Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR).

BACKGROUND: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. METHODS: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. RESULTS: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. CONCLUSIONS: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Improving Practice Readiness Among Nurse Residents.

Background Recent evidence indicates a mere 8% of new graduate RNs are prepared to make entry-level clinical judgments. Residency programs, designed to overcome the academic-practice gap, lack universal guidelines for content, delivery, structure, and consistent assessment of practice readiness prior to independent practice. Method Virtual simulation to overcome practice gaps, with pre- and post-assessment of practice readiness prior to independent practice, was implemented in an existing nurse residency program. Results A 373% improvement in virtual clinical performance scores, as well as reductions in medication errors, sentinel events, and failures to rescue, was noted. These improvements readily translated to practice, as noted in a corresponding decrease in the rate of practice errors during actual clinical performance. Conclusion Transformed pedagogical technologies and learning methodologies are providing promising interventions to overcome the practice readiness deficit and set the stage for safer practice among new graduate RNs. [J Contin Educ Nurs. 2022;53(9):411-416.].

Nature contact at school: The impact of an outdoor classroom on children's well-being.

Nature contact facilitates healthy child development and a disconnect with nature presents potential health risks. This study was designed to test a nature intervention at an elementary school among children. An experimental crossover design was implemented over six weeks; two teachers taught their respective kindergarten classes the daily language arts lesson in either the control (indoor classroom) or nature treatment (outdoor classroom) conditions. Child well-being measures were compared in the two conditions. Teachers' redirections of child behavior were significantly fewer in the nature condition (t = 2.49, p < 0.05) compared to the control. Also, fewer children were off task in the nature condition on average. There were mixed well-being results; children reported no significance difference in happiness in the two conditions, but teachers reported modest benefit in child well-being in the nature condition. The outdoor classroom is a promising method for increasing nature contact and promoting student well-being.

A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Strategies to address gait and balance deficits early poststroke are minimal. The postural and motor control requirements of Backward Walking Training (BWT) may provide benefits to improve balance and walking speed in this population. This pilot study (1) determined the feasibility of administering BWT during inpatient rehabilitation and (2) compared the effectiveness of BWT to Standing Balance Training (SBT) on walking speed, balance, and balance-related efficacy in acute stroke. METHODS: Eighteen individuals 1-week poststroke were randomized to eight, 30-minute sessions of BWT or SBT in addition to scheduled therapy. Five-Meter Walk Test, 3-Meter Backward Walk Test, Activities-Specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, and Function Independence Measure-Mobility were assessed pre- and postintervention and at 3 months poststroke. RESULTS: Forward gait speed change (BWT: 0.75 m/s; SBT: 0.41 m/s), assessed by the 5-Meter Walk Test, and backward gait speed change (BWT: 0.53 m/s; SBT: 0.23 m/s), assessed by the 3-Meter Backward Walk Test, preintervention to 1-month retention were greater for BWT than for SBT (P < 0.05). Group difference effect size from preintervention to 1-month retention was large for Activities-Specific Balance Confidence Scale, moderate for Berg Balance Scale and Function Independence Measure-Mobility, and small for Sensory Organization Test. DISCUSSION AND CONCLUSIONS: Individuals 1-week poststroke tolerated 30 min/d of additional therapy. At 1-month postintervention, BWT resulted in greater improvements in both forward and backward walking speed than SBT. Backward walking training is a feasible important addition to acute stroke rehabilitation. Future areas of inquiry should examine BWT as a preventative modality for future fall incidence.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A193).

How Well Do Functional Assessments of Mobility and Balance Discriminate Fallers and Recurrent Fallers from Non-Fallers among Ambulatory Older Adults in the Community?

PURPOSE: 1) To compare the ability of functional mobility and balance assessments in discriminating fallers from non-fallers and recurrent fallers from those with fewer or no falls. 2) To compare the discriminatory accuracy of cut-off scores specific to this study sample with that of cut-off scores proposed in the literature for community-dwelling older adults. METHODS: In a sample of 39 ambulatory older adults living independently in the community, fallers were identified on the basis of number of falls in the past year. Seven functional tests of mobility and balance were used to identify fallers and recurrent fallers on the basis of their fall history. RESULTS: Discrimination of fallers from non-fallers was poor: Only a high-level balance assessment significantly discriminated these groups (p=0.0498, area under the curve [AUC]=0.68). Four assessments significantly discriminated recurrent fallers from those with fewer or no falls (ps=0.006-0.009), but their discriminatory powers were not significantly different from one another (AUCs=0.77-0.80, p>0.05). For two assessments, cutoff scores based on the study sample enhanced discriminatory accuracy relative to the literature-based cutoff scores. CONCLUSIONS: To improve fall prediction for ambulatory community-dwelling older adults, future prospective studies should consider including high-level mobility and balance assessments and targeting cutoff scores to the level of function of this relatively high-functioning population.

