Extra Medication Research Articles

Metformin Combinatorial Therapy for Type 2 Diabetes Mellitus

Type 2 Diabetes mellitus (T2D) is a worldwide chronic epidemic with increasing incidence. The current algorithm for medical management of type 2 diabetes includes the pharmacological treatment with nine classes of anti-diabetic drugs. Among the nine classes of drugs approved, metformin, an oral hypoglycemic agent from the biguanide family is widely prescribed as the first-line anti-diabetic monotherapy for the treatment of initially diagnosed T2D individuals. The failure of monotherapy to achieve sustain glycemic control prompted the early use of aggressive combination therapies with other anti-diabetic drugs. The primary aim of T2D treatment is to achieve target glycemic control and reducing further complications of diabetes. Hence, fixed dose combination drugs are preferable in order to reduce pill burden and capital investment. Single pill combinations containing drugs for two different diseases can also be prescribed for avoiding extra medication and to reduce further diabetic complications. Our review addresses the mode of action of anti-diabetic drugs and their combinatorial therapy with metformin.

Patient Infusion Pattern based Access Control Schemes for Wireless Insulin Pump System

Wireless insulin pumps have been widely deployed in hospitals and home healthcare systems. Most of them have limited security mechanisms embedded to protect them from malicious attacks. In this paper, two attacks against insulin pump systems via wireless links are investigated: a single acute overdose with a significant amount of medication and a chronic overdose with a small amount of extra medication over a long time period. They can be launched unobtrusively and may jeopardize patients’ lives. It is very urgent to protect patients from these attacks. We propose a novel personalized patient infusion pattern based access control scheme (PIPAC) for wireless insulin pumps. This scheme employs supervised learning approaches to learn normal patient infusion patterns in terms of the dosage amount, rate, and time of infusion, which are automatically recorded in insulin pump logs. The generated regression models are used to dynamically configure a safe infusion range for abnormal infusion identification. This model includes two sub models for bolus (one type of insulin) abnormal dosage detection and basal abnormal rate detection. The proposed algorithms are evaluated with real insulin pump. The evaluation results demonstrate that our scheme is able to detect the two attacks with a very high success rate.

What Do Patients Do With Unused Opioid Medications?

The volume of opioid medications being prescribed in the United States is increasing rapidly. Problems associated with the misuse of opioid medications are also increasing, in part because of medication diversion from legitimate prescriptions. However, little is known about what patients do with any unused opioid medications. This paper uses a qualitative analysis of patients' self-report of medication storage and retention habits to begin to address this gap. We analyzed responses to the Prescription Drug Use Questionnaire in conjunction with other data on prescription opioid use in a sample of 191 Veteran patients (83% of whom had a preexisting factor associated with higher rates of opioid misuse) who received one or more opioid prescriptions in the previous 12 months. Only 6.3% of participants disposed of extra medications and 24.1% reported having no extra opioids. A total of 65.4% of participants reported retaining some or all opioids even if they ceased taking the medication, and some participants accumulated large amounts of medication. A total of 34.0% of participants described engaging in sharing or diversion of opioids at least once, most often receiving them from a family member or a friend. A majority of patients retain unused opioids, and medication sharing is common. Interventions to improve monitoring of patient experience with opioid medication, educate patients about the dangers of opioid use by nonprescribed others, and increase information about medication disposal options could decrease the supply of opioid medications available for misuse.

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

International Variations In Essential Medication Lists

Every nation in the world has established a National Medication Formulary to account for all the medications present in the country. Many countries follow the Essential Medication List provided by the World Health organization (WHO) when making their own National Medication Formulary. Our study looked at variations in the National Formularies when compared to the Essential Medication Lists. Different relationships such as missing and extra medications lists were formulated and the statistics analyzed. It was noted that on average most of the countries studied were lacking 47% of medications, and had 30% additional medications on their national formulary. Further studies need to be conducted as Essential Medications may be lacking, or harmful medications may be present in a country's formulary leading to severe health problems.
 
