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Soltany KA, Segovia Molina R, Pappo C, Thomson S, Pring K, Cox S, Merrill R, Fishman E, Ambrosini A, Bognet G, Dodenhoff K, Munger Clary H, Strauss L, Graham R, Guzik AK, Strowd RE. Interest and Satisfaction of Telemedicine Use Among Ambulatory Neurology Patients in Western North Carolina During the COVID-19 Pandemic. Telemed J E Health 2024; 30:e1071-e1080. [PMID: 37883644 DOI: 10.1089/tmj.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Introduction: During the COVID-19 pandemic, care shifted from exclusively telemedicine to hybrid models with in-person, video, and telephone visits. We explored how patient satisfaction and visit preferences have changed by comparing in-person versus virtual visits (telephone and video) in an ambulatory neurology practice across three time points. Methods: Patients who completed a virtual visit in March 2020 (early-pandemic), May 2020 (mid-pandemic), and March 2021 (later-pandemic) were contacted. Patients were assessed for visit satisfaction and desire for future telemedicine. Univariate and multivariable logistic regression analysis was conducted to determine factors independently associated with video visit completion. Results: Four thousand seven hundred seventy-eight the number of ambulatory visits (n = 4,778) were performed (1,004 early; 1,265 mid; and 2,509 later); 1,724 patients (36%) assented to postvisit feedback; mean age 45.8 ± 24.4 years, 58% female, 79% white, and 56% with Medicare/Medicaid insurance. Patient satisfaction significantly increased (73% early, 79% mid, 81% later-pandemic, p = 0.008). Interest in telemedicine also increased for patients completing telephone visits (40% early, 50% mid, 59% later, p = 0.027) and video visits (52% early, 59% mid, 62% later, p = 0.035). Patients satisfied with telemedicine visits were younger (p < 0.001). White patients were more interested in future telemedicine (p = 0.037). Multivariable analysis showed that older patients (for each 1 year older), Black patients, and patients with Medicare/Medicaid were 2%, 45%, and 54% less likely to complete a video visit than telephone, respectively. Discussion: Patients, especially younger ones, have become more satisfied and more interested in hybrid care models during the COVID-19 pandemic. Barriers to conducting video visits persist for older, Black patients with Medicare or Medicaid insurance.
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Affiliation(s)
- K Alexander Soltany
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Reyna Segovia Molina
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carly Pappo
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sharon Thomson
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kelly Pring
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Siobhan Cox
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Merrill
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily Fishman
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexander Ambrosini
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gabby Bognet
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristen Dodenhoff
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lauren Strauss
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachel Graham
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Roy E Strowd
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Decker BM, Clary HM, Holmes MG, Al-Faraj AO, Esmaeili B, Waldman G, Becker DA, Johnson J, Voinescu PE, Gerard EE. Letter regarding "Seizure control in women with epilepsy undergoing assisted reproductive technology". Epilepsia 2024; 65:1141-1144. [PMID: 38098189 DOI: 10.1111/epi.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Barbara M Decker
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Manisha G Holmes
- Department of Neurology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Abrar O Al-Faraj
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Behnaz Esmaeili
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Genna Waldman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle A Becker
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julia Johnson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Paula E Voinescu
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Gerard
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Roeder BM, She X, Dakos AS, Moore B, Wicks RT, Witcher MR, Couture DE, Laxton AW, Clary HM, Popli G, Liu C, Lee B, Heck C, Nune G, Gong H, Shaw S, Marmarelis VZ, Berger TW, Deadwyler SA, Song D, Hampson RE. Developing a hippocampal neural prosthetic to facilitate human memory encoding and recall of stimulus features and categories. Front Comput Neurosci 2024; 18:1263311. [PMID: 38390007 PMCID: PMC10881797 DOI: 10.3389/fncom.2024.1263311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Here, we demonstrate the first successful use of static neural stimulation patterns for specific information content. These static patterns were derived by a model that was applied to a subject's own hippocampal spatiotemporal neural codes for memory. Approach We constructed a new model of processes by which the hippocampus encodes specific memory items via spatiotemporal firing of neural ensembles that underlie the successful encoding of targeted content into short-term memory. A memory decoding model (MDM) of hippocampal CA3 and CA1 neural firing was computed which derives a stimulation pattern for CA1 and CA3 neurons to be applied during the encoding (sample) phase of a delayed match-to-sample (DMS) human short-term memory task. Main results MDM electrical stimulation delivered to the CA1 and CA3 locations in the hippocampus during the sample phase of DMS trials facilitated memory of images from the DMS task during a delayed recognition (DR) task that also included control images that were not from the DMS task. Across all subjects, the stimulated trials exhibited significant changes in performance in 22.4% of patient and category combinations. Changes in performance were a combination of both increased memory performance and decreased memory performance, with increases in performance occurring at almost 2 to 1 relative to decreases in performance. Across patients with impaired memory that received bilateral stimulation, significant changes in over 37.9% of patient and category combinations was seen with the changes in memory performance show a ratio of increased to decreased performance of over 4 to 1. Modification of memory performance was dependent on whether memory function was intact or impaired, and if stimulation was applied bilaterally or unilaterally, with nearly all increase in performance seen in subjects with impaired memory receiving bilateral stimulation. Significance These results demonstrate that memory encoding in patients with impaired memory function can be facilitated for specific memory content, which offers a stimulation method for a future implantable neural prosthetic to improve human memory.
