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PubMed2005

"What sort of health promotion are you talking about?": a discourse analysis of the talk of general practitioners.

In New Zealand, health promotion is now expected to be an integral part of the work of a general practitioner, and in the recently implemented New Zealand Primary Health Organisation structure, specific funding is available to undertake health promotion activities in primary care. Eighteen general practitioners recruited to take part in two focus groups discussing men's health, talked extensively about health promotion. This talk was analysed through a discourse analysis. This study of the 'talk' of general practitioners suggests that there are problems in transferring the concept, which must be recognised and addressed if health promotion is going to be taken up effectively within general practice. The meaning given to health promotion in the consultation is unclear and general practitioners were unsure about its value in 'health checks' and screening. Lack of time and lack of confidence in the evidence appeared to be barriers to undertaking health promotion within general practice consultations. In the current climate general practitioners are uncertain, to the point of ambivalence, about health promotion in their work. Further work will be required to ensure this ambivalence does not result in covert resistance.

Adult↗
PubMedDate not supplied

Depression in general medical settings. Implications of three health policy studies for consultation-liaison psychiatry.

Prepaid or prospective reimbursement has implications for the consultation-liaison (C-L) psychiatrist. The author reviews results from three health policy studies that indicated 1) degree of reliance on general medical providers for mental health care is not affected by generosity of fee-for-service (FFS) coverage, but is greater in some prepaid health care systems; 2) psychological sickness of depressed outpatients visiting general medical providers is similar across prepaid and FFS systems of care; 3) prepaid care is associated with lower rates of detection of depression and counseling in the general medical sector; 4) depression outcomes in the general medical sector are similar under prepaid or FFS care; 5) quality of care for depressed patients is moderate to low in the general medical sector; and 6) depressed elderly inpatients receive higher quality of psychological care in psychiatric units, but they receive higher quality of physical care in general medical wards. The discussion emphasizes the C-L psychiatrist's role in educating general medical providers, improving outcomes for the sickest patients, and improving psychosocial care in prepaid practices.

Depressive Disorder↗
PubMed1989

A comparative study between the use of analgesia/anaesthesia and of episiotomy in women delivered under consultant supervision or general practitioner care.

A retrospective cohort study based on obstetric records was performed, to compare the use of analgesia/anaesthesia during labour by consultants and general practitioners. The episiotomy rates for the two groups were also compared. 111 general practitioner patients were identified and these were matched with 111 consultant patients. No difference was found between the two groups for duration of stages I or II. The rates for episiotomy, 1 degree or 2 degrees tear or intact perineum were the same in each group. Women delivered under consultant supervision used more entonox than women delivered under general practitioner care, but this was counterbalanced by an increased use of pethidine in the latter group. No difference was found between the two groups with regard to the use of epidurals. There was an increased use of local anaesthetic by general practitioners. This was due to general practitioners preferring to use local anaesthetic for suturing after an epidural had worn off, whereas hospital doctors preferred to top-up the epidural to provide anaesthesia for suturing. This study supports the view that women delivered under the care of their own general practitioner in a hospital obstetric unit fare no worse than similar women delivered under consultant supervision. The former group have the advantage of continuity of care from their general practitioner.

Anesthesia, Obstetrical↗
PubMed2002

[What do general practitioners expect from internal medicine? Results of postal survey].

SUBJECT: The place of internal medicine in the French health care system is a matter of debate. In the process of writing down a project for the department of internal medicine of a University hospital, we decided to assess the expectations of general practitioners toward internal medicine in general, and toward this department in particular. METHODS: We carried out a postal survey over a population of general practitioners working in the referral area of our University hospital. The answers of physicians familiar or not with our department were compared with a chi 2 test. RESULTS: 852 questionnaires were sent over and 49.5% were returned. The general practitioners as a whole acknowledge the classical features of internal medicine: medicine dealing with diagnosis and taking in charge unexplained symptoms; holistic medicine in cases of multiple illnesses; medicine dealing with systemic diseases as well as medicine of "niches" (incidentalomas, orphan diseases). The specific orientations of this department of internal medicine are also well known by most physicians: a great majority (94%) of them are satisfied with the help they receive; they stress the need on swift sending of letters (74%); above all, 94% of them wish to obtain rapid appointments for their patients at their request. CONCLUSION: These results are in complete accordance with our aim of setting a general internal medicine department at the disposal of general practitioners. They do confirm that outpatient consultation is the hardcore of internal medicine that must be readily available to the patients referred by their general practitioner.

Attitude of Health Personnel↗
PubMed1998

Which aspects of general practitioners' behaviour determine patients' evaluations of care?

