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At least 289 records · Page 16Linked to original sources
PubMed1984

Potential risks, benefits of progestins in birth control pills outlined.

Progestins in oral contraceptives (OCs) produce potential complications, as well as noncontraceptive benefits, according to Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics, Emory University Medical School. Hatcher told CTU that lowering the progestin content in an OC may decrease complications, but could also decrease the benefits experienced by women. "The extent to which that will happen remains to be seen," he said. Hatcher cited the following potential complications of progestins in OC: hypertension; decreased levels of high density lipoproteins; acne; oily skin; headaches between pill cycles; dilated leg veins; pelvic congestion syndrome; thrombosis of superficial leg veins; gallstones; Monilia vaginitis; cholestatic jaundice; and depression, fatigue, and decreased libido. Progestins, according to Hatcher, also produce these noncontraceptive benefits: protection against PID; decreased dysmenorrhea; decreased menstrual blood loss, decreased iron deficiency anemia; protection against endometrial cancer; protection against fibrocystic breast disease, and fibroadenomas of the breast; decreased bleeding from fibroids; decreased growth of fibroids. When ovulation is suppressed, Hatcher emphasized, additional benefits that may occur include the following: decreased risk of functional ovarian cysts; elimination of mittleschmerz pain; decreased rick of ovarian cancer; protection against endometriosis.

Behavior↗
PubMed2002

New approach to high-risk pregnancy begins far earlier than traditional programs.

Why? Because traditional programs that focus on women as soon as they become pregnant are not making any headway against the incidence of low and very low birth weight (LBW) babies. As a result, while more of these babies are surviving, a significant number have disabilities that will impact them for life while costing the health care system dearly. Experts at Emory University in Atlanta believe there must be a better way to curb the incidence of poor birth outcomes, and they are putting their theories to work in a new program focused on "interpregnancy" care.

Case Management↗
PubMed1992

Invasive cervical cancer in young women. Clinicopathologic correlation and demonstration of human papillomavirus by in situ hybridization.

It has been suggested that invasive cervical carcinoma is biologically more aggressive in young patients than in older patients. The clinicopathologic characteristics and human papillomavirus (HPV) status of women < or = 35 years of age with invasive cervical carcinoma treated at Emory University Hospital from 1985-1989, were evaluated in a retrospective study. The group consisted of 23 patients, 35% of all patients with invasive cervical carcinoma. Age at diagnosis, clinical stage, histologic classification, lymph node status, treatment and clinical follow-up were obtained from medical records. HPV status was evaluated by colorimetric in situ hybridization for HPV types 6, 11, 16, 18, 31, 33 and 35 in archival formalin-fixed paraffin-embedded tumor material available from 16 of the patients. This study found that the young patients had lower survival and greater extent of disease than predicted by clinical staging. The rate of detection of HPV (69% positive) and HPV typing (type 16 predominated) in these young patients showed no difference from other series of cervical carcinomas from all age groups. Although a higher proportion of patients who died of disease had HPV-negative tumors (3/7, 43%) than those patients who were alive and free of disease (2/9, 22%), this difference was not statistically significant (P = .73, Fisher's Exact T-Test).

Adenocarcinoma↗
PubMed2003

The Second Annual Primary Care Conference--Programming to eliminate health disparities among ethnic minority populations: an introduction to proceedings.

