Assessment of the adequacy of counselling regarding reproductive-related issues in women of childbearing age on anti-epileptic drugs.

BACKGROUND: The use of anti-epileptic drugs (AEDs) in women of childbearing age (WCBA) necessitates careful counselling regarding reproductive-related issues. AIM: (i) To compare documentation of appropriate counselling regarding reproductive-related issues in WCBA prescribed AEDs for non-epilepsy vs. epilepsy indications, and (ii) to examine whether the frequency of counselling improved after introduction of 'standardized typed advice'. DESIGN: Retrospective audit and quality assessment and improvement programme. METHODS: We analysed medical records of all WCBA prescribed gabapentin, pregabalin, topiramate, valproate or carbamazepine by a general neurology clinical service before (Study period A) and after (Study period B) introduction of standardized typed passages regarding potential teratogenicity ± interactions with hormonal contraception at a university teaching hospital. The χ2 test or the Fisher's exact test was employed, as appropriate. RESULTS: In WCBA prescribed AEDs for non-epilepsy indications, documentation of appropriate counselling regarding potential teratogenicity improved from 49% (17/35 patients) in Period A to 79% (27/34 patients) in Period B (P = 0.008). The frequency of counselling regarding teratogenicity was higher in patients prescribed AEDs for epilepsy compared with non-epilepsy indications in Study period A (100% vs. 49%, P = 0.002), but was no longer significantly different in Study period B (86% vs. 79%, P = 0.64). Documentation of counselling regarding potential interaction of enzyme-inducing AEDs with hormonal contraception did not significantly change between study periods. CONCLUSION: Significant improvements in documentation regarding potential teratogenicity of AEDs prescribed for non-epilepsy indications can be achieved by introducing standardized, typed passages copied to patients. Such a practice change is practical and widely applicable to neurological and non-neurological practice worldwide.

An unusual presentation of Guillain-Barré syndrome in a young man with bilateral upper extremity weakness.

A 30-year-old man attended the emergency department with a 4-day history of progressive, bilateral upper limb weakness. He had mild shortness of breath and occasional swallowing difficulties. One month prior to presentation, he had flu-like symptoms and diarrhoea. Examination revealed upper limb hypotonia, symmetrical distal arm weakness and hyporeflexia. Power and reflexes in the lower limbs were normal. Nerve conduction studies and lumbar puncture demonstrated features consistent with Guillain-Barré syndrome (GBS). The patient was treated with a 5-day course of intravenous immunoglobulins. He improved significantly over the next 2 weeks. Breathing and swallow function did not deteriorate and required no further intervention. He had a sustained improvement, and remained at baseline 1 year later. Work-up for underlying structural, infectious, inflammatory and paraneoplastic aetiologies were negative. Serum antiganglioside antibodies were positive for the anti-GT1a IgG isotype supporting the clinical diagnosis of the pharyngeal-cervical-brachial variant of GBS.

Partnerships in neonatal care: a model in reverse neonatal transport.

An agreement between a pediatric tertiary-care center and a community hospital provides a model of a program that has facilitated appropriate, cost-effective, high-quality care for high-risk neonates through reverse transport. This agreement has established trust between the professionals at both hospitals, increased communications to ensure continuity of care and psychosocial support for families, and obtained supplemental financial resources for families of high-risk neonates.

Vocabulary test performance of old and young adults: another look at qualitative scoring.

The hypothesis that qualitative scoring of the WAIS vocabulary subtest has the sensitivity to reveal an age decline generally masked by standard scoring in cross-sectional studies was tested by means of a comparison of responses of 26 college students and 26 alumni of the same university on the basis of both types of scoring, with the use of Botwinick and Storandt's (1974) criteria. The older Ss (means = 72.8 years) equalled or surpassed the young (means = 19.8) on every measure, tending to disconfirm the hypothesis. An explanation is offered for the finding that the performance of older Ss was superior to that of the young in this study but inferior in the research of Botwinick and Storandt which used the same methodology with Ss of lesser verbal ability: Older adults may generally respond less well to the early, most frequent test words but only high-ability older Ss outscore the young on the least frequent test words.