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Papers by Mary Hopkins

Medical Education Online, 2013

The American journal of managed care, 2012

To refine a previously published standardized quality and utilization measurement set for migrain... more To refine a previously published standardized quality and utilization measurement set for migraine care and to establish performance benchmarks. Retrospective application of the migraine measurement set to health plan data in order to assess patterns of health service utilization. Measurement specifications were applied to data from 10 health plans for measurement year 2009. Of the 2.9 million continuously enrolled members of the health plans, 138,004 (4.7%) met inclusion criteria for the migraine population. Of these, 26% did not have a migraine diagnosis, but were utilizing migraine drugs; 12% had a computed tomography scan within the year (range 8%-25% across plans); and 8% had magnetic resonance imaging (range 6%-11%). Nearly 18% of the migraineurs had 1 or more visits to an emergency department/urgent care center for migraine; few (6%) were followed up with primary care visits. Approximately one-fourth of the migraineurs were not being routinely monitored by a physician. Medica...

Proceedings. 17th IEEE Symposium on Computer-Based Medical Systems, 2004

Contemporary medical education faces new challenges as the climate of the health care delivery sy... more Contemporary medical education faces new challenges as the climate of the health care delivery system transforms. Diminished length-of-stay and continuity-of-care have radically altered the way medical students are exposed to and learn about illness. These educational challenges are particularly pronounced in the teaching of surgery.

2009 International Conference on Information and Communication Technologies and Development (ICTD), 2009

Nearly 40 million people in Africa suffer from HIV/AIDS. African governments and international ai... more Nearly 40 million people in Africa suffer from HIV/AIDS. African governments and international aid agencies have been working to combat this epidemic by vigorously promoting Highly Active Anti-Retroviral Therapy (HAART) programs. Despite the enormous subsidies offered by governments along with free Anti-RetroViral (ARV) drugs supplied by agencies, the introduction and implementation of HAART programs on a large scale has been limited by two fundamental problems: (a) lack of adherence to the ARV therapy regimen; (b) lack of accountability in drug distribution due to theft, corruption and counterfeit medication.

Journal American Water Works Association, 1990

Expert systems are an emerging technology that has potential benefit to the water industry. The b... more Expert systems are an emerging technology that has potential benefit to the water industry. The basic elements that comprise an expert system and the method of development of typical systems are reviewed. A simple example relates such a system to the operation of a water treatment plant. The tools (software) available for expert-system development are reviewed, and a procedural basis

The American Journal of Surgery, 2007

Major changes in health care delivery and financing have negatively impacted students&amp... more Major changes in health care delivery and financing have negatively impacted students' experience during the surgery clerkship, particularly their exposure to physicians' decision-making processes and to the continuity of patient care. In response to these dilemmas in surgical education, we have developed the Web Initiative for Surgical Education (WISE-MD), a comprehensive surgery clerkship curriculum delivered through multimedia teaching modules and designed to enhance exposure to surgical disease and clinical reasoning. As part of the process of creating WISE-MD, we conducted preliminary studies to assess the impact of this computer-assisted approach on students' knowledge, clinical reasoning, and satisfaction. Compared to students who did not view the modules, early data show a trend toward improved knowledge and an improvement in clinical reasoning for students who used the WISE-MD modules. This effect was specific to the clinical content area addressed in the module seen by the students. Most students felt the module was superior to traditional teaching methods and enhanced their understanding of surgical technique and anatomy. WISE-MD, a theory-driven example of a concerted technology-based approach to surgical education, has the potential to address the myriad problems of today's clinical learning environment.

Obstetrics & Gynecology, 2003

graphics, knowledge in colon cancer epidemiology and pathophysiology, and practice patterns. We u... more graphics, knowledge in colon cancer epidemiology and pathophysiology, and practice patterns. We used a number identification system to hide the respondent identity from the reviewers. Nonrespondents were mailed a second questionnaire. We analyzed the responses using descriptive statistics and 2 .