From October 31, 2002 through November 2, 2002, the Second Annual Primary Care Conference was held, sponsored by the Morehouse School of Medicine's National Center for Primary Care and its Prevention Research Center. The conference was designed as a collaborative activity with the Atlanta Regional Health Forum; The Carter Center; Emory University's School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Georgia Chapter of the American College of Physicians/American Society of Internal Medicine; Georgia Nurses Foundation; Southeastern Primary Care Consortium, Inc./Atlanta Area Health Education Center; St. Joseph's Mercy Care Services; United States Department of Health and Human Services: Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention; Health and Human Services (Region IV); Health Resources and Services Administration; Office of Minority Health (Region IV); and Office on Women's Health (Region IV). The 2 and a half-day conference featured 5 plenary sessions and 3 tracks of medical education for primary care physicians and other healthcare providers. The tracks were categorized as: Track A: Adult Health; Track B: Public Health and Prevention; and Track C: Maternal/Child/Youth Health. Within each track, 6 working sessions were presented on topic areas including diabetes, obesity, cardiovascular disease, cancer, mental health, infectious disease, behavioral and social health, women's health, stroke, and asthma. A total of 18 working sessions took place and each working session included 3 presentations. Continuing medical education credits or continuing education units were granted to participants. In all, 485 individuals participated in the conference, with the majority of the participants from the southeastern United States. Of the attendees, 35% were physicians (MD); 13% were nurses (RN); 12% held master-level degrees; and 12% held other doctorate-level degrees.

Ethnicity↗
PubMed1992

Acute mesenteric ischemia after cardiopulmonary bypass.

Acute mesenteric ischemia is an uncommon but catastrophic event after cardiopulmonary bypass. From 1980 to 1990, 16,951 cardiac procedures requiring cardiopulmonary bypass were performed at Emory University Hospital in Atlanta, Ga. Eighteen patients (0.1%) had acute mesenteric ischemia that resulted in intestinal infarction. Emergency cardiac surgery had been performed in 16 of the 18 patients, and all 18 patients were vasopressor dependent for hemodynamic support after surgery. Diagnostic difficulties resulted in the diagnosis of intestinal infarction an average of 9 1/2 days after cardiopulmonary bypass. Nonocclusive mesenteric arterial ischemia was the determined cause in all cases. Statistically significant risk factors associated with acute mesenteric ischemia after cardiopulmonary bypass surgery included (1) emergency cardiac surgery (p less than 0.0001), (2) the use of an intraaortic balloon pump (p less than 0.0001), (3) failed angioplasty requiring emergency surgery (p = 0.0074), (4) prolonged pump time (p = 0.0093), and (5) advanced age (p = 0.0016). A high index of suspicion for mesenteric ischemia after cardiopulmonary bypass in patients with identified risk factors may decrease the diagnostic delay and lead to an improvement in the 67% mortality rate seen in this series.

Age Factors↗
PubMed1992

Electrosurgical laparoscopic cholecystectomy.

Though laparoscopic cholecystectomy has become widespread, questions remain as to its success rate, its role in acute cholecystitis, the role of cholangiography, and whether laser use is necessary. To attempt to answer these questions, the first 100 patients undergoing laparoscopic cholecystectomy at Emory University using electrosurgical diathermy were reviewed. Patients underwent cholecystectomy for biliary colic (87), gallstone pancreatitis (1), and acute cholecystitis (12). The average length of hospital stay was 29 hours (range: 12 hours to 5 days). Laparoscopic cholecystectomy was not possible in 7 patients because of gangrenous cholecystitis (2), adhesions from previous surgery (2), equipment failure (2), and choledochoduodenal fistula found at surgery (1). Two patients developed bile leaks from accessory bile ducts that healed spontaneously. There were no other complications. The average time required to complete the laparoscopic cholecystectomy was 115 minutes (range: 45 to 238 minutes) and was not significantly different in those patients undergoing intraoperative cholangiography (117 minutes) versus those without (109 minutes). Common duct stones were uncommon in this series. Thirty-three patients underwent intraoperative cholangiogram. One patient was found to have a common duct stone, which was pushed into the duodenum using a Fogarty catheter (American Edwards Laboratories; Anasco, Puerto Rico) inserted through the cystic duct at the time of laparoscopic cholecystectomy. Twelve patients with acute cholecystitis underwent an attempt at laparoscopic cholecystectomy that was successful in nine. These procedures were difficult and lengthy (mean of 143 minutes). Causes for failure were gangrenous cholecystitis (2) and equipment failure (1). In conclusion, laparoscopic cholecystectomy can be performed with a high success rate (93%) and low morbidity (2%). No complications seemed attributable to electrosurgical dissection.

Adolescent↗
PubMed1992

Complications of hepatic resection for colorectal carcinoma metastasis.

