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PubMedDate not supplied

Simultaneous pancreas kidney transplantation: initial experience of the Emory University transplant service.

The successful replacement of islet tissue by pancreas transplantation appears to be beneficial in the early course of those uremic diabetic recipients who receive a simultaneous renal transplant. The long-term advantages of SKP transplantation remain to be determined, however, current improvement in patient and graft survival following SPK and the difficulties thus far reported in islet cell transplantation have renewed clinical interests in SPK, PAK and PA transplantation. In our experience, pancreas transplantation has been a challenging technical, immunological and physiological endeavor which was well received by our patients despite the initial problems and complications we and they encountered. Notwithstanding extensive preparation, our team experienced a "learning curve" and we present many of the lessons we learned. This knowledge has aided our transplant team in the successful management and avoidance of these complications and other inherent problems associated with SKP transplantation in subsequent patients.

Anastomosis, Surgical↗
PubMedDate not supplied

Improving pain management in an acute care setting. The Crawford Long Hospital of Emory University experience.

PURPOSE: To identify which of three pain intensity measurement scales is most appropriate for use with patients admitted to the inpatient units of the study hospital. The following questions were addressed: Is one of the scales easier for most patients? Is the choice of scales influenced by nursing unit, age, education, race, SES, diagnosis, or type of pain experienced? Do patients perceive that a rating scale helps them describe their pain more effectively? SAMPLE: 267 patients admitted over a 3-week period completed a four-page questionnaire and demographic form distributed on admission. The primary admitting diagnosis for 39.5% of the sample reflected acute pain, 40.3% chronic pain, and 20.2 no pain. METHODS: Three pain rating scales were presented: two visual analogues (one contained a 100 mm line; the other contained six faces depicting graduated levels of distress); and a cognitive number rating scale. Each scale used a 0 (no pain) to 10 (worst pain possible) rating format. Patients completed the questionnaire by rating the intensity of pain experienced using each of the three scales once over the next 24 hours. The last page contained questions related to which of the scales was easiest to use, whether the scale was helpful or needed further explanation, and work and education information. The demographic form was completed from information contained in the patient record. FINDINGS: The scale selected most frequently was the visual analogue containing faces (48.6%), followed by the number (35.3%) and line scales (16.1%). None of the demographic information was found to significantly influence choice of preferred scale. A majority (85.8%) indicated a rating scale as helpful; only 13.6% indicated a need for further explanation. The means for pain intensity ranged from 5.09 to 5.75. The interval between pain ratings for the majority (> 71%) was less than 2 hours. Patients tended to tell the nurse about their pain when the intensity exceeded the midpoint on the scales. A reliability coefficient for the three scales was computed at alpha = 0.88. CONCLUSION: The use of rating scales for pain assessment in adult inpatient units was viewed positively by patients. Recommendations for incorporating self-ratings of pain intensity are set forth. Involving both patients and providers in the process is essential to improving both our processes and the outcomes achieved.

Adult↗
PubMed1993

Search for correlation of radon levels and incidence of salivary gland tumors.

Studies were undertaken to determine if there is a statistical correlation between radon levels and the incidence of salivary gland tumors because of high levels of radon in Pennsylvania. In Part I of the study, the incidence of minor salivary gland tumors accessioned by Temple University, Emory University, and University of Southern California from 1986 to 1988 were correlated with average radon levels in the three locations with the use of standard statistical analyses. In Part II, the occurrence of malignant salivary gland tumors was obtained for each of the 67 counties in Pennsylvania from 1986 to 1988 and correlated statistically with radon levels and population figures in each of those counties. A statistically significant correlation between radon levels and incidence of salivary gland tumors could not be demonstrated in either case.

Air Pollutants, Radioactive↗
PubMed2006

Center for Behavioral Neuroscience: a prototype multi-institutional collaborative research center.

