C, Shuang-Zi L, Cheng WJ, Wang T. Mediating effects of coping styles on the relationship between family resilience and self-care status of adolescents with epilepsy transitioning to adult healthcare: A cross-sectional study in China. J Pediatr Nurs 2022; 63:143-150. [PMID: 34844824 DOI: 10.1016/j.pedn.2021.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE This study aimed to explore the relationship between family resilience, coping styles, and self-care among Chinese adolescents with epilepsy. DESIGN AND METHODS A total of 1238 adolescents with epilepsy in nine tertiary hospitals in China participated in a cross-sectional survey conducted from May 2018 to March 2020. Structural equation modeling was used to analyze the mediating effect. RESULTS The total scores for family resilience and coping styles were positively correlated with the total self-care status score of adolescents with epilepsy during their transition (r = 0.209, 0.202, P < 0.01). Family resilience was positively correlated with coping style (r = 0.450, P < 0.01). The modified model's fit index included χ2/df = 1.970, P = 0.001, RMSEA = 0.054, TLI = 0.973, CFI = 0.978, GFI = 0.941, AGFI = 0.917, NFI = 0.956, and IFI = 0.978. The confidence interval (CI) was 0.004-0.140 for the indirect effect and 0.033-0.306 for the direct effect. CONCLUSIONS The self-care status of adolescents with epilepsy during the transitional period is closely related to coping style and family resilience. Coping style mediates family resilience and self-care status. PRACTICE IMPLICATIONS Healthcare teams should pay attention to the coping ability of adolescents with epilepsy to help them transition smoothly and to improve family functioning. This study provides a theoretical basis for establishing transitional care programs for adolescents with chronic illnesses. The significant mediating effect of coping style should be emphasized in modalities of healthcare that include patient participation.
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Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Li Shuang-Zi
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Seizure documentation is an essential component of epilepsy management. Not all persons with epilepsy choose to document their seizures, but many view the practice as essential to managing their disease. While seizure documentation is a valuable aspect of patient care, clinicians and patients must remain aware that seizure underreport and overreport commonly occur due to lack of seizure awareness. Additionally, in rare cases, persons with epilepsy may intentionally conceal their seizures from clinicians. The continued development of electronic seizure diaries and epilepsy self-management software provides patients with new and expanding options for seizure documentation and disease management. In order for these tools to be utilized most effectively, patient input must be central to their development. Given the limitations of seizure documentation, the development of accurate, non-invasive seizure detection devices is crucial for accurate seizure monitoring.
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Kaddumukasa M, Bongomin F, Kaddumukasa MN, Blixen C, Sajatovic M, Katabira E. Feasibility, acceptability, and efficacy of an adopted novel self-management intervention among people with epilepsy in Uganda. Epilepsy Behav 2021; 122:108200. [PMID: 34280726 PMCID: PMC10164612 DOI: 10.1016/j.yebeh.2021.108200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epilepsy is a common neurological condition characterized by poor quality of life and associated stigma. Studies in long-term health conditions suggest that self-management interventions improve the quality of life (QoL) and reduce the perceived stigma among people with epilepsy (PWE). Yet, the utilization of these interventions remains low in sub-Saharan Africa. OBJECTIVES We investigated the feasibility, acceptability, and preliminary efficacy of an adopted novel self-management intervention, Self-management for people with epilepsy and a history of negative health events (SMART) among PWE in Uganda. DESIGN A two-year, uncontrolled, prospective pilot study in Ugandans with epilepsy was conducted. PARTICIPANTS Adults aged ≥ 18 years with epilepsy attending a neurology outpatient clinic were enrolled. INTERVENTION Using a nurse led and peer educator interactions; nine self-management approach sessions (1 individual session and 8 group sessions) were conducted. MAIN OUTCOME MEASURES The primary outcome was QoL, perceived stigma and depression in PWE at 24-month follow-up using the Quality Of Life In Epilepsy 31 (QOLIE-31) scale and perceived stigma using the Kilifi stigma score and Neurological disorders depression index for epilepsy (NDDI-E). RESULTS There were 17 individuals and their caregivers who were enrolled into this study with a mean age of 23.47 (SD = 5.3) years. The study intervention was feasible and acceptable within our settings. Overall, quality of life, stigma level, depression, and seizure frequency in the past 30 days were significantly improved from the baseline scores before the intervention with p-values of <0.0001, <0.0001, 0.004, and <0.0001, respectively. SIGNIFICANCE The SMART intervention engages individuals to actively participate in self-management, and can help reduce depressive symptom severity in PWE. Given the high morbidity and mortality associated with epilepsy, additional research is needed to better identify how SMART might be implemented in routine care settings.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda.
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
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Bulaj G, Clark J, Ebrahimi M, Bald E. From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies. Front Pharmacol 2021; 12:612602. [PMID: 33972825 PMCID: PMC8105510 DOI: 10.3389/fphar.2021.612602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
| | - Jacqueline Clark
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Maryam Ebrahimi
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Elizabeth Bald
- Department of Pharmacotherapy, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
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Miller WR, Wion RK, Eads P. Evaluation of emergency department-based seizure and epilepsy education: Exploring the need for early epilepsy self-management intervention. Epilepsy Behav 2021; 116:107702. [PMID: 33561765 PMCID: PMC8120479 DOI: 10.1016/j.yebeh.2020.107702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022]
Abstract
Many people with epilepsy (PWE) present to the emergency department setting with their first seizure and must wait weeks or months to be seen by a specialized epilepsy provider. The time period between presentation of first seizure and entry into specialized care can be extremely stressful and precarious for PWE and their families. In order to achieve optimal outcomes, epilepsy self-management should be initiated as soon as possible, including in the emergency department setting. The purpose of this study was to review and evaluate existing epilepsy/seizure-related education materials provided to patients in the emergency room setting to determine the degree to which these materials prepare patients and their families for self-management of epilepsy, or potential epilepsy, during the interim between emergency department discharge and entry into specialized care. Twenty emergency department epilepsy/seizure patient discharge education materials were collected and evaluated using a rubric based on the framework of the Epilepsy Self-Management Scale (AESMMI). Materials were rated on a 0-3 scale based on the degree to which self-management education, resources, and skill building were included. The mean score of materials reviewed was quite low at just 10.4, with a score of 33 possible. Also concerning is that the materials scored lowest in the domains of social support, stress management, and coping, all of which are extremely important areas for PWE, especially in the early phases of the disease when patients and families are adjusting. Findings highlight the need for development of robust self-management interventions tailored to PWE in the transition period from presentation of first seizure to entry to specialized care.
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Affiliation(s)
- Wendy R Miller
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States.
| | - Rachel K Wion
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States
| | - Pam Eads
- UCB Pharmaceuticals, 1950 Lake Park Drive, Smyrna, GA 30080, United States.
