Ochsner Journal最新文献_第7页

Comparative Analysis of Ultrasound-Guided Pain Management Approaches for Sternotomy in Cardiac Surgeries-Transversus Thoracic Muscle Plane Block vs Pecto-Intercostal Fascial Block. 超声引导胸骨切开术疼痛管理方法的比较分析——胸经肌平面阻滞与胸肋间筋膜阻滞。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0052

Hemant Vanjare, Chetana Prakash Deshmukh, Swapnil Kumar Barasker, Akheela Mohamed Kassim, Bipin Arya

{"title":"Comparative Analysis of Ultrasound-Guided Pain Management Approaches for Sternotomy in Cardiac Surgeries-Transversus Thoracic Muscle Plane Block vs Pecto-Intercostal Fascial Block.","authors":"Hemant Vanjare, Chetana Prakash Deshmukh, Swapnil Kumar Barasker, Akheela Mohamed Kassim, Bipin Arya","doi":"10.31486/toj.24.0052","DOIUrl":"10.31486/toj.24.0052","url":null,"abstract":"Background: Pain management after sternotomy in cardiac surgery is vital for recovery. Opioids are commonly used, but they carry risk. Central neuraxial techniques and nerve blocks are options for a multimodality approach. Fascial plane blocks such as the transversus thoracic muscle plane block (TTMPB) and the pecto-intercostal fascial block (PIFB) are a relatively new way to relieve pain, and their popularity has increased with the use of ultrasound for precise anatomic visualization. Because the effectiveness of both blocks is similar, we conducted this study to compare the pain management of the TTMPB and the PIFB after sternotomy in cardiac surgery.Methods: This randomized double-blind study included 118 patients who underwent cardiac surgery. In the TTMPB group (n=59), 20 mL of 0.2% ropivacaine was injected bilaterally using ultrasound assistance in the transversus thoracic plane. In the PIFB group (n=59), 20 mL of 0.2% ropivacaine was injected in the pecto-intercostal plane. Study outcomes were opioid consumption in the first 24 hours and pain scores at 0, 3, 6, 12, and 24 hours postoperatively.Results: Patient characteristics in the 2 groups were similar. Opioid consumption was similar in both groups (P=0.672), and we found no difference in pain scores between the 2 groups at any of the time intervals.Conclusion: The TTMPB and the PIFB were similarly effective in treating acute poststernotomy pain in our patient population.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"11-16"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694104","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

Enhancing Physician Satisfaction and Patient Safety Through an Artificial Intelligence-Driven Scheduling System in Anesthesiology. 通过人工智能驱动的麻醉科排班系统提高医生满意度和患者安全。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0104

William D Sumrall, Jakob V Oury, George M Gilly

{"title":"Enhancing Physician Satisfaction and Patient Safety Through an Artificial Intelligence-Driven Scheduling System in Anesthesiology.","authors":"William D Sumrall, Jakob V Oury, George M Gilly","doi":"10.31486/toj.24.0104","DOIUrl":"10.31486/toj.24.0104","url":null,"abstract":"Background: Overcoming challenges to effective clinical practice depends on finding dynamic solutions to issues such as physician burnout and patient safety. This study evaluated the impact of an artificial intelligence (AI)-driven scheduling system on physician burnout and patient safety, using intraoperative transitions of care as an operative metric for patient safety.Methods: In May 2019, the Department of Anesthesiology at Ochsner Health in New Orleans, Louisiana, implemented an AI-driven scheduling system called Lightning Bolt Scheduling (PerfectServe, Inc). Utilizing an idealized design framework, the department steering committee analyzed 12 months of historic operating room data and developed more than 400 scheduling rules to optimize staffing. The scheduling rules, representing the steering committee's new work model, were provided as inputs into Lightning Bolt Scheduling, which then used combinatorial optimization to recommend an ideal staff schedule. Preimplementation and postimplementation data were collected on physician satisfaction, vacation approval rates, and intraoperative transitions of care.Results: Six months postimplementation, physician satisfaction scores and vacation approvals increased, reflecting improved work-life balance, schedule flexibility, and decreased symptoms of burnout. Additionally, 1,072 fewer handoffs occurred, equating to 71.5 fewer adverse events and a savings of approximately $335,550 in health care costs during the 21 months after implementation.Conclusion: Our study findings underscore the potential of data-driven scheduling systems to enhance physician well-being and patient safety, thereby promoting continuous improvement and adaptability in health care operations.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"44-49"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694109","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

