Long-term survival after epilepsy surgery compared with matched epilepsy controls and the general population.

This study evaluates if there was a difference in long-term survival between epilepsy surgery patients, individually matched controls with intractable epilepsy, and controls from the general population. In a cohort study, we compared the survival of patients operated with epilepsy surgery in Norway 1948-1988 with: (1) a control group with prolonged medical treatment for intractable epilepsy individually matched for age, gender, and seizure type (n = 139), and (2) expected mortality for matched individuals in historical cohorts of the general population (n = 196). Survival was compared using Kaplan-Meier curves and stratified proportional hazards analysis. After on average 25 years of observation after surgery, there was no difference in survival between the epilepsy surgery group and the controls with intractable epilepsy (p = 0.18). The risk ratio for death after epilepsy surgery was 0.6 (95% CI 0.4-1.1; p = 0.08) compared with the control group. However, survival of epilepsy surgery patients was lower than that of a matching general population (p < 0.001), with a risk ratio for death of 6.2 (95% CI 3.1-12.6; p < 0.001). In this long-term study of a national cohort of epilepsy surgery patients, we found no beneficial effect of epilepsy surgery on survival compared with a control group of medically treated patients with intractable epilepsy. The mortality after epilepsy surgery was higher than expected in the general population.

The Patient Experiences Questionnaire: development, validity and reliability.

OBJECTIVE: . To describe the development of the Patient Experiences Questionnaire (PEQ) and to evaluate reliability and validity of constructed summed rating scales. DESIGN: Literature review, focus groups and pilot surveys. Two national cross-sectional studies performed in 1996 and 1998. SETTING: Two postal surveys in a national sample of 14 hospitals stratified by geographical region and hospital size. Subjects. Patients consecutively discharged from surgical wards and wards of internal medicine. The surveys included 36 845 patients and 19 578 responded (53%). RESULTS: We constructed 10 summed rating scales based on factor analysis and theoretical considerations: Information on future complaints, Nursing services, Communication, Information examinations, Contact with next-of-kin, Doctor services, Hospital and equipment, Information medication, Organization and General satisfaction. Eight scales had a Cronbach alpha coefficient of >0.70, the remaining two were >0.60. Repeatability was >0.70 for five scales and >0.60 for the remaining scales. CONCLUSIONS: The PEQ is a self-report instrument covering the most important subjects of interest to hospital patients. Results are presented as 10 scales with good validity and reliability. It emphasizes practicability and comprehensibility while at the same time providing sufficient information about domains applicable to most patients admitted to medical and surgical wards.