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Li X, Cui L, Zhang GQ, Lhatoo SD. Can Big Data guide prognosis and clinical decisions in epilepsy? Epilepsia 2021; 62 Suppl 2:S106-S115. [PMID: 33529363 PMCID: PMC8011949 DOI: 10.1111/epi.16786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/16/2023]
Abstract
Big Data is no longer a novel concept in health care. Its promise of positive impact is not only undiminished, but daily enhanced by seemingly endless possibilities. Epilepsy is a disorder with wide heterogeneity in both clinical and research domains, and thus lends itself to Big Data concepts and techniques. It is therefore inevitable that Big Data will enable multimodal research, integrating various aspects of "-omics" domains, such as phenome, genome, microbiome, metabolome, and proteome. This scope and granularity have the potential to change our understanding of prognosis and mortality in epilepsy. The scale of new discovery is unprecedented due to the possibilities promised by advances in machine learning, in particular deep learning. The subsequent possibilities of personalized patient care through clinical decision support systems that are evidence-based, adaptive, and iterative seem to be within reach. A major objective is not only to inform decision-making, but also to reduce uncertainty in outcomes. Although the adoption of electronic health record (EHR) systems is near universal in the United States, for example, advanced clinical decision support in or ancillary to EHRs remains sporadic. In this review, we discuss the role of Big Data in the development of clinical decision support systems for epilepsy care, prognostication, and discovery.
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Affiliation(s)
- Xiaojin Li
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Licong Cui
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Guo-Qiang Zhang
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Samden D. Lhatoo
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Chan HY, Leenen LA, Wijnen BF, van der Putten IM, Evers SM, Hjm Majoie M, van Heugten CM. ZMILE, a multicomponent self-management intervention for adults with epilepsy: Rationale and description of the intervention. Clin Rehabil 2020; 35:629-638. [PMID: 33225721 PMCID: PMC8076840 DOI: 10.1177/0269215520975327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: In this paper, we aim to provide a comprehensive description of the multicomponent self-management intervention for adults with epilepsy, ZMILE. Rationale or theory: Acquiring self-management skills has been shown to play a vital role in enabling patients with epilepsy overcoming (health-related) struggles in daily life and coping with limitations their condition poses on them. ZMILE is a course consisting of education (to increase concordance to treatment), goal-setting (proactive coping), and self-monitoring. Resources needed: The course is guided by two nurse practitioners and each patient is allowed to bring one family member or friend. Self-monitoring plays an important role and can be done through e-Health tools or written diaries. Processes involved: During and after the course, patients are required to work toward a personally defined goal using a five-step approach by means of pro-active coping. Moreover, patients are expected to use self-monitoring tools to reflect on their own behavior and identify ways to optimize medication intake when required. Quantification: ZMILE is provided in an outpatient setting over five weekly group sessions and one booster session. From the start, patients are encouraged to set individual goals. Each group session will have a different theme but part of every session is reflecting on personal goals and to learn from eachother. Conclusions: The ZMILE-intervention has been evaluated and may be a promising intervention in terms of effectiveness and feasibility for adults with epilepsy, relatives, and professionals. We present the adapted version which can be implemented in clinical practice.
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Affiliation(s)
- Hoi Yau Chan
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Loes Am Leenen
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Ben Fm Wijnen
- Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ingeborg M van der Putten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Silvia Maa Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Marian Hjm Majoie
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.,MHeNS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, The Netherlands
| | - Caroline M van Heugten
- MHeNS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
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LeRouge CM, Hah H, Deckard GJ, Jiang H. Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e18391. [PMID: 32597788 PMCID: PMC7367539 DOI: 10.2196/18391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/05/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023] Open
Abstract
Background Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results Our qualitative analysis identified adolescents’ intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management.
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Affiliation(s)
- Cynthia M LeRouge
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Hyeyoung Hah
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Gloria J Deckard
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Haoqiang Jiang
- College of Informatics, Northern Kentucky University, Highland Heights, KY, United States
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13
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Hixson JD, Braverman L. Digital tools for epilepsy: Opportunities and barriers. Epilepsy Res 2020; 162:106233. [DOI: 10.1016/j.eplepsyres.2019.106233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/10/2019] [Accepted: 10/26/2019] [Indexed: 11/27/2022]
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Braga P, Mifsud J, D'Souza C, Clarke M, Honein A, Tovuudorj A, Pfäfflin M. Education and epilepsy: Examples of good practice and cooperation. Report of the IBE Commission on Education. Epilepsy Behav 2020; 103:106653. [PMID: 31761687 DOI: 10.1016/j.yebeh.2019.106653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022]
Abstract
Education for patients, for families, for professionals, and for officials is one of the most important tools for improving knowledge about epilepsy and fighting discrimination. There are many educational initiatives worldwide, but they are often known only at a local level. Studies on epilepsy educational programs are rare and therefore published to a limited extent. The newly established International Bureau for Epilepsy (IBE) Education Commission enforces the exchange of educational activities and best practices, discussing education content and topics, target groups, and their educational needs, timing, tutors, and funding. A brief review of examples of all continents will be given. The needs for studies and for more exchange and closer cooperation will be addressed with proposals for further actions.
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Affiliation(s)
- Patricia Braga
- Neurological Institute, Facultad de Medicina, Universidad de la República, Uruguay
| | - Janet Mifsud
- Dep. of Clinical Pharmacology and Therapeutics, Univ. of Malta Msida, Malta
| | | | - Marina Clarke
- National Office Epilepsy, IBE Chapter, Cape Town, South Africa
| | - Arlette Honein
- AVANCE - School and Association for children with epilepsy and special needs, Lebanon
| | - Avirmed Tovuudorj
- Dep. of Neurology, Mongolian National University of Medical Sciences, Mongolia
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15
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Shegog R, Braverman L, Hixson JD. Digital and technological opportunities in epilepsy: Toward a digital ecosystem for enhanced epilepsy management. Epilepsy Behav 2020; 102:106663. [PMID: 31778878 DOI: 10.1016/j.yebeh.2019.106663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 01/01/2023]
Abstract
This commentary details the implications of a growing body of literature supporting several categories of supportive digital tools for the self-management of epilepsy. Although many prior review articles have focused on specific forms of digital epilepsy solutions, we propose the concept of an integrated self-management digital ecosystem. This would include categories of tools including self-management education programs, electronic diaries for self-monitoring, and automated wearables for seizure detection. Within these categories, individual interventions have been studied and made available to patients for years, but the evolution of a digital ecosystem promises the potential to integrate these tools in a manner that can meaningfully benefit patients' health. This commentary presents a discussion of the possible concerns that are preventing more widespread adoption of these digital health resources. Barriers are identified at multiple positions of the healthcare system, including the individual, the organizational, the community, and the policy levels.
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Affiliation(s)
- Ross Shegog
- University of Texas School of Public Health, 7000 Fannin, Suite 2668, Houston, TX 77030, United States of America
| | | | - John D Hixson
- University of California San Francisco and the San Francisco VA Medical Center, 4150 Clement Street, 127E, San Francisco, CA 94121, United States of America.
