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Spanos S, Hutchinson K, Ryder T, Rapport F, Goodwin N, Zurynski Y. Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery. Int J Integr Care 2024; 24:18. [PMID: 38463746 PMCID: PMC10921962 DOI: 10.5334/ijic.7659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management. Methods Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated. Results Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended. Discussion There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education. Conclusion Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Tayhla Ryder
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- CanTeen Australia, Sydney, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Goodwin
- Central Coast Local Health District, Gosford, NSW, Australia
- Central Coast Research Institute for Integrated Care, University of Newcastle, Gosford, NSW, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Johnson EC, Atkinson P, Muggeridge A, Cross JH, Reilly C. Knowledge about, and attitudes towards epilepsy among school staff: A UK-based survey. Epilepsy Res 2023; 192:107116. [PMID: 36921479 DOI: 10.1016/j.eplepsyres.2023.107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To survey attitudes towards, and knowledge about, epilepsy among school staff in a defined geographical region in the United Kingdom. METHODS School staff (n = 160) from 18 schools (56% of eligible schools) where children with epilepsy were currently attending were surveyed. Surveys were developed in collaboration with educational professionals. Questions focussed on attitudes towards, and knowledge about, epilepsy. Factors associated with attitudes and knowledge were analyzed using multivariable logistic regression. RESULTS The majority of staff expressed positive attitudes towards the inclusion of children with epilepsy in school, although for most questions there was a significant minority who expressed less positive views. Only 30% of staff agreed that they would feel confident managing a child having a seizure whilst 42% of all staff would be concerned if they had to administer emergency medication. Regarding knowledge, half (50%) of respondents correctly indicated that a child who has a seizure should not always leave the classroom, whilst 54% knew that an ambulance should not always be called every time a child has a seizure. Regarding seizure semiology, almost all respondents (96%) answered 'yes' when asked if seizures could involve convulsions/limb jerking or whole-body convulsions. The vast majority (94%) also identified that seizures could involve 'staring blankly into space'. From a list of eight medical/neurodevelopmental conditions, epilepsy was the condition staff ranked of most concern. Factors independently associated with more positive attitudes and better knowledge included working in a special school as opposed to a mainstream school, having previously witnessed a seizure, and having been in receipt of training on epilepsy (all p < 0.05). Most respondents expressed a desire for more training on seizure management and on the learning and behavioral aspects of epilepsy. CONCLUSION Whilst attitudes toward children with epilepsy are largely positive, epilepsy was the condition staff were most concerned about. Additionally, attitudes towards seizure management and administration of emergency medication in school are less positive, and knowledge of correct actions in the event of seizures in the classroom is deficient in nearly half of respondents. More positive attitudes and better knowledge were associated with previous experience of witnessing seizures, working in special schools, and having received epilepsy training. School staff in UK schools are likely to benefit from access to training on epilepsy in order to improve attitudes and increase knowledge and confidence towards supporting a child with epilepsy in their classroom.
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Affiliation(s)
- Emma C Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK.
