Local-area monitoring and supervision in Indonesia: tools to improve the coverage and quality of vaccination services.
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Humans↗
Biomedical subjects
R Hatfield
Publications and source records attributed to R Hatfield.
The cognitive and psychological sequelae of uncomplicated aneurysm surgery.
Many patients are left with psychological symptoms after surgery for a ruptured intracranial aneurysm. Often the reason for these symptoms is not clear. A prospective study was carried out of 27 patients who were in a good (Grade 1 or 2) condition before operation to identify the origin of such symptoms and discover whether the basic techniques of aneurysm surgery could lead to serious psychological sequelae even in the absence of any specific complication. Each patient was given a modified psychometric assessment just before surgery and at the time of discharge from hospital. One year later a full psychometric and social assessment was carried out. Even a temporary worsening of psychometric performance did not occur unless there had been some specific surgical or post-operative problem. Five patients showed worsening of psychometric performance in the immediate post-operative period but by one year, only two of the 27 patients showed any abnormalities on formal psychometric evaluation; in both, clear reasons were evident. Although the majority of patients reported minor psychological symptoms, these had not hindered full functional recovery, and we doubt whether they had any organic basis. It is concluded that aneurysm surgery does not, itself, threaten higher intellectual function unless some specific complication occurs.
Adult↗
Short-term tranexamic acid treatment in aneurysmal subarachnoid hemorrhage.
Antifibrinolytic treatment for 4 weeks after a subarachnoid hemorrhage has been shown to have no effect on outcome since a reduction in the rate of rebleeding was offset by an increase in ischemic events. To determine if a shorter course (4 days) of antifibrinolytic treatment before the expected onset of ischemic complications might reduce the rate of rebleeding yet avoid ischemic complications, we prospectively studied a series of 119 patients with subarachnoid hemorrhage; 479 patients with subarachnoid hemorrhage from our previous randomized double-blind study (238 treated with placebo, 241 with long-term tranexamic acid) served as historical control groups. At 3 months' follow-up, the outcome of patients treated with short-term tranexamic acid was not different from that of patients treated with long-term tranexamic acid. The rate of rebleeding (24 of 119, 20%) was near that with placebo (56 of 238, 24%). In contrast, the rate of cerebral infarction (33 of 119, 28%) was almost identical to that after long-term tranexamic acid (59 of 241, 24%), although mortality from cerebral infarction was reduced. Compared with historical control groups, treatment with tranexamic acid for 4 days fails to reduce the incidence of rebleeding but still increases the rate of cerebral infarction.
Cerebral Angiography↗
Closed head injuries: where does delay occur in the process of transfer to neurosurgical care?
In the United Kingdom most head injury patients are first admitted to a District General Hospital (DGH); selected patients are later referred to a Neurosurgical Unit (NSU). It is known that this system leads to some avoidable deaths. In an attempt to discover whether the minimum amount of time involved in such a system of secondary referral must of necessity put some patients at risk, and whether any significant delay could be eliminated without radical change in this system, we have carried out a detailed prospective analysis of the sequence of events involved in the emergency transfer of 117 consecutive patients with suspected traumatic intracranial haematoma (TICH). We discovered that once it had been decided to transfer a patient, the actual process of transfer consumed relatively little time regardless of the distance from the DGH to the NSU. Where harmful avoidable delay did occur was at the DGH itself either from failure to institute appropriate treatment for non-cranial injuries or from failure to realise that transfer was necessary. We believe that the geographical dispersal of neurosurgical services would not improve the outlook of patients with head injury. The optimum outcome could be achieved by concentrating head injury admissions at selected DGH's each of which would be equipped both with a CT scanner linked to a neurosurgical unit and a standby ambulance for transferring head injury patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Brain Injuries↗