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Sajatovic M, Needham K, Colón-Zimmermann K, Richter N, Liu H, Garrity J, Ryan ER, Storer N, Harper V. The Community-targeted Self-management of Epilepsy and Mental Illness (C-TIME) initiative: A research, community, and healthcare administration partnership to reduce epilepsy burden. Epilepsy Behav 2018; 89:175-180. [PMID: 30385215 PMCID: PMC7484726 DOI: 10.1016/j.yebeh.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/22/2023]
Abstract
AIMS Comorbid mental health conditions (MHCs) such as depression and anxiety are common in people with epilepsy. Targeted Self-Management for Epilepsy and Mental Illness (TIME) is a behavioral program that targets mood symptoms in adults with epilepsy and comorbid MHCs. Building upon positive findings of a randomized controlled study to establish the efficacy of TIME, the Community-TIME (C-TIME) initiative assessed the implementation feasibility and pre-/post-outcomes of this new evidence-based epilepsy self-management intervention in a community setting and in collaboration with key stakeholders. METHODS The C-TIME program is a group-format curriculum-based intervention delivered in ten 60-90 sessions over the course of 12 weeks. The C-TIME initiative used research staff to guide intervention performance evaluation, staff of a regional epilepsy advocacy agency to assist with community engagement and a county mental health services agency to support the transition from science to service. Process evaluations included outreach and engagement efforts needed to reach people with epilepsy and MHCs, the barriers and facilitators to roll out, and the participants' retention and satisfaction. The primary intervention participant outcome was depressive symptom severity at 4-month follow-up. RESULTS Referrals came from a variety of sources and approximately 1 in 3 referrals resulted in an enrollment. Thirty individuals were enrolled in 3 "cohorts" of 10. The most common reason for not being enrolled postscreening was that individuals did not show up for the baseline evaluation. Mean age of participants was 49.1 (12.8) years, 50% (N = 15) female, 55.2% (N = 16) white, 34.5% (N = 10) African-American. With respect to participation, 2/3 of the enrolled sample attended at least 7 out of the maximum 10 C-TIME sessions. Mean number of C-TIME sessions attended was 6.9 (4.1). Five participants (17%) had family members attend the C-TIME sessions, although family members were encouraged to play a supportive rather than primary role. Four-month follow-up outcome evaluation was available for 66% of the enrolled group. There was a significant reduction in depression severity, and patient satisfaction was over 90%. CONCLUSIONS The C-TIME program can be successfully implemented in the community and is associated with improved outcomes in adults with epilepsy and comorbid MHCs. Continued and broader scale-up of C-TIME and similar approaches could reach larger groups of adults with epilepsy and improve the health of our communities.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | | | - Kari Colón-Zimmermann
- Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Hongyan Liu
- Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John Garrity
- Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, Cleveland, OH USA*
| | - Eleanor R. Ryan
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Norma Storer
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Valeria Harper
- Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, Cleveland, OH USA*
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Oppenheimer J, Leviton A, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler EW, Chan E, Loddenkemper T. Caring electronically for young outpatients who have epilepsy. Epilepsy Behav 2018; 87:226-232. [PMID: 30197227 DOI: 10.1016/j.yebeh.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability. METHOD We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems. CONCLUSIONS The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.
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Affiliation(s)
- Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric W Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Ferastraoaru V, Goldenholz DM, Chiang S, Moss R, Theodore WH, Haut SR. Characteristics of large patient-reported outcomes: Where can one million seizures get us? Epilepsia Open 2018; 3:364-373. [PMID: 30187007 PMCID: PMC6119749 DOI: 10.1002/epi4.12237] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To analyze data from Seizure Tracker, a large electronic seizure diary, including comparison of seizure characteristics among different etiologies, temporal patterns in seizure fluctuations, and specific triggers. Methods Zero‐inflated negative binomial mixed‐effects models were used to evaluate temporal patterns of seizure events (during the day or week), as well as group differences in monthly seizure frequency between children and adults and between etiologies. The association of long seizures with seizure triggers was evaluated using a mixed‐effects logistic model with subject as the random effect. Incidence rate ratios (IRRs) and odds ratios were reported for analyses involving zero‐inflated negative binomial and logistic mixed‐effects models, respectively. Results A total of 1,037,909 seizures were logged by 10,186 subjects (56.7% children) from December 2007 to January 2016. Children had more frequent seizures than adults did (median monthly seizure frequency 3.5 vs. 2.7, IRR 1.26; p < 0.001). Seizures demonstrated a circadian pattern (higher frequency between 07:00 a.m. and 10:00 a.m. and lower overnight), and seizures were reported differentially across the week (seizure rates higher Monday through Friday than Saturday or Sunday). Longer seizures (>5 or >30 min) had a higher proportion of the following triggers when compared with shorter seizures: “Overtired or irregular sleep,” “Bright or flashing lights,” and “Emotional stress” (p < 0.004). Significance This study explored a large cohort of patients with self‐reported seizures; strengths and limitations of large seizure diary databases are discussed. The findings in this study are consistent with those of prior work in smaller validated cohorts, suggesting that patient‐recorded databases are a valuable resource for epilepsy research, capable of both replication of results and generation of novel hypotheses.
