ABSTRACT
This study evaluated seizure documentation after participants observed videotaped seizures to determine how their background (educational level, employment position, years of experience, practice frequency, and familiarity with epilepsy and seizures) and attributes of the seizures themselves affected their skill. Observer variables did not show significant differences when mean seizure rating scores of 348 documented seizures for 58 participants were compared. Combinations of variables were significant; certified nursing assistants (CNAs) with clinical seizure experience had significantly higher mean seizure rating scores than those without experience (p < .01). There were significant differences in the mean percentile scores for each seizure observed (p < .001). Seizures with excess motor activity had the highest scores. Most common observations for any seizure observed were location and description of movement. Participants had significantly higher scores when observing a seizure a second time (p < .001). Differences in education, employment position, and years of employment are not limiting factors in performing seizure observation and documentation for persons who have been trained and certified in the skill. Opportunities to periodically view seizures improved seizure observation and documentation. Because motor movement observations predominate seizure documents, seizure observation instruction should not only emphasize key observational details but also highlight less frequent observations, such as responsiveness, that may play a key role in seizure classification. Using videotaped seizures and a scoring tool are useful for initial training and certification as well as periodic retraining to maintain quality in the skill.
Subject(s)
Documentation , Epilepsy/diagnosis , Nursing Diagnosis , Nursing Records , Seizures/diagnosis , Child , Clinical Competence , Epilepsy/classification , Epilepsy/nursing , Humans , Inservice Training , Nursing Assessment , Observer Variation , Seizures/classification , Seizures/nursingABSTRACT
BACKGROUND AND PURPOSE: Advances in thrombolytic therapy, brain imaging, and neurointerventional techniques provide new therapeutic options for acute stroke. Intra-arterial thrombolysis has proved to be a potent therapeutic tool. To show that this procedure can be performed in community hospitals, we describe our experience with a group of 11 patients treated for middle cerebral artery occlusions. METHODS: Twenty-two patients seen during a period of 1 year with clinical findings of acute major-vessel stroke met screening criteria and were evaluated under an institutional review board-approved protocol. After CT scanning, 17 of those patients met strict criteria, gave informed consent, and underwent angiography. Eleven patients had M1 and M2 middle cerebral artery occlusions and received local thrombolytic therapy with urokinase. Recanalization efficacy, complications, and outcome data were compiled. RESULTS: The average score on the National Institutes of Health Stroke Scale was 22.2 at the onset of treatment and 12.5 after therapy, with 91% of patients showing neurologic improvement. Complete (TIMI 3) recanalization occurred in 73% of cases and partial recanalization (TIMI 2) in 18%. At the 90-day follow-up evaluation, 56% of patients had good outcomes (modified Rankin score, 0 to 1). One intracranial hemorrhage occurred. CONCLUSION: Intra-arterial thrombolysis can be performed in a community hospital by radiologists with interventional and neuroradiologic skills given appropriate institutional preparation.
Subject(s)
Brain Ischemia/drug therapy , Intracranial Embolism/drug therapy , Intracranial Thrombosis/drug therapy , Thrombolytic Therapy , Urokinase-Type Plasminogen Activator/administration & dosage , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Cerebral Angiography , Female , Humans , Infusions, Intra-Arterial , Intracranial Embolism/diagnostic imaging , Intracranial Thrombosis/diagnostic imaging , Male , Middle Cerebral Artery/diagnostic imaging , Middle Cerebral Artery/drug effects , Neurologic Examination/drug effects , Treatment Outcome , Urokinase-Type Plasminogen Activator/adverse effectsABSTRACT
PURPOSE: The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients. METHODS: Operation logs from 1988 through 1993 were reviewed to identify patients who underwent lateral suboccipital craniotomy or craniectomy. The nature of the operation, preoperative and postoperative complaints of headache, treatment for postoperative headache, and the use of primary cranioplasty were recorded from the medical records. RESULTS: Fifty-six suboccipital approaches were performed by the senior authors between 1988 and 1990. Seven patients had debilitating postoperative headaches. None responded to conservative management, and all underwent secondary cranioplasty. All seven patients showed significant improvement in their pain, with four of seven requiring no other treatment (follow-up from 15 to 38 months). Fifty patients underwent cranioplasty at the time of their initial operation, from 1991 to 1993. No case of debilitating headache was identified post-operatively in these patients. CONCLUSIONS: Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.