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Affiliation(s)
- Brent M Roeder
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Xiwei She
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Alexander S Dakos
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Bryan Moore
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert T Wicks
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Johns Hopkins Children's Center, Baltimore, MD, United States
| | - Mark R Witcher
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA, United States
| | - Daniel E Couture
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Adrian W Laxton
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | | | - Gautam Popli
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Charles Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Brian Lee
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Christianne Heck
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - George Nune
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Hui Gong
- Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Susan Shaw
- Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Vasilis Z Marmarelis
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Theodore W Berger
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Sam A Deadwyler
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert E Hampson
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
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Munger Clary H, Gilliam F. Suicidality in Epilepsy: Common With Various Mood and Anxiety Disorders. Neurology 2023; 100:499-500. [PMID: 36539300 DOI: 10.1212/wnl.0000000000206839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Heidi Munger Clary
- From the Department of Neurology (H.M.C.), Wake Forest University School of Medicine; and Department of Neurology (F.G.), University of Texas Rio Grande Valley School of Medicine.
| | - Frank Gilliam
- From the Department of Neurology (H.M.C.), Wake Forest University School of Medicine; and Department of Neurology (F.G.), University of Texas Rio Grande Valley School of Medicine
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Tegeler CL, Munger Clary H, Shaltout HA, Simpson SL, Gerdes L, Tegeler CH. Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial. Glob Adv Integr Med Health 2023; 12:27536130221147475. [PMID: 36816469 PMCID: PMC9933987 DOI: 10.1177/27536130221147475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023]
Abstract
Background Interventions for insomnia that also address autonomic dysfunction are needed. Objective We evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function. Methods Adults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity). Results Of 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control. Conclusions This pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.
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Affiliation(s)
- Catherine L. Tegeler
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA
| | | | - Sean L. Simpson
- Department of Biostatistics and Data Sciences, WFSM, Winston-Salem, NC, USA
| | - Lee Gerdes
- Brain State Technologies, LLC, Scottsdale, AZ, USA
| | - Charles H. Tegeler
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA,Charles H. Tegeler, MD, Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1078, USA.
