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Objective: Completion of radiation therapy (RT) within 60 days has been proposed as a national quality measure for patients with carcinoma of the cervix as protracted RT has been associated with worse oncologic outcomes. The objective of this study was to compare compliance rates based on location of RT administration., Methods: This was a retrospective chart review of patients diagnosed with cervical cancer between January of 2000 to December of 2016 who were planned to undergo primary treatment with sensitizing chemotherapy and RT. Patients who completed both external beam radiation therapy (EBRT) and brachytherapy (BT) at the primary institution were compared to patients who completed a portion or all of their RT elsewhere. The primary outcome measured was completion of RT within 60 days. Secondary outcomes included compliance with sensitizing chemotherapy, total radiation dose, recurrence rate, progression free survival (PFS) and overall survival (OS). The groups were compared using standard statistical analysis., Results: This study included 100 patients, 75 of which received all of their RT at the primary institution. These patients were more likely to complete RT within 60 days when compared to patients who underwent RT at different facilities (58.7% vs 24%, respectively; p = 0.005). Patients who underwent all of their RT at the primary institution completed their therapy an average of 16.4 days sooner (75.1 ± 21.3 days versus 58.7 ± 13.2 days; p = 0.001). Overall survival was significantly improved in this group (p = 0.03)., Conclusion: Women who complete EBRT and BT at different institutions are more likely to have a protracted RT course (>60 days). These patients should be identified at diagnosis and efforts made to coordinate their care to avoid delays in treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Most art therapy research has involved patients with malignancies other than gynecologic cancer. The current study aimed to assess the impact of an art therapy intervention on the quality of life (QOL) in patients with gynecologic cancer who were receiving chemotherapy., Methods: This was a prospective, non-randomized, pilot study. Eligible patients had a primary or recurrent gynecologic malignancy scheduled to be treated with at least 6 cycles of chemotherapy over 18 weeks. The intervention consisted of five sessions of art therapy during the chemotherapy. Patients completed a Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire prior to starting chemotherapy, and again at completion of the fifth session. Differences between the FACT-G scores were examined by paired t-tests. An increase in the mean FACT-G score indicated an improvement in QOL. At each session, the patients completed a separate, supplemental questionnaire to subjectively rate the benefit of the session and to express their experience with the art intervention., Results: Twenty-four patients enrolled. Eight did not complete the study, leaving 16 evaluable patients. The mean FACT-G score pre-chemotherapy was 82.3 (95% CI: 75.5, 89.2), and post-art therapy was 78.6 (95% CI: 71.7, 85.5). The mean change in QOL was -3.7 points (95% CI: -10.7, 3.2, p = 0.270). A supplemental questionnaire indicated that 15 of 16 patients felt that art therapy was beneficial at each session., Conclusions: FACT-G scores did not significantly change over the course of chemotherapy in patients with gynecologic cancers receiving art therapy. Several published studies have indicated that chemotherapy is associated with a decline in QOL. Our results suggest art therapy may help to prevent or mitigate this decline., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy., Methods: The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction., Results: Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%)., Conclusions: While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Persons with epilepsy (PWE) are more likely to report never being married than those without epilepsy. Social support, especially from marriage, may buffer the negative impact of stressful events and chronic health conditions. In 2005, sixteen U.S. states asked about epilepsy and social support in the Behavioral Risk Factor Surveillance System. A set of survey weight-adjusted logistic regression analyses were conducted to examine the impact of marriage and social support on self-rated health status and life satisfaction in persons with active epilepsy. PWE who were married with poor social support were less likely to report excellent/very good self-rated health status (OR=0.34) and better life satisfaction (OR=0.20), compared with those who were married with good support (reference group) after controlling for demographics and comorbid conditions. Once poor mental health status was controlled for, these differences were no longer significant. In contrast, persons with active epilepsy who were not married with poor support were significantly less likely to report better life satisfaction (OR=0.22) after controlling for demographics, comorbid conditions, and poor mental health status. Epilepsy practitioners need to address poor mental health through appropriate treatment and/or referral. Practitioners should also encourage PWE to improve their social support contacts., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The objective was to compare practitioners' impressions of patients' concerns with those expressed by the patients themselves. Prior to clinical interaction, adult patients with epilepsy and their established practitioners were asked to choose their top five concerns via a modified version of the Epilepsy Foundation Concerns Index. Patients with epilepsy (n=257) with varying degrees of seizure control from the outpatient clinic practices of five prescribing practitioners completed the modified concerns index. The three most frequent concerns reported by patients were having a seizure unexpectedly, issues related to driving, and memory problems. These were similar to those reported by the practitioners, though memory was much less of a concern expressed by the practitioner. For the paired data, the concern with the largest gap from the patients' perspective was "your memory." Though there was an overlap, patients were concerned more about life issues and practitioners were concerned about clinical issues. This should serve as a major "wakeup call" to address memory problems in patients with epilepsy, regardless of seizure control., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Previous studies have found that psychosocial factors have the greatest impact on health-related quality of life (HRQOL). Social support can buffer the negative impact of stressful events and chronic health conditions. To date, no population studies have examined the association between social support and epilepsy. In the 2003 California Health Interview Survey (CHIS), four questions were used to assess social support. A set of survey weight-adjusted logistic regression analyses were conducted with self-rated health status as the outcome. In those regression models, we examined the effect of epilepsy status, social support, and their interactions, after controlling for demographics. Analyses examining the interaction between epilepsy and social support showed a significant interaction between epilepsy and "availability of someone to love you and make you feel wanted." Once demographics were controlled for, persons without epilepsy and poor affectionate support reported fair/poor self-rated health status (odds ratio=1.7). Persons with epilepsy and good affectionate support also reported fair/poor self-rated health status (odds ratio=3.3). Persons with epilepsy and poor affectionate support were the most likely to report fair/poor self-rated health status (odds ratio=9.1). Persons with epilepsy need encouragement to actively seek and sustain supportive personal relationships that may help improve their quality of life.

