Ochsner Journal最新文献_第6页

HEART Score Agreement Between Attending and Resident Emergency Medicine Physicians for Patients With Potential Acute Coronary Syndrome. 潜在急性冠脉综合征患者的主治医师和住院急诊医师的心脏评分一致性

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0108

Joel C Mosley, Greggory R Davis, Michael H Truax

{"title":"HEART Score Agreement Between Attending and Resident Emergency Medicine Physicians for Patients With Potential Acute Coronary Syndrome.","authors":"Joel C Mosley, Greggory R Davis, Michael H Truax","doi":"10.31486/toj.24.0108","DOIUrl":"10.31486/toj.24.0108","url":null,"abstract":"Background: Chest pain in the emergency department requires swift diagnosis to distinguish between acute coronary syndrome and noncardiac causes. The use of the HEART score, which risk-stratifies patients based on history, electrocardiogram, age, risk factors, and troponin, reduces unnecessary admissions and costs. However, evaluations by resident physicians supervised by attending physicians can delay treatment and increase costs.Methods: We assessed interrater reliability between attending physician and resident physician HEART scores in 2 study phases. In phase 1, participants were not provided with a standardized form, but in phase 2, participants used a standardized form to calculate HEART scores. Differences in scores were compared by years of experience and by study phase.Results: A total of 75 HEART score comparisons were analyzed. Fifty comparisons between attending physicians and resident physicians were completed in phase 1, and 25 comparisons were completed in phase 2. Discrepancies between attending and resident physician scores ≤3 vs >3 decreased from 24% in phase 1 to 8% in phase 2. Attending physician years of experience did not affect discrepancies in HEART scores ≤3 vs >3 between attending and resident physicians (odds ratio [OR] 1.18 [95% CI 0.78 to 1.81]). Similarly, resident physician years of experience did not affect differences in HEART scores ≤3 vs >3 between attending and resident physicians (OR 0.77 [95% CI 0.38 to 1.53]).Conclusion: The study found good agreement between attending physician and resident physician HEART scores, with experience level not significantly affecting discrepancies. The standardized scoring form improved consistency, although not significantly.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"77-84"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reduction in Opioid Requirements Following Changes to Regional Anesthesia for Patients Undergoing Total Knee Arthroplasty. 全膝关节置换术患者改变区域麻醉后阿片类药物需求的减少。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0137

Jeffrey Mauras, Michael McMahon, Jaudé Petrie, Ryan Roubion, Amy Bronstone, Claudia Leonardi, Vinod Dasa

{"title":"Reduction in Opioid Requirements Following Changes to Regional Anesthesia for Patients Undergoing Total Knee Arthroplasty.","authors":"Jeffrey Mauras, Michael McMahon, Jaudé Petrie, Ryan Roubion, Amy Bronstone, Claudia Leonardi, Vinod Dasa","doi":"10.31486/toj.24.0137","DOIUrl":"10.31486/toj.24.0137","url":null,"abstract":"Background: Newer analgesic techniques to reduce opioid use and pain after total knee arthroplasty (TKA) include preoperative cryoneurolysis, adductor canal block (ACB), and local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block. The purpose of this study was to evaluate whether changing the regional analgesic from ropivacaine to liposomal bupivacaine would provide superior pain relief and reduce opioid requirements at 2 and 12 weeks following TKA.Methods: We conducted a retrospective medical records review of 140 consecutive patients who underwent primary TKA at a single site and received ACB with ropivacaine (multimodal-ropivacaine [MM-R] group, n=70) or ACB/iPACK with liposomal bupivacaine (multimodal-liposomal bupivacaine [MM-LB] group, n=70). The primary outcomes were the morphine milligram equivalent (MME) of filled opioid prescriptions at discharge and during the first 12 weeks after TKA, as well as the Knee injury and Osteoarthritis Outcome Score and the Patient-Reported Outcomes Measurement Information System pain intensity and pain interference scores at 2 and 12 weeks postsurgery.Results: The median MMEs for discharge opioid prescriptions and all opioid prescriptions were, respectively, 65% (P<0.0001) and 48% (P<0.0001) lower for patients in the MM-LB group vs the MM-R group. The MM-LB group had significantly better patient-reported outcomes 2 weeks after TKA compared to the MM-R group.Conclusion: Compared with ropivacaine-based regional analgesia, liposomal bupivacaine-based regional analgesia in the context of a modern multimodal pain regimen may reduce opioid requirements and improve patient-reported outcomes during acute and short-term recovery after TKA.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"99-106"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Partnering With Schools for Community-Based Health Interventions: How Educating Children Improves Hypertension Awareness. 与学校合作开展社区卫生干预：如何教育儿童提高对高血压的认识。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0099

Jennifer Hundley, Kristine Olson, Cherylann Rocha, Margaret K Wallace, Grace Smith, Katharina Martin, Micheal Crane, Ralph D'Agostino, Amy Ladd, Sangeeta Shah