Medical Education, 2004

correct identification from a pull-down menu, and in ÔquizÕ mode students are asked to correctly ... more correct identification from a pull-down menu, and in ÔquizÕ mode students are asked to correctly identify structures drawn at random for that panel. Up to 6 multiple-choice question flags are included for each image, with random sequencing of options on repeated attempts. The program also generates an index allowing students to quickly locate structures of interest anywhere in the program. Academic staff can produce each image panel within 30-50 minutes, depending on the number of structures and level of question difficulty. Evaluation of results Approximately 250 copies of the program are produced and distributed on demand each year, with students sharing copies between colleagues. Ready availability of the program reduces wear and tear on precious human prosections, while providing students with a convenient revision tool for use at home. The generic nature of the template means that units can be easily tailored for specific groups of students using actual teaching material they will encounter during assessment.

Medical Education, 2004

Skip to Main Content. Due to scheduled maintenance access to the Wiley Online Library may be disr... more Skip to Main Content. Due to scheduled maintenance access to the Wiley Online Library may be disrupted as follows: Saturday, 16 October - New York 0700 EDT to 0900 EDT; London 1200 BST to 1400 BST; Singapore 1900 SGT to 2100 SGT. ...

Journal of the International Neuropsychological Society, 2008

Comprehension difficulties associated with periventricular and deep white matter alterations (WMA... more Comprehension difficulties associated with periventricular and deep white matter alterations (WMA) in mild dementia were investigated using portions of the Boston Diagnostic Aphasia Examination (BDAE) Complex Ideation subtest and Syntax subtests. Mild dementia participants were grouped according to the extent of their WMA as observed on magnetic resonance imaging (mild WMA n 5 45 vs. moderate to severe WMA n 5 52). Correlation and regression analyses also were performed to examine the link between WMA and comprehension abilities, as well as the link between comprehension abilities and neuropsychological measures of executive functioning, language, episodic memory, and overall dementia severity. Results showed that the WMA groups differed on the BDAE-Syntax subtests, with the severe WMA group demonstrating more impairment. Correlation and regression analyses including the entire sample also demonstrated that the extent of WMA was significantly linked to Syntax test scores but not Complex Ideation scores. Regression analyses including neuropsychological measures showed that the BDAE-Complex Ideation score was marginally predicted by only overall dementia severity, whereas the BDAE-Syntax scores were significantly predicted by independent measures of working memory0executive functioning. In conclusion, greater subcortical WMA and executive deficits are associated with greater difficulties in syntactic comprehension in individuals with mild dementia. (JINS, 2008, 14, 542-551.)

Journal of the American College of Surgeons, 2004

BACKGROUND: The number of US medical students applying for general surgery residency has been dec... more BACKGROUND: The number of US medical students applying for general surgery residency has been declining.

Journal of the American College of Surgeons, 2007

Sustainable international surgery expertise is more frequently being discussed in the US surgical... more Sustainable international surgery expertise is more frequently being discussed in the US surgical community. At the resident level, there is discussion about incorporating international experience into residency training, but current opportunities for residents are limited and often require personal funding and use of vacation time. This study analyzed resident interest in acquiring international experience. A structured questionnaire was administered anonymously to all New York University general surgery residents. The questionnaire elicited demographic information and information about interest in an international surgery elective and future volunteerism. Descriptive statistics and chi-square analyses were performed for the completed data. Fifty-two of 63 residents (82.5%) completed surveys. Fifty-one residents (98%) were interested in an international elective, and 38 residents (73%) would prioritize such an elective over all other electives. Twenty-three (44%) and 25 (48%) residents would be willing to use vacation and finance the elective, respectively. The most frequent expectations of international training were acquiring technical and clinical skills (94% of residents) and cultural skills (88%). Residents believed financial difficulties and scheduling conflicts were the most significant barriers to international training (82% and 53%, respectively). Thirty-two residents (62%) planned to incorporate volunteer work into their future practice. Chi-square analyses revealed a significant relationship between residents who would prioritize international training and those who planned to incorporate volunteerism into their future practice (p<0.01). International training represents an opportunity for US surgical education to provide residents with broader clinical expertise and increased cultural awareness. Our data suggest that surgical residents at NYU are strongly interested in acquiring this experience and that international training may provide an opportunity to encourage lifelong volunteerism. National study of US residents and faculty is warranted to further investigate these conclusions.

