Continuous Video Electroencephalographic (EEG) Monitoring for Electrographic Seizure Diagnosis in Neonates: A Single-Center Study.

The objective of this study was to determine the diagnostic yield of continuous video electroencephalographic (EEG) monitoring in critically ill neonates in the setting of a novel, university-based Neonatal Neurocritical Care Service. Patient demographic characteristics, indication for seizure monitoring, and presence of electrographic seizures were obtained by chart review. Among 595 patients cared for by the Neonatal Neurocritical Care Service, 400 (67%) received continuous video EEG. The median duration of continuous video EEG monitoring was 49 (interquartile range = 22-87) hours. Electrographic seizures were captured in 105 of 400 (26% of monitored patients) and of those, 25 of 105 (24%) had no clinical correlate. In addition, 52 of 400 subjects (13%) were monitored due to paroxysmal events concerning for seizures, but never had electrographic seizures. Continuous video EEG monitoring helped confirm or rule out ongoing seizures in more than one-third of the cases. This finding helps to support the use of continuous video EEG in critically ill neonates.

Video-EEG monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.

BACKGROUND: Therapeutic hypothermia (TH) is becoming standard of care in newborns with hypoxic-ischemic encephalopathy (HIE). The prognostic value of the EEG and the incidence of seizures during TH are uncertain. OBJECTIVE: To describe evolution of EEG background and incidence of seizures during TH, and to identify EEG patterns predictive for MRI brain injury. METHODS: A total of 41 newborns with HIE underwent TH. Continuous video-EEG was performed during hypothermia and rewarming. EEG background and seizures were reported in a standardized manner. Newborns underwent MRI after rewarming. Sensitivity and specificity of EEG background for moderate to severe MRI brain injury was assessed at 6-hour intervals during TH and rewarming. RESULTS: EEG background improved in 49%, remained the same in 38%, and worsened in 13%. A normal EEG had a specificity of 100% upon initiation of monitoring and 93% at later time points. Burst suppression and extremely low voltage patterns held the greatest prognostic value only after 24 hours of monitoring, with a specificity of 81% at the beginning of cooling and 100% at later time points. A discontinuous pattern was not associated with adverse outcome in most patients (73%). Electrographic seizures occurred in 34% (14/41), and 10% (4/41) developed status epilepticus. Seizures had a clinical correlate in 57% (8/14) and were subclinical in 43% (6/14). CONCLUSIONS: Continuous video-EEG monitoring in newborns with HIE undergoing TH provides prognostic information about early MRI outcome and accurately identifies electrographic seizures, nearly half of which are subclinical.

Depression, disease severity, and sickle cell disease.

The present study examined depressive symptomatology in 440 adults with sickle cell disease (SCD). Participants completed the Center for Epidemiologic Studies--Depression scale (CES-D) as part of their yearly routine visits to the Duke University--University of North Carolina Comprehensive Sickle Cell Center. They also completed questions regarding demographics, disease severity, pain, and health care use. Data analyses revealed that the percentage of patients with SCD exhibiting significant depressive symptomatology dropped from 43 to 18% when a more stringent cutoff was used on the CES-D, suggesting that future studies should determine the most valid cutoff score for identifying depression in patients with SCD. Gender and family income were positively and significantly associated with depressive symptomatology. Also, patients who reported more frequent painful episodes were more likely to report depressive symptoms. Implications for assessment and treatment of depression in adults with SCD are discussed.

Educational preparation for contemporary health care social work practice.

Health and health care delivery continue as dominant domestic issues in the United States. Health also represents a highly sophisticated social work practice area, requiring specific expertise for intervention with complex biopsychosocial patient care issues. Current social work curriculum content must reflect contemporary practice issues and educational resources must be improved to meet the documented need for adequately prepared health care professionals. This paper proposes a curriculum template for practice education and offers additional recommendations to enhance the educational process through increased field and academic collaboration.

The sickle cell mutual assistance movement.

The purpose of this paper is to describe the mutual help movement that is occurring in the sickle cell community. As sickle cell disease primarily affects African Americans in the United States, the research can show how mutual assistance groups are proliferating among this group of individuals. The study will provide the only qualitative analysis of mutual assistance groups known to exist that are primarily comprised of African Americans. In addition, demographic information on the leaders of these groups will be reported. This information can serve to educate individuals interested in forming mutual assistance groups for individuals affected by sickle cell disease. It is hoped that this information will broaden the perspective of mutual assistance groups and will illustrate that mutual assistance groups also serve diverse cultures in this country.