This qualitative study explored those behaviours of a general practitioner which were used by patients in their evaluations of 14 aspects of general practice care. Thirty patients were interviewed immediately after visiting their general practitioner. Interview transcripts were analyzed by two authors, who independently marked general practitioners' behaviours used by patients. Then, these text fragments were categorised into task or affective behaviours according to an existing taxonomy of doctor behaviour in consultations. The results showed that patients reported using task oriented behaviours when they evaluated task oriented aspects of general practice care. However, when they evaluated affective aspects they reported using both affective behaviours and task behaviours, although the latter to a lesser extent. The evaluations of "tell you all you wanted to know about your illness", "explain the purpose and the course of the treatment", "pay attention to your feelings" and "kind and attentive" are clearly linked to specific general practitioners' behaviour. Therefore, evaluations of these aspects can be interpreted straightforwardly. Evaluation of the aspects "GP understands you", "having faith in your GP" and "were you involved in decisions about your medical treatment?" were based on a large variety of physician behaviours which may lead to interpretation problems. Thus, this study gives some important considerations for a better understanding of patients' evaluations of general practice care.

Adult↗
PubMed2001

General medical and psychiatric comorbidity among HIV-infected veterans in the post-HAART era.

We examined the prevalence of HIV, general medical, and psychiatric comorbidities by age based on a recent multisite cohort of HIV infected veterans receiving care: the Veterans with HIV/AIDS 3 Site Study (VACS 3). VACS 3 includes 881 adult patients with HIV infection enrolled between June 1999 and July 2000. Providers reported their patients' CDC-defined HIV comorbidities, general medical comorbidities (based on Duke and Charlson comorbidity scales), and psychiatric comorbidity. Mean age of participants was 49 years and 54% were African-American. The most common HIV comorbidities were oral candidiasis (21%), peripheral neuropathy (16%), and herpes zoster (16%). The most common general medical comorbidities included chemical hepatitis (53%), hypertension (24%), and hyperlipidemia (17%). The mean number of HIV and general medical comorbidities experienced by patients were respectively 1.1 and 1.4 (P < .001). Older (> or = 50 years) HIV-infected patients experienced a greater number of general medical comorbidities than those < 50 years (respectively 1.7 versus 1.2, P < .001). There was no significant difference in mean HIV comorbidity number by age. Based on patient report, 46% had significant depressive symptoms (> or = 10 on 10-item CES-D) and 21% reported at-risk drinking (> or = 8 on AUDIT). Providers reported 32% of patients had anxiety, 4% mania, 4% schizophrenia, and 11% cognitive impairment/dementia. General medical and psychiatric comorbidities constituted a higher disease burden for HIV-infected veterans than HIV comorbidities. Whether these comorbidities are due to antiretroviral drug toxicity or are age or lifestyle-associated conditions, the substantial prevalence of these "non-HIV" comorbidities suggest an important role for general medical and psychiatric management of HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1999

Statistical issues encountered in the comparison of health-related quality of life in diseased patients to published general population norms: problems and solutions.

The objectives of this study were (1) to illustrate the statistical problems encountered when comparing health-related quality of life (HRQL) measured by the Medical Outcome Study Short Form-36 (SF-36) in a diseased group to general population norms, and (2) to define age- and gender-standardized dichotomous indicator variables for each health concept and show that these indicator variables facilitate comparisons between the diseased sample and the general population. Our "diseased" group consisted of 136 sequentially consenting patients referred to the syncope clinic for assessment and treatment. Participants completed the SF-36 questionnaire before undergoing diagnostic testing. General population norms for the SF-36 are available from the responses of 2474 participants in the National Survey of Functional Health Status, conducted in 1990 in the United States. Comparison of the SF-36 in a diseased sample with general population norms is difficult, owing to skewed and unusual distributions in both groups. In addition, making comparisons within age and gender strata is difficult if the within strata sample size is small. We propose a dichotomous indicator variable for each health concept that classifies an individual as having impaired health if he or she scored lower than the 25th percentile for the appropriate age and gender general population strata. By definition, the prevalence of impaired health in the general population is 25% for all eight health concepts. Comparison between the eight health-concept variables is easy because the population norm is the same for each of them. These indicator variables are age and gender adjusted, so that even if the sample did not have the age and gender distribution as the general population, comparisons can still be made with the value of 25.

Activities of Daily Living↗
PubMed1998

General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.

Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients with more maternal diseases (17.2% to 35.8%; P=0.0034). Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section.

Journal Article↗
PubMed1997

Symptom profiles of depression among general medical service users compared with specialty mental health service users.

