Effective headache management in the aneurysmal subarachnoid patient: a literature review

Subarachnoid haemorrhage (SAH) is described throughout the literature as a devastating neurological disorder associated with significant mortality and morbidity rates, arising not just from the haemorrhage itself, but also as a result of the catastrophic multisystem sequelae that can accompany the condition. Rupture of an intracranial aneurysm accounts for up to 85% of instances of SAH, occurring in approximately 6–7 per 100,000 in most populations and costing an estimated £510 million annually in the United Kingdom alone (Rivero-Arias et al, 2010). Treatment of Aneurysmal Subarachnoid Haemorrhage (aSAH) includes prevention of re-bleeding, evacuation of space occupying haematomas, management of hydrocephalus and prevention of secondary cerebral insult. Headache has been highlighted as the predominant, most characteristic and often the only symptom of aSAH, its severity having a variety of physiological and psychological effects on the patient. This paper summarises the findings of a literature review conducted as part of a research study to examine existing practices in the assessment and management of headache in patients with aSAH in an Irish Neurosciences Centre. The review demonstrates that despite a wealth of published literature on the diagnosis and management of aSAH, evaluation and management of its main symptom, headache, remains suboptimal and under-researched. The lack of available literature demonstrates that such enquiry is both timely and necessary

Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review

Abstract Background Systematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people. Methods This review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis. Results From a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs. Conclusions There remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research

Neither prepared nor transformed: Institutional responses to unconventional oil and gas development in Australian and Canadian communities

Resource dependent regions in Australia, Canada, and in other industrialized areas have experienced rapid change due to forces of both political and economic restructuring over the past three decades. Policy and program responses by senior levels of government to these accelerating processes of change have too often only exacerbated the negative impacts of major resource exploitation. As a result, rural and small-town places dependent upon primary industries and natural resource sectors continue to struggle to find traction in a new economy marked by the vagaries of demographic, economic, social, cultural, political, and environmental change. In this paper, we explore these resource economy and institutional dynamics within the context of unconventional oil and gas development (UOGD). Our comparative case context includes the Surat Basin in eastern Australia and the Peace River region in northeastern British Columbia, Canada. Both regions have significant recent experience with UOGD. The paper draws upon staples theory and evolutionary economic geography to frame the dynamics of truncated development patterns and the prospects for path variation. Despite the well-known negative impacts and disruptions associated with major resource projects, we make three inter-related arguments challenging the efficacy of senior government responses to the community and regional impacts of UOGD. These are that senior governments: 1) react too slowly in their mitigation responses; 2) are generally dragged into action by local opposition to construct institutional and redistributive funding measures to compensate for local disruption, that; 3) ultimately fall short in terms of offering any kind of strategic, post-resource boom transformational potential to restore or redirect the economic future of resource regions

The socio-spatial politics of royalties and their distribution: A case study of the Surat Basin, Queensland

This paper is concerned with the socio-spatial and ethical politics of redistribution, specifically the allocation of natural resources rents from political and economic cores to the economic and geographical peripheries whence the resource originated. Based on a case study of the coal seam gas sector in Queensland's Surat Basin, this paper focuses on the operation of the Queensland State Government's regional development fund for mining and energy extraction-affected regions. Employing an environmental justice framework, we critically explore the operation of these funds in ostensibly helping constituent communities in becoming resilient to the worst effects of the 'staples trap'. Drawing on secondary demographic and housing data for the region, as well as primary information collected from key respondents from mid-2018 to early 2019, we show that funds were distributed across all of the local government areas, and allocated to projects and places primarily on a perceived economic needs basis. However, concerns were raised with the probity of the funds' administration. In terms of recognition justice, the participation of smaller and more remote towns and local Indigenous communities was hampered by their structural marginalisation. Procedurally, the funds were criticised for the lack of local consultation taken in the development and approval of projects. While spatially concentrated expenditure may be the most cost-effective use of public monies, we argue that grant application processes should be open, transparent and inclusive, and the outcomes cognisant of the developmental needs of smaller communities, together with the need to foster regional solidarity and coherence

Be careful what you wish for: Resource boomtowns and disillusionment in the Surat Basin

Communities near resource extraction projects are notoriously prone to boomtown dynamics, and in the Australian context, the boom and bust cycles have shaped the nation's economic history. Australia is the seventh largest gas producer in the world, with production escalating after the establishment of onshore unconventional gas extraction in the early 2000 ' s. This paper examines the rapid development of onshore unconventional gas extraction, specifically coal seam gas, in the Surat Basin of Queensland, which is also the location of long-established and highly valued agricultural industries. The impact of neoliberal economic principles and public policies, broadly imposed from the early 1980s, caused many services to be rationalised across the region and smaller communities. A new industry, promising industry diversification, alternative employment and royalties, was promoted by the Queensland government and the gas companies in 2005. Very quickly however, tensions between the gas companies and the agricultural industry regarding secretive agreements, land use conflict and lack of consultation developed into blockades, protests and antagonism. Towns were also impacted with an escalation in land prices and competition for labour. Many residents of the Surat believed the government had been greedy in its haste to provide approvals with an eye to lucrative royalties, with little consideration for their welfare or their livelihoods. Resource economies throughout the world are replete with examples of this scenario. This paper documents the conflicts and the subsequent measures undertaken by government and the gas com-panies to appease the residents of the Surat, all of which took considerable time and expense. If more considered consultation and understanding had been developed prior to the first approvals being granted, this could have been avoided. This paper is timely, given that the Queensland has once again granted exploration licenses in the highly sensitive western Channel country without consultation or consideration, causing angst and uncertainty