Ketamine reduces seizure and interictal continuum activity in refractory status epilepticus: a multicenter in-person and teleneurocritical care study.

BACKGROUND: There is not a preferred medication for treating refractory status epilepticus (RSE) and intravenous ketamine is increasingly used. Ketamine efficacy, safety, dosage, and influence of other variables on seizure cessation while on ketamine infusions are not well studied. We aimed to characterize ketamine effect on RSE, including interictal activity on electroencephalogram (EEG) and when done by Teleneurocritical care (TNCC). METHODS: We conducted a multicenter, retrospective study from August 2017 to October 2022. Patients 18 years or older who had RSE and received ketamine were included. The primary outcome was effect of ketamine on RSE including interictal activity; secondary outcomes were effect of other variables on RSE, care by TNCC, ketamine infusion dynamics, adverse events, and discharge outcomes. Logistic regression was used. RESULTS: Fifty-one patients from five hospitals met inclusion criteria; 30 patients had RSE and interictal activity on EEG. Median age was 56.8 years (IQR 18.2) and 26% had previously diagnosed epilepsy. Sixteen (31%) patients were treated virtually by TNCC. In those with RSE on EEG, ketamine was added as the fourth antiseizure medication (mean 4.4, SD 1.6). An initial bolus of ketamine was used in 24% of patients (95 mg, IQR 47.5), the median infusion rate was 30.8 mcg/kg/min (IQR 40.4), and median infusion duration was 40 h (IQR 37). Ketamine was associated with 50% cessation of RSE and interictal activity at 24 h in 84% of patients, and complete seizure cessation in 43% of patients. In linear regression, ASMs prior to ketamine were associated with seizure cessation (OR 2.6, 95% CI 0.9-6.9, p = 0.05), while the inverse was seen with propofol infusions (OR 0.02, 95% CI 0.001-0.43, p = 0.01). RSE management by in-person NCC versus virtual by TNCC did not affect rates of seizure cessation. CONCLUSIONS: Ketamine infusions for RSE were associated with reduced seizure burden at 24 h, with 84% of patients having 50% seizure reduction. Similar efficacy and safety was observed irrespective of underlying RSE etiology or when done via TNCC vs in-person NCC.

Using the health belief model to assess the impact of student pharmacist-led health outreach events.

INTRODUCTION: This study sought to assess the impact student pharmacist-led health outreach events had on participants in the Health Belief Model domains of perceived severity of disease, perceived barriers, perceived benefits, and self-efficacy. METHODS: This study was an observational pre-/post-survey design conducted between January and December 2019 at student pharmacist-led community health outreach events in the Salt Lake City, Utah metropolitan area. The survey was developed partially based on the Health Belief Model and consisted of seven items with a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). The survey was completed by participants before and immediately after engaging in the outreach event. RESULTS: A total of 31 participants across a variety of demographics and educational backgrounds completed the study. The surveys from the outreach events showed statistically significant increases in the participants' perceived severity of disease, perceived barriers, and self-efficacy. Perceived benefits was not significantly changed. CONCLUSIONS: Student pharmacist-led community health outreach events significantly increase participants' perceived severity of disease, perceived barriers, and self-efficacy, which may indicate increased willingness to adopt the recommended health behavior.