BACKGROUND: Since depressive disorders are now eminently treatable and early detection and treatment could bring substantial benefits, it is critical to address alternative presentations of depression in the general medical setting. Concern regarding under-diagnosis of depression in general medical settings has given rise to the question of whether the clinical disorder of depression differs qualitatively or only quantitatively across care settings. METHODS: Symptom profiles of depression were compared across care sectors to investigate how the presentation of depression among general medical service users might differ qualitatively from specialty mental health service users. Data on depression symptoms within 6 months of interview gathered in three community surveys that were part of the NIMH Epidemiologic Catchment Area Program were analysed using methods developed to assess item bias. The subjects were 4931 and 363 persons who reported a visit to the general medical sector or to specialty mental health respectively, within 6 months of interview. RESULTS: Compared with specialty mental health service users, general medical service users were less likely to present dysphoria (adjusted Odds Ratio, aOR = 0.57; 95% Confidence Interval, CI = 0.38-0.84) and feeling worthless, sinful, or guilty (aOR = 0.63; 95% CI = 0.40-0.98), but were more likely to present fatigue (aOR = 1.71; 95% CI = 1.09-2.69), even after holding constant other characteristics that might influence reporting of symptoms as well as level of depression. CONCLUSIONS: These results suggest that there are qualitative differences in depression presenting in general medical care compared with specialty mental health care and call for a re-conceptualization of depression in the general medical setting.

Adolescent↗
PubMed1999

Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population.

AIMS: To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. DESIGN: Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity-frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. SETTING: Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. PARTICIPANTS: Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. FINDINGS: The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively (p > or = 0.05). Among women the corresponding figures were 9%, 6% and 13% (p < 0.05). CONCLUSIONS: The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over-represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.

Adult↗
PubMed1998

An evaluation of whole blood testing for Helicobacter pylori in general practice.

BACKGROUND: Rapid whole blood tests for Helicobacter pylori infection were developed to assist in the management of patients with dyspepsia in general practice. However, they have not been extensively tested in this setting. AIM: To investigate the test characteristics of the BM-Test (Helisal Quick Test) when used in general practice. METHOD: One hundred and ten dyspeptic patients attending local general practitioners were recruited into the study. The BM-Test was administered by the general practitioner at the screening visit according to standard instructions supplied with the test kit. The patient was then referred to Nepean or Mornington Peninsula Hospitals for further assessment. including a 14C-urea breath test. The test kit was forwarded to the appropriate hospital centre for an independent, blinded reading. The sensitivity and specificity of the BM-Test were evaluated against the results of the 14C-UBT. RESULTS: Based on general practitioner readings, the BM-Test had a sensitivity of 59.3% and a specificity of 90.2%. The positive and negative predictive values were 87.5% and 65.7%, respectively. When based on independent readings, sensitivity rose to 71.2% and specificity fell to 88.2%. The BM-Test was more sensitive for older patients than for younger patients when based on both the general practitioner and independent readings. CONCLUSION: The BM-Test performs below the generally recommended sensitivity and specificity of 90% required for clinical practice.

Adult↗
PubMed2001

A comparative study of work characteristics and reactions between general and mental health nurses: a multi-sample analysis.

AIM OF THE STUDY: The first aim of this study was to examine differences in work characteristics (autonomy, social support and workload) and work reactions (emotional exhaustion and job involvement) between general and mental health nurses. The second aim was to validate whether a specific pattern of relationships between work characteristics and reactions was the same for mental health and general nurses. BACKGROUND: Nurses are generally being considered as an above risk group regarding work stress. However, health care is a diverse sector and literature suggests important differences regarding the work of different categories of nursing, such as general and mental health nurses. In addition, little empirical evidence exists about these differences. In order to improve their work situation, more insight is needed regarding differences and similarities in the work of general and mental health nurses. The demand-control-support (DCS) model was used as a research framework. We hypothesized that autonomy, job involvement, and emotional exhaustion are higher in mental health nursing, whereas social support is expected to be lower. Next, in line with the propositions of this model and several recent studies, we hypothesized that emotional exhaustion is primarily predicted by workload and social support, whereas job involvement is primarily predicted by autonomy. In addition, we investigated whether this pattern of relationships was similar in both groups. DESIGN/METHODS: Questionnaires were distributed to nurses working in a general and a psychiatric hospital in the Netherlands. We used MANOVA and MSA (by means of LISREL) to analyse the data. RESULTS AND CONCLUSIONS: Regarding the differences in work characteristics and work reactions between mental health and general nurses, our hypotheses were confirmed, except for social support and job involvement. Autonomy and emotional exhaustion were higher among mental health nurses, whereas their job involvement proved to be significantly lower. Emotional exhaustion was primarily predicted by workload and lack of social support. Contrary to our expectations, the relationship between autonomy and job involvement was not significant in both samples. Finally, we found that the proposed pattern of relationships appeared to be invariant across the two samples.

