The Ochsner journal
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The Ochsner journal · Jan 2014
ReviewClinical decision support alert appropriateness: a review and proposal for improvement.
Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. ⋯ The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety.
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Acute kidney injury (AKI) is frequently encountered in the nephrology practice. Serum creatinine, with its many shortcomings, is still the main biomarker used to detect AKI. ⋯ Despite major advances in AKI research, serum creatinine remains the major biomarker for the detection of AKI. The following interventions have shown to be beneficial: IV fluids for contrast-induced AKI; diuretics for acute decompensated heart failure/cardiorenal syndrome; and combination therapy with midodrine, octreotide, and albumin for hepatorenal syndrome. Fluid resuscitation in a patient with AKI should be used with caution because too liberal use of fluids can be associated with increased mortality. AKI appears to be related to increased rates of subsequent chronic kidney disease, and patients with AKI should therefore be monitored closely. Recent studies on renal replacement therapy have neither revealed an optimal timing for initiation of dialysis nor a clear advantage for a specific dialysis modality.
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The Ochsner journal · Jan 2014
Urgent cesarean section in a patient with a spinal cord stimulator: implications for surgery and anesthesia.
Spinal cord stimulation used in the treatment of chronic pain is offered to women of child-bearing age. This practice warrants special consideration on the part of the obstetricians and anesthesiologists charged with their care. ⋯ Accepted approaches to managing labor and delivery-such as neuraxial anesthesia and analgesia-need not be denied patients with spinal cord stimulators. Whenever possible, however, the pain specialist should communicate the specific characteristics of the implanted device to the team who will manage the patient in the peripartal period.
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The Ochsner journal · Jan 2014
Analgesic efficacy and technique of ultrasound-guided suprascapular nerve catheters after shoulder arthroscopy.
Conventional approaches to brachial plexus blocks may not cover the suprascapular nerve. Accordingly, after shoulder arthroscopy, sensation from the posterior part of the shoulder is commonly spared. Most previous research involving suprascapular nerve blocks described single-injection techniques. However, with the widespread availability and fairly reasonable cost of disposable infusion pumps, continuous catheter techniques provide a more appealing method of prolonging postoperative analgesia. ⋯ Continuous suprascapular catheter techniques provide good pain relief and improve postoperative analgesia after shoulder arthroscopy.