HeartMate 3 Left Ventricular Assist Device Implantation in a Pediatric Patient With Limb-Girdle Muscular Dystrophy. 心脏伴侣3型左心室辅助装置植入在小儿肢带肌萎缩症患者中的应用。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0109

Christopher M Zumwalt, Katerina Boucek, Dennis A Wells

{"title":"HeartMate 3 Left Ventricular Assist Device Implantation in a Pediatric Patient With Limb-Girdle Muscular Dystrophy.","authors":"Christopher M Zumwalt, Katerina Boucek, Dennis A Wells","doi":"10.31486/toj.24.0109","DOIUrl":"10.31486/toj.24.0109","url":null,"abstract":"Background: The development of cardiac complications is common in patients with muscular dystrophy. However, advanced heart failure therapies such as implantation of durable ventricular assist devices and transplant are infrequently used in patients who develop cardiomyopathy, often because of comorbid impairments in mobility and respiratory function.Case report: A 16-year-old male with limb-girdle muscular dystrophy type R4 presented with chronic decompensated heart failure. Recent worsening of his respiratory function and mobility were confounded by severe heart failure. In addition to our core advanced heart failure team, multidisciplinary assessment preoperatively included Neurology, Pulmonology, Genetics, and Physical Medicine and Rehabilitation. The patient underwent implantation of a HeartMate 3 left ventricular assist device and had an uneventful postoperative course. After intensive inpatient physical and occupational therapy, he was discharged home on postoperative day 16 with minimal residual heart failure symptoms and plans to continue robust outpatient physical therapy.Conclusion: Patients with muscular dystrophy often have cardiac involvement; however, certain subtypes of muscular dystrophy are associated with an earlier presentation of severe life-limiting cardiomyopathy. Pediatric patients with muscular dystrophy should be considered for advanced heart failure therapies such as implantation of a durable left ventricular assist device at an appropriate center. Carefully selected patients may experience substantial improvements in their quality of life. Given the variable disease progression and life expectancy of patients with subtypes of muscular dystrophy, a thorough assessment by a multidisciplinary team is critical.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"116-118"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334158","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

Rectal Administration of Carbidopa/Levodopa. 直肠给药卡比多巴/左旋多巴。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0103

Andrew Guthrie, Joshua King, Ashley Casey

引用次数: 0

Reading Between the Striatal Lines: Magnetic Resonance Imaging Insights Into Huntington Disease. 纹状体之间的阅读：亨廷顿病的磁共振成像洞察。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0052

Robert Boothe, David J Houghton, James Milburn

引用次数: 0

Effect of Statin Potency on Rapid Coronary Intimal Thickening and Rejection in Heart Transplant Recipients. 他汀类药物对心脏移植受者冠状动脉内膜快速增厚和排斥反应的影响。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0053

Alyssa Stutes, Steven Quoc Thai, Brooke Baetz, Cruz Velasco-Gonzalez, Selim Krim

{"title":"Effect of Statin Potency on Rapid Coronary Intimal Thickening and Rejection in Heart Transplant Recipients.","authors":"Alyssa Stutes, Steven Quoc Thai, Brooke Baetz, Cruz Velasco-Gonzalez, Selim Krim","doi":"10.31486/toj.25.0053","DOIUrl":"10.31486/toj.25.0053","url":null,"abstract":"Background: Statins help prevent cardiac allograft vasculopathy (CAV) and rejection in heart transplant recipients. Whether these adverse outcomes can be further attenuated with higher potency statins is unknown.Methods: In this single-center, retrospective study, we compared outcomes of heart transplant patients who received either a higher dose statin (HDS) or a lower dose statin (LDS) at discharge after transplant. Exclusion criteria were age <18 years old, not prescribed a statin, and any of the following within 1 year: death, loss to follow-up, or incomplete data to determine the primary outcome. The primary outcome was CAV at 1 year, defined as International Society for Heart and Lung Transplantation CAV grade ≥1 on angiography or intravascular ultrasound demonstrating rapid coronary intimal thickening (0.5-mm increase in coronary maximal intimal thickness at 1 year). Secondary outcomes were biopsy-proven acute rejection, treated rejection, hemodynamically unstable rejection, and adverse effects.Results: The study population consisted of 81 patients in the HDS group and 103 patients in the LDS group. The incidence of CAV was not different in the HDS vs LDS group (32.1% vs 31.1%, respectively; P=0.881) despite less biopsy-proven acute rejection (2.5% vs 12.6%, respectively; P=0.013) and less treated rejection (2.5% vs 17.5%, respectively; P=0.001) in the HDS group. All other secondary outcomes were similar between groups.Conclusion: Increasing statin intensity in heart transplant patients appears to be safe and may reduce rejection but did not attenuate CAV at 1 year in our population.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"241-247"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769612","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

