Lawrence H

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highlights · 3038

• In the basic version, a straightforward dichotomy is utilized; seizures are described as either having observable manifestations or not. Observable manifestations are easily identified by eyewitnesses,47 are nonvolitional, and can include motor, aphasic, autonomic, or other features (see Table 2). In the expanded version, seizures are described in detail, by listing in chronological order the semiological features (see Table 2) that occur during the seizure.56,

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• In real-world scenarios, information may be available about only one of these characteristics (awareness or responsiveness). If either is impaired in any way, the seizure is classified as impaired consciousness.

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• n inadequate response or a significantly longer response latency compared to the interictal (baseline) state qualifies as impaired responsiveness

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Rather than asking patients and caregivers about consciousness, it is advisable to ask specifically about recall of the events (awareness) and degree of responsiveness during the seizure.

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Consciousness is operationally defined by establishing both awareness and responsiveness, relying on information obtained from medical history21 or through behavioral testing by medical personnel

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• If the state of consciousness is undetermined, the seizure is classified under the parent term (focal seizure or seizure of unknown origin).

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Classifiers define the seizure types, considered as biological classes with direct influence on patient management by guiding syndrome diagnosis, therapeutic decisions, and prognosis. Descriptors, on the other hand, are important clinical characteristics of the seizures that, along with other clinical data and modalities, indirectly contribute to shaping patient management. Descriptors are essential for clinical decisions and, in specific contexts, may significantly influence therapy (e.g., epileptic spasm or myoclonus in the context of a focal seizure).

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• This updated classification comprises four main classes and 21 seizure types

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Generalized seizures are grouped into absence seizures, generalized tonic–clonic seizures, and other generalized seizures, now including recognition of negative myoclonus as a seizure type

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• If the state of consciousness is undetermined, the seizure is classified under the parent term, that is, the main seizure class (focal seizure or seizure of unknown origin).

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Focal seizures and those of unknown origin are further classified by the patient's state of consciousness (impaired or preserved) during the seizure, defined operationally through clinical assessment of awareness and responsiveness

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified

  Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy - Beniczky - 2025 - Epilepsia - Wiley Online Library

• Severe nausea and vomiting with dehydration may require aggressive intravenous rehydration and correction of electrolyte abnormalities on a medical unit.

  Opioid withdrawal: Medically supervised withdrawal during treatment for opioid use disorder - UpToDate

• Precipitated withdrawal by this test can be serious and require more intensive medical management. For this reason, extended-release formulations or high doses of naloxone are never used in the test [34].

  Opioid withdrawal: Clinical features, assessment, and diagnosis - UpToDate

• Withdrawal precipitated by medications (eg, antagonists, partial agonists, inverse agonists) is more rapid in onset and often with more severe symptoms, with reports of life-threatening delirium and severe autonomic instability

  Opioid withdrawal: Clinical features, assessment, and diagnosis - UpToDate

• Unmedicated opioid withdrawal can be quite uncomfortable but rarely life threatening, though Takotsubo (stress-induced) cardiomyopathy may be underappreciated [28] and seizures are reported at the case report level

  Opioid withdrawal: Clinical features, assessment, and diagnosis - UpToDate

• This simple example introduces the concept of service time distribution. This is a random variable that measures how long it will take a customer to be served. It contains information about the average (mean) service time and about the standard deviation from the mean, which represents how the service time fluctuates depending on how long different customers need. The other important variable is how often customers join the queue (the arrival rate). This depends on the average amount of time that passes between two consecutive customers entering the shop. The more people that arrive to use a s…

  There’s a mathematical formula for choosing the fastest queue

• If you start measuring the time between customers when you join a queue, it is more likely that the first customer you see will take longer than average to be served. This will make you feel like you were unlucky and chose the wrong queue.

  There’s a mathematical formula for choosing the fastest queue

• By the same logic, we may evolve into creatures that can do more but find that what we do has somehow been robbed of the satisfaction we hoped it might contain.

  The Problem with Easy Technology | The New Yorker

• when every task in life is easy, there remains just one profession left: multitasking

  The Problem with Easy Technology | The New Yorker

• The problem is that, as every individual task becomes easier, we demand much more of both ourselves and others. Instead of fewer difficult tasks (writing several long letters) we are left with a larger volume of small tasks (writing hundreds of e-mails)

  The Problem with Easy Technology | The New Yorker

• freedom from a life of drudgery to focus on what we really care about. Life is hard enough; do we need to be churning our own butter

  The Problem with Easy Technology | The New Yorker

• They also distribute technological power more widely: consider that, nowadays, you don’t need special skills to take pretty good photos, or to capture a video of police brutality. Nor

  The Problem with Easy Technology | The New Yorker

• There is much to be said for the convenience technologies that have remade human society over the past century. They often open up life’s pleasures to a wider range of people (downhill skiing, for example, can be exhausting without lifts).