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Affiliation(s)
- Victor Ferastraoaru
- Department of Neurology Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York U.S.A
| | - Daniel M Goldenholz
- Division of Epilepsy Beth Israel Deaconess Medical Center Boston Massachusetts U.S.A
| | - Sharon Chiang
- Department of Neurology University of California San Francisco San Francisco California.,Department of Statistics Rice University Houston Texas U.S.A
| | - Robert Moss
- SeizureTracker LLC Alexandria Virginia U.S.A
| | - William H Theodore
- National Institutes of Health National Institute of Neurological Disorders and Stroke Bethesda Maryland U.S.A
| | - Sheryl R Haut
- Department of Neurology Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York U.S.A
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Escoffery C, McGee R, Bidwell J, Sims C, Thropp EK, Frazier C, Mynatt ED. A review of mobile apps for epilepsy self-management. Epilepsy Behav 2018; 81:62-69. [PMID: 29494935 DOI: 10.1016/j.yebeh.2017.12.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 01/09/2023]
Abstract
Mobile health app developers increasingly are interested in supporting the daily self-care of people with chronic conditions. The purpose of this study was to review mobile applications (apps) to promote epilepsy self-management. It investigates the following: 1) the available mobile apps for epilepsy, 2) how these apps support patient education and self-management (SM), and 3) their usefulness in supporting management of epilepsy. We conducted the review in Fall 2017 and assessed apps on the Apple App Store that related to the terms "epilepsy" and "seizure". Inclusion criteria included apps (adult and pediatric) that, as follows, were: 1) developed for patients or the community; 2) made available in English, and 3) less than $5.00. Exclusion criteria included apps that were designed for dissemination of publications, focused on healthcare providers, or were available in other languages. The search resulted in 149 apps, of which 20 met the selection criteria. A team reviewed each app in terms of three sets of criteria: 1) epilepsy-specific descriptions and SM categories employed by the apps and 2) Mobile App Rating Scale (MARS) subdomain scores for reviewing engagement, functionality, esthetics, and information; and 3) behavioral change techniques. Most apps were for adults and free. Common SM domains for the apps were treatment, seizure tracking, response, and safety. A number of epilepsy apps existed, but many offered similar functionalities and incorporated few SM domains. The findings underline the need for mobile apps to cover broader domains of SM and behavioral change techniques and to be evaluated for outcomes.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Robin McGee
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States
| | - Jonathan Bidwell
- School of Interactive Computing, Georgia Institute of Technology, 85 Fifth Street NW, Atlanta, GA 30308, United States
| | - Christopher Sims
- Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA 30322, United States
| | - Eliana Kovitch Thropp
- Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA 30322, United States
| | - Cherise Frazier
- Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA 30322, United States
| | - Elizabeth D Mynatt
- School of Interactive Computing, Georgia Institute of Technology, 85 Fifth Street NW, Atlanta, GA 30308, United States
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20
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Leenen LAM, Wijnen BFM, Kessels AGH, Chan H, de Kinderen RJA, Evers SMAA, van Heugten CM, Majoie MHJM. Effectiveness of a multicomponent self-management intervention for adults with epilepsy (ZMILE study): A randomized controlled trial. Epilepsy Behav 2018; 80:259-265. [PMID: 29449140 DOI: 10.1016/j.yebeh.2018.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy (PWE) over a six-month period. METHODS Participants (PWE & relative) were randomized into intervention or CAU groups. Self-report questionnaires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy, adherence, seizure severity, emotional functioning, quality of life, proactive coping, and side-effects of antiepileptic drugs (AED) as secondary outcome measures. Instruments used at baseline and during a six-month follow-up period were the following: disease-specific self-efficacy (Epilepsy Self-Efficacy Scale [ESES], General Self-Efficacy Scale [GSES]); adherence (Medication Adherence Scale [MARS] and Medication Event Monitoring System [MEMS]); seizure severity (National Hospital Seizure Severity Scale [NHS3]); emotional well-being (Hospital Anxiety and Depression Scale [HADS]); quality of life (Quality of Life in Epilepsy [QOLIE-31P]); proactive coping (Utrecht Proactive Coping Competence [UPCC]); and side-effects of antiepileptic drugs [SIDAED]. Multilevel analyses were performed, and baseline differences were corrected by inclusion of covariates in the analyses. RESULTS In total, 102 PWE were included in the study, 52 of whom were in the intervention group. On the SIDAED and on three of the quality of life subscales QOLIE-31P, a significant difference was found (p<0.05) in the intervention group. Self-efficacy, however, showed no significant differences between the MCI and the CAU groups. None of the other outcome measures showed any significant difference between the two groups. SIGNIFICANCE Although we found no statistically significant difference in the primary outcome measure, disease-specific self-efficacy, this MCI could prove promising, since we found improvement in some domains of quality of life in epilepsy scale and a decrease in AED side-effects in the MCI group compared with the CAU group.
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Affiliation(s)
- Loes A M Leenen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Ben F M Wijnen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Alfons G H Kessels
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - HoiYau Chan
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - Reina J A de Kinderen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Silvia M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neurosciences: Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Atkinson-Clark E, Charokopou M, Van Osselaer N, Hiligsmann M. A discrete-choice experiment to elicit preferences of patients with epilepsy for self-management programs. Epilepsy Behav 2018; 79:58-67. [PMID: 29248866 DOI: 10.1016/j.yebeh.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an increasing number of self-management programs developed for patients with epilepsy, with the goal of supporting treatment management and improving their quality of life. With the aim of increasing medication adherence and effectiveness of self-management programs, it is important to design programs that are engaging to, and align with the preferences of patients with epilepsy. This study aimed to evaluate and compare the preferences of patients with epilepsy for self-management programs in three European countries. This is the first cross-border evaluation of the preferences of patients with epilepsy in Europe for such programs. METHODS Using a discrete-choice experiment, patients with epilepsy from Germany, France, and the Netherlands were surveyed, and chose repetitively between two hypothetical self-management programs. These differed in the following six characteristics: i) the thematic area which would be the main focus of the program, ii) the method of interaction, iii) the source of information or provider of the program, iv) the amount of time spent on the program per week, v) the cost, and vi) whether the program would start immediately, or if there would be a delay of 3weeks before its initiation. A Bayesian efficient design was used to construct 15 choice sets, and a mixed panel logit model was used to estimate patients' preferences. Subgroup analyses were conducted according to socioeconomic status, burden of disease, and previous activation in self-management. RESULTS A total of 299 people with epilepsy were included in the study, with a mean age of 45.5years. Only 15% had previously made use of a self-management program, although 44.5% reported having previously heard of them. In all three countries, all attributes barring the content were significant at 10%. The cost attribute - i.e., an out-of-pocket expenditure for a program - was reported as the most important feature in each country and across subgroups (significant at 1%). This was followed by the length of program sessions per week, which ranged from 20 to 90min per week. Although there was some heterogeneity between countries and subgroups, the patients, overall, had a preference for a face-to-face meeting with a doctor. In the Netherlands, a preference for online programs and physician assistants was observed when compared with the other countries. Other attributes, including the information source - whether a program was led by a physician, another patient with epilepsy, or another combination - was also important to patients, who appear willing to trade preferences in order to gain their favored attribute level. However, 20% of the population chose consistently to not participate in any self-management program. CONCLUSION Given the heterogeneity of the epilepsies, preferences, and dispreferences across subgroups, our study highlights that if full account is not taken of different segmentation strategies when designing a self-management program, a large proportion of the population may not be attracted to it.
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Affiliation(s)
- Edward Atkinson-Clark
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | | | | | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
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Shegog R, Begley CE. Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach. Front Public Health 2017; 5:256. [PMID: 29043247 PMCID: PMC5632356 DOI: 10.3389/fpubh.2017.00256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Epilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient's epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient's needs, and increase the patient's self-efficacy to achieve those goals. METHODS The purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.
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Affiliation(s)
- Ross Shegog
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Charles E. Begley
- School of Public Health, University of Texas Health Science Center, Houston, TX, United States
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23
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Abstract
This article reviews the major paradigm shifts that have occurred in the area of the application of clinical and experimental neuropsychology to epilepsy and epilepsy surgery since the founding of the International Neuropsychological Society. The five paradigm shifts discussed include: 1) The neurobiology of cognitive disorders in epilepsy - expanding the landscape of syndrome-specific neuropsychological impairment; 2) pathways to comorbidities: bidirectional relationships and their clinical implications; 3) discovering quality of life: The concept, its quantification and applicability; 4) outcomes of epilepsy surgery: challenging conventional wisdom; and 5) Iatrogenic effects of treatment: cognitive and behavioral effects of antiepilepsy drugs. For each area we characterize the status of knowledge, the key developments that have occurred, and how they have altered our understanding of the epilepsies and their management. We conclude with a brief overview of where we believe the field will be headed in the next decade which includes changes in assessment paradigms, moving from characterization of comorbidities to interventions; increasing development of new measures, terminology and classification; increasing interest in neurodegenerative proteins; transitioning from clinical seizure features to modifiable risk factors; and neurobehavioral phenotypes. Overall, enormous progress has been made over the lifespan of the INS with promise of ongoing improvements in understanding of the cognitive and behavioral complications of the epilepsies and their treatment. (JINS, 2017, 23, 791-805).
