Computed tomography in patients with epileptic seizures admitted acutely to hospital: A population level analysis of routinely collected healthcare data.

Approximately 1.4% of emergency medical admissions are due to epileptic seizures. For the majority of such cases, computed tomography (CT) will not inform acute management and is unnecessary.Pseudonymised, routinely collected data from seven hospitals within the Cheshire and Merseyside area of the UK were analysed. All patients with emergency admissions to hospital due to seizures between 2014 and 2017 were included. Use of CT of the head was identified from routine coding.We identified 4,183 individuals with an acute seizure admission, of which over 30% received a CT of the head. There was significant variation in CT among hospital trusts.The rate of CT for patients admitted with seizures is high and CT is not being directed to those where they may be indicated. Integrated care pathways and guidelines are required to improve the management of patients presenting acutely with seizures.

National Audit of Seizure management in Hospitals (NASH): results of the national audit of adult epilepsy in the UK.

OBJECTIVES: About 100,000 people present to hospitals each year in England with an epileptic seizure. How they are managed is unknown; thus, the National Audit of Seizure management in Hospitals (NASH) set out to assess prior care, management of the acute event and follow-up of these patients. This paper describes the data from the second audit conducted in 2013. SETTING: 154 emergency departments (EDs) across the UK. PARTICIPANTS: Data from 4544 attendances (median age of 45 years, 57% men) showed that 61% had a prior diagnosis of epilepsy, 12% other neurological problems and 22% were first seizure cases. Each ED identified 30 consecutive adult cases presenting due to a seizure. PRIMARY AND SECONDARY OUTCOME MEASURES: Details were recorded of the patient's prior care, management at hospital and onward referral to neurological specialists onto an online database. Descriptive results are reported at national level. RESULTS: Of those with epilepsy, 498 (18%) were on no antiepileptic drug therapy and 1330 (48%) were on monotherapy. Assessments were often incomplete and witness histories were sought in only 759 (75%) of first seizure patients, 58% were seen by a senior doctor and 57% were admitted. For first seizure patients, advice on further seizure management was given to 264 (27%) and only 55% were referred to a neurologist or epilepsy specialist. For each variable, there was wide variability among sites that was not explicable. For the sites who partook in both audits, there was a trend towards better care in 2013, but this was small and dwarfed by the intersite variability. CONCLUSIONS: These results have parallels with the Sentinel Audit of Stroke performed a decade earlier. There is wide intersite variability in care covering the entire care pathway, and a need for better organised and accessible care for these patients.

The spatial distribution of fungi on decomposing alder leaves in a freshwater stream.

Transects were cut from alder leaves incubated in a freshwater stream and plated as quadrats so that fungal isolates could be mapped by reconstruction of each transect. Initially there was fewer than one aquatic hyphomycete colonist per quadrat, but the mode increased to 6-7 then progressively decreased to <1. Numbers of species of aquatic hyphomycetes per quadrat rose and fell similarly with a maximum mode of 3-4, as did species per transect with a maximum of 11 and a diversity of 16, comprising 6 'dominant' species and about 10 'occasional' species. The latter showed no pattern of appearance but the dominant group was established early and persisted in a dynamic equilibrium. Aquatic hyphomycetes were initially randomly distributed but developed progressively into clumped consortia which persisted after peak colonization, declining as leaf degradation became total. Colonies of the most persistent aquatic hyphomycete species were initially discrete,developing into a complex network of overlapping colonies and species, no two of which showed positive association. These complexes broke down to large colonies of a few species and finally to 1-2 small colonies. The pattern of isolates of the 18 genera of other fungi was the reverse of that for aquatic hyphomycetes. Only Cladosporium, Epicoccum and Fusarium were important colonizers. The first two appear to be inhibited by aquatic hyphomycetes, but were found to degrade substrates representative of cell-wall polymers vigorously whereas aquatic hyphomycetes showed varied degradative ability. Leaf transects were examined by S.E.M. and epifluorescent microscopy so that hyphal colonization could be followed at progressive stages of leaf degradation. Bacteria on transects were patchily distributed, the temporal pattern indicating inhibition by aquatic hyphomycetes and colonization of senescent hyphae.

Pectinases in leaf degradation by aquatic hyphomycetes I: the field study : The colonization-pattern of aquatic Hyphomycetes on leaf packs in a surrey stream.

The colonization-pattern of aquatic Hyphomycetes on five-gram leaf packs of oak and alder submerged in a stream was quantified and compared. There were three series of alder leaves, submerged two weeks apart, and one series of oak. Colonization of leaves by pectolytic bacteria was also measured. There were marked similarities in the colonization of all four series. Total spore counts/g dry wt of leaf rose to a peak followed by a decline. The time taken to peak colonization was slower in oak than in alder, and in alder depended on the level of inoculum in the stream, as did the extent of colonization. Pectolytic bacteria counts followed the pattern of total spore counts, suggesting the exploitation of the same substrates by bacteria and fungi. Temperature and micro-environmental factors influence the overall rate of leaf degradation. Alder I was skeletonized in 10 wks, Alders II and III in 12 wks and oak in 25 wks.The resource was shown to have an upper limit of microbial colonization, and within this 'unit-community' of microbes, there was an association of four dominant species of aquatic Hyphomycetes, together with about ten occasional species. The dominant species are subject to selection from the inoculum available in the stream and the formation and maintenance of the association appears to be the result of competitive interactions between species which results in a dynamic equilibrium. There is a low degree of resource specificity. The species equilibrium is 14 for all series, and species numbers are initially low, rise to a peak, then tend to decline. There is a taxonomic similarity of about 60% between successive stands of all series and between matched stands of alder.