107 First come, first served: a comparison of first-ever seizure patients and those presenting after recurrent-untreated seizures

2018 ◽  
Vol 89 (6) ◽  
pp. A42.2-A43
Author(s):  
Sarah Holper ◽  
Emma Foster ◽  
Patrick Kwan
Keyword(s):  
Correct Diagnosis ◽  
Medical Attention ◽  
Inclusion Criteria ◽  
Social Barriers ◽  
Patient Demographics ◽  
Icd 10 ◽  
Impaired Awareness ◽  
To Receive ◽  
New Onset

IntroductionFirst seizure diagnosis may be delayed due to financial, geographical or social barriers to healthcare, or misdiagnosis with differentials including syncope or stroke. Seizures may recur until correct diagnosis and appropriate treatment is instituted; meanwhile, patients may experience increased seizure-related morbidity and mortality. We compare patient and seizure characteristics between a first-ever ‘new-onset’ seizure (NOS) cohort, and a recurrent-untreated seizure (RUS) cohort.MethodMedical charts were reviewed to extract information on patient demographics and clinical characteristics using a standardised proforma. Inclusion criteria were patients aged 18 or over who attended a tertiary-level Melbourne hospital between 1 January 2008 and 30 November 2016 with discharge codes ICD-10 G40-Epilepsy, G41-Status epilepticus, or R56.9-Unspecified convulsions.Results367 episodes were identified. 151 episodes met inclusion criteria: new-onset seizures (115) and recurrent-untreated seizures.36 216 excluded cases included pre-existing epilepsy (186), and non-seizure events.30 RUS-cohort experienced a median of two seizures prior to coming to medical attention, most commonly focal impaired awareness seizures (50.00%). Considering the index seizure, focal seizures were more common in RUS-cohort (36.11 vs 24.35%) while primary generalised seizures predominated in NOS-cohort (62.61% vs 50.00%). Compared to NOS-cohort, RUS-cohort was more likely to have unprovoked seizures (72.22% vs 55.65%), identifiable remote risk factors (41.67% vs 26.09%), younger age (69 vs 76), normal MRI and EEG, and be discharged on antiepileptic drugs (86.11% vs 73.91%). RUS-cohort was more likely to receive Neurology outpatient follow-up (72.22% vs 39.99%), and in a more timely manner compared to NOS-cohort (30.56% vs 11.31% saw a Neurologist within a month of discharge).ConclusionRecurrent-untreated seizures often have subtler semiology and are more likely to have normal MRI and EEG results than patients presenting immediately following new-onset seizures. RUS-cohort tend to receive more inpatient investigations and AED prescriptions, and are offered more timely neurology follow-up than NOS-cohort.

scholarly journals The Incidence of Nonunion of the Hallux Interphalangeal Joint Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Mark Prissel ◽  
Eric So ◽  
Anson Chu ◽  
Matthew Wilson
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Interphalangeal Joint ◽  
Effective Procedure ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Weighted Mean ◽  
Patient Demographics ◽  
Contributory Factors

Category: Midfoot/Forefoot Introduction/Purpose: Hallux interphalangeal joint (HIPJ) arthrodesis is an effective procedure to treat pain and provide stability, which is often performed for intrinsic pain to the HIPJ. Additionally, this procedure is typically employed in concert with the Jones tenosuspension. Despite that this is an accepted technique, the available literature is scant and questions remain regarding nonunion rates and contributory factors to poor healing. A systematic review of the literature was undertaken to determine the rate of nonunion for HIPJ arthrodesis. Methods: To acquire the highest quality and most relevant studies available, publications were eligible for inclusion only if they involved patients undergoing HIPJ arthrodesis. Studies additionally required mean follow-up of at least six weeks and inclusion of appropriate detail regarding complications, nonunion rates, and patient demographics. Ultimately, 7 studies involving 313 HIPJ arthrodeses met inclusion criteria. Results: A total of 291 patients with a weighted mean age of 48.9 were included. The nonunion rate was 28.3% at a weighted mean follow-up of 8.4 months. The overall complication rate was 33.0%. Conclusion: Considering the increased rate of complications and nonunions for this commonly employed procedure, additional prospective comparative analyses are needed to identify important patient demographics and to determine superior fixation constructs.

