Generalized periodic discharges and ‘triphasic waves’: A blinded evaluation of inter-rater agreement and clinical significance

Foreman, Brandon; Mahulikar, Advait; Tadi, Prasanna; Claassen, Jan; Szaflarski, Jerzy P.; Halford, Jonathan J.; Dean, Brian C.; Kaplan, Peter W.; Hirsch, Lawrence J.; LaRoche, Suzette

doi:10.1016/j.clinph.2015.07.018

Cited by 78 publications

(58 citation statements)

References 29 publications

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“…This indicated moderate to almost perfect agreement for all coding variables [28]. This finding is similar to the level of inter-rater agreement previously reported in published research on content analysis of newspaper media [35,36]. The validity of this study was enhanced by pre-coding 10 articles followed by adjustment to the coding framework.…”

Section: Discussionsupporting

confidence: 89%

Health Care Apps Reported in Newspapers: Content Analysis (Preprint)

Bawab¹,

Alqahtani²,

McElnay³

2018

Preprint

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Background: Newspapers are considered as one of the most viewed and influential media sources in both UK and USA. Information about how newspapers portray healthcare apps to the readers has been lacking. Objectives:The present study investigated the reporting on healthcare apps in newspapers published in the UK and USA. Methods:The Nexus® UK database was utilised to identify and select relevant articles. Systematic content analysis of the articles that met the inclusion criteria (articles of any format that contained reference to healthcare apps or medical apps) within the highest circulated newspapers in the UK and USA over a period of 10 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) was conducted. Inter-rater reliability of coding was established using a 10% sample of the chosen articles.Results: 151 UK and 69 USA relevant newspaper articles were retrieved. Healthcare apps were most frequently reported on in the Daily Mail and The Guardian (UK newspapers) and in the New York Times and the Washington Post (US newspapers). An exponential rise in published scientific articles (PubMed®) on healthcare related apps was noted during the study period. A total of 26.4 and 19.1% of the retrieved newspaper articles appeared in the features and main news sections respectively. General information about healthcare applications was the main theme coved by the newspapers (45.9%). Most of the articles represented a societal point of view (72.3%). The main focus of the articles was on general health matters (48%) and specific disease matters (37%). Diabetes was the most frequently mentioned disease in the articles. A high proportion (91.8%) of the articles mentioned benefits of using healthcare apps mainly for personalised care, while 24.0% of the articles commented on related risks such as anxiety and confidentiality issues. Almost half (45.9%) of the articles mentioned potential facilitators to the use of apps while less than 10% discussed barriers. Most of the articles (83.6%) were judged as having balanced judgement on the present topic while more than half (60.0%) of the articles were judged to be of generally low quality. Conclusions:Healthcare apps were not widely reported in newspaper articles in the UK and the USA over the study period, however, there appeared to be much more recent interest. Characteristically the articles focused on societal impact and on general health rather than on disease specific applications.Keywords: apps, Newspaper articles, Newspapers, health 2 IntroductionHealthcare applications (apps) are defined by the FDA as "software programs that run on smartphones and other mobile communication devices in order to, for example, provide health information to the public, provide other health related support to patients and healthcare professionals and remotely transfer data to health care providers". These apps can also be used to facilitate decision making and provide the opportunity for consultations to take place remotely [1].Smartphone apps are becoming increasingly popular glo...

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Section: Discussionsupporting

confidence: 89%

Health Care Apps Reported in Newspapers: Content Analysis (Preprint)

Bawab¹,

Alqahtani²,

McElnay³

2018

Preprint

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“…Triphasic morphology refers to “repetitive electrographic elements consisting of three phases, each longer than the preceding one: a surface positive high-amplitude (>70 uV) wave preceded and followed by negative waves with smaller amplitude” (Sutter et al, 2013). However, accurately identifying triphasic waves is challenging: one study of 11 cEEG reviewers assessing 20 samples of GPDs found only fair inter-rater agreement (κ = 0.33) in whether or not GPDs had a triphasic morphology (Foreman et al, 2016). …”

Section: Generalized Periodic Discharges (Gpds)mentioning

confidence: 99%

“…However, TWs are also seen in other scenarios such as hypernatremia, hypothyroidism, sepsis, lithium toxicity, and hypertensive encephalopathy (Faigle et al, 2013, Kaplan and Sutter, 2015). One recent study of GPDs found that those with triphasic morphology were just as likely to be associated with seizures as were GPDs without (Foreman et al, 2016). …”

Section: Generalized Periodic Discharges (Gpds)mentioning

confidence: 99%

Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Johnson

Kaplan

2017

Clinical Neurophysiology Practice

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“…We noticed that 2–3 Hz GPD with a high negative component (above baseline) seemed to characterize cefepime‐induced encephalopathy in contrast to the triphasic waves induced by other illnesses, such as hepatic encephalitis or Creutzfeldt–Jakob disease . Moreover, the triphasic morphology with negative polarity in the dominant phase was perceived as differing from the ‘typical’ triphasic wave by clinicians (odds ratio: 0.09, 0.02–0.22), suggesting that the clinicians differentiated the Tri‐HNC from ‘typical’ triphasic wave; however, only a few studies have focused on this characteristic feature …”

Section: Discussionmentioning

confidence: 90%

Cefepime‐induced encephalopathy: Neural mass modeling of triphasic wave‐like generalized periodic discharges with a high negative component (Tri‐HNC)

Tamune

Hamamoto

Aso

et al. 2018

Psychiatry Clin Neurosci

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Aim Cefepime, a fourth‐generation cephalosporin, acts as a GABAA receptor antagonist. Cefepime‐induced encephalopathy (CIE) is frequently overlooked. We aimed to clarify the clinical features, characteristic electroencephalography (EEG), and mechanisms of CIE to aid in its early recognition. Methods CIE cases documented by a single‐center consultation–liaison team between April 2015 and March 2017 were retrospectively reviewed. For further investigation, neural mass modeling was performed in silico. Results Three patients with CIE refused medication/examination and showed overt pain, palilalia, and much greater deterioration of eye and verbal response than the motor response, which was possibly related to GABAergic dysfunction. Triphasic wave‐like generalized periodic discharges with a high negative component (Tri‐HNC) were identified on the EEG of all three cases. The simulation reproduced the characteristic feature of 2–3 Hz Tri‐HNC and recovery course on EEG, and a possible involvement of individual differences in pharmacological intervention. It also suggested that auto‐inhibition (synaptic inputs from interneuron to interneuron) dysregulation contributed to generating Tri‐HNC in CIE. Conclusion As CIE is iatrogenic and continues unless cefepime is stopped, early recognition is crucial. Physicians should be vigilant about altered mental status, pain, and verbal changes in patients taking cefepime. Tri‐HNC on EEG can expedite the diagnosis of CIE, and the association between Tri‐HNC and CIE suggests that an excitatory and inhibitory imbalance due to the dysfunction of GABAergic interneurons is the underlying mechanism. This modeling may offer a new method of investigating disorders related to GABAergic dysfunction.

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Generalized periodic discharges and ‘triphasic waves’: A blinded evaluation of inter-rater agreement and clinical significance

Abstract: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation.

Cited by 78 publications

References 29 publications

Health Care Apps Reported in Newspapers: Content Analysis (Preprint)

Health Care Apps Reported in Newspapers: Content Analysis (Preprint)

Population of the ictal-interictal zone: The significance of periodic and rhythmic activity

Cefepime‐induced encephalopathy: Neural mass modeling of triphasic wave‐like generalized periodic discharges with a high negative component (Tri‐HNC)

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