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Affiliation(s)
- Bruce Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison Wisconsin
| | - David W Loring
- 2Departments of Neurology and Pediatrics,Emory University School of Medicine,Atlanta Georgia
| | - Sarah Wilson
- 3Department of Psychology,Melbourne University,Melbourne,Australia
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Wijnen BFM, Leenen LAM, de Kinderen RJA, van Heugten CM, Majoie MHJM, Evers SMAA. An economic evaluation of a multicomponent self-management intervention for adults with epilepsy (ZMILE study). Epilepsia 2017; 58:1398-1408. [DOI: 10.1111/epi.13806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ben F. M. Wijnen
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
- Department of Health Services Research; Maastricht University; Maastricht The Netherlands
- Department of Research & Development; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
| | - Loes A. M. Leenen
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
- Department of Health Services Research; Maastricht University; Maastricht The Netherlands
- Department of Research & Development; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
| | - Reina J. A. de Kinderen
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
- Department of Health Services Research; Maastricht University; Maastricht The Netherlands
- Department of Research & Development; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology; MHENS, School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Department of Neuropsychology and Psychopharmacology; Maastricht University; Maastricht The Netherlands
| | - Marian H. J. M. Majoie
- Department of Research & Development; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
- Department of Psychiatry and Neuropsychology; MHENS, School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht The Netherlands
- Department of Neurology; Academic Center for Epileptology; Epilepsy Center Kempenhaeghe and Maastricht University Medical Center; Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences; School of Health Professions Education; Maastricht University; Maastricht The Netherlands
| | - Silvia M. A. A. Evers
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
- Department of Health Services Research; Maastricht University; Maastricht The Netherlands
- Trimbos Institute; Netherlands Institute of Mental Health and Addiction; Utrecht The Netherlands
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Crooks RE, Bell M, Patten SB, Wiebe S, Holroyd-Leduc J, Bulloch AG, Macrodimitris S, Mackie A, Sauro KM, Federico P, Jetté N. Mind the gap: Exploring information gaps for the development of an online resource hub for epilepsy and depression. Epilepsy Behav 2017; 70:18-23. [PMID: 28407525 DOI: 10.1016/j.yebeh.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/27/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Depression is common in epilepsy, and is often under-detected and under-treated. The motivation to create a depression eHub for persons with epilepsy is to connect them to the best available online resources to effectively manage their depression. The study sought to: 1) identify facilitators and barriers to accessing resources related to management of epilepsy and/or depression and 2) discuss gaps in available resources (free and in the public domain) and 3) identify suggestions for future content. METHODS Semi-structured interviews were conducted with ten patients with epilepsy and a history of depression. Using inductive analysis, two team members engaged in a process of textual open-coding utilizing a conventional content analysis approach whereby content was conceptually clustered based on the research questions. A phenomenological framework was applied to describe the phenomenon of online health resource access and utilization from the perspective of people with epilepsy. RESULTS Facilitators to the use of online resources included information credibility, thoughtful organization, and accessibility of resources. Barriers included difficulties finding and piecing together information from many different sites. Patients reported difficulty having the motivation to seek out resources while depressed, which was compounded by feelings of stigma, social isolation, and lack of control. Gaps in resources included a lack of information about living with epilepsy day-to-day and resources for family and friends. Suggested content included information to raise awareness about epilepsy and depression; questionnaires to screen for symptoms of depression; stories of other patients with epilepsy and depression via video or moderated forums; current research and news; local community resources; and tools and strategies to manage depression in epilepsy. CONCLUSIONS There is a gap in accessible resources for patients with epilepsy and depression as well as barriers that include epilepsy-related restrictions, depression-related impairments, lack of awareness, and stigmatization. These results should be used to guide the development of e-Health resources for patients with epilepsy.
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Affiliation(s)
- Rachel E Crooks
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Meaghan Bell
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Scott B Patten
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jayna Holroyd-Leduc
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Andrew G Bulloch
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; The Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Sophia Macrodimitris
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Aaron Mackie
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Khara M Sauro
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1195, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 1A10, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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Liu JM, Xu RX, Hu YS, Ren LK, Qiao H, Ding H, Liu ZL. Chinese Internet Searches Provide Inaccurate and Misleading Information to Epilepsy Patients. Chin Med J (Engl) 2016; 128:3324-8. [PMID: 26668147 PMCID: PMC4797508 DOI: 10.4103/0366-6999.171425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Most patients with epilepsy want to learn as much as possible about the disease, and many have turned to the internet for information. Patients are likely to use information obtained from the internet to control their epilepsy, but little is known about the accuracy of this information. In this survey, we have assessed the feasibility and usability of internet-based interventions for the treatment of epilepsy. Methods: Data were collected from an internet search. Different search terms were used to obtain general information on epilepsy together with information about medication, types of epilepsy, treatment, women's health, and other information. The accuracy of the information was evaluated by a group of experts. Results: A total of 1320 web pages were assessed. The majority were websites related to health. A large number (80.2%) of web pages contained content related to the search term. A significant number of web pages 450/1058 (42.5%) claimed to provide information from a credible source; however, only 206/1058 (19.5%) of the information was accurate and complete; 326/1058 (30.8%) was accurate but incomplete; 328/1058 (31.0%) was correct but nonstandard, and 198/1058 (18.8%) was inaccurate. The authenticity of the information was not significantly different between the two search engines (χ2 = 0.009, P = 0.924). No significant difference was observed in the information obtained from a specialist or nonspecialist source (χ2 = 7.538, P = 0.057). There was also no correlation between the quality of the information and the priority (χ2 = 6.880, P = 0.076). Conclusions: Searching for information about epilepsy on the internet is convenient, but the information provided is not reliable. Too much information is inaccurate or for advertisement purposes, and it is difficult for patients to find the useful information. Turning to the internet for medical knowledge may be harmful. Physicians should be aware that their patients may search for information on the internet and guide them to safe, reputable websites.
