Screening for anxiety, depression and suicidality by epilepsy specialists in adult services in Scotland

OBJECTIVE: Clinical guidelines recommend screening people with epilepsy (PWE) regularly for mental distress, but it is unclear how guidelines are implemented. We surveyed epilepsy specialists in adult Scottish services to determine approaches used to screen for anxiety, depression, and suicidality; the perceived difficulty of screening; factors associated with intention to screen; and treatment decisions made following positive screens.METHODS: An anonymous email-based questionnaire survey of epilepsy nurses and epilepsy neurology specialists (n = 38) was conducted.RESULTS: Two in every three specialists used a systematic screening approach; a third did not. Clinical interview was employed more often than standardized questionnaire. Clinicians reported positive attitudes towards screening but found screening difficult to implement. Intention to screen was associated with favorable attitude, perceived control, and social norm. Pharmacological and non-pharmacological interventions were proposed equally often for those screening positive for anxiety or depression.CONCLUSION: Routine screening for mental distress is carried out in Scottish epilepsy treatment settings but is not universal. Attention should be paid to clinician factors associated with screening, such as intention to screen and resulting treatment decisions. These factors are potentially modifiable, offering a means of closing the gap between guideline recommendations and clinical practice.</p

Critical success index or F measure to validate the accuracy of administrative healthcare data identifying epilepsy in deceased adults in Scotland

Background: Methods to undertake diagnostic accuracy studies of administrative epilepsy data are challenged bylack of a way to reliably rank case-ascertainment algorithms in order of their accuracy. This is because it isdifficult to know how to prioritise positive predictive value (PPV) and sensitivity (Sens). Large numbers of truenegative (TN) instances frequently found in epilepsy studies make it difficult to discriminate algorithm accuracyon the basis of negative predictive value (NPV) and specificity (Spec) as these become inflated (usually &gt;90%).This study demonstrates the complementary value of using weather forecasting or machine learning metricscritical success index (CSI) or F measure, respectively, as unitary metrics combining PPV and sensitivity. Wereanalyse data published in a diagnostic accuracy study of administrative epilepsy mortality data in Scotland.Method: CSI was calculated as 1/[(1/PPV) + (1/Sens) – 1]. F measure was calculated as 2.PPV.Sens/(PPV +Sens). CSI and F values range from 0 to 1, interpreted as 0 = inaccurate prediction and 1 = perfect accuracy. Thepublished algorithms were reanalysed using these and their accuracy re-ranked according to CSI in order to allowcomparison to the original rankings.Results: CSI scores were conservative (range 0.02–0.826), always less than or equal to the lower of the correspondingPPV (range 39–100%) and sensitivity (range 2–93%). F values were less conservative (range0.039–0.905), sometimes higher than either PPV or sensitivity, but were always higher than CSI. Low CSI and Fvalues occurred when there was a large difference between PPV and sensitivity, e.g. CSI was 0.02 and F was0.039 in an instance when PPV was 100% and sensitivity was 2%. Algorithms with both high PPV and sensitivityperformed best in terms of CSI and F measure, e.g. CSI was 0.826 and F was 0.905 in an instance when PPV was90% and sensitivity was 91%.Conclusion: CSI or F measure can combine PPV and sensitivity values into a convenient single metric that is easierto interpret and rank in terms of diagnostic accuracy than trying to rank diagnostic accuracy according to the twomeasures themselves. CSI or F prioritise instances where both PPV and sensitivity are high over instances wherethere are large differences between PPV and sensitivity (even if one of these is very high), allowing diagnosticaccuracy thresholds based on combined PPV and sensitivity to be determined. Therefore, CSI or F measures maybe helpful complementary metrics to report alongside PPV and sensitivity in diagnostic accuracy studies ofadministrative epilepsy data

Case-control study developing Scottish Epilepsy Deaths Study score to predict epilepsy-related death

This study aims to develop a risk prediction model for epilepsy-related death in adults. In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009-2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index - the Scottish Epilepsy Deaths Study Score (SEDS Score). Odds ratios (OR) were estimated with 95% confidence intervals (CIs). 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency (A&E) attendance (OR 5.1, 95% CI 3.2-8.3), living in deprived areas (OR 2.5, 95% CI 1.6-4.0), developmental epilepsy (OR 3.1, 95% CI 1.7-5.7), raised Charlson Comorbidity Index (CCI) score (OR 2.5, 95% CI 1.2-5.2), alcohol abuse (OR 4.4, 95% CI 2.2-9.2), absent recent neurology review (OR 3.8, 95% CI 2.4-6.1), and generalised epilepsy (OR 1.9, 95% CI 1.2-3.0). SEDS Score model variables were derived from the first four listed above, with CCI ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points, and recent epilepsy-related A&E attendance given 3 points. Compared to having a SEDS Score of 0, those with a SEDS Score of 1 remained low risk, with OR 1.6 (95% CI 0.5-4.8). Those with a SEDS Score of 2-3 had moderate risk, with OR 2.8 (95% CI 1.3-6.2). Those with a SEDS Score of 4-5 and 6-8 were high risk, with OR 14.4 (95% CI 5.9-35.2) and 24.0 (95% CI 8.1-71.2), respectively. The SEDS Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation

Global inventory of nitrogen oxide emissions constrained by space-based observations of NO2 columns

sions (37.7 Tg N yr #1 ) agrees closely with the GEIAbased a priori (36.4) and with the EDGAR 3.0 bottom-up inventory (36.6), but there are significant regional differences. A posteriori NO x emissions are higher by 50 -- 100% in the Po Valley, Tehran, and Riyadh urban areas, and by 25 -- 35% in Japan and South Africa. Biomass burning emissions from India, central Africa, and Brazil are lower by up to 50%; soil NO x emissions are appreciably higher in the western United States, the Sahel, and southern Europe