Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Heart failure. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Intensity-Modulated Radiation Therapy Dose Prescription, Recording, and Delivery: Patterns of Variability Among Institutions and Treatment Planning Systems

Abstract: Results Of the 803 patients, 12% were treated for brain cancer, 26% for head and neck cancer, and 62% for prostate cancer. The recorded dose variability from prescription was widespread for the minimum, maximum, and isocenter doses. A total of 46% of the patients received a maximum dose that was more than 10% higher than the prescribed dose, and 63% of the patients received a dose that was more than 10% lower than the prescribed dose. At all five institutions, the prostate cancer cases had the smallest dosimetric variation and the head and neck cancer cases had the largest variation. The median dose to the target varied from the prescribed dose by ±2% in 68% of the patients, by ±5% in 88% of the patients, and by ±10% in 96% of the patients. The recorded isocenter dose varied from prescription for all disease sites and treatment planning systems. Conclusions Substantial variation in the prescribed and delivered doses exists among medical institutions, raising concerns about the validity of comparing clinical outcomes for IMRT. The isocenter dose in IMRT is simply a point dose and often does not reflect the prescription dose that is specified by a selected isodose line encompassing the target volume. This study suggests the need for national and/or international guidelines for dose prescription, planning, and reporting for a meaningful clinical trial in IMRT. J Natl Cancer Inst 2008;100: 300 – 307 An improvement in radiation therapy outcomes could be achieved by periodic comparisons of clinical practices through outcome evaluations from clinical trials and studies. For a multicenter study, a meaningful comparison of clinical outcomes in response to radiation treatment requires a standardized process for dose specifi cation. Treatment outcome can be interpreted meaningfully only with accurate knowledge of the reference dose and the dose distribution. National guidelines for clinical reference dosimetry, such as those put forth by Task Groups 21 and 51 of the Radiation Therapy Committee of the American Association of Physicists in Medicine ( 1 , 2 ), recommend that the reference dose (machine output) should not vary by more than ±2% among centers. For patient treatment, the combined dosimetric uncertainty in the target volume (which includes differences in patient setup and

The Importance of Bactericidal Drugs: Future Directions in Infectious Disease

Abstract: Background. Although a considerable amount of research has gone into the study of the role of bactericidal versus bacteriostatic antimicrobial agents in the treatment of different infectious diseases, there is no accepted standard of practice. Methods. A panel of infectious diseases specialists reviewed the available literature to try to define specific recommendations for clinical practice. Results. In infections of the central nervous system, the rapidity with which the organism is killed may be an important determinant, because of the serious damage that may occur during these clinical situations. The failure of bacteriostatic antibiotics to adequately treat endocarditis is well documented, both in human studies and in animal models. Conclusion. The bulk of the evidence supports the concept that, in treating endocarditis and meningitis, it is important to use antibacterial agents with in vitro bactericidal activity. This conclusion is based on both human and animal data. The data to support bactericidal drugs' superiority to bacteriostatic drugs do not exist for most other clinical situations, and animal models do not support this concept in some situations. Clinicians should be aware that drugs that are bacteriostatic for one organism may in fact be bactericidal for another organism or another strain of the same organism.

Relation of inflammation and benefit of statins after percutaneous coronary interventions.

Abstract: Background— Beyond lipid lowering, statins are known to possess antiinflammatory and antithrombotic properties. Recent studies suggested an association between statins and early reduction in death or myocardial infarction (MI) after percutaneous coronary interventions (PCIs). We sought to examine the interrelationship between inflammation, statin use, and PCI outcomes. Methods and Results— In the year 2000, 1552 consecutive United States residents underwent elective or urgent PCI at the Cleveland Clinic and were prospectively followed for 1 year. Preprocedural serum high-sensitivity C-reactive protein (hsCRP) levels were routinely measured. Patients who had statins initiated before the procedure (39.6%) had a lower median hsCRP level (0.40 versus 0.50 mg/dL, P=0.012) independent of the baseline cholesterol levels and had less frequent periprocedural MI (defined by CKMB ≥3×upper limit of normal, 5.7% versus 8.1%, P=0.038). At 1 year, statin pretreatment was predictive of survival predominantly among patien...

Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery.

Abstract: PURPOSE: The study contained herein was undertaken to establish the incidence of small-bowel obstruction, adhesiolysis for obstruction, and additional abdominal surgery after open colorectal and general surgery. METHODS: A retrospective cohort study was performed using patient-specific Health Care Financing Administration data to evaluate a random 5 percent sample of all Medicare patients who underwent surgery in 1993. Of these, 18,912 patients had an index abdominal procedure. Two-year follow-up data documented outcomes of hospitalizations with obstruction, adhesiolysis for obstruction, and/or additional open colorectal or general surgery. RESULTS: Within two years of incision, excision, and anastomosis of intestine (International Classification of Diseases (ICD)-9 code 