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Munger Clary H, Josephson SA, Franklin G, Herman ST, Hopp JL, Hughes I, Meunier L, Moura LMVR, Parker-McFadden B, Pugh MJ, Schultz R, Spanaki MV, Bennett A, Baca C. Seizure Frequency Process and Outcome Quality Measures: Quality Improvement in Neurology. Neurology 2022; 98:583-590. [PMID: 35379694 DOI: 10.1212/wnl.0000000000200239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Heidi Munger Clary
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - S Andrew Josephson
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Gary Franklin
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Susan T Herman
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Jennifer L Hopp
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Inna Hughes
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lisa Meunier
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lidia M V R Moura
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Brandy Parker-McFadden
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Mary Jo Pugh
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Rebecca Schultz
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Marianna V Spanaki
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Amy Bennett
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Christine Baca
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
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7
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Brenes G, Clary HM, Miller M, Divers J, Anderson A, Hargis G, Danhauer S. Effects of Treatment Preference on Adherence, Attrition, and Process Measures Among Older Adult Worriers. Innov Aging 2020. [PMCID: PMC7741487 DOI: 10.1093/geroni/igaa057.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patient preference may be related to treatment outcomes through decreased rates of attrition and higher rates of adherence and patient satisfaction. We present findings from a 2-stage randomized preference trial of cognitive-behavioral therapy (CBT) and yoga for the treatment of late-life worry. We examine rates of preference for CBT and yoga, as well as the stability of these preferences over time. We also examine the impact of preference on adherence, attrition, and process measures (satisfaction, treatment expectancies, and working alliance). Five hundred participants were randomized to either the randomized controlled trial (RCT; N=250) or the preference trial (participants chose the treatment; N=250). All participants received 10 weeks of an intervention. Among those in the preference trial, 48% chose CBT and 52% chose yoga (p>.05). Strength of preference was similar between the groups; 73.3% and 76.2% reported a strong preference for CBT and yoga, respectively (p>.05). Fourteen percent of those who preferred CBT at baseline preferred yoga upon completion of the intervention, while 12.2% of those who preferred yoga at baseline preferred CBT upon completion of the intervention (p>.05). There were no significant differences between participants in the RCT and preference trial on intervention adherence, attrition, satisfaction, or working alliance (p’s>.05). Treatment expectancies were higher for the preferred intervention (p’s<.0001). Results suggest that older adults prefer CBT and yoga at similar rates, and these preferences are stable. Receiving a preferred treatment had no effect on adherence, attrition, satisfaction, or working alliance.
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Affiliation(s)
- Gretchen Brenes
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Heidi Munger Clary
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Michael Miller
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | | | - Andrea Anderson
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Gena Hargis
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Suzanne Danhauer
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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8
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Peterson K, LaRoche S, Cummings T, Woodard V, Moise AM, Munger Clary H. Addressing the epilepsy surgery gap: Impact of community/tertiary epilepsy center collaboration. Epilepsy Behav Rep 2020; 14:100398. [PMID: 33313499 PMCID: PMC7720013 DOI: 10.1016/j.ebr.2020.100398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Collaboration agreements can improve epilepsy surgery referral volumes. Standardized referral pathways may help address epilepsy surgery gap. Internal and external process changes can improve referral process. Sociodemographic variables continue to influence referral completion.
To assess whether a formal collaboration between a non-surgical, community epilepsy center and a surgical, tertiary-care epilepsy center can improve patient progress throughout the pre-surgical referral process, and to elucidate predictors of referral completion among inter-center referrals. The inter-center referral process was tracked, and the number of patients completing surgical conference (primary outcome) and epilepsy surgery at the tertiary center were collected and compared in the 45-month immediate pre/post-collaboration periods. Demographic and clinical variables were collected on post-collaboration inter-center patient referrals to explore factors associated with completion of the referral process. Compared to the pre-collaboration period, the proportion of tertiary center epilepsy surgery conference patients referred from the community epilepsy center increased from 3/88 to 14/113 (263% increase, p = .01) during the post-collaboration period. The proportion of patients completing surgery via the community to tertiary referral process increased from 2/63 pre-collaboration to 8/71 post-collaboration (254% increase, p = .04). Referral completion was associated with higher seizure frequency, shorter travel distance, private insurance status and positive employment status (p < 0.05). Collaboration agreements between community and tertiary-care epilepsy centers may improve patient completion of the epilepsy surgery referral process. Implementation of similar programs at other centers may be beneficial in reducing the epilepsy surgery gap.
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Affiliation(s)
- Keyan Peterson
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | | | - Tiffany Cummings
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | - Valerie Woodard
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | | | - Heidi Munger Clary
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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Strowd RE, Strauss L, Graham R, Dodenhoff K, Schreiber A, Thomson S, Ambrosini A, Thurman AM, Olszewski C, Smith LD, Cartwright MS, Guzik A, Wells RE, Munger Clary H, Malone J, Ezzeddine M, Duncan PW, Tegeler CH. Rapid Implementation of Outpatient Teleneurology in Rural Appalachia: Barriers and Disparities. Neurol Clin Pract 2020; 11:232-241. [PMID: 34484890 DOI: 10.1212/cpj.0000000000000906] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 01/01/2023]
Abstract
Objective To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States. Methods A retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call. Results Of 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p < 0.001), more likely to be female (63% vs 55%, p < 0.007), be White or Caucasian (p = 0.024), and not have Medicare or Medicaid insurance (p < 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p = 0.05). Conclusion Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.