Ischemic Necrosis of the Gastric Remnant 42 Years After Bariatric Surgery. 减肥手术后42年残胃缺血性坏死。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0031

Natalie L Whitfield, Kyle J Hoffman

{"title":"Ischemic Necrosis of the Gastric Remnant 42 Years After Bariatric Surgery.","authors":"Natalie L Whitfield, Kyle J Hoffman","doi":"10.31486/toj.25.0031","DOIUrl":"10.31486/toj.25.0031","url":null,"abstract":"Background: Ischemic necrosis of the gastric remnant following Roux-en-Y gastric bypass (RYGB) surgery is a rare but life-threatening complication. The etiology remains poorly understood, and delayed presentation can result in poor outcomes. Prompt recognition and intervention are critical, particularly in patients with a remote history of bariatric surgery.Case report: A 78-year-old male (body mass index 28.73 kg/m2) with a history of RYGB performed 42 years prior presented to the emergency department with nausea, diffuse abdominal pain, and signs of septic shock. Physical examination revealed abdominal distension, peritonitis, tachycardia, and hypotension. Laboratory findings showed elevated lactate and lipase levels. Imaging demonstrated a dilated gastric remnant and free intra-abdominal fluid. Emergent exploratory laparotomy identified a necrotic gastric remnant, necessitating remnant gastrectomy. The patient initially stabilized postoperatively but developed pneumonia on postoperative day 6, followed by a duodenal stump leak. Despite conservative management, his condition deteriorated, and comfort care measures were initiated. He died on postoperative day 13.Conclusion: This case highlights the importance of maintaining a high index of suspicion for rare complications such as gastric remnant necrosis in patients with a history of RYGB and a low threshold for surgical exploration. Timely diagnosis and surgical intervention are essential for improving outcomes in these critically ill patients.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"214-216"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137551","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

Maternal Quality of Life Following a Periviable Delivery. 围生期分娩后的产妇生活质量。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0008

Juliann Wang, Christina Blanchard, Angela Seasely, Abigail Cooley, Danyon Beitel, Colm Travers, Brian Sims, Alan Tita, Brian Casey, Rachel Sinkey

{"title":"Maternal Quality of Life Following a Periviable Delivery.","authors":"Juliann Wang, Christina Blanchard, Angela Seasely, Abigail Cooley, Danyon Beitel, Colm Travers, Brian Sims, Alan Tita, Brian Casey, Rachel Sinkey","doi":"10.31486/toj.25.0008","DOIUrl":"10.31486/toj.25.0008","url":null,"abstract":"Background: Data on long-term maternal quality of life following a periviable delivery are lacking. We investigated quality of life measures among patients who delivered a periviable infant.Methods: We conducted a retrospective cohort study of patients who delivered between gestational ages 220/7 to 256/7 weeks at a single institution from 2013 to 2019 and who completed the validated World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) questionnaire between 2021 and 2022. Mothers who had a surviving infant discharged from the hospital were compared with mothers who had an intrauterine or neonatal demise. Baseline characteristics were summarized, and scores were evaluated based on the 4 prespecified WHOQOL-BREF domains: physical health, psychological health, social relationships, and environment.Results: Overall, 58 patients participated: 32 mothers with a surviving infant and 26 mothers with a demise. Maternal age was lower in the mothers with a surviving infant (25.2 ± 3.9 years vs 29.0 ± 6.0 years; P=0.01). Mean duration from delivery to study start date was not different between the groups (5.1 ± 2.0 years vs 4.5 ± 2.1 years; P=0.31). Mothers with surviving infants scored higher (indicating higher quality of life) in the WHOQOL-BREF psychological health and social relationships domains compared to mothers with a demise. Mothers with a surviving infant were more likely to be satisfied with their own health than mothers with a demise, but overall quality of life was not different between the 2 groups.Conclusion: In this small cohort, mothers with an infant who survived a periviable delivery, despite possible long-term health complications for the infant, reported improved quality of life in some domains compared to mothers whose infants did not survive.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 3","pages":"162-169"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138565","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