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Safety of Diazepam Nasal Spray in Children and Adolescents With Epilepsy: Results From a Long-Term Phase 3 Safety Study. Pediatr Neurol 2022; 132:50-55. [PMID: 35636283 DOI: 10.1016/j.pediatrneurol.2022.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate safety and tolerability of long-term treatment with diazepam nasal spray (Valtoco) for seizure clusters in patients aged six to 17 years. METHODS The study enrolled patients aged six to 65 years with frequent seizure clusters. Age- and weight-based doses of diazepam nasal spray were administered; second doses were permitted if needed. Safety assessments included treatment-emergent adverse events (TEAEs). RESULTS Of 163 treated patients, 45 (27.6%) were aged six to 11 years and 33 (20.2%) were aged 12 to 17 years. Mean doses per month were 2.1 in the 6 to 11 subgroup and 2.4 in the 12 to 17 subgroup. Of 1634 seizure clusters in pediatric patients, 186 (11.4%) required a second dose of diazepam nasal spray within 24 hours of the first dose. Similar proportions of TEAEs and serious TEAEs were reported in 6 to 11 (91.1%, 40.0%) and 12 to 17 subgroups (81.8%, 30.3%), respectively. No serious TEAEs were considered treatment related, and no patients discontinued because of TEAEs. Treatment-related TEAEs were more frequent in the 12 to 17 subgroup; only epistaxis and somnolence occurred in two or more patients overall. TEAE rates were similar across subgroups that received concomitant clobazam (90.0%), received prior diazepam rectal gel (90.9%), and were administered less than two versus greater than or equal to two doses per month (87.2% for both) of diazepam nasal spray. Most survey respondents (88%) were satisfied or very satisfied with treatment. CONCLUSIONS In this long-term safety analysis in pediatric patients with seizure clusters, repeated doses of diazepam nasal spray demonstrated a safety profile consistent across subgroups. These data support the dosing guidelines for diazepam nasal spray according to age and weight for pediatric patients.
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Patel AD, Debs A, Terry D, Parker W, Burch M, Luciano D, Patton L, Brubaker J, Chrisman J, Moellman K, Herbst J, Cohen DM. Decreasing Emergency Department Visits for Children With Epilepsy. Neurol Clin Pract 2021; 11:413-419. [PMID: 34840868 DOI: 10.1212/cpj.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives Epilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy. Methods In 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible. Our aim statement was to decrease the number of ED visits, per 1000 established patients with epilepsy, from 13.03 to 11.6, by December 2019 and sustain for 1 year. Results We successfully decreased ED visits for seizure-related care in patients with epilepsy from 13.03% to 10.2% per 1,000 patients, which resulted in a centerline shift. Discussion Using QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.
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Affiliation(s)
- Anup D Patel
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Andrea Debs
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debbie Terry
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - William Parker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Mary Burch
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debra Luciano
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Lauren Patton
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Jena Brubaker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Julie Chrisman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Kathy Moellman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - James Herbst
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Daniel M Cohen
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
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Dean P, O'Hara K, Brooks L, Shinnar R, Bougher G, Santilli N. Managing Acute Seizures: New Rescue Delivery Option and Resources to Assist School Nurses. NASN Sch Nurse 2021; 36:346-354. [PMID: 34189971 PMCID: PMC8586177 DOI: 10.1177/1942602x211026333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately 470,000 children and adolescents in the United States have epilepsy, 30% of whom experience seizures despite antiseizure drug regimens. School nurses, teachers, caregivers, and parents play integral roles in implementing a care plan that avoids triggers, recognizes signs, and provides supportive care—ideally, guided by a patient-specific seizure action plan, which may include the use of rescue medication. Benzodiazepines are the mainstay of seizure rescue medication; for decades, rectally administered diazepam was the only approved rescue medication for seizure clusters outside the hospital setting. However, rectal administration has limitations that could delay treatment (e.g., social acceptability, removal of clothing, positioning). More recently, intranasal midazolam (for patients ≥12 years) and intranasal diazepam (for patients ≥6 years) were approved for this indication. Training and education regarding newer forms of rescue medication should improve confidence in the ability to treat seizures in school with the goal of increasing the safety of students with epilepsy.