Hepatic resection of metastatic colorectal carcinoma is widely advocated with 5-year survival rates quoted at 20 to 25 per cent. However, concerns about the morbidity and mortality for this procedure still exist. It is estimated that only 25 per cent of patients potentially eligible for hepatic resection are actually referred for evaluation, possibly secondary to concerns about the morbidity and mortality of the surgical procedure involved. All patients undergoing such resections at the Emory University Affiliated Hospitals between January 1, 1984 and December 31, 1989 were reviewed to determine the associated morbidity and mortality. Forty-three patients were identified (23 men, 20 women, ranging in age from 32 to 80 years (mean of 60.8). The average postoperative intensive care unit (ICU) stay was 3.2 days (range 1 to 12) and the average hospital stay was 15 days (range 6 to 45). There were no postoperative deaths, and 10 patients (23%) developed significant complications (1 biliary fistula, 2 thrombophlebitis, 3 abscess/wound infections, 1 hepatic insufficiency, 1 pneumothorax, 1 pleural effusion, 1 lobar pulmonary collapse). The occurrence of complications was not related to preoperative liver enzymes, absolute tumor mass present, or associated co-morbid disease. The extent of liver resection, length of operation, and number of units of blood transfused were all correlated with the occurrence of complications (P = 0.01, 0.01, and 0.05, respectively). Likewise, the length of hospital stay and ICU stay were directly related to the extent of hepatic resection (P = 0.05 and 0.09) and number of transfusions (P = 0.05 and 0.01). The length of operation showed such a trend but was not statistically significant (P = 0.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Novel approach to cancer care prioritizes routine management of the 'sixth sign'.

Recognizing that issues surrounding pain, palliation, and behavioral health are often related in cancer patients, a group of specialists at Emory University has decided to work together under the umbrella of a new Quality of Life program. The aim of the program is to make sure that all cancer patients are routinely evaluated for depression, anxiety, pain, and other symptoms that can undermine treatment objectives, and to deliver individualized support in a timely fashion. While the mission of the program has nothing to do with economics, developers maintain there are financial benefits that go along with providing this kind of comprehensive care.

Cancer Care Facilities↗
PubMed2000

Emtricitabine (Emory University/Glaxo Wellcome/Triangle Pharmaceuticals).

Triangle Pharmaceuticals has licensed the development rights to emtricitabine (FTC), an antiviral nucleoside analog that is structurally related to 3TC, from Emory University [207618]. It is in phase III trials for HIV [324921] and in phase I/II trials for hepatitis B (HBV) [305302]. In June 1999, Triangle and Abbott Laboratories entered into an alliance for the development and marketing of six antiviral products, including FTC [326824]. An NDA was expected to be filed in 2000 [324921]. US-05814639 has been issued covering FTC [300465]. In April 2000, a report appeared in the South African media which suggested that a Triangle-sponsored trial (FTC-302), commenced in August 1999, had been halted [361984]. A total of 470 patients had been enrolled on the trial, which is a comparison of Coviracil and lamivudine, both drugs being used in combination with d4T and nevirapine. Patients with high viral loads received efavirenz instead of nevirapine. There was a higher than expected incidence of liver toxicity in this study and, in two cases, this liver toxicity resulted in death. Initially, Triangle reported that the trial was ongoing, although no additional patients were being enrolled at the time. However, the company received notification from the Medicines Control Council (MCC) in South Africa informing it that study FTC-302 should be terminated. The company is in ongoing discussions with the MCC [361792,361793]. Subsequently, the FDA also issued a hold on the trial, which is being carried out in South Africa under a US IND, and indicated that as a result of factors leading to this decision, study FTC-302 may not provide adequate support as part of an NDA submission. The planned NDA filing may now be delayed until the second half of 2001 and Triangle will discuss with the FDA any additional data required for the NDA application [361984].

Journal Article↗
PubMed2005

Medical students' self-reported typical counseling practices are similar to those assessed with standardized patients.

