Objectives To determine the number of inappropriate requests for electroencephalography (EEG) and whether guidelines on use could reduce this number. Design Audit with retrospective and prospective components. Setting EEG department in district general hospital and centre for neurology and neurosurgery. Participants Retrospective: 368 at the general hospital and 143 patients at the neurology centre. Prospective: 241 patients undergoing EEG at the general hospital. Interventions Guidelines for EEG issued to users of service at the general hospital. Outcomes Retrospective: differences in requesting practice, result in different clinical scenarios, relative roles of procedure, clinical acumen in establishing diagnosis, usefulness of procedure. Prospective: change of requesting practice, impact on use. Results There were considerable differences in requesting practice. Non-specialists seem to use EEG as a diagnostic tool, especially in patients with "funny turns," when it is much more likely to yield potentially misleading than clinically useful information. The overall proportion of procedures considered to influence management, to be justifiable, and to be inappropriate were 16% (59), 28.3% (104), and 55.7% (205), respectively. In the prospective study the total number of requests was significantly reduced ( 2 = 33.85, df = 5, P < 0.0001), mainly because of fewer requests in patients with non-specific "funny turns" ( 2 = 21.90, df = 6, P = 0.0013). There was a concomitant change in the usefulness of EEG ( 2 26.99, df = 2, P < 0.0001). Conclusions This original audit informed clinical practice and had potential benefits for patients, clinicians, and provision of service. Systematic replication of this project, possibly on a regional basis, could result in financial savings, which would allow development of accessible local neurophysiology services.

AimsTo determine the effects of breastfeeding and nursery attendance on respiratory symptoms and quality of life related to respiratory symptoms in infants from Liverpool over the first 22 months of life.MethodsThe Liverpool Baby Breathing Study (LBBS) uses a parent completed respiratory symptom questionnaire, to assess respiratory symptoms in infants from four to twenty-two months of age. Infants were recruited from the Liverpool Women’s Hospital between 23/01/2013 and 03/11/2014. Questionnaires were sent to participants at four, ten, sixteen and twenty-two months of age via post or an automated emailing system. The cross-sectional analysis of the LBBS was weighted to ensure the cohort’s index of multiple deprivations was comparable to the eligible births. χ2, Mann-Whitney U and Fisher’s Exact Test were used to compare questionnaire scores and symptom prevalence between those who were breastfed and attended nursery and those who were not. The longitudinal analysis of the LBBS was performed using multi-level mixed effects models.ResultsAt four, ten and sixteen months of age infants who were breastfed had a lower symptom scores and a smaller prevalence of a variety of respiratory symptoms than those who were not. Some of these findings showed a dose-response relationship. This relationship was no longer present at twenty-two months of age. Longitudinally, breastfeeding was shown to reduce symptom scores over the first twenty-two months of life.At four months infants who attended nursery had a higher prevalence of snoring and were more likely to attend the GP with respiratory symptoms. At ten, sixteen and twenty-two months of life nursery attenders had higher symptom scores and a higher prevalence of various respiratory symptoms than non-attendees. Longitudinally over time, nursery attendance increased symptom scores over the first twenty-two months of life. Nursery attendance reduced the quality of life of both the infant and their families due to respiratory symptoms at ten and sixteen months of age.ConclusionBreastfeeding was protective of respiratory symptoms over the first 22 months of life. Contrastingly, nursery attendance increased respiratory symptoms and reduced the quality of life of both infants and their family over the first 22 months of life.