Home testing and monitoring for epilepsy - Available in the Houston Area ..and now in London.

A hospital in London is pioneering a home diagnosis test and monitoring for epilepsy. This is described as a first of its kind. 

But, as an epilepsy specialist, I noted the value and convenience of such a service. My pediatric neurology practice has been offering home EEG service for the Houston area a number of years. 

-JR

A London hospital is the first in Britain to pioneer home testing for epilepsy patients.

The brain-scanning service rolled out by King’s College Hospital NHS Foundation Trust will benefit hundreds of people who suffer devastating seizures, and improve treatment.

Home monitoring allows patients to carry on with daily life without the disruption of days in hospital — it is also thought to be a more accurate method.

The service is called Home Video Telemetry and the patient wears a special head device fitted with electrodes which records brain activity over several days.

A video camera also captures the physical seizures. A technician visits the patient’s home and collects the data on a daily basis which is analysed by a consultant.  Epilepsy affects about 600,000 people in the UK including more than 60,000 children. The condition affects the brain and causes multiple seizure attacks in severe cases. Brain scanning is crucial for doctors to diagnose patients with suspected epilepsy correctly and provide them with tailored treatment.

Hospital checks have been the gold standard until now for those who suffer multiple attacks. However, other NHS trusts are now expected to adopt home testing following the success of pilots by King’s. It comes as new research reveals that testing epilepsy patients in hospital may produce biased results. Dr Franz Brunnhuber at King’s has carried out work revealing that people are about half as likely to experience seizures in hospital than at home.

The consultant clinical neurophysiologist said this can make it difficult for doctors to determine the exact nature of a patient’s condition.

He added: “Misdiagnosis is a major problem with epilepsy because there are lots of conditions which mimic the disorder so it’s crucial to capture seizure attacks accurately. The home service is more convenient for patients. Hospital is a huge stress factor for them. Home testing means patients can lead a normal life.”

Read more here

What are the NFL players being told about concussions by their own Players' Association?

I think its fascinating that the teams have physicians but that the Players' Association is advocating the use of IMPARTIAL specialists: neurologists. JR


What is a concussion?

A concussion is a type of brain injury. It occurs when the brain moves quickly enough to interrupt its function. Most concussions result in full recovery, but some can lead to more severe injuries if not recognized and treated properly.

The source of the injury is not always clear. It can come from a blow to the head or even from a blow to the body. It can come from one big hit  or from several smaller ones.

You may not always be aware that you are concussed. It is common that  concussed people do not know they are injured. Look out for the health of your teammates. Be aware of these signs and symptoms in yourself  and fellow players:
What is interesting is that the NFL plaers' association is teaming up with neurologists (the American Academy of Neurologists)


WHAT IS A CONCUSSION?

• Disorientation or confusion
• Memory loss
• Behavior or personality change
• Trouble concentrating
• Feeling sleepy or groggy
• Sensitive to light or sound
• Dizziness or nausea
• Headache

If you or a teammate have any of these symptoms, tell your medical staff immediately. Trying to play with a concussion puts  you at serious risk for further injury
.
WHAT SHOULD I EXPECT FROM MY TEAM?

IMMEDIATE EVALUATION OF A SUSPECTED CONCUSSION.
If a concussion is suspected (in either a game or practice), you should
be evaluated immediately. There is an NFL protocol for this evaluation
that can be done in under 10 minutes. If you think you may have a
concussion, report your symptoms and request this exam. DO NOT
TRY TO PLAY THROUGH THIS INJURY.


THOROUGH EVALUATION TO DETERMINE PRESENCE OF
CONCUSSION.

Not every hit that causes symptoms is a concussion and  only medical personnel can make the diagnosis. You should be evaluated  with a comprehensive neurological evaluation, ideally in a quiet, distractionfree place.

RETURN TO WORK. If you have a concussion, you should not participate  in a game or practice until you are (1) symptom free at rest and during physical exertion and (2) cleared by your team physician AND the team’s  independent neurological consultant.

 The return to work protocol should
involve several steps of increasing exertion – from a stationary bike, to
jogging, to agility work, to non-contact drills. With each step, a player must
be symptom free to move to the next step. You should never play football
after a concussion if you have not been evaluated appropriately or are still  experiencing symptoms.