Rare Ocular Association With Hailey-Hailey Disease. 罕见的与黑利-黑利病的眼部关联。

IF 1.3

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.24.0116

Mamta Singh, Yashdeep Singh Pathania, Praggya Mishra

{"title":"Rare Ocular Association With Hailey-Hailey Disease.","authors":"Mamta Singh, Yashdeep Singh Pathania, Praggya Mishra","doi":"10.31486/toj.24.0116","DOIUrl":"10.31486/toj.24.0116","url":null,"abstract":"Background: Hailey-Hailey disease is an autosomal dominant blistering disorder characterized by junctional abnormalities of epidermal keratinocytes. Vesiculobullous eruptions affect the intertriginous areas of individuals with the condition. Ocular involvement associated with Hailey-Hailey disease is rare.Case report: A 12-year-old female with a history of recurrent blisters since the age of 3 years presented with concurrent redness, irritation, and watering of both eyes. Slit lamp examination revealed bilateral conjunctival congestion, peripheral corneal neovascularization, lack of corneal luster, and corneal haze. The ocular signs were more prominent in the left eye. Important differentials considered were pemphigus vulgaris and allergic conjunctivitis. However, lack of clinical signs of allergic conjunctivitis, lack of involvement of the oral mucosa, the classic distribution of blisters and their aggravation by triggering factors, the absence of Nikolsky sign, and biopsy of a skin lesion ruled out these 2 diagnoses. The patient was treated with low-potency steroid eye drops, an ocular lubricant, and eye ointment. At her 2-week follow-up examination, the patient exhibited decreased conjunctival congestion, improved corneal luster, and symptomatic relief.Conclusion: Ocular involvement in Hailey-Hailey disease can lead to chronic ocular inflammation and sequelae, causing a decrease in vision. Our case is noteworthy because of the early onset of Hailey-Hailey disease and the associated ocular manifestations.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 2","pages":"133-136"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334163","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

Pharmacologic Management of Central Fever in Patients With Acute Brain Injury. 急性脑损伤患者中枢性发热的药物治疗。

IF 1.2

Ochsner Journal Pub Date : 2025-01-01 DOI: 10.31486/toj.25.0045

Maria Turcanu, Ethan Levitch, Bobby D Nossaman

{"title":"Pharmacologic Management of Central Fever in Patients With Acute Brain Injury.","authors":"Maria Turcanu, Ethan Levitch, Bobby D Nossaman","doi":"10.31486/toj.25.0045","DOIUrl":"10.31486/toj.25.0045","url":null,"abstract":"Background: Central fever is a noninfectious increase in body temperature to >37.5 °C that commonly occurs in patients with acute brain injury. Because central fever has detrimental effects on the injured brain and is associated with prolonged neurointensive care unit stays, timely diagnosis and treatment are imperative. Management includes both pharmacologic and nonpharmacologic methods. However, the optimal pharmacologic approach for the management of central fever remains unclear, so we conducted a scoping review to evaluate the pharmaceutical therapies currently being used.Methods: We screened 183 articles from database searches of PubMed, Embase, and Cochrane. Information on study type, interventions, outcomes, and side effects were extracted and analyzed from 13 articles that met inclusion criteria.Results: Our literature search showed that acetaminophen, baclofen, baclofen with propranolol, bromocriptine, dantrolene, and diclofenac have been administered to patients with central fever. While most of the articles included in this review are case reports, a randomized clinical trial identified continuous diclofenac infusion as a promising intervention. Acetaminophen reduced fever in patients with central fever; however, when compared to placebo, no significant difference in core temperature reduction was observed. In the articles that included a discussion of side effects, hepatotoxicity was the most commonly mentioned adverse effect.Conclusion: Diclofenac emerged as the most evidence-supported therapy, backed by higher-quality studies and consistent central fever resolution with relatively few side effects. Because of the paucity of high-quality evidence, further research is needed to establish optimal treatment strategies with minimal adverse effects for patients experiencing central fever.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 4","pages":"254-259"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769540","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