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Oakley CI, Banks SA, Pinto MV, Setter DO, Clark SL, Keser Z, Klaas JP, Leep Hunderfund AN, Mustafa R. Improving Dual Antiplatelet Therapy Adherence Via Implementation of a Pocket Card: A Quality Improvement Pilot Program. J Am Heart Assoc 2024; 13:e037444. [PMID: 39344636 DOI: 10.1161/jaha.124.037444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024]
Affiliation(s)
- Carlee I Oakley
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | - Samantha A Banks
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | - Marcus V Pinto
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | - Deborah O Setter
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | - Sarah L Clark
- Department of Pharmacy Mayo Clinic College of Medicine and Science Rochester MN USA
| | - Zafer Keser
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | - James P Klaas
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
| | | | - Rafid Mustafa
- Department of Neurology Mayo Clinic College of Medicine & Science Rochester MN USA
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Roberti R, Riva A, D'Onofrio G, Giacheri E, Amadori E, Vari MS, La Neve A, Vigevano F, Verrotti A, Cordelli DM, Romeo A, Palmieri A, Mancardi MM, Caglieris S, Varone A, Minetti C, Russo E, Buratti S, Striano P. A proposal for a shared therapeutic algorithm in children with prolonged convulsive seizures and status epilepticus. Expert Rev Neurother 2024; 24:133-138. [PMID: 38230547 DOI: 10.1080/14737175.2024.2305813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gianluca D'Onofrio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Emanuele Giacheri
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maria Stella Vari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù, IRCCS Children's Hospital, Full member of European Reference Network EpiCARE, Rome, Italy
| | - Alberto Verrotti
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio"of Chieti-Pescara, Chieti, Italy
| | - Duccio Maria Cordelli
- UOC Neuropsychiatry of the Pediatric Age, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Antonella Palmieri
- Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Margherita Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sergio Caglieris
- Health System of Liguria, Territorial Emergency Liguria, Genoa, Italy
| | - Antonio Varone
- Department of Neuroscience, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carlo Minetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Philpott NG, Dante SA, Philpott D, Perin J, Bhatia P, Henderson E, Costabile P, Stratton M, Dabrowski A, Kossoff EH, Klein BL, Noje C. Treatment Guideline Nonadherence Pretransport Associated With Need for Higher Level of Care in Children Transferred to a Pediatric Tertiary Care Center for Status Epilepticus. Pediatr Emerg Care 2023; 39:780-785. [PMID: 37163683 DOI: 10.1097/pec.0000000000002952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES We sought to investigate the association between adherence to the American Epilepsy Society (AES) 2016 guidelines for management of convulsive status epilepticus (SE) and clinical outcomes among children requiring interhospital transport for SE. We hypothesized that pretransport guideline nonadherence would be associated with needing higher level of care posttransfer. METHODS This was a retrospective cohort study of children aged 30 days to 18 years transferred to our pediatric tertiary center from 2017 to 2019 for management of SE. Their care episodes were classified as 2016 American Epilepsy Society guideline adherent or nonadherent. There were 40 referring hospitals represented in this cohort. RESULTS Of 260 care episodes, 55 (21%) were guideline adherent, 184 (71%) were guideline nonadherent, and 21 (8%) had insufficient data to determine guideline adherence. Compared with the adherent group, patients in the nonadherent care group had longer hospitalizations (32 hours [17-68] vs 21 hours [7-48], P = 0.006), were more likely to require intensive care unit admission (47% vs 31%), and less likely to be discharged home from the emergency department (16% vs 35%; χ 2 test, P = 0.01). Intubation rates did not differ significantly between groups (25% vs 18%, P = 0.37). When we fit a multivariable model to adjust for confounding variables, guideline nonadherence was associated with need for higher level of care (odds ratio, 2.04; 95% confidence interval, 1.04-3.99). Treatment guideline adherence did not improve over the 3-year study period (2017: 22%, 2018: 19%, 2019: 29% [χ 2 test for differences between any 2 years, P = 0.295]). CONCLUSIONS Guideline nonadherence pretransport was associated with longer hospitalizations and need for higher level of care among children transferred for SE at our institution. These findings suggest a need to improve SE guideline adherence through multifaceted quality improvement efforts targeting both the prehospital and community hospital settings.
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Affiliation(s)
- Natalia Garza Philpott
- From the Department of Pediatrics. Johns Hopkins University School of Medicine, Baltimore, MD
| | - Siddhartha A Dante
- Department of Pediatrics, University of Maryland School of Medicine. Baltimore, MD
| | - David Philpott
- From the Department of Pediatrics. Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jamie Perin
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Pooja Bhatia
- Pediatric Transport, Johns Hopkins Children's Center, Baltimore, MD
| | - Eric Henderson
- Pediatric Transport, Johns Hopkins Children's Center, Baltimore, MD
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Kellinghaus C. Making SENSE of what we do - How to bring evidence to clinical practice. Epilepsy Behav 2023; 140:109103. [PMID: 36739635 DOI: 10.1016/j.yebeh.2023.109103] [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: 10/22/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Status epilepticus is a frequent neurological emergency. Several audits and registries have enhanced our knowledge regarding patient demography, etiology, treatment, and outcome. Several large registries have also contributed significantly to current treatment guidelines that emphasize the importance of instant and effective treatment onset. Large registries also document that deviation from these treatment guidelines is not the exception but the rule. Therefore, careful analysis of the treatment pathways as well as balanced intervention efforts are necessary to overcome the gap between knowledge and action. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Christoph Kellinghaus
- Department of Neurology, Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrück, Germany.
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