To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This review aims to consolidate scarce literature on the use of modern nanomechanical testing technique like instrumented nanoindentation in the field of archaeometry materials research. The review showcase on how can the nanoindentation tests provide valuable data about mechanical properties which, in turn, relate to the evolution of ancient biomaterials as well as human history and production methods. This is particularly useful when the testing is limited by confined volumes and small material samples (since the contact size is in the order of few microns). As an emerging novel application, some special considerations are warranted for characterization of archaeometry materials. In this review, potential research areas relating to how nanoindentation is expected to benefit and help improve existing practices in archaeometry are identified. It is expected that these insights will raise awareness for use of nanoindentation at various world heritage sites as well as various museums.
Secondary prevention of cerebrovascular disease through dedicated stroke clinics has been shown to decrease recurrent vascular events in patients. However, there is limited literature describing such stroke clinic experiences from low and middle income countries. This study describes patient characteristics and observations made at the first systematized stroke clinic in Pakistan.
Aretrospective audit of medical records of all patients presenting between September 2006 and August 2008 with a cerebrovascular event was conducted. Information about clinical presentation, modifiable risk factors and laboratory and radiological investigations was collected. Burden of disability was assessed using Modified Rankin score. Data was entered and analyzed using SPSS 14.0.
159 patients with a mean age of 57.0 ± 13.9 years were included in this study and 34.6% of all patients were women. 108 patients were diagnosed with ischemic stroke (67.9%) while 34 patients presented with hemorrhagic stroke (21.4%) and 17 patients presented with transient ischemic attacks (10.7%). Hypertension was the most common modifiable risk factor seen in 78.0%, followed by diabetes in 40.3% and dyslipidemia in 31.5%. At presentation to clinic, only 26.0% patients with dyslipidemia and 64.5% patients with hypertension were on appropriate medications.
A high prevalence of modifiable risk factors such as hypertension in stroke patients was observed and it presents an opportunity for conventional interventions in Pakistan. Systematized clinics for stroke and an algorithmic approach in primary care towards stroke may improve the implementation of evidence based secondary prevention strategies in developing countries.
This audit is particularly relevant to older-adult in-patient units where terminally ill patients suffering from dementia are placed.
The Human Rights Act 1998 imposes an obligation to facilitate a good death. Despite the fact that it is difficult to define a ‘good death’, pathways have been developed to help patients make their final transition with the least distress. One such pathway is the Liverpool Care Pathway for the Dying Patient (Marie Curie Palliative Care Institute, 2007). It uses the National Gold Standards Framework, which is a systematic, evidence-based approach to optimising care for patients nearing the end of life. This audit is important because the Department of Health's end-of-life care strategy states that ‘every organisation involved in providing end-of-life care will be expected to adopt a co-ordination process, such as the Gold Standards Framework’ (Department of Health, 2008).
Standards were obtained from the Liverpool Care Pathway for the Dying Patient (Marie Curie Palliative Care Institute, 2007):
ᐅ recognition of the terminal stage and documentation in notes
ᐅ decision not to resuscitate (DNR) discussed with next of kin and documented
ᐅ discontinuation of non-essential drugs in terminal phase
ᐅ unnecessary investigations not to be carried out
ᐅ unnecessary monitoring of vital signs to be stopped
ᐅ use of medication as required to relieve distressing symptoms
ᐅ general practitioner informed of patient's death.
Data were retrospectively collected from medical notes, prescription cards and temperature, pulse rate and respiratory rate (TPR) charts, for all patients who had died on in-patient wards/units with terminal dementia in the past 2 years. The medical notes, prescription cards and TPR charts were examined to find documentation of the seven standards listed above.
The percentage of patients who had received terminal care as outlined by the guidelines was calculated and tabulated.
It is suggested that this audit is undertaken by at least two people, because suitable patients may be placed on different wards.
The collation of notes and collection of data from nine suitable cases in the first cycle of the present audit took one person around one working day.
The audit is specific to the specialty of perinatal psychiatry yet is relevant to all psychiatrists, as well as midwives and primary care professionals. It relates to out-patients.
The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the prediction, detection and management of mental illness among pregnant women (including but not exclusively concerning those with established mental illness) and also the criteria for referral to perinatal psychiatric services.
The following standards come from the NICE guidelines Antenatal and Postnatal Mental Health (National Institute for Health and Clinical Excellence, 2007):
ᐅ Healthcare professionals should ensure that adequate systems are in place to ensure continuity of care and effective transfer of information, to reduce the need for multiple assessments.
ᐅ At a woman's first contact with services in both the antenatal and the postnatal periods, healthcare professionals (including midwives, obstetricians, health visitors and general practitioners) should ask about:
▹ past or present severe mental illness, including schizophrenia and bipolar disorder
▹ psychosis in the postnatal period and severe depression
▹ previous treatment by a psychiatrist or specialist mental health team, including in-patient care
▹ a family history of perinatal mental illness.
ᐅ If the woman has, or is suspected of having, a severe mental illness, she should be referred to a specialist mental health service.
Data were collected from referral letters or referral forms received by the perinatal service. The referral letter and forms were examined to see if the following information was present.
ᐅ information regarding the reason for referral, e.g. reasons for suspecting a mental illness
ᐅ details of past psychiatric history
ᐅ current risk factors for mental illness.
The percentages of referrals that met each of the three standards mentioned above were calculated.
It is recommended that two or three people conduct the audit, which is suitable for multidisciplinary involvement.
Around 3–4 weeks should be allowed for data collection and analysis.
The frequencies with which the different types of information were recorded in the referral letters and forms are given in the table below, for both an initial and a re-audit performed 1 year later.