WHAT ELSE CAN I DO?

You have the right to a second opinion.

It is your health and your brain. If  you are unsure about your medical condition and/or your medical care,
do not hesitate to seek additional care. There are many experts in sports  concussion that can provide the care you need.

Don’t let any question go unasked. You and your family deserve the best  information. If you would like help getting a second opinion, or have a question, call

What pediatric illnesses provoke readmission? Pediatric Readmission Prevalence & Variability Across Hospitals

What diseases provoked the highest Number

 of  Hospital Re - admissions?

• Seizure

• Bronchiolitis

• Pneumonia

My advice to parents -  Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.

January 23/30, 2013, Vol 309, No. 4 >

Original Contribution | January 23/30, 2013

Pediatric Readmission Prevalence 

and Variability Across Hospitals

Jay G. Berry, MD, MPH; Sara L. Toomey, MD, MPhil, MPH; Alan M. Zaslavsky, PhD; Ashish K. Jha, MD, MPH; Mari M. Nakamura, MD, MPH; David J. Klein, MS; Jeremy Y. Feng, BA; Shanna Shulman, PhD; Vincent K. Chiang, MD; William Kaplan, BS; Matt Hall, PhD; Mark A. Schuster, MD, PhD

JAMA. 2013;309(4):372-380. doi:10.1001/jama.2012.188351.

Text Size: A A A

ABSTRACT

ABSTRACT | METHODS | RESULTS | COMMENT | CONCLUSIONS | AUTHOR INFORMATION| REFERENCES

Importance  Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge.

Objective  To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals.

Design, Setting, and Patients  We analyzed 568 845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and Chronic Condition Indicators. Hospitals with adjusted readmission rates that were 1 SD above and below the mean were defined as having “high” and “low” rates, respectively.

Main Outcome Measures  Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.

Results  The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36 734). Adjusted rates were 28.6% greater in hospitals with high vs low readmission rates (7.2% [95% CI, 7.1%-7.2%] vs 5.6% [95% CI, 5.6%-5.6%]). For the 10 admission diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs low readmission rates. For example, sickle cell rates were 20.1% (95% CI, 20.0%-20.3%) vs 12.7% (95% CI, 12.6%-12.8%) in high vs low hospitals, respectively.

Conclusions and Relevance  Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.

Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.

Study: Concussions Affect Children's Brains After Symptoms Subside

Study shows that concussions continue to affect children after the symptoms go away. Seeking specialty care from a pediatric brain specialist is sensible. JR

Brain changes in children who have sustained a mild traumatic brain injury, or concussion, persist for months following injury -- even after the symptoms of the injury are gone, according to a study published in the December 12 issue of The Journal of Neuroscience. The findings highlight the potential benefit of using advanced imaging techniques to monitor recovery in children following concussions.

Despite growing concerns over the risk of concussions in youth, the majority of research examining their effects on the brain has involved adults. These studies suggest that, among other things, concussions alter the brain's white matter -- the long fibers that carry information from one area of the brain to another. Some recent data suggest the developing brains of children may be more vulnerable to the effects of mild traumatic brain injury.

In the current study, Andrew Mayer, PhD, and colleagues at the Mind Research Network and the University of New Mexico in Albuquerque, New Mexico, specifically studied older children (ages 10-17) with mild traumatic brain injury. They found that structural changes in the children's white matter seen about two weeks after the injury remained evident more than three months later despite the disappearance of symptoms related to the injury.

"These findings may have important implications about when it is truly safe for a child to resume physical activities that may produce a second concussion, potentially further injuring an already vulnerable brain," Mayer said.

The researchers conducted cognitive testing and used an advanced imaging technique known as diffusion tensor imaging (DTI) to examine the brains of 15 children who had recently (within 21 days of injury) experienced a concussion and 15 unaffected children. In the brain, DTI specifically images white matter. During a follow-up visit approximately four months post-injury, scientists repeated cognitive testing and imaging.

Initial testing revealed that children with the mild brain injury had subtle cognitive deficits and changes in white matter compared with healthy counterparts. While the children did not report symptoms of the injury during the follow-up visit months later, DTI revealed that the structural changes to the brain remained.