The Center for Behavioral Neuroscience was launched in the fall of 1999 with support from the National Science Foundation, the Georgia Research Alliance, and our eight participating institutions (Georgia State University, Emory University, Georgia Institute of Technology, Morehouse School of Medicine, Clark-Atlanta University, Spelman College, Morehouse College, Morris Brown College). The CBN provides the resources to foster innovative research in behavioral neuroscience, with a specific focus on the neurobiology of social behavior. Center faculty working in collaboratories use diverse model systems from invertebrates to humans to investigate fear, aggression, affiliation, and reproductive behaviors. The addition of new research foci in reward and reinforcement, memory and cognition, and sex differences has expanded the potential for collaborations among Center investigators. Technology core laboratories develop the molecular, cellular, systems, behavioral, and imaging tools essential for investigating how the brain influences complex social behavior and, in turn, how social experience influences brain function. In addition to scientific discovery, a major goal of the CBN is to train the next generation of behavioral neuroscientists and to increase the number of women and under-represented minorities in neuroscience. Educational programs are offered for K-12 students to spark an interest in science. Undergraduate and graduate initiatives encourage students to participate in interdisciplinary and inter-institutional programs, while postdoctoral programs provide a bridge between laboratories and allow the interdisciplinary research and educational ventures to flourish. Finally, the CBN is committed to knowledge transfer, partnering with community organizations to bring neuroscience to the public. This multifaceted approach through research, education, and knowledge transfer will have a major impact on how we study interactions between the brain and behavior, as well as how the public views brain function and neuroscience.

Journal Article↗
PubMed1996

Linking health services research to education at an academic health center.

Academic health centers (AHCs) face numerous challenges as they prepare students, housestaff, and faculty for the rapidly changing health care environment. An already overburdened curriculum makes it difficult to provide medical students with skills in outcomes assessment, health economics, clinical decision making, epidemiology, and basic statistics. Practicing physicians may find it difficult to expend the time and resources needed for degree programs in public health or the evaluative clinical sciences. AHCs may need to tap into existing resources in the health evaluation sciences, as Emory University (Atlanta, Georgia) has done by establishing the Emory University Center for Clinical Evaluation Sciences. Although the Center's primary missions are to be an analytical resource for Emory's health care delivery system and to promote health services research across the university, the authors illustrate its potential as a resource for training medical students, housestaff, and faculty in the evaluative clinical sciences.

Academic Medical Centers↗
PubMed1993

Benefits of stopping smoking.

This article launches a special WESTERN JOURNAL OF MEDICINE effort to help prevent disease and disability. Erica Frank, MD, MPH, an Assistant Professor in the Department of Community and Preventive Medicine and Department of Medicine, Emory University School of Medicine, and Adjunct Professor at the Emory University School of Public Health, Atlanta, Georgia, will head the endeavor. The goals are to present scientific foundations for prevention and to provide practical ways to improve patients' lives. This first article addresses smoking cessation. We may think that we know it all, but we may not, and patients do not: about 25% of Americans smoke, and more than half of persons who ever smoked began their fatal habit before they were 18 years old. Side-stream smoke affects adults and children adversely, too, causing inflammation, infection, and cancer. Smokers need to stop smoking, and young people need to not start. Dr Frank's review is accompanied by a page for patients. It debunks myths and is designed to be duplicated so patients can leave their physician's office with a new lease on life in hand. Look for future prevention-oriented articles in this series that feature science and patient education.

Adult↗
PubMed1998

Optic neuritis in African Americans.

