PubMed Health⌕ Search

Biomedical subjects

D Coghlan

Publications and source records attributed to D Coghlan.

16 recordsLinked to original sources
PubMed2002

Hereditary cerebral cavernous angiomas: presentation as idiopathic familial epilepsy.

In cavernous angiomas of the brain, abnormally dilated blood vessels are tightly clustered together with no intervening neural parenchyma. Commonly recognised as a sporadic finding, these lesions may also be inherited in an autosomal dominant fashion. This disorder was recognised as a common entity with the advent of MRI. As lesions were often not detected on CT imaging, symptomatic patients presenting with seizures were mistakenly diagnosed with an idiopathic seizure disorder. Seizures are the commonest presenting symptom followed by haemorrhage and focal neurologic deficit. We present another cause of familial epilepsy that also emphasises the importance of MRI as the modality of choice in investigating seizures in children.

Brain↗
PubMed2001

Action research from the inside: issues and challenges in doing action research in your own hospital.

BACKGROUND AND RATIONALE: Nurses are increasingly engaging in action research projects to improve aspects of nursing practice, education and management and contribute to the development of the profession. Action research involves opportunistic planned interventions in real time situations and a study of those interventions as they occur, which in turn informs further interventions. Insider action research has its own dynamics which distinguish it from an external action researcher approach. The nurse-researchers are normally already immersed in the organization and have a pre-understanding from being an actor in the processes being studied. There is a paucity of literature on the challenges that face nurse action researchers on doing action research in their own hospital. AIM: The aim of this article is to address this paucity by exploring the nature of the challenges which face nurse action researchers. Challenges facing such nurse-researchers are that they frequently need to combine their action research role with their regular organizational roles and this role duality can create the potential for role ambiguity and conflict. They need to manage the political dynamics which involve balancing the hospital's formal justification of what it wants in the project with their own tactical personal justification for the project. MAIN ISSUES: Nurse-researchers' pre-understanding, organizational role and ability to manage hospital politics play an important role in the political process of framing and selecting their action research project. In order that the action research project contribute to the organization's learning, nurse action researchers engages in interlevel processes engaging individuals, teams, the interdepartmental group and the organization in processes of learning and change. CONCLUSIONS: Consideration of these challenges enables nurse-action researchers to grasp the opportunities such research projects afford for personal learning, organizational learning and contribution to knowledge.

Bias↗
PubMed2000

Paracetamol efficacy and safety in children: the first 40 years.

Paracetamol (acetaminophen) has a unique role in children because it is the first-line choice for the treatment of both fever and pain. When used in the recommended doses, it has few side effects and is remarkably well tolerated. While fever alone requires no treatment, when associated with discomfort or pain, paracetamol offers relief. Also, for mild to moderate pain, paracetamol, either alone or in combination with another drug, is effective. Even in severe pain, paracetamol offers a significant additive analgesic effect to opiates. Globally, the pediatric dose varies between 10 and 15 mg/kg. In the United Kingdom, 10 mg/kg is given every 4 hours, up to a maximum of four doses per day; in Australia, 15 mg/kg is administered 4-hourly up to a total dose of 60 mg/kg/day. In overdose, paracetamol is hepatotoxic. Single ingestions of more than ten times the recommended dose are potentially toxic. The development of specific antidotes and the universal availability of the Rumack-Matthew Nomogram have made the early treatment of overdose effective without long-term sequelae. There are sporadic case reports of chronic overdosing resulting in liver failure. Although the specific predictors are still being defined, exposures greater than 140 mg/kg/day for several days carry a risk of serious toxicity. In children, aspirin use has almost disappeared with the concurrent decline in Reye Syndrome. Less clinical experience has accumulated with ibuprofen, and it remains the second-line treatment for fever and pain. In conclusion, paracetamol remains the first-choice over-the-counter treatment for analgesia and antipyresis in children.

Acetaminophen↗
PubMed2000

Does height influence progression through primary school grades?