CONTEXT/OBJECTIVES: We surveyed fourth-year medical students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia, about various personal and clinical practices. We were especially interested in the frequency that these seniors reported of talking with patients about nutrition, weight, exercise, alcohol, and cigarette smoking. Because the validity of our findings about these counseling practices was limited by our having only self-reported data from seniors' questionnaires, we developed a standardized patient (SP) examination to test the relationship between what students reported on the questionnaires and how they actually performed with SPs. DESIGN/SETTING/MAIN OUTCOME MEASURES: As part of a lengthy questionnaire, 88 senior medical students answered these 5 separated questions: "With a typical general medicine patient, how often do you actually talk to patients about: (1) nutrition; (2) exercise/physical activity; (3) weight; (4) smoking cessation (among smokers); and (5) alcohol? (never/rarely, sometimes, usually/always)." As part of their internal medicine subinternship final exam, students clinically assessed 4 SP cases with predetermined risk factors (poor diet, exercise, alcohol, and/or cigarette-smoking habits). RESULTS: For every risk factor, the proportion of SPs actually counseled was higher for those students who self-reported discussing that risk factor more frequently with their patients. Additionally, the odds of counseling an SP for any risk factor were significantly higher (odds ratio = 1.76-2.80, P < .05) when students reported more frequent counseling. CONCLUSION: Student self-reports regarding patient counseling may be useful when resources are limited, and the purpose is to grossly and anonymously distinguish between higher and lower performers.

Adult↗
PubMed2005

A description and qualitative assessment of a 4-year intervention to improve patient counseling by improving medical student health.

BACKGROUND: To test whether promoting medical student health could efficiently improve patient counseling, we developed and implemented a 4-year-long curricular and extracurricular intervention to promote healthy behaviors among students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia. METHODS: We asked students: (1) "What did you think about these [listed intervention components]"; (2) "did any of these interventions influence your personal health habits/attitudes toward your personal health"; and (3) "did any of these interventions influence your behavior or attitudes regarding current or future clinical practices, including history taking or counseling? If so, how? If not, why not?" Students evaluated the effectiveness of these formats and proposed changes in our intervention. The focus groups were transcribed and analyzed with QSR N5. RESULTS: Several major themes emerged from the focus groups: Listen to the students early, often, substantively, and noticeably; Incorporate many faculty and student leaders; Quietly integrate the curricular activities into the regular curriculum; Provide a strong, science-based, pragmatic prevention curriculum to complement the personal health promotion; Don't just use lectures to teach; Offer plentiful, nonrequired, fun extracurriculars; Don't nag; Have achievable interventions and recommendations; Provide collective data, but don't overexpose the students to it, and don't assume that collective data apply to every student, especially if it's unpleasant news; Provide personalized data where possible; and Uncouple evaluations from the intervention, and keep evaluations brief. CONCLUSIONS: Some students seemed pleased to have their medical school be attentive to their health, and believed that the project positively influenced their personal health practices and clinical practices (which was our goal). The students enjoyed many components of the intervention, especially the extracurricular activities, and recognized that they and their classmates were at risk for unhealthy behaviors that had personal and clinical implications. However, many also felt resentful and that they were nagged. Although we had anticipated these responses, and had therefore taken pains to avoid the things that the students most resented, we were insufficiently sensitive to how strong those responses would be.

Attitude of Health Personnel↗
PubMed2006

Innovative CF program responds to the unique needs of adults.

The median age of survival among CF patients has risen from 14 to nearly 40 over the past three decades, but these individuals have many different medical and psychosocial needs than the pediatric population. To better meet these needs, Atlanta-based Emory University Medical School has developed a distinct program for adult patients that provides multidisciplinary care to older CF patients from throughout the Southeast.

Adult↗
PubMed2006

Using performance feedback to change provider behavior.

Using performance feedback to overcome clinical inertia. For a variety of reasons, physicians have a strong tendency to under-treat, particularly with respect to diseases like diabetes, which are often asymptomatic. However, researchers at Emory University have a developed an intervention that can successfully overcome this problem, and ultimately improve clinical outcomes as well.

Diabetes Mellitus↗
PubMed1990

Current management of choledocholithiasis.

