The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most widely utilized class of cholesterol-lowering agents, carrying multiple indications for both primary and secondary cardiovascular risk reduction. Concern was raised by previously published post hoc analyses and observational studies that noted an increased risk of hemorrhagic stroke in patients receiving a statin. Subsequent studies have demonstrated conflicting results regarding the role of statin therapy on hemorrhagic stroke risk and patient outcomes. New evidence suggests that statins taken prior to or continued during admission for intracerebral hemorrhage (ICH) may be associated with positive outcomes. Evidence also suggests deleterious outcomes resulting from the abrupt discontinuation of statins upon hospital admission for multiple disease states including ICH. Conflicting data also exist for the use of statins following aneurysmal subarachnoid hemorrhage (aSAH). Recent evidence suggests statins started during admission for aSAH confer no additional benefit in reducing delayed ischemic neurologic deficits despite initial positive results. Larger scale evaluation of the role of statin therapy following hemorrhagic stroke is warranted. The available literature is reviewed to provide guidance for therapeutic decision making.
Professional organizations and trade associations influence both the structure of the journalistic field and the nature of news work. News media trade associations attempt to advance the interests of industry firms through campaign contributions, political lobbying, and public relations activities. They trace their origins back to the founding of state and regional newspaper trade associations in the mid‐nineteenth century. Journalistic professional organizations foster a shared identity among journalists, establish norms of behavior and ethical codes, and engage in political advocacy around issues of press freedom and information access. Unlike professional organizations in more established professions, such as medicine and law, journalistic professional organizations do not control access to the profession and possess little authority to discipline members. This is a result of journalism's semiprofessional status relative to full professions.
The understanding of costs of quality has evolved considerably over the past few decades. Traditionally, quality costs were thought of as prevention, appraisal, internal failures, and external failures. We also thought there was an optimal level of quality where costs were minimized. Newer thinking of quality costs has questioned the concept of optimum level, added the concept of quadratic loss, and explored many other costs associated with the costs of poor quality. Often, these new costs are far, far greater than the traditional costs.
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