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.

It All Depends What You Count—The Importance of Definitions in Evaluation of CF Screening Performance

Screening metrics are essential to both quality assessment and improvement, but are highly dependent on the way positive tests and cases are counted. In cystic fibrosis (CF) screening, key factors include how mild cases of late-presenting CF and CF screen positive, inconclusive diagnosis (CFSPID) are counted, whether those at prior increased risk of CF are excluded from the screened population, and which aspects of the screening pathway are considered. This paper draws on the New Zealand experience of almost forty years of newborn screening for CF. We demonstrate how different definitions impact the calculation of screening sensitivity. We suggest that, to enable meaningful comparison, CF screening reports should clarify what steps in the screening pathway are included in the assessment, as well as the algorithm used and screening target.

The ESA-EVE Polarization Lidar for Assessing the Aeolus Aerosol Product Perfomance

We present the EVE lidar concept, a combined linear/circular polarization system, tailored to evaluate the spaceborne ALADIN Doppler lidar system aerosol retrievals. EVE, currently under development, aims to provide the ESA-Aeolus mission with a flexible, mobile reference ground-based lidar system capable of providing well-characterized fiducial reference measurements of aerosol optical properties. Since ALADIN detects only the co-polar component of the backscattered circularly polarized radiation, a portion of the received radiation gets lost, leading to an un-derestimation of the backscatter coefficient and the circular depolarization ratio in strongly depolarizing scenes with non-spherical particles. The main focus of the new EVE lidar is to quantify these uncertainties and to evaluate aerosol backscatter/extinction retrievals for Aeolus, and later also for EarthCARE product validation, quality assessment and improvement.