Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures.

BACKGROUND AND OBJECTIVES: Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures. METHODS: We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently. RESULTS: We enrolled 475 of 625 (76%) eligible patients. Of 354 patients for whom cranial MRI or CT scans were obtained in the ED or within 4 months of the ED visit, 40 (11.3%; 95% confidence interval [CI]: 8.0-14.6%) had clinically relevant intracranial abnormalities, with 3 (0.8%; 95% CI: 0.1-1.8%) having emergent/urgent abnormalities. On logistic regression analysis, a high-risk past medical history (adjusted odds ratio: 9.2; 95% CI: 2.4-35.7) and any focal aspect to the seizure (odds ratio: 2.5; 95% CI: 1.2-5.3) were independently associated with clinically relevant abnormalities. CONCLUSIONS: Clinically relevant intracranial abnormalities occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most children do not require neuroimaging in the ED. Findings on patient history and physical examination identify patients at higher risk of relevant abnormalities.

Interobserver agreement in the assessment of clinical findings in children with first unprovoked seizures.

OBJECTIVES: Variables used in prediction rules and clinical guidelines should show acceptable agreement when assessed by different observers. Our objective was to determine the interobserver agreement of patient history and physical examination variables used to assess children undergoing emergency department (ED) evaluation for a first seizure not provoked by a known precipitant such as fever or trauma (ie, an unprovoked seizure). METHODS: We conducted a prospective cohort study of children aged 28 days to 18 years evaluated for unprovoked seizures at 6 tertiary care EDs. We excluded patients if previously evaluated for a similar event. Two clinicians independently completed a clinical assessment before neuroimaging. We determined agreement for each clinical variable by using the unweighted κ statistic. RESULTS: A total of 217 paired observations were analyzed; median patient age was 53.5 months, and 38% were younger than 2 years. Agreement beyond chance was at least moderate (κ ≥ 0.41) for 21 of 31 (68%) variables for which κ could be calculated. κ was ≥0.41 for 7 of 11 (64%) general history variables, all 8 seizure-specific history variables (including seizure focality), and 6 of 12 (50%) physical examination variables. Agreement beyond chance was substantial or better (κ ≥ 0.61) for 2 of 11 (18%) general history variables, for 5 of 8 (63%) seizure-specific history variables, and for 2 of 12 (17%) physical examination variables. CONCLUSIONS: For children with first unprovoked seizures evaluated in the ED, clinicians frequently assess findings from seizure-specific history with substantial agreement beyond chance. Those clinical variables that have been associated with the presence of intracranial abnormalities and show reliability between assessors, such as seizure focality and the presence of any focal neurological finding, may be more useful in the ED assessment of children with first unprovoked seizures.

Assessing the impact of a study skills programme on the academic development of nursing diploma students at Northumbria University, UK.

BACKGROUND: The Government's nursing recruitment campaign has widened access for those wishing to enter the profession, resulting in some students entering university with clinical experience but little experience of academic writing or using libraries. For these students, the library and study advice staff have an important role to play in helping them acquire appropriate information literacy and study skills. OBJECTIVE: To evaluate the impact of workshops supplementing online instruction in study skills on students' study and writing skills, and level of information literacy. METHODS: A small group of pre-registration nursing students identified as needing support with information literacy and study skills participated in focus groups to identify areas of concern, and were offered four remedial workshops. A follow-up focus group explored whether the students' needs had been addressed. Further evaluation of the workshops' impact was completed by diagnostic testing within the University's information literacy programme, Skills Plus. OUTCOMES: The results showed that all students who attended at least one workshop improved their academic grade in their next assignment. Qualitative data indicated that the students' confidence level and information literacy, including referencing skills, had improved. CONCLUSION: Evaluating the impact of this intervention has provided the evidence to demonstrate the value of this additional support.

Distance learning in post-qualifying nurse education.

There has been a prolific development of distance education in nursing during the previous decade. This has not been supported by an increase in research activity to generate the knowledge that is required to support these developments. In response to this, within a wider action research approach, a team of academics undertook a study to examine post-qualifying nurses' experiences of distance learning, and the impact of distance education on lecturing staff. Five teaching modules, delivered through distance learning, were selected for the study using a matrix sampling technique. Data collection took place at key points during these modules: at the commencement of study students and lecturers were asked to maintain a diary account of their experiences, students were sent questionnaires at the mid point of the module ( n=115, 30.4% return rate), and at the end of the module the students and lecturers participated in one of nine group interviews (students =15; LECTURERS = 15). Findings suggest that distance education is an effective learning medium that enables students to balance learning with personal and work commitments. Students and lecturers face a transitional period when embarking on distance education and this involves the development of new understandings and skills to successfully adapt to this approach to education.