Post-stroke infection: A systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p><b>s</b>troke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome.</p> <p>Methods</p> <p>MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome.</p> <p>Results</p> <p>87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU). There was significant heterogeneity between studies (P < 0.001, I²= 97%). The overall pooled infection rate was 30% (24-36%); rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10%) and 10% (95%CI 9-12%). For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%), 28% (95%CI 18-38%) and 20% (95%CI 0-40%). Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68).</p> <p>Conclusions</p> <p>Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.</p

Crowning glory: public law, power and the monarchy

‘New public law’ has a keen interest in the deployment of power and the shifting nature of the public and private. In this article, we argue that the historical legacy of the Crown has hindered the ability of public lawyers to respond to changes in modes of governance in the UK. The constitutional law textbook tradition has played a key role in limiting critiques of the Crown because of the obfuscation that surrounds the legal and political status of the Monarch. However, instead of discounting the significance of the monarchy, we use it as a resource for exploring governing power, the blurring of boundaries and constitutional renewal. Our starting point is the life, death and, most importantly, the funeral of Diana, Princess of Wales. The latter event exposed the political relevance of the ‘personal’ in a most dramatic way, generating claims about the ‘feminisation of the government’ and ‘emotions augmenting democracy’. We follow through on these claims in order to focus on the effects of adopting private, intimate-sphere norms in the public sphere, in particular public-sphere decision making. While aware of the risks associated with this ‘transformation’ of democracy, we conclude that the increasing centrality of the intimate merits onsideration in new public law’s search for progressive tools of modern governance

Cinderella and her cruel sisters: parenthood, welfare and gender in the human fertilisation and embryology act 2008

This paper takes as its starting point the comparative parliamentary time spent discussing the welfare of the child and parenthood provisions of the Human Fertilisation and Embryology Act 2008. While the former commanded over 8 hours of debate - most of which was spent discussing the proposed removal of the words "the child's need for a father" from the legislation - the parenthood provisions generated approximately only one hour of debate. This seems curious, given that the parenthood provisions (which govern the attribution of legal parenthood following certain fertility treatments governed by the legislation) are likely to have much more of a "real life" effect, and given that subtle changes in the wording of the welfare provision from "need for a father" to "need for supportive parenting" are unlikely to make a great deal of difference to actual clinical practice. In contrast, extending legal parenthood to a second female parent from the moment of a child's birth has important symbolic as well as practical legal consequences for two women having a child together. This paper begins by setting this curious scene and explaining why it is problematic. The first part of the paper focusses on the reform of the welfare clause and will contextualize the extensive discussion of this clause in socio-political concerns about assisted reproduction, the role of men and masculinity in family life, and the role of genetics in underpinning these concerns. Against this backdrop, the second part of the paper then analyzes why so little attention was paid to the parenthood provisions, pointing to the "common sense" assumptions which typically shored up the discussions surrounding this part of the legislation. This part of the paper will also draw attention to a number of significant gender-based connotations in the parenthood provision