Automated spike and seizure detection: Are we ready for implementation?

OBJECTIVE: Automated detection of spikes and seizures has been a subject of research for several decades now. There have been important advances, yet automated detection in EMU (Epilepsy Monitoring Unit) settings has not been accepted as standard practice. We intend to implement this software at our EMU and so carried out a qualitative study to identify factors that hinder ('barriers') and facilitate ('enablers') implementation. METHOD: Twenty-two semi-structured interviews were conducted with 14 technicians and neurologists involved in recording and reporting EEGs and eight neurologists who receive EEG reports in the outpatient department. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). RESULTS: We identified 14 barriers and 14 enablers for future implementation. Most barriers were reported by technicians. The most prominent barrier was lack of trust in the software, especially regarding seizure detection and false positive results. Additionally, technicians feared losing their EEG review skills or their jobs. Most commonly reported enablers included potential efficiency in the EEG workflow, the opportunity for quantification of EEG findings and the willingness to try the software. CONCLUSIONS: This study provides insight into the perspectives of users and offers recommendations for implementing automated spike and seizure detection in EMUs.

Automated spike detection: Which software package?

PURPOSE: We assessed three commercial automated spike detection software packages (Persyst, Encevis and BESA) to see which had the best performance. METHODS: Thirty prolonged EEG records from people aged at least 16 years were collected and 30-minute representative epochs were selected. Interictal epileptiform discharges (IEDs) were marked by three human experts and by all three software packages. For each 30-minutes selection and for each 10-second epoch we measured whether or not IEDs had occurred. We defined the gold standard as the combined detections of the experts. Kappa scores, sensitivity and specificity were estimated for each software package. RESULTS: Sensitivity for Persyst in the default setting was 95% for 30-minute selections and 82% for 10-second epochs. Sensitivity for Encevis was 86% (30-minute selections) and 61% (10-second epochs). The specificity for both packages was 88% for 30-minute selections and 96%-99% for the 10-second epochs. Interrater agreement between Persyst and Encevis and the experts was similar than between experts (0.67-0.83 versus 0.63-0.67). Sensitivity for BESA was 40% and specificity 100%. Interrater agreement (0.25) was low. CONCLUSIONS: IED detection by the Persyst automated software is better than the Encevis and BESA packages, and similar to human review, when reviewing 30-minute selections and 10-second epochs. This findings may help prospective users choose a software package.

Automated seizure detection in an EMU setting: Are software packages ready for implementation?

PURPOSE: We assessed whether automated detection software, combined with live observation, enabled reliable seizure detection using three commercial software packages: Persyst, Encevis and BESA. METHODS: Two hundred and eighty-six prolonged EEG records of individuals aged 16-86 years, collected between August 2019 and January 2020, were retrospectively processed using all three packages. The reference standard included all seizures mentioned in the clinical report supplemented with true detections made by the software and not previously detected by clinical physiologists. Sensitivity was measured for offline review by clinical physiologists and software seizure detection, both in combination with live monitoring in an EMU setting, for all three software packages at record and seizure level. RESULTS: The database contained 249 seizures in 64 records. The sensitivity of seizure detection was 98% for Encevis and Persyst, and 95% for BESA, when a positive results was defined as detection at least one of the seizures occurring within an individual record. When positivity was defined as recognition of all seizures, sensitivity was 93% for Persyst, 88% for Encevis and 84% for BESA. Clinical physiologists' review had a sensitivity of 100% at record level and 98% at seizure level. The median false positive rate per record was 1.7 for Persyst, 2.4 for BESA and 5.5 for Encevis per 24 h. CONCLUSION: Automated seizure detection software does not perform as well as technicians do. However, it can be used in an EMU setting when the user is aware of its weaknesses. This assessment gives future users helpful insight into these strengths and weaknesses. The Persyst software performs best.

Psychosocial counselling for intended parents who opt for donor sperm treatment: which topics do they find relevant?

Objective: This study aimed to explore which topics intended parents who opt for donor sperm treatment find relevant to discuss in psychosocial counselling. Background: The choice for donor sperm treatment has psychosocial implications for intended parents and therefore psychosocial counselling is advised as an integral part of DST. To date, little is known about which topics intended parents find relevant to discuss in psychosocial counselling. Methods: We conducted 25 semi-structured in-depth interviews between 2015 and 2017 with heterosexual men and women, lesbian women and single women who opted for donor sperm treatment and had a counselling session as part of their intake. They were recruited through three Dutch fertility centres, three network organisations and by snowball sampling. Results: Intended parents found it relevant to discuss the following seven topics in psychosocial counselling: the decision to opt for donor sperm treatment, choosing a sperm donor, coping with questions from family and friends, non-genetic parenthood, single motherhood, openness and disclosure, and future contact between the child and half-siblings. Conclusion: We recommend that counsellors take a more active role in bringing up the topics found in our study and that a clear distinction is made between counselling with the aim to screen intended parents and counselling with the aim to offer guidance.

