Summary: Purpose:To compare the frequency of seizures and status epilepticus and their response to first-line drugs in patients with idiopathic generalized epilepsies receiving carbamazepine or phenytoin to those receiving other drugs or no treatment.Methods: We performed a retrospective chart review of all cases of idiopathic generalized epilepsies treated by the authors between 1985 and 1994. We compared seizure frequency and mean intravenous benzodiazepine dose required to control absence status epilepticus, intraindividually in subjects on carbamazepine or phenytoin before and after discontinuation of these compounds, and interindividually to subjects without treatment or receiving other drugs.Results: Bouts of absence or tonic-clonic status epilepticus and seizures in subjects treated with phenytoin or carbamazepine at therapeutic concentrations were considerably more frequent and proved intractable to treatment with valproic acid or benzodiazepines, compared with a cohort of subjects also with idiopathic generalized epilepsies, but naive to, or receiving subtherapeutic or therapeutic doses of other agents.Conclusions: Our observations strongly suggest that therapeutic concentrations of phenytoin and carbamazepine exacerbate idiopathic generalized epilepsies. Subjects in whom absence is one of the seizure types seem at a particularly high risk for responding paradoxically. These findings underscore the value of accurate classification of seizures and particularly the syndromic approach to diagnosis and point to the potential for iatrogenic complications with indiscriminate use of antiseizure drugs. Key Words: Idiopathic generalized epilepsiesAbsence status epilepticus-Refractoriness-Paradoxical effects-Phenytoin-Carbamazepine.Convulsive status epilepticus refractory to appropriate treatment is well recognized and comprises a sizable percentage of all cases of status (1,2). In contrast, idiopathic generalized absence status epilepticus (IGASE), refractory to appropriate drugs, is rate (3-6). A survey of the literature revealed that complete control was attained in 93% of cases from 10 different studies (7).Paradoxical increases in seizure frequency is a recognized, but difficult-to-document, adverse effect of antiepileptic agents (8-10). The main limitation evident in the existing body of literature is a lack of systematic observations over reasonably long periods of time to minimize the confounding effect of the inherently high variability in seizure frequency, a phenomenon known as "regression of seizure frequency to the median" (9, I 1 ).In addition, the majority of reported cases have been patients with symptomatic epilepsy. We report eight carefully studied cases (Group 1) with idiopathic generalized epilepsy (ICE) on phenytoin (PHT) and carbamazepine (CBZ) with very frequent, seemingly intractable absence (AS) and tonic-clonic seizures who presented in absence status epilepticus (ASE) that proved refractory to intravenous high-dose benzodiazepines (BZDs). The lack of response in these cases was in star...

The next steps include the development of an advanced programme. Residency programmes for new nurse leaders are critical for successful transition into management positions.

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

HIV-infected individuals are at risk for psychological distress, including depression, sadness, and suicidality. The purpose of this qualitative descriptive study was to examine 22 HIV-infected African American women's experiences of psychological distress and use of coping strategies. Data were collected through in-person one-on-one interviews until conceptual saturation was reached. Data were analyzed using inductive content analysis. Four themes were found: (a) psychoemotional suffering, (b) contextual factors negatively influence the everydayness of living with HIV infection, (c) HIV-related stigma perpetuates isolation and loneliness, and (d) creating a safe haven. Implications for nurses and other health care providers include (a) holistic assessment to include evaluation of emotional and mental state, and (b) coping strategies. Integration of spiritual practices into plan of care is also important. Development and evaluation of individualized coping interventions that address stigma and psychological distress through holistic modalities is warranted.

This supportive approach assists patients to accept the functional or nonorganic nature of their symptoms and the need for psychological services.

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As nurses engage as partners in addressing complex healthcare issues, it is increasingly important to develop nurse leaders. Many nurses need expanded knowledge and training to lead change. The purpose of this article is to describe an innovative statewide nurse leadership residency program to prepare new nurse leaders in four specialty areas. Suggestions are offered for continued advancement of leadership training for RNs across specialty roles and settings.

Increasingly researchers are using qualitative research to explore clinically important issues. As consumers of research or members of a research team, clinical nurse specialists need to understand the nature of this research that can provide in-depth insight and meaning.