AIM: To examine the relation between a child's height and grade progression in primary school. METHODS: Height was measured in a representative cross sectional sample of children from 24 primary schools in Victoria in late 1997. Height measurements were transformed to standardised scores using Cole's "LMS" method to allow for comparison across ages and genders. Children within each grade were divided into three equal groups based on age (youngest third, middle third, oldest third), again to allow for cross age comparison. RESULTS: A total of 2848 children aged 5-12 years (51% male) were included, with approximately 400 children in each of the seven grades from preparatory to grade 6. Analysis of variance showed a significant relation overall between age and height, with a sequential decrease in height from the youngest to the oldest third. When genders were considered separately, the relation remained significant for boys but not for girls. A total of 133 children (66% male) repeated a grade in primary school. When this group of grade repeaters was removed from the sample, analysis of variance showed no significant relation between standardised height score and age tertile for boys. Although birth weight category and maternal education were independent predictors of height scores overall, they did not appear to influence decisions to retain pupils in grades. CONCLUSIONS: Older boys within grades, notably those who have repeated a grade, are shorter than their peers. Decisions to retain pupils, particularly boys who are experiencing school difficulties, may be influenced by their height.

Analysis of Variance↗
PubMed1996

Rheumatic manifestations of the myelodysplastic syndromes: a comparative study.

BACKGROUND: The myelodysplastic syndromes (MDS) are a group of common haematological disorders that increase in incidence with age. Case reports have suggested an arthritis associated with myelodysplasia. This comparative study reviews patients with myelodysplasia and patients with a myeloproliferative disorder (MPD) as the control group. AIM: To document the rheumatological manifestations in patients with MDS and to determine if there is an association between MDS and an inflammatory arthritis/vasculitis. METHODS: Between July 1990 and July 1995 all patients with a known diagnosis of MDS and MPD attending the Haematology clinics of two teaching hospitals were reviewed. There were 87 MDS patients and 86 MPD patients identified. Twenty-six of the MDS patients and 28 of the MPD patients attended a clinical review by a single examiner. A history of joint symptoms, skin rashes, family and drug history was obtained. Physical examination and serology were routinely performed. The case notes of the remaining patients were reviewed by a single observer. Approval was obtained from the Ethics Committee at both hospitals. RESULTS: The two patient groups were matched for sex and age. There were equal numbers of patients with osteoarthritis, rheumatoid arthritis and crystal arthritis in the two groups. The significant finding was the presence of a seronegative inflammatory arthritis in five patients in the MDS group. One patient had both a seronegative arthritis and a cutaneous leukocytoclastic vasculitis, and another a cutaneous leukocytoclastic vasculitis only. These rheumatic manifestations were not seen in the MPD group. Five of six patients were treated with prednisolone and responded impressively. The rheumatological symptoms preceded the diagnosis of MDS in two of the six cases. CONCLUSIONS: A seronegative arthritis is an associated finding in MDS. The arthritis can precede the development of the bone marrow disorder, and can be a guide to the diagnosis of this haematological disorder in elderly patients presenting with an inflammatory arthritis and cytopenias.

Aged↗
PubMed1995

Multiple granulocyte transfusions facilitating successful unrelated bone marrow transplantation in a patient with very severe aplastic anemia complicated by suspected fungal infection.

The successful use of granulocyte transfusions in a patient undergoing volunteer unrelated donor BMT for very severe aplastic anemia complicated by presumed fungal infection is described. Granulocytes were obtained by leukapheresis of normal volunteer donors stimulated by granulocyte colony-stimulating factor. The yields of granulocytes obtained by this method were sufficient to produce sustained neutrophil increments in the recipient throughout the transplant course. In vitro studies indicated that granulocytes were functionally normal, a finding which was supported clinically by the rapid resolution of infection, even in the setting of immunosuppression post-transplantation. This demonstrated the potential value of granulocyte transfusions in high-risk BMT.

Adult↗
PubMed1994

Increase in copy number of an integrated vector during continuous culture of Hansenula polymorpha expressing functional human haemoglobin.

Recombinant human haemoglobin A (rHbA) was produced by a leucine-requiring strain of Hansenula polymorpha which had been transformed with an integration vector containing the Saccharomyces cerevisiae LEU2 gene and cDNAs for the expression of alpha and beta globin each driven by the H. polymorpha MOX promoter. After 40 generations in a chemostat it was found that the integrated vector had become amplified in the host strain. In some cases this led to an increase in LEU2 gene dosage, but a loss of globin expression cassettes. In other cases the globin gene dosage also increased. These changes coincided with an increase in rHbA production in the culture, which was reversed when the dilution rate was increased. Isolates from a chemostat culture producing elevated levels of rHbA were grown in fed-batch fermentations, resulting in higher productivities than when inoculated with the parent strain. The rHbA produced was purified and characterized. Oxygen binding studies and electrospray mass spectrometry showed that the rHbA had been processed and assembled correctly, and behaved as a fully functional co-operative tetramer.

Genetic Vectors↗
PubMed1992

Structural and functional characterisation of recombinant human haemoglobin A expressed in Saccharomyces cerevisiae.