scholarly journals Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

Neurology ◽  
2020 ◽  
Vol 95 (9) ◽  
pp. e1257-e1266 ◽  
Author(s):  
Salvatore C. Rametta ◽  
Sara E. Fridinger ◽  
Alexander K. Gonzalez ◽  
Julie Xian ◽  
Peter D. Galer ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Minority Groups ◽  
Child Neurology ◽  
Patient Demographics ◽  
Retrospective Comparison ◽  
Before And After ◽  
Future Care ◽  
Icd 10 ◽  
Audio Video

ObjectiveTo assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020.MethodsThis was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers.ResultsThere were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups.ConclusionsWe effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.

Patterns of Hypomethylating Agent and Transfusion Use in Myelodysplastic Syndrome: a Claims Database Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2490-2490
Author(s):  
Hind T Hatoum ◽  
Swu-Jane Lin ◽  
Deborah Buchner ◽  
Edward Kim
Keyword(s):  
Logistic Regression ◽  
Myelodysplastic Syndrome ◽  
Poisson Regression ◽  
Research Funding ◽  
Myelogenous Leukemia ◽  
Transfusion Rate ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
To Receive

Abstract Abstract 2490 Poster Board II-467 Introduction: Myelodysplastic syndrome (MDS) is characterized by ineffective hematopoiesis, multilineage dysplasia, peripheral cytopenias, and susceptibility to leukemic transformation. Supportive treatments include red blood cell (RBC) and platelet (PLT) transfusions as well as erythrocyte stimulating agents (ESAs) to correct disease-induced cytopenias. Active treatment with hypomethylating agents (HMAs) have been shown in clinical trials to reduce transfusion dependence and leukemic progression among patients with MDS. The purpose of this study is to describe the patterns of care among patients with MDS, and outcomes associated with HMA treatment options. Methods: Data were obtained from the MarketScan® database, which contains pharmacy, medical, hospital, and laboratory claims for several million members, from January 2002 through June 2008. Inclusion criteria included: age 18 or older; at least 2 claims with an ICD-9 diagnosis of MDS in 2006 or later; at least 6 months of pre-diagnosis health plan enrollment; at least 4 months of enrollment after initial HMA treatment; at least 1 complete cycle of decitabine (DAC; 5 treatments) or azacitidine (AZA, 7 treatments). Patients were excluded if they were treated with lenalidomide, had a prior cancer diagnosis, prior treatment with DAC or AZA, or had other isolated cytopenia or myeloproliferative diagnoses. Patients with a diagnosis of acute myelogenous leukemia within the first 28 days of treatment were also excluded. Descriptive statistics characterized patient demographics, including time between diagnosis and treatment, days per cycle, use of ESA, and number of treatment cycles. Logistic regression assessed predictors of HMA treatment using age at MDS diagnosis, gender, Charlson Comorbidity Index (CCI), and calendar year as predictors. Poisson regression compared the risk of RBC or PLT transfusion between DAC and AZA, controlling for age, gender, CCI, treatment cycles, time to initiating treatment, and follow-up duration. Results: 2525 patients met full inclusion criteria (51% female), of whom 95.4% received no HMA treatment. Logistic regression revealed that females were less likely to receive HMA therapy (OR 0.486, p<0.001). There was no significant difference in follow-up duration between the DAC and AZA groups. Over 50% of HMA-treated patients received 4 or more treatment cycles, with no significant difference between DAC (n=37) and AZA (n=60). Mean (SD) days from MDS diagnosis to first treatment was 93.7 (101.4) for DAC vs. 50.8 (73.4) for AZA (p=0.03). Median treatment days per cycle were 4.86 for DAC and 5.00 for AZA (p>0.05). Mean (SD) days to discontinuation of RBC/PLT transfusion was 15.8 (48.3) for DAC and 70.1 (136.1) for AZA (p<0.05). The RBC/PLT transfusion rate was lower for DAC than for AZA (0.06 vs 0.17 per month, p<0.05). Poisson regression found a significantly lower likelihood of RBC/PLT transfusion in the DAC group (OR=0.206, p<0.05). Use of ESA did not differ between treatments (p>0.05). Discussion: Only a small portion of MDS patients receive HMA treatments, with females less likely to receive drug therapy. Initiation of decitabine occurs later than azacitadine after MDS diagnosis for unclear reasons. Decitabine is associated with lower rates of RBC/PLT transfusion and shorter time to discontinuation of transfusions, consistent with a prompt time to clinical response. Further research is needed to clarify optimal initiation timing for HMA treatment to maximize therapeutic benefits. Disclosures: Hatoum: Eisai Inc.: Research Funding. Lin:Eisai Inc.: Research Funding. Buchner:Eisai Inc.: Employment. Kim:Eisai Inc.: Employment.