Adult↗
PubMed1999

A comparison of the educational opportunities on junior medical attachments in general practice and in a teaching hospital: a questionnaire survey.

OBJECTIVES: To obtain students' perceptions of the educational quality of the general internal medicine teaching overall and to determine whether specific learning objectives were better addressed in general practice or in hospital. DESIGN: The survey was carried out after a 10 week block of general internal medicine, consisting of five weeks taught in general practice and five weeks taught in a teaching hospital. Students were randomly allocated to start in either general practice or hospital. The outcome measure was a questionnaire survey of students perceptions' of their learning on the two halves of the block. Each student completed the same questionnaire twice: once after their hospital experience and once after their general practice experience. Statistical Analysis was carried out using the SPSS package for Windows 3.1. Group means were calculated for each response, and the mean differences for each student's responses for the two learning environments were analysed using t-tests for paired samples. SETTING: Royal Free and University College Medical School at University College London. SUBJECTS: The study population was the entire annual intake (n = 225) of students into the first clinical year at one UK medical school. RESULTS: Students perceived they learnt more about history taking and physical examination in the community, whereas they learnt more about writing up their clerkings, keeping progress notes and disease management in hospital. CONCLUSIONS: The community and hospital environments appear to have different strengths for the teaching of medical students. These data support judicious transfer of clinical skills teaching from teaching hospitals into general practice, when the circumstances achieved here can be duplicated. However, some aspects of the clinical attachment, particularly record keeping and disease management, are probably better taught in hospital at present.

Clinical Medicine↗
PubMed2002

Deciding how NHS money is spent: a survey of general public and medical views.

OBJECTIVES: To examine the validity of the Prioritization Scoring Index (PSI) methodology by obtaining the views of our local population and clinicians regarding the criteria and weightings that should be used in deciding how NHS money is spent. BACKGROUND: We have used a PSI in Argyll and Clyde to allocate new money since 1996 and to determine priorities for our 1999/2000-2003/2004 Health Improvement Programme (HIP). Since the criteria and weightings for this methodology were developed subjectively, we sought to validate these by consulting local people and to change our methodology to take account of wider population views. METHODS: A postal questionnaire was sent to 1969 members of the general public, all 314 general practitioners and all 189 hospital consultants in Argyll and Clyde in March 1999. A reminder was sent after 4 weeks. Questions were asked about general funding and prioritization in the NHS and about specific issues relating to potential criteria for prioritization, including those used in our PSI methodology. Responses were analysed quantitatively in the Statistical Package for the Social Sciences (SPSS) and qualitatively through examination of the responses to open questions. RESULTS: The response rate was 51% for the general public and 71% for GPs and consultants. Respondents from the general public were broadly representative of the Argyll and Clyde population. The main findings were that: greater importance should be given to care that improves health, quality of life or prevents ill health rather than to cost, or to government and local health board priorities; half of the general public and most clinicians thought there should be a limit on NHS funding; extra money for the NHS should come from the national lottery (general public) or higher taxes on cigarettes and alcohol (clinicians); doctors should have the greatest influence in deciding how NHS money is spent; a higher priority should not be given to the health-care needs of younger people rather than older people. Our public and clinicians would allocate approximately 50% of the prioritization weighting to direct patient benefits, 25% to the cost of health-care and 25% to strategic health issues. CONCLUSIONS: Consideration of public and clinician views suggests that a revised PSI should place greater weight on benefits to patients and lower weight on the cost of health-care.

Attitude of Health Personnel↗
PubMed2003

Paediatric atopic dermatitis in Perth general practice.

Ninety-seven Perth general practitioners completed a self-administered postal questionnaire that aimed to examine their caseload and management practices for childhood atopic dermatitis (AD). General practitioners saw a median of two new cases and three follow-up consultations per month for childhood AD, and referred a median of 10% of cases to a specialist, usually a dermatologist. Most (77%) recommended emollients for all patients, but only 21% specifically reported advising their use immediately after bathing. Sixty-one percent would use topical corticosteroids in all or most patients, but cream preparations were more commonly used (58%) than ointments (40%). Atrophy was rated as a common or very common side-effect of topical corticosteroid therapy by 23% of general practitioners. Twenty-six percent reported using oral corticosteroids in children with AD. Dietary changes would be recommended in at least a few AD patients by 79% of general practitioners, and 31% would recommend a change from cow's milk to soy in the absence of a history of dietary triggers. We conclude that general practitioners appeared generally well informed about AD management. However, dermatologists, through targeted education, may be in a position to help general practitioners further improve outcomes for these patients.