{"title":"Partnering With Schools for Community-Based Health Interventions: How Educating Children Improves Hypertension Awareness.","authors":"Jennifer Hundley, Kristine Olson, Cherylann Rocha, Margaret K Wallace, Grace Smith, Katharina Martin, Micheal Crane, Ralph D'Agostino, Amy Ladd, Sangeeta Shah","doi":"10.31486/toj.24.0099","DOIUrl":"10.31486/toj.24.0099","url":null,"abstract":"Background: More than 16,000 Virginians die of cardiovascular disease each year, with increased morbidity among Black and low-income adults. Hypertension (HTN) is the most modifiable cardiovascular disease risk factor. A community-based health intervention administered in partnership with schools may increase HTN awareness and reduce the development of unhealthy practices.Methods: Elementary school students (n=52) attending a majority Black and low-income school participated in an educational intervention program called Teach BP that is designed to increase HTN awareness across 4 topics: knowledge of blood pressure (BP) and HTN, organ systems impacted by HTN, habits to maintain a healthy BP, and competency in operating a BP monitor.Results: Students' ability to define and recognize HTN increased by an average of 62.7%. Their awareness of how HTN affects the body increased by an average of 92.1%. Additionally, students demonstrated competency in operating a BP monitor.Conclusion: The Teach BP program was effective at increasing students' awareness of HTN.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"34-43"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

ERRATUM. 勘误表。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.5054

引用次数: 0

Use of a Novel Training Aid for Teaching the Nursing Care of Central Venous Catheters. 一种新型辅助训练设备在中心静脉置管护理教学中的应用。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0042

Michael D Smith, Christie Poindexter, Ashlee Ellington, Richard Guthrie

{"title":"Use of a Novel Training Aid for Teaching the Nursing Care of Central Venous Catheters.","authors":"Michael D Smith, Christie Poindexter, Ashlee Ellington, Richard Guthrie","doi":"10.31486/toj.25.0042","DOIUrl":"10.31486/toj.25.0042","url":null,"abstract":"Background: The occurrence of central venous catheter infections is a metric that hospital systems track. We determined that central line-associated bloodstream infections (CLABSIs) at our institution occurred in a delayed fashion, prompting us to raise the question of whether the infections were related to insertion or to catheter care and then to design a training simulation focused on how to change the dressing for central venous catheters.Methods: Using low-cost equipment, such as refrigerator magnets and tape, we constructed a reusable SorbaView SHIELD Contour (Centurion Medical Products Corporation) sterile central line dressing for use in training.Results: This cost-effective simulation innovation gives staff who care for central venous catheters the opportunity to practice the manual skills involved in dressing changes and eliminates the problem of expending a single-use dressing with each learner experience. The magnetic dressings can be reused as long as the integrity of the SorbaView SHIELD Contour is preserved.Conclusion: We hope that ongoing training with this simulation model, along with demonstration of competency, will result in standardized central line care and a decrease in CLABSI rates at our institution.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"248-253"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Potential Role of Zilretta in Reducing Intra-Articular Effusions. Zilretta在减少关节内积液中的潜在作用。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0027

Kyle Maloney, Taylor Colon

{"title":"The Potential Role of Zilretta in Reducing Intra-Articular Effusions.","authors":"Kyle Maloney, Taylor Colon","doi":"10.31486/toj.25.0027","DOIUrl":"10.31486/toj.25.0027","url":null,"abstract":"Background: Osteoarthritis pain results from articular cartilage degeneration that leads to the breakdown and ulceration of the joint surface accompanied by hypertrophic bone changes with osteophyte formation. Steroids are commonly used to treat osteoarthritis pain.Case report: An 81-year-old female with a medical history of bilateral knee osteoarthritis presented to the outpatient physical medicine and rehabilitation clinic for management of chronic bilateral knee pain and effusion. The patient had historically been managed with short-acting steroids, viscosupplementation, and deep genicular radiofrequency ablation. After changing providers, the patient underwent a series of image-guided intra-articular injections with the steroids Kenalog (triamcinolone) and Zilretta (triamcinolone acetonide extended-release injectable suspension) and was also treated with Monovisc (hyaluronic acid viscosupplementation). In addition, the patient underwent cryoneurolysis treatment (iovera° [Pacira BioSciences, Inc]). Injections were administered bilaterally when indicated, while cryoneurolysis was limited to the left knee. A substantial reduction in aspirated effusion volume was observed following Zilretta injections, with 92.6% and 88.1% reductions in aspirate volume in the patient's left and right knees, respectively.Conclusion: Steroids have anti-inflammatory properties that reduce pain and improve function in patients with osteoarthritis, but steroid use for chronic effusion management also needs to be considered. Given our patient's knee effusion reduction after Zilretta injection, research is needed to confirm the ability of Zilretta to effectively reduce chronic effusion.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"275-278"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Privilege of Advancing Knowledge. 推进知识的特权。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.5055

Ronald G Amedee

引用次数: 0

Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome Coexisting With JAK2-Positive Polycythemia Vera and Myelofibrosis. 小脑共济失调伴神经病变和双侧前庭反射综合征与JAK2阳性多发性红细胞增多症和骨髓纤维化并存