OBJECTIVE: To describe the clinical profile of demyelinating optic neuritis in African Americans. METHODS: The medical records of all patients with a diagnosis of optic neuritis examined at the Neuro-Ophthalmology Unit at the Emory University Eye Center (Emory) and at the Grady Memorial Hospital Eye Clinic (Grady), Atlanta, Ga, between 1989 and 1996 were retrospectively reviewed. PATIENTS: African American and white patients, aged 15 through 55 years, with a single initial episode of acute optic neuritis of unknown or demyelinative origin were included in the study. Study patients included 23 African American patients and 56 white patients examined at Emory as well as 10 African American patients examined at Grady. RESULTS: There were no significant differences among the African American study patients, the white study patients, and patients from the Optic Neuritis Treatment Trial (ONTT) regarding sex (P=.36), age (P=.73), or the presence of disc edema (P=.40), lesions found on magnetic resonance imaging (P=.43), or multiple sclerosis (P=.54) at the onset of an initial episode of optic neuritis. The Emory African American patients presented with more frequent severe visual loss (13 [93%] of 14 patients with a visual acuity < or =20/200) compared with Emory white patients (12 [39%] of 31 patients; P=.002) and with ONTT patients (161 [36%] of 448 patients; P<.001). At follow-up examination of at least 1 year, Emory African American patients had worse vision (9 [39%] of 23 patients <20/40, and 4 [17%] of 23 patients < or =20/200) compared with Emory white patients (5 [8%] of 63 patients <20/40, P=.001; 3 [5%] of 63 patients < or =20/200, P=.08), and with ONTT patients (29 [7%] of 409 patients <20/ 40, P=.0001; 12 [3%] of 409 patients < or =20/200, P=.01). Compared with ONTT patients, the Emory African American patients combined with the Grady African American patients had more frequent severe visual loss (visual acuity < or =20/200) at presentation (18 [90%] of 20 patients vs 161 [36%] of 448 patients; P<.001) and at follow-up examination of at least 1 year (6 [18%] of 33 patients vs 12 [3%] of 409 patients; P=.002). Seven (58%) of 12 African American patients with multiple sclerosis had a "neuromyelitis optica" presentation defined by the presence of neurological deficits limited to the optic nerves and spinal cord. CONCLUSIONS: The African American study patients with a single episode of demyelinating optic neuritis had visual acuities more severely affected at onset and after 1 year of follow-up compared with the white study patients and with patients in the ONTT. In the African American patients, multiple sclerosis occurred most frequently in a "neuromyelitis optica" form.

Acute Disease↗
PubMed1997

Caring in full circle: the legacy of Edith Honeycutt.

Edith Folsom Honeycutt, now retired, is the only staff nurse in the United States to be honored by a funded chair at a major university. In 1990, a chair of oncology nursing was established in her name at Emory University by the Metropolitan Atlanta Community Foundation. A life history method was used to examine the professional life of Edith Honeycutt through interviews and with a focus group of nurses who had worked with her. Three themes emerged: teaching by showing; expecting excellent practice; and investing in each other. A synthesized overall theme of "caring in full circle" was identified as the core descriptor. The findings of this study demonstrate how clinical education and expertise are shared and learned among staff nurses. Findings also suggest how nursing knowledge can be, and is, developed at the bedside. The connection between Emory University and Edith Honeycutt demonstrates an enduring link between a university setting and a practice arena.

Georgia↗
PubMed2000

Interinstitutional study to compare the effectiveness of a radiology-anatomy module of instruction.

RATIONALE AND OBJECTIVES: The purpose of this study was to validate the effectiveness of a proven radiology-anatomy instructional module during I st-year gross anatomy courses at Emory University College of Medicine and the University of Iowa College of Medicine. MATERIALS AND METHODS: This prospective study involved 108 Emory students and 177 Iowa students. The instructional content was the same at both institutions. Each student was randomly assigned into one of three groups at each institution, and each group received a unique, randomized, five-item pretest. All students were posttested as part of their gross anatomy laboratory examination, and the posttests consisted of all 15 items used in the three five-item pretests. RESULTS: No statistically significant pretest effects were demonstrated by t tests. Posttest performances across items ranged from 73% to 96% correct for Emory students and 67% to 98% for Iowa students. Performance levels on the posttests were significantly higher than on pretests, and few significant differences were found in the performance of the two populations. CONCLUSION: The radiology-anatomy instructional module integrated into the gross anatomy courses for 1st-year Emory University and University of Iowa students was not instructor or institution dependent.

Anatomy↗
PubMed1978

Physicians' assistants on a university cardiothoracic surgical service. A five-year update.