 Type: Commentary

Phase II, Open Label, Randomized Comparative Trial Of Ondansetron Alone Versus The Combination Of Ondansetron Plus Aprepitant For The Prevention Of Nausea and Vomiting In Patients (Pts) With Hematological Malignancies Receiving Regimens Containing High Dose Cytarabine

▪ BackgroundChemotherapy induced nausea and vomiting can be a significant problem for pts with acute myeloid leukemia (AML) receiving induction chemotherapy causing deterioration in quality of life. Cytarabine-containing regimens are the cornerstone for the management of AML and cytarabine is a moderate emetic risk chemotherapy agent. Combination of cytarabine with other chemotherapeutic agent can substantially worsen nausea and vomiting. Ondansetron has been used for nausea control in pts receiving chemotherapy. Aprepitant is a P/neurokinin-1 (NK1)-receptor antagonist approved for use in combination with a 5-HT3-receptor antagonist and dexamethasone for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. We explored whether the combination of two drugs with different mechanisms of action may improve the control of nausea in pts with AML receiving cytarabine-based induction. MethodsPts with AML, high-risk MDS or CML blast phase receiving induction chemotherapy with cytarabine at a dose of ≥1 g/m2/day for at least 3 days were randomized to: Arm 1) Ondansetron 8mg IV 30 minutes before high dose cytarabine followed by ondansetron 24mg IV continuous infusion daily until 6-12 hours after the end of last chemotherapy infusion. Arm 2) Aprepitant 125mg PO plus ondansetron 8mg IV 30 minutes before high dose cytarabine followed by ondansetron 24mg IV continuous infusion daily until 6-12 hours after the end of last chemotherapy, plus aprepitant 80 mg PO daily and to continue for 1 day after last dose of chemotherapy. Pts were followed for 72 hrs post chemotherapy. A diary was used by the pts to record daily number of episodes of nausea and /or vomiting experienced during the study, as well as to record any need of extra medications for escape nausea. Complete response was defined as no emesis episodes and no use of rescue medication during the study period. Partial response was defined as ≤ 1 episode of emesis during the entire study period, no use of rescue medication during the study period, and no more than moderate nausea (NCI grade 2). ResultsForty nine pts were enrolled in each arm. Fifty seven percent were men in arm 1 and 55% men in arm 2. The median age was 53yrs (ranges, 30-68) in arm 1 and 49yrs (ranges, 21-70) arm 2. Caucasians were 83% in arm 1 and 76% in arm 2. African American and Hispanics were 10 % and 6% respectively in arm 1 and 8% and 12% in arm 2. Among the population studied 96% were diagnosed with AML in each arm. MDS 2% in arm 1 and 4% in arm 2. Fourteen percent received Idarubicin with cytarabine (Ara-C) in each arm. Twenty percent in ondansetron (OND) arm and 16% in ondansetron plus aprepitant (OND+APREP) arm receive Ara-C combined with Fludarabin. Ara-C in combination with anthracycline plus nucleoside analogues was given to 49% of pts in each arm. Ten percent in arm 1 received Ara-C with anthracycline and targeted therapy, 8% in arm 2 receive similar combination. Forty two pts on OND arm and 41 pts in the OND+APREP arm were evaluable for efficacy. Patient in the OND+APREP arms achieved higher overall response rates (complete plus partial responses) as shown in Figure 1, but the difference was not statistically significant (OND 67%, OND+APREP 80%; P= 0.11). More than 75% of pts overall were free of nausea on Days 1 and 2. On days 6 and 7 higher proportion of pts in OND+APREP arm were free from nausea than OND arm. Overall 36% of pts required rescue medications, 38% in OND arm and 34% in OND+APREP arm. Among them 14% of pts required rescue more than once; 19% in the OND arm and 10% in OND+APREP arm, as shown in Figure 2. Requirement of rescue medications on Days 2 and 3 were fewer in OND+APREP arm 7% and 5% respectively compare to 21% and 16% in the ondansetron arm (P = 0.06 and P=0.07).Most common adverse events were headache and diarrhea. Twenty percent of pts in OND arm and 19% in OND+APREP arm reported to have NCI grade 2 headache (P= 0.56). Five percent of pts in ondansetron arm and 12% in ondansetron plus aprepitant arm had grade 2 diarrhea (P=0.19). ConclusionsThe daily assessment of emesis and nausea did not show statistically significant differences between the study arms but there was a clear trend towards better responses in ondansetron plus aprepitant arm with more overall response rates and lower use of rescue medications. Further larger studies are warranted to further define the benefits of this combination of antiemetic drugs. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction

BackgroundIn mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting β2 agonists (SABAs) on demand.ObjectiveThe hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB...

Medication Counselling: Physicians' Perspective

Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record.

DGI-004 Analysis of Consultations Made by Patients in an Outpatient Service

Background hospital pharmacists interview all outpatients with a new prescription, including medication changes, and those who are suspected of not having good compliance. However, patients sometimes voluntarily demand to talk...

Is Previous Disaster Experience a Good Predictor for Disaster Preparedness in Extreme Poverty Households in Remote Muslim Minority Based Community in China?

Disaster preparedness is an important preventive strategy for protecting health and mitigating adverse health effects of unforeseen disasters. A multi-site based ethnic minority project (2009–2015) is set up to examine health and disaster preparedness related issues in remote, rural, disaster prone communities in China. The primary objective of this reported study is to examine if previous disaster experience significantly increases household disaster preparedness levels in remote villages in China. A cross-sectional, household survey was conducted in January 2011 in Gansu Province, in a predominately Hui minority-based village. Factors related to disaster preparedness were explored using quantitative methods. Two focus groups were also conducted to provide additional contextual explanations to the quantitative findings of this study. The village household response rate was 62.4 % (n = 133). Although previous disaster exposure was significantly associated with perception of living in a high disaster risk area (OR = 6.16), only 10.7 % households possessed a disaster emergency kit. Of note, for households with members who had non-communicable diseases, 9.6 % had prepared extra medications to sustain clinical management of their chronic conditions. This is the first study that examined disaster preparedness in an ethnic minority population in remote communities in rural China. Our results indicate the need of disaster mitigation education to promote preparedness in remote, resource-poor communities.

Sensibilidade espécie-específica aos anti-inflamatórios não esteroidais: humanos X animais de companhia

Este estudo forneceu subsídios para o melhor entendimento das intoxicações pelos anti-inflamatórios não esteroidais (AINES) em humanos e animais de companhia. Os principais focos foram a diferença espécie-específica e os serviços prestados por Centros de Informação Toxicológica. Para tanto, foram utilizados dados referentes às intoxicações por AINES em pessoas, cães e gatos reportadas ao CIT/RS entre 2005 e 2009. Além disso, foram abordados, comparativamente, os dados do American Association of Poison Centers (AAPCC) entre 2004 e 2008, bem como as referências na literatura acerca da sensibilidade espécie-específica. Constatou-se que a maioria das intoxicações por AINES, independentemente da espécie, abrangeu o cetoprofeno, o ibuprofeno e o diclofenaco, sendo 54% destes intencionais em humanos, destacando-se o diclofenaco. Em se tratando de animais de companhia, 73% das intoxicações em cães ocorreram pelo diclofenaco, e 60% dos acidentes em gatos foram ocasionados pelo ibuprofeno. Chama-se a atenção para a importância dos Centros de Informação Toxicológica como forma de assistência e prevenção desses acidentes, bem como para a venda indiscriminada desses fármacos, aliados à medicação extraprescrição - que leva, na maioria das vezes, cães e gatos ao óbito.