Journal of Surgical Research, 2003

The Journal of Psychology, 1977

Page 1. Published as a separate and in The Journal of Psychology, 1977, 96, 71-72. JAPANESE AND A... more Page 1. Published as a separate and in The Journal of Psychology, 1977, 96, 71-72. JAPANESE AND AMERICAN MANAGERS* College of Business .4dministrution, Universify of Hawaii MARY E. HOPKINS,' LOUISE Lo, RE PETERSON, AND KK SEO ...

Headache: The Journal of Head and Face Pain, 2006

To evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headache... more To evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headaches and premenstrual syndrome (PMS) symptoms throughout the menstrual cycle in women with migraine. Menstrually related headache and PMS significantly impact the quality of life of many women. The time relationship of these 2 menstrually related problems is not well understood and not well described. Twenty women with migraine experiencing regular menstrual cycles were enrolled in a prospective study designed to date- and time-stamp data, both self- and computer-prompted, headache and PMS symptoms, for 3 consecutive months. A previously validated PMS score was calculated by grading 23 PMS criteria on a scale of 0 to 3 (0 = no symptoms, 3 = severe symptoms). The total number of data entries recorded was 2009, composed of 56 menstrual cycles in 20 migraineurs. Five hundred forty-four entries reported a current, prodromal, or previous headache. The mean daily occurrence of headache increased beginning on cycle day -5, peaked on days +1 to +5, and returned to baseline by day +7. Mean daily PMS scores ranged from 2.4 to 12. Mean daily PMS scores peaked on days -6 to +2 and returned to baseline by day +8. An electronic diary may have potential as a diagnostic tool in studying headaches and PMS symptoms throughout the menstrual cycle. The occurrence of headache and PMS symptoms in migraineurs follows similar time courses.

Headache: The Journal of Head and Face Pain, 2010

Background: Electronic medical records (EMRs) are used in large healthcare centers to increase ef... more Background: Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage. Methods: We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique deidentified records, which were used to determine topiramate dose and persistence of treatment.

Headache: The Journal of Head and Face Pain, 2007

To gain knowledge of episodic headache patients who seek care at an urban university emergency de... more To gain knowledge of episodic headache patients who seek care at an urban university emergency department (ED), to evaluate the care they receive and to examine the impact of the ED on these headache patients. In the United States, 1% of all ED visits are for the chief complaint of headache. The ED has a significant role in the identification and treatment of primary headache sufferers. Patients who presented to the ED with a chief complaint of headache were prospectively administered a patient survey, the PRIME-MD Patient Health Questionnaire, and MIDAS. any patient 18 years or older with a nontraumatic headache of less than 1 month in duration. The patients included had episodic headache. any patient with a history of a lumbar puncture or epidural procedure in the previous 7 days or those with chronic daily headache. Patients who met criteria were asked questions about headache type, health care utilization, satisfaction, co-morbid illnesses, and demographics. A neurologist independently reviewed the ED chart. A total of 219 of 364 patients were eligible and consented. The median age was 34. Most (147, 67.1%) were women; 104 (47.5%) were diagnosed with migraine or probable migraine by chart review; 36% did not have enough information for a neurologist to code a diagnosis. Relatively few headache-specific medications were used 24 hours prior to ED arrival. Only 5% of patients were on headache-preventive medication. Patients commonly received neuroleptics (dopamine antagonists 98 [67.5%]) or opioids (93 [64.1%]) in the ED; however, 74 (33.8%) subjects received neither medication nor IV fluids. Upon leaving the ED, 21.8% were pain free and 89 (40.6%) patients were asked to follow-up with a physician. A total of 137 (62.6%) patients had no documented discharge medications. One person received a prescription for a preventive medication. Sixty-four percent of those who returned the diary reported that the headache returned within 24 hours of leaving the ED. Migraine ICHD-2 criteria are underused, and patients are undertreated in the ED. Many patients leave without a discharge diagnosis, outpatient medications, or instructions. ED physicians could help identify the migraineurs and channel them toward appropriate outpatient treatment.