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Affiliation(s)
- Roy E Strowd
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Lauren Strauss
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Rachel Graham
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Kristen Dodenhoff
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Allysen Schreiber
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Sharon Thomson
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Alexander Ambrosini
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Annie Madeline Thurman
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Carly Olszewski
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - L Daniela Smith
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Michael S Cartwright
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Amy Guzik
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Rebecca Erwin Wells
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Heidi Munger Clary
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - John Malone
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Mustapha Ezzeddine
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Pamela W Duncan
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
| | - Charles H Tegeler
- Wake Forest School of Medicine (RES, LS, KD, AS, ST, AA, AMT, CO, LDS, MSC, HMC, JM, ME, CT); and Wake Forest Baptist Medical Center (RG, AG, RW, PD), Winston-Salem, NC
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Patel AD, Baca C, Franklin G, Herman ST, Hughes I, Meunier L, Moura LM, Munger Clary H, Parker-McFadden B, Pugh MJ, Schultz RJ, Spanaki MV, Bennett A, Josephson SA. Quality improvement in neurology. Neurology 2018; 91:829-836. [DOI: 10.1212/wnl.0000000000006425] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/15/2022] Open
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11
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Tatum WO, Selioutski O, Ochoa JG, Clary HM, Cheek J, Drislane FW, Tsuchida TN. American Clinical Neurophysiology Society Guideline 7: Guidelines for EEG Reporting. Neurodiagn J 2018; 56:285-293. [PMID: 28436792 DOI: 10.1080/21646821.2016.1245576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This EEG Guideline incorporates the practice of structuring a report of results obtained during routine adult electroencephalography. It is intended to reflect one of the current practices in reporting an EEG and serves as a revision of the previous guideline entitled "Writing an EEG Report." The goal of this guideline is not only to convey clinically relevant information, but also to improve interrater reliability for clinical and research use by standardizing the format of EEG reports. With this in mind, there is expanded documentation of the patient history to include more relevant clinical information that can affect the EEG recording and interpretation. Recommendations for the technical conditions of the recording are also enhanced to include post hoc review parameters and type of EEG recording. Sleep feature documentation is also expanded upon. More descriptive terms are included for background features and interictal discharges that are concordant with efforts to standardize terminology. In the clinical correlation section, examples of common clinical scenarios are now provided that encourages uniformity in reporting. Including digital samples of abnormal waveforms is now readily available with current EEG recording systems and may be beneficial in augmenting reports when controversial waveforms or important features are encountered.
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Affiliation(s)
| | | | - Juan G Ochoa
- c University of South Alabama , Mobile , Alabama
| | | | | | | | - Tammy N Tsuchida
- g George Washington University , Washington , District of Columbia
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Choi H, Hamberger MJ, Munger Clary H, Loeb R, Onchiri FM, Baker G, Hauser WA, Wong JB. Seizure frequency and patient-centered outcome assessment in epilepsy. Epilepsia 2014; 55:1205-12. [DOI: 10.1111/epi.12672] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Hyunmi Choi
- Department of Neurology; Columbia University; New York New York U.S.A
| | | | - Heidi Munger Clary
- Department of Neurology; Wake Forest University School of Medicine; Winston-Salem North Carolina U.S.A
| | - Rebecca Loeb
- Department of Psychiatry and Behavioral Sciences; Memorial Sloan-Kettering Cancer Center; New York New York U.S.A
| | | | - Gus Baker
- Department of Neurosciences; University of Liverpool; Liverpool United Kingdom
| | - W. Allen Hauser
- Department of Neurology; Columbia University; New York New York U.S.A
| | - John B. Wong
- Department of Medicine; Division of Clinical Decision Making; Tufts University School of Medicine; Boston Massachusetts U.S.A
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