Bupivacaina ou bupivacaina e morfina intra-articular pós reconstrução do LCA

ObjectiveReconstructive surgery of the ACL is one of the most commonly performed surgeries today and the control of postoperative pain is part of the priorities of the surgeon. Within the arsenal of analgesia we have the intra-articular application of drugs, and the most studied one is bupivacaine with or without morphine. This study compared the application of bupivacaine with or without morphine with a control group after ACL reconstruction with flexor tendon graft.MethodsForty-five patients were randomized into three groups: in group I, 20 ml of saline were applied intra-articularly at the end of the surgery; in group II, 20 ml of bupivacaine 0.25%; and in group III, bupivacaine 0.25% associated with 1 mg of morphine. The groups were assessed for degree of pain by the Visual Analog Scale at 6, 24 and 48 hours postoperatively.ResultsGroup III had less pain at all times, but the pain was not as intense in all groups to the point of needing extra medications beyond the established protocol.ConclusionThe intra-articular application of these medications after ACL reconstruction with flexor tendon graft when performed under spinal anesthesia is not useful enough to use regularly. Level of Evidence II, Lesser quality RCT

Managing risk and conflict behaviours in acute psychiatry: the dual role of constant special observation

This is a report of a study of events before and after the use of constant special observation on acute psychiatric wards, and the characteristics of patients who received it. Constant special observation is a method of preventing acutely disturbed inpatients from harming themselves or others. It has been characterized as impersonal, intrusive and non-therapeutic. The circumstances of its use and place in broader intervention strategies are not well understood. A sample of 522 patients were recruited from 84 acute psychiatric wards in 31 hospital locations in London and surrounding areas during 2009-2010. Data were collected for the first 2 weeks of admission from patients' case notes. Sixteen per cent of patients received constant special observation during the first 2 weeks in hospital (7% at the point of admission and 11% after admission), but with variation between hospitals. Absconding, violence and self-harm were the most common events to precede constant special observation during a shift. Other methods of containment, especially intermittent special observation, were frequently tried first. Episodes of constant special observation often involved de-escalation and extra medication. Aggression was more prominent during than before constant special observation. Attempted suicides were limited to postadmission episodes. Constant special observation is usually used in combination with other forms of containment, irrespective of when it is initiated. Placing patients considered at risk of suicide under constant special observation on admission may have a protective effect.

Assessment of significant factors affecting acceptability of home administration of misoprostol for medical abortion

BackgroundKnowledge on factors affecting acceptability of medical abortion with mifepristone followed by home administration of misoprostol is scarce. The objective of this study was therefore to assess factors affecting acceptability and experience of home use of misoprostol for medical abortion up to 63 days' gestation. Study DesignProspective observational study with acceptability assessed through questionnaires. Factors affecting acceptability were analyzed using multivariate logistic regression. ResultsA total of 395 women were included. Independent factors for acceptability were having a partner/friend present and having a positive low-sensitivity urine hCG at follow-up, although most of these patients had successful abortions. Age, gestational length and requirement of extra pain medication did not affect acceptability. ConclusionHome administration of misoprostol is highly acceptable. Increasing the number of complete abortions should be a focus of future research. Women should be encouraged to have a partner/friend present during home administration of misoprostol.

Effect of topical lignocaine on postoperative pain after laparoscopic tubal sterilisation in awake patients

OBJECTIVE: To evaluate postoperative pain after administration of topical lignocaine during laparoscopic sterilization in awake patients using Falope rings. STUDY DESIGN: Thirty-six women who underwent laparoscopic tubal sterilization were assigned randomly to receive topical lignocaine (1%, 10ml) or placebo. A 4-point verbal rating score was used to assess pain at ring application, 15 minutes, 1 hour and at discharge. Side effects, complications, extra pain medication requirements, satisfaction rates at follow up were assessed postoperatively. RESULTS: The pain scores were significantly lower in the lignocaine group at 15 minutes (2.06 vs. 2.94), one hour (1.187 vs. 2.33) and at discharge (0.18 vs. 1.1). The side effects and complications were similar in the two groups. Procedure satisfaction and acceptability was more in the lignocaine group (p=0.005). CONCLUSION: Topical lignocaine applied to the fallopian tubes at the time of laparoscopic tubal sterilization decreases postoperative pain and improves satisfaction rates even if done under sedation and local anesthesia.