Objet : Comparer la capacité qu'ont les évaluations de la mobilité fonctionnelle et de l'équilibre d'établir une distinction entre les personnes qui chutent et les personnes qui ne chutent pas, et entre celles qui chutent fréquemment et celles qui chutent peu ou jamais; comparer la précision en matière de distinction des points de coupure propres à l'échantillon de cette étude par rapport à ceux proposés dans la littérature concernant les personnes âgées qui résident dans la collectivité. Méthodes : Dans un échantillon de 39 personnes âgées mobiles qui vivent en autonomie dans la collectivité, les personnes qui chutent ont été déterminées selon le nombre de chutes faites au cours de l'année précédente. Sept tests fonctionnels concernant la mobilité et l'équilibre ont été utilisés pour déterminer les personnes qui chutent et les personnes qui chutent fréquemment selon leurs antécédents en matière de chutes. Résultats : La distinction des personnes qui chutent des personnes qui ne chutent pas était faible: seule une évaluation avancée de l'équilibre a établi une distinction importante entre ces groupes (p=0,0498, AUC=0,68). Quatre évaluations ont établi une distinction importante entre les personnes qui chutent fréquemment par rapport à celles qui chutent peu souvent ou jamais (p=0,006 à 0,009), mais leurs puissances de distinction n'étaient pas assez différentes les unes des autres (AUC=0,77 à 0.80, p>0,05). Dans le cadre de deux évaluations, les points de coupure fondés sur l'échantillon de l'étude ont amélioré la précision en matière de distinction des points de coupure établis selon la littérature. Conclusions : Pour améliorer la prédiction des chutes chez les personnes âgées qui résident dans la collectivité, les prochaines études prospectives doivent prendre en considération l'inclusion d'évaluations avancées de la mobilité et de l'équilibre et cibler les points de coupure au niveau de cette population hautement fonctionnelle.

Ultrasound marking by gastroenterologists prior to percutaneous liver biopsy removes the need for a separate radiological evaluation.

BACKGROUND/AIM: Ultrasound marking by radiologists prior to percutaneous liver biopsy (PLB) results in biopsy site adjustment, decreased pain related complications and improved tissue yield. Minimal data exists on the impact of ultrasound marking by gastroenterologists on these parameters. The study aim was to evaluate whether ultrasound marking by gastroenterologists results in improved PLB tissue yield, fewer needle passes and decreased biopsy failure rates compared to blind biopsy, eliminating the need for a separate radiological evaluation. METHODOLOGY: All PLB performed by gastroenterologists from June 1999 to February 2003 at the University of Florida College of Medicine, Jacksonville, were reviewed retrospectively. Data collected included ultrasound marked or blind PLB, demographics, indication, number of passes performed, and specimen length, if obtained. RESULTS: Four hundred and eighty PLB were included: 328 performed with ultrasound marking and 152 blind. Ultrasound marking by gastroenterologists prior to PLB resulted in fewer passes and longer specimens as well as a decreased failure rate in ultrasound marked compared to blind PLB. CONCLUSIONS: Ultrasound marking by gastroenterologists prior to PLB provided significantly larger tissue samples, fewer needle passes and a decreased biopsy failure rate compared to blind PLB. This removes the need for a separate radiological evaluation on the procedure day.

Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-known nosocomial pathogen of neonatal intensive care unit (NICU) patients and can cause both serious infections in preterm neonates and prolonged MRSA outbreaks in NICUs. OBJECTIVES: Our objectives were to determine the prevalence of and identify risk factors for MRSA colonization and infection in the NICU and the impact of an active surveillance program on MRSA in the NICU. METHODS: We collected weekly nasal MRSA surveillance cultures on 2,048 infants admitted to NICU over 3 years. Data on these infants were collected retrospectively. Characteristics of MRSA colonized and infected infants were analyzed and compared. RESULTS: MRSA colonization was detected in 6.74% of infants, and MRSA infection occurred in 22% of those colonized. Using clinical cultures alone, only 41 (27.5%) of 149 MRSA affected infants were identified. The majority (75%) developed MRSA infection within 17 days of colonization. For every 10-day increment in NICU stay, the odds ratio of being infected and colonized with MRSA increased by 1.32 and 1.29, respectively. Colonization was significantly associated with longer NICU stay, low birth weight, low gestational age, and multiple gestation status. CONCLUSION: Colonization is a risk factor for infection with MRSA in NICUs. Clinical cultures underestimate MRSA affected infants in NICUs, whereas active surveillance cultures could detect MRSA affected infants earlier and limit nosocomial spread.

