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Biomedical subjects

M Dougherty

Publications and source records attributed to M Dougherty.

At least 55 records · Page 3Linked to original sources
PubMed1992

Nonsurgical treatment of urinary incontinence.

Genuine stress urinary incontinence can be treated by surgical or nonsurgical methods. Conservative treatments include pelvic muscle exercises, hormonal and nonhormonal pharmacologic therapy, and functional electrical stimulation with vaginal or anal electrodes. All of these methods improve or cure stress incontinence in a significant proportion of selected women, with less cost and morbidity. Patients with genuine stress incontinence generally should have a trial of conservative therapy before corrective surgery is offered. Behavioral and pharmacologic methods, alone and in combination, are used for women with detrusor instability. Behavioral regimens, including bladder retraining and biofeedback, are particularly effective for urge and stress incontinence, but are dependent on compliance and motivation of both patient and caregiver. Drug therapy is effective, but with potential morbidity. As with genuine stress incontinence, surgical methods should only be employed for patients with detrusor instability who do not respond to nonsurgical treatment.

Adrenergic alpha-Agonists↗
PubMed1991

Preoperative chemotherapy for children with Wilms' tumor.

Five years ago, the use of preoperative chemotherapy for Wilms' tumor was adopted at this institution. Thirty children ranging in age from 5 months to 9 years had histologically confirmed Wilms' tumor (needle biopsy, n = 26; open biopsy, n = 4). Stage was determined by chest and abdominal computed tomography (CT) scan. Bilateral tumors were present in 6 children. All children received actinomycin D and vincristine from 3 weeks to 6 months before surgery. Seven children with bilateral tumors or stage IV disease also received adriamycin. CT-measured tumor masses shrunk in most cases. Subsequently, nephrectomy was performed in 23 patients and partial nephrectomy in 4, 2 of whom had bilateral disease. In 2 patients, residual bilateral well-differentiated epithelial tumor was not surgically resected. One child died before surgery. Reevaluation at delayed total or partial nephrectomy resulted in a downstaging of disease in 12 (41%). Further chemotherapy and radiation was based on the surgical stage. Postoperative chemotherapy (4 months to 2 years) was administered to all patients. The chest and/or abdomen were radiated in 12. Four patients (13%) died, 1 of radiation pneumonitis and 3 of the disease progression (2 with unfavorable histology, 1 of whom had bilateral disease). Two of 4 with unfavorable histology and 4 of 6 with stage IV disease have survived. It is concluded that this preoperative chemotherapy protocol is as effective as the National Wilms' Tumor Study (NWTS) protocol. The treated tumor is smaller, less friable, and easier to remove. Furthermore, because of downstaging, less radiation is necessary for cure.

Biopsy, Needle↗
PubMed1986

Cardiorespiratory fitness evaluation in climacteric women: comparison of two methods.

Middle-aged women are becoming increasingly interested in aerobic exercise. For exercise to be meaningful, training needs to be performed at 70% to 85% of VO2max for 20 minutes, three times weekly. The graded exercise test is the standard method used to determine maximum oxygen uptake, but this test is impractical for use in clinical practice. A cross-sectional study evaluated 163 women between 35 and 75 years of age by graded exercise test and compared the result with a matched group of 121 women tested by bicycle ergometer (predicted maximum oxygen uptake). Bicycle testing and the graded exercise test had a similar range of values; this was confirmed by 29 climacteric women performing both tests (r = 0.789). Menopausal status has no effect on cardiorespiratory fitness: the predicted maximum oxygen uptake of age-matched menstruating women was 27.4 +/- 6.3 ml/kg/min and that of nonmenstruating women was 25.3 +/- 4.2 ml/kg/min (p greater than 0.05). Bicycle ergometry can thus be used as a screen to determine the cardiorespiratory fitness status of climacteric women.

Adult↗
PubMed1983

Merkel cell tumor of the eyelid. A clinicopathologic case report.

We treated a patient who had clinical and pathological findings of a primary cutaneous tumor of the eyelid with histological and ultrastructural features of a Merkel cell carcinoma. This neoplasm is composed of cells that are thought to be derived from the neural crest and are found normally in the skin. While it may be a low-grade malignant neoplasm, this tumor can grow rapidly and metastasize. Histologically, it can mimic a metastatic undifferentiated small-cell carcinoma from the lung or other primary sites. To our knowledge, this is the first reported case involving an eyelid.

Adenocarcinoma↗
PubMed1981

Menopausal status associated with increased inhibition of blood coagulation.

Postmenopausal women receiving estrogen replacement therapy (ERT) are not as prone to inappropriate venous and arterial thrombosis as are younger women taking oral contraceptives. To establish whether menopausal status per se has any effect on the coagulation-fibrinolytic system normal premenopausal women (mean age 29 years) were compared with younger (mean age 23) and older (mean age 51) surgically menopausal women and a group of naturally postmenopausal women (mean age 53). The results show that in postmenopausal women, irrespective of age or type, the shift is away from clot formatiuon and toward clot inhibition and fibrinolysis as determined by static in vitro analysis. This was characterized by statistically significant increases in antithrombin III antigen, alpha 1-antitrypsin antigen, and plasminogen activity. These changes may help to explain in part why ERT does not appear to cause increased thrombosis in older women.

Adult↗
PubMed1976

Assay for type C virus in mouse sera based on particulate reverse transcriptase activity.

Assay of particulate reverse transcriptase activity in the sera from feral mice naturally infected with type C virus provides a sensitive and rapid procedure for the determination of in vivo virus infection. The results compare well with assays for infectious virus and with complement fixation or competitive radio-immunoassays for the p30 internal antigen of the virus.

Animals↗
PubMedDate not supplied

Effects of age, parity, and adherence on pelvic muscle response to exercise.

OBJECTIVE: To examine factors that affect pelvic muscle response to 12 weeks of pelvic muscle exercise. DESIGN: Repeated measures design in which intravaginal pressures during pelvic muscle contractions were recorded at baseline and after four exercise levels. SETTING: College of Nursing research site in Gainesville, Florida. PARTICIPANTS: Eighty-five parous, community-dwelling women, aged 35-78 years and without incontinence as a primary concern. INTERVENTIONS: A 12-week graded program of regular (three times per week, every other day) pelvic muscle exercise at home. MAIN OUTCOME MEASURES: The hypotheses were that younger age, lower parity, higher baseline intravaginal pressures, and adherence to the pelvic muscle exercise program each would result in significant improvement in maximum intravaginal pressures. RESULTS: The only factor showing significance in predicting a successful outcome was age (t = -2.29, df = 41, one-tail probability = .0136). CONCLUSIONS: Regular, graded exercise over several weeks is needed to build pelvic muscles, and some women who exercise do not improve. Although the reasons for not improving are unclear, age is a significant factor.

Adult↗
PubMedDate not supplied

Continence for women: evaluation of AWHONN's third research utilization project. Association of Women's Health Obstetric and Neonatal Nurses.

OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

Adult↗
PubMedDate not supplied

Continence for women: a test of AWHONN's evidence-based protocol in clinical practice. Association of Women's Health Obstetric and Neonatal Nurses.

OBJECTIVE: To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes. DESIGN: Prospective formative evaluation study. SETTING: Twenty-one public, private, and other women's health care sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available. INTERVENTIONS: Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution. MAIN OUTCOME MEASURES: Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness. RESULTS: Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence. CONCLUSIONS: This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory women's health care settings, has benefited women's continence status. The results of this project strongly support widespread application.

Adult↗