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Abildgaard Hansen O, Clemensen J, Beier CP, Pors Klinting G, Smith AC, Kaas Larsen M. Being an adolescent with epilepsy during the transition from pediatric to adult hospital care: A qualitative descriptive study. Epilepsy Behav 2024; 155:109780. [PMID: 38640727 DOI: 10.1016/j.yebeh.2024.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The transition from pediatric to adult care is challenging for adolescent patients despite numerous recommendations in recent decades. However, the perspective of the patients is sparsely investigated. AIM To explore the experiences and needs of adolescents with epilepsy (AWE) during the transition from pediatric to adult hospital care. METHODS We conducted 15 semi-structured interviews with AWEs aged 13-20 years and 10 h of field observations of consultations. Interviews were audio-recorded, transcribed, anonymized, and entered into NVivo (version 12, QSR International) with the transcribed field notes. Data were analyzed using systematic text condensation. RESULTS Three themes were identified: (1) Navigating epilepsy in everyday life; (2) The difficult balance between concealment and openness about epilepsy; and (3) Being seen as an individual and not an illness. AWEs' needs in transition are closely associated with their experiences and perceptions of illness, treatment, consultations, and seizures. Notably, AWEs reveal a significant concern about being overlooked beyond their medical condition in appointments. CONCLUSIONS This study highlights the vulnerability and challenges of AWEs transitioning to adult care. Overall, AWEs seek understanding, acceptance, and autonomy in managing their epilepsy and transitioning to adult care. Their experiences underscore the importance of holistic support and communication in healthcare settings. A concerted effort from healthcare professionals (HCP) is necessary to foster the recognition of AWEs as individuals with distinct personalities, needs, and capabilities.
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Affiliation(s)
- Ole Abildgaard Hansen
- Department of Neurology, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark.
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | | | - Anthony C Smith
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | - Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
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Kim HW, Shin DH, Kim J, Lee GH, Cho JW. Assessing the performance of ChatGPT's responses to questions related to epilepsy: A cross-sectional study on natural language processing and medical information retrieval. Seizure 2024; 114:1-8. [PMID: 38007922 DOI: 10.1016/j.seizure.2023.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Epilepsy is a neurological condition marked by frequent seizures and various cognitive and psychological effects. Reliable information is essential for effective treatment. Natural language processing models like ChatGPT are increasingly used in healthcare for information access and data analysis, making it crucial to assess their accuracy. OBJECTIVE This study aimed to investigate the accuracy of ChatGPT in providing educational information related to epilepsy. METHODS We compared the answers from ChatGPT-4 and ChatGPT-3.5 to 57 common epilepsy questions based on the Korean Epilepsy Society's "Epilepsy Patient and Caregiver Guide." Two epileptologists reviewed the responses, with a third serving as an arbiter in cases of disagreement. RESULTS Out of 57 questions, 40 responses from ChatGPT-4 had "sufficient educational value," 16 were "correct but inadequate," and one was "mixed with correct and incorrect" information. No answers were entirely incorrect. GPT-4 generally outperformed GPT-3.5 and was often on par with or better than the official guide. CONCLUSIONS ChatGPT-4 shows promise as a tool for delivering reliable epilepsy-related information and could help alleviate the educational burden on healthcare professionals. Further research is needed to explore the benefits and limitations of using such models in medical contexts.
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Affiliation(s)
- Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, 50612 Geumoro 20, Yangsan, South Korea
| | - Dong-Hyeon Shin
- Department of Neurology, Pusan National University Yangsan Hospital, 50612 Geumoro 20, Yangsan, South Korea
| | - Jiyoung Kim
- Department of Neurology, Pusan National University Hospital, Busan, South Korea; Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | - Gha-Hyun Lee
- Department of Neurology, Pusan National University Hospital, Busan, South Korea; Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, 50612 Geumoro 20, Yangsan, South Korea; Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea.
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Cook G, Bray L, Carter B, Gringras P, Morris C, Pal DK, Saron H, Tudur Smith C, Wiggs L. A cross-sectional survey of healthcare professionals supporting children and young people with epilepsy and their parents/carers: which topics are raised in clinical consultations and can healthcare professionals provide the support needed? Epilepsy Behav 2023; 149:109543. [PMID: 38006842 DOI: 10.1016/j.yebeh.2023.109543] [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: 08/14/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND PURPOSE Children and young people (CYP) with epilepsy see healthcare professionals (HCPs) for management of their seizures but may require information, advice and support with a range of broader topics. The purpose of the survey was to identify from HCPs, which topics CYP with epilepsy and their parents/carers ask about other than seizure management, and how adequately HCPs feel able to support them with these topics. METHOD A cross-sectional online survey was used to collect data. Adverts which included a link to the survey were shared via social media channels, professional networks and United Kingdom (UK)-based epilepsy networks. Eighty-eight HCPs in the UK (who worked with CYP with epilepsy and their parents/carers) completed the survey. Quantitative data are presented descriptively. Qualitative data (free-text responses) were reflexively thematically analysed. RESULTS CYP with epilepsy and their parents/carers were reported to ask HCPs for information, advice and support about a range of topics, most commonly, cognition and mental health. CYP were reported as also frequently asking about aspects of their social life while parents/carers commonly asked about sleep. HCPs varied in how able they felt to adequately support families about these topics, as well as in their views about which resources could be most useful. Having insufficient time and a lack of suitable services and resources to refer to, or draw upon, were key barriers to HCPs being able to support CYP and their families. DISCUSSION Findings highlight the broad array of topics CYP with epilepsy and their families are reported as seeking support for. HCPs identified gaps in services and their abilities to meet those needs. There appeared to be a mismatch between the support that families were seeking and the ability of HCPs to meet these needs. Findings have implications for how HCPs could best be supported to deal with topics raised by CYP and families in clinic, highlighting the potential usefulness of informational resources on key topics for HCPs, parents/carers and CYP.
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Affiliation(s)
- Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Paul Gringras
- Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK; Kings College London, Strand, London, WC2R 2LS, UK
| | - Christopher Morris
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Deb K Pal
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; MRC Centre for Neurodevelopmental Disorders, Neurodevelopmental Disorders, New Hunt's House, Guy's Campus, King's College London, SE1 1UL, UK; Variety Club Children's Department, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Catrin Tudur Smith
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford, OX3 0BP, UK
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Miller VA, Miller C, Davis SM, Nokoff NJ, Buchanan C, Friedrich EA, Carl A, Strine S, Vogiatzi MG. Information needs and health status in adolescents and young adults with differences of sex development or sex chromosome aneuploidies. J Pediatr Urol 2023; 19:586-595. [PMID: 37308330 DOI: 10.1016/j.jpurol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION When and how to provide condition-related information to adolescents and young adults (AYAs) with differences of sex development or sex chromosome aneuploidies (DSDs or SCAs) is largely based on anecdotal experience and lacks informed guidance. For AYAs with a DSD or SCA, having accurate information is critical for attaining optimal adjustment and well-being, participating in decision making related to treatment options, and transitioning successfully to adult health care, yet prior studies have focused exclusively on parental perspectives and not on the views of adolescents themselves. OBJECTIVE The objective of this study was to describe unmet information needs in AYAs with a DSD or SCA and examine associations with perceived global health. METHODS Participants were recruited from specialty clinics at Children's Hospital of Philadelphia (n = 20) and Children's Hospital Colorado (n = 60). AYAs ages 12-21 years with a DSD or SCA and a parent completed a survey assessing perceived information needs across 20 topics, importance of those topics, and global health using the PROMIS Pediatric Global Health questionnaire (PGH-7). RESULTS AYAs had diagnoses of Klinefelter syndrome (41%), Turner syndrome (25%), and DSD (26%) and were 16.7 years (SD = 2.56) and 44% female. Parent participants were primarily mothers (81%). AYAs perceived that 48.09% of their information needs were unmet (SD = 25.18, range: 0-100). Parents perceived that 55.31% of AYAs' information needs were unmet (SD = 27.46 range: 5-100). AYAs and parents across conditions reported unmet needs related to information about transition to adult health care, financial support for medical care, and how the condition might affect the AYA's health in the future. While AYA-reported PGH-7 scores were not associated with percentage of AYA unmet information needs, parent-reported PGH-7 scores were (r = -.46, p < .001), such that lower parent-reported global health was associated with higher percentage of AYA unmet information needs. DISCUSSION/CONCLUSION On average, parents and AYAs perceived that half of AYAs' information needs were unmet, and a higher percentage of AYA unmet information needs was associated with lower perceived global health. The frequency of unmet needs in this sample of AYAs reflects an opportunity for improvement in clinical care. Future research is needed to understand how education to children and AYAs unfolds as they mature and to develop strategies to address the information needs of AYAs with a DSD or SCA, promote well-being, and facilitate AYA engagement in their own health care.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Christina Miller
- Graduate Program in Genetic Counseling, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, W5107, Aurora, CO, 80045, USA
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Cindy Buchanan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Elizabeth A Friedrich
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Alexandra Carl
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Sophia Strine
- Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Maria G Vogiatzi
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
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[Transition to adult care for patients with epilepsy]. DER NERVENARZT 2022; 93:359-365. [PMID: 35288775 DOI: 10.1007/s00115-022-01271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
The transition of children and adolescents with epilepsy to the adult healthcare system presents many challenges. The disease is frequently accompanied by cognitive and developmental impairments that make it difficult to achieve self-management of the disease. Seizures are often associated with a loss of consciousness; therefore, conversations regarding medical history often take place only between the physician and the parents. The children and adolescents then usually have a very little knowledge about their disease and do not learn to talk about their seizures and other disease-related problems. Childhood epilepsies are partly caused by rare genetic diseases, and neurologists usually have little experience with these diseases. In the past many of these etiologies were underdiagnosed in pediatrics and never reclassified during adulthood. An improvement of this situation requires long-term assistance over numerous years for the young patients to learn more about their own disease and the healthcare structures for adults. They should also be trained in how to talk about their medical problems with the doctor (physician-patient communication). At the medical level, a well-structured transfer of clinical findings, EEGs, imaging findings, etiologies, the current seizure situation, and the history of therapeutic measures is required. This article provides useful recommendations and information about existing programs and materials to support the management of transition.