Nursing Practices Recorded in Reports of Episodes of Seclusion

The purpose of this study is to describe the nursing practices recorded in reports of patient episodes of seclusion, with or without restraints, in a specialized psychiatric facility in Quebec. The reports for all adult patients secluded (n = 4863) in a psychiatric unit between April 1, 2007 and March 31, 2009, were examined. Descriptive analyses were performed. The main reasons for seclusion were agitation, disorganization, and aggressive behaviour. The alternative methods that were attempted included stimulus reduction, extra medication, and working with the patient to find a solution. Few families were notified about their relation's seclusion. More hours of seclusion were reported in the evening and at night. Our results are comparable to those obtained by other investigators. Some of the variables have not been the subject of much research: for example, health conditions during seclusion with or without restraint and partnerships with family members. Our findings also suggest that, in their analyses, studies should differentiate between cognitive-impairment and adult-psychiatry units as well as long-term seclusion and short-term seclusion. The information reported by the nurse makes no distinction between short-stay and long-stay adult psychiatric units. Only one psychiatric facility was investigated in this study, precluding generalization.

Effect of Lyophilized Lactobacilli and 0.03 mg Estriol (Gynoflor®) on Vaginitis and Vaginosis with Disrupted Vaginal Microflora: A Multicenter, Randomized, Single-Blind, Active-Controlled Pilot Study

Objectives: To evaluate the efficacy of lyophilized lactobacilli in combination with 0.03 mg estriol when compared to metronidazole in the treatment of bacterial vaginal infections. Setting: Multicenter, randomized, single-blind, active-controlled pilot study in 3 independent gynecological practices in Belgium. Methods: Forty-six, 18- to 50-year-old premenopausal women with a disrupted vaginal flora due to a bacterial vaginal infection (bacterial vaginosis, aerobic vaginitis) were included, provided that fresh phase-contrast microscopy of the vaginal fluid showed lactobacillary flora grade 2B or 3. Patients were given a blinded box with either 12 vaginal tablets of Gynoflor® (study medication) or 6 vaginal suppositories containing 500 mg metronidazole (control medication). Eight efficacy variables were studied to assess the status of the vaginal flora at entry, 3–7 days (control 1), 4–6 (control 2) weeks and 4 months after the end of therapy. Results: At control 1, the combined variables equally improved in the lactobacilli group as in the metronidazole group. At control 2, the lactobacillus preparation showed slightly inferior results when compared to metronidazole. At 4 months, this analysis could not be performed due to low numbers, but analysis of recurrence rate and extra medication needed was not different between both groups. Conclusion: Lyophilized lactobacilli in combination with low-dose estriol are equivalent to metronidazole in the short-term treatment of bacterial vaginal infections, but have less effect after 1 month. Further studies are required to evaluate the long-term efficacy of lactobacilli when applied repeatedly.

Early intervention for psychosis in Hong Kong – the EASY programme

This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed.

Nuevas tecnologías aplicadas al proceso de dispensación de medicamentos. Análisis de errores y factores contribuyentes