Headache: The Journal of Head and Face Pain, 2006

The sequence and timing of taking migraine medications, whether prescription or over-the-counter,... more The sequence and timing of taking migraine medications, whether prescription or over-the-counter, and the patient's response to their treatment, is unknown. To describe the use of, response to, and satisfaction with acute medications for 1 migraine attack. We performed a clinic-based survey of 127 patients at Jefferson Headache Center, Philadelphia. Adult patients who met the International Headache Society criteria for migraine with or without aura were included in the study. Patients were asked to complete a questionnaire. Of 109 participants who met the inclusion criteria, most waited 1 hour or more after the onset of symptoms to take medication. Triptans were most commonly used as first, second, and third medications. Triptan use was associated with higher 2-hour pain-free response rates compared with other agents, whether the triptan was used as the first, second, or third medication. Patients who were treated with medications other than triptans were more likely to have pain at 2 hours (P = .36). NSAIDs had relatively low pain-free and headache relief response rates at 2 hours. Sixty-two participants (56.9%) had to treat a second time and 31 (28.4%) had to treat a third time. Some participants (17.6%) had headache recurrence within 24 hours after becoming headache free following initial medication and some (23.5%) had recurrence after becoming headache free following their second medication. Sixty-six percent of participants reported being very satisfied/satisfied with their initial medication and 33% were somewhat dissatisfied/dissatisfied to some degree. Even though most patients were satisfied with their medication, 88% reported that they would be willing to try a new antimigraine medication. Most patients (60 [55%]) preferred a long-acting agent versus a rapid-onset, short-acting agent (which was preferred by 49 [45%] patients). Migraine patients have treatment preferences. They generally want a drug that provides complete headache relief, and they are often satisfied with the current treatment options.

Archives of Disease in Childhood, 2011

IntroductionAcute respiratory infection (ARI) is a major cause of mortality and morbidity in chil... more IntroductionAcute respiratory infection (ARI) is a major cause of mortality and morbidity in children, particularly in the developing world. In June 2009 the WHO declared a new strain of swine-origin H1N1 influenza virus as a pandemic. The aim of this study was to assess the impact of H1N1 on ARI presentations to A&E in preschool children over a year in

Medical Education Online, 2013

The American journal of managed care, 2012

To refine a previously published standardized quality and utilization measurement set for migrain... more To refine a previously published standardized quality and utilization measurement set for migraine care and to establish performance benchmarks. Retrospective application of the migraine measurement set to health plan data in order to assess patterns of health service utilization. Measurement specifications were applied to data from 10 health plans for measurement year 2009. Of the 2.9 million continuously enrolled members of the health plans, 138,004 (4.7%) met inclusion criteria for the migraine population. Of these, 26% did not have a migraine diagnosis, but were utilizing migraine drugs; 12% had a computed tomography scan within the year (range 8%-25% across plans); and 8% had magnetic resonance imaging (range 6%-11%). Nearly 18% of the migraineurs had 1 or more visits to an emergency department/urgent care center for migraine; few (6%) were followed up with primary care visits. Approximately one-fourth of the migraineurs were not being routinely monitored by a physician. Medica...

Proceedings. 17th IEEE Symposium on Computer-Based Medical Systems, 2004

Contemporary medical education faces new challenges as the climate of the health care delivery sy... more Contemporary medical education faces new challenges as the climate of the health care delivery system transforms. Diminished length-of-stay and continuity-of-care have radically altered the way medical students are exposed to and learn about illness. These educational challenges are particularly pronounced in the teaching of surgery.

2009 International Conference on Information and Communication Technologies and Development (ICTD), 2009

Nearly 40 million people in Africa suffer from HIV/AIDS. African governments and international ai... more Nearly 40 million people in Africa suffer from HIV/AIDS. African governments and international aid agencies have been working to combat this epidemic by vigorously promoting Highly Active Anti-Retroviral Therapy (HAART) programs. Despite the enormous subsidies offered by governments along with free Anti-RetroViral (ARV) drugs supplied by agencies, the introduction and implementation of HAART programs on a large scale has been limited by two fundamental problems: (a) lack of adherence to the ARV therapy regimen; (b) lack of accountability in drug distribution due to theft, corruption and counterfeit medication.

