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At least 253 records · Page 14Linked to original sources
PubMed1995

In-hospital and long-term outcome after reoperative coronary artery bypass graft surgery.

BACKGROUND: Increasingly over the past several years, patients have returned after coronary surgery for reoperative procedures, and the experience has become substantial. In this report, we describe immediate- and long-term outcomes after reoperative coronary artery bypass graft surgery. METHODS AND RESULTS: The source of data was the clinical database at Emory University. The surgical procedure and statistical methods were standard. Data were collected prospectively and entered into a computerized database. Follow-up was by letter, telephone, or hospital records documenting additional events resulting in readmission. In-hospital correlates of survival were determined by logistic regression, and long-term correlates were determined by Cox model analysis. There were 2030 patients with a mean age of 61 and a mean of 7.8 +/- 4.1 years since the first surgery. The mean ejection fraction was close to 50%, and the majority had three-vessel or left main disease. Urgent or emergency surgery was required in 16.6%. The internal mammary was used in 60.1%. Q-wave myocardial infarctions occurred in just over 5%. Neurological events increased from 1.2% at less than age 50 to 4.1% at more than age 70. The hospital mortality increased from 5.7% at less than age 50 to 10% at more than age 70, with an overall rate of 7.0%. Mortality was 5.7% for elective, 10.9% for urgent, and 16.4% for emergency cases. Angina was noted at follow-up in 41.3%. Urgent or emergency surgery, reduced ejection fraction, hypertension, older age, and female sex were univariate and multivariate correlates of in-hospital death. Diabetes was a univariate correlate only. Five- and 10-year survival rates were 76% and 55%, respectively. Five- and 10-year myocardial infarction-free survival rates were 63% and 40%, respectively. By 12 years, few patients were free of cardiac events. The univariate and multivariate correlates of long-term mortality were older age, reduced ejection fraction, hypertension, diseased vessels, presence of diabetes, congestive failure, and emergency surgery, with a strong trend for female sex. The use of the internal mammary artery was not a correlate for long-term mortality. CONCLUSIONS: Patients undergoing reoperative procedures have higher mortality initially and at long term than patients undergoing a first procedure. Expected mortality based on covariates may help in the decision of whether to perform reoperative coronary artery bypass graft surgery.

Age Factors↗
PubMed1997

Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery.

BACKGROUND: The immediate and long-term outcomes of reoperative coronary artery bypass surgery (CABG) (n = 1561) and catheter-based coronary intervention (angioplasty) (n = 2613) were compared in patients from Emory University Hospitals who had previous CABG. METHODS AND RESULTS: The surgical and angioplasty procedures and statistical methods were standard. Data were collected prospectively and entered into a computerized database. Followup was by letter, telephone, or additional events resulting in readmission. In the angioplasty group, 2.9% required in-hospital CABG. Hospital mortality was 1.2% after angioplasty versus 6.8% after repeat CABG (P < .0001). Recurrent angina was noted frequently at about 4 years and was more common after angioplasty. One-, 5-, and 10-year mortalities were 11%, 24%, and 49% after CABG versus 6%, 22%, and 38% after angioplasty. Survival corrected for baseline differences did not vary with the choice of procedure. There were more additional procedures after angioplasty. Patients undergoing angioplasty may be divided into those with procedures only in native coronary arteries (n = 1545), only in vein grafts (n = 869), and a mixture (n = 199), with respective 10 year survivals of 66%, 56%, and 65% (P < .0001). CONCLUSIONS: These patients have a high incidence of events both in-hospital and in the long term. Although initial mortality was higher after CABG, after baseline differences were accounted for, there was no difference in the long term. Patients more frequently have additional procedures after angioplasty. Choice of therapy should consider clinical and angiographic suitability and patient preference.

Analysis of Variance↗
PubMed2005

Development of an interactive bioterrorism and emerging infections curriculum for medical students and internal medicine residents.

While awareness of bioterrorism threats and emerging infectious diseases has resulted in an increased sense of urgency to improve the knowledge base and response capability of physicians, few medical schools and residency programs have curricula in place to teach these concepts. Public health agencies are an essential component of a response to these types of emergencies. Public health education during medical school is usually limited to the non-clinical years. With collaboration from our local public health agency, the Emory University School of Medicine developed a curriculum in bioterrorism and emerging infections. By implementing this curriculum in the clinical years of medical school and residency programs, we seek to foster improved interactions between clinicians and their local public health agencies.

