Retrospective audit of the acute management of stroke in two districy general hospitals in the UK

Background: There is some evidence to suggest that the standard of acute medical care provided to patients with cerebrovascular disease is a major determinant of the eventual outcome. Consequently, the Royal College of Physicians (RCP) of London issues periodic guidelines to assist healthcare providers in the management of patients presenting with stroke.Objective: An audit of the acute management of stroke in two hospitals belonging to the same health care trust in the UK.Method: Retrospective review of 98 randomly selected case-notes of patients managed for cerebrovascular disease in two acute hospitals in the UK between April and June 2004. The pertinent guidelines of RCP (London) are highlighted while audit targets were set at 70%.Results: 84% of patients presenting with cerebrovascular disease had a stroke rather than a TIA, anterior circulation strokes were commonest. All patients with stroke were admitted while those with TIAs were discharged on the same day but most patients with TIA were not followed up by Stroke specialists. Most CT-imaging of the head was done after 24 hours delaying the commencement of anti-platelets for patients with ischaemic stroke orneurosurgical referral for haemorrhagic stroke. Furthermore, there was a  low rate of referral for carotid ultrasound in patients with anterior circulationstrokes. Anti-platelets and statins were commenced for most patients with ischaemic stroke while diabetes was well controlled in most of them. However, ACE-inhibitors and diuretics such as indapamide were under-utilized for secondary prevention in such patients. Warfarin anti-coagulation was underutilized in patients with ischaemic stroke who had underlying chronic atrial fibrillation. While there was significant multi-disciplinary team input, dysphagia and physiotherapy assessments were delayed. Similarly, occupational therapy input and psychological assesment were omitted from the care of most patients.Conclusion: Hospital service provision for the management of  cerebrovascular disease needs to provide appropriate specialist follow up for patients with TIA, prompt radiological imaging and multi-disciplinary team input for patients with stroke. Furthermore, physicians need to utilize appropriate antihypertensives and anti-coagulation more frequently in the secondary prevention of stroke.Keywords: Stroke, anti-platelets, anti-coagulation, carotid stenosis, secondary preventio

Pengaruh Model Pembelajaran Inkuiri Terstruktur Terhadap Peningkatan Kompetensi Literasi Sains Kelas VIII SMP Negeri 01 Bajeng

Penelitian ini bertujuan: Untuk mengetahui: 1) peningkatan kompetensi literasi sains peserta didik kelas VIII SMP Negeri 01 Bajeng yang diajar dengan menggunakan model pembelajaran inkuiri terstruktur, 2) peningkatan kompetensi literasi sains peserta didik kelas VIII SMP Negeri 01 Bajeng yang diajar dengan menggunakan model pembelajaran konvensional, 3) pengaruh model pembelajaran inkuiri terstruktur terhadap peningkatan kompetensi literasi sains peserta didik kelas VIII SMP Negeri 01 Bajeng. Penelitian ini merupakan penelitian Quasi-Experiment dengan desain penelitian Nonequivalent Control Group Design. Populasi penelitian ini adalah seluruh peserta didik kelas VIII SMP Negeri 01 Bajeng sebanyak 9 kelas dengan jumlah 309 peserta didik. Pengambilan sampel melalui teknik purposive sampling sehingga diperoleh VIIIA sebagai kelas eksperimen dengan jumlah 29 peserta didik dan kelas VIIIB sebagai kelas kontrol dengan jumlah 29 peserta didik. Hasil penelitian menunjukkan bahwa 1) kompetensi literasi sains peserta didik yang diajar dengan menggunakan model pembelajaran inkuiri terstruktur pada materi cahaya dan alat optik di SMP Negeri 01 Bajeng mengalami peningkatan dengan skor rata-rata N-gain 0,54 berada pada kategori sedang. 2) kompetensi literasi sains peserta didik yang diajar dengan menggunakan model pembelajaran konvensional pada materi cahaya dan alat optik di SMP Negeri 01 Bajeng mengalami peningkatan dengan skor rata-rata N-gain 0,40 berada pada kategori sedang. 3) terdapat pengaruh model pembelajaran inkuiri terstruktur terhadap peningkatan kompetensi literasi sains peserta didik kelas VIII SMP Negeri 01 Bajeng

Validation of the CREST score for predicting circulatory-aetiology death in out-of-hospital cardiac arrest without STEMI

Aims: The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission. Methods: The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival. Results: Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X2 difference in -2 log likelihood =0.326, P=0.850). Conclusion: Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.Publisher PDFPeer reviewe

Identifying Cardiac Amyloid in Aortic Stenosis: ECV Quantification by CT in TAVR Patients.

