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Biomedical subjects

J W Moncrief

Publications and source records attributed to J W Moncrief.

At least 19 recordsLinked to original sources
PubMed1998

Telemedicine in the care of the end-stage renal disease patient.

Interactive video was used to monitor patients undergoing hemodialysis in a rural community over a 55-mile distance. Between April of 1991 and April 1993, the Texas Telemedicine Project sponsored the contact and record management. During this period, 1,500 patient contacts were documented. After the termination of the Texas Telemedicine Projects, the transmission lines were maintained between the central dialysis center and the satellite facility. Between 1993 and 1996, another 12,000 patient contacts were made. Dialysis monitoring accounted for approximately 80% of contacts, and 20% were nondialysis (primary care) contacts. This report discusses the historical and recent developments of interactive video medical care delivery and technical and medical implications of this emerging medium.

Humans↗
PubMed1996

Primary care and hemodialysis monitoring through telemedicine.

Telemedicine offers the primary care physician an opportunity to improve time management while continuing to provide optimal, cost efficient care. The following paper offers a means with which to deliver such care and describes the relationship required between physician and patient to deliver optimal telemedical care. The Texas Telemedicine Project offered an avenue for the physician participants to explore the best delivery system with which to successfully employ telemedicine in the practice of medicine. Patients became comfortable with interactive healthcare delivery quickly, and preferred it as a means of receiving primary care as well as continuous physician monitoring during dialysis treatments. This study leads the authors to the opinion that telematic healthcare delivery will only be successful when the patient/physician relationship most closely mimics that of face-to-face contact.

Attitude to Computers↗
PubMed1995

Use of bethanechol chloride to increase available ultrafiltration in CAPD.

Reabsorption of peritoneal dialysis fluid during the prolonged dwell time of continuous ambulatory peritoneal dialysis (CAPD) reduces the efficiency of ultrafiltration and sacrifices effective dialysis adequacy. Studies by Nolph indicate a predominant role of lymphatics in this fluid loss. Khanna has reported that lymphatic flow may be influenced by acetylcholine. This study was designed to determine if bethanechol chloride (BC) would increase the availability of drained volume during CAPD. Nine patients were studied, including 7 patients who exhibited inadequate ultrafiltration. During a 5-day control period, total dialysate drained volume was collected and a standard peritoneal equilibration test (PET) performed. This was followed by a corresponding 5-day test period in which BC (mean dose 0.27 +/- 0.13 mg/kg/day) was administered orally. Drained volume during the control standard 4-hr PET was 1996.68 +/- 279.87 mL. The result for the test period was 2363.33 +/- 321.13 mL (p < 0.05), indicating an 18.4% increase using BC. The PET indicated no change in transport of urea, creatinine, and glucose. In conclusion, the total drained volume can be effectively increased with a subsequent increase in metabolite clearance using BC. Patients exhibiting inadequate ultrafiltration were able to be maintained on CAPD using this cholinergic drug.

Absorption↗
PubMed1993

Reduction in peritonitis incidence in continuous ambulatory peritoneal dialysis with a new catheter and implantation technique.

Recurrent episodes of peritonitis with the same organism cultured at the catheter exit site suggest that early tunnel colonization is associated with a transfer of these organisms through the catheter tunnel directly from the skin into the peritoneal cavity. In this instance the catheter has failed in its fundamental design to establish and maintain a bacteriological barrier. A three-part study was conducted using the Moncrief-Popovich catheter and implantation technique. The first part of the study included 59 patients who used standard spike exchange systems with this new catheter and implantation technique. A reduction in the incidence of peritonitis occurred in the continuous ambulatory peritoneal dialysis (CAPD) program at the Austin Diagnostic Clinic. The previous peritonitis incidence was 1 every 9 patient-months. This study had 1 every 29 patient-months with 530 patient-months of experience. The second part of the study had 79 patients. All except 11 used disconnect exchange systems. There was a total of 482 patient-months of experience with 1 episode every 27 patient-months. Those using the disconnect systems (86%) had 1 episode every 32 patient-months. The third part of the study included microscopic studies of 12 excised catheters. Three were known to be contaminated. The examiners identified those catheters that were free or nearly free of biofilm on the catheter segment between the two cuffs. It is concluded that biofilm analysis and reduction in peritonitis incidence supports the theory that the new catheter and implantation technique form an improved bacteriological barrier in the access for peritoneal dialysis.

Catheterization↗
PubMed1990

A distributed model of fluid and mass transfer in peritoneal dialysis.

A mathematical model has been developed to study peritoneal fluid and solute transfer. The model uses the concept of a distributed capillary system within the peritoneal tissue. The model accounts explicitly for transport across the capillary membrane, through interstitial tissue, and across the mesothelium. The capillary and mesothelial membranes are modeled using pore theory and a dual pathway (through pores and across cells) for fluid transfer. The nonperitoneal tissues are modeled as a single body pool. Lymphatic uptake from the peritoneal cavity is included. Model parameters were found from the literature and by simultaneously fitting experimental data for dialysate volume and dialysate concentrations of blood urea nitrogen, glucose, creatinine, and inulin. The model was also shown to predict concentration gradients within several tissues surrounding the peritoneal cavity. Variation of the model parameters revealed the importance of the mesothelial cell layer in peritoneal ultrafiltration. The results of model simulations indicate an initial transfer of fluid from the tissue space to the peritoneal cavity followed by transcapillary fluid transfer.

Animals↗
PubMed1981

Continuous ambulatory peritoneal dialysis. Impact on management of patients with end-stage renal disease.

Continuous ambulatory peritoneal dialysis has been demonstrated to be a successful dialysis therapy for those patients who are emotionally, socially, and intellectually capable of safely performing the self-dialysis technique. Rapid expansion of the procedure, modification of the technique to reduce the incidence of peritonitis, development of experienced personnel and adequate funding by the government can serve to increase the home dialysis population, save tax dollars and free patients from the requirement of machine dialysis.

Ambulatory Care↗
PubMed1980

A comparison of the relative efficacy of CAPD and hemodialysis in the control of solute concentration.

Metabolite concentrations found in patients on both continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis are predicted by means of a theoretical transport model. Effects of variation in parameters such as generation rate, mass transfer, coefficients and residual renal clearance are studied. The information obtained indicates that CAPD is as effective as hemodialysis in reducing the concentrations of low molecular weight metabolites occurring in the "average" ESRD patient. CAPD becomes increasingly more effective than hemodialysis as molecular weight increases.

Ambulatory Care↗