Whole-Sellar Stereotactic Radiosurgery for Functioning Pituitary Adenomas

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 227-237 ◽  
Author(s):  
Cheng-Chia Lee ◽  
Ching-Jen Chen ◽  
Chun-Po Yen ◽  
Zhiyuan Xu ◽  
David Schlesinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Pituitary Adenomas ◽  
Maximum Dose ◽  
Remission Rate ◽  
Inclusion Criteria ◽  
Cushing Disease ◽  
Radiation Delivery ◽  
Median Margin ◽  
New Onset

Abstract BACKGROUND: Functioning pituitary adenomas (FPAs) can be difficult to delineate on postoperative magnetic resonance imaging, making them difficult targets for stereotactic radiosurgery (SRS). In such cases, radiation delivery to the entire sella has been utilized as a radiosurgical equivalent of a total hypophysectomy. OBJECTIVE: To evaluate the outcomes of a cohort of patients with FPA who underwent SRS to the whole-sellar region. METHODS: This is a retrospective review of patients who underwent whole-sellar SRS for FPA between 1989 and 2012. Sixty-four patients met the inclusion criteria: they were treated with whole-sellar SRS following surgical resection for persistently elevated hormone levels, and (1) no visible lesions on imaging studies and/or (2) tumor infiltration of dura or adjacent venous sinuses observed at the time of a prior resection. The median radiosurgical volume covering sellar structures was 3.2 mL, with a median margin dose of 25 Gy. RESULTS: The median endocrine follow-up was 41 months; 22 (68.8%) patients with acromegaly, 20 (71.4%) patients with Cushing disease, and 2 (50.0%) patients with prolactinoma achieved endocrine remission. The 2-, 4-, and 6-year actuarial remission rates were 54%, 78%, and 87%, respectively. New-onset neurological deficit was found in 4 (6.3%) patients following treatment. New-onset hypopituitarism was observed in 27 (43.5%) patients, with panhypopituitarism in 2 (3.2%). Higher margin/maximum dose were significantly associated with a higher remission rate and development of post-SRS hypopituitarism. CONCLUSION: Whole-sellar SRS for invasive or imaging-negative FPA following failed resection can offer reasonable rates of endocrine remission. Hypopituitarism following whole-sellar SRS is the most common complication.

RhD negative women transfused RhD positive blood: Alloimmunization prophylaxis protocol and experiences

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
R Alkhateb ◽  
V Prajapati ◽  
J Daniels ◽  
L Greebon
Keyword(s):  
Post Treatment ◽  
High Dose ◽  
Red Cell ◽  
Inclusion Criteria ◽  
Total Blood ◽  
Significant Drop ◽  
To Receive ◽  
Hospital Protocol