Lower albumin levels in African Americans at colon cancer diagnosis: a potential explanation for outcome disparities between groups?

BACKGROUND AND AIM: Colorectal cancer is the third most common cancer and 3rd leading cause of cancer-related death in the USA. African Americans (AA) have inferior outcomes when matched for diagnosis stage and socioeconomic situation. Nutritional status, at diagnosis and its contribution to the observed cancer outcome disparity, between AA and non-Hispanic whites (nHw) has not been evaluated to date. The aim of the investigation was to determine if differences in nutritional surrogate markers, such as serum albumin and body mass index (BMI), exist at the time of colorectal cancer diagnosis between AA and nHw. METHODS: The University of Florida College of Medicine-Jacksonville endoscopy database was reviewed for all patients with a biopsied colorectal mass between January 2000 and December 2007. Patients were excluded if histology did not reveal colorectal adenocarcinoma or albumin/BMI was unavailable. Demographic data, tumor location, serum albumin within 60 days of diagnosis, presence of diabetes along with serum HbA1c were obtained. RESULTS: During the study period, 321 patients had colorectal masses discovered and 156 met entry criteria. There was no difference between ethnic groups regarding gender distribution, tumor location, diabetes presence, or BMI. Mean albumin was significantly less in AA compared to nHw (p < 0.01). This persisted after adjustment for gender, presence/absence of diabetes, and BMI. CONCLUSIONS: Lower albumin levels in AA indicate poorer nutritional status at colorectal cancer diagnosis compared to nHw. This may contribute to the outcome disparities observed between AA and nHw. Aggressive nutritional interventions to reverse this disparity should be evaluated.

Poorly treated or unrecognized GERD reduces quality of life in patients with COPD.

BACKGROUND: The effect of gastroesophageal reflux disease (GERD) on health-related quality of life (HRQL) in COPD has never been assessed. AIM: To evaluate HRQL in patients with COPD alone compared with those with both COPD and continuing GERD symptoms. METHODS: A questionnaire-based, cross-sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting the criteria and agreeing to participate were asked to complete the Mayo Clinic GERQ and SF-36 questionnaires, by either personal or telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Study patients were divided into two groups for HRQL analysis based on the GERQ response: COPD+/GERD+ and COPD only. Statistical analysis was performed using the Mann-Whitney-Wilcoxon T test for unequal variables and linear regression was performed using ANOVA. All data are expressed as mean and standard deviation. RESULTS: Eighty-six patients completed both questionnaires. Males were 55% and COPD+/GERD+ patients comprised 37% of the study group. Compared with COPD only, HRQL was reduced across all measures for the COPD+ GERD+ patients and achieved significance for bodily pain (P < 0.02), mental health (P < 0.05), and physical component score (P < 0.05). CONCLUSION: Patients with COPD and continuing GERD symptoms have reduced HRQL in comparison with those with COPD alone.

Pediatric self-inflating resuscitators: the dangers of improper setup.

BACKGROUND: Self-inflating resuscitators (SIRs) are often used in pediatric resuscitation. Improper setup of the SIR can lead to inadequate ventilation and oxygenation. OBJECTIVES: To present clinical scenarios in which SIRs delivered inadequate tidal volumes due to improper use. Second, to evaluate tidal volumes delivered using SIRs at varying lung compliances with the manometer and pop-off valve port open and closed. Third, to suggest methods to overcome improper use. METHODS: Five pediatric resuscitators were tested under conditions simulating normal lungs, lungs with moderately decreased compliance, and lungs with poor compliance (0.015, 0.010, and 0.005 L/cm H(2)O, respectively) to determine volumes delivered with proper SIR setup (manometer and pop-off valve closed) and improper SIR setup (manometer or pop-off valve open). RESULTS: With each SIR, an open manometer port or an open pop-off valve (improper setup) led to significant decreases in volume delivered. In normal lung compliance, the proper setup delivered 149 ± 10 cc, vs. 112 ± 12 cc, 106 ± 25 cc, and 90 ± 14 cc (pop-off open, manometer open, and both open, respectively). In poor lung compliance, the proper setup delivered 122 ± 13 cc, vs. 56 ± 10 cc, 70 ± 17 cc, and 44 ± 7 cc (pop-off open, manometer open, and both open, respectively). All differences above are significant (p < 0.0001). CONCLUSIONS: In a normal lung, the volumes delivered by SIRs are significantly decreased with the pop-off valve and manometer port open. Proper set-up of the SIR becomes even more important when lung compliance is poor.

