Usefulness and yield of routine electroencephalogram: a retrospective study.

BACKGROUND: The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. AIMS: To investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. METHODS: We retrospectively reviewed all routine adult EEG performed in a hospital over a 6-month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. RESULTS: Two hundred and thirty-nine routine EEG were included with indications, including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non-epileptic events (5.4%), unresponsiveness/intensive care unit (4.6%) and psychiatric presentation (1.3%). Most (48.1%) EEG were normal; 8.9% of the EEG demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEG conducted in an inpatient setting and within 48 h of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. CONCLUSIONS: Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.

Localisation and stimulation of the parietal eye field.

Localisation of the human parietal eye fields (PEF) has not been as well studied as the human frontal eye fields (FEF). Stimulation studies in rhesus monkeys have suggested the localisation of the PEF to be within the intraparietal sulcus. Functional MRI studies have demonstrated this region to be highly active and potentially connected in saccadic and gaze shifting tasks. Here, we present a case of a patient with left versive seizures evaluated with SEEG, in whom electrical stimulation within the right intraparietal sulcus resulted in horizontal and downward conjugate eye movements contralateral to stimulation. We illustrate clinical differences between the FEF and PEF on cortical stimulation. In addition to the frontal eye field, it is important to recognise other cortical regions involved in eye movement which can cause conjugate contralateral eye movement.

Single centre observational study on antibiotic prescribing adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infection.

BACKGROUND: Urinary tract infections are one of the most common infections encountered in ambulatory care and the inpatient setting. Antibiotic resistance is a growing concern in healthcare worldwide and has been described by the World Health Organisation as one of the key global health issues facing our generation. The objective of this study was to evaluate antibiotic prescribing adherence to national therapeutic guidelines for patients with uncomplicated urinary tract infection. METHODS: A single centre, retrospective study of patients with uncomplicated urinary tract infections presenting to the Gold Coast University Hospital in May 2015. Infections were categorised according to male cystitis, female cystitis, mild pyelonephritis and severe pyelonephritis, with antibiotic prescribing assessed against the Australian Therapeutic Guidelines. RESULTS: 103 patients met the inclusion criteria, 47 (45.6%) received treatment that adhered to the Australian Therapeutic Guidelines. Eight (7.8%) did not adhere but the decision of non-adherence was justified. 48 (46.6%) received treatment that did not adhere to the Australian Therapeutic Guidelines. The most common reason for non-adherence were incorrect dose followed by incorrect duration. There was a lack of fluoroquinolone use in this study. CONCLUSIONS: These results highlight the poor adherence to guidelines in uncomplicated urinary tract infection. Non-adherent duration of treatment is likely contributed by inappropriate number of tablets being dispensed in boxes.