Abstract Introduction/Objective Preventing allomiunization from D-mismatched transfusions, i.e., transfusion RhD positive (RhD+) red blood cells (RBC) to an RhD negative (RhD–) individual, is not well established. We describe our hospital protocol and experiences managing RhD– young women who received emergency release D-mismatched transfusions. Methods/Case Report The pathologists evaluate all patients who received D-mismatched blood transfusions. The inclusion criteria for alloimmunization prophylaxis protocol include: RhD– females; &lt;50 years old; No current or historical Anti-D; and received ≥1 unit of RhD+ blood. The prophylaxis protocol depends on the RBC volume (RBCV) transfused. Patients who receive RBCV &lt;20% of their total blood volume (TBV) are eligible to receive high dose RhIg, calculated based on the volume transfused. Those who received RBCV ≥20% of TBV would be eligible for red cell exchange (RBCX) followed by RhIg. Results (if a Case Study enter NA) Since 2016, four eligible patients received RhIg prophylaxis protocol and none met the criteria for RBCX. All the patients started the prophylaxis protocol within 24 hours of transfusion and completed it within 72 hours. One patient developed post treatment hemolysis and significant drop in hemoglobin requiring blood transfusion. Passive anti-D post treatment was confirmed in three patients, and one had passive anti C. Three of the four patients had follow up antibody screens &gt;6 months post treatment that were negative for RhD alloimmunization. Conclusion Our therapeutic plan, the first well established protocol, involves identifying eligible patients based on set criteria and protocols. Our experience demonstrates that this protocol is effective in reducing/preventing RhD alloimmunization.

Serous Cystadenomas of the Pancreas: Long-term Follow-up Measurement of Growth Rate

2011 ◽  
Vol 62 (3) ◽  
pp. 190-196 ◽  
Author(s):  
Alexandre Menard ◽  
George Tomlinson ◽  
Sean Cleary ◽  
Alice Wei ◽  
Steven Gallinger ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Linear Growth ◽  
Inclusion Criteria ◽  
Patient Demographics ◽  
Imaging Characteristics ◽  
Serous Cystadenomas ◽  
Long Term Follow Up

Purpose To measure the growth rate of microcystic subtype serous adenomas of the pancreas diagnosed by imaging. Methods For this retrospective study, 241 imaging studies were reviewed from 1998 to 2005. Thirty-one patients met our strict diagnostic imaging inclusion criteria and had at least 18 months of imaging follow-up. Patient demographics and lesion imaging characteristics were tested as predictors of growth. Results Growth was measured over a mean period of 42 months. There was a significant ( P = .0004) linear growth of tumour for the population. There was significant clustering ( P = .001) of the population into 2 growth rates: 0.50 mm/y ( n = 23) and 5.5 mm/y ( n = 8). The diameter of the lesion at presentation was significantly correlated with growth (r = 0.45; P = .01). Conclusion The microcystic subtype of serous cystadenomas of the pancreas diagnosed with imaging criteria demonstrates 2 distinct and slow growth rates. The size of the lesion at presentation is correlated with growth rate.

scholarly journals Danish Nationwide Data Reveal a Link between Diabetes Mellitus, Diabetic Retinopathy, and Glaucoma

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Anna Horwitz ◽  
Beáta Éva Petrovski ◽  
Christian Torp-Pedersen ◽  
Miriam Kolko
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Strong Association ◽  
Reference Population ◽  
Medicinal Products ◽  
Danish Population ◽  
Icd 10 ◽  
Glaucoma Treatment ◽  
New Onset

Aims. To determine the association between treatment against diabetes mellitus (DM) and treatment with antiglaucomatous drugs in the entire Danish population and to investigate the comorbidity between DM and its complications with antiglaucomatous treatment. Methods. Retrospective nationwide cohort study with data over a 16-year follow-up period. The National Danish Registry of Medicinal Products Statistics was used to identify all claimed prescriptions for antiglaucomatous medication and DM drugs. ICD-10 classifications were furthermore used to identify comorbidities between antiglaucomatous medication and the DM complications, diabetic retinopathy (DR), and nephropathy. Results. A total of 6,343,747 individuals in the period between 1996 and 2012 were analyzed. The overall incidence rate of new-onset glaucoma patients was 0.07 per 1000 person-years for the reference population compared to 36 per 1000 person-years for all diagnosed DM cases. Patients treated with DM drugs had about two times higher relative risk of glaucoma, when adjusting for a range of factors. The presence of DR alone or in combination with nephropathy increased the risk of glaucoma. Conclusions. The present study reports a strong association between DM and onset of glaucoma treatment in the entire Danish population.

