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Search Results: 1 - 10 of 7500 matches for " Benjamin Coghlan "
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An online framework for introducing STI point-of-care tests in Pacific island countries and areas
Lisa Natoli,Benjamin Coghlan
Western Pacific Surveillance and Response , 2012,
Abstract: Sexually transmitted infections (STIs) are an important public health issue in Pacific island countries and areas. Diagnosis is challenging, often requiring laboratory facilities and technical expertise rarely available. Patients seldom have results before they leave the health facility, with management primarily based on symptoms. As the delay between testing and treatment increases, so does the potential for complications of infection for the individual, the likelihood of STI transmission to other sexual partners and the chance the client will not return for follow-up. Effective tests that can be used at the point of care (POC) can conceivably overcome these consequences of delayed diagnosis. Such tests for STIs are becoming more available and affordable, with the potential to improve STI control. However, the introduction of POC tests is complex, requiring consideration of a range of implications to operationalize testing successfully and minimize potential harms.
Learning lessons from field surveys in humanitarian contexts: a case study of field surveys conducted in North Kivu, DRC 2006-2008
Rebecca F Grais, Francisco J Luquero, Emmanuel Grellety, Heloise Pham, Benjamin Coghlan, Pierre Salignon
Conflict and Health , 2009, DOI: 10.1186/1752-1505-3-8
Abstract: In media and agency reports on complex emergencies, an estimate of the number of people who have died, the prevalence of childhood malnutrition and other key health indicators are often quoted. Although a discriminating reader may understand that these are estimates, we rarely question how or from where these numbers come. In most cases, estimates are obtained by means of field surveys which are subject to a number of limitations. In the past, the application of standard survey methods by various humanitarian actors has been criticised [1]. Currently, different methods of conducting field surveys are the subject of debate among epidemiologists and their strengths and weakness have been described in the literature [2-6]. Beyond the technical arguments, decision makers may find it difficult to conceptualize what the estimates actually mean. For instance, what makes this particular situation an emergency? And how should the operational response - humanitarian, political, even military - be adapted accordingly [7,8]? This brings into question not only the quality of the survey methodology, but also the difficulties epidemiologists face in interpreting results and selecting the most important information to guide operations.As a case study, we reviewed publicly available field surveys of a current acute-on-chronic humanitarian crisis - North Kivu, Democratic Republic of Congo (DRC) - to examine the methodologies employed, the findings presented, the interpretation of the results and the recommendations made. The eastern DRC Province of North Kivu has been the scene of conflict that has erupted sporadically for over a decade (Figure 1). The most recent renewal of violence has forced some 250,000 people to flee their homes since August 2008 [9].We searched PubMed/Medline for articles published from January 1, 2006 to January 1, 2009, in English, French, German, and Spanish using the key words ["mortality" (major topic) OR "nutrition" (major topic)] AND ["Congo" (text word)
Bosentan in the treatment of pulmonary arterial hypertension with the focus on the mildly symptomatic patient
Christopher J Valerio, John G Coghlan
Vascular Health and Risk Management , 2009, DOI: http://dx.doi.org/10.2147/VHRM.S4713
Abstract: osentan in the treatment of pulmonary arterial hypertension with the focus on the mildly symptomatic patient Review (4558) Total Article Views Authors: Christopher J Valerio, John G Coghlan Published Date August 2009 Volume 2009:5 Pages 607 - 619 DOI: http://dx.doi.org/10.2147/VHRM.S4713 Christopher J Valerio, John G Coghlan Department of Cardiology, Royal Free Hospital, London, UK Abstract: Pulmonary arterial hypertension (PAH) is a progressive disease with poor survival outcomes. Bosentan is an oral endothelin-1 receptor antagonist (ERA) that has been shown in a large randomized placebo-controlled trial (BREATHE-1) to be effective at improving exercise tolerance in patients with PAH in functional class III and IV. Further studies have been conducted showing: benefit in smaller subgroups of PAH, eg, congenital heart disease, efficacy in combination with other PAH therapies, eg, sildenafil, improved long-term survival compared with historical controls. More recently, controlled trials of new ERAs have included patients with milder symptoms; those in functional class II. Analysis of the functional class II data is often limited by small numbers. These trials have generally shown a similar treatment effect to bosentan, but there are no controlled trials directly comparing these new ERAs. The EARLY trial exclusively enrolled functional class II patients and assessed hemodynamics at 6 months. Though significant, the reduction in pulmonary vascular resistance is merely a surrogate marker for the intended aim of delaying disease progression. Significant adverse effects associated with bosentan include edema, anemia and transaminase elevation. These may preclude a long duration of treatment. Further studies are required to determine optimum treatment strategy in mild disease.
