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Kilminster S.,Institute of Naval Medicine | Muller S.,University Hospital North Norway | Menon M.,Ford Motor Company | Joseph J.V.,University of Rochester | And 2 more authors.
BJU International | Year: 2012

What's known on the subject? and What does the study add? Over the last decade, the surgical treatment of prostate cancer has evolved towards minimal access surgery, particularly via a robot-assisted technique. However, there is still debate regarding the true benefit for patients with respect to a functional outcome such as erectile function. The present prediction model provides a reliable estimation of the likelihood of regaining erectile function after prostatectomy. OBJECTIVE To identify the reported rates of potency after prostatectomy in the recent literature for men without preoperative erectile dysfunction (ED) and to develop a statistical model for predicting the expected potency after prostatectomy. MATERIALS AND METHODS A Medline search was conducted with the keywords 'potency' and 'prostatectomy' from 2003 to 2009. In total, 33 studies in the English language reporting pre- and postoperative erectile function were identified. Data from studies reporting outcome after open, laparoscopic and robot-assisted prostatectomy were analyzed separately. Only data obtained from potent men before surgery were included in the analysis. RESULTS In potent men before surgery, the main predictors of post-treatment erectile function are age and time after treatment. The cumulative range of potency rates at 48 months for all ages (45-75 years) was 49-74% for open, 58-74% for laparoscopic and 60-100% for robotic prostatectomy. The predicted outcome differs by type of operation and patient age. CONCLUSIONS Men aged <60 years have a significant likelihood of regaining erectile function after radical prostatectomy. The reported statistical model provides a reliable estimation of erectile function outcome after prostatectomy for men with localized prostate cancer and intact erectile function. © 2011 BJU INTERNATIONAL. Source


Hill N.,Imperial College London | Fallowfield J.,Institute of Naval Medicine | Price S.,University of Birmingham | Wilson D.,Royal Center for Defence Medicine
Philosophical Transactions of the Royal Society B: Biological Sciences | Year: 2011

Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel. © 2011 The Royal Society. Source


Paddan G.S.,Institute of Naval Medicine
Annals of Occupational Hygiene | Year: 2014

Sound pressure levels were measured on a military ship during firing of a Heavy Machine Gun (HMG). Measurements were made at three locations on the ship's bridge (the wheelhouse) and one location on the starboard bridge wing. The highest peak sound pressure levels measured on the bridge wing and on the bridge were 160.7 dB(C) (2170 Pa) and 122.7 dB(C) (27.3 Pa), respectively. The highest sound exposure levels measured on the bridge wing and on the bridge corresponding to one round being fired were 127.8 dB(A) and 88.9 dB(A), respectively. The ship's structure provided about 40 dB attenuation in the transmitted noise. The operator of the weapon would be required to wear some form of hearing protection. Based on the measured peak noise levels, there would be no requirement for bridge crew to wear any hearing protection during firing of a HMG. However, crew exposure to noise on the bridge is likely to exceed the upper exposure action value corresponding to 85 dB(A) after about 11 750 rounds. © The Author 2015. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. Source


Harris R.C.,Junipa Ltd. | Hoffman J.R.,University of Central Florida | Allsopp A.,Institute of Naval Medicine | Routledge N.B.H.,Junipa Ltd.
Nutrition Research | Year: 2012

Differences in plasma l-glutamine (L-Gln) concentrations from ingestion of different formulations of L-Gln were examined in 8 men (26.8 ± 4.2 years old, 181.1 ± 10.9 cm, 85.8 ± 15.4 kg). Subjects reported to the laboratory on 4 separate occasions and randomly consumed 1 of 4drinks containing 60 mg/kg of L-Gln; 89 mg/kg of Sustamine (l-alanylglutamine [AlaGln]; Kyowa Hakko Europe GmbH, Düsseldorf, Germany), which contained an equivalent L-Gln dose as consumed in L-Gln); 200 mg/kg of an enzymatically hydrolyzed wheat protein (HWP) with an L-Gln content of 31 mg/kg; or a control that consisted only of water. It was hypothesized that the AlaGln trial would increase plasma glutamine concentrations greater than the other experimental trials. Ingestion of L-Gln, AlaGln, and HWP resulted in significant increases in the plasma L-Gln concentration, peaking at 0.5, 0.5, and 0.75 hours, respectively. The corresponding mean peak increases were 179 ± 61, 284 ± 84, and 134 ± 36 μmol/L, respectively. Concentrations returned to baseline in all subjects by 2 hours after L-Gln and HWP and by 4 hours after AlaGln. Mean areas under the plasma concentration curve, calculated between 0 and 4 hours, were 127 ± 61, 284 ± 154, and 151 ± 63 μmol{bullet operator}h{bullet operator}L -1 for L-Gln, AlaGln, and HWP, respectively. When allowance was made for the lower L-Gln dose administered as HWP, the peak plasma concentration and area under the plasma concentration curve were approximately the same as for AlaGln. The results suggest a greater transfer from the gut to plasma of L-Gln when supplied as AlaGln and possibly also as HWP compared with when the same dose was provided as the free amino acid. © 2012 Elsevier Inc. Source


Brown D.C.,Institute of Naval Medicine
Journal of the Royal Naval Medical Service | Year: 2010

The symposium successfully brought together key military medical and personnel managers with civilian experts in hearing disorders and charities to help streamline our knowledge of the aetiology, investigation, prevention and management of NIHL. A requirement for seamless medical care for veterans with NIHL was recognised and collaborative work has commenced. Source

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