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The rescue therapy in epilepsy project Part 2: Insights from people with epilepsy and families on expert-derived preferred practices. Epilepsy Behav 2021; 125:108444. [PMID: 34839243 DOI: 10.1016/j.yebeh.2021.108444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The number and type of therapies available to treat seizure clusters (SCs) or periods of increased seizure activity have risen in recent years. Gaps still exist on defining SCs, when to use them, and educating patients and families. The Epilepsy Foundation developed and published expert-derived consensus on preferred practices for rescue therapies (RTs), 79% of which were agreed upon by a larger group of healthcare professionals (HCPs). This paper describes insights from people with epilepsy (PWE) and families/caregivers (FCGs) on these practices to assess similarities and trends between PWE, FCGs, an expert panel, and HCPs. METHODS Online survey including expert-derived preferred practices for RT was completed by a convenience sample of 176 PWE/FCGs. Respondents rated agreement with each preferred practice using a 0-8 point Likert scale. Results were examined by relationship to epilepsy, prior use of RTs, and comparison to the expert panel and larger group of HCPs. RESULTS 41.5% of respondents were PWE and 54.6% were FCGs; 70% represented PWE age 18 and over or those who cared for adults with epilepsy. Levels of agreement were similar to those of HCPs - consensus was obtained on 79% of preferred practices. Differences were noted on which items achieved consensus and strength of consensus for some items. Differences between PWE and FCG, and between those who had and had not previously used a RT were found. A proposed definition of SCs did not reach consensus, but there was strong consensus for individualized seizure action plans and more RT education.
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Knowledge, attitudes, and practices of caregivers of children with epilepsy in Sudan. Epilepsy Behav 2021; 123:108283. [PMID: 34500433 DOI: 10.1016/j.yebeh.2021.108283] [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: 05/05/2021] [Revised: 07/24/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the knowledge, attitudes, and practices of caregivers of children with epilepsy. METHODS This cross-sectional study included 107 consecutive caregivers of children diagnosed with epilepsy, attending the neurology outpatient clinic in a Pediatric tertiary university hospital, in Khartoum, Sudan for regular check-up. Data were obtained by an interviewer through a structured questionnaire, while clinical parameters of children with epilepsy were taken from medical records. RESULTS Most respondents knew that epilepsy is not an infectious disease (92.5%), while the least proportion of caregivers (41.1%) knew that epilepsy did not emanate from a supernatural origin. The majority of caregivers were with the idea that epilepsy caused lost opportunities for study (66.4%) and that epilepsy was looked upon negatively by others (64.5%). Less than half (39.7%) of these caregivers rolled their child on to the side during a seizure, and more than a third (37.2%) admitted to sprinkling water over the child during his/her seizure. Caregivers' of children with Generalized Tonic-Clonic (GTC) convulsions, reported significantly lower knowledge scores than caregivers whose children did not experience GTC seizures (p = 0.016). Caregivers of children with GTC seizures were more likely to believe epilepsy was for the most part hereditary (p = 0.006), and that children with epilepsy lost consciousness during a seizure (p < 0.001). CONCLUSION Our findings suggest that caregivers require periodic epilepsy-related educational programs. This study is an invaluable tool for tailoring the delivery of information and support resources for caregivers in our region.
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Jeschke S, Woltermann S, Neininger MP, Pauschek J, Kiess W, Bertsche T, Bertsche A. Interviews with patients aged 6-17 years provide valuable insights for physicians who need to deliver an epilepsy diagnosis. Acta Paediatr 2021; 110:1556-1561. [PMID: 33207002 DOI: 10.1111/apa.15672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
AIM Meeting children's needs when communicating an epilepsy diagnosis can have a large impact on their treatment. We investigated children's experiences and wishes concerning their first conversation about epilepsy. METHODS This prospective study was performed in the neuropaediatric departments of two German university hospitals from 2 October 2018 to 12 April 2019. The semi-structured interview contained open questions, and multiple answers were allowed. RESULTS We interviewed 101 patients (57 male) aged 6-17 (median 11) years and asked them to put themselves in the place of a physician delivering an epilepsy diagnosis. They said they would be careful and friendly and consider the children's feelings (29%), give them detailed information about their condition (29%) and reduce their fears and offer hope (26%). They would tell them the importance of always taking their medication and explain why (25%), make sure that the conversation took place in a comfortable setting (21%), explain any safety precautions (19%), keep the conversation straightforward and provide examples (16%). CONCLUSION Children with epilepsy provided concrete recommendations for physicians delivering an epilepsy diagnosis, with regard to the ideal setting, important topics and optimal communication. The recommendations could help physicians meet children's needs.
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Affiliation(s)
- Sarah Jeschke
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
| | - Sarah Woltermann
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Josefine Pauschek
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
| | - Wieland Kiess
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Astrid Bertsche
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
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Samanta D, Singh R, Gedela S, Scott Perry M, Arya R. Underutilization of epilepsy surgery: Part II: Strategies to overcome barriers. Epilepsy Behav 2021; 117:107853. [PMID: 33678576 PMCID: PMC8035223 DOI: 10.1016/j.yebeh.2021.107853] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
Interventions focused on utilization of epilepsy surgery can be divided into groups: those that improve patients' access to surgical evaluation and those that facilitate completion of the surgical evaluation and treatment. Educational intervention, technological innovation, and effective coordination and communication can significantly improve patients' access to surgery. Patient and public facing, individualized (analog and/or digital) communication can raise awareness and acceptance of epilepsy surgery. Educational interventions aimed at providers may mitigate knowledge gaps using practical and concise consensus statements and guidelines, while specific training can improve awareness around implicit bias. Innovative technology, such as clinical decision-making toolkits within the electronic medical record (EMR), machine learning techniques, online decision-support tools, nomograms, and scoring algorithms can facilitate timely identification of appropriate candidates for epilepsy surgery with individualized guidance regarding referral appropriateness, postoperative seizure freedom rate, and risks of complication after surgery. There are specific strategies applicable for epilepsy centers' success: building a multidisciplinary setup, maintaining/tracking volume and complexity of cases, collaborating with other centers, improving surgical outcome with reduced complications, utilizing advanced diagnostics tools, and considering minimally invasive surgical techniques. Established centers may use other strategies, such as multi-stage procedures for multifocal epilepsy, advanced functional mapping with tailored surgery for epilepsy involving the eloquent cortex, and generation of fresh hypotheses in cases of surgical failure. Finally, improved access to epilepsy surgery can be accomplished with policy changes (e.g., anti-discrimination policy, exemption in transportation cost, telehealth reimbursement policy, patient-centered epilepsy care models, pay-per-performance models, affordability and access to insurance, and increased funding for research). Every intervention should receive regular evaluation and feedback-driven modification to ensure appropriate utilization of epilepsy surgery.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, United States
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, United States
| | - M Scott Perry
- Cook Children's Medical Center, Fort Worth, TX, United States
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Diby T, Khumalo PG, Anokyewaa-Amponsah G, Mustapha R, Ampofo AG. Knowledge about epilepsy and factors associated with attitudes toward marrying, employing, and driving people with epilepsy: A cross-sectional survey of Asokore Mampong community dwellers in Ghana. Epilepsy Behav 2021; 115:107646. [PMID: 33339739 DOI: 10.1016/j.yebeh.2020.107646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Due to lack of information and illiteracy, epilepsy remains a stigmatized disease in sub-Saharan Africa. OBJECTIVES The main aim of the study was to determine, among community dwellers in Asokore Mampong Municipality (Ghana): (i) the knowledge on risk factors, signs and symptoms, management of epilepsy, and (ii) factors associated with attitudes toward marrying, employing, or driving people with epilepsy (PWE). METHODS A cross-sectional study of 100 randomly selected individuals aged 18 years and older in Asokore Mampong Municipality was conducted in February 2019. A self-administered questionnaire was used to assess the knowledge about epilepsy and attitudes toward marrying, employing, and driving people with epilepsy. Frequencies and corresponding percentages were used to describe the study participants, their knowledge regarding epilepsy and attitudes toward marrying, employing, or driving people with epilepsy. Univariate and multivariate logistic regression analyses were used to determine the factors associated with attitudes toward marrying, employing, or driving people with epilepsy. RESULTS Majority (33%) of the respondents indicated that epilepsy is caused by possession of evil spirits or witchcraft. More than 60% of the respondents correctly identified all signs and symptoms presented in the survey. Almost half (45%) of the respondents selected orthodox/medical treatment as the treatment for epilepsy. The odds of marrying PWE among Akans and Ewe/Ga Adangbe were 90% [adjusted Odds ratio (aOR) = 0.10, 95% CI: 0.01-0.67] and 84% lower [aOR = 0.16, 95% CI: 0.04-0.62] compared to odds of marrying PWE among Northerners, respectively. Compared to respondents with no formal education, the odds of employing PWE were 88% lower [aOR = 0.12, 95% CI: 0.03-0.40] among those with tertiary education. In addition, the odds of driving a person with an epileptic attack among Muslims/Traditionalists were 81% lower [aOR = 0.19, 95% CI: 0.05-0.68] than Christians. Respondents between 18 and 30 years old had more than 5 times higher odds of driving a person with an epileptic attack [aOR 5.28, 95% CI: 1.15-24.84] compared to respondents above 30 years. CONCLUSIONS Individuals in Asokore Mampong have less knowledge about the risk factors and treatment of epilepsy. Generally, they have negative attitudes toward marrying, employing, and driving PWE. Findings from this study highlight the need to increase education to reduce the stigma associated with epilepsy. We recommend that a massive educational campaign should be organized by the Ghana Health Service to address deficiencies in knowledge as well as the negative attitudes toward PWE.