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Affiliation(s)
| | - Ru-Xiang Xu
- Affiliated Bayi Brain Hospital, Bayi Clinical College, Southern Medical University, Beijing 100700, China
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Leenen LAM, Wijnen BFM, de Kinderen RJA, van Heugten CM, Evers SMAA, Majoie MHJM. Are people with epilepsy using eHealth-tools? Epilepsy Behav 2016; 64:268-272. [PMID: 27780086 DOI: 10.1016/j.yebeh.2016.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Self-management for people with epilepsy (PWE) should lead to shared decision-making and thus to adherence to the treatment plan. eHealth is an important way of supporting PWE in their self-management. METHOD In this survey, we used a mixed method to explore the following: 1) which factors were monitored by PWE and how (using pen and paper or eHealth-tools), 2) how many PWE own a computer or smartphone, and 3) how do they perceive the use of eHealth. A consecutive series of 1000 PWE attending the outpatient clinic of a tertiary epilepsy center were asked to fill in a questionnaire. RESULTS In comparison with the general population, fewer PWE owned a computer or smartphone. They were, however, more likely to self-monitor their health than other patients suffering from a chronic condition. Although PWE did not use eHealth-tools often, they perceived it as a user-friendly tool, promoting health behavior as well as adherence. On the other hand, problems with privacy and the perception that not everyone is able to use eHealth were considered as disadvantages by PWE. Promoting self-care was perceived as both an advantage and a disadvantage. It was seen as an advantage when PWE mentioned the option of eHealth-tools in order to gain insight into one's epilepsy. At the same time, it was seen as a disadvantage because it confronts PWE with their disease, which causes emotional stress. CONCLUSION The high level of self-monitoring combined with a low usage of eHealth-tools seems to indicate that there is a need for a more tailored approach to stimulate the use of eHealth-tools by PWE. Further research should focus on this aspect, e.g., what PWE need in order to make more use of eHealth-tools in their self-care.
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Affiliation(s)
- Loes A M Leenen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, The Netherlands.
| | - Ben F M Wijnen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
| | - Reina J A de Kinderen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
| | - Caroline M van Heugten
- MHENS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
| | - Silvia M A A Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, The Netherlands; MHENS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht UMC+, The Netherlands.
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Us Centers For Disease Control And Prevention Epilepsy Program. About one-half of adults with active epilepsy and seizures have annual family incomes under $25,000: The 2010 and 2013 US National Health Interview Surveys. Epilepsy Behav 2016; 58:33-4. [PMID: 27039018 DOI: 10.1016/j.yebeh.2016.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
People with active epilepsy are those who reported being told that they have epilepsy or a seizure disorder and either take antiseizure medication or have had a seizure during the past 12months. We used combined 2010 and 2013 National Health Interview Survey (NHIS) data on US adults with active epilepsy to examine whether taking medications and seizure frequency differed by sex, age, race/ethnicity, and reported or imputed annual family income. Of adults with active epilepsy, 45.5% reported taking medication and having at least one seizure, 41.3% reported taking medication and having no seizures, and 13.2% reported not taking any medication and having at least one seizure. About one-half of adults with active epilepsy and seizures have annual family incomes of less than $25,000. Promoting self-management supports and improved access to specialty care may reduce the burden of uncontrolled seizures in adults with epilepsy.
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Dlugos D, Worrell G, Davis K, Stacey W, Szaflarski J, Kanner A, Sunderam S, Rogawski M, Jackson-Ayotunde P, Loddenkemper T, Diehl B, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area III: Improve Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. Epilepsy Curr 2016; 16:192-7. [PMID: 27330452 PMCID: PMC4913858 DOI: 10.5698/1535-7511-16.3.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dennis Dlugos
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Greg Worrell
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kathryn Davis
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William Stacey
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
| | - Jerzy Szaflarski
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
| | - Andres Kanner
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Sridhar Sunderam
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
| | - Mike Rogawski
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
| | - Patrice Jackson-Ayotunde
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
| | - Tobias Loddenkemper
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Beate Diehl
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
| | - for the Epilepsy Benchmark Stewards
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
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30
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Shafer PO, Buchhalter J. Patient Education: Identifying Risks and Self-Management Approaches for Adherence and Sudden Unexpected Death in Epilepsy. Neurol Clin 2016; 34:443-56, ix. [PMID: 27086989 DOI: 10.1016/j.ncl.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patient education in epilepsy is one part of quality epilepsy care and is an evolving and growing field. Health outcomes, patient satisfaction, safety, patient/provider communication, and quality of life may all be affected by what people are taught (or not taught), what they understand, and how they use this information to make decisions and manage their health. Data regarding learning needs and interventions to address medication adherence and sudden unexpected death in epilepsy education can be used to guide clinicians in health care or community settings.
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Affiliation(s)
- Patricia Osborne Shafer
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue KS 457, Boston, MA 02215, USA; Epilepsy Foundation, Landover, MD 20785-2353, USA.
| | - Jeffrey Buchhalter
- Comprehensive Children's Epilepsy Centre, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8, Canada
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31
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Hosseini N, Sharif F, Ahmadi F, Zare M. Determining the disease management process for epileptic patients: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:54-62. [PMID: 26985223 PMCID: PMC4776561 DOI: 10.4103/1735-9066.174748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epilepsy exposes patients to many physical, social, and emotional challenges. Thus, it seems to portray a complex picture and needs holistic care. Medical treatment and psychosocial part of epilepsy remain central to managing and improving the patient's qualify of life through team efforts. Some studies have shown the dimensions of self-management, but its management process of epilepsy patients, especially in Iran, is not clear. This study aimed to determine the disease management process in patients with epilepsy in Iran. MATERIALS AND METHODS This qualitative approach and grounded theory study was conducted from January 2009 to February 2012 in Isfahan city (Iran). Thirty-two participants were recruited by the goal-oriented, and snowball sample selection and theoretical sampling methods. After conducting a total of 43 in-depth interviews with the participants, the researchers reached data saturation. Data were analyzed using Strauss and Corbin method. RESULTS With a focus on disease management process, researchers found three main themes and seven sub-themes as a psychosocial process (PSP). The main themes were: perception of threat to self-identity, effort to preserve self-identity, and burn out. The psychosocial aspect of the disease generated one main variable "the perception of identity loss" and one central variable "searching for self-identity." CONCLUSIONS Participants attributed threat to self-identity and burn out to the way their disease was managed requiring efforts to preserve their identity. Recommendations consist of support programs and strategies to improve the public perception of epilepsy in Iran, help patients accept their condition and preserve self-identity, and most importantly, enhance medical management of epilepsy.
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Affiliation(s)
- Nazafarin Hosseini
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Farkhondeh Sharif
- Department of Psychiatric Nursing, Community Based Psychiatric Nursing Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Zare
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Blond BN, Detyniecki K, Hirsch LJ. Assessment of Treatment Side Effects and Quality of Life in People with Epilepsy. Neurol Clin 2016; 34:395-410, viii. [PMID: 27086986 DOI: 10.1016/j.ncl.2015.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epilepsy impairs quality of life in physical, psychological, cognitive, social, and occupational domains. In people who are not seizure free, depression and adverse medication effects have a predominant role in determining quality of life. The assessment of these factors and other comorbidities is essential for maximizing quality of life in epilepsy. There are multiple tools available to assess medication effects and quality of life in a structured format. Such tools can provide superior assessments and allow clinicians to have a greater impact on their patients' quality of life.
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Affiliation(s)
- Benjamin N Blond
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Kamil Detyniecki
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA.
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33
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Bulaj G, Ahern MM, Kuhn A, Judkins ZS, Bowen RC, Chen Y. Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases. CURRENT CLINICAL PHARMACOLOGY 2016; 11:128-45. [PMID: 27262323 PMCID: PMC5011401 DOI: 10.2174/1574884711666160603012237] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023]
Abstract
Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, Skaggs Pharmacy Institute, University of Utah, 30 South 2000 East, Salt Lake City, Utah 84112, USA.