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Affiliation(s)
- Patricia Dean
- Epilepsy Program Specialist, Comprehensive Epilepsy Center, Nicklaus Children's Hospital, Miami, FL
| | - Kathryn O'Hara
- Clinical Research Nurse, Department of Neurology, Virginia Commonwealth University, Richmond, VA
| | - Lai Brooks
- Senior Director of the Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN
| | | | - Genei Bougher
- Vice President/Subinvestigator, Northwest Florida Clinical Research Group, LLC, Gulf Breeze, FL
| | - Nancy Santilli
- Global Managing Director, Human Care Systems, Boston, MA
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Bert F, Pompili E, Gualano MR, Venuti S, Minniti D, Siliquini R. Empowering seizure management skills: Knowledge, attitudes, and experiences of school staff trained in administering rescue drugs in Northern Italy. Epilepsy Behav 2021; 114:107362. [PMID: 33041219 DOI: 10.1016/j.yebeh.2020.107362] [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: 05/22/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The administration of rescue medication at school concerns students for which it may be essential, on doctor's prescription, to take therapy during school hours. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death. METHODS Every year, the Local Health Unit "TO3" in Northern Italy, provides training for school staff to administrate rescue medication at school. From December 2019 to February 2020, the same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases completed it before the course. RESULTS About 60% of the sample (N = 123) had been trained in seizure management at least once in their lifetime. Median knowledge score in subjects with no seizures training was 7 (Q25/Q75: 5/8), while it was 9 (Q25/Q75: 6/10) in subjects with seizures training (p < 0.001). The self-reported level of confidence in their skills to administer rescue medication was high in 10.2% of subjects not trained for seizures and in 62.9% of those trained (p < 0.001). CONCLUSION Results suggest that medical training for school staff increases knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude toward seizures, no longer considering them a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a better place for all students.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health Sciences, University of Turin, Italy; Molinette Hospital, AOU City of Health and Science of Turin, Italy
| | - Erika Pompili
- Department of Public Health Sciences, University of Turin, Italy
| | | | | | | | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Italy; Molinette Hospital, AOU City of Health and Science of Turin, Italy
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Gidal B, Klein P, Hirsch LJ. Seizure clusters, rescue treatments, seizure action plans: Unmet needs and emerging formulations. Epilepsy Behav 2020; 112:107391. [PMID: 32898744 DOI: 10.1016/j.yebeh.2020.107391] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The aim of the study was to provide an overview of the prevalence, risk factors, burden, and current and emerging pharmacologic treatments for seizure clusters in patients with epilepsy. RECENT FINDINGS Close to half of patients with active epilepsy experience seizure clusters, and the clinical, social, and financial burdens of seizure clusters are high. However, there is no widely accepted definition of seizure clusters; their prevalence is underappreciated, contingencies for addressing them (seizure action plans) are often lacking, and their effects are not well-studied. These issues have resulted in an insufficient number of investigations and approved medications for this condition. Novel formulations are in late-stage development to meet this unmet need.
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Affiliation(s)
- Barry Gidal
- University of Wisconsin-Madison, School of Pharmacy, Madison, WI, USA.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
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Paediatric status epilepticus: finally, some evidence-based treatment guidance, but still a long way to go. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:351-352. [DOI: 10.1016/s2352-4642(20)30030-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/23/2022]
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Lather T, Behgal J, Bhardwaj H, Kaushik JS. Impact of prescribing intranasal midazolam as rescue medication for domiciliary management of acute seizure among children with epilepsy. Epilepsy Behav 2019; 96:41-43. [PMID: 31078934 DOI: 10.1016/j.yebeh.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/15/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
Prescription pattern of rescue medication like intranasal midazolam (INM) for domiciliary management of seizure is highly variable. The present cross-sectional study was designed to determine the impact of the use of INM on healthcare utilization by those who used INM when compared with those who are not on any rescue medications in a resource-constraint setting. Children with epilepsy aged 1-14 years who have used INM to abort seizure at home (INM group) were compared with those who have not used INM (control group). The baseline demographic and seizure characteristics including the severity of epilepsy were comparable between the INM group (n = 50) and controls (n = 50). The INM group had significantly better knowledge of the correct method of administration when compared with controls [43 (86%) vs. 17 (34%); p < 0.01]. Seizures were aborted in 36 (72%) users in the INM group; of the rest of 14 children, 4 (8%) used it for the second time. The median Interquartile range (IQR) time taken to abort the seizure was 2.5 (1.0, 5.2) min. The need for intensive care admissions was comparable between the INM group and control group, although the number of emergency visits was significantly higher in the former [2.9 vs. 1.4, p = 0.04]. Despite comparable severity of epilepsy and better knowledge of its correct use, children who were prescribed INM required more hospital emergency visits. This study with a limited sample size prompts us to introspect the practice of INM for children with epilepsy.
