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Biomedical subjects

D C Hunter

Publications and source records attributed to D C Hunter.

18 recordsLinked to original sources
PubMed2001

Going the distance: how far will women travel to undergo free mammography?

This study examined the effect of travel distance on mammography facility choice, with mammography cost held constant. Women who were eligible to undergo free mammography at a military treatment facility (MTF) responded to a mail survey by indicating whether their last mammograms were performed at an MTF (for free) or at a civilian medical facility (for a fee). The distance from each respondent's home to the MTF was also recorded. Analyses indicated that a majority of the women who traveled to the MTF for a mammogram lived within 20 miles of the facility. Results of this study suggest that, even if mammography screening is offered free of charge, women may not use the service if they must travel more than 20 miles to receive it. Furthermore, any MTF trying to increase its TRI-CARE market share may want to focus its marketing efforts on individuals who live within a 20-mile radius.

Adult↗
PubMed2001

Abnormal uterine bleeding: an evaluation endometrial biopsy, vaginal ultrasound and outpatient hysteroscopy.

Abnormal uterine bleeding is a common gynaecological symptom. Whilst most patients have benign disease, thorough investigation is necessary, particularly in the peri- and post-menopausal woman. Hysteroscopy with directed biopsy of suspicious lesions is the gold standard investigation but it is invasive and is not offered in all units as an outpatient procedure. Ultrasound and outpatient biopsy techniques may allow patients to be triaged to select those who require formal evaluation by hysteroscopy. We assessed the records of 100 consecutive referrals to the outpatient hysteroscopy clinic at the Royal Maternity Hospital, Belfast. In order to develop a nomogram for the investigation of women with abnormal bleeding patterns, we compared ultrasound/biopsy diagnoses with hysteroscopy/biopsy diagnosis. Pre- and peri-menopausal patients, and post-menopausal patients taking hormone replacement therapy should be investigated further if the endometrial thickness is more than 10 mm, if endometrial biopsy is abnormal, or if symptoms are recurrent. Similarly, post-menopausal patients not taking hormone replacement therapy with an endometrial thickness of 5 mm or more should be referred for hysteroscopy.

Adult↗
PubMed1999

Teleoncology in the Department of Defense: a tale of two systems.

Two telemedicine networks were developed for the purpose of conducting multidisciplinary oncology ("teleoncology") conferences. The infrastructure of each system differed: one system was Internet-based; the other was delivered via Integrated Services Digital Network (ISDN) lines. The purpose of this study was to describe the infrastructure and cost, consultative process, technical aspects, and conference format of the two teleoncology programs. The two systems' technical aspects, participant satisfaction with the systems, and conference participation were compared qualitatively. Assessment of the technical aspects of the systems suggested that each had distinct advantages. Survey results indicated that provider satisfaction with the technical and logistical aspects of each type of teleoncology conference was high. The present study may prove helpful for individuals who are considering implementing their own teleoncology programs.

Government Agencies↗
PubMed1998

Trans-cervical resection of the endometrium: the first four years' experience at the Belfast City Hospital.

We have evaluated the quality of service provided in performing trans cervical resection of the endometrium (TCRE) in the treatment of women presenting with menstrual dysfunction. Of the 78 patients who underwent TCRE, ten had, at the time of writing, subsequently undergone hysterectomy. A chart review was carried out on those patients. Two others were on the waiting list for hysterectomy. Sixty-one of 68 (90%) patients responded to the postal questionnaires. Of these, 50 (82%) were satisfied with the result of the procedure. Twenty-three (38%) were rendered amenorrhoeic. Thirty-eight still had bleeding, but of these, 19 (31%) had very light regular periods and 13 (21%) had only an occasional stain. Overall, 90% of women felt that there had been an improvement in their bleeding. Six (10%) women claimed that there had been no improvement. TCRE is a safe and effective alternative to hysterectomy or medical treatment for the treatment of menstrual dysfunction.

Adult↗
PubMed1996

Accuracy of five electronic pedometers for measuring distance walked.

