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Biomedical subjects

Samuel Wiebe

Publications and source records attributed to Samuel Wiebe.

13 recordsLinked to original sources
PubMed2003

Comparative responsiveness of generic and specific quality-of-life instruments.

We assessed the relative responsiveness of generic and specific quality of life instruments in 43 randomized controlled trials that compared head-to-head 31 generic and 84 specific instruments. Using weighted effect size as the metric of responsiveness, we assessed the impact of instrument type, disease category, and magnitude of underlying therapeutic effect on responsiveness, and assessed the responsiveness of specific instruments relative to the corresponding domains of generic measures. In studies with a nonzero therapeutic effect, specific instruments (mean = 0.57) were significantly more responsive than generic instruments (mean = 0.39, P =.01), and than the corresponding domains of generic instruments (mean = 0.40, P =.03). Studies with low, medium, and high therapeutic effects showed a corresponding gradation in responsiveness differences between specific and generic instruments. We conclude that, overall, specific instruments are more responsive than generic tools, and that investigators may come to misleading conclusions about relative instrument responsiveness if they include studies in which the magnitude of the underlying therapeutic effect is zero.

Health Status Indicators↗
PubMed2003

Practice parameter: temporal lobe and localized neocortical resections for epilepsy.

PURPOSE: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures. METHODS: Systemic review and analysis of the literature since 1990. RESULTS: One intention-to-treat Class I randomized controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available. CONCLUSIONS: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

Anticonvulsants↗
PubMed2003

Randomized controlled trials of epilepsy surgery.

PURPOSE: To review the following aspects of surgical randomized controlled trials (RCTs) in epilepsy: rationale, methodological issues, and state of the art. METHODS: An overview of the literature and author's experience with methodological issues in surgical RCTs, contrasting them with those encountered in medical trials; a general comparison of RCTs and non-RCTs (observational studies); and a literature search for and review of existing surgical RCTs in epilepsy. RESULTS: Nonrandomized (observational) studies provide useful but potentially biased information about the effect of interventions. Because of their ability to deal with bias, RCTs are the optimum vehicle to obtain a true estimate of the effect of interventions, including surgery. Only seven surgical RCTs, encompassing 535 patients, have been performed in epilepsy, with variable adhesion to standard methodology for conducting RCTs. The major issues facing researchers undertaking surgical RCTs in epilepsy include timing of the study in relation to adoption of the intervention as standard practice, acceptance of randomization to an invasive procedure, timing of randomization in relation to the actual intervention, standardization of the surgical procedure, blinding, and patient recruitment. CONCLUSIONS: RCTs are the gold standard for evaluating surgical treatments. Despite the large number and types of surgical interventions used to treat epilepsy, only a handful has been subjected to the scientific rigour of RCTs. The challenges faced by researchers undertaking surgical RCTs in epilepsy are substantial but not insurmountable. Possible avenues to address these methodological hurdles are suggested.

Clinical Protocols↗
PubMed2003

Quality of life after vagus nerve stimulation for intractable epilepsy: is seizure control the only contributing factor?

We assessed the impact of vagus nerve stimulation on a cohort of patients with intractable epilepsy. A 1-year prospective trial of vagus nerve stimulation for intractable epilepsy was done in 26 patients. Seizure frequency, anti-epileptic drugs, and quality of life were assessed using QOLIE-89, ELDQOL, and a Likert scale of impact of treatment. Seizures were reduced by more than 50% in 19% of the patients, by less than 50% in 46%, and were unchanged in 35% of them. Antiepileptic drugs were reduced in 43% of the patients. There was a significant improvement in the mean overall QOLIE-89 score and other measures of quality of life, but these did not correlate with changes in seizure frequency. Subjective improvement occurred in 84% of the patients. The quality of life improves in some patients following vagus nerve stimulation for intractable epilepsy. The favorable effects of this treatment may be attributable to additional factors besides seizure control which in this study was modest.

Adaptation, Psychological↗
PubMed2002

Launching a research initiative: the Canadian Pediatric Epilepsy Network (CPEN).

The Canadian Pediatric Epilepsy Network is a network of scientists and health care professionals in partnership with organizations which provide education and support to children with epilepsy. The objective of the network is to gain a better understanding of childhood epilepsy through collaborative research conducted with doctors, psychologists, nurses, social workers, educators and scientists across Canada. The network was launched at a meeting in Ottawa in the spring of 2000 where several oral presentations addressed the issues of the fundamental questions of epilepsy, the economic impact and the neuropsychology of childhood epilepsy. The intent was to provoke discussion on future areas of research for the network.

Canada↗
PubMed2002

An epilepsy questionnaire study of knowledge and attitudes in Canadian college students.

PURPOSE: Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure. METHODS: We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students. RESULTS: Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group. CONCLUSIONS: Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.

Adult↗
PubMed2002

Cost-effectiveness of epilepsy therapy: how should treatment effects be measured?

Economic evaluations aim to inform policy makers about the cost-effectiveness of different therapies so that limited health care resources may be allocated efficiently. For such evaluations, the effects of therapy must be captured by measures that are reliable, valid, and clinically meaningful. Mortality and changes in disease activity (e.g., seizure freedom, reduction in seizure frequency) may be reliable and valid, but their clinical meaning is not always apparent. Changes in widely used "quality-of-life" measures can quantify therapeutic effects, but the value of such changes to patients is not necessarily clear. This article reviews conceptual and methodological issues involved in determining the value of health effects in the context of economic evaluations of epilepsy therapies. Techniques for eliciting preferences for health effects are reviewed. The limited information on preferences for epilepsy-related health states is described. Directions for further research are suggested.

Algorithms↗
PubMed2002

Evidence based care in the neurosciences.

We examine the relevance of Evidence Based Care (EBC) to the field of clinical neurosciences, with particular emphasis on feasible methods of implementing EBC in clinical practice. By using pre-appraised EBC summaries, busy clinicians can move toward EBC without engaging in the laborious process of searching and critically appraising the literature. After reviewing the neurological content, accessibility and ease of use of current sources of EBC summaries, we find them substantially lacking in coverage of the neurosciences, and therefore of limited use to clinicians in this field. We emphasize a particular type of EBC summary, the critically appraised topic, and comment on its usefulness and limitations as a tool to assist clinical decision-making in the neurosciences. Finally, we propose that a collection of easily accessible, good quality, peer reviewed critically appraised topics, covering a breadth of relevant topics, is a reasonable way of moving toward EBC in the clinical neurosciences.

Evidence-Based Medicine↗
PubMed2002

An evidence based approach to the first unprovoked seizure.

The objective is to illustrate the creation and structure of a particular type of Evidence Based Care (EBC) summary that has direct clinical relevance, the Critically Appraised Topic (CAT). The process consists of a step-by-step application of the EBC principles to a common neurological problem, i.e., a patient presenting with a first, unprovoked generalized seizure. This includes asking a focused clinical question about prognosis for recurrence and the role of antiepileptic drugs; searching the literature to answer the question; selecting the relevant evidence (a meta-analysis about prognosis and a randomized controlled trial about therapy); appraising the literature for its validity and usefulness; and applying the results to the clinical scenario. The result is a one-page, user friendly CAT whose title states a declarative answer to the clinical question. It also contains a description of the literature search and of the evidence, the clinical bottom lines derived from the evidence, and general comments.

Adult↗