Successful implementation of a family and patient activated rapid response team in an adult level 1 trauma center.

BACKGROUND: When cardiac arrests occur in hospitalized patients, delays in treatment are associated with lower survival and poorer outcomes. Patients often show a physiological deterioration hours before cardiac or pulmonary arrest. As a result, many hospitals have implemented a rapid response team (RRT) as part of their involvement in the 100,000 Lives Campaign sponsored by the Institute for Healthcare Improvement. METHOD: In conjunction with the University Health System Consortium (UHC) Patient- and Family-Centered Care Implementation Collaborative, Shands Jacksonville Medical Center (SJMC) launched a pilot RRT program in October 2006 followed by campus-wide implementation in July 2007. The program was enhanced to allow patient and family activation of the RRT in October 2007. RESULTS: A review of the first 2 years of data indicates that the SJMC RRT received 25 patient or family activated calls. Forty-eight percent of the calls were initiated by a family member and 52% by the actual patient. Reasons for the calls have varied but the most frequent reason identified by the patient or family member was "something just doesn't feel right" with the patient. Other leading reasons for calls were similar to criteria that are used by staff-initiated calls, such as shortness of breath and pain issues. CONCLUSION: This is one of the first initiations of a family activated component of the RRT in an adult hospital that has led to improvements in outcomes such as reduction in mortality rates and non-ICU codes, without an overload of false positive calls.

Change in rotavirus epidemiology in northeast Florida after the introduction of rotavirus vaccine.

Retrospective analysis done at a children's hospital showed significant decrease in infections and hospitalizations caused by rotavirus in northeast Florida after the introduction of rotavirus vaccines in 2006. The rotavirus season was delayed in onset by 8 months and duration prolonged by 2-3 months in 2008, and no definite season occurred in 2009.

Fall-related pediatric brain injuries: the role of race, age, and sex.

BACKGROUND: Falls remain a major cause of childhood morbidity and mortality. To improve effectiveness of our prevention program, we used our electronic injury surveillance database to analyze patient variables and the incidence of fall-related brain injury. METHODS: The database was queried for all injuries treated in the pediatric emergency department for which the word "fall" was listed as part of the chief complaint. Age, sex, and mechanism variables were cross tabulated for analysis with traumatic brain injury (TBI) codes. RESULTS: Between June 2005 and June 2008, the electronic surveillance system reported 39,718 injury-related visits to the pediatric emergency department. Falls were reported in 3,436 patients (2,107 males, 1,329 females). TBI occurred from falls in 171 patients. Although black children had a higher fall rate (69.24%) than white children (23.75%) and non-black, non-white children (7.01%), white children had the highest TBI rate from falls (9.47%). TBI from falls occurred at a lower mean age for females (5.40 +/- 4.45) than males (6.6 +/- 5.15) and for non-whites (5.98 +/- 4.88) than whites (6.21 +/- 4.93). Multiple logistic regression demonstrated a significant influence of age, race, and sex on the likelihood that a fall results in TBI. Females have a higher risk of TBI from falls than males from ages 0 to 11.5. This runs contrary to previous studies suggesting that toddler males are at highest risk for TBI. CONCLUSION: A disproportionate number of infants, toddlers, and adolescents sustain brain injury from falls. Race and sex group differences mandate enhanced focus on environmental safety and risk-taking behaviors.

The association between health literacy and outcomes of care among epilepsy patients.