This is a three-part study that examined the accuracy of five brands of electronic pedometers (Freestyle Pacer, Eddie Bauer, L.L. Bean, Yamax, and Accusplit) under a variety of different conditions. In Part I, 20 subjects walked a 4.88-km sidewalk course while wearing two devices of the same brand (on the left and right side of the body) for each of five different trials. There were significant differences among pedometers (P < 0.05), with the Yamax, Pacer, and Accusplit approximating the actual distance more closely than the other models. The Yamax pedometers showed close agreement, but the left and right Pacer pedometers differed significantly (P = 0.0003) and the Accusplit displayed a similar trend (P = 0.0657). In Part II, the effects of walking surface on pedometer accuracy were examined. Ten of the original subjects completed an additional five trials around a 400-m rubberized outdoor track. The devices showed similar values for sidewalk and track surfaces. In Part III, the effects of walking speed on pedometer accuracy were examined. Ten different subjects walked on a treadmill at various speeds (54, 67, 80, 94, and 107 m.min-1). Pedometers that displayed both distance and number of steps were examined. The Yamax was more accurate than the Pacer and Eddie Bauer at slow-to-moderate speeds (P < 0.05), though no significant differences were seen at the fastest speed. While there are variations among brands in terms of accuracy, electronic pedometers may prove useful in recording walking activities in free-living populations.

Adolescent↗
PubMed1989

Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia.

A prospective randomized trial was conducted to determine the effects of branched chain amino acids (BCAA) as the protein component of total parenteral nutrition (TPN) on protein kinetics in patients with intraabdominal adenocarcinoma. Nine malnourished patients were given both conventional TPN containing 19 per cent BCAA (AA) and isocaloric, isonitrogenous TPN containing 50 per cent BCAA (BCAA-TPN), in random order. Both [13C]leucine and [14C]tyrosine were employed as tracers to avoid the potential bias due to the different amino acid composition of the two TPN solutions. With BCAA-TPN, leucine and tyrosine flux increased significantly from (mean +/- s.d.) 158.0 +/- 37.2 to 243.5 +/- 75.8 mumol kg-1 h-1 (P less than 0.025) and from 35.0 +/- 8.4 to 42.6 +/- 11.0 mumol kg-1 h-1 (P less than 0.05) respectively. Leucine oxidation was significantly higher on BCAA-TPN (24.1 +/- 6.3 on AA versus 68.3 +/- 37.1 mumol kg-1 h-1, P less than 0.025) while tyrosine oxidation was significantly lower (3.7 +/- 1.8 mumol kg-1 h-1 on AA versus 2.5 +/- 2.0 mumol kg-1 h-1 on BCAA-TPN, P less than 0.05). Whole body protein synthesis and breakdown was significantly higher on BCAA-TPN by the tyrosine tracer (31.3 +/- 7.3 on AA versus 40.1 +/- 9.3 mumol kg-1 h-1, P less than 0.025 and 33.0 +/- 8.4 on AA versus 41.3 +/- 11.1 mumol kg-1 h-1, P less than 0.05) respectively. Using the leucine tracers both synthesis and breakdown were increased, but not significantly, from 133.8 +/- 40.0 to 175.3 +/- 65.1 mumol kg-1 h-1 and from 127.9 +/- 33.6 to 167.7 +/- 71.2 mumol kg-1 h-1 respectively. The fractional albumin synthetic rate increased significantly on BCAA-TPN from 4.3 +/- 2.9 on AA to 8.0 +/- 5.1 per cent per day (P less than 0.05). The reduction in tyrosine oxidation, suggesting improved protein utilization, coupled with an increase in protein and albumin synthesis, strongly support a positive benefit from BCAA-TPN in cancer cachexia.

Abdominal Neoplasms↗
PubMed1988

Resting energy expenditure in the critically ill: estimations versus measurement.