Recombinant human HbA, produced by co-expressing alpha-globin and beta-globin chains in the yeast Saccharomyces cerevisiae, has been characterised extensively both physically and functionally. Structural studies using N-terminal sequence analysis, peptide mapping, amino acid composition analysis and electrospray MS demonstrated that the recombinant protein was identical to standard HbA purified from erythrocytes. The functional properties of the recombinant protein were assessed using equilibrium and kinetic measurements of oxygen and carbon monoxide binding. The oxygen-binding studies demonstrated that the yeast-derived HbA behaved as a fully functional, cooperative tetramer (Hill coefficient, 2.9), exhibited a normal Bohr effect and response to phosphate, and displayed a rate of oxygen dissociation identical to that of the native human molecule. The recombinant protein also showed the same characteristics of carbon monoxide combination as the standard protein. These studies demonstrate that yeast provides an ideal system for the production of Hb for structural and functional analysis and a potentially useful source of HbA for formulation into a Hb-based oxygen carrier.

Amino Acids↗
PubMedDate not supplied

Parents' Evaluation of Developmental Status in the Australian day-care setting: developmental concerns of parents and carers.

OBJECTIVE: To trial the Parents' Evaluation of Developmental Status (PEDS) as an instrument for reporting developmental concerns for Australian preschool children. METHOD: A cross-sectional survey of parents and carers of 262 children attending five day-care centres and two kindergartens in Melbourne was conducted between October and November 1999. Parents and carers completed the written PEDS questionnaire, comprising 10 questions eliciting concerns about learning, development and behaviour, and answered questions about the acceptability and use of the PEDS. RESULTS: Of 445 children, 389 were eligible for inclusion. Complete parent and carer PEDS data were available for 262 children (67% response: 47% boys; 53% girls) aged from 18 months to 5 years, 9 months. Most parents found the PEDS questionnaire easy to complete (98%) and likely to be useful to health professionals (89%). Twenty-four children (9%) were classified as being at high-risk of disabilities and 49 (19%) were classified as being at medium-risk of disabilities. Parents of 125 children (48%) reported no concerns. The prevalence of parental concerns was similar to the USA norming sample. Carers reported similar prevalences of concerns. Although overall agreement was high, parent/carer kappa-values were modest, being highest for the gross motor (kappa = 0.40) and social-emotional (kappa = 0.37) domains. CONCLUSIONS: The PEDS is acceptable to parents of Australian preschool children, with a prevalence of significant concerns (i.e. children at high- and medium-risk of developmental problems) that is similar to those in the USA. Further research is needed to assess what factors differentially influence whether a concern is felt in a particular domain for a particular child.

Adult↗
PubMedDate not supplied

Neonatal abstinence syndrome.

A 12 month review of infants admitted with neonatal abstinence syndrome to a neonatal intensive care unit was undertaken. The relationship of maternal drug abuse to symptoms, the effectiveness of pharmacologic agents in controlling symptoms and the length of inpatient stay were investigated. A retrospective review of maternal and infant records was performed. Those infants with a serial Finnegan score greater than 8 were treated. Pharmacologic treatment was oral morphine sulphate (0.2 mg 4-6 hourly), phenobarbitone (3-7 mgs/kg/day), or combination of the above. 43 infants were admitted to the hospital during the year. The average maternal age was 24.6 years, (18-34 years). Drug use volunteered by the mothers was methadone alone in 6 cases, methadone and benzodiazepines in 14, methadone and heroin and benzodiazepines in 7, methadone and heroin in 10, heroin alone in 2, and other multiple drug use including oral morphine sulphate, dothiepin and cannabis in 4. Average gestational age was 40.3 (35-42 weeks). The average birthweight was 2.81 kgs (1.89-3.91 kgs). Time to onset of withdrawal symptoms was 2.8 (1-13) days. The duration of pharmacologic treatment (oral morphine sulphate and/or phenobarbitone) was 21.8 (1-62) days. The total hospital stay for the 43 infants was 1,011 days. This study confirms that polydrug abuse is the commonest type of drug abuse in Dublin. The duration of withdrawal symptoms is loosely related to drug type, but increasing duration of symptoms is noted for infants exposed to benzodiazepines. Our experience would favour the use of morphine sulphate to treat pure opiate withdrawal symptoms. Over the 12-month period, there was an average occupancy of 3 beds per day in the paediatric department.

Adolescent↗
PubMedDate not supplied

Making meetings work.

Explore the source record for details and available documents.

Congresses as Topic↗