  The Problem with Easy Technology | The New Yorker

• Just what is a demanding technology? Three elements are defining: it is technology that takes time to master, whose usage is highly occupying, and whose operation includes some real risk of failure

  The Problem with Easy Technology | The New Yorker

• By doing so, abnormalities remain bright but normal CSF fluid is attenuated and made dark. This sequence is very sensitive to pathology and makes the differentiation between CSF and an abnormality much easier.

  MRI  Basics

• CSF is dark on T1-weighted imaging and bright on T2-weighted imaging.

  MRI  Basics

• For example, if the practice will use the registry to report Merit-Based Incentive Payment System (MIPS) data, then all patients should be included. If the practice will use the registry only for diabetes management, then only patients with diabetes should be included, or the registry should be able to segment patients with diabetes from all patients

  Put Your Clinical Data to Work With a Registry | AAFP

• A national or regional database registry is used for population management, setting benchmarks, comparing performance among participants, value-based payment, risk stratification, strategic planning, contract negotiation, quality improvement, and reporting. Reports are generated at regular intervals, such as monthly, and fed back to the practice. These types of registries are not generally designed to be used at the point of care due to the data lag.

  Put Your Clinical Data to Work With a Registry | AAFP

• Information can be used to make clinical and administrative decisions, such as reaching out to patients to close care gaps or proactively identifying at-risk patients who may need more intense care so the staff can develop intervention strategies

  Put Your Clinical Data to Work With a Registry | AAFP

• However, registries are often an optional add-on to EHRs that practices need to purchase, and many are limited to basic functionality and cannot perform more sophisticated population queries or queries on nontraditional medical values

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Patient registries are more of a true population health tool. Practices can use registries to identify all patients in their panel who have gaps in care, are overdue for care, or have risks and conditions needing additional attention

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• However, all of these types of functions still occur primarily at the point of care, requiring a visit rather than being true proactive population health care features.

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• most systems provide too many such alerts that are not prioritized and often clinically inappropriate, resulting in alert fatigue and reducing their effectiveness

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• each health system or practice must create its own quality or health maintenance tabs.

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• safety alerts have been shown to decrease prescribing contraindicated medications

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• encompasses strategies to make the delivery of evidence-based care easy. It shifts care from being reactive (e.g., someone has to schedule an appointment) to being proactive (e.g., identify and reach out to those in need); and it expands care beyond individuals to caring for entire communities. For example, alerts, reminders, and quality or health maintenance tabs5 built into EHRs increase guideline-based care

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Wearable devices are generally not remotely integrated with an EHR, yet these same devices are widely integrated across a range of smartphone applications (Dinh-Le et al., 2019). The direct integration of glucometers within the EHR is in the early stages of development and can improve monitoring of people with diabetes between encounters

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Still, the overall percentage of primary care via telemedicine was low, and it was most commonly used by people in urban locations, who typically have greater access in general compared to those in more rural locations

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• One study of telemedicine trends among a large, commercially insured population showed that primary care was the most frequently delivered form

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• In 2018, for example, a nationally representative survey found that 35 percent of respondents reported owning an electronic monitoring device, such as a smart watch or blood glucose monitor, and 84 percent reported owning a smartphone or tablet. Of the latter, 49 percent reported they used a health or wellness application on their device to track health goals

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• However, the corresponding change among many clinicians to adopt technologies that could make care more accessible and convenient has lagged because of a combination of factors, such as burdensome regulatory restrictions, resistance to change from a traditional hierarchical model that is less person centered, and technology-related professional burnout

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• However, current payment systems do not reimburse clinicians for providing this critical service

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Today, many patients and clinicians strive for health care to be less transactional and based more on relationships and partnerships (see Chapter 4). More patients now expect to own their health information, be included with their clinicians in the health care decision-making process, and have their care be collaborative, convenient, and accessible

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Three vendors dominate, with Epic, Cerner, and Meditech controlling 75 percent of the U.S. hospital market share (Landi, 2020).

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• April 2018, CMS renamed this incentive program to “Promoting Interoperability Programs” and shifted priorities to include patient access to information, interoperability, and e-prescribing (CMS, 2020a).

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• CMS and ONC had limited authority to enforce Meaningful Use standards and primarily acted through incentive and penalty payments to clinicians. It did not provide a way to incentivize or force EHR vendors to change and improve their systems, beyond certification

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Meaningful Use did catalyze the uptake of HIT in primary care, and it also created burdens for which the incentives only partially compensated

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• Meaningful Use stage 1 focused on data capture and sharing, stage 2 on advanced clinical processes, and stage 3 on improved outcomes (Ornstein et al., 2015), but the EHR functionality and use requirements only supported very basic functions of primary care

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf

• In a 2019 survey, a majority of physicians across specialties felt that technology enabled them to provide better care. Among primary care physicians, 40 percent reported that technology gave them a “definite” advantage, and 46 percent reported that it gave them “somewhat” of an advantage in providing care

  Digital Health and Primary Care - Implementing High-Quality Primary Care - NCBI Bookshelf