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Screening for Anxiety Symptoms With the Generalized Anxiety Disorder-2 Versus Generalized Anxiety Disorder-7 in Children With Headache or Epilepsy.
No full textBACKGROUND: To assess the accuracy of the Generalized Anxiety Disorder-2 (GAD-2) Scale for screening anxiety symptoms in children with headache and epilepsy.
METHODS: Single-center and large-scale assessment of the two-item GAD-2 as compared to the seven-item Generalized Anxiety Disorder-7 (GAD-7) to screen for moderate-severe anxiety symptoms in children undergoing follow-up neurology appointments.
RESULTS: The GAD-7 was fully completed for 3960 of 6060 (65%) encounters. Anxiety symptoms were moderate in 534 (13%) encounters and severe in 337 (9%) encounters. The GAD-2 and GAD-7 were very strongly correlated (spearman\u27s rho 0.91; P \u3c 0.001). When assessing moderate-severe anxiety symptoms based on the GAD-7, a GAD-2 score of ≥3 yielded an area under the receiver operating characteristics curve of 0.96, sensitivity 89%, specificity 91%, positive predictive value 74%, and negative predictive value 97%. If assessment stopped with the GAD-2 at the ≥3 cutoff, then 74% of encounters would be considered not to have anxiety symptoms and would not complete additional questions, but 11% of encounters with moderate-severe anxiety symptoms would not be identified, including 0.6% of patients with severe anxiety symptoms.
CONCLUSIONS: Anxiety symptoms were common. Use of the GAD-2 would reduce the number of questions needing completion compared to the GAD-7 for 74% of patients but would fail to identify 11% of patients with moderate-severe anxiety symptoms, including 0.6% of patients with severe anxiety symptoms. These data indicate that the use of the GAD-2 may be appropriate as a briefer alternative to the GAD-7 which may be ideal in clinical settings with a substantial questionnaire burden
Predictors of Futile Recanalization After Endovascular Therapy for Acute Large Vessel Occlusive Intracranial Atherosclerosis: A Secondary Analysis of RESCUE-ICAS.
No full textBACKGROUND AND OBJECTIVES: Futile recanalization in endovascular thrombectomy (EVT) occurs when recanalization is achieved but patients nevertheless experience a poor functional outcome. Variables associated with futile recanalization after endovascular therapy in intracranial atherosclerosis-related large vessel occlusion have not been previously described.
METHODS: This was a secondary analysis of Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis (RESCUE-ICAS), a multicenter prospective observational cohort study conducted at 25 EVT-capable centers in North America, Europe, and Asia. RESCUE-ICAS enrolled patients who underwent EVT, after which they had residual stenosis of 50% to 99% or intraprocedural reocclusion. This particular analysis focused on patients who had futile recanalization after endovascular therapy, that is modified Rankin Score 3 to 6 at 90-day follow-up despite successful revascularization at procedure end (modified thrombolysis in cerebral ischemia [mTICI] 2b-3). All Included patients in the study had baseline modified Rankin Scale 0 to 2, occlusion of the intracranial internal carotid artery or M1 segment, and successful recanalization (mTICI 2b-3) after endovascular therapy.
RESULTS: In total, 325 patients (62.8% male, mean age: 66.2 years) met the inclusion criteria. On multivariable logistic regression analysis, several variables were independently associated with futile recanalization and poor outcome, including relatively old age, higher National Institutes of Health Stroke Scale, history of type 2 diabetes, and total number of revascularization attempts. On the other hand, complete angiographic recanalization (mTICI 3 vs mTICI 2b/c) and use of an intracranial stent were inversely associated with poor outcome and were independently protective against futile recanalization.
CONCLUSION: Recanalization outcomes in intracranial atherosclerosis-related large vessel occlusion are inferior to thromboembolic large vessel occlusion. The broader RESCUE-ICAS cohort showed that stenting may augment end EVT thrombolysis in cerebral ischemia grading. In this analysis, which was restricted to patients experiencing good recanalization, stenting remained inversely associated with futile recanalization. Follow-up vessel imaging suggests this may be due to more durable vessel patency with stenting
Improving Inaccuracies in Augmented Reality Neuronavigation during Anterior Petrosectomy by Recalibrating Using Fixed Bony Landmarks
No full text
Expansion and characterization of tumor-infiltrating lymphocytes from primary and metastatic immune checkpoint inhibitor-exposed renal cell carcinoma tumors
No full textOphthalmologist and Optometrist Co-management Model for Glaucoma: Outcomes from a Single Tertiary Care Health Center.
No full textPURPOSE: The growing demand for eye care poses significant challenges to the effective management of patients with glaucoma. This study evaluated long-term clinical outcomes of patients with glaucoma co-managed by institutionally trained optometrists and glaucoma specialists at UCSF.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Patients with glaucoma suspect or stable glaucoma diagnoses from 2016-2023.
METHODS: Patients were co-managed by glaucoma specialists and optometrists with postgraduate institutional glaucoma-specific training via either alternate care (alternating glaucoma specialist and optometrist visits) or transfer care (optometrist visits only) for up to 5 years of follow-up. Generalized linear models were used to assess long-term changes in clinical parameters.
MAIN OUTCOME MEASURES: Changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), medications, Humphrey visual field (HVF), and OCT retinal nerve fiber layer (RNFL).
RESULTS: The study included 391 patients (775 eyes), with 136 (34.8%) in alternate care and 255 (65.2%) in transfer care. The most common diagnoses were glaucoma suspect (51.2%) and primary open-angle glaucoma (POAG, 36.0%). No significant changes were observed in BCVA (p=0.34), IOP (p=0.18), medications (p=0.11), or RNFL (p=0.65) while mean deviation of HVF improved (p=0.003) over 5 years among both groups. Overall, 132 eyes (17.0%) required treatment escalation: 81 (10.5%) needed increased medications, 34 (4.4%) underwent glaucoma-related laser treatment, and 17 (2.2%) had incisional surgery. Among all eyes, 56 (14.3%) were re-referred to glaucoma specialists, with 43 (11.0%) returning to co-management after evaluation or treatment. Alternate care patients saw both optometrists and glaucoma specialists a median of once per year while transfer care patients saw optometrists a median of twice per year and none by glaucoma specialists. In multivariable analysis, escalation was associated with older age (OR 1.30 per decade; 95% CI 1.04-1.63; p=0.02), POAG vs suspect (OR 2.99; 95% CI 1.59-5.65; p\u3c 0.001), and higher baseline IOP (OR 1.18 per mmHg; 95% CI 1.07-1.30; p=0.01). The care pathway of each patient was not significantly associated with treatment escalation.
CONCLUSION: With appropriate training, a well-defined and closely monitored co-management model can maintain patient safety and glaucoma stability over five years with improved resource allocation and reduced utilization of glaucoma specialists
AES ILAE North America Symposium: Guiding Evidence-Based Epilepsy Management.
No full textClinical practice guidelines (CPG) provide evidence-based recommendations to optimize patient care. Their development should be rigorous and include defining the scope, conducting systematic reviews, evaluating the quality of the evidence and formulating recommendations that are linked to the evidence. When peer reviewed evidence is insufficient to inform CPGs, consensus-based recommendations (CBR) are an alternative. Both CPG and CBR are essential to inform best practices and inform health policy. This review highlights recent epilepsy CPG and CBR about genetic testing, neonatal seizures, pediatric depression, epilepsy surgery referral timing and addresses their impact on outcomes