Bioterrorism↗
PubMedDate not supplied

Neoglottis reconstruction following total laryngectomy: the Emory experience.

A number of studies over the last decade have reported on a viability of the primary neoglottis reconstruction after total laryngectomy. Early results have been encouraging, although operative and perioperative complications are higher than with a classic laryngectomy. This article reports on a series of 13 neoglottis reconstructions performed at Emory University Medical School using the techniques developed by Mario Staffieri, MD. During the course of the study, the overall success rate has fallen from 80% at three years to 54% at five years. With each succeeding year there has been an increasing need for revision surgery. The series emphasizes the need for long-term follow-up in any vocal rehabilitation procedure.

Adult↗
PubMed1986

Treatment of posterior pharyngeal wall carcinoma.

Thirty cases of posterior pharyngeal wall carcinoma (seen in the Emory University system between 1977 and 1982) are reviewed. The study was implemented to resolve the question, "Which therapeutic alternative is preferred for the treatment of the lesion--radiation or therapy?" From our clinical experience, a treatment plan of primary surgery with postoperative radiation appears to be preferred over a treatment plan of radiation for cure with surgery held for salvage. A current review of the literature on the treatment of posterior wall carcinoma will be presented along with a review of our series.

Carcinoma, Squamous Cell↗
PubMed2006

Therapeutic drug monitoring of psychoactive drugs during pregnancy in the genomic era: challenges and opportunities.

Various symptoms of mental illness occur commonly during pregnancy. It is estimated that serious mental disorders, including major depression, bipolar disorder, schizophrenia, panic and other anxiety disorders, occur with a frequency of 10 to 25% in community samples of US women in their child-bearing years. As a result, approximately a third of all women take at least one psychoactive drug during pregnancy. Fetal drug exposure has been documented for all psychoactive drugs studied to date. However, the rate and extent of placental transfer within and between psychoactive drug classes remains ill defined. The contribution of various genetic factors such as the role of polymorphic drug metabolizing enzymes and drug transporters in controlling the variability of fetal drug exposure is also unclear. Therapeutic drug monitoring (TDM) has traditionally played an important role in psychiatric pharmacotherapy during pregnancy to ensure an adequate drug dose to achieve desired benefits while avoiding excessive fetal accumulation for drugs. In the genomic era, individualized treatment with specific drugs tailored to the mother's and fetus's genotype should eventually become the standard of care. Several methodological problems need to be overcome for this prediction to become reality. One approach to this goal taken by the Specialized Center of Research on Sex and Gender Factors Affecting Women's Health at the Emory University Women's Mental Health Program is described. This research is grounded on TDM of pregnant women receiving antidepressants, antipsychotics, anti-epileptic drugs and mood stabilizers. The use of pharmacokinetic and pharmacogenetic models to predict maternal plasma drug concentrations, fetal drug exposure, and maternal and neonatal outcomes, is expected to improve our understanding of dose-response relationships of psychoactive drugs in pregnancy.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2003

Building capacity for success: the Tobacco Technical Assistance Consortium.

The Master Settlement Agreement with the tobacco industry has infused resources into tobacco control and prevention, which has helped fund tobacco control programs at the national, state, and local levels. Many tobacco control programs face challenges in areas such as strategic planning, fiscal operations, advocacy, and personnel management. To provide technical assistance to these programs, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the American Cancer Society combined resources to fund the Tobacco Technical Assistance Consortium (TTAC). TTAG, housed at the Rollins School of Public Health at Emory University, provides support for tobacco control programs and matches requests for technical assistance with consultants who have the appropriate expertise. TTAC is a valuable addition to tobacco control and prevention resources and is a viable component within a school of public health.

Cooperative Behavior↗
PubMed2005

The human capital study 2002-04: tracking, data collection, coverage, and attrition.

Between 2002 and 2004, the Institute of Nutrition of Central America and Panama (INCAP), in collaboration with Emory University, the International Food Policy Research Institute (IFPRI), and the University of Pennsylvania, re-surveyed young Guatemalan adults who had, as children, been participants in a nutrition supplementation trial conducted by INCAP between 1969 and 1977. This "Human Capital Study 2002-04" complements and extends data obtained in previous studies by collecting new information on measures of physical health and well-being, schooling and cognitive ability, wealth, consumption and economic productivity, and marriage and fertility histories. This paper describes the study domains and data collection procedures. Among 2,393 members of the original sample, 1,856 (77%) were targets for enrollment. Response rates varied by gender, current place of residence, and domain of data collection, with 80% of males and 89% of females completing at least one data collection instrument. Attrition was not random and appears to be associated with a number of initial characteristics of individuals and their households that should be controlled for in future analyses. We conclude that data collection was successful and data quality is high, facilitating the successful undertaking of our planned investigation of important study hypotheses.