Journal American Water Works Association, 1990

Expert systems are an emerging technology that has potential benefit to the water industry. The b... more Expert systems are an emerging technology that has potential benefit to the water industry. The basic elements that comprise an expert system and the method of development of typical systems are reviewed. A simple example relates such a system to the operation of a water treatment plant. The tools (software) available for expert-system development are reviewed, and a procedural basis

The American Journal of Surgery, 2007

Major changes in health care delivery and financing have negatively impacted students&amp... more Major changes in health care delivery and financing have negatively impacted students' experience during the surgery clerkship, particularly their exposure to physicians' decision-making processes and to the continuity of patient care. In response to these dilemmas in surgical education, we have developed the Web Initiative for Surgical Education (WISE-MD), a comprehensive surgery clerkship curriculum delivered through multimedia teaching modules and designed to enhance exposure to surgical disease and clinical reasoning. As part of the process of creating WISE-MD, we conducted preliminary studies to assess the impact of this computer-assisted approach on students' knowledge, clinical reasoning, and satisfaction. Compared to students who did not view the modules, early data show a trend toward improved knowledge and an improvement in clinical reasoning for students who used the WISE-MD modules. This effect was specific to the clinical content area addressed in the module seen by the students. Most students felt the module was superior to traditional teaching methods and enhanced their understanding of surgical technique and anatomy. WISE-MD, a theory-driven example of a concerted technology-based approach to surgical education, has the potential to address the myriad problems of today's clinical learning environment.

Obstetrics & Gynecology, 2003

graphics, knowledge in colon cancer epidemiology and pathophysiology, and practice patterns. We u... more graphics, knowledge in colon cancer epidemiology and pathophysiology, and practice patterns. We used a number identification system to hide the respondent identity from the reviewers. Nonrespondents were mailed a second questionnaire. We analyzed the responses using descriptive statistics and 2 .

Medical Education, 2004

correct identification from a pull-down menu, and in ÔquizÕ mode students are asked to correctly ... more correct identification from a pull-down menu, and in ÔquizÕ mode students are asked to correctly identify structures drawn at random for that panel. Up to 6 multiple-choice question flags are included for each image, with random sequencing of options on repeated attempts. The program also generates an index allowing students to quickly locate structures of interest anywhere in the program. Academic staff can produce each image panel within 30-50 minutes, depending on the number of structures and level of question difficulty. Evaluation of results Approximately 250 copies of the program are produced and distributed on demand each year, with students sharing copies between colleagues. Ready availability of the program reduces wear and tear on precious human prosections, while providing students with a convenient revision tool for use at home. The generic nature of the template means that units can be easily tailored for specific groups of students using actual teaching material they will encounter during assessment.

Medical Education, 2004

Skip to Main Content. Due to scheduled maintenance access to the Wiley Online Library may be disr... more Skip to Main Content. Due to scheduled maintenance access to the Wiley Online Library may be disrupted as follows: Saturday, 16 October - New York 0700 EDT to 0900 EDT; London 1200 BST to 1400 BST; Singapore 1900 SGT to 2100 SGT. ...

Journal of the International Neuropsychological Society, 2008

Comprehension difficulties associated with periventricular and deep white matter alterations (WMA... more Comprehension difficulties associated with periventricular and deep white matter alterations (WMA) in mild dementia were investigated using portions of the Boston Diagnostic Aphasia Examination (BDAE) Complex Ideation subtest and Syntax subtests. Mild dementia participants were grouped according to the extent of their WMA as observed on magnetic resonance imaging (mild WMA n 5 45 vs. moderate to severe WMA n 5 52). Correlation and regression analyses also were performed to examine the link between WMA and comprehension abilities, as well as the link between comprehension abilities and neuropsychological measures of executive functioning, language, episodic memory, and overall dementia severity. Results showed that the WMA groups differed on the BDAE-Syntax subtests, with the severe WMA group demonstrating more impairment. Correlation and regression analyses including the entire sample also demonstrated that the extent of WMA was significantly linked to Syntax test scores but not Complex Ideation scores. Regression analyses including neuropsychological measures showed that the BDAE-Complex Ideation score was marginally predicted by only overall dementia severity, whereas the BDAE-Syntax scores were significantly predicted by independent measures of working memory0executive functioning. In conclusion, greater subcortical WMA and executive deficits are associated with greater difficulties in syntactic comprehension in individuals with mild dementia. (JINS, 2008, 14, 542-551.)