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0056

Jayaram Saibaba, Jayachandran Selvaraj, Stalin Viswanathan, Vivekanandan Pillai

{"title":"Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome Coexisting With JAK2-Positive Polycythemia Vera and Myelofibrosis.","authors":"Jayaram Saibaba, Jayachandran Selvaraj, Stalin Viswanathan, Vivekanandan Pillai","doi":"10.31486/toj.24.0056","DOIUrl":"10.31486/toj.24.0056","url":null,"abstract":"Background: Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a rare, progressive, neurodegenerative disorder characterized by late-onset ataxia, bilateral vestibular impairment, and sensory neuropathy.Case report: A 51-year-old male presented to the hospital with worsening dizziness, tremulousness of limbs, and falls during the preceding year. The patient experienced gradually progressive sensorimotor lower motor neuron quadriparesis, asymmetric ataxia, chronic pancerebellar dysfunction, oscillopsia, and impaired vestibulo-ocular reflex. His comorbidities included poorly controlled type 2 diabetes mellitus, chronic alcohol use, and thalidomide therapy for polycythemia vera with myelofibrosis. Diagnostic workup revealed sensory axonal neuropathy, hypercellular bone marrow with myelofibrosis, and utriculo-saccular dysfunction. Diabetes and thalidomide- and alcohol-related complications were presumed to be the reason for the patient's symptoms, but investigations revealed a diagnosis of CANVAS coexisting with polycythemia vera. The patient was treated with rehabilitation exercises and medications that slightly improved but did not resolve his symptoms. More than 1 year after the patient's last follow-up, a physician at another hospital discontinued the thalidomide prescription because of the patient's neuropathy. Two months later, the patient developed febrile neutropenia and died of pneumonia and sepsis.Conclusion: To our knowledge, CANVAS coexisting with polycythemia vera has only been reported once in the literature. The significance of this coexistence is not clear. Future case studies may help elucidate a link between these two entities.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"50-53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the Role of the Jaw Thrust Maneuver During Tracheal Intubation in Reducing the Incidence of Postoperative Sore Throat: A Prospective Randomized Study. 评估气管插管过程中的下颌推举动作在降低术后咽喉痛发生率方面的作用：前瞻性随机研究

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0072

Dipti Saxena, Arohi Rathore, Pallavi Jain, Anuj Jain, Swapnil Kumar Barasker

{"title":"Evaluating the Role of the Jaw Thrust Maneuver During Tracheal Intubation in Reducing the Incidence of Postoperative Sore Throat: A Prospective Randomized Study.","authors":"Dipti Saxena, Arohi Rathore, Pallavi Jain, Anuj Jain, Swapnil Kumar Barasker","doi":"10.31486/toj.24.0072","DOIUrl":"10.31486/toj.24.0072","url":null,"abstract":"Background: Endotracheal intubation is commonly associated with postoperative sore throat. We evaluated the effect of the jaw thrust maneuver on the incidence and severity of sore throat.Methods: A total of 110 female patients undergoing laparoscopic abdominal procedures were enrolled in the study, and 99 patients were included in the final analysis. The patients were randomized into 2 groups: the jaw thrust group (n=49) and the non-jaw thrust group (n=50). Sore throat monitoring and grading were performed at 0, 2, 4, 8, 12, and 24 hours postextubation.Results: The overall incidence of sore throat was higher in the non-jaw thrust group than in the jaw thrust group, with a maximum incidence at 4 hours, and the difference in incidence between the 2 groups was significant at the 4-, 8-, 12-, and 24-hour time points postextubation. However, no significant difference in sore throat severity was found between the non-jaw thrust and jaw thrust groups. The time of laryngoscopy was significantly less for patients in the jaw thrust group.Conclusion: In our population, the jaw thrust maneuver lowered the incidence but not the severity of sore throat during the initial 24 hours after extubation. The jaw thrust maneuver also significantly lowered laryngoscopy time.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"17-23"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Low Unintended Dural Puncture Rate Using a Flush-Measure-Check-Advance Technique to Perform Combined Spinal-Epidural Anesthesia in Parturients: A Quality Improvement Clinical Series. 使用冲洗-测量-检查-提前技术对产妇进行脊髓-硬膜外联合麻醉的低意外硬膜穿刺率：质量改善临床系列。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0133

James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton

{"title":"Low Unintended Dural Puncture Rate Using a Flush-Measure-Check-Advance Technique to Perform Combined Spinal-Epidural Anesthesia in Parturients: A Quality Improvement Clinical Series.","authors":"James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton","doi":"10.31486/toj.24.0133","DOIUrl":"10.31486/toj.24.0133","url":null,"abstract":"Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s.Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm.Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) needle during 2 CSEAs. In 19 parturients, the initial spinal anesthesia portion of CSEA failed, prompting conversion to CEA in 18 parturients and to spinal anesthesia in 1 parturient.Conclusion: The use of a flush-measure-check-advance Tuohy needle insertion algorithm to reduce the likelihood of unintended dural puncture during performance of CSEA in parturients deserves further study.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"187-195"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0