European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre­hospital management of stroke

Background and purpose The reduction of delay between onset and hospital arrival and adequate pre­hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence­based practices for the management of patients with suspected stroke in the pre­hospital setting. Methods The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations. Results Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre­hospital 'code stroke' including highest priority dispatch, pre­hospital notification and rapid transfer to the closest 'stroke­ready' centre. Insufficient evidence was found to recommend a pre­hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre­hospital telemedicine during ambulance transport. Conclusions These guidelines inform on the contemporary approach to patients with suspected stroke in the pre­hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome.

Marine habitats map of "Isla del Caño", Costa Rica, comparing Quickbird and Hymap images classification results

Isla del Caño is a marine protected area on the south Pacific coast of Costa Rica, surrounded by coral reefs and coral communities. The ecology of these coral reefs has been studied for over 20 years, but they have not been mapped. Maps are considered a great research, planning, management and monitoring tool. Medium to high resolution images (HyMap 2005 and Quickbird 2007 respectively) were processed and classified in order to test and compare their accuracy in producing a marine habitat map. Manta tow surveys were performed in the field for identification of 7 marine habitats 1. Coral community; 2. Coral reef; 3. Bed rock; 4. Sand; 5. Sand with boulders; 6. Sand with rodolyths; and 7. Deep water. The overall accuracy was slightly higher using Quickbird (87%) than using Hymap (60%), however the difference was not significant. The map produced using Quickbird was selected to represent the marine habitats of Isla del Caño. This map will help to analyze the adequate size and zoning of the marine protected area. Rev. Biol. Trop. 58 (1): 373-381. Epub 2010 March 01.

Isla del Caño es un área marina protegida en la costa del Pacífico de Costa Rica y está rodeada de arrecifes coralinos. La ecología de estos arrecifes coralinos ha sido estudiada a lo largo de 20 años pero todavía no habían sido mapeados. Los mapas son considerados una buena herramienta de investigación, planificación, manejo y monitoreo. Imágenes de mediana y alta resolución (Hymap 2005 y Quickbird 2007 respectivamente) fueron procesadas y clasificadas con el fin de evaluar y comparar su desempeño en la elaboración de un mapa de hábitats marinos. En el campo se realizaron sondeos tipo Manta para la identificación de siete hábitats marinos: 1. Comunidad coralina; 2. Arrecife coralino; 3. Roca; 4. Arena; 5. Arena con cantos; 6. Arena con rodolitos; y 7. Agua profunda. La exactitud de la clasificación resultó un poco mayor usando Quickbird (87%) que Hymap (60%), sin embargo la diferencia no era significativa. Se seleccionó el mapa resultante de la clasificación con Quickbird para representar los hábitats marinos de Isla del Caño. Este mapa puede ayudar a analizar el tamaño adecuado y la zonificación del área marina protegida.

[Evaluation of health care by means of infant death investigation] / Avaliação da atenção à saúde através da investigação de óbitos infantis.

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mother's interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this study's operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.