Postpartum rupture of an intracranial aneurysm.

BACKGROUND: The relative risk of intracerebral hemorrhage during pregnancy and 6 weeks postpartum is higher than that of the nongravid population. CASE: A 37-year-old multiparous, previously healthy woman appeared to have had a seizure on emergence from general anesthesia for cesarean delivery. Subsequent neuro-imaging revealed a giant unruptured internal carotid artery aneurysm. The day after discharge from the hospital, with planned outpatient neurosurgery follow-up, she re-presented with a subarachnoid hemorrhage. This ultimately resulted in her death. CONCLUSION: Given the significant morbidity and mortality associated with cerebral aneurysms in pregnancy, they should be considered in all cases of acute neurological deterioration. Also, given the increased risk of aneurysmal rupture in the gravid patient, expedited management of newly discovered cerebral aneurysms should be contemplated.

AcademyHealth's Delivery System Science Fellowship: Training Embedded Researchers to Design, Implement, and Evaluate New Models of Care.

AcademyHealth's Delivery System Science Fellowship (DSSF) provides a paid postdoctoral pragmatic learning experience to build capacity within learning healthcare systems to conduct research in applied settings. The fellowship provides hands-on training and professional leadership opportunities for researchers. Since its inception in 2012, the program has grown rapidly, with 16 health systems participating in the DSSF to date. In addition to specific projects conducted within health systems (and numerous publications associated with those initiatives), the DSSF has made several broader contributions to the field, including defining delivery system science, identifying a set of training objectives for researchers working in delivery systems, and developing a national collaborative network of care delivery organizations, operational leaders, and trainees. The DSSF is one promising approach to support higher-value care by promoting continuous learning and improvement in health systems.

Case report: transfusion-related acute lung injury (TRALI) - a clear and present danger.

PURPOSE: To describe a case of transfusion-related acute lung injury (TRALI) after platelet transfusion immediately following cardiac surgery, and to review the clinical features, pathophysiology, management, and morbidity and mortality associated with such an event. CLINICAL FEATURES: A 62-yr-old man was transferred to our centre for urgent coronary artery bypass grafting in the setting of recent anti-platelet medication use. Soon after surgery he received platelet transfusions despite having only moderate blood loss. Shortly following the platelet transfusion, he suffered acute hypoxic and hypotensive decompensation requiring nitric oxide therapy, inotropic support, and prolonged need for mechanical ventilation. The patient was eventually discharged from the intensive care unit nine days following the event. The diagnosis of TRALI was made by clinical and radiographic criteria. CONCLUSION: Transfusion-related acute lung injury is now the leading cause of transfusion-related fatalities. Early diagnosis of TRALI is important and these reactions should be reported to the blood transfusion service so that appropriate action can be taken to prevent future morbidity and mortality in other patients. To reduce serious transfusion reactions, inappropriate transfusions must be minimized and the decision to transfuse blood products should be taken with care.