In 1973 two physicans' assistants (P.A.'s) were employed on a cardiothoracic surgical service at Emory University Hospital. In 1974 our initial experience with these paramedical personnel was presented to this Association. Since that time eight additional P.A.'s have been added to our service. They are now employed in four hospitals of the Emory University Woodruff Medical Center. New guidelines and regulations have been imposed at both the state and federal levels regarding P.A.'s, and their role in our center has become rather well defined. With over 1,700 cardiac cases and 600 thoracic cases per year to cover on our service, the P.A. has assumed a position of increasing importance both in operating room assistance and in preoperative and postoperative care. Since the university has maintained a constant number of residents and fellows during this interval, P.A.'s have filled needs of expanded clinical service in the various hospitals. In the pediatric and community hospitals associated with a university, the P.A. now functions as a junior house officer. In our university center, with a large resident staff, their role has become narrowed with definite guidelines. A Credentials Committee now governs the hiring of all P.A.'s by the University. When properly utilized and supervised, the P.A. can be a vital member of the cardiothoracic team. This report details our experience with P.A.'s for the past 5 years--culminating in a staff of ten P.A.'s working on our service in four types of hospitals within our university medical center.

Georgia↗
PubMed2000

Stroke after coronary artery operation: incidence, correlates, outcome, and cost.

BACKGROUND: Stroke is a major complication of coronary operation, with reported rates of postoperative cerebral dysfunction ranging from 0.4% to 13.8%. In this report, the incidence, correlates, outcomes, and costs of stroke in coronary operation were evaluated at Emory University between 1988 and 1996. METHODS: Data were entered prospectively into a dedicated computerized database at Emory University and analyzed retrospectively. Univariate and multivariate analyses were utilized where appropriate. RESULTS: Data from 10,860 patients undergoing primary coronary operation between 1988 and 1996 were analyzed. There were 250 patients not entered into the database. Stroke occurred in 244 (2.2%). Univariate predictors of stroke (p<0.05) included age, female gender, hypertension, diabetes, prior stroke, prior transient ischemic attack (TIA), and carotid bruits. Multivariate correlates included age (odds ratio 1.07) previous TIA (odds ratio 2.2), and carotid bruits (odds ratio 1.9), although the area under the Receiver Operating Characteristics (ROC) curve was only 0.69, suggesting limited ability to predict stroke. One and 5 year survival rates were 64% and 44% with stroke, and 94% and 81% without stroke, respectively. Among the stroke group, 23% of the patient population died before hospital discharge. The stroke group had a significantly longer length of hospital stay, as well as higher costs. CONCLUSIONS: Stroke is a devastating complication of coronary operation, significantly increasing morbidity, mortality, and cost. Three independent variables were identified for predicting stroke, including age, previous TIA, and carotid bruits. Patients should be carefully screened for cerebrovascular disease to help prevent stroke and its associated morbidity.

Cardiopulmonary Bypass↗
PubMed1993

Coronary surgery and coronary angioplasty in patients with two-vessel coronary artery disease.

There is uncertainty regarding the selection between coronary artery surgery and angioplasty in many patients with coronary artery disease, especially in those with 2-vessel disease. Whereas randomized trials will provide the best possible and most detailed data comparing therapy in these patients, clinical data bases may be used to provide a current perspective. The purpose of this study was to compare the long-term outcome of patients with 2-vessel coronary artery disease undergoing coronary surgery or angioplasty at Emory University hospitals in the years 1984 and 1985. Data on all patients with 2-vessel disease diagnosed at Emory University who underwent elective angioplasty or coronary surgery in the years 1984 and 1985 were compared. Categoric variables were analyzed by chi-square and continuous variables by unpaired t test. Survival was determined by the Kaplan-Meier method and differences in survival by the Mantel-Cox method. Determinants of survival were determined by Cox model analysis. There were 415 angioplasty patients and 454 surgical patients. Surgical patients were older and had more frequent systemic hypertension, diabetes mellitus, prior myocardial infarction, severe angina and congestive failure, and more significant narrowing in the left anterior descending coronary artery, totally occluded vessels and left ventricular dysfunction than did angioplasty patients. Complete revascularization was achieved more often in surgical patients. There was no difference in Q-wave myocardial infarction in the hospital. No angioplasty patient died compared with 1.1% of surgical patients (p = 0.03). Whereas 5-year survival was 93% in angioplasty patients and 89% in surgical patients (p = 0.11), there was no difference in risk-adjusted survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