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Affiliation(s)
- Tanvi Lather
- Department of Pediatrics, Pt B D Sharma Postgraduate Insititute of Medical Sciences, Rohtak, Haryana 124001, India
| | - Jai Behgal
- Department of Pediatrics, Pt B D Sharma Postgraduate Insititute of Medical Sciences, Rohtak, Haryana 124001, India
| | - Harish Bhardwaj
- Department of Pediatrics, Pt B D Sharma Postgraduate Insititute of Medical Sciences, Rohtak, Haryana 124001, India
| | - Jaya Shankar Kaushik
- Department of Pediatrics, Pt B D Sharma Postgraduate Insititute of Medical Sciences, Rohtak, Haryana 124001, India.
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Lepkowski AM, Maughan ED. Introducing NASN's New Evidence-based Clinical Guideline: Students With Seizures and Epilepsy. NASN Sch Nurse 2018; 33:345-350. [PMID: 30295151 DOI: 10.1177/1942602x18806824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Jones C, Atkinson P, Helen Cross J, Reilly C. Knowledge of and attitudes towards epilepsy among teachers: A systematic review. Epilepsy Behav 2018; 87:59-68. [PMID: 30173018 DOI: 10.1016/j.yebeh.2018.06.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/17/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
The objective of this study was to systematically review research that has focused on knowledge of and attitudes towards epilepsy among teachers. Embase, PubMed, PsycINFO, Google Scholar, and Cochrane library databases from 2000 to 2017 were searched. Cross-sectional and interventional studies were included and analyzed for quality. Thematic analysis was used to identify common themes in the results. Fifty-four eligible studies (17,256 total participants in 27 different countries) were identified in the search period including seven studies that focused on assessing attitudes and knowledge before and after an educational intervention. It was not possible to systematically analyze levels of knowledge and nature of attitudes because of the wide variety of mostly bespoke study specific instruments used. Few studies employed valid and reliable instruments. Thematic analysis revealed three main themes in the results: 1.) deficits in knowledge and negative attitudes were pervasive across all studies; 2.) teachers often had a negative attitude towards participation of children with epilepsy in physical activities/sport; and 3.) teachers often expressed limited knowledge of seizure management/emergency procedures. There was a lower level of knowledge and more negative attitudes among teachers towards epilepsy compared with other conditions. All studies focusing on interventions showed that at least some aspects of knowledge and attitudes improved as a result of teacher participation in an educational intervention, but study quality was universally rated as low. A higher level of education and experience of teaching a child with epilepsy was significantly associated with greater knowledge in a number of studies. Additionally, having experience of teaching a child with epilepsy and greater assessed knowledge of epilepsy were associated with more positive attitudes. The wide range of methods used makes it difficult to generalize regarding level of attitudes and knowledge among teachers towards epilepsy. Nevertheless, all studies indicate that there are some deficits in knowledge of and negative attitudes towards epilepsy among teachers. It would appear that knowledge and attitudes can be improved by educational interventions. Future research should focus on developing psychometrically sound assessment instruments that can be used globally and on identifying the most effective ways of delivering efficacious educational initiatives employing robust study designs.
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Affiliation(s)
- Chloe Jones
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, Crawley, West Sussex RH11 7DH, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK.
