Ultra-Early Blood Pressure Control in Aneurysmal Subarachnoid Hemorrhage

Background: The incidence of aneurysmal subarachnoid hemorrhage (aSAH) occurs in approximately 10 - 15 per 100,000 (Labovitz et al., 2006 & Shea et al., 2007). Within twenty-four hours twenty-five percent of these patients die (AHA, 2012). Additionally two thirds have some neurological deficit and decreased quality of life (AHA, 2012). Re-bleeding is a serious complication prior to repair. The highest risk of re-bleeding occurs in the first twelve hours, most occurring in the first three hours with mortality rates as high as seventy percent (American Stroke Association [ASA], 2012). According to the ASA (2012), ultra-early blood pressure management is one of the most important interventions to prevent re-bleeding. These guidelines were updated May 2012 with recommendations to keep systolic blood pressure less than 160 mmHg. Purpose: The objective of this quality improvement project was to determine if the publication of the updated 2012 AHA/ASA aSAH Guidelines affected adherence, by Cleveland Clinic Critical Care Transport Team members, to those evidence based practice guidelines for blood pressure control for patients with subarachnoid hemorrhage. Methods: Descriptive statistics were used looking at secondary data from a retrospective chart review to examine blood pressure management during transport. The sample includes 137 patients transported by Cleveland Clinic Critical Care Transport with a diagnosis of aSAH in 2012. Data collected included length of transport in minutes and systolic blood pressures during transport. Data was analyzed and compared for the periods of January through June 2012 and July through December 2012. A chi-square test was used to see if there was a statistically significant change. Results: The data indicated there was not a statistically significant difference between the two groups. Adequate blood pressure management was achieved in eighty six percent of the patients in both groups. Conclusion: After a statistical review of the data was completed it was determined that there was not a statistically significant difference in adequate systolic blood pressure management (SBP > 159 mmHg) following the July 2012 publication of the AHA/ASA guidelines.A three-year embargo was granted for this item

The Grizzly, March 17, 1989

Pledging Violations Abound: Change Imminent • Approaching Commencement Scares Seniors • Letters: Bermans Ship Garbage Here?; Alumni Concerned About Curtis Fire; Bond Facts Straight?; Collegeville Water Now Non-Toxic; Visser Vicous to Hocsters • CAB Earns Kudos • Bears Look to Bright Furture • Lady Bears Always A Bridesmaid • Track Stars Shine! • Easton\u27s Colonial Genuine Italian • Blues: A+ • Guess Who\u27s Coming for Dinner? • Senior Matters Leave Their Mark • Peruvian Junglehttps://digitalcommons.ursinus.edu/grizzlynews/1232/thumbnail.jp

The Grizzly, February 19, 1991

Wismer Renovations • Movies Moved • Clark Wins NEH Grant: Travels to China • Teaching Catalan, An Alternative Language • Book Fair Comes to Ursinus • Italian Market: A Way of Life • Unchangeable South Street • Screaming Trees • Death of a Salesperson • Murder at Toranno\u27s • Swimmers Prepare for MAC Championship • Men\u27s Basketball Finishes Season with 11-14 Record • Black History Month • He\u27s Back! David Lee Roth, Stud or Stroker? • Modern Shakespeare • Wrestlers Romp • Schafer Tells of Track Troubles • Women Race at MAC Championships • Gymnasts Having Fun • Letter: Olin, for Students or Posterity? • Domestic Policy: A Matter of Perspective • Ah, Um, Uh... • An Elegantly Simple Plan • Radioactivity at Ursinus Collegehttps://digitalcommons.ursinus.edu/grizzlynews/1271/thumbnail.jp

To make new choices - The network´s involvement in the process of young addicts´ leaving abuse

