Medical Center of Central Georgia

About: Medical Center of Central Georgia is a healthcare organization based out in Macon, Georgia, United States. It is known for research contribution in the topics: Health care & Vasodilation. The organization has 187 authors who have published 223 publications receiving 4114 citations.

Stenting and angioplasty with protection in patients at high-risk for endarterectomy: SAPPHIRE Worldwide Registry first 2,001 patients

Abstract: Background Previously, the Stenting and Angioplasty with Protection of Patients with High Risk for Endarterectomy (SAPPHIRE) randomized trial showed that carotid artery stenting (CAS) was not inferior to carotid endarterectomy (CEA) in the treatment of high-surgical risk patients Objective The primary objective of the SAPPHIRE Worldwide Registry is to evaluate 30-day major adverse events (MAE) after CAS performed by physicians with varied experience and utilizing a formal training program Data will be analyzed on the overall patient population and by high-risk inclusion criteria Methods SAPPHIRE Worldwide is a multicenter, prospective, postapproval registry to evaluate CAS with distal protection in patients at high-risk for surgery using the Cordis PRECISE Nitinol Stent and ANGIOGUARD™ XP/RX Emboli Capture Guidewire Participating physicians are encouraged to treat patients according to their standard of practice and consistent with current Food and Drug Administration-approved labeling Results Enrollment began in October 2006 Data are available on the first 2,001 patients enrolled and followed to 30 days Of these patients, the mean age was 722 ± 975 yr; 62% were male; and 277% were symptomatic Entry criteria for surgical high-risk included anatomic (n = 716), physiologic (n = 918), or both risk factors (n = 327) At 30-day follow-up, the MAE was 44% (death 11%, stroke 32%, MI 07%) for the overall population Patients with anatomic risk had a significantly lower 30-day MAE than patients with physiologic risk (28% vs 49%, P = 00306), respectively Conclusions While the number of physicians performing CAS continues to increase, MAE rates seen in this registry (44%) are well within an acceptable range, as was first seen in the SAPPHIRE randomized trial (48%) A significant decrease in MAE was seen in patients with anatomic risk compared with physiologic risk factors The SAPPHIRE Worldwide Registry supports the use of CAS as an alternative to CEA in patients who are at high-risk for surgery due to anatomic risk factors © 2008 Wiley-Liss, Inc

Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.

Abstract: Cervical spine (C-spine) collar clearance or removal is well established for the alert patient with or without symptoms; 1,2 however, for the obtunded adult blunt trauma patient, it is unclear whether primary screening with computed tomography (CT) is sufficient or whether a second diagnostic adjunct is required.3 The imprecise and possible overly broad interpretation of the word obtunded along with continual advances in imaging technology confound the decision to remove the cervical collar after blunt traumatic injury. Despite the multispecialty impact that a guideline directing efficient cervical collar clearance in the obtunded adult blunt trauma patient would have, there is no consensus recommendation available. With the use of the framework advocated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group,4–6 our aims were to perform a systematic review and to develop evidence-based recommendations that might be used to direct decision making in the removal of a cervical collar from the adult obtunded blunt trauma patient.

Toward a structure of preschool temperament: factor structure of the temperament assessment battery for children.

Abstract: Much of the research and thinking in the area of childhood temperament has been guided by the structural and measurement model of Thomas, Chess, and colleagues. Recently, researchers have called into question this structural conception and have explored the factor structure of the instruments based on the Thomas and Chess model. A review of the literature indicates that there are few studies at any one age level, and that much of the research is limited by small samples. The results of a large sample factor analysis of parent and teacher ratings of preschool children are reported. A five-factor solution was judged most appropriate for parent ratings, and a three-factor solution seemed most appropriate for teacher ratings. Relations of these factors to the Big Five personality factors found in adult personality research are discussed.

Bacteremic urinary tract infection in older people

Abstract: OBJECTIVES: To describe patients with bacteremic urinary tract infections, compare characteristics of young and older patients, and suggest appropriate empiric antibiotic therapy for this clinical condition. DESIGN: Case series, with an observation period of 3 years. SETTING: A large southeastern community hospital. PARTICIPANTS: One hundred eighty patients more than 18 years old (101 older than age 65) with urine and blood cultures simultaneously positive for bacterial organisms. MEASUREMENTS: Chart review-determined demographic characteristics, clinical data, bacterial organism and antibiotic susceptibility, number of medical diagnoses, use of a urinary catheter, admission source, and mortality. RESULTS: The 180 patients experienced bacteremias caused by 183 bacterial organisms. Sixty-one patients were aged 65 to 79 years, and 40 were 80 years of age or older; 63.9% of patients were female; 62.2% were black. Gram-negative organisms accounted for 80.3% of bacterial isolates, with Escherichia coli accounting for 54.1% of cases. Gram-positive organisms accounted for 19.7% of isolates, including Staphylococcus aureus (13.1%) and Enterococcus (5.5%). Older patients had a distribution of Gram-positive and Gram-negative organisms similar to that of younger patients. Men and patients with chronic urinary catheters had higher proportions of Gram-positive organisms and non-E. coli Gram-negative rods. Organisms showed excellent susceptibilities to commonly used antibiotics. In-hospital mortality was 16.1%, with higher mortality in patients with chronic urinary catheters, in patients who were admitted from nursing homes, and when a Gram-positive organism was identified. Advanced age was not associated with higher mortality. CONCLUSIONS: Concomitant illness and especially the use of urethral catheters, but not advanced age itself, are associated with a higher mortality from bacteremic urinary tract infection. Single agent empiric antimicrobial therapy such as ceftriaxone may be appropriate in older patients with presumed urosepsis, except in catheterized patients or those with other risk factors for Gram-positive or resistant Gram-negative infections. J Am Geriatr Soc 44:927–933, 1996.