by Yuk-Tong Lee. / "September 2001." / Thesis (M.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 255-288). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Despite medical technology and research advances postpartum hemorrhages (PPH) continue to be a leading cause of morbidity and mortality for pregnant women, even in developed countries. One possible explanation for PPHs continuing to be a leading cause of maternal death is inconsistent recognition and timely treatment of women experiencing a PPH. This doctor of nursing practice project attempts to improve labor and delivery nurse knowledge through an educational intervention which will contribute to rapid identification and treatment of PPH. Knowledge change was demonstrated though change in pretest and posttest scores. The educational information and process was guided by adult learning theory and content was based on current research and evidence-based practice guidelines on PPH. Ninety six participants were assessed using a PPH pretest posttest design. The tests consisted of 15 questions. Correct scores were added and a percent correct score was calculated. The data demonstrated that 63% of the participants passed the pretest with an 80% or higher and 90% of the participants passed the posttest with an 80% or higher. The difference was statistically significant, indicating there was an increase in knowledge after the educational materials were presented. This DNP project contributes to social change by ensuring women receive excellent and timely PPH care by nurses who have a strong understanding of PPH and can apply that knowledge through rapid identification and treatment.

<p><strong>Background</strong> Subarachnoid hemorrhage is a condition with high rates of mortality and morbidity. The diagnosis requires an urgent cerebral computed tomography scan and also a lumbar puncture if the scan fails to demonstrate intracranial blood. In Sweden the cerebrospinal fluid (CSF) is analyzed by spectrophotometric scanning for the presence of hemoglobin and bilirubin. The aim of the study was to develop a quantitative diazo reagent based analysis of cerebrospinal fluid bilirubin as a replacement for spectrophotometric scanning.</p><p><strong>Methods</strong> The CSF bilirubin assay on an Architect C8000 chemistry analyzer was compared with spectrophotometry using patient samples.</p><p><strong>Results</strong> The method correlates with spectrophotometry, has a good linearity and precision.</p><p><strong>Conclusions</strong> Quantitative bilirubin measurement offers shorter turnaround times, simplifies the interpretation of the results and reduces work load in comparison with spectrophotometry.</p>

Background Subarachnoid hemorrhage is a condition with high rates of mortality and morbidity. The diagnosis requires an urgent cerebral computed tomography scan and also a lumbar puncture if the scan fails to demonstrate intracranial blood. In Sweden the cerebrospinal fluid (CSF) is analyzed by spectrophotometric scanning for the presence of hemoglobin and bilirubin. The aim of the study was to develop a quantitative diazo reagent based analysis of cerebrospinal fluid bilirubin as a replacement for spectrophotometric scanning. Methods The CSF bilirubin assay on an Architect C8000 chemistry analyzer was compared with spectrophotometry using patient samples. Results The method correlates with spectrophotometry, has a good linearity and precision. Conclusions Quantitative bilirubin measurement offers shorter turnaround times, simplifies the interpretation of the results and reduces work load in comparison with spectrophotometry.

Atherosclerotic plaque (AP) composition is an important factor influencing plaque rupture. Intraplaque hemorrhage (IPH) is a marker of complicated-plaque formation, responsible for many of the clinical manifestations of atherosclerotic disease. Magnetic resonance imaging (MRI) has emerged as a modality to image carotid AP. The in-vivo high-resolution MR imaging of carotid complicated-plaque forms the basis of this thesis. In the first part, Magnetic Resonance Imaging of Intraplaque Hemorrhage (MRIPH), an in-vivo high-spatial-resolution 3-dimensional MRI sequence specifically designed to depict complicated-plaque in the carotid arteries is described. MRIPH was applied, as compared with histologic analysis (gold standard), to demonstrate that T1-hyperintense intraplaque signal represented blood products. Strong agreement was seen between T1-hyperintensity and histologically-identified hemorrhage, with high sensitivity/specificity/positive- and negative-predictive values for T1-hyperintense detection of hemorrhage. While IPH increases plaque rupture risk, high degrees of calcification promote stability. Calcium can generate T1-hyperintensity in some gradient-echo (GRE) sequences. Therefore, distinction between these two components is crucial. In the second part, T1-hyperintensity in MRIPH was shown to be almost exclusively due to hemorrhage and not calcification by directly comparing in-vivo T1-hyperintensity with calcification in ex-vivo specimens imaged with microCT. T1- hyperintesity showed very good albeit inverse agreement with calcification and excellent agreement with lack of calcification as seen on microCT. IPH is thought to be the result of rupture/leakage of the vasa vasora. In the third part, we tested the hypothesis that if IPH were due to vasa vasorum rupture/leakage, the majority of the IPH would be associated with the adventitial rather than the luminal surface of the plaque. Deep (closer to vessel wall) and superficial (closer to vessel lumen) regions of complicated plaques were identified. Very good inter-rater agreement was seen for the location of IPH using MRIPH, with IPH being more frequently present in the deeper compared to superficial segments of the plaque. In summary, an in-vivo MR technique to detect IPH at high spatial-resolution in carotid complicated-plaque was developed; demonstrating T1-hyperintensity in MRIPH is the result of IPH and not calcification. The predilection of IPH for the deeper segments of the plaques suggests that IPH is due to vasa vasorum rupture/leakage.