OBJECTIVES: The purpose of this study was to validate computed tomography measured ECV (ECVCT) as part of routine evaluation for the detection of cardiac amyloid in patients with aortic stenosis (AS)-amyloid. BACKGROUND: AS-amyloid affects 1 in 7 elderly patients referred for transcatheter aortic valve replacement (TAVR). Bone scintigraphy with exclusion of a plasma cell dyscrasia can diagnose transthyretin-related cardiac amyloid noninvasively, for which novel treatments are emerging. Amyloid interstitial expansion increases the myocardial extracellular volume (ECV). METHODS: Patients with severe AS underwent bone scintigraphy (Perugini grade 0, negative; Perugini grades 1 to 3, increasingly positive) and routine TAVR evaluation CT imaging with ECVCT using 3- and 5-min post-contrast acquisitions. Twenty non-AS control patients also had ECVCT performed using the 5-min post-contrast acquisition. RESULTS: A total of 109 patients (43% male; mean age 86 ± 5 years) with severe AS and 20 control subjects were recruited. Sixteen (15%) had AS-amyloid on bone scintigraphy (grade 1, n = 5; grade 2, n = 11). ECVCT was 32 ± 3%, 34 ± 4%, and 43 ± 6% in Perugini grades 0, 1, and 2, respectively (p < 0.001 for trend) with control subjects lower than lone AS (28 ± 2%; p < 0.001). ECVCT accuracy for AS-amyloid detection versus lone AS was 0.87 (0.95 for 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid Perugini grade 2 only), outperforming conventional electrocardiogram and echocardiography parameters. One composite parameter, the voltage/mass ratio, had utility (similar AUC of 0.87 for any cardiac amyloid detection), although in one-third of patients, this could not be calculated due to bundle branch block or ventricular paced rhythm. CONCLUSIONS: ECVCT during routine CT TAVR evaluation can reliably detect AS-amyloid, and the measured ECVCT tracks the degree of infiltration. Another measure of interstitial expansion, the voltage/mass ratio, also performed well

The Influence of Mineral Fertilizer Combined With a Nitrification Inhibitor on Microbial Populations and Activities in Calcareous Uzbekistanian Soil Under Cotton Cultivation

Application of fertilizers combined with nitrification inhibitors affects soil microbial biomass and activity. The objective of this research was to determine the effects of fertilizer application combined with the nitrification inhibitor potassium oxalate (PO) on soil microbial population and activities in nitrogen-poor soil under cotton cultivation in Uzbekistan. Fertilizer treatments were N as urea, P as ammophos, and K as potassium chloride. The nitrification inhibitor PO was added to urea and ammophos at the rate of 2%. Three treatments—N200P140K60 (T1), N200 P140 POK60 (T2), and N200 P140 POK60 (T3) mg kg-1 soil—were applied for this study. The control (C) was without fertilizer and PO. The populations of oligotrophic bacteria, ammonifying bacteria, nitrifying bacteria, denitrifying bacteria, mineral assimilating bacteria, oligonitrophilic bacteria, and bacteria group Azotobacter were determined by the most probable number method. The treatments T2 and T3 increased the number of oligonitrophilic bacteria and utilization mineral forms of nitrogen on the background of reducing number of ammonifying bacteria. T2 and T3 also decreased the number of nitrifying bacteria, denitrifying bacteria, and net nitrification. In conclusion, our experiments showed that PO combined with mineral fertilizer is one of the most promising compounds for inhibiting nitrification rate, which was reflected in the increased availability and efficiency of fertilizer nitrogen to the cotton plants. PO combined with mineral fertilizer has no negative effects on nitrogen-fixing bacteria Azotobacter and oligo-nitrophilic bacteria

Strategi Perekrutan Santri Pondok Pesantren Salafiyah Ibnu Qasim Desa Tassiwalie Kecamatan Suppa Kabupaten Pinrang

This study aims to determine the strategy of recruiting students carried out by the Salafiyah Ibnu Qasim Islamic boarding school, Tassiwalie Village, Suppa District, Pinrang Regency and the obstacles it faces. This study uses a descriptive qualitative approach. Data collection techniques used are field research, such as observation, interviews and documentation. The data analysis technique used in this research is data reduction, data presentation and conclusion drawing. The results of this study indicate that the recruitment strategy carried out by the Salafiyah Ibnu Qasim Islamic boarding school is in the form of carrying out several approach activities that can establish good relations with the community, such as attending or attending events held by the community, and also inviting the community to attend the events held, sending students in each area to conduct sermons and lectures, and also provide free registration fees. The obstacle in recruiting students is inadequate learning facilities. There are several indicators of the success of recruiting students at the Salafiyah Ibnu Qasim Islamic boarding school, including this Islamic boarding school that has quality in terms of good attitudes and morals as well as mastering qualified knowledge in the field of religionPenelitian ini bertujuan untuk mengetahui strategi perekrutan santri yang dilakukan oleh pondok pesantren Salafiyah Ibnu Qasim Desa Tassiwalie Kecamatan Suppa Kabupaten Pinrang dan kendala yang dihadapinya. Penelitian ini menggunakan pendekatan kualitatif deskriptif. Teknik pengumpulan data yang digunakan yaitu, penelitian lapangan (field research) seperti, observasi, wawancara dan dokumentasi. Teknik analisis data yang digunakan dalam penelitian ini adalah reduksi data, penyajian data serta&nbsp; penarikan kesimpulan. Hasil penelitian ini menunjukkan bahwa strategi perekrutan yang dilakukan pondok pesantren Salafiyah Ibnu Qasim berupa melakukan beberapa kegiatan pendekatan yang dapat menjalin hubungan yang baik dengan masyarakat, seperti mengikuti atau menghadiri acara yang digelar oleh masyarakat, dan juga mengundang masyarakat dalam menghadiri acara yang dilaksanakan, mengutus santri di setiap daerah&nbsp; untuk melakukan khutbah dan ceramah, dan juga memberikan biaya pendaftran gratis. Kendala dalam merekrut santri yaitu sarana belajar yang belum memadai. Terdapat beberapa indikator&nbsp; keberhasilan perekrutan santri di pondok pesantren Salafiyah Ibnu Qasim, diantaranya pondok pesantren ini&nbsp; memiliki kualitas dalam hal sikap dan akhlak yang baik serta menguasai ilmu pengetahuan yang mumpuni dalam bidang agama