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Dumeier HK, Neininger MP, Bernhard MK, Merkenschlager A, Kiess W, Bertsche T, Bertsche A. Providing teachers with education on epilepsy increased their willingness to handle acute seizures in children from one to 10 years of age. Acta Paediatr 2017; 106:1811-1816. [PMID: 28561263 DOI: 10.1111/apa.13938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/29/2017] [Indexed: 01/27/2023]
Abstract
AIM In Germany, preschool teachers supervise children up to six years of age and are also responsible for supervising older pupils after school. This study explored the impact of a teaching session on epilepsy for teachers in charge of children from 1 to 10 years of age. METHODS We evaluated the benefit of a teaching session offered to all preschool teachers in Leipzig, Germany, in 2014-2015, by asking them to complete the same questionnaire 12-24 months pre-intervention, and 12 months postintervention. RESULTS Both questionnaires were completed by 123 teachers. The number of teachers who felt they were prepared to handle an acute seizure rose from 36 (29%) pre-intervention to 65 (53%) post-intervention (p < 0.001) and their willingness to administer a prescribed rescue medication rose from 66 (54%) to 93 (76%, p < 0.001). The session also increased the number of teachers who were prepared to take children with epilepsy on excursions under any circumstance from 38 (31%) to 52 (42%, p < 0.05). In addition, the number of teachers who would place a solid object in the child's mouth during an attack fell from 16 (13%) to seven (6%) (p < 0.05). CONCLUSION Providing a teaching session on epilepsy increased the teachers' knowledge and willingness to act and reduced obsolete, counterproductive measures.
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Affiliation(s)
| | | | - Matthias Karl Bernhard
- Centre of Pediatric Research; University Hospital for Children and Adolescents; Leipzig Germany
| | - Andreas Merkenschlager
- Centre of Pediatric Research; University Hospital for Children and Adolescents; Leipzig Germany
| | - Wieland Kiess
- Centre of Pediatric Research; University Hospital for Children and Adolescents; Leipzig Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy; Drug Safety Center; Leipzig University; Leipzig Germany
| | - Astrid Bertsche
- Centre of Pediatric Research; University Hospital for Children and Adolescents; Leipzig Germany
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Jansen P, Neininger MP, Bernhard MK, Kiess W, Merkenschlager A, Bertsche T, Bertsche A. Knowledge and attitudes about epilepsy: A survey of high school students in Germany. Seizure 2017; 51:139-144. [DOI: 10.1016/j.seizure.2017.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022] Open
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Dumeier HK, Neininger MP, Kaune A, Schumacher PM, Merkenschlager A, Kiess W, Bernhard MK, Bertsche T, Bertsche A. Seizure management by preschool teachers: A training concept focussing on practical skills. Seizure 2017; 50:38-42. [DOI: 10.1016/j.seizure.2017.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022] Open
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Abstract
Children and adolescents with epilepsy may experience prolonged seizures in school-associated settings (eg, during transportation, in the classroom, or during sports activities). Prolonged seizures may evolve into status epilepticus. Administering a seizure rescue medication can abort the seizure and may obviate the need for emergency medical services and subsequent care in an emergency department. In turn, this may save patients from the morbidity of more invasive interventions and the cost of escalated care. There are significant variations in prescribing practices for seizure rescue medications, partly because of inconsistencies between jurisdictions in legislation and professional practice guidelines among potential first responders (including school staff). There also are potential liability issues for prescribers, school districts, and unlicensed assistive personnel who might administer the seizure rescue medications. This clinical report highlights issues that providers may consider when prescribing seizure rescue medications and creating school medical orders and/or action plans for students with epilepsy. Collaboration among prescribing providers, families, and schools may be useful in developing plans for the use of seizure rescue medications.