Calcular la prevalencia de los errores producidos en diferentes sistemas de dispensación de medicamentos, las etapas en que se producen y los factores contribuyentes. Estudio observacional prospectivo. Se revisaron las etapas del proceso de dispensación en 5 sistemas de dispensación: stock o botiquín de planta, sistema de distribución de medicamentos en dosis unitaria (SDMDU) sin prescripción electrónica asistida (PEA), SDMDU con PEA, sistema automatizado de dispensación (SAD) sin PEA y SAD con PEA. Se identificaron los errores de dispensación, las etapas en que ocurrieron dichos errores y sus factores contribuyentes. De 54.169 oportunidades de error, se detectaron 2.181 errores. Tasa de error: stock, 10,7%; SDMDU sin PEA, 3,7%; SDMDU con PEA, 2,2%; SAD sin PEA, 20,7%; SAD con PEA, 2,9%. Etapa más frecuente en la que se produce el error: stock, preparación del pedido; SDMDU sin PEA y con PEA, llenado del carro; SAD sin PEA y con PEA, llenado del SAD. Error más frecuente: stock, SAD sin PEA y con PEA, omisión; SDMDU con PEA, diferente cantidad de medicamento; SDMDU sin PEA, sobra medicamento. Factor contribuyente: stock, SAD sin PEA y con PEA, rotura de stock/desabastecimiento; SDMDU con PEA, personal sin experiencia y sistema de comunicación deficiente entre profesionales; SDMDU sin PEA, sistema de comunicación deficiente entre profesionales. La aplicación de nuevas tecnologías en el proceso de dispensación ha aumentado su seguridad, concretamente la implantación de la PEA ha permitido disminuir los errores en el proceso de dispensación. Calculate error prevalence occurred in different medication-dispensing systems, the stages of occurrence, and contributing factors. Prospective observational study. The staging of the dispensing process were reviewed in five dispensing systems: Stock, Unitary-Dose dispensing systems (UDDS) without Computerized Prescription Order Entry (CPOE), CPOE-UDDS, Automated Dispensing Systems (ADS) without CPOE and CPOE-ADS. Dispensing errors were identified, together with the stages of occurrence of such errors and their contributing factors. 2,181 errors were detected among 54,169 opportunities of error. Error-rate: Stock, 10.7%; no-CPOE-UDDS, 3.7%, CPOE-UDDS, 2.2%, no-CPOE-ADS, 20.7%; CPOE-ADS, 2.9%. Most frequent stage when error occurs: Stock, preparation of order; no-CPOE-UDDS and CPOE-UDDS, filling of the unit dose cart; no-CPOE-ADS and CPOE-ADS, filling of the ADS. Most frequent error: Stock, no-CPOE-ADS and CPOE-ADS, omission; CPOE-UDDS, different amount of drug and no-CPOE-UDDS, extra medication. Contributing factor: Stock, CPOE-ADS and no-CPOE-ADS, stock out/supply problems; CPOE-UDDS, inexperienced personnel and deficient communication system between professionals; no-CPOE-UDDS, deficient communication system between professionals. Applying new technologies to the dispensing process has increased its safety, particularly, implementation of CPOE has enabled to reduce dispensing errors.

Triggers and techniques in termination of partial seizures

Objective Growing interest in seizure prediction exists as a means to deliver newer antiepileptic therapies, though patient self-termination of seizures has received little attention. Methods Two hundred twenty-three patients able to recognize seizure onset were surveyed in an outpatient epilepsy clinic. A seven-question survey administered prospectively assessed self-reported seizure prediction and clinical techniques used for self-termination. Survey responses targeted percentage predictability of seizures, timing of clinical prediction, likelihood/timing of termination, frequency and effectiveness of methods used, and perspectives of patient and physician belief in self-termination. Results Two hundred twenty-three patients (89 males) with a mean age of 42.7 years, average duration of epilepsy of 20.8 years and monthly mean seizure frequency of 4.1 comprised the study group. Thirty-eight percent completed >75% of the survey. Prior treatment included a mean of 6.0 AEDs (40/192 had surgery); 65% had ongoing seizures. Sixty percent of 223 patients reported a history of an aura, and 39% consistently noted auras for >75% of their current seizures. Of the patients with auras, seizure triggers were reported in 74%, with worry and stress ( N = 69), sleep deprivation ( N = 60), and missed medication ( N = 56) most frequently cited. Seventeen percent were positive/somewhat sure they could predict onset, with approximately 20% noting rapid onset in <15 seconds. Twenty-two of 82 noted that they had some ability to self-terminate their seizures, and 9% were positive that they could do so. Methods to self-terminate were effective (>75% certainty) in 35% (26/75). The primary methods were lying down/resting and taking extra medication. Conclusion The majority of patients with partial seizures recognize triggers of seizure onset. In addition, more than one-third believe they can effectively self-terminate their partial-onset seizures. Lying down, resting, and taking extra medication were the most common techniques instituted by patients. Correlating clinical symptoms at seizure onset with termination may help improve the sensitivity in seizure prediction.