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Us Centers For Disease Control And Prevention Epilepsy Program. Internet use and looking up information online in adults with epilepsy varies by epilepsy status--2013 National Health Interview Survey. Epilepsy Behav 2016; 54:47-9. [PMID: 26655448 DOI: 10.1016/j.yebeh.2015.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
We estimated US national prevalences of Internet use and looking up health information online among adults with epilepsy and those without, overall (age-standardized) and by three age groups (18-44, 45-59, and ≥60years) using the 2013 National Health Interview Survey. Results showed that both overall and across all age groups, a significantly lower percentage of adults with active epilepsy reported using the Internet compared with that of adults without epilepsy. However, among Internet users, the percentage of looking up health information online did not differ by epilepsy status or age. Ensuring access to the Internet and encouraging use of quality, secure, and easy-to-access resources and e-tools might help adults with epilepsy to optimize their self-management and improve their quality of life.
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Ostherr K, Killoran P, Shegog R, Bruera E. Death in the Digital Age: A Systematic Review of Information and Communication Technologies in End-of-Life Care. J Palliat Med 2015; 19:408-20. [PMID: 26713368 PMCID: PMC4827321 DOI: 10.1089/jpm.2015.0341] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND End-of-life (EOL) communication plays a critical role in ensuring that patients receive care concordant with their wishes and experience high quality of life. As the baby boomer population ages, scalable models of end-of-life communication will be needed to ensure that patients receive appropriate care. Information and communication technologies (ICTs) may help address the needs of this generation; however, few resources exist to guide the use of ICTs in EOL care. OBJECTIVE The primary objective was to identify the ICTs being used in EOL communication. The secondary objective was to compare the effectiveness of different ICTs in EOL communication. METHODS The study was a systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched seven databases for experimental and observational studies on EOL communication between doctors and patients using ICTs, published in 1997-2013. RESULTS The review identified 38 relevant articles. Eleven types of technology were identified: video, website, telephone, videoconferencing, e-mail, telemonitoring, Internet search, compact disc, fax, PalmPilot, and short message service (SMS) text messaging. ICTs were most commonly used to provide information or education, serve as decision aids, promote advance care planning (ACP), and relieve physical symptom distress. CONCLUSIONS The use of ICTs in EOL care is a small but growing field of research. Additional research is needed to adapt older, analog technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for e-health applications in related fields should guide future interventions in EOL care.
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Affiliation(s)
| | - Peter Killoran
- 2 Department of Anesthesiology, University of Texas Medical School at Houston , Houston, Texas.,3 School of Biomedical Informatics, University of Texas , Houston, Texas.,4 School of Public Health, University of Texas , Houston, Texas
| | | | - Eduardo Bruera
- 5 M.D. Anderson Cancer Center, University of Texas , Houston, Texas
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Hixson JD, Barnes D, Parko K, Durgin T, Van Bebber S, Graham A, Wicks P. Patients optimizing epilepsy management via an online community: the POEM Study. Neurology 2015; 85:129-36. [PMID: 26085605 PMCID: PMC4515038 DOI: 10.1212/wnl.0000000000001728] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/18/2015] [Indexed: 01/17/2023] Open
Abstract
Objective: The study objective was to test whether engaging in an online patient community improves self-management and self-efficacy in veterans with epilepsy. Methods: The study primary outcomes were validated questionnaires for self-management (Epilepsy Self-Management Scale [ESMS]) and self-efficacy (Epilepsy Self-Efficacy Scale [ESES]). Results were based on within-subject comparisons of pre- and postintervention survey responses of veterans with epilepsy engaging with the PatientsLikeMe platform for a period of at least 6 weeks. Analyses were based on both completer and intention-to-treat scenarios. Results: Of 249 eligible participants enrolled, 92 individuals completed both surveys. Over 6 weeks, completers improved their epilepsy self-management (ESMS total score from 139.7 to 142.7, p = 0.02) and epilepsy self-efficacy (ESES total score from 244.2 to 254.4, p = 0.02) scores, with greatest impact on an information management subscale (ESMS–information management total score from 20.3 to 22.4, p < 0.001). Results were similar in intention-to-treat analyses. Median number of logins, postings to forums, leaving profile comments, and sending private messages were more common in completers than noncompleters. Conclusions: An internet-based psychosocial intervention was feasible to implement in the US veteran population and increased epilepsy self-management and self-efficacy scores. The greatest improvement was noted for information management behaviors. Patients with chronic conditions are increasingly encouraged to self-manage their condition, and digital communities have potential advantages, such as convenience, scalability to large populations, and building a community support network. Classification of evidence: This study provides Class IV evidence that for patients with epilepsy, engaging in an online patient community improves self-management and self-efficacy.
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Affiliation(s)
- John D Hixson
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.).
| | - Deborah Barnes
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
| | - Karen Parko
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
| | - Tracy Durgin
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
| | - Stephanie Van Bebber
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
| | - Arianne Graham
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
| | - Paul Wicks
- From the Departments of Neurology (J.D.H., K.P.), Psychiatry (D.B.), and Epidemiology & Biostatistics (D.B.), University of California San Francisco and the SF VA Medical Center; US Medical Affairs (T.D.), UCB, Inc.; Northern California Institute for Research and Education and the SF VA Medical Center (S.V.B.); and PatientsLikeMe (A.G., P.W.)
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LaFrance WC, Ranieri R, Bamps Y, Stoll S, Sahoo SS, Welter E, Sams J, Tatsuoka C, Sajatovic M. Comparison of common data elements from the Managing Epilepsy Well (MEW) Network integrated database and a well-characterized sample with nonepileptic seizures. Epilepsy Behav 2015; 45:136-41. [PMID: 25825372 DOI: 10.1016/j.yebeh.2015.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epilepsy and psychogenic nonepileptic seizures (PNES) are both chronic illnesses characterized by similar and overlapping clinical features. A limited number of studies comparing people with epilepsy (PWE) and patients with PNES that address determinants of health outcomes exist. We conducted an analysis using a well-characterized sample of people with PNES and the Managing Epilepsy Well (MEW) Network integrated data, comparing descriptive data on samples with epilepsy and with documented PNES. Based on the pooled data, we hypothesized that people with PNES would have worse QOL and higher depression severity than PWE. MATERIAL AND METHODS We used data from the MEW Network integrated database involving select epilepsy self-management studies comprising 182 PWE and 305 individuals with documented PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Clinic. We conducted a matched, case-control study assessing descriptive comparisons on 16 common data elements that included gender, age, ethnicity, race, education, employment, income, household composition, relationship status, age at seizure onset, frequency of seizures, seizure type, health status, healthy days, quality of life, and depression. Standardized rating scales for depression and quality of life were used. RESULTS Median seizure frequency in the last 30days for PWE was 1, compared to 15 for patients with PNES (p<0.05). People with epilepsy had a QOLIE-10 mean score of 3.00 (SD: 0.91) compared to 3.54 (0.88) (p<0.01) for patients with PNES. Depression severity was moderate to severe in 7.7% of PWE compared to 34.1% (p<0.05) of patients with PNES. DISCUSSION People with epilepsy in selected MEW Network programs are fairly well educated, mostly women, with few minorities and low monthly seizure rates. Those with PNES, however, have higher levels of not working/on disability and had more frequent seizures, higher depression severity, and worse QOL. These differences were present despite demographics that are largely similar in both groups, illustrating that other determinants of illness may influence PNES.