Previous population surveys outside the United States have found an increased prevalence of comorbid conditions in persons with epilepsy. However, the effect of comorbid conditions on health-related quality of life (HRQOL) has not been previously examined in the epilepsy literature from the United States. Results from the California Health Interview Survey (CHIS) indicate an increased prevalence of comorbid conditions in persons with a history of epilepsy compared to those without epilepsy. After controlling for demographics and comorbid conditions, persons with a history of epilepsy were significantly more likely to report poor HRQOL. Although seizure freedom should continue to be a primary clinical goal, optimal care should also include primary and secondary prevention of comorbid conditions, especially cardiovascular and pulmonary diseases. Prevention, early identification, and treatment of comorbid conditions may reduce mortality risk and improve health outcomes in persons with epilepsy.

A survey was developed to gather information from both patients with epilepsy and community pharmacists on the issue of antiepileptic drug (AED) formulation switching, which includes brand to generic, generic to brand, and generic to generic. Data were obtained from 82 patients (or parents of patients) with epilepsy and 112 community pharmacists. More than 92% of patients and 85% of pharmacists agreed that switching between forms of the same AEDs may cause an increase in seizures or adverse effects. More than two-thirds of our patient sample reported having problems with formulation switching; many also reported knowing other patients with problems. Just more than half (51%) of the pharmacists knew of patients who have described problems when they have changed AED formulations. Less than 50% of both populations knew that problems resulting from formulation switching should be reported as adverse drug events to the FDA. Not many pharmacists and far fewer patients use MedWatch to report these problems. We conclude that both patients with epilepsy and pharmacists are underinformed and underinvolved with reporting adverse drug events.

Comprehensive treatment of epilepsy involves many facets including self-management behaviors. The primary purpose of this study was to characterize the self-management behaviors of our patients. Additionally, we wanted to assess if the behaviors differed depending on the level of seizure control. Adult patients with epilepsy were recruited for this cross-sectional study. We used two previously validated scales to assess various self-management behaviors and collected clinical data. Our sample consisted of 50 patients (23 women). The mean overall Epilepsy Self-Management Scale (ESMS) question score was 3.72+/-0.41. The mean question scores on the ESMS subscales Medication Management, Information Management, Safety Management, Seizure Management, and Lifestyle Management were 4.4, 2.7, 3.9, 4.0, and 2.6, respectively. Information Management and Safety Management subscale scores were higher in the patients continuing to have seizures. Based on the Morisky scale, patients fell into either the low (n=2), medium (n=27), or high (n=21) medication-taking behavior category. Self-management skills, beyond medication-taking behaviors, should be emphasized during patient interactions.

Previous research on driving and epilepsy has focused primarily on determining predictors of who will continue to drive when told not to. An analysis of health behavior attitudes and beliefs in persons with epilepsy may provide insight into effective patient counseling. A three-page, 46-item questionnaire was adapted and completed by 213 respondents with epilepsy. Nineteen percent indicated that in order to drive, they were not completely honest about their seizure frequency. Twenty-six percent reported having had a car accident because of a seizure. On Safety Concern, Attitudes toward Driving, Perceived Severity/Susceptibility, Perceived Barriers, Helping Relationships, and Self-Efficacy, there were no significant differences with respect to gender or place of residence. Respondents indicated that being in good health and taking precautions were important to them. Predictors of driving behavior included race/ethnicity, employment status, dishonesty about seizure frequency with the doctor, Attitudes toward Driving, Perceived Severity/Susceptibility, Perceived Barriers to changing driving behavior, and Self-Efficacy. Recommendations for communication strategies are discussed.

