CHAPTER III
METHODOLOGY
This study was conducted to assess the adherence pattern to antiepileptic regimen among patients with epilepsy and to identify the socio demographic, clinical and patient related factors associated with the adherence pattern to antiepileptic regimen.
Research Design Cross sectional survey design was adopted for the study.
Setting of the Study The study was conducted in Jawaharlal Institute of Post graduate medical Education and Research (JIPMER) a tertiary care hospital, an Institute of National Importance under the Ministry of Health and Family Welfare, Government of India. JIPMER is a tertiary care hospital with a daily average number of out-patient attendance of 6247 and total number of yearly patient admission
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The clinical data sheet included duration of epilepsy, type of epilepsy, frequency of seizure, co-morbidity, complexity of treatment, medication frequency, side-effects, and family history of epilepsy.
• Section C: Assessment of the Patient related factors such as lifestyle, social support and patient-prescriber relationship by using Rating Scale.
• Section D: Assessment of the Behavioural factors such as knowledge, belief and attitude by using Questionnaire consisting of 30 questions.
Validity and Reliability: The questionnaire to assess the determinants of antiepileptic medication adherence was developed by the investigator from literature search. The tool and was validated by 4 experts, two medical experts from Neuromedicine department and two nursing experts. According to the suggestions of the experts, modifications were done on the
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Pre testing of the tools were done in 20 epilepsy patients and found that the languages used in the tools were clear, simple and unambiguous. They were able to understand and respond to the items in the tools. The reliability of the questionnaire was 0.80 and it was calculated using test-retest method.
Data collection procedure
• The study was approved by JIPMER Scientific Advisory Committee and Institute Ethics Committee.
• Patients who fulfilled the inclusion criteria were selected through convenience sampling technique. Once in a week (every Monday), 12-15 subjects per day were interviewed.
• Structured interview and record review were carried out after explaining purpose of the study and getting informed consent from the participant.
• Good interpersonal relationship was maintained with the patients.
• It was a one-time data collection requiring 30-40 minutes per patient.
Data Analysis Both descriptive and inferential statistics were used for analysis of data. Descriptive statistics (mean, standard deviation, frequency and percentages) were used to describe the clinical and demographic variables of study participants. The determinants of medication adherence were analyzed using Chi-Square test and Independent Student T Test.
Pilot
So, Lia was getting the wrong dosage of medications or not even getting medications. The doctors wanted to check her blood to know whether the medications were actually helping her or not. But they have realized that Lia’s mother has been lying or confused about how she administered the medications to her throughout this time (Guerrero et al, 2002). The next time Lia had a grand mal seizure; her parents blamed it on all the medications that were prescribed to
Anne Fadiman’s book, The Spirit Catches You and You Fall Down, explicitly illustrates the cultural divide between a Hmong family, the Lees, and the physicians treating their daughter, Lia Lee, at the Merced Community Medical Center. Lia first begins to experience seizures when she is about three months old. This is initially when the conflict arises between the physicians and the Lees. In contrast to Lia’s Western medicine diagnosis of epilepsy, her parents interpret epilepsy, or quag deb peg in the Hmong language, as both a serious and dangerous disease and a sign of distinction, indicating that she could potentially become a shaman (Fadiman 20-21). On the other hand, the physicians are continuously trying to prevent and treat Lia’s seizures,
In Lia’s case a “soul-calling ritual,” takes place in order to restore life into her soul. As for Epilepsy, would be treated by a doctor and different medications would
The guidelines were developed by reviewing published meta- analysis and systematic reviews making it the strongest evidence however, the method used to formulate the recommendations was that of a level I to an expert consensus which is a level IV. The guidelines were validated by an external peer review. All recommendations for this guideline was tagged by the level of evidence and linked with scientific evidence. The limitation that were evident in this study was that its intended users were immediate healthcare providers in the hospital settings and not those in the out- patient healthcare
People of all ages can get it and a significant sign of diagnosing the condition is experiencing two or more seizures in a 24 hour period (“The Epilepsies” 2016). Although there is no cure for epilepsy, the condition can be controlled with anticonvulsants drugs. I personally have prior knowledge to the condition from my AP Biology class. I immediately thought of my senior year of high school, when I first was taught about epilepsy. My friend Nadine showed us a documentary which showed a old man who would suddenly fall out of consicouness during his daily tasks; I remember this documentary very well because it was a scary sight for me
Fourth Experiment Forty-eight children under the age of 18 who had suffered an unprovoked seizure were studied in Lung-Chang’s experiment. Exclusion criteria included current “neurodegenerative” ailments and absence of epileptic discharges. Parents and legal guardians of the children were asked for permission to included their child in the experiment. This study was conducted at the Kaohsiung Medical University Hospital. The subjects were randomly placed in treatment and control groups using computer generated group lists.