Journal of the American College of Surgeons, 2004

BACKGROUND: The number of US medical students applying for general surgery residency has been dec... more BACKGROUND: The number of US medical students applying for general surgery residency has been declining.

Journal of the American College of Surgeons, 2007

Sustainable international surgery expertise is more frequently being discussed in the US surgical... more Sustainable international surgery expertise is more frequently being discussed in the US surgical community. At the resident level, there is discussion about incorporating international experience into residency training, but current opportunities for residents are limited and often require personal funding and use of vacation time. This study analyzed resident interest in acquiring international experience. A structured questionnaire was administered anonymously to all New York University general surgery residents. The questionnaire elicited demographic information and information about interest in an international surgery elective and future volunteerism. Descriptive statistics and chi-square analyses were performed for the completed data. Fifty-two of 63 residents (82.5%) completed surveys. Fifty-one residents (98%) were interested in an international elective, and 38 residents (73%) would prioritize such an elective over all other electives. Twenty-three (44%) and 25 (48%) residents would be willing to use vacation and finance the elective, respectively. The most frequent expectations of international training were acquiring technical and clinical skills (94% of residents) and cultural skills (88%). Residents believed financial difficulties and scheduling conflicts were the most significant barriers to international training (82% and 53%, respectively). Thirty-two residents (62%) planned to incorporate volunteer work into their future practice. Chi-square analyses revealed a significant relationship between residents who would prioritize international training and those who planned to incorporate volunteerism into their future practice (p<0.01). International training represents an opportunity for US surgical education to provide residents with broader clinical expertise and increased cultural awareness. Our data suggest that surgical residents at NYU are strongly interested in acquiring this experience and that international training may provide an opportunity to encourage lifelong volunteerism. National study of US residents and faculty is warranted to further investigate these conclusions.

Journal of Surgical Research, 2003

The Journal of Psychology, 1977

Page 1. Published as a separate and in The Journal of Psychology, 1977, 96, 71-72. JAPANESE AND A... more Page 1. Published as a separate and in The Journal of Psychology, 1977, 96, 71-72. JAPANESE AND AMERICAN MANAGERS* College of Business .4dministrution, Universify of Hawaii MARY E. HOPKINS,' LOUISE Lo, RE PETERSON, AND KK SEO ...

Headache: The Journal of Head and Face Pain, 2006

To evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headache... more To evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headaches and premenstrual syndrome (PMS) symptoms throughout the menstrual cycle in women with migraine. Menstrually related headache and PMS significantly impact the quality of life of many women. The time relationship of these 2 menstrually related problems is not well understood and not well described. Twenty women with migraine experiencing regular menstrual cycles were enrolled in a prospective study designed to date- and time-stamp data, both self- and computer-prompted, headache and PMS symptoms, for 3 consecutive months. A previously validated PMS score was calculated by grading 23 PMS criteria on a scale of 0 to 3 (0 = no symptoms, 3 = severe symptoms). The total number of data entries recorded was 2009, composed of 56 menstrual cycles in 20 migraineurs. Five hundred forty-four entries reported a current, prodromal, or previous headache. The mean daily occurrence of headache increased beginning on cycle day -5, peaked on days +1 to +5, and returned to baseline by day +7. Mean daily PMS scores ranged from 2.4 to 12. Mean daily PMS scores peaked on days -6 to +2 and returned to baseline by day +8. An electronic diary may have potential as a diagnostic tool in studying headaches and PMS symptoms throughout the menstrual cycle. The occurrence of headache and PMS symptoms in migraineurs follows similar time courses.

Headache: The Journal of Head and Face Pain, 2010

Background: Electronic medical records (EMRs) are used in large healthcare centers to increase ef... more Background: Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage. Methods: We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique deidentified records, which were used to determine topiramate dose and persistence of treatment.