Based on the 2005 California Health Interview Survey, persons with a history of epilepsy report lower educational attainment, lower annual income, and poorer health status, similar to other state-based epidemiological surveys. Previous studies have found persons with epilepsy exercise less and smoke more than the nonepilepsy population. The medical literature has also shown that antiepileptic drugs may cause nutritional deficiencies. Persons with a history of epilepsy in the 2005 CHIS report they walk more for transportation, drink more soda, and eat less salad than the nonepilepsy population. Exercise and dietary behaviors at recommended levels have been found to reduce mortality from many comorbid conditions such as cardiovascular disease, stroke, depression, anxiety, and osteoporosis for which persons with epilepsy are at increased risk. Health professionals in the epilepsy field should step up their efforts to engage patients in health promotion, especially in the areas of exercise, diet, and smoking cessation.

Psychogenic nonepileptic spells (PNES) are typically evaluated by primary care and emergency physicians before neurologists. The attitudes and beliefs of such physicians about PNES may impact long-term outcomes and quality of care for these challenging patients. A 21-question survey was created to assess knowledge of, beliefs about, and attitudes toward the diagnosis and management of PNES. The survey found misperceptions that PNES are voluntary, that video/EEG monitoring is not needed to confirm the diagnosis of PNES, and that clinical history is sufficient for diagnosis. Ninety-five percent believe that counseling and psychotherapy are the most appropriate therapies. Ongoing education and outreach to referring physicians about PNES are indicated, especially because early diagnosis of PNES has been associated with better outcomes.

In 2006, Ohio added questions to the Centers for Disease Control and Prevention's yearly Behavioral Risk Factor Surveillance System (BRFSS) survey to assess epilepsy prevalence. Ninety-seven of 5506 respondents reported a history of epilepsy, yielding a weight-adjusted prevalence rate of 1.48% (95% CI=0.9-2.1), which is supportive of previous state-based epidemiology estimates. Persons with a history of epilepsy report double the rate of cigarette smoking than the population without epilepsy. Persons with both active epilepsy and a history of epilepsy report poor physical and mental health. Health screening behaviors were comparable to or higher than those of the population without epilepsy. Data from previous BRFSS surveys are used to identify major risk factor trends, as well as to explore the health promotion implications for people with epilepsy. Assessments reveal a need for smoking cessation and increased physical activity for persons with a history of epilepsy in Ohio.

Health literacy is defined as the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions. Based on the 2003 US National Assessment of Adult Literacy (NAAL), more than 90 million people have literacy levels rated as "basic" or "below basic." The Institute of Medicine recommends that health-related information be written at a sixth grade level or below. As Web-based health information is being accessed by more than 50 million people, a reading level assessment of the National Epilepsy Foundation of America Web site was undertaken. Two online programs were used to assess the reading level of each Web page in two main areas, "Understanding Epilepsy" and "Living with Epilepsy," using established readability formulas. One hundred seventy-six Web links were evaluated in English and 43 in Spanish. Based on the Flesch Reading Ease and Huerta Reading Ease assessments, 5.7% of National Epilepsy Foundation Web pages in English and 31-46% in Spanish had a sixth grade or lower reading level. Similar results have been reported in previous reviews of other health education Web sites in cancer, pediatrics, and asthma. The National Epilepsy Foundation Web site, a well-respected resource for patients and their families, contains a significant amount of health education content that is not appropriate for those with marginal health literacy. Editorial changes are needed to bring the information to suggested levels. Suggestions for developing appropriate materials are provided.

In epilepsy populations there are multiple barriers to the prevention, diagnosis, and treatment of metabolic bone disease. This study explored issues that may be unique to inner-city care. We screened 101 consecutive patient charts from our clinic to identify barriers to optimal care. According to the Health Belief Model, when patients view a condition as not severe and their perceived susceptibility is low, they are unlikely to comply with screening and/or adopt preventative behaviors. Despite routine communications to primary care doctors regarding bone health, its importance is still overlooked. In addition, the managed care referral process makes it difficult for a specialist to prevent, screen, and treat a primary care condition with no symptoms. For optimal patient care and to stimulate prevention and screening compliance, a communication style adapted to the patient's knowledge, beliefs, and attitudes toward antiepileptic drug-induced bone loss is crucial to help reduce barriers against change.