Sickle cell mutual assistance groups and the health services delivery system.

One of the main reasons individuals with sickle cell disease (SCD) join self-help groups is to address the problems they perceive in the health care delivery system, such as long delays in hospital emergency departments, inadequate training of health care workers about SCD, and frequent accusations of drug-seeking behavior. This formative evaluation study surveyed the leaders of 11 self-help groups which are attempting to make changes in the health care system, representing 8% of the 134 known SCD self-help groups. The group leaders reported the problems their groups perceived in health care delivery, the obstacles they encountered in trying to make changes in the system, and the approaches they employed in addressing the perceived problems. This study shows that, in educating themselves and others about the experience of SCD, the members of the groups have taken a pro-active role in their own health care which gives them a sense of empowerment that they would not otherwise have. The activism of the SCD self-help groups is also helping to redefine the traditional relationship between patient and provider, and it signals an emerging new role for self-help groups in general.

A psychosocial perspective. Growing up with thalassemia, a chronic disorder.

Thalassemia influences individual and family psychosocial functioning. Parental reaction to diagnosis affects the parent-child relationship, parents' roles, and family resources for coping. A child frequently translates parental reactions into personal attitudes of dependency and lowered self-esteem. In coping with one child's disease, parents often sacrifice the needs of other siblings. Attainment of optimal development may be promoted or hindered. As the child's environment widens, negative attitudes may be reinforced. Poor school performance due to absenteeism, physical differences that lead to teasing, and limitations imposed by others may be interpreted by the child as personal inadequacy. Such feelings often persist through adolescence due to the individual's lag in physical growth, marginal academic record, poor self-concept, and/or pessimistic outlook on life. The central psychosocial issues of late adolescence and young adulthood--career, vocation, dating, marriage--are compounded by the perspective of institutions and potential employers. Different periods of the life cycle are vulnerable to specific psychosocial problems.

Neuropsychologic and academic functioning of children with sickle cell anemia.

This study compared neuropsychologic test results and academic functioning among 28 school-age children with sickle cell anemia (SCA), and 28 healthy, age-, sex-, and socioeconomically matched black peers followed at a tertiary care center. Children with SCA scored significantly lower on reading and spelling achievement scores than healthy matched peers. Also, older children with SCA performed significantly less well on tests of visual-motor and attention skills than younger children with SCA. These results were unrelated to most measures of physical illness severity. The data suggest that sickle cell anemia may be associated with subtle neuropsychological and learning deficits that can contribute to decreased school performance.

Developing roles for macro practitioners within the health field.

The authors examine and describe a department of social work in a university teaching hospital where macro practitioners and students are introduced into service delivery areas at the line level. This new role for macro practitioners promotes generic practice through which both macro and micro skills can be utilized without compromising one for the other. The introduction of macro practitioners into the Department of Social Work has improved the department's status within the hospital, the school of social work, and the community.

Issues for hospitals in educating social work students for social work practice in health care settings.

Conflicting values and issues emerge when hospital and professional school converge to educate the next generation of the profession. These values derive from issues of authority, responsibility, accountability, status, communication, and mutuality. This paper identifies their occurrence, describes a method for managing them, and delineates a hospital social work department's role in developing an educationally based, practice focused practicum site. The components and results of the relationship between the department and the school, including details of the practicum model, are discussed.

Overview of humanistic progress in sickle cell anemia during the past 10 years.

Humanistic progress in sickle cell anemia over the past 10 years is described, with a focus on individual, institutional, and societal progress. Accessibility, acceptability, and accountability are examined for humanistic progress in medical care, counseling, education, support services, and public education. Specific dimensions of humanistic progress are noted, including career development, work with schools and employers, establishment of tutorial programs, retraining of health care providers, utilization of the team concept, and increasing awareness of this disease. Constraints, such as funding patterns and the political climate, will be considered as part of the challenge for the next decade. A frame of reference is suggested for meeting the challenges ahead for further humanistic progress.