Bosentan in the treatment of pulmonary arterial hypertension with the focus on the mildly symptomatic patient
Christopher J Valerio,John G Coghlan
Vascular Health and Risk Management , 2009,
Abstract: Christopher J Valerio, John G CoghlanDepartment of Cardiology, Royal Free Hospital, London, UKAbstract: Pulmonary arterial hypertension (PAH) is a progressive disease with poor survival outcomes. Bosentan is an oral endothelin-1 receptor antagonist (ERA) that has been shown in a large randomized placebo-controlled trial (BREATHE-1) to be effective at improving exercise tolerance in patients with PAH in functional class III and IV. Further studies have been conducted showing: benefit in smaller subgroups of PAH, eg, congenital heart disease, efficacy in combination with other PAH therapies, eg, sildenafil, improved long-term survival compared with historical controls. More recently, controlled trials of new ERAs have included patients with milder symptoms; those in functional class II. Analysis of the functional class II data is often limited by small numbers. These trials have generally shown a similar treatment effect to bosentan, but there are no controlled trials directly comparing these new ERAs. The EARLY trial exclusively enrolled functional class II patients and assessed hemodynamics at 6 months. Though significant, the reduction in pulmonary vascular resistance is merely a surrogate marker for the intended aim of delaying disease progression. Significant adverse effects associated with bosentan include edema, anemia and transaminase elevation. These may preclude a long duration of treatment. Further studies are required to determine optimum treatment strategy in mild disease.Keywords: pulmonary arterial hypertension, bosentan, endothelin-1 receptor antagonist
Screening for pulmonary arterial hypertension in systemic sclerosis
J-L. Vachiéry,G. Coghlan
European Respiratory Review , 2009,
Abstract: The onset and progression of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc) can be particularly aggressive; however, effective treatments are available. Therefore, early identification of patients with suspected PAH, confirmation of diagnosis, and intervention is essential. PAH may be challenging to diagnose in its earliest stages, particularly in populations that have multiple causes of breathlessness, and, therefore, screening is required. The optimal screening tools and methodology are, as yet, unknown, and this is confounded by a lack of consensus over which patients to screen. Current practice favours annual screening of all SSc patients using Doppler echocardiography to detect elevated right heart pressures. This will typically identify most patients with the various forms of pulmonary hypertension found in SSc. The optimum thresholds for Doppler echocardiography are still subject to investigation, especially for patients with mild pulmonary hypertension, and this technique may, therefore, yield a significant number of false-positives and a currently unknown number of false-negatives. Confirmatory right heart catheterisation remains necessary in all suspected cases. Further research is needed to identify the optimal tools and the screening approach with greatest specificity and selectivity.
Early detection and management of pulmonary arterial hypertension
Marc Humbert,J. Gerry Coghlan,Dinesh Khanna
European Respiratory Review , 2012,
Abstract: The long-term prognosis for patients with pulmonary arterial hypertension (PAH) remains poor, despite advances in treatment options that have been made in the past few decades. Recent evidence suggests that World Health Organization functional class I or II patients have significantly better long-term survival rates than patients in higher functional classes, thus providing a rationale for earlier diagnosis and treatment of PAH. However, early diagnosis is challenging and there is frequently a delay between symptom onset and diagnosis. Screening programmes play an important role in PAH detection and expert opinion favours echocardiographic screening of asymptomatic patients who may be predisposed to the development of PAH (i.e. those with systemic sclerosis or sickle cell disease), although current guidelines only recommend annual echocardiographic screening in symptomatic patients. This article reviews the currently available screening programmes, including their limitations, and describes alternative screening approaches that may identify more effectively those patients who require right heart catheterisation for a definitive PAH diagnosis.
Evaluating Trust in Grid Certificates
David O'Callaghan,Louise Doran,Brian Coghlan
Computer Science , 2009,
Abstract: Digital certificates are used to secure international computation and data storage grids used for e-Science projects, like the Worldwide Large Hadron Collider Computing Grid. The International Grid Trust Federation has defined the Grid Certificate Profile: a set of guidelines for digital certificates used for grid authentication. We have designed and implemented a program and related test suites for checking X.509 certificates against the certificate profiles and policies relevant for use on the Grid. The result is a practical tool that assists implementers and users of public key infrastructures to reach appropriate trust decisions.
Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial
Jennifer A Coghlan, Andrew Forbes, Simon N Bell, Rachelle Buchbinder
BMC Musculoskeletal Disorders , 2008, DOI: 10.1186/1471-2474-9-56
Abstract: This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo arthroscopic subacromial decompression with or without rotator cuff repair, all operations performed by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. All participants will receive a pre-incision bolus injection of 20 mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40 mg. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75%) or placebo (normal saline) administered continuously into the subacromial space by an elastomeric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively.The primary end point will be average pain at rest over the first 12-hour post-operative period on a verbal analogue pain score. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient stay and incidence of post-operative adhesive capsulitis.The results of this trial will contribute to evidence-based recommendations for the effectiveness of pain management modalities following arthroscopic rotator cuff surgery. If the local anaesthetic pain-buster provides no additional benefits over placebo then valuable resources can be put to better use in other ways.Australian Clinical Trials Register Number ACTR12606000195550Surgical options for rotator cuff disease that has failed to improve with conservative treatments include open or arthroscopic subacromial decom
Knowledge and malaria treatment practices using artemisinin combination therapy (ACT) in Malawi: survey of health professionals
Linda V Kalilani-Phiri, Douglas Lungu, Renia Coghlan
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-279
Abstract: A cross-sectional survey was conducted to assess the knowledge and perceptions of Malawian medical doctors and pharmacists on the use of ACT and the drivers of treatment choice and clinical treatment decisions. Medical doctors and pharmacists who are involved in managing malaria patients in Malawi were recruited and a self-administered questionnaire was used to obtain information on socio-demographic characteristics of the study participants, knowledge on ACT, source of information on ACT and methods used to decide on the treatment of patients with malaria.Most of the participants (95.7%) know at least one form of ACT, 67.4% reported that different forms of ACT have different characteristics, 77.3% reported that there are special formulations for children. The most commonly mentioned ACT was artemether-lumefantrine (AL), by 94.6% of the participants and 75.0% of the participants indicated that they prefer to prescribe AL. 73.9% of participants had ever received information on ACT. However, only 31.5% had received training on management of malaria using ACT. There were 71.7% respondents who had heard of ACT causing side effects. Only 25.0% of the participants had received training on how to report SAEs.It was found that most of the participants know about ACT and treatment guidelines for malaria. However, most of the participants have not received any training on how to use ACT and how to report adverse effects arising from the use of ACT. There is need for more training of health care professionals to ensure correct and effective use of ACT.Malaria still remains a major public health problem worldwide. It is estimated that between 190 and 311 million cases of malaria occurred in 2008 (1). Malaria and its complications are controlled by preventing infection, prompt diagnosis and effective treatment [1,2]. Due to the widespread resistance to chloroquine and sulphadoxine-pyrimethamine (SP), the World Health Organization (WHO) currently recommends the use of artemisinin
Prevalencia de hipertensión arterial en una comunidad aborigen del norte argentino Prevalence of hypertension in an Indian community in the North of Argentina
Eduardo Coghlan,Luciana Bella Quero,Marcos Schwab,Débora Pellegrini
Medicina (Buenos Aires) , 2005,
Abstract: El objetivo fue establecer la prevalencia de hipertensión arterial (HTA) en adultos de ambos sexos en la comunidad aborigen Wichi-Chorote de Santa Victoria Este, Provincia de Salta, Argentina. Se midió la presión arterial a personas mayores de 18 a os de ambos sexos, en posición sentada luego de 5 minutos de reposo con esfingomanómetro calibrado. La población evaluada fue de 522 adultos, 318 mujeres y 204 hombres, con una media de edad de 43.5 a os (DS 16.31). La presión arterial sistólica (PAS) media fue de 125.21 mm Hg (DS 22.74) y la presión arterial diastólica (PAD) media de 76.34 mm Hg (DS 12.57). El 35% de las personas evaluadas presentaron valores de normotensión (<120/80), el 37% de pre-hipertensión (PAS 120-139 o PAD 80-89) y el 28% de HTA (>140/90). Treinta y un porciento de los hombres (media de edad: 43.93 ± 17.11, PAS media: 126.81 ± 22.61 y PAD media: 77.80 ± 13.33) y 27% de las mujeres (media de edad: 42.93 ± 16.3, PAS media: 124.92 ± 24.02 y PAD media: 75.28 ± 12.57) presentaron cifras de HTA así como el 59% de los mayores de 65 a os (58 gerontes evaluados, media de edad de 73.15 ± 6.36, PAS media 144.81 ± 28.72 y PAD media 79.68 ± 13.17). La prevalencia de hipertensión arterial en esta comunidad aborigen inmersa en un ámbito rural y con condiciones geográficas y socioeconómicas desfavorables es muy similar a la descripta para una sociedad desarrollada y urbanizada como EE.UU., pero inferior a la descripta para habitantes de áreas rurales como capitales provinciales de nuestro país. The prevalence of hypertension among adults of both sexes was assessed as part of a primary medical attention program in an Indian Wichi-Chorote community in Santa Victoria Este, province of Salta, Argentina. Arterial blood pressure was measured after a five minutes rest in a sitting position in adults (over 18 years old) of both sexes with a calibrated sphygmomanometer. A total of 522 adults (318 women and 204 men) were evaluated with median age of 43.5 ± 16.3. The mean systolic blood pressure (SBP) was 125.2 ± 22.7 mm Hg, and the mean dyastolic blood pressure (DBP) was 76.3 ± 12.8 mm Hg. Thirty five percent of the people evaluated had normal pressure values (SBP<80 and DBP<120), 37% prehypertensive (SBP 120-139 or DBP 80-89) and 28% hypertensive (SBP>140 or DBP>90). Thirty one percent of the men (mean age: 43.93 ± 17.11, mean SBP: 126.81 ± 22.61 and mean DBP: 77.80 ± 13.33) and 27% of the women studied (mean age: 42.93 ± 16.3, mean SBP: 124.92 ± 24.02 and mean DBP: 75.28 ± 12.57) were hypertense. Fifty nine percent of the people over 65 years of age (n:58)
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