scholarly journals Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

2022 ◽  
Author(s):  
Vasileios K. Mousafeiris ◽  
Anastasia Vasilopoulou ◽  
George D. Chloros ◽  
Michalis Panteli ◽  
Peter V. Giannoudis
Keyword(s):  
High Energy ◽  
Injury Mechanism ◽  
Cochrane Library ◽  
Acetabular Fractures ◽  
Inclusion Criteria ◽  
Degenerative Arthritis ◽  
Patient Demographics ◽  
Included Patient ◽  
Injury Mechanisms

Abstract Background Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown. Materials and Methods A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes. Results Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%). Conclusions Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

A Pilot Study of Mobile Telephone Message Interventions with Suicide Attempters in China

Crisis ◽  
2010 ◽  
Vol 31 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Hui Chen ◽  
Brian L. Mishara ◽  
Xiao Xian Liu
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Text Message ◽  
Text Messages ◽  
Mobile Telephone ◽  
Future Research ◽  
Quick Method ◽  
Suicide Attempters ◽  
To Receive

Background: In China, where follow-up with hospitalized attempters is generally lacking, there is a great need for inexpensive and effective means of maintaining contact and decreasing recidivism. Aims: Our objective was to test whether mobile telephone message contacts after discharge would be feasible and acceptable to suicide attempters in China. Methods: Fifteen participants were recruited from suicide attempters seen in the Emergency Department in Wuhan, China, to participate in a pilot study to receive mobile telephone messages after discharge. All participants have access to a mobile telephone, and there is no charge for the user to receive text messages. Results: Most participants (12) considered the text message contacts an acceptable and useful form of help and would like to continue to receive them for a longer period of time. Conclusions: This suggests that, as a low-cost and quick method of intervention in areas where more intensive follow-up is not practical or available, telephone messages contacts are accessible, feasible, and acceptable to suicide attempters. We hope that this will inspire future research on regular and long-term message interventions to prevent recidivism in suicide attempters.

Lesson Study dan Implikasinya Terhadap Pembelajaran Berbasis Kurikulum Tingkat Satuan Pendidikan

2016 ◽  
Vol 1 ◽  
pp. 189-196
Author(s):  
Vian Harsution
Keyword(s):  
Learning Environment ◽  
Learning Process ◽  
Lesson Study ◽  
Learning Difficulties ◽  
Learning Needs ◽  
Democratic Leadership ◽  
Entrepreneurial Spirit ◽  
To Receive

Lesson study is a systematic, collaborative, and sustainable method of improving the quality of learning. Lesson study emphasizes the exploration of students’ learning needs; teacher openness towards learning difficulties encountered; the willingness of teachers to receive and provide advice and solutions to the difficulties encountered; and the consistency of the various parties to follow up the suggestions and solutions. Implementation of lesson study involving teachers, principals, and experts in the field of education. Kurikulum tingkat satuan pendidikan or abbreviated KTSP is operational curriculum formulated and implemented by each educational unit. KTSP has the characteristics, namely: giving broad autonomy to the educational unit, involving the community and parent participation, involving the democratic leadership of the principal, and require the support of a working team that is synergistic and transparent. KTSP based on the learning process, needs to be supported by a conducive learning environment and fun to be created by teachers.Teachers and principals in a professional, systematic and collaborative create an atmosphere that fosters independence, tenacity, entrepreneurial spirit, adaptive and proactive nature of the learning process. Thus, the learning needs of students who fulfilled optimally and professional ability of teacher who have increased on an ongoing basis, may usher in success – based learning KTSP. It means that the lesson study provides positive implications for the KTSP – based learning.

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