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Affiliation(s)
| | - Rebecca Ranieri
- San Paolo Hospital, Dipartimento di Scienze Della Salute Mentale, Psychiatry Branch Universita' degli Studi di Milano, Italy
| | - Yvan Bamps
- Rollins School of Public Health, Emory University, USA
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Sahoo SS, Zhang GQ, Bamps Y, Fraser R, Stoll S, Lhatoo SD, Tatsuoka C, Sams J, Welter E, Sajatovic M. Managing information well: Toward an ontology-driven informatics platform for data sharing and secondary use in epilepsy self-management research centers. Health Informatics J 2015; 22:548-61. [PMID: 25769938 DOI: 10.1177/1460458215572924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epilepsy is a chronic neurological condition that requires active self-management to reduce personal and population burden. The Managing Epilepsy Well Network, funded by the US Centers for Disease Control and Prevention, conducts research on epilepsy self-management. There is an urgent need to develop an integrated informatics platform to maximize the secondary use of existing Managing Epilepsy Well Network data. We have implemented multiple steps to develop an informatics platform, including: (a) a survey of existing outcome data, (b) identification of common data elements, and (c) an integrated database using an epilepsy domain ontology to reconcile data heterogeneity. The informatics platform enables assessment of epilepsy self-management samples by site and in aggregate to support data interpretations for clinical care and ongoing epilepsy self-management research. The Managing Epilepsy Well informatics platform is expected to help advance epilepsy self-management, improve health outcomes, and has potential application in other thematic research networks.
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Affiliation(s)
- Satya S Sahoo
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
| | | | | | | | | | - Samden D Lhatoo
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
| | - Curtis Tatsuoka
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
| | - Johnny Sams
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
| | - Elisabeth Welter
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
| | - Martha Sajatovic
- Case Western Reserve University, USAEmory University, USAUniversity of Washington, USAUniversity of Michigan, USACase Western Reserve University, USA
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Caller TA, Secore KL, Ferguson RJ, Roth RM, Alexandre FP, Henegan PL, Harrington JJ, Jobst BC. Design and feasibility of a memory intervention with focus on self-management for cognitive impairment in epilepsy. Epilepsy Behav 2015; 44:192-4. [PMID: 25731132 DOI: 10.1016/j.yebeh.2014.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the feasibility of a self-management intervention targeting cognitive dysfunction to improve quality of life and reduce memory-related disability in adults with epilepsy. The intervention incorporates (1) education on cognitive function in epilepsy, (2) self-awareness training, (3) compensatory strategies, and (4) application of these strategies in day-to-day life using problem-solving therapy. In addition to the behavioral modification, formal working memory training was conducted by utilizing a commercially available program in a subgroup of patients. Our findings suggest that a self-management intervention targeting cognitive dysfunction was feasible for delivery to a rural population with epilepsy, with 13 of 16 enrolled participants completing the 8-session program. Qualitative data indicate high satisfaction and subjective improvement in cognitive functioning in day-to-day life. These findings provide support for further evaluation of the efficacy of this intervention through a randomized controlled trial.
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Affiliation(s)
- Tracie A Caller
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Karen L Secore
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Robert M Roth
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Faith P Alexandre
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Patricia L Henegan
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Barbara C Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Nasi G, Cucciniello M, Guerrazzi C. The performance of mHealth in cancer supportive care: a research agenda. J Med Internet Res 2015; 17:e9. [PMID: 25720295 PMCID: PMC4446659 DOI: 10.2196/jmir.3764] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022] Open
Abstract
Background Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. Objective This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. Methods We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Results Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Conclusions Further research should start by stating and explaining what is meant by the evaluation of mHealth’s performance and then conduct more in-depth analysis in order to create shared frameworks to specifically identify the different dimensions of mHealth’s performance.
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Affiliation(s)
- Greta Nasi
- Department of Policy Analysis and Public Management, Bocconi University, Milano, Italy.
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Leenen LA, Wijnen BF, de Kinderen RJ, Majoie MH, van Heugten CM, Evers SM. (Cost)-effectiveness of a multi-component intervention for adults with epilepsy: study protocol of a Dutch randomized controlled trial (ZMILE study). BMC Neurol 2014; 14:255. [PMID: 25540089 PMCID: PMC4301056 DOI: 10.1186/s12883-014-0255-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In patients with epilepsy, poor adherence to anti-epileptic drugs has been shown to be the most important cause of poorly controlled epilepsy. Furthermore, it has been noted that the quality of life among patients with epilepsy can be improved by counseling and treatments aimed at increasing their self-efficacy and concordance, thus stimulating self-management skills. However, there is a need for evidence on the effectiveness of such programs, especially within epilepsy care. Therefore, we have developed a multi-component intervention (MCI) which combines a self-management/education program with e-Health interventions. Accordingly, the overall objective of this study is to assess the (cost)-effectiveness and feasibility of the MCI, aiming to improve self-efficacy and concordance in patients with epilepsy. Methods A RCT in two parallel groups will be conducted to compare the MCI with a control condition in epilepsy patients. One hundred eligible epilepsy patients will be recruited and allocated to either the intervention or control group. The intervention group will receive the MCI consisting of a self-management/education program of six meetings, including e-Health interventions, and will be followed for 12 months. The control group will receive care as usual and will be followed for 6 months, after which patients will be offered the possibility of participating in the MCI. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) process evaluation. The primary outcome will be self-efficacy. Secondary outcomes include adherence, side effects, change in seizure severity & frequency, improved quality of life, proactive coping, and societal costs. Outcome assessments will be done using questionnaires at baseline and after 3, 6, 9, and 12 months (last two applicable only for intervention group). Discussion In times of budget constraints, MCI could be a valuable addition to the current healthcare provision for epilepsy, as it is expected that higher concordance and self-efficacy will result in reduced use of healthcare resources and an increased QOL. Accordingly, this study is aimed helping patients to be their own provider of health care, shifting epilepsy management from professionals to self-care by patients equipped with appropriate skills and tools. Trial registration number NTR4484.
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Affiliation(s)
- Loes Am Leenen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Ben Fm Wijnen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Reina Ja de Kinderen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Marian Hjm Majoie
- Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands. .,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, Maastricht, The Netherlands. .,MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Caroline M van Heugten
- MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands. .,Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands.
| | - Silvia Maa Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
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Wagner J. A 15-year snapshot of the behavioral and psychosocial aspects of epilepsy. Epilepsy Behav 2014; 40:108-9. [PMID: 25281299 DOI: 10.1016/j.yebeh.2014.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Janelle Wagner
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, USA.
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