Choledocholithiasis may be managed by surgical extraction of stones or endoscopic papillotomy with extraction of stones. To evaluate these methods of management, the charts of all patients with choledocholithiasis admitted to Crawford Long Hospital of Emory University between April 1, 1983, and April 30, 1988, were reviewed. One hundred patients were identified; 42 were treated by common bile duct exploration (CBDE) and 58 had endoscopic papillotomy with extraction of stones (EP) as their initial treatment. The two groups were similar in regards to age, but the CBDE group had more comorbid conditions (average 2.5/patient in CBDE vs 1.8/patient in EP) and a higher incidence of acute cholecystitis and/or cholangitis (74% of CBDE patients; 24% of EP patients). Successful extraction of all stones occurred in 79 per cent of CBDE patients and 90 per cent of EP patients. Of those patients with retained stones following CBDE, all were later extracted by EP. Of patients having EP as their initial procedure, 24 per cent required repeat endoscopic procedures for extraction of residual stones and only six patients (10.4%) required CBDE for retained stones. Morbidity was lower (10% vs 23%) and hospital stay shorter (3.6 days vs 10.4 days) in the EP than CBDE patients; thus, the two groups are not completely comparable. Mortality was similar in the two groups (1.7% EP, 2.3% CBDE).

Adolescent↗
PubMed1990

Radiation therapy of pure seminoma of the testicle.

An analysis of 45 patients with seminoma of the testis treated at the Radiation Oncology Department of Crawford Long Hospital of Emory University, from 1975-1986. Thirty patients with Stage I and II pure seminoma received prophylactic irradiation to the mediastinum and supraclavicular area in addition to receiving periaortic and pelvic irradiation alone. The only recurrence in the supraclavicular region was in a Stage I patient not receiving mediastinal and supraclavicular prophylaxis. No recurrences were observed in Stage II patients. The observed actuarial 5-year disease-free survival of all patients was 91.2%. In patients with Stage I disease, the actuarial 5-year survival was 93.3%. The actuarial 5 and 10-year survival of Stage II patients was 100%.

Adult↗
PubMed1990

Determinants of primary therapy of early stage breast cancer.

Controversy exists in the local treatment of early stage breast cancer. In an effort to determine what criteria are used in selection of therapy for patients with breast cancer, we reviewed the experience of early stage breast cancer at Crawford Long Hospital of Emory University during 1986 and 1987. One hundred eighty-three patients were identified with Stage 0, I, or II breast cancer. A total of 11% of patients were treated by lumpectomy and radiotherapy. Residence distant from the hospital was associated with a low rate of utilization of lumpectomy and radiotherapy (p = .05). The strongest predictor of therapy was the surgeon involved in the patient's care (p = 0.001). For surgeons who cared for five or more patients with breast cancer over this time period, rates of utilization of lumpectomy and radiotherapy ranged from 0 to 20% of patients. The results of this study suggest that the surgeon consulted is the major determinant of the type of therapy used in the primary management of breast cancer.

Breast Neoplasms↗
PubMed1990

Conservative surgery and definitive radiation therapy for early breast cancer.

Fifty-six patients with clinical Stage I and II breast cancer were treated at Crawford Long Hospital of Emory University with conservative surgery and definitive radiation therapy between the years 1978-1987. All patients had pathologic examination of their lymph nodes except for four patients who had their axillae clinically staged only. All patients received definitive radiation therapy with doses in the range of 45-60 Grays. Boost to the site of the primary was done by electrons, and 10-20 Grays were given. Overall actuarial 5-year survival was 77.8% and disease-free survivals were 69.1% and 64.5% at 5 and 7 years respectively. The actuarial survival for Stage I patients was 77.6% at 5 years with a disease-free survival of 71.1% at 5 years. For Stage II patients, it was 78.7%, with a disease-free survival of 66.3% at 5 years. The most common complication was asymptomatic apical pulmonary fibrosis in 3/50 patients. The overall complication rate was 9%.

Actuarial Analysis↗
PubMed1990

Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty.

The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.

Aged↗