"The magnitude of the white matter changes in children with mild traumatic brain injury was larger than what has been previously been reported for adult patients with mild traumatic brain injury," Mayer said. "This suggests that developmental differences in the brain or the muscular-skeletal system may render pediatric patients more susceptible to injury," he added.

Based on the imaging data collected during the study, the researchers were able to accurately distinguish the brains of patients who had mild traumatic brain injury from those who were healthy 90 percent of the time. Such findings suggest DTI, which does not require the use of ionizing radiation, could one day be used to diagnose the injury and to better characterize the recovery process in the brain.

Christopher Giza, MD, an expert on developmental brain injury from the Mattel Children's Hospital and the Brain Injury Research Center at the University of California, Los Angeles, who was not involved in the study, noted that while the number of patients in the study was small, the findings mark "an important step forward in our understanding of the effects of mild traumatic brain injury on the developing brain."

"Further work is needed to determine whether the changes in white matter present at four months represent a prolonged recovery process or permanent change in the brain," Giza added. "Determining the duration of the structural changes, and whether these changes have clinical implications, remain critical areas for future studies," he said.

Read more here

Pediatric Shortages, Long Wait Times Reinforce Need for Improved Access to Health Care for Children

Its worse in Texas!!!


Be vocal and advocate for your child to see a pediatric specialist! One way to reduce health care costs is to restrict access.


. If you have an access issue, speak to your primary care, your HR department at your employer, your insurance representative and/or a case manager! JR



From HealthNewsDigest.com
Children's Health

Pediatric Shortages, Long Wait Times Reinforce Need for Improved Access to Health Care for Children
By
Jul 23, 2012 - 10:43:10 AM

(HealthNewsDigest.com) - Alexandria, VA – As the fight around the constitutionality of the Affordable Care Act settles, new data indicate that the battle to ensure timely access to health care for America’s child patients is far from over. Today, the Children’s Hospital Association unveils results of a national survey that shows severe physician shortages and long wait times are a harsh reality for many kids seeking health care in the United States. The Association releases these findings as part of its Family Advocacy Day, July 23-25, an annual, national event that enables children’s hospital patients and their families to share their health care stories and make their voices heard on Capitol Hill.

“Although significant progress has been made to support children’s health care in recent years, children still face barriers when accessing pediatric care,” says Mark Wietecha, president and CEO of the Children’s Hospital Association. “Children deserve better. More needs to be done to ensure they’re getting the care they need, when they need it and in the right care setting.”

The survey analysis of nearly 70 children’s hospitals across the country reveals ongoing vacancies of 12 months or longer among key pediatric specialties – such as neurology (39 percent of hospitals surveyed), general surgery (30 percent) and developmental-behavioral medicine (28 percent) – that are impacting hospitals’ ability to provide timely medical care to kids. These findings are reinforced by American Board of Pediatrics Workforce Data 2011-2012, which show restricted access to certified specialists in several areas of the country.[i]

In fact, 3 out of 4 hospitals say the shortages have caused delayed appointments. By the time a child is able to get in for an appointment, he or she may be waiting up to seven times longer when compared to the ideal two-week appointment wait time that hospitals strive for. In the most affected specialties, children can wait nearly 15-weeks for appointments in developmental-behavioral medicine and nine weeks in neurology. Overall, children’s hospitals say the shortages most affecting their ability to deliver care lie in neurology (15 percent of hospitals surveyed), developmental-behavioral medicine (8 percent), gastroenterology (7 percent), pediatric surgery (7 percent), and neurosurgery (5 percent).

Experts agree that without federal funding for critical child health care programs, children’s access to care could be jeopardized even further. The Children’s Hospitals Graduate Medical Education (CHGME), a national program solely devoted to helping children’s hospitals train pediatricians and pediatric specialists, supports the training and development of half of all pediatricians and pediatric specialists practicing in the U.S. Unfortunately, CHGME funding has been rolled back by more than $50 million since FY 2010 and is far below the support needed to close the gap between demand for care and the supply of these specialized caregivers. While CHGME has been successful and has helped increase the number of pediatric providers trained annually, more is still needed. Without sufficient funding for CHGME, as illustrated through the new data, a national shortage of pediatric specialists will persist.