A prospective trial was conducted in 20 surgical intensive care unit patients receiving mechanical ventilation to compare estimates of resting energy expenditure (REE) with the measured values. The 12 women and 8 men (mean age 61.7 +/- 2.8 (s.e.m.) years) underwent a full nutritional assessment before measurement of their REE by indirect calorimetry using the MGM II metabolic cart (Utah Medical). Their REE was estimated by the Harris-Benedict formula (mean 1324 +/- 53 (s.e.m.) kcal/day) as well as an empirical formula (where empirical formula = 22 x body weight in kg) (1370 +/- 68 (s.e.m.) kcal/day). Results by either estimate were not statistically different from the measured resting energy expenditure (MREE) (1382 +/- 130 (s.e.m.) kcal/day), by one-way analysis of variance. No multiplication factors were needed to relate the Harris-Benedict formula to MREE in this critically ill population and the estimate by the empirical formula was as good and simpler to perform. Although values by the Harris-Benedict formula and empirical formula correlated significantly with MREE (P less than 0.05) the correlation coefficients were low: 0.48 and 0.45 respectively. Thus, mean estimates were excellent for the group but less predictive for the individual. Multiple linear regressions did reveal that body composition and metabolic stress were of greater predictive value, since an equation relating weight (P less than 0.003), sex (P less than 0.003), white blood cell count (P less than 0.003) and 24-h urinary creatinine excretion (P less than 0.05) could predict 76 per cent of the variation (r = 0.87) in the MREE with an overall significance of P = 0.0002. Given the importance of matching energy intake to needs in many critically ill patients who are mechanically ventilated, accurate measurement of the REE is recommended now that instrumentation is equal to the task.

Adult↗
PubMed1988

Suture granuloma.

Explore the source record for details and available documents.

Abdominal Neoplasms↗
PubMed1985

Immediate resection in emergency large bowel surgery: a 7 year audit.

In a consecutive series of 153 emergency admissions with large bowel disease during a 7 year period, 49 per cent were for colonic obstruction, 46 per cent for peritonitis and 5 per cent for miscellaneous conditions. Urgent operation was performed on 104 (68 per cent) patients. Of those operated upon, 82 (79 per cent) had a primary resection with a mortality rate of 12.2 per cent, intraperitoneal sepsis rate of 2.4 per cent and wound sepsis rate of 7.3 per cent. The median postoperative hospital stay was 21 days. An immediate anastomosis was performed in 46 (56 per cent) patients with a mortality rate of 8.7 per cent, anastomotic leak rate of 2.2 per cent, and wound sepsis rate of 8.7 per cent. The median postoperative hospital stay was 19 days. The mortality in patients presenting with large bowel emergencies is related to age and advanced malignant disease. Immediate resection is applicable in over 80 per cent of patients requiring urgent operation and morbidity can be low and treatment economical. Immediate anastomosis after proximal colonic resection is safe and the use of intra-operative colonic irrigation permits a primary anastomosis in selected patients after emergency resection of the distal colon.

Adult↗
PubMed1979

Safety and efficacy of micronized estradiol vaginal cream.

Fifty-four postmenopausal patients with atrophic vaginitis satisfactorily completed one to two months' therapy with daily intravaginal application of 0.2 mg of 17 beta-estradiol in a cream base. No significant alterations were noted in the hematologic biochemical, and urine analyses. A number of response criteria showed significant improvement (P less than .01), including the severity rating for atrophic vaginitis, the maturation index of vaginal cells, the frequency and severity of hot flashes, the presence of vaginal dryness and itching, dyspareunia, skin flushing, and the severity of sweating episodes. The incidence of side effects was low and included breast tenderness and abdominal cramping.

Adult↗
PubMedDate not supplied

Controversies in the management of malignant melanoma.

Early recognition and treatment of malignant melanoma may lead to a better prognosis. Lesions < 0.76 mm thick need only simple excision. There is little evidence that prophylactic lymphadenectomy is of benefit in advanced lesions. Multiple small recurrences can be effectively treated using the carbon dioxide laser.

Chemotherapy, Cancer, Regional Perfusion↗