 The aim of this study was to examine how young people, who have been treated for their misuse and/or to learn to handle a parent's misuse, portrayed the network's implication in their wishes about improving their lives, to make new choices. The network included members of nuclear family, relatives, important persons at school/work and friends. The “professional network” (therapists and social workers) also became a part in the young people's life during a period. The main issues of this study concerned differences in their experiences of the young persons´ network relationships in before, during and after completed treatment. And also what has been important in the treatment. The most important result of the study shows that despite that all the young people have had experiences of difficult problems and life relations nevertheless came to improve their life conditions. The process of change, for several of the young people, took place during a long period of time, sometimes several years. The most important aspect in this process was the own will to change. The study shows a significant change in the composition of the network. From the time of drug abuse friends of the same age were the most important persons in the network. But the relationships with the family network did improve and was experienced as important after the completion of the drug abuse, also when the youth was over 18 years of age. When the treatment was connected to a network perspective the youths´ social networks came to play a more important role after completed treatment. And thus, when there was no network approach the youth often stood entirely alone, lacking support from both family and “the professional network”. Other important factors in the treatment concerned the relationship between the youth and the professional, where private consultations played an important role. It was likewise important that the professional made it possible for the youth and other members of the family network to start a dialogue about problems in the life situation of the youth. The fact, furthermore, that other related persons outside the core family has been invited to conversations, did also contribute to a positive outcome of the process.Uppsatsen är också publicerad genom FoU Södertörn, Skriftserie nr 77/09 - Att göra nya val - om nätverkets delaktighet i ungdomars väg ut ur missbru

An outpatient heart failure clinic reduces 30-day readmission and mortality rates for discharged patients: process and preliminary outcomes

BACKGROUND: The first outpatient heart failure clinic (HFC) in Western New York was developed within a large private cardiology practice with the objective of reducing 30-day all-cause rehospitalization and inpatient mortality. PURPOSE: The aim of this study was to analyze the process and patient outcomes of this independent outpatient HFC. The specific aims were to (a) describe the outpatient care strategies employed and (b) determine whether the HFC reduced 30-day all-cause rehospitalizations and inpatient mortality by comparing HFC data with census data. METHODS: This study used a retrospective chart analysis of 415 adults who had been enrolled in the target HFC after hospitalization for HF. Data were summarized using frequency comparisons and descriptive statistics. One-sample chi-square tests were conducted to test the observed values in the study sample against census data. RESULTS: Patients in the HFC were less likely to experience a readmission to hospital within 30 days of discharge (69% reduction within the study period, p \u3c .001). Patients were seen acutely after discharge, had multiple medication adjustments, and received ongoing telephonic follow-up. The HFC had statistically lower inpatient mortality rates (1.2% vs. 11.6% national average, p \u3c .001), likely a result of the HFC care regimen and referrals for palliative care (17%). CONCLUSIONS: The results of this analysis highlight the importance of developing an outpatient HFC in collaboration with hospitals that is aimed at reducing 30-day all-cause readmissions and inpatient mortality, with referral to palliative care when indicated

Understanding voluntary return

Voluntary return of refugees and asylum seekers is seen as an increasingly important element of the UK policy agenda on immigration and asylum, consistent with proposals contained within the 2002 White Paper Secure Borders, Safe Haven: Integration with Diversity in Modern Britain. Since 1999, the Immigration and Nationality Directorate (IND) of the UK Home Office has been funding programmes to assist failed asylum applicants, those awaiting a decision and those with time-limited exceptional leave to enter or remain, who wish to return to their country of origin. In the context of increasing UK government interest in this area, this report describes the findings of a study commissioned by the Home Office to explore the factors influencing the decision to return, including the role played by incentives, as well as to enhance understanding of the concept of the ‘sustainability’ of return. The research was conducted by a team based at the Sussex Centre for Migration Research, and involved fieldwork both in the UK and in the Balkans. This chapter sets out the aims and objectives of the report, its background and relevance, and its structure

Understanding voluntary return

Voluntary return of refugees and asylum seekers is seen as an increasingly important element of the UK policy agenda on immigration and asylum, consistent with proposals contained within the 2002 White Paper Secure Borders, Safe Haven: Integration with Diversity in Modern Britain. Since 1999, the Immigration and Nationality Directorate (IND) of the UK Home Office has been funding programmes to assist failed asylum applicants, those awaiting a decision and those with time-limited exceptional leave to enter or remain, who wish to return to their country of origin. In the context of increasing UK government interest in this area, this report describes the findings of a study commissioned by the Home Office to explore the factors influencing the decision to return, including the role played by incentives, as well as to enhance understanding of the concept of the 'sustainability' of return. The research was conducted by a team based at the Sussex Centre for Migration Research, and involved fieldwork both in the UK and in the Balkans. This chapter sets out the aims and objectives of the report, its background and relevance, and its structure