Medicine

Now showing 1 - 3 of 3

Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial
(BioMed Central, 2017) Jafar, T.H.; Jehan, I.; de Silva, H.A.; Naheed, A.; Gandhi, M.; Assam, P.; Finkelstein, E.A.; Quigley, H.L.; Bilger, M.; Khan, A.H.; Clemens, J.D.; Ebrahim, S.; Turner, E.L.; Kasturiratne, A.; for COBRA-BPS Study Group
BACKGROUND: High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN: This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION: The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries.
Outpatient treatment of isolated strangulated haemorrhoids with single dose injection sclerotherapy and oral Daflon
(Taylor and Francis, 1996) Deen, K.I.
OBJECTIVE: To assess the efficacy of single, large dose injection sclerotherapy together with oral Daflon 500 mg in the management of isolated strangulated haemorrhoids. DESIGN: Prospective non randomised study. SETTING: Private hospital, Sri Lanka. SUBJECTS: 15 patients (9 men and 6 women, median age 28 years, range 19-54) with isolated strangulated haemorrhoids. MAIN OUTCOMEMEASURES: Resolution of symptoms at 12 weeks, residual haemorrhoids, and side effects of Daflon. RESULTS: 14 patients were evaluated at 12 weeks, and symptoms had resolved completely in 13. In all of these patients, the prolapsed haemorrhoid was restored within the anal canal. The remaining patient developed circumferential prolapsed haemorrhoids which were treated by surgical excision. No side effects of Daflon were reported. CONCLUSION: Single, large dose injection sclerotherapy combined with Daflon 500 mg was beneficial in the short term in patients with isolated strangulated haemorrhoids.
Preoperative adjuvant radiation with chemotherapy for rectal cancer: its impact on stage of disease and the role of endorectal ultrasound
(Springer International, 1996) Bernini, A.; Deen, K.I.; Madoff, R.D.; Wong, W.D.
BACKGROUND: Preoperative adjuvant radiation combined with chemotherapy is a recent development in the management of patients with rectalcancer invading perirectal tissue and regional lymph nodes. This study was performed to assess the impact of preoperative adjuvant therapy in patients judged by endorectal ultrasound to have extramural invasion of rectal cancer and/or regional lymph node involvement on tumor regression in bowel wall and lymph nodes. The predictive value of ultrasound in staging wall penetration and lymph node involvement after preoperative adjuvanttherapy was also assessed. METHODS: Patients (n = 43) were selected by ultrasound to have preoperative irradiation (4,500-5,040 cGy over 5-6 weeks). In 30 patients this was combined with 5-fluorouracil, 370 mg/m(2), for 5 days in the first and last weeks of irradiation. Pretreatment ultrasound was compared with pathologic findings in the resected specimen in all patients. Twenty-one were assessed by ultrasound after adjuvant therapy and findings compared with histology. RESULTS: Downstaging was seen in 23 (53%) patients with wall invasion and in 23 (72%) of 32 patients with lymph node involvement. Overall, downstaging was achieved in 30 (70%). Positive predictive values of ultrasound after irradiation were 72% and 56% for wall penetration and lymph node status, respectively. Negative predictive values of ultrasound after irradiation were 100% and 82%, respectively. CONCLUSION: In the majority of patients with rectal cancer invading perirectal tissues or lymph nodes, lesions may be downstaged by preoperative adjuvant therapy. Endorectal ultrasound after adjuvant therapy for rectal cancer is of a lesser predictive value chiefly because of overstaging.

Medicine

Browse

Filters

Settings

Sort By

Results per page

Search Results