CHGME is not the only national child-focused health care program at risk. Federal budget proposals would slash funding to Medicaid, the federal-state program that provides health coverage to 1 in 3 children, further restricting children’s access to health care. Today, there are numerous proposals to cut Medicaid by billions over the next 10 years. These proposals are on top of the billions in cuts that states have already implemented over the past few years as a means to balance their budgets. (A $1 cut at the state level produces a federal savings of $0.57.)

No one understands the impact of the pediatric specialty shortages quite like the families who have experienced it firsthand. Joining the Children’s Hospital Association in Washington this week to discuss the impact of pediatric shortages is the Johnston family of Minneapolis, MN. Mike Johnston, age 14, suffered from debilitating headaches for over a year until he was diagnosed with a cancerous brain tumor in April 2011. Long waits were an unfortunate reality for Johnston, who attempted to get appointments with psychologists and neurologists before the discovery of the tumor. He was admitted to the emergency room before either of the appointments arrived.

“Had we visited the neurology department earlier, I’m confident they would have seen the mass forming,” explains his dad John Johnston. “And while the treatment likely would have been the same, Mike would have suffered far less. He was lucky, and thanks to specialized care, he’s now cancer free. Sadly, for millions of other children waiting for care, the outcome may be very different.”

The Johnston family is joined in Washington this week by nearly 30 other child patients, from 19 states and the District of Columbia, to bring to life the importance of timely, quality pediatric care for kids, and encourage legislators to take action to protect and improve care for children.

“As the data confirm, and the patient stories illustrate, many children wait far too long to get needed services to diagnose, treat and manage all kinds of diseases,” notes Wietecha. “When children don’t get timely care, they miss school; they can fall behind; their parents miss work, creating more family stress. A domino effect can occur when children don’t have timely access to specialized pediatric care.”

While shortages in neurology and behavioral-developmental care rise to the top of the Association’s list of shortages, the data show the overall impact of shortages is widespread, with children waiting for care in other key areas, including genetics (11 weeks), rheumatology (8 weeks), dermatology (8 weeks), child and adolescent psychiatry (7.5 weeks), and endocrinology (7 weeks).

As a result of difficulties recruiting pediatric specialists, children’s hospitals also report increased recruitment costs (67 percent of hospitals surveyed); lost referrals - where children are referred to other providers who are adult clinicians (64 percent); decreased staff morale (56 percent); increased salaries (55 percent); delayed and/or lost surgeries and reduction in level of service (52 percent).

# # #


About the Children’s Hospitals Pediatric Specialist Workforce Survey
Fielded by the Children’s Hospital Association during the month of May 2012, 69 member hospitals of the Association completed the survey.

Methodology: Surveys were sent to all medical directors (or their designees) in hospitals that are members of the Children’s Hospital Association. The survey, consisting of seven questions, was sent in an Adobe PDF format via email, and respondents were asked to email or fax their completed survey back to the Association. In total, 69 hospitals responded (approximately a 30 percent response rate) including many of the largest children’s teaching hospitals in the nation. Analysis was completed using SPSS Statistics 20.0.

Limitations: Responses came from a variety of hospitals: acute care to specialty care, large hospitals to small hospitals. Not every hospital provided a wait time for every specialty, due to the fact that some hospitals do not offer all services or do not collect data on all of services.

About the Children’s Hospital Association
The Children’s Hospital Association advances child health through innovation in the quality, cost and delivery of care. Representing more than 220 children’s hospitals, the Association is the voice of children’s hospitals nationally. The Association advances public policy enabling hospitals to better serve children, and is the premier resource for pediatric data and analytics driving improved clinical and operational performance of member hospitals. Formed in 2011, the Association brings together the strengths and talents of three organizations: Child Health Corporation of America (CHCA), National Association of Children’s Hospitals and Related Institutions (NACHRI) and National Association of Children’s Hospitals (N.A.C.H.).

For more information on Family Advocacy Day, visit www.childrenshospitals.net, or follow the families on Facebook at http://www.facebook.com/childrenshospitals or Twitter, @speaknowforkids, #FAD12.


[i] American Board of Pediatrics, 2011: https://www.abp.org/abpwebsite/stats/wrkfrc/workforcebook.pdf