Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea.

BACKGROUND AND PURPOSE: Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS: Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility. RESULTS: There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS: Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.

[Reporting of incidents. Experiences with medical registration systems]. / Rapportering af utilsigtede haendelser. Erfaringer med medicinske registreringssystemer.

Current incident reporting systems in Denmark are primarily focused on litigation. Epidemiological studies in the United States have shown that only 2.7% of adverse events that qualify for litigation are identified in such systems. Existing Danish reporting on adverse effects and complications is not exhaustive and often focused on new medicine/technologies and only a few specialties. Published findings on the quality of reporting systems are mostly based on local systems, certain specialties, procedures, or products. Observational biases are found in both mandatory and voluntary reporting systems. Current documentation does not support theories of higher coverage in mandatory reporting systems than in voluntary systems. Reporting systems run by authorities have shown significantly lower coverage than those run by medical professions. Anonymous and confidential systems have higher coverage than open systems. Fast, relevant, and constructive feedback to the informants increases the quantity and quality of reports. Risk managers and locally based systems could increase reporting through better possibilities for direct feedback, although local systems have difficulty in initiating major prophylactic actions. Foreign epidemiological studies have shown an adverse events incidence of 3-13%. However, more than half of the adverse events occur at such a low frequency that it is unlikely that isolated hospital systems can produce sufficient information for prophylactic action.

[Incidence of adverse events in hospitals. A retrospective study of medical records]. / Forekomsten af utilsigtede haendelser på sygehuse. En retrospektiv gennemgang af journaler.

INTRODUCTION: Over the past decade a number of studies on the incidence and preventability of adverse events in the health care have been published in the US, Australia and the UK. So far no similar study has been performed in Denmark. In order to determine whether foreign findings could be generalised to Danish health care, a pilot study on adverse events was carried out in Danish acute care hospitals. METHOD: Chart reviews were carried out on 1.097 acute care hospital admissions, sampled from the central Danish National Patient Register. The sample was truly proportional with no over-sampling of high-risks groups. Chart reviews was done in 17 different acute care hospitals, reviewing between 20 and 204 admissions per hospital. Adverse events was identified using a three-step procedure: 1) Nurse screening by 18 criteria identifying high-risk groups. 2) Independent reviews by pairs of consultants. 3) In case of disagreement between second step consultants, two additional independent reviews was performed by new consultants (internist and surgeon) followed by conference. All chart reviews were performed independent of medical specialty. All nurses and doctors were senior and experienced clinicians. RESULTS: In 114 admissions 176 Adverse Events (AEs) were identified. The prevalence of admissions with adverse events were 9.0% of all admissions. Preventability of adverse events was found in 46 of admissions (40.4% of AEs). The adverse events caused on average a 7.0 days prolonged hospital stay. Most adverse events resulted in minor, transient disabilities. Permanent disability or death in relation to adverse event were recorded in 30 admissions. DISCUSSION: The findings from the Danish Adverse Event Study are similar to the results found in Australia, United Kingdom and the United States. It is therefore recommended that further Danish research, is directed towards high-risk groups focussing on narratives and intervention and towards research in primary health care.

Information technology factors in transferability of knowledge based systems in medicine.

The history of knowledge based systems in medicine has been that they are generally very localised, serving a special need in a single setting. Very few have proven to be capable of transfer to a distant environment. With the advent of tele-medical services and the associated transfer of data and knowledge in such services, the ability of medical KBS to transfer will be crucial to the success of tele-medical services. Differences in knowledge acquisition methods, knowledge representation techniques and in the epidemiological composition of training databases may influence viable transfer of knowledge based systems. Through experiments we demonstrate how rule-based systems may impose inflexible demands on data, how different knowledge acquisition techniques acquire different aspects of knowledge, though trained on a common training database, and how different knowledge acquisition techniques show varying degrees of robustness to slight changes in training databases.

Clinical utility of an international thyroid database.

Assessment of thyroid function is prone to errors from several sources. Confusion is most often due to inappropriate use of tests, especially in patients with acute non-thyroid illness. With these problems in mind we have designed an international prospective thyroid database in three countries, which registers clinical and laboratory data on new patients with suspected thyroid disease. An additional aim was to assess the use of a computerised decision support tool to interpret thyroid data. The database permits rapid access to temporal trends in thyroid tests, which is useful in monitoring therapy and in follow up for hyperthyroidism. Marked contrasts in local clinical practices have highlighted the challenge in providing a valid decision tool to serve all clinical needs. Experience with multi-centre databases such as this hold promise in the drive to coordinate the disciplines of laboratory analysis and clinical decision making.

Problem-oriented management of laboratory work through dynamic test scheduling.

This paper gives an overview of problems inherent in dynamic test scheduling together with some model solutions. Dynamic test schedules are decision tree-like protocols for cost-efficient management of analytical production in a clinical laboratory. The present analysis is based on previous practical experience and concludes that it is not feasible to introduce dynamic test scheduling on a large scale without computer-based support, because of the increase in complexity of the laboratory work processes. Further, our experience is that it is extremely complex to incorporate the dynamic test scheduling functionality into an existing Laboratory Information System (LIS). The approach pursued in the OpenLabs (A2028) AIM Project for implementing dynamic test scheduling is to provide the necessary functionality as a stand-alone module interconnected with a LIS in an open systems solution.

Treatment of hay fever with sodium cromoglycate, hyposensitization, or a combination.

In 77 consecutive patients with grass pollen rhinitis as the only allergic disease, treatment with sodium cromoglycate (SCG) nasal spray, hyposensitization with aluminium hydroxide adsorbed extract of grass pollen as perennial treatment, and a combination of the two was compared. Specific serum-IgE, IgG and IgG4 were determined in patients who participated in three consecutive seasons. Significant immune response was found in the hyposensitization group, but not in the group treated with SCG. No correlation between the immunoglobulin responses and the individual symptom and/or medicine scores was found. Symptom and medicine scores were analysed in the 3 weeks with the highest pollen counts each year during 4 consecutive years. Higher scores were found in the group treated with sodium cromoglycate compared with the other two groups, but the difference was only significant for eye and total symptoms in the first season. None of the groups, however, suffered from more than mild to moderate symptoms even in the weeks with peak pollen counts. A significantly larger decrease in the wheals of the skin prick test was shown during hyposensitization than during treatment with SCG. No difference was found in the frequency of patients who became symptom-free or developed pollen asthma.