Adult↗
PubMed2002

Development and standardization of a rapid, PCR-based method for the detection of Wuchereria bancrofti in mosquitoes, for xenomonitoring the human prevalence of bancroftian filariasis.

PCR has recently been studied as a promising tool for monitoring the progress of efforts to eliminate lymphatic filariasis. PCR can be used to test concurrently at least 30 pools, with as many as 40 mosquitoes in each pool, for the presence of filarial larvae. The SspI PCR assay for the detection of Wuchereria bancrofti DNA in pools of mosquitoes has been used since 1994 in a variety of laboratories worldwide. During that time, the original assay has been modified in these different laboratories and no standardized assay currently exists. In an effort to standardize and improve the assay, a meeting was held on 15-16 November 2001, at Emory University in Atlanta, with representatives from most of the laboratories currently using the assay. The first round of testing was designed to test the four most promising methods for DNA extraction from pools of mosquitoes. Two of the four methods stood out as clearly the best and these will be now optimised and evaluated in two further rounds of testing.

Animals↗
PubMed2006

The cell biology of HIV-1 and other retroviruses.

In recognition of the growing influence of cell biology in retrovirus research, we recently organized a Summer conference sponsored by the American Society for Cell Biology (ASCB) on the Cell Biology of HIV-1 and other Retroviruses (July 20-23, 2006, Emory University, Atlanta, Georgia). The meeting brought together a number of leading investigators interested in the interplay between cell biology and retrovirology with an emphasis on presentation of new and unpublished data. The conference was arranged from early to late events in the virus replication cycle, with sessions on viral fusion, entry, and transmission; post-entry restrictions to retroviral infection; nuclear import and integration; gene expression/regulation of retroviral Gag and genomic RNA; and assembly/release. In this review, we will attempt to touch briefly on some of the highlights of the conference, and will emphasize themes and trends that emerged at the meeting. MEETING REPORT: The conference began with a keynote address from W. Sundquist on the biochemistry of HIV-1 budding. This presentation will be described in the section on Assembly and Release of Retroviruses.

Animals↗
PubMed1983

Clinical indications for computer-assisted myelography.

Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord, CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.

Adult↗
PubMed1983

Evaluation of cardiac rehabilitation in relation to prognosis.

We designed a rehabilitation program for patients with post-myocardial infarction by modifying the 14-step program of Emory University into a more suitable form for a Japanese. The usefulness of this rehabilitation program was evaluated by comparing the clinical course of our patients with that of the patients in our affiliated institutions, where patients had no systematic rehabilitation therapy. The following results were obtained: 1) Most patients of the rehabilitation-completed group were living a non-restricted life 6 months after discharge. The life style of the rehabilitation group even including the rehabilitation-non-completed group, was far better than that of the non-rehabilitation group. 2) Many patients of the rehabilitation group were working at the same job as before infarction 3 years after discharge, while a substantial number of the patients of the non-rehabilitation group had changed their job or retired within 3 years after discharge. 3) The reason for changing job or retiring was primarily subjective symptoms or objective findings in the rehabilitation-completed group, while it was mostly fear in the non-rehabilitation group. 4) Patients who could not complete our program were mainly old patients of over 70 years of age, patients with extensive anterior infarction and subendocardial infarction and ones with complications such as shock and cardiac failure.

Aged↗
PubMed1984

Hypopharyngeal stenosis.

Hypopharyngeal stenosis after total laryngectomy is a relatively frequent complication. In our series we found that approximately 20% of total laryngectomies require treatment for hypopharyngeal stenosis. This presentation analyzed the factors that contribute to hypopharyngeal stenosis in a large series of patients treated at Emory University and affiliated hospitals. Analysis is presented on the effects of location of the cancer, extent of resection, radiation therapy, and methods of reconstruction. The highest incidence of hypopharyngeal stenosis was found in hypopharyngeal vs. endolaryngeal lesions. The surgical decision examined in this paper is whether a primary "tight closure" of the hypopharynx or a flap or graft reconstruction gives the best results with the lowest complication rate. The best treatment of hypopharyngeal stenosis is its prevention. This paper deals with the methods of identifying the surgical situation when one is most apt to have stenosis and suggest appropriate measures to prevent these complications.