[Validation of the Job Content Questionnaire in hospital nursing staff]. / Validación del Job Content Questionnaire en personal de enfermería hospitalario.

OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.

Validación del Job Content Questionnaire en personal de enfermería hospitalario / Validation of the Job Content Questionnaire in hospital nursing staff

Objetivo: Determinar la fiabilidad, validez de contenido y validez de concepto de las tres dimensiones de la versión mínima reducida en castellano del cuestionario Job Content Questionnaire (JCQ) (demandas, control y apoyo en el trabajo) en personal de enfermería hospitalario. Métodos: Se ha utilizado la versión mínima reducida del cuestionario JCQ, que incluye tres dimensiones: demandas psicológicas (9 ítems), control sobre el trabajo (9 ítems) y apoyo en el trabajo (11 ítems). La validación se realizó sobre una muestra aleatoria de 330 profesionales de enfermería de dos hospitales generales públicos de la provincia de Alicante. La fiabilidad del cuestionario se valoró tras la readministración a una submuestra aleatoria de 50 profesionales de enfermería, con un intervalo de 15 días. La validez de concepto se obtuvo mediante la correlación de las tres dimensiones del JCQ obtenidas tras el análisis factorial, con la escala de efectos psíquicos del burnout (EPB) y 6 dimensiones del cuestionario de salud SF-36. Resultados: El análisis factorial demuestra que la versión del cuestionario validada en este estudio presenta la misma estructura factorial que el cuestionario original. El coeficiente de correlación intraclase entre ambas administraciones, para cada una de las tres dimensiones, es alto (0,83-0,87), así como el alfa de Cronbach (0,74-0,88). Se encuentra una correlación moderada pero significativa entre las tres dimensiones del JCQ y la escala EPB: (-0,27 para apoyo en el trabajo, 0,31 para demandas psicológicas y -0,12 para control sobre el trabajo). Así mismo, se encuentra una correlación moderada pero significativa con algunas dimensiones del cuestionario de salud SF-36. Conclusión: La versión mínima reducida del JCQ presenta una estructura factorial similar a la versión original americana en nuestro contexto cultural. Cada una de las tres dimensiones presenta alta fiabilidad y validez de contenido, y moderada validez de concepto (AU)

[Isolation of Gardnerella vaginalis in the diagnosis of sexual abuse in children]. / Papel de la Gardnerella vaginalis en el diagnóstico de abuso sexual infantil.

INTRODUCTION: The study of sexual transmitted diseases is more and more frequent in patient with suspicion of sexual abuse, and this help to the final medical diagnosis. Organisms like Neisseria gonorrhoeae and Treponema indicate a sure sexual contact. However the role of the rest of organisms in the sexual abuse is more difficult of specifying. OBJECTIVE: To know the role of the Gardnerella vaginalis in the diagnosis of sexual abuse in patient with this possible diagnosis. METHODS: Retrospective study of 135 girls with suspicion of abuse, visited from May of 1997 to February of 1998. Vaginal swabs were taken from 45 of 135 girls evaluated. RESULTS: In five patients the vaginal culture were positive to Gardnerella. The characteristics of these five patients are described (age, aggressor, type and duration of the abuse, physical exploration and final diagnosis). All our patients were the pubertal or prepubertal girls. In these patients the final diagnosis settled with the clinical history and the physical exploration, without keeping in mind the result of the culture. CONCLUSION: It is necessary to discard sexual abuse in all prepubertal girl with a positive culture with Gardnerella vaginalis, being difficult to specify the value of the Gardnerella in the adolescent patients.

Computer-assisted morphometry: point, intersection, and profile counting and three-dimensional reconstruction.

The use of computers in morphometry can involve 1) automated image analysis, semiautomated image analysis and point, intersection, intercept and profile counts of two-dimensional images on tissue sections with mathematical extrapolation to the third dimension, 2) direct measurement of volumes, surfaces, lengths, and curvature using x,y,z coordinates of serial sectioned images, or 3) stereologic techniques and serial sections which is a combination of 1 and 2 above. Automated and semiautomated image analysis are generally restricted to specimens that are characterized by differential contrast such as interalveolar septa in the lung or histochemically stained mucous granules in pulmonary epithelium. Point, intersection, and profile counts using hand-held, notebook PCs, portable PCs, or standard PCs and MS-DOS-based application programs are extremely efficient, precise, affordable, and convenient methods of quantitating average values of a population. When morphometric measurements of individual structures are required, computer-assisted three-dimensional reconstruction using x,y,z coordinates of the surface outline from serial sections is a tedious yet precise method. We describe a computer program that efficiently estimates mean caliper diameter, volume, and surface area with less than five percent error with five sections per structure. We also describe a program that does digital image subtraction on serial sections, superimposes digitally generated test systems on biological images, and accumulates point, intersection, and profile counts using a Macintosh II series computer.