PURPOSE: To determine the association between health literacy and outcomes of care (seizure control and quality of life) in individuals with epilepsy followed at a level four epilepsy center. METHODS: We conducted a face-to-face interview of patients seen at the Comprehensive Epilepsy Program of the University of Florida HSC/Jacksonville. We obtained demographic and clinical data, administered the Quality of Life in Epilepsy-10 inventory, and performed the Liverpool Seizure Severity Scale. We asked three screening questions taken from the Short Test of Functional Literacy in Adults. Using each health literacy question as the target variable we determined the predictor variables that were associated with responses to these questions and performed multiple linear regression to determine those that retained their significance. RESULTS: One hundred and forty adult patients with epilepsy comprised the study population. On univariate analysis, patients who did poorly on questions for health literacy that included "difficulty reading hospital materials" and "difficulty filling out medical forms" had lower scores on the QOLIE-10 and lower annual household incomes. This significance was maintained on multivariate analysis. Those who had problems learning about their medical condition due to difficulties understanding written information had poorer scores on the QOLIE-10, increased seizure frequency, and lower educational levels on univariate analysis. However, on multivariate analysis, only poorer scores on quality of life were independently significant. CONCLUSION: Patients with epilepsy who have limited health literacy do not necessarily have poorer seizure control but have lower quality of life scores.

A multi-method assessment of satisfaction with services in the medical home by parents of children and youth with special health care needs (CYSHCN).

OBJECTIVE: To assess satisfaction of parents of children with special health care needs with treatment by office staff, communication with the pediatrician, involvement in decision-making and coordination of services outside the practice. PATIENTS AND METHODS: We used a mixed-method (qualitative and quantitative) approach to collect parental perceptions of the Medical Home services provided by their pediatricians. Six practices were selected to participate in the study based on geographic and patient demographic characteristics. In total, 262 (75% response rate) families completed surveys, and 28 families of these participated in focus groups. The Family Survey collected information (corroborated and enriched with focus group interviews) on parent and child demographics, severity of the child's condition and the burden on parents. We assessed parental satisfaction with treatment by office staff, communication with the pediatrician, involvement in decision-making, and connection to services outside the practice. Survey responses were analyzed using SAS with all associations considered significant at the P < 0.05 level. Focus groups were recorded, transcribed into EZ-Text and analyzed by a team of three researchers to identify patterns and themes inherent in the data. RESULTS: Families reported in focus group interviews that they experienced significant stress due to the demands of caring for a child with special health care needs. Overall, only a small percentage of families reported being dissatisfied with their treatment by office staff (13-14%), communication with the pediatrician (10%), and involvement in decision-making (15-16%). However, a majority of families (approximately 58%) were dissatisfied with the ability of the pediatrician and his/her office to connect the families with resources outside the pediatric office. Families whose children had more severe conditions, or whose conditions had more of an impact on the families, reported being less satisfied with all aspects of communication and care coordination Families of youth with special health care needs (>12 years of age) were less satisfied than families of younger children with the practice's ability to connect them to resources outside the practice. CONCLUSIONS: Both the focus groups and surveys demonstrated that families of children with special needs are under very significant stress. Pediatricians must become better equipped to identify and communicate more proactively with families of CYSHCN that are experiencing significant parent burden. Pediatricians and their staff also need to improve their knowledge of community resources and proactively make referrals to community services needed by families of CYSHCN.

Implementation of possession laws and the social ecology of tobacco control.

The objective of this evaluation research was to assess the impact of programs intended to support the enforcement component of a comprehensive youth tobacco control. The research method was a survey of a randomly stratified cluster sample of law enforcement officers. Results of the evaluation showed that the enforcement behaviors of officers were increased through the state programs to support tobacco enforcement activities. The study showed that support for implementing a policy is important to achieve the objectives of a policy. The results of a study of the enforcement component of a Florida tobacco control program are reported and discussed within the ecological context of previously reported enforcement-linked decreases in youth tobacco use and funding and defunding of the Florida Tobacco Control Program.

Influenza vaccine: awareness and barriers to immunization in families of children with chronic medical conditions other than asthma.