The importance of preventing and managing chronic diseases, which include renal failure and cardiovascular diseases, along with their risk factors are emphasized by the Department of Chronic Disease and Health Promotion of the World Health Organization (Desroches, Lapointe, Ratté, Gravel, Légaré, & Turcotte, 2013). However, there is evidence in literature showing a gap of knowledge in the kinds of educational interventions being considered as most effective in compliance to dietary regimen. The study by Desroches et al., 2013 states that there are limitations to their study including that being a short duration, low quality and adherence measures varied widely (Desroches et al., 2013) Hence, these limitations assisted in the generation of research questions, which are: 1) Which educational interventions being used show reliability in compliance or adherence to dietary regimen; 2) What are the detrimental factors contributing to low compliance to dietary regimen among patients with ESRD and CHF; and 3) Can a study performed in a longer length of time produce a higher rate of compliance to dietary regimen among patients with ESRD and
Non-adherence is a problem that has many determinants and health professionals, the health care system, the community and the patients must share the responsibility for adherence. Various dimensions affecting on adherence figure (21), and these have been grouped into the five dimensions through two main factors, are: 1- Medical factors: three medical factors face the patient to affecting on to health therapy: a. Therapy related factors: Many therapies-related factors affect adherence. Most notable are those related to the complexity of the medical regimen, duration of treatment, previous treatment failures, frequent changes in treatment, the immediacy of beneficial effects, side-effects, and the availability of medical support to deal with
Introduction: Delirium is a clinical syndrome characterized by an acute impairment of cognitive and perceptual function, and also an alteration in consciousness and attention. The onset of delirium is sudden, often within a few hours or days, and confusion tends to fluctuate during the course of the day. Moreover to confirm a diagnosis of delirium, there should be evidence that this disturbance is caused by the direct physiopathological consequence of a general medical condition.[1] They are different types of delirium: the hyperactive form, characterized by agitation and aggressiveness, the hypoactive delirium, with reduced psychomotor activity and lethargy symptoms, and the mixed form with alternating episodes of hyperactive and hypoactive
In the same way, Kinley (2004, cited in Courtney, 2006) and supported by Nuttall and Rutt-Howard (2011) who acknowledged that it has been a big hindrance to agree CMP with GPs as an implementation of supplementary prescribing is requiring more time which is greater than the advantages of Supplementary prescribing. Furthermore, Courtney (2006) states that for successful implementation of supplementary prescribing, good interprofessional relationships and team working is necessary. In the author’s opinion that Supplementary Prescribing is not that expanded this can be either because of GP are reluctant or because many supplementary prescribers have chosen their role as a non medical prescriber to take the independent
Neuropsychological testing All data were collected in at the Institute of Technology and Advanced Bioimaging (ITAB). To get a comprehensive neuropsychological
Proper sample size was used and the trial duration was long enough to capture the characteristics of
RCT involves the random allocation of participants between experimental groups, whose members receive the treatment or other intervention, and control group whose members receive a standard or placebo treatment. Also, it is a gold standard in testing the efficacy of an intervention (UCL, 2011). To commence the article assessment is the view of the abstract. The heading and abstract of the study was well outlined, concise and focused on the sample population, methodology, data analysis as well as the result of the study.
The up and coming technology in the realm of neuropsychology is allowing clinicians to “use various technologies to improve the efficiency, reliability, and cost-effectiveness of neuropsychological assessment” according to the US National Library of Medicine. This also means that many of the tests can be administered without the direct supervision of a clinician, which allows for patients to be diagnosed and treated faster. The increase in the use of technology also has many other benefits for neuropsychological testing. According to Laura Rabin the “advantages attributed to computerized methods (e.g., standardization, large-scale screening, measurement of performance attributes inaccessible by traditional means) enhance prospects for growth” in the industry and this means that now neuropsychological research will become easier and more efficient as this technology is more widely
Parents role about Triggering factors:- Triggering factors should be evaluated during the management of children with epilepsy. Future studies may consider empowering patients with avoidance strategies and self-control techniques done (Balamurugan et al., 2013). The parents may intervene to identify the triggering factors and make changes in the environment that may prevent or decrease seizure frequency. (Hockenberry and Wilson, 2009).