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
Intraoperative and Postoperative Blood Glucose Concentrations in Diabetic Surgical Patients Receiving Lactated Ringer's Versus Normal Saline: A Retrospective Review of Medical Records.
Hyperglycemia is associated with poor postoperative outcomes after carotid endarterectomy. This retrospective study examined the effect of lactated Ringer's and normal saline solutions on intraoperative blood glucose control in diabetic patients undergoing carotid endarterectomy. ⋯ Lactated Ringer's solution does not appear to cause a significant change in the mean blood glucose levels in diabetic patients undergoing carotid endarterectomy compared to patients receiving normal saline. Randomized controlled trials are needed to further determine whether lactated Ringer's solution adversely affects glucose control in diabetic surgical patients.
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The Ochsner journal · Jan 2014
Interlaminar epidural steroid injection for degenerative lumbar spinal canal stenosis: does the intervertebral level of performance matter?
Interlaminar epidural steroid injections (ILESIs) are commonly employed in the management of patients with symptomatic degenerative lumbar spinal canal stenosis despite little experimental evidence to guide technique optimization. One untested performance parameter is the intervertebral level at which the ILESI should be performed for maximum patient relief. ⋯ Results suggest that patient symptom improvement is optimized when the ILESI is performed at the intervertebral level of maximal stenosis.
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The Ochsner journal · Jan 2014
Midline minimally invasive placement of spinal cord stimulators: a technical note.
Spinal cord stimulators (SCSs) have conventionally been implanted through open approaches requiring extensive muscle dissection to perform laminectomies and permanently place the paddle lead. This approach could contribute to worsening the pain syndrome in patients who experience chronic pain. In an attempt to reduce operative times, minimize blood loss and postoperative pain, and ease the technical challenges of placing the paddle lead in the midline via a paramedian and off-midline incision, we designed a new minimally invasive surgery (MIS) technique to place the paddle lead using a tubular retractor system through a true midline approach. ⋯ Our technique is safe and effective and carries minimal surgical morbidity compared to standard open techniques for placement of SCSs.