OBJECTIVES: Children with chronic medical conditions (CMCs) are considered to be at increased risk for influenza and its related complications. Despite this, influenza immunization rates in the United States for children with CMCs in the primary care setting remain between 7-10%. This was a survey study looking at the barriers to influenza immunization among children with CMCs other than asthma. We examined caregiver knowledge and perceptions regarding influenza vaccine in addition to assessing other barriers, such as availability and perceived safety of the vaccine. METHODS: The study was conducted during the fall-winter influenza seasons of 2002-2003 and 2003-2004 at five academic institutions across the southeastern US. Convenience samples of 100-150 families attending pediatric subspecialty clinics were surveyed. RESULTS: A total of 794 surveys were completed. Controlling for disease, failure to recommend vaccination was significantly associated with failure to get the vaccine (P < 0.0001). Of the children who did not receive the vaccine, 61% of their parents believed that the vaccine itself could give influenza, 54% cited other safety concerns, and 30% thought it did not work. Among vaccine recipients, 163 (43%) reported that the primary care provider had given the vaccine, whereas 171 (45%) reported that the vaccine had been given at the subspecialty clinic. CONCLUSION: This study highlights the importance of physician recommendation, as well as parental education, as some of the key elements crucial to the receipt of influenza vaccination in children with CMCs.

Randomized comparison between traditional and traditional plus interactive Web-based methods for teaching seizure disorders.

BACKGROUND: Teaching seizure disorders requires use of multiple formats including pictures and videos. Web technology permits combination of formats and interactive features to deliver information. PURPOSE: The purpose of this study was to determine the benefits of incorporating Web-based interactive methodology into a neurology clerkship to enhance the teaching about seizure disorders to 3rd-year medical students. METHODS: A Web-based interactive program was created and administered by the University of Florida blackboard. A multiple-choice questionnaire about epileptic disorders was utilized to assess the degree of learning. Participants were randomized to a Web group or control. Twenty-two students in each group were enrolled. The control group was assigned to a traditional written material. In the Web study group 4 students failed to complete the test. RESULTS: The Web group obtained better scores on Multiple Choice Questionnaire than the control group (p = .03). CONCLUSIONS: This small study suggests that an interactive format using Web technology enhances learning about seizure disorders, perhaps by stimulation of critical thinking and promoting greater student motivation.

Factors associated with utilization of healthcare resources among epilepsy patients.

PURPOSE: To determine those variables associated with utilization of healthcare resources in epilepsy patients. METHODS: We interviewed 256 epilepsy patients. Target variables included the number of clinic visits, ER visits and in-patient admissions over the past year and AEDs currently being used. Predictor variables were age, race/ethnicity, marital status, education, income, insurance, seizure frequency and QOLIE-10 results. We used univariate analysis to determine those factors associated with the target variables and multivariate analysis to ascertain those independently significant. RESULTS: On univariate analysis, higher seizure frequency and poorer QOLIE-10 scores were associated with the number of clinic visits, ER visits and in-patient admissions. Increased seizure frequency and male gender were associated with higher use of AEDs. Using ordinal logistic regression, QOLIE-10 scores was the only variable associated with the number of clinic visits. Both seizure frequency and QOLIE-10 scores were independently associated with the number of in-patient admissions while seizure frequency and male gender remained independently associated with AED use. Using binary logistic regression, QOLIE-10 scores and seizure frequency were independently associated with the number of ER visits. CONCLUSION: Seizure frequency and quality of life are major factors associated with utilization of healthcare resources in epilepsy patients.

A systematic review of outcomes in patients with staged carotid artery stenting and coronary artery bypass graft surgery.

BACKGROUND AND PURPOSE: Although current guidelines state that carotid endarterectomy is probably recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with carotid stenosis, significant controversies to this recommendation still persist. Carotid artery stenting has been recently introduced as an alternative revascularization modality in high-risk patients. The aim of this study was to define, based on the published information, if carotid artery stenting is beneficial in this setting. METHODS: A search of MEDLINE and a manual search of the literature from selected articles were performed. A total of 6 studies with 277 patients reporting carotid stenting followed by staged CABG were available for this clinical outcome analysis. All were retrospective and single-center studies. RESULTS: The mean age was 69 years; 78% were males. Asymptomatic carotid stenosis was present in 76% of patients. The mean time to CABG was 32 days. The incidence of stroke and death associated with the stent procedure was 4.7%. Only 6 patients (2.2%) developed stroke associated with CABG. The overall combined 30-day event rate after CABG, including all events during carotid artery stenting, were as follows: minor stroke, 2.9%; major stroke, 3.2%; mortality, 7.6%; and combined death and any stroke, 12.3%. CONCLUSIONS: In this pooled analysis, the combined incidence of death and stroke in patients undergoing carotid artery stenting and staged CABG remains elevated. These results confirm that the presence of carotid stenosis is per se a marker of risk that might persists independent of its treatment. A systematic or randomized evaluation appears warranted.