Atherosclerotic plaque (AP) composition is an important factor influencing plaque rupture. Intraplaque hemorrhage (IPH) is a marker of complicated-plaque formation, responsible for many of the clinical manifestations of atherosclerotic disease. Magnetic resonance imaging (MRI) has emerged as a modality to image carotid AP. The in-vivo high-resolution MR imaging of carotid complicated-plaque forms the basis of this thesis. In the first part, Magnetic Resonance Imaging of Intraplaque Hemorrhage (MRIPH), an in-vivo high-spatial-resolution 3-dimensional MRI sequence specifically designed to depict complicated-plaque in the carotid arteries is described. MRIPH was applied, as compared with histologic analysis (gold standard), to demonstrate that T1-hyperintense intraplaque signal represented blood products. Strong agreement was seen between T1-hyperintensity and histologically-identified hemorrhage, with high sensitivity/specificity/positive- and negative-predictive values for T1-hyperintense detection of hemorrhage. While IPH increases plaque rupture risk, high degrees of calcification promote stability. Calcium can generate T1-hyperintensity in some gradient-echo (GRE) sequences. Therefore, distinction between these two components is crucial. In the second part, T1-hyperintensity in MRIPH was shown to be almost exclusively due to hemorrhage and not calcification by directly comparing in-vivo T1-hyperintensity with calcification in ex-vivo specimens imaged with microCT. T1- hyperintesity showed very good albeit inverse agreement with calcification and excellent agreement with lack of calcification as seen on microCT. IPH is thought to be the result of rupture/leakage of the vasa vasora. In the third part, we tested the hypothesis that if IPH were due to vasa vasorum rupture/leakage, the majority of the IPH would be associated with the adventitial rather than the luminal surface of the plaque. Deep (closer to vessel wall) and superficial (closer to vessel lumen) regions of complicated plaques were identified. Very good inter-rater agreement was seen for the location of IPH using MRIPH, with IPH being more frequently present in the deeper compared to superficial segments of the plaque. In summary, an in-vivo MR technique to detect IPH at high spatial-resolution in carotid complicated-plaque was developed; demonstrating T1-hyperintensity in MRIPH is the result of IPH and not calcification. The predilection of IPH for the deeper segments of the plaques suggests that IPH is due to vasa vasorum rupture/leakage.

No description available.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 73-84).

No description available.

Spontaneous subarachnoid hemorrhage (SAH) is a form of hemorrhagic stroke that accounts for approximately 7% of all strokes worldwide. Recently, researchers have gained insight into some possible genetic influences involved in the response to SAH. The goal of this study was to investigate the potential contribution of different mouse genetic backgrounds to brain injury after SAH. SAH was induced in 7 inbred strains of mice, and the degree of large artery vasospasm and brain injury was assessed. After 48 hours, SAH mice showed a significant reduction in middle cerebral artery diameter and increased neuronal injury in the cerebral cortex compared to sham controls. The degree of vasospasm and brain injury varied across strains. This data suggests that vasospasm and neuronal injury may not correlate, and that different genetic factors may influence each one. Future investigations may provide invaluable insight into the causes of these inter-strain differences and potential genetic contributors.