Headache: The Journal of Head and Face Pain, 2007

To gain knowledge of episodic headache patients who seek care at an urban university emergency de... more To gain knowledge of episodic headache patients who seek care at an urban university emergency department (ED), to evaluate the care they receive and to examine the impact of the ED on these headache patients. In the United States, 1% of all ED visits are for the chief complaint of headache. The ED has a significant role in the identification and treatment of primary headache sufferers. Patients who presented to the ED with a chief complaint of headache were prospectively administered a patient survey, the PRIME-MD Patient Health Questionnaire, and MIDAS. any patient 18 years or older with a nontraumatic headache of less than 1 month in duration. The patients included had episodic headache. any patient with a history of a lumbar puncture or epidural procedure in the previous 7 days or those with chronic daily headache. Patients who met criteria were asked questions about headache type, health care utilization, satisfaction, co-morbid illnesses, and demographics. A neurologist independently reviewed the ED chart. A total of 219 of 364 patients were eligible and consented. The median age was 34. Most (147, 67.1%) were women; 104 (47.5%) were diagnosed with migraine or probable migraine by chart review; 36% did not have enough information for a neurologist to code a diagnosis. Relatively few headache-specific medications were used 24 hours prior to ED arrival. Only 5% of patients were on headache-preventive medication. Patients commonly received neuroleptics (dopamine antagonists 98 [67.5%]) or opioids (93 [64.1%]) in the ED; however, 74 (33.8%) subjects received neither medication nor IV fluids. Upon leaving the ED, 21.8% were pain free and 89 (40.6%) patients were asked to follow-up with a physician. A total of 137 (62.6%) patients had no documented discharge medications. One person received a prescription for a preventive medication. Sixty-four percent of those who returned the diary reported that the headache returned within 24 hours of leaving the ED. Migraine ICHD-2 criteria are underused, and patients are undertreated in the ED. Many patients leave without a discharge diagnosis, outpatient medications, or instructions. ED physicians could help identify the migraineurs and channel them toward appropriate outpatient treatment.

Headache: The Journal of Head and Face Pain, 2006

The sequence and timing of taking migraine medications, whether prescription or over-the-counter,... more The sequence and timing of taking migraine medications, whether prescription or over-the-counter, and the patient's response to their treatment, is unknown. To describe the use of, response to, and satisfaction with acute medications for 1 migraine attack. We performed a clinic-based survey of 127 patients at Jefferson Headache Center, Philadelphia. Adult patients who met the International Headache Society criteria for migraine with or without aura were included in the study. Patients were asked to complete a questionnaire. Of 109 participants who met the inclusion criteria, most waited 1 hour or more after the onset of symptoms to take medication. Triptans were most commonly used as first, second, and third medications. Triptan use was associated with higher 2-hour pain-free response rates compared with other agents, whether the triptan was used as the first, second, or third medication. Patients who were treated with medications other than triptans were more likely to have pain at 2 hours (P = .36). NSAIDs had relatively low pain-free and headache relief response rates at 2 hours. Sixty-two participants (56.9%) had to treat a second time and 31 (28.4%) had to treat a third time. Some participants (17.6%) had headache recurrence within 24 hours after becoming headache free following initial medication and some (23.5%) had recurrence after becoming headache free following their second medication. Sixty-six percent of participants reported being very satisfied/satisfied with their initial medication and 33% were somewhat dissatisfied/dissatisfied to some degree. Even though most patients were satisfied with their medication, 88% reported that they would be willing to try a new antimigraine medication. Most patients (60 [55%]) preferred a long-acting agent versus a rapid-onset, short-acting agent (which was preferred by 49 [45%] patients). Migraine patients have treatment preferences. They generally want a drug that provides complete headache relief, and they are often satisfied with the current treatment options.

Archives of Disease in Childhood, 2011

IntroductionAcute respiratory infection (ARI) is a major cause of mortality and morbidity in chil... more IntroductionAcute respiratory infection (ARI) is a major cause of mortality and morbidity in children, particularly in the developing world. In June 2009 the WHO declared a new strain of swine-origin H1N1 influenza virus as a pandemic. The aim of this study was to assess the impact of H1N1 on ARI presentations to A&E in preschool children over a year in