Child↗
PubMed2001

General practitioner participation in the second Australian National Blood Pressure Study (ANBP2).

1. The second Australian National Blood Pressure Study (ANBP2) is an outcome trial of the treatment of hypertension in the elderly conducted entirely in general practices across Australia. Prior to ANBP2, no study of this size and nature had been undertaken in Australian general practice and the response of General Practitioners (GPs) to becoming involved in long-term cardiovascular research was unknown. 2. Academic departments and Divisions of General Practice were approached to support the project. General Practitioners were approached by letter of invitation and contacted by a regional medical coordinator (RMC) either at a face-to-face meeting or by telephone. 3. At the close of recruitment to ANBP2, 1938 GPs from 950 practices had registered as investigators. Sixty-two Divisions of General Practice were approached to support the study in five mainland Australian states with 39 (63%) participating, although participation by state was highly variable (range: 18-100%). Thirty divisional or promotional dinner meetings were held, with 56% (368/658) of those attending registering as investigators. Of the 8098 GPs sent a letter of invitation to participate in the study, 1357 (17%) expressed interest and eventually enrolled as investigators, ranging from 8% in Queensland to 28% in New South Wales. Ninety-six per cent of GPs who had a personal face-to-face contact (696/724) with the RMC registered in the study. 4. The GP recruitment phase of ANBP2 has been successfully completed. Peer-to-peer recruitment was the most successful strategy; however, success varied between states. General Practitioner recruitment to long-term clinical trials appears to be successful with a multifactorial approach focusing on peer-to-peer recruitment.

Aged↗
PubMed1999

The provision of preventive care by general practitioners measured by patient completed questionnaires.

The objective of this study was, by means of patient self-report, to measure the provision of preventive care to patients of a sample of Australian general practitioners. Patient-completed questionnaires from a consecutive sample of Australian general practitioners enrolled in the Quality Assurance and Continuing Medical Education Program of the Royal Australian College of General Practitioners were used. Patients were attendees at Australian general practices. The main outcome measures included the following: the provision of tetanus immunization within the last 10 years; blood pressure measurement within the last 12 months; cholesterol screening within the past 5 years; provision of adequate information to enable patients to stop smoking if they desired; discussion about the benefits of diet and exercise to enhance life, and about alcohol intake; provision of cervical smears in the past 2 years; provision of adequate instruction in breast self-examination and overall satisfaction with service provision. A total of 12,605 questionnaires from 133 general practices were completed. There was wide variability between practices in the reported provision of preventive care items including an average of 86% (range 36-100) of patients reporting the provision of blood pressure checking in the past 12 months, 62% (range 25-97%) reporting the provision of tetanus immunization in the past 10 years, and 63% (range 10-91%) reporting having had a cervical smear in the past 2 years. Patients who were very satisfied were more likely to have reported that they had received blood pressure measurement in the past 12 months, participated in discussions about the benefits of diet and exercise in enhancing life, and participated in discussions about alcohol intake and provision of adequate instruction in the technique of breast self-examination. Patient self-reporting identified variability between practitioners in the provision of preventive care conforming to accepted guidelines. Patients who reported that they were very satisfied or who regularly attend only one general practice reported the provision of more preventive care than those who were not very satisfied or who regularly visited two or more general practitioners.

Adolescent↗
PubMed1999

Generalized convulsive epilepsy: possible mechanisms.

Neuronal mechanisms underlying focal convulsions and secondary generalized convulsions continue to be intensively investigated and many important pathophysiological processes are now recognized. Our understanding of primary generalized convulsions remains limited in spite of a variety of approaches. While there are well known clinical situations offering insights into some aspects of the pathophysiology, studies in animal models of generalized convulsions offer a deeper understanding of some of the processes likely to be occurring. Animal studies have indicated that generalized convulsive epilepsies are likely to be comprised of several types of convulsion and that these arise from more than one neuronal network. In particular, the cortex and brain stem can interact in various ways to lead to convulsions and may even act independently. Pharmacological agents can produce specific changes in the excitability of neurons and cause generalized convulsions, so providing models of the possible neurophysiological defects in humans. Based on electrophysiological recordings of generalized convulsions in these animal models, we also suggest that the convulsion involves subcortical mechanisms and raise the idea that primary generalized convulsive epilepsy arises out of intensified (synchronized) normal brain rhythms. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