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16
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Dumeier HK, Neininger MP, Bernhard MK, Syrbe S, Merkenschlager A, Zabel J, Kiess W, Bertsche T, Bertsche A. Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures. Arch Dis Child 2015; 100:851-5. [PMID: 26111815 DOI: 10.1136/archdischild-2015-308306] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/04/2015] [Indexed: 11/04/2022]
Abstract
PROBLEM School and preschool teachers play a key role in the care of children with epilepsy. Yet, data about their knowledge on epilepsy are scarce. METHODS Assessment of knowledge and attitudes towards epilepsy in teachers by conducting a questionnaire survey in Leipzig and Blankenburg, Germany, from August 2013 to January 2014. RESULTS 1243 questionnaires were completed by 302 school teachers, 883 preschool teachers, 56 students and two unclassified participants. Of the respondents, 140 (11%) stated to have already been actively involved in an epilepsy emergency situation, another 148 (12%) as observers. Only 214 (17%) of respondents felt sufficiently prepared for an emergency. A rescue medication had already been applied by 79 (6%) of respondents; only 186 respondents (15%) stated they would be willing to administer a prescribed rescue medication under any circumstances. In response to an open-ended question about the most common fatal outcomes of a seizure, status epilepticus and drowning were rarely mentioned. 233 (19%) of respondents assumed that epileptic seizures cannot result in death. 606 (49%) of respondents were concerned about the legal repercussions to an incorrect response to a seizure.129/403 (32%) of teachers with >20 years of professional experience claimed never to have had a child suffering from epilepsy in their care, even though the prevalence of childhood epilepsy indicates that they should. In total, 1066 (86%) respondents expressed a desire to gain more knowledge on epilepsy. CONCLUSIONS Training programmes for teachers should be established. Furthermore, a clear legal regulatory framework needs to be set up.
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Affiliation(s)
- Henriette K Dumeier
- Drug Safety Center and Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany
| | - Martina P Neininger
- Drug Safety Center and Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany
| | - Matthias K Bernhard
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany
| | - Steffen Syrbe
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany
| | - Andreas Merkenschlager
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany
| | - Jörg Zabel
- Department of Biology Education, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Department of Clinical Pharmacy, University of Leipzig, Leipzig, Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Leipzig, Germany
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17
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Mecarelli O, Messina P, Capovilla G, Michelucci R, Romeo A, Beghi E, Lucibello S, Ferrari A, Vecchi M, de Palma L, Monti F, Ferlazzo E, Gasparini S, Passarelli D, Lodi M, Cesaroni E, Stranci G, Elia M, Severi S, Pizzanelli C, Ausserer H, Dordi B, Montalenti E, Pieri I, Galeone D, Germano M, Cantisani T, Casellato S, Pruna D. An educational campaign toward epilepsy among Italian primary school teachers: 1. Survey on knowledge and attitudes. Epilepsy Behav 2014; 32:84-91. [PMID: 24521730 DOI: 10.1016/j.yebeh.2014.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/08/2014] [Accepted: 01/17/2014] [Indexed: 11/28/2022]
Abstract
A questionnaire survey was undertaken to assess the impact of a nationwide educational campaign about epilepsy on the knowledge and attitudes toward the disease among Italian primary school teachers. Five hundred and eighty-two teachers participated. All interviewees were aware of the existence of epilepsy, and most of them had direct experience with the disease. Answers about frequency, causes, outcome, and response to treatments were variable and not correlated with age, residency, and years of experience. Teachers had positive attitudes toward epilepsy, except for the idea that driving and sports can be safe for people with epilepsy. Epilepsy and its treatment were considered a source of learning disability and social disadvantages. Several teachers declared themselves being unable to help a child having seizures. Calling an ambulance was a frequent action. Knowledge and attitudes toward epilepsy are improved compared with those reported in our previous studies. Although this may be a positive reflection of the increasing knowledge and the greater availability of information on epilepsy, there are still areas of uncertainty and incorrect behaviors.
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Affiliation(s)
- Oriano Mecarelli
- Sapienza Università di Roma, Dipartimento di Neurologia e Psichiatria, Azienda Policlinico Umberto 1°, Roma, Italy
| | - Paolo Messina
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Neuroscienze, Milano, Italy
| | - Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center "C. Poma Hospital", Mantova, Italy
| | - Roberto Michelucci
- IRCCS-Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Ettore Beghi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Neuroscienze, Milano, Italy.
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18
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Millichap JG. Rescue Medication in Children at Risk of Prolonged Convulsive Seizures. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-11-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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