Carcinoma, Squamous Cell↗
PubMed2005

Bored, yawning residents falling asleep during orientation? Wake 'em up with a test!.

The librarians at the Grady Branch Library of Emory University School of Medicine describe the Ovid MEDLINE pretest given to incoming residents. The pretest is a "wake-up call" to the residents who have an inflated perception about their searching skills. This pretest gives the new residents an incentive to listen carefully to the Ovid MEDLINE presentation during the orientation of incoming residents.

Attention↗
PubMedDate not supplied

The complex world of military medicine: a conversation with William Winkenwerder. Interview by Robert Galvin.

Starting as assistant secretary of defense for health affairs just ten days after the 9/11 terrorist attacks, William Winkenwerder has probably the most complex and challenging leadership role in health care. In this interview he talks about the innovations taking place in battlefield medicine; the cost pressures and consolidation that exist in the military health system; the challenges of reporting to his notoriously demanding boss, Secretary of Defense Donald Rumsfeld; and the need to deal with a questioning, skeptical media. Trained in internal medicine and business administration, Winkenwerder came to the Defense Department after stints at Emory University and Blue Cross of Massachusetts.

Humans↗
PubMed1988

Suppurative mediastinitis after open heart surgery. A case control study of risk factors.

Suppurative mediastinitis occurred in 68 of 9,965 patients (0.7 percent) who underwent median sternotomy at Emory University Hospital from 1973 through 1982. Case-control methodology was used to identify preoperative, intraoperative, and postoperative risk factors for the development of poststernotomy mediastinitis. The following 12 individually significant risk factors were identified by univariate analysis: preoperative factors: history of chronic obstructive pulmonary disease (COPD), history of prior sternotomy, pyuria, low ejection fraction, and high left ventricular end-diastolic pressure; intraoperative factors: valvular or aortic aneurysm surgery, prolonged bypass pump time, repeat placement on bypass, duration of surgery; and postoperative factors: surgical reexploration due to postoperative hemorrhage, cardiopulmonary resuscitation in the immediate postoperative period, prolonged time (greater than 48 hours) on mechanical ventilation. By logistic regression analysis, three of these factors were found to be associated independently with increased odds of developing mediastinitis: duration of surgery, history of COPD, and prolonged postoperative mechanical ventilation.

Adult↗
PubMed2002

Development and implementation of the cross-site evaluation of the CDC/HRSA corrections demonstration project.

U.S. prisons and jails have the nation's highest concentration of individuals infected with and at risk for HIV infection. Many correctional institutions offer 1-HIV care, but advances are oftentimes lost when individuals with a lack of health insurance and access to care are released into the community. In 1999 the Centers for Disease Control and Prevention and the Health Resources and Services Administration jointly funded seven health departments to address this need. These projects target soon-to-be-released inmates of jails, prisons, and juvenile facilities and offer enhanced discharge planning, case management, HIV prevention, disease screening, and staff training. The Evaluation and Program Support Center (EPSC) at Emory University and Abt Associates was funded to oversee a cross-site evaluation of these demonstration projects. This paper describes the process of developing a cross-site evaluation, the implementation of this evaluation, and lessons learned by the EPSC throughout this process.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Research capacity building and collaboration between South African and American partners: the adaptation of an intervention model for HIV/AIDS prevention in corrections research.

This article examines a partnership between researchers from the United States who are involved in corrections health issues and scientists from South Africa who conduct prison health research, a previously underresearched area in South Africa. The article discusses some of the challenges as well as opportunities for knowledge and skills exchange via capacity building and collaboration strategies. Through historical and contemporary perspectives, it also discusses barriers and benefits of collaboration when forging links between researchers from developed and less developed nations. A focus on conducting public health research in South Africa, and on HIV/AIDS studies in particular, is placed within the context of the 2001 document of the Council on Health Research for Development. The South African prison health study represents a collaborative between the South African National Health Promotion Research and Development Group of the Medical Research Council, the South African Department of Correctional Services, and Emory University in Atlanta, Georgia. The article illuminates the process of adapting a model for a postapartheid prison study from one designed for use in the American correctional system.

Cooperative Behavior↗