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The benefits of intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke is time dependent. Guidelines recommend a door-to-needle (DTN) time of less than 60 minutes.
A retrospective audit of 730 stroke charts from 2008 - 2011 was conducted at Health Sciences Centre. 158 patients treated with IV rt-PA were identified. The time intervals between Emergency Department (ED) arrival, administration of rt-PA and uninfused brain computed axial tomographic scan (CT) were recorded. From this, CT to needle times were calculated. During November 2010 to January 2011 feedback was given to neurologists, ED physicians, ED nurses, and CT technologists. This raised awareness and emphasized the importance of this time driven protocol.
The median DTN times for 2008, 2009, and 2010 were 69, 71 and 76 minutes respectively. The median CT-to-needle time for this time period was 47 minutes. In 2011 (n =58) the median DTN time was 49 minutes and the median CT-to-needle was 18 minutes, which were marked improvements (p<0.00005 and p<0.005, respectively). In 2008-2010 only 31% of treated patients (n=100) received rt-PA within 60 minutes, whereas in 2011 this increased to 64%.
Dramatic improvements in DTN times and in the percentage of patients receiving rt-PA treatment within 60 minutes were observed in 2011 after feedback was provided regarding the suboptimal performance. Prior to receiving feedback, DTN times were similar to national median DTN times. All centres administering rt-PA for acute ischemic stroke should monitor their clinical performance and give feedback on a regular basis.
In this article Susan Alcock examines the issues relating to outsourcing of legal information services. She reflects the many concerns felt within the industry and offers many points-of-view that have been collected from those working in the field as in-house law librarians and legal information professionals.
This chapter, covering the period from roughly 200 BC to AD 300, sketches out some of the structural determinants of the eastern Mediterranean's economic performance, and then traces that performance through the processes: production, distribution, and consumption. Isolating these very closely interwoven elements is helpful for the purposes of this particular type of overview; ultimately, however, the interaction of the three requires reconciliation and synthesis in other, more targeted studies. The chapter also visits the issue of relative growth across the empire. Agriculture was central to the Roman economy but agricultural production was uncertain in the eastern Mediterranean. Land-ownership in the Roman east offered avenues to security and status, and the preeminent means to garner wealth in the ancient world. Regional distribution of goods was very active in the eastern Mediterranean. An inland city such as Sagalassos appears to enjoy fewer imported wares than coastal cities such as Anemurion or Perge, but has the usual signs of conspicuous consumption.
One of the more admirable things about this collection of papers is how the authors resist the almost overwhelming temptation to employ food-related, lip-smacking puns. I noted, for example, only one coy ‘food for thought’. This resistance neatly symbolizes, to my mind, a growing sophistication in the archaeology of food, a development seen everywhere in this particular smorgasbord of essays.