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Affiliation(s)
- Thomas Diby
- Department of Anatomy, College of Health Sciences, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Phinda G Khumalo
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Australia
| | | | - Rafiyatu Mustapha
- Garden City University College, Department of Nursing, Kumasi, Ghana
| | - Ama G Ampofo
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Australia; Garden City University College, Department of Nursing, Kumasi, Ghana.
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Salehizadeh S. Recommendations for a Better Control of Seizures in Epileptic Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:213-214. [PMID: 34178786 PMCID: PMC8213610 DOI: 10.18502/ijph.v50i1.5095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The article's abstract is not available.
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Affiliation(s)
- Saeideh Salehizadeh
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Quality of life (QOL) narratives of growing up with epilepsy from youth and family perspectives. Epilepsy Behav 2021; 114:107613. [PMID: 33309235 DOI: 10.1016/j.yebeh.2020.107613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Qualitative research studies deepen our understanding of growing up with epilepsy but are limited to the singular perspective of children or their parents at one point in childhood. A more complete view requires multiple perspectives and narrative accounts that represent development from early childhood to young adulthood. Thematic study of life narratives of 7 young people and at least one person within their families were interviewed separately (15 participants) for two interviews each (30 interviews). The objective was to obtain narratives of the life experiences, the attributions of those experiences, and crucial periods relating to quality of life (QOL) with no apriori assumptions that their lives were shaped by epilepsy. Themes were formed inductively from subthemes and codes were created based on the constant comparative method by two interviewers who iteratively co-coded the data. RESULTS Themes emerging from the data: "Story of My Health," "Growing by Doing," "To Adapt or Not to Adapt," "Supports and Challenges," "Parent World," and "Looking in and Out, Forward and Back", often included components of seizure and epilepsy experiences but also mirrored life challenges of growing up in general. The only exclusively epilepsy-specific theme: "To Adapt or Not to Adapt", was about the challenges and solutions for dealing with the uncertainty caused by seizures and potential isolation that results from others' reactions. CONCLUSIONS There were a range of experiences related to QOL described by participants growing up with epilepsy. The 'ingredients' of a good life (e.g., social and self-acceptance) were consistent with QOL research for general populations, although these were often expressed as more difficult to attain when growing up with epilepsy.
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Nevin SM, Wakefield CE, Schilstra CE, McGill BC, Bye A, Palmer EE. The information needs of parents of children with early-onset epilepsy: A systematic review. Epilepsy Behav 2020; 112:107382. [PMID: 32854014 DOI: 10.1016/j.yebeh.2020.107382] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Early-onset epilepsy has broad physical and psychosocial impacts, and parents have a wide variety of information needs. This systematic review set out to assess 1) whether parents of children with early-onset epilepsy have unmet information needs and 2) their preferences regarding information content and style of information delivery. METHODS We searched Medline, Embase, PsychInfo, and CINAHL using keywords relating to information needs, information resources, and preferences for information delivery. We limited the search to parent populations and included all peer-reviewed publications published in English after the year 2005. RESULTS Eleven studies met our inclusion criteria. Parents reported a clear need for understandable, realistic, and focused information, highlighting a particular need for content about comorbidities and emotional support. Parents reported limited availability of detailed information resources on early-onset epilepsy, which compromised their ability to access appropriate healthcare services. Unmet information needs were associated with greater levels of stress, poorer psychosocial outcomes, and lower satisfaction with healthcare services. SIGNIFICANCE The results highlight the importance of detailed epilepsy information for families. Healthcare professionals should be aware of the impact of a lack of epilepsy information on family wellbeing. Multipronged and tailored interventions targeting the information needs of families are warranted.
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Affiliation(s)
- Suzanne M Nevin
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Clarissa E Schilstra
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ann Bye
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Elizabeth E Palmer
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, Australia
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Mooney O, McNicholl A, Lambert V, Gallagher P. Self-management in children and young people with epilepsy: A systematic review and qualitative meta-synthesis. J Health Psychol 2020; 26:126-139. [PMID: 33040578 DOI: 10.1177/1359105320963536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this review was to conduct a meta-synthesis of qualitative studies exploring the self-management experiences, attitudes and perspectives of children and young people (CYP) living with epilepsy. Five databases were systematically searched up to September 2019. Fourteen papers were included. One analytical theme: self-management strategies was generated informed by four descriptive themes; concealment; medicine adherence; self-monitoring of activities; and seeking social support. The synthesis identified that while CYP with epilepsy engage in specific self-management strategies, there is limited evidence in understanding self-management and the processes underlying the use of it. Future research examining self-management in childhood is required.
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Nurre ER, Smith AW, Rodriguez MG, Modi AC. Patient, Caregiver, and Provider Perceptions of Transition Readiness and Therapeutic Alliance during Transition from Pediatric to Adult Care in Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTransition from pediatric to adult health care is a time of high risk for adolescents and young adults (AYAs) with epilepsy. Our aims are to examine patient, caregiver, and provider perceptions of transition readiness and the influence of patient-provider alliance in the context of transition readiness. Our cross-sectional study included 82 AYAs with epilepsy prior to transition. Patients, caregivers, and providers completed questionnaires (e.g., transition readiness and working alliance). Statistical analyses included independent samples and paired t-tests. Participants were 17.3 ± 2.8 years on average, 54% were females, 84% were White (non-Hispanic), and 38% had generalized epilepsy. Caregivers reported significantly higher transition readiness than their AYAs (t (72) = −10.6, p < 0.001). AYAs and providers reported similar alliance scores. Providers who felt patients were ready to transition had higher patient-reported transition readiness and provider-reported alliance scores. These data suggest that patients and providers are well aligned in the transition process, and providers appropriately perceive key areas necessary for transition. Caregivers and patients had discrepant perceptions of transition readiness, highlighting the importance of assessing both unique transition perspectives. Dedicated transition programs are likely to be beneficial in improving transition readiness and increase alignment across patients, caregivers, and providers.
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Affiliation(s)
- Emily R. Nurre
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Aimee W. Smith
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States
| | - Marie G. Rodriguez
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Woltermann S, Jeschke S, Herziger B, Müller RM, Kiess W, Bertsche T, Bertsche A, Neininger MP. Anticonvulsant long-term and rescue medication: The children's perspective. Eur J Paediatr Neurol 2020; 28:180-185. [PMID: 32727667 DOI: 10.1016/j.ejpn.2020.06.009] [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: 01/16/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about children's perspectives and attitudes towards their long-term and rescue anticonvulsant medication. METHODS We interviewed paediatric patients aged 6-18 years in two university hospitals concerning their anticonvulsant treatment based on a structured questionnaire. We also asked them to draw a picture titled "Me and my medication". RESULTS We interviewed 100 patients with anticonvulsant long-term medication. 87/100 patients considered their medication to be helpful. 66/100 patients gave an explanation on why a regular medication intake is important, e.g. "Reduction/prevention of seizures", "Otherwise I have to go to hospital", "I don't want to die" or "Kill the virus which is causing epilepsy". Of 92 patients with a prescribed rescue medication, 22 (24%) did not know about it. Of the remaining 70, 39 (56%) stated they always carry it with them. When asked to imagine being the physician and to inform about the medication, the children would use illustrative (e.g. brochures) or demonstration material (e.g. "real tablets") to aid their consultation (47/100). 55/100 would stress the necessity of a regular intake. 52 participants drew a picture related to the given topic. Of those, only 1 depicted rescue medication. CONCLUSION Paediatric patients mostly have a positive attitude towards their medication. However, misconceptions exist and participants expressed the desire for more interactive support in the medical counselling. Children are not sufficiently aware of their rescue medication in everyday life. Consequently, physicians should consider the children's needs in their consultations and put more focus on potentially life-saving rescue medication.
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Affiliation(s)
- Sarah Woltermann
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany; Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
| | - Sarah Jeschke
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Birthe Herziger
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Ruth Melinda Müller
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany.
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany; University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
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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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Higgins A, Downes C, Varley J, Doherty CP, Begley C, Elliott N. Supporting and empowering people with epilepsy: Contribution of the Epilepsy Specialist Nurses (SENsE study). Seizure 2019; 71:42-49. [DOI: 10.1016/j.seizure.2019.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/28/2019] [Accepted: 06/08/2019] [Indexed: 11/25/2022] Open
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Le Marne FA, Towns SJ, Gaskin C, Ho J, Baker R, Beavis E, Bye AM. Implementing a new adolescent epilepsy service: Improving patient experience and readiness for transition. J Paediatr Child Health 2019; 55:819-825. [PMID: 30474164 DOI: 10.1111/jpc.14301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/21/2018] [Accepted: 10/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To implement and appraise a new model of care in terms of: patient experience, knowledge of epilepsy, readiness for transition and emotional and behavioural support in a new purpose-built facility for adolescents and young adults. METHODS The new model of care included: upskilling of neurology staff in adolescent engagement and provision of group education sessions on epilepsy and mental health (MH), along with MH support, in a new purpose-built adolescent facility. Parameters examined pre- and post-attendance at the new clinic included: adolescent experience of service delivery, transition readiness, emotional and behavioural well-being, epilepsy knowledge and medication adherence. RESULTS A total of 45 adolescents (mean age 15.7 years) attended the new epilepsy clinic between February 2017 and December 2017. Adolescents felt significantly better informed following education in relation to epilepsy and driving, alcohol/street drugs and birth control/pregnancy. There was no significant improvement in self-reported medication adherence, transition readiness or mental well-being at follow-up. While MH education was ranked highly in terms of importance by adolescents and parents at baseline, attendance at MH education and engagement with MH support was low. CONCLUSIONS This paper documents what is important to young people with epilepsy regarding service delivery. The new adolescent service was well received. Based on feedback from adolescents and parents relating to the service, and the suboptimal uptake of MH supports, the model of care has been revised to reduce attendance burden on families and improve patient experience.
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Affiliation(s)
- Fleur A Le Marne
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan J Towns
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Gaskin
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Faculty of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Ho
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Baker
- Consultation-Liaison Psychiatry, Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Anne M Bye
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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20
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Yassaee A, Hale D, Armitage A, Viner R. The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews. J Adolesc Health 2019; 64:709-720. [PMID: 30833120 DOI: 10.1016/j.jadohealth.2018.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes? METHODS We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded. RESULTS Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer. CONCLUSION We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.
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Affiliation(s)
- Arrash Yassaee
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom.
| | - Daniel Hale
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Alice Armitage
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Russell Viner
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
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21
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Exploring the needs and challenges of parents and their children in childhood epilepsy care: A qualitative study. Epilepsy Behav 2018; 88:268-276. [PMID: 30321756 DOI: 10.1016/j.yebeh.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/15/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
Because of the nature of epilepsy, and the unpredictability of seizure recurrence, epilepsy requires long-term treatment with medications. As a consequence, epilepsy has a negative pervasive impact in children with epilepsy (CWE), and their parents. Hence, our aim was to explore the needs and challenges of parents and their CWE. In-depth interviews (IDIs) were conducted with 15 families (12 mothers and 3 fathers) and 15 CWE (aged 8-18 years). Data were transcribed verbatim and thematically analyzed using the descriptive phenomenology approach. The experiences of parents and their CWE could be divided into two time frames: "experiences during a child's first seizure" and "experiences whilst growing up with epilepsy". Parents' main concerns and worries were regarding their child's physical health, psychological and emotional wellbeing, academic achievement, and future. The children's main concerns were restrictions imposed, their interpersonal relationship with peers, and being independent in the future. Parents reported that they needed epilepsy-related information, continuity of care, and a parental support group, while CWE reported that their main needs were independence and autonomy. The views of parents and their child with epilepsy were similar in physical functioning and academic achievement. However, parents and children had different views on how epilepsy impacted on the child emotionally, as well as behavioral and interpersonal relationship with peers.
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22
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Nagan M, Caffarelli M, Donatelli S, Rosman NP. Epilepsy or a Seizure Disorder? Parental Knowledge and Misconceptions About Terminology. J Pediatr 2017; 191:197-203.e5. [PMID: 29173305 DOI: 10.1016/j.jpeds.2017.08.068] [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: 04/12/2017] [Revised: 07/03/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess primary caregiver understanding of the term epilepsy. STUDY DESIGN A cross-sectional telephone survey evaluated understanding of the term epilepsy among primary caregivers of children diagnosed with epilepsy at an urban referral center during a 24-month period. Three measures of primary caregiver understanding were used: (1) identifying if their child had a seizure disorder, epilepsy, or both; (2) providing an open-ended definition of epilepsy; and (3) selecting from a multiple-choice definition of epilepsy. Caregivers with 3 correct answers were assigned the greatest knowledge score. Associations with possible predictor variables were analyzed. RESULTS Caregivers for 75 of 116 eligible patients were contacted successfully. Of those, 55 of 75 met eligibility criteria; 45 of the eligible caregivers completed the survey. Twenty-six of 45 caregivers (58%) identified that their child had both a seizure disorder and epilepsy, 5 of 45 (11%) provided a correct open-ended definition of epilepsy, and 16 of 45 (36%) selected the correct multiple-choice definition. Fifteen caregivers (33%) had no correct answers. Seventeen (38%) answered 1, 9 (20%) answered 2, and 4 (9%) answered all 3 measures correctly. Caregivers with greater self-rated understanding had greater epilepsy knowledge scores (P = .008). Having a child neurologist as the first person to discuss the diagnosis with the caregiver also predicted a greater epilepsy knowledge score (P = .04). CONCLUSIONS Most primary caregivers of children with epilepsy have a poor understanding of the term epilepsy. Changes are needed in how we educate caregivers about the meaning of this term.
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Affiliation(s)
- Margot Nagan
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Children's Hospital of Colorado, Aurora, CO; Department of Pediatrics and Neurology, Division of Pediatric Neurology, University of Colorado Denver, Denver, CO
| | - Mauro Caffarelli
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Benioff Children's Hospital, San Francisco, CA; Department of Pediatrics and Neurology, Division of Pediatric Neurology, University of California San Francisco School of Medicine, San Francisco, CA
| | - Stephanie Donatelli
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Children's Hospital, Boston, MA; Department of Pediatrics and Neurology, Division of Pediatric Neurology, Harvard Medical School, Boston, MA; Department of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Medical Center, Boston, MA; Department of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston, MA
| | - N Paul Rosman
- Department of Pediatrics and Neurology, Division of Pediatric Neurology, Boston Medical Center, Boston, MA; Department of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston, MA.
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Hafeez B, Miller S, Patel AD, Grinspan ZM. Care coordination at a pediatric accountable care organization (ACO): A qualitative analysis. Epilepsy Behav 2017. [PMID: 28641166 DOI: 10.1016/j.yebeh.2017.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Care coordinators may help manage care for children with chronic illness. Their role in pediatric epilepsy care is understudied. We aimed to qualitatively describe the content of a care coordination intervention for children with epilepsy. METHODS We conducted nine semi-structured interviews and one focus group with care coordinators at a pediatric accountable care organization (ACO) in Ohio. The care coordinators used a modified version of a published care coordination checklist for children with epilepsy (Patel AD, 2014). We analyzed transcripts using thematic analysis. We focused on (1) the content of the intervention; and (2) perceptions of facilitators and barriers to improve outcomes, with an emphasis on epilepsy specific facilitators and barriers. RESULTS Care coordinators interacted with children and families in multiple contexts (phone calls, physician visits, home visits), and included relationship building (developing rapport and trust between families and the health system), communication (transmission of information between the child, family, physician, and other care providers), and service (help with housing, transportation, scheduling, liaison with community resources, etc.). Facilitators and barriers of care coordination included factors related to parents, physicians, health system, payers, and community. Epilepsy-specific barriers included stigma (felt & enacted) and the anxiety associated with clinical uncertainty. Epilepsy related facilitators included a seizure action plan, written educational materials, and an epilepsy specific care coordination checklist. CONCLUSION In addition to facilitators and barriers common to many care coordination programs, pediatric epilepsy care coordinators should be particularly aware of epilepsy stigma and clinical uncertainty. A care coordination checklist and epilepsy focused educational materials written to accommodate people with low health literacy may provide additional benefit. Further research is required to understand the effect of care coordination on costs, use of health services, seizure control, and quality of life for children with epilepsy.
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Affiliation(s)
- Baria Hafeez
- Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, United States
| | | | - Anup D Patel
- Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, United States; Clinical Pediatrics and Neurology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Zachary M Grinspan
- Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, United States; Pediatrics, NewYork-Presbyterian Hospital, New York, NY, United States.
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Joo B, Lee YM, Kim HD, Eom S. An Analysis of a Novel, Short-Term Therapeutic Psychoeducational Program for Children and Adolescents with Chronic Neurological Illness and Their Parents; Feasibility and Efficacy. Front Neurosci 2017; 11:311. [PMID: 28620276 PMCID: PMC5450004 DOI: 10.3389/fnins.2017.00311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/17/2017] [Indexed: 11/13/2022] Open
Abstract
The purpose of this intervention was to develop a therapeutic psycho-educational program that improves quality of life in children and adolescents who are experiencing chronic neurological illness, including epilepsy, and their parents, and to analyze the intervention's feasibility and efficacy and participants' satisfaction. Participants were eight children (n = 8) and adolescents and their parents; participating children were experiencing chronic neurological illness with psychological comorbidity; children with intellectual impairment were excluded (IQ < 80). The program was carried out weekly for four sessions. In each of the 4 weeks, children's session content addressed self, emotion, coping skills, and finishing up, respectively; and parents' session content targeted family dynamic and emotional intervention, coping skills, childcare and education, and finishing up, respectively. Clinical psychologists administered psychological assessments (viz., Child Behavior Checklist, Pediatric Quality of Life Inventory, Parenting Stress Index, Beck Depression Inventory, Children's Depression Inventory, and Revised Children's Manifest Anxiety Scale) at pre- and post-intervention, and administered satisfaction surveys following the intervention. Participants' opinions about the program's necessity, contents, and process, and participants' overall program satisfaction were analyzed. Parents and children reported high levels of satisfaction with the program. Externalizing behavioral problems, anxiety/depression, and emotional functioning from quality of life showed improvement after the intervention. Although not statistically significant, total child stress trended downward from pre- to post-intervention. A four-session structured therapeutic psycho-educational program for children and adolescents with chronic neurological illness and their parents was successfully implemented, showing good compliance and high satisfaction and efficacy.
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Affiliation(s)
- Bonglim Joo
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of MedicineSeoul, South Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of MedicineSeoul, South Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Severance Children's Hospital, Yonsei University College of MedicineSeoul, South Korea
| | - Soyong Eom
- Epilepsy Research Institute, Yonsei University College of MedicineSeoul, South Korea
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Kampra M, Tzerakis N, Lund Holm Thomsen L, Katsarou E, Voudris K, D Mastroyianni S, Mouskou S, Drossou KS, Siatouni A, Gatzonis S. The challenges that parents of children with epilepsy face: A qualitative study. Epilepsy Behav 2017; 71:94-103. [PMID: 28564623 DOI: 10.1016/j.yebeh.2017.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This qualitative study explored the challenges that Greek parents/caregivers of children with controlled epilepsy (CwE) face regarding the disorder. METHODS Interviews were conducted based on open-ended questions guided by a review of the literature. A total of 91 parents/caregivers were recruited by neurologists at the neurology clinics of two Athens public hospitals. A hermeneutic phenomenological approach was used to explore parent/caregiver experiences. The data were grouped and analyzed through a textual interpretation. RESULTS Two key challenges were identified for parents of CwE: the disclosure of epilepsy and the absence of adequate information about coping with epilepsy. Parents in Greece were hesitant to reveal their child's epilepsy to school staff and their wider social milieu. Also, although satisfied with the patient-centered approach they experienced with their hospital doctor, parents/caregivers found that they needed more education about the existing sources of psychosocial and emotional support to cope with their child's epilepsy personally and as a family. Finally, the parents/caregivers who let their child know about the epilepsy and discussed the implications with the child found that parent-child communication improved. CONCLUSION This study provides valuable insight into the impact of epilepsy on parents of CwE, which might help hospital and school staff support families with greater understanding, sensitivity, and skill. The findings suggest that Greek authorities should staff hospitals and schools with experts and more systematically advertise sources of information about epilepsy and ways to cope with it.
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Affiliation(s)
- Matina Kampra
- Ministry of Health, 40-42C Amarisias Artemidos st., PC 151 24 Marousi, Greece.
| | - Nikolaos Tzerakis
- Department of Neurosurgery, University Hospital of North Midlands NHS Trust, United Kingdom.
| | - Louise Lund Holm Thomsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 1., room 3-208|, 9220 Aalborg Øst, Denmark.
| | - Efstathia Katsarou
- Neurology Department, "P&A Kyriakou" Children's Hospital, Athens, Greece.
| | | | - Sotiria D Mastroyianni
- Department of Neurology, Children's Hospital of Athens "P. and A. Kyriakou", Thivon and Levadias str, Athens P.C. 115 27, Greece.
| | - Stella Mouskou
- Children's Hospital "P&A Kyriakou", Athens 115 27, Greece.
| | - Kyriaki S Drossou
- Human Resource Management, Newcastle College, Department of Health & Enterprise, United Kingdom.
| | - Anna Siatouni
- A' Department of Neurosurgery, "Evangelismos" Hospital, National and Kapodistrian University, Greece.
| | - Stylianos Gatzonis
- A' Department of Neurosurgery, "Evangelismos" Hospital, National and Kapodistrian University, Greece.
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Kolahi AA, Abbasi-Kangevari M, Bakhshaei P, Mahvelati-Shamsabadi F, Tonekaboni SH, Farsar AR. Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital. Epilepsy Behav 2017; 69:147-152. [PMID: 28285235 DOI: 10.1016/j.yebeh.2016.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/23/2016] [Accepted: 10/16/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs. METHODS In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview. RESULTS Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions. CONCLUSION Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs.
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Affiliation(s)
- Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohsen Abbasi-Kangevari
- Social Determinants of Health Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouya Bakhshaei
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed-Hassan Tonekaboni
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad-Reza Farsar
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Piškur B, Beurskens AJHM, Ketelaar M, Jongmans MJ, Casparie BM, Smeets RJEM. Daily actions, challenges, and needs among Dutch parents while supporting the participation of their child with a physical disability at home, at school, and in the community: a qualitative diary study. BMC Pediatr 2017; 17:12. [PMID: 28077123 PMCID: PMC5225511 DOI: 10.1186/s12887-016-0768-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents have a vital influence on the participation of their child with a physical disability. The aim of this study is to gain insight into parents' own daily actions, challenges, and needs while supporting their child with a physical disability at home, at school, and in the community. An additional objective of this study is to refine the preliminary thematic framework previously identified in a scoping review. METHODS A qualitative research inquiry was performed based on using a diary over a 7-day period to gather data. To systematically organise data into a structured format, content analysis has been applied using both inductive and deductive reasoning guided by the existing preliminary thematic framework. RESULTS Analysis of the eligible diaries shows that the actions mentioned by the 47 parents describe several efforts to enhance participation of their children with a physical disability by using, enabling, or changing the social and physical environment, or by supporting their child to perform or engage in meaningful activities. Those parents' actions are primarily a result of challenges caused by restrictions in social and physical environments. Parental responses highlighted, above all, the need for environments designed for all people. Based on the findings a redefined thematic framework is presented. CONCLUSIONS Parents' actions, challenges, and needs are mainly directed towards the social or/and physical environment. The presented thematic framework can offer practitioners knowledge to support parents. More work is necessary to provide tailored approaches. Paediatric rehabilitation may need to address the importance of the environment on the participation of a child with a physical disability.
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Affiliation(s)
- Barbara Piškur
- Research Centre Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Science, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands. .,Department of Occupational Therapy, Faculty of Health, Zuyd University of Applied Science, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands. .,Department of Rehabilitation Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Department of Neonatology, Wilhemina Children's Hospital, University Medical Centre Utrecht, AB 3508, Utrecht, The Netherlands.
| | - Anna J H M Beurskens
- Research Centre Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Science, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands.,Department of General Practice, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Marjolijn Ketelaar
- Brain Centre Rudolf Magnus and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.,Partner of NetChild, University Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands
| | - Marian J Jongmans
- Partner of NetChild, University Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands.,Department of Child, Family and Education Studies, Faculty of Social and Behavioral Sciences, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.,Department of Neonatology, Wilhemina Children's Hospital, University Medical Centre Utrecht, AB 3508, Utrecht, The Netherlands
| | - Barbara M Casparie
- Research Centre Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Science, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands.,BOSK, The Dutch Association of People with Disabilities and Their Parents, 3502 GJ, Utrecht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation, Zandbergsweg 111, 6432 CC, Hoensbroek, The Netherlands
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28
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Huntley AL, King AJ, Moore TH, Paterson C, Persad R, Sharp D, Evans M. Methodological exemplar of integrating quantitative and qualitative evidence - supportive care for men with prostate cancer: what are the most important components? J Adv Nurs 2016; 73:5-20. [DOI: 10.1111/jan.13082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Alyson L. Huntley
- Centre for Academic Primary Care; School of Social and Community Medicine; University of Bristol; UK
| | - Anna J.L. King
- Centre for Academic Primary Care; School of Social and Community Medicine; University of Bristol; UK
| | - Theresa H.M. Moore
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust; UK
- School of Social and Community Medicine; University of Bristol; UK
| | - Charlotte Paterson
- Centre for Academic Primary Care; School of Social and Community Medicine; University of Bristol; UK
| | - Raj Persad
- Bristol Urological Institute Southmead Hospital; Bristol UK
| | - Debbie Sharp
- Centre for Academic Primary Care; School of Social and Community Medicine; University of Bristol; UK
| | - Maggie Evans
- Centre for Academic Primary Care; School of Social and Community Medicine; University of Bristol; UK
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Chernyak N, Stephan A, Bächle C, Genz J, Jülich F, Icks A. Assessment of information needs in diabetes: Development and evaluation of a questionnaire. Prim Care Diabetes 2016; 10:287-292. [PMID: 26777538 DOI: 10.1016/j.pcd.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
AIM To develop a questionnaire suitable for assessing the information needs of individuals with diabetes mellitus types 1 and 2 in diverse healthcare settings (e.g. primary care or long-term care) and at different time points during the course of the disease. METHODS The initial questionnaire was developed on the basis of literature search and analysis, reviewed by clinical experts, and evaluated in two focus groups. The revised version was pilot-tested on 39 individuals with diabetes type 2, type 1 and gestational diabetes. RESULTS The final questionnaire reveals the most important information needs in diabetes. A choice task, a rating task and open-ended questions are combined. First, participants have to choose three topics that interest them out of a list with 12 general topics and specify in their own words their particular information needs for the chosen topics. They are then asked how informed they feel with regard to all topics (4-point Likert-scale), and whether information is currently desired (yes/no). The questionnaire ends with an open-ended question asking for additional topics of interest. CONCLUSIONS Careful selection of topics and inclusion of open-ended questions seem to be essential prerequisites for the unbiased assessment of information needs. The questionnaire can be applied in surveys in order to examine patterns of information needs across various groups and changes during the course of the disease. Such knowledge would contribute to more patient-guided information, counselling and support.
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MESH Headings
- Choice Behavior
- Comprehension
- Consumer Health Information
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/therapy
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/physiopathology
- Diabetes, Gestational/therapy
- Female
- Focus Groups
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Male
- Needs Assessment
- Patient Education as Topic
- Pilot Projects
- Pregnancy
- Qualitative Research
- Review Literature as Topic
- Surveys and Questionnaires
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Affiliation(s)
- N Chernyak
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - A Stephan
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - C Bächle
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - J Genz
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - F Jülich
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - A Icks
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany.
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Geerlings RPJ, Aldenkamp AP, Gottmer-Welschen LMC, de With PHN, Zinger S, van Staa AL, de Louw AJA. Evaluation of a multidisciplinary epilepsy transition clinic for adolescents. Eur J Paediatr Neurol 2016; 20:385-92. [PMID: 26818400 DOI: 10.1016/j.ejpn.2016.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The main goal of the transition clinic is to explore and optimize medical issues during transition from adolescence to adulthood, and to ease the transition into adult care. However, only limited data on the process and outcomes of transitional care in clinical practice are available. OBJECTIVE To describe the process and outcomes of an Epilepsy Transition Clinic in a tertiary referral center in The Netherlands. METHODS Data were collected from patients with epilepsy (aged 15-25 years), who visited the transition clinic between March 2012 and September 2014. RESULTS The Epilepsy Transition Clinic is staffed with a multidisciplinary team including a neurologist/epileptologist, clinical neuropsychologist, a social worker and an educationalist/occupational counselor, all with knowledge of paediatric and adult medical and developmental issues. In total, 117 patients with epilepsy were included in the analysis. After consultation, 89 patients received a diagnostic work-up (76.1%), change in AED prescription (n = 64, 54.7%), or consultation/tailored advice (n = 73, 62.4%). In fourteen patients (12.0%) the epilepsy diagnosis was changed. Nineteen patients (16.2%) had complete epilepsy remission for over one year. Forty-three patients (36.8%) were referred to adult care. CONCLUSION This study describes a multidisciplinary epilepsy transition clinic staffed by a neurologist/epileptologist, neuropsychologist, a social worker and an educationalist/occupational counselor. Diagnostic work-up and evaluation of psychosocial and educational/vocational status during adolescence are strongly recommended.
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Affiliation(s)
| | - A P Aldenkamp
- Epilepsy Center Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands; Department of Neurology, Maastricht University Hospital, The Netherlands; Department of Neurology, Ghent University Hospital, Belgium.
| | | | - P H N de With
- Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.
| | - S Zinger
- Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.
| | - A L van Staa
- Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Research Centre Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands.
| | - A J A de Louw
- Epilepsy Center Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands.
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Kirkpatrick M, Dunkley C. Guidelines and Quality Standards in the Care of Children with Epilepsy. Neurol Clin 2016; 34:327-37, vii. [PMID: 27086981 DOI: 10.1016/j.ncl.2015.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To provide quality care for children with epilepsy there is a continuing need to synthesize clinical research into forms that reflect best clinical practice. The design of evidence-based guidelines allows the gathering of this information together. This review discusses the components needed to analyze published data and produce recommendations for clinical management. Guideline implementation should be seen as an essential component that is integrated into guideline development. Robust clinical practice guidelines can also form the basis of defining quality standards that in turn should allow the development and measurement of clinical outcomes that lead to direct improvements in patient care.
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Affiliation(s)
| | - Colin Dunkley
- Department of Paediatrics, Sherwood Forest Hospitals, King's Mill Hospital, Sutton in Ashfield, Nottinghamshire NG17 4JL, UK
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Corrigan FM, Broome H, Dorris L. A systematic review of psychosocial interventions for children and young people with epilepsy. Epilepsy Behav 2016; 56:99-112. [PMID: 26859319 DOI: 10.1016/j.yebeh.2016.01.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/02/2016] [Accepted: 01/04/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite recognition that psychosocial interventions can improve quality of life and mental health, there continues to be a lack of clarity and guidance around effective psychosocial interventions for children and young people with epilepsy. This review utilizes specific quality criteria to systematically identify and appraise the evidence for the effectiveness of psychosocial interventions for children and young people with epilepsy. METHODS A systematic search of six electronic databases was conducted using predefined eligibility criteria. The reference lists of previous review papers were also manually searched. Seventeen studies met the inclusion and exclusion criteria. A quality appraisal checklist, the 'Crowe Critical Appraisal Tool' (CCAT) (Crowe, 2013) [1] was applied to the included articles, and effect sizes were calculated when not provided in the papers. RESULTS Methodological quality of the majority of studies included was moderate, with only three studies rated as high quality. Meta-analysis was not conducted as the studies used heterogeneous methodologies and lacked consistency in outcome measures. Limited evidence was found for interventions improving epilepsy knowledge, quality of life, and psychological outcomes. CONCLUSIONS Psychosocial interventions may provide clinical benefit although further research is needed to clarify the most effective treatment components, delivery methods, and measurement of intervention outcomes. The existing evidence base for children and young people is limited by methodological issues such as the use of small samples, inadequate power, and a lack of controlled studies.
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Affiliation(s)
- Fiona M Corrigan
- Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow G12 OXH, Scotland, UK
| | - Helen Broome
- Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow G12 OXH, Scotland, UK; Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow G51 4TF, Scotland, UK
| | - Liam Dorris
- Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow G12 OXH, Scotland, UK; Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow G51 4TF, Scotland, UK.
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Tricco AC, Soobiah C, Antony J, Cogo E, MacDonald H, Lillie E, Tran J, D'Souza J, Hui W, Perrier L, Welch V, Horsley T, Straus SE, Kastner M. A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. J Clin Epidemiol 2016; 73:19-28. [PMID: 26891949 DOI: 10.1016/j.jclinepi.2015.08.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/05/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To systematically identify, define, and classify emerging knowledge synthesis methods through a scoping review. STUDY DESIGN AND SETTING MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Methodology Register, the Cochrane Database of Systematic Reviews, Social Sciences Abstracts, Library and Information Science Abstracts, Philosopher's Index, and Education Resources Information Center were searched to identify articles reporting emerging knowledge synthesis methods across the disciplines of health, education, sociology, and philosophy. Two reviewers independently selected studies and abstracted data for each article. RESULTS In total, 409 articles reporting on 25 knowledge synthesis methods were included after screening of 17,962 titles and abstracts and 1,010 potentially relevant full-text articles. Most of the included articles were an application of the method (83.9%); only 3.7% were seminal articles that fully described the method (i.e., operationalized the steps). Most of the included articles were published after 2005. The methods were most commonly used across the fields of nursing, health care science and services, and health policy. CONCLUSION We found a lack of guidance on how to select a knowledge synthesis method. We propose convening an international group of leaders in the knowledge synthesis field to help clarify emerging approaches to knowledge synthesis.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Elise Cogo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Judy Tran
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Jennifer D'Souza
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Wing Hui
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Vivian Welch
- Bruyère Research Institute, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K1S 5N8, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
| | - Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario M5B 1W8, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada
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Frantzen KK, Fetters MD. Meta-integration for synthesizing data in a systematic mixed studies review: insights from research on autism spectrum disorder. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11135-015-0261-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Transition to adult medical care for adolescents with epilepsy. Epilepsy Behav 2015; 44:127-35. [PMID: 25679495 DOI: 10.1016/j.yebeh.2014.12.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/05/2014] [Accepted: 12/30/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION During transition to adult medical care, the adolescent with epilepsy is especially prone to emotional, mental, physical, and social developmental difficulties, leading to stigma and poor psychosocial and socioeconomic outcome in the long term. OBJECTIVES The aim of this review is twofold: to describe the psychosocial and medical transition from adolescence to adulthood and to evaluate the most effective model for transitional services in adolescents with epilepsy. METHODS We searched PubMed for quantitative and qualitative data about transition from adolescence to adulthood in patients with epilepsy. RESULTS A total of 49 articles were retrieved. We reviewed personal, psychosocial, and medical issues during transition and their long-term individual and societal consequences. Identifying risk factors for poor transition can lead to appropriate interventions for patients and their family. Although the concept of multidisciplinary transition care for adolescents with epilepsy is widely recognized, only a few transition clinics have been established. There is lack of evidence for their quality and cost-effectiveness. CONCLUSION In addition to medical problems, more attention should be paid to the risk of psychosocial problems during transition from pediatric to adult care. The implementation of transition care for adolescents with epilepsy is considered beneficial; however, its effectiveness should be further investigated.
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A Qualitative Study of Communication between Young Women with Disorders of Sex Development and Health Professionals. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/653624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Objectives. Health communication is a critical aspect of care for both providers and recipients having a direct influence on engagement and outcomes. Communicating which in this context includes talking and listening in order to share information or support young women to understand their DSD can be difficult especially since the topic area is sensitive. Methods. In this qualitative study thirteen young women (aged 14–19 years) with a disorder of sex development who engaged with health care professionals were purposively recruited between 2011 and 2012 from three specialist centres across the United Kingdom. The young women either were interviewed or completed a diary about their experiences of communication with a range of health care professionals. An interpretative phenomenological approach was used to analyse these data. Results. By analysis of data the young women were able to clearly articulate the qualities and skills health professional needed in relation to communication. Two main categories focused on the duty in which professionals have to share information and their role in supporting young women to manage this information. Discussion and Conclusion. The study results revealed that these young women with a DSD expected to meet skilled professionals who could recognise the emotional aspects of dialogues in the short and longer term.
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Parental knowledge, attitudes, and behaviors towards children with epilepsy in Belgrade (Serbia). Epilepsy Behav 2014; 41:210-6. [PMID: 25461218 DOI: 10.1016/j.yebeh.2014.09.062] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of our study was to assess knowledge, attitudes, and behaviors of parents whose children were diagnosed with epilepsy. METHODS This cross-sectional study included 213 consecutive parents who accompanied their children, diagnosed with epilepsy, at regular checkups in the outpatient department of the Child and Adolescent Neurology and Psychiatry Clinic in Belgrade. Data were obtained through a questionnaire before completion of the child's neurological checkup, while clinical parameters of children with epilepsy were taken from medical records. RESULTS Almost all respondents knew that epilepsy is not an infectious disease (99.5%), while the least proportion of parents (31.9%) knew that epilepsy is not, for the most part, hereditary. Parents felt that their family and friends should know that their child is suffering from epilepsy (average score: 4.3 out of 5). Also, parents felt the most confident in taking care of their child during seizures (4.7 out of 5), while they felt the least confident in letting their child go on school trips for several days (3.4 out of 5). Parental longer schooling (i.e., higher education level) was an independent predictor of higher epilepsy knowledge. Taking less number of medications was an independent predictor of more supportive parental behavior towards children with epilepsy. CONCLUSION Some epilepsy-related issues still require improvement in parental knowledge. Ensuring education and support at community and school levels for both parents and children with epilepsy should be the principal goal of health-care service.
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Agarwal R, Patel R, Set K, Zidan M, Sivaswamy L. Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years (SAFETY): understanding the adolescents' perspective about their disease. Epilepsy Behav 2014; 41:114-8. [PMID: 25461200 DOI: 10.1016/j.yebeh.2014.09.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/11/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the understanding of adolescent patients regarding epilepsy. METHODS The SAFETY (Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years) questionnaire (content validity index: 0.96, Flesch readability score: 66.6) was administered to 165 cognitively normal adolescents with epilepsy (85 females, mean age: 15.2 ± 1.6 years, range: 13-18 years). The first part of the questionnaire was devised to evaluate knowledge about epilepsy and antiepileptic medications (SAFETY-K: 7 questions). The second part queried lifestyle modifications and safety (SAFETY-S: 10 questions). Female participants answered 5 additional questions related to reproductive health (RH questionnaire). RESULTS The correct response rate for the composite SAFETY questionnaire was 51.5%. The average rates of correct responses for the SAFETY-K and SAFETY-S questions were 47.9% and 53.9%, respectively. On univariate logistic regression analysis, factors which were significant predictors of correct responses included age (odds ratio: 1.8, C.I. = 1.3-2.4), race (Caucasian vs. African-American; odds ratio: 3.9, C.I. = 1.4-10.4), and employment of at least one parent in a professional occupation (odds ratio: 3.3, C.I. = 1.1-10.3). The correct response rate did not correlate with the duration of epilepsy, extent of seizure control, number of antiepileptic medications, parental educational, or (un)employment status. The mean rate of correct responses for the RH questions amongst teenage girls was 17.4%. CONCLUSIONS There is lack of awareness about epilepsy and its associated lifestyle modifications in adolescents with epilepsy seen at our institution. This is especially true in young adolescents, African-American patients, and those whose parents are not employed in professional occupations. Teenage girls with epilepsy appear to have limited knowledge with respect to contraception and childbearing.
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Affiliation(s)
- Rajkumar Agarwal
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Riddhiben Patel
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Kallol Set
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Marwan Zidan
- Department of Biostatistics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Lalitha Sivaswamy
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
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Lewis SA, Noyes J, Hastings RP. Systematic review of epilepsy self-management interventions integrated with a synthesis of children and young people's views and experiences. J Adv Nurs 2014; 71:478-97. [PMID: 25131643 DOI: 10.1111/jan.12511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 01/07/2023]
Abstract
AIM To determine the effectiveness of epilepsy self-management interventions and explore the views and experiences of medication and seizures by children and young people. BACKGROUND Experiencing seizures and side-effects from anti-epileptic medicines have negative impacts on children and young people managing their epilepsy. Children commonly experiment with not taking epilepsy medication as prescribed and engage in unhealthy lifestyles. DESIGN/REVIEW METHODS: Mixed-method systematic review with theory development. Cochrane quantitative methods and thematic synthesis of qualitative and survey evidence. DATA SOURCES Eight databases were searched from earliest dates to July 2013. RESULTS Nineteen studies were included. Meta-analysis was not possible. Zero of nine intervention studies showed improvement in anti-epilepsy medication adherence. Skill-based behavioural techniques with activities such as role play and goal setting with young people increased epilepsy knowledge and seizure self-management (small effects). Intervention studies were methodologically weak and no studies reported if improvement in self-management was sustained over time. Synthesis of nine qualitative and one mixed-method studies generated six themes encapsulating anti-epilepsy medication and epilepsy effects. There was a lack of fidelity between intervention programme theories and what children and young people found difficult with medication self-management and managing the effects of epilepsy. CONCLUSION Children and young people knowingly and/or unknowingly take risks with their epilepsy and give reasoned explanations for doing so. There are no effective interventions to change epilepsy medication adherence behaviours. There is an urgent need for more innovative and individually tailored interventions to address specific challenges to epilepsy self-management as identified by children and young people themselves.
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Affiliation(s)
- Sheila A Lewis
- Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, UK; The Walton Centre NHS Foundation Trust, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, North Wales, UK
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Valdez-Martinez E, Noyes J, Bedolla M. When to stop? Decision-making when children's cancer treatment is no longer curative: a mixed-method systematic review. BMC Pediatr 2014; 14:124. [PMID: 24884514 PMCID: PMC4028290 DOI: 10.1186/1471-2431-14-124] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with cancer, parents, and clinicians, face difficult decisions when cure is no longer possible. Little is known about decision-making processes, how agreement is reached, or perspectives of different actors. Professionals voice concerns about managing parental expectations and beliefs, which can be contrary to their own and may change over time. We conducted the first systematic review to determine what constitutes best medico-legal practice for children under 19 years as context to exploring the perspectives of actors who make judgements and decisions when cancer treatment is no longer curative. METHODS Theory-informed mixed-method thematic systematic review with theory development. RESULTS Eight legal/ethical guidelines and 18 studies were included. Whilst there were no unresolved dilemmas, actors had different perspectives and motives. In line with guidelines, the best interests of the individual child informed decisions, although how different actors conceptualized 'best interests' when treatment was no longer curative varied. Respect for autonomy was understood as following child/parent preferences, which varied from case to case. Doctors generally shared information so that parents alone could make an informed decision. When parents received reliable information, and personalized interest in their child, they were more likely to achieve shared trust and clearer transition to palliation. Although under-represented in research studies, young people's perspectives showed some differences to those of parents and professionals. For example, young people preferred to be informed even when prognosis was poor, and they had an altruistic desire to help others by participating in research. CONCLUSION There needs to be fresh impetus to more effectively and universally implement the ethics of professionalism into daily clinical practice in order to reinforce humanitarian attitudes. Ethical guidelines and regulations attempt to bring professionals together by articulating shared values. While important, ethics training must be supported by institutions/organizations to assist doctors to maintain good professional standards. Findings will hopefully stimulate further normative and descriptive lines of research in this complex under-researched field. Future research needs to be undertaken through a more deliberative cultural lens that includes children's and multi-disciplinary team members' perspectives to more fully characterize and understand the dynamics of the decision-making process in this specific end-of life context.
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Affiliation(s)
- Edith Valdez-Martinez
- Health Research Council of the Mexican Institute of Social Security, Centro Medico Nacional Siglo XXI. Av. Cuauhtemoc # 330. Col. Doctores. C.P, Mexico 06720 D,F, Mexico
| | - Jane Noyes
- School of Healthcare Sciences, Bangor University, Bangor LL57 2EF, UK
| | - Miguel Bedolla
- Policy Studies Centre of the University, San Antonio TX, USA
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Thomson L, Fayed N, Sedarous F, Ronen GM. Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review. Dev Med Child Neurol 2014; 56:421-33. [PMID: 24237329 DOI: 10.1111/dmcn.12335] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy. METHOD We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks. RESULTS Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness. INTERPRETATION The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.
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Affiliation(s)
- Lauren Thomson
- Undergraduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Pluye P, Hong QN. Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health 2013; 35:29-45. [PMID: 24188053 DOI: 10.1146/annurev-publhealth-032013-182440] [Citation(s) in RCA: 681] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides an overview of mixed methods research and mixed studies reviews. These two approaches are used to combine the strengths of quantitative and qualitative methods and to compensate for their respective limitations. This article is structured in three main parts. First, the epistemological background for mixed methods will be presented. Afterward, we present the main types of mixed methods research designs and techniques as well as guidance for planning, conducting, and appraising mixed methods research. In the last part, we describe the main types of mixed studies reviews and provide a tool kit and examples. Future research needs to offer guidance for assessing mixed methods research and reporting mixed studies reviews, among other challenges.
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Affiliation(s)
- Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, H3S 1Z1, Canada; ,
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Lewis SA, Noyes J. Effective process or dangerous precipice: qualitative comparative embedded case study with young people with epilepsy and their parents during transition from children's to adult services. BMC Pediatr 2013; 13:169. [PMID: 24131769 PMCID: PMC4016204 DOI: 10.1186/1471-2431-13-169] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/26/2013] [Indexed: 11/15/2022] Open
Abstract
Background Transition from children’s to adult epilepsy services is known to be challenging. Some young people partially or completely disengage from contact with services, thereby risking their health and wellbeing. We conducted a mixed-method systematic review that showed current epilepsy transition models enabling information exchange and developing self-care skills were not working well. We used synthesised evidence to develop a theoretical framework to inform this qualitative study. The aim was to address a critical research gap by exploring communication, information needs, and experiences of knowledge exchange in clinical settings by young people and their parents, during transition from children’s to adult epilepsy services. Method Qualitative comparative embedded Case study with 2 'transition’ cases (epilepsy services) in two hospitals. Fifty-eight participants: 30 young people (13–19 years) and 28 parents were interviewed in-depth (individual or focus group). Clinical documents/guidelines were collated. 'Framework’ thematic analysis was used. The theoretical framework was tested using themes, pattern matching and replication logic. Theory-based evaluation methods were used to understand how and why different models of service delivery worked. Results A joint epilepsy clinic for young people 14–17 years coordinated by children’s and adult services was more likely to influence young people’s behaviour by facilitating more positive engagement with adult healthcare professionals and retention of epilepsy-related self-care information. Critical success factors were continuity of care, on-going and consistent age-appropriate and person centred communication and repeated information exchange. Three young people who experienced a single handover clinic disengaged from services. Psychosocial care was generally inadequate and healthcare professionals lacked awareness of memory impairment. Parents lacked knowledge, skills and support to enable their child to independently self-care. Translation of transition policies/guidelines into practice was weak. Conclusion Findings make a significant contribution to understanding why young people disengage from epilepsy services, why some parents prevent independent self-care, and what constitutes good communication and transition from the perspective of young people and parents. The type of service configuration, delivery and organisation influenced the behaviours of young people at transition to adult services. The novel theoretical framework was substantially supported, underwent further post-hoc development and can be used in future practice/intervention development and research.
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Affiliation(s)
- Sheila A Lewis
- Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, Bangor LL57 2EF, UK.
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Mapping the information-coping trajectory of young people with long term illness. JOURNAL OF DOCUMENTATION 2013. [DOI: 10.1108/jd-10-2012-0133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Piškur B, Beurskens AJ, Jongmans MJ, Ketelaar M, Norton M, Frings CA, Hemmingsson H, Smeets RJ. Parents' actions, challenges, and needs while enabling participation of children with a physical disability: a scoping review. BMC Pediatr 2012; 12:177. [PMID: 23137074 PMCID: PMC3538071 DOI: 10.1186/1471-2431-12-177] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 10/25/2012] [Indexed: 11/24/2022] Open
Abstract
Background Pediatric rehabilitation considers Family-centered service (FCS) as a way to increase participation of children with a physical disability in daily life. An important principal is that parents greatly contribute to their child’s participation at school, at home, and in the community. However, it is unclear what kind of information is available from literature about what parents actually do to support their child’s participation and what problems and needs they experience? Hence, the aim of this study was to provide an overview of the actions, challenges, and needs of parents in enabling participation of their child with a physical disability that is neurological and non-progressive in nature. Methods Scoping review with extensive literature search (September 2011) and a thematic analysis to synthesize findings. Results Fourteen relevant articles revealed two major themes: ‘parents enable and support performance of meaningful activities’ and ‘parents enable, change and use the environment’. Each theme holds a number of actions (e.g. choosing the right type of meaningful activities for facilitating social contacts) and challenges (e.g. negative attitudes of other people). Less information is available about the needs of parents. Conclusions This study indicates that parents apply a broad range of strategies to support participation of their children. They experience many challenges, especially as a result of constraints in the social and physical environments. However, this review also shows that little is known about needs of parents in facilitating participation. As Family-centered service (FCS) philosophy is all about the needs of the child and the family, it is essential to further investigate the needs of the parents and to understand if and to what extent they wish to be supported in enabling their child’s participation in daily life.
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Affiliation(s)
- Barbara Piškur
- Faculty and Health Care, Centre of Research Autonomy and Participation for persons with a chronic illness, Zuyd University, Nieuw Eyckholt 300, Heerlen, DJ 6419, the Netherlands.
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Pfäfflin M, Petermann F, Rau J, May TW. The psychoeducational program for children with epilepsy and their parents (FAMOSES): results of a controlled pilot study and a survey of parent satisfaction over a five-year period. Epilepsy Behav 2012; 25:11-6. [PMID: 22980075 DOI: 10.1016/j.yebeh.2012.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/05/2012] [Accepted: 06/11/2012] [Indexed: 11/24/2022]
Abstract
Feasibility of the educational program FAMOSES (modular service package epilepsy for families) was evaluated in a controlled pilot study. Parents of children with epilepsy from epilepsy centers in Germany were allocated to either educational group (treatment group, n=55) or waiting-list group (control group, n=48). Questionnaires included epilepsy-specific scales (knowledge, coping, adaptation, anxiety, rules and limitations, seizure management, impact of epilepsy). Multivariate analysis of variance with repeated measurements indicated significant improvements in the treatment group compared to the control group (time×group interaction: p<0.01). Univariate analyses (ANOVA) confirmed improvements in knowledge (p<0.001), adaptation (p<0.01), epilepsy-related anxiety (p<0.05), and seizure management (p<0.05). Surveillance as well as seizure frequency (p<0.05) of children whose parents participated in the treatment group was reduced (p<0.05). Furthermore, parents' satisfaction with the content and interactive didactic format of the program was assessed in a survey with 852 parents over a five-year period. This survey showed an improvement over the course of time (p<0.05). Feasibility and need for the educational program were confirmed.
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Affiliation(s)
- M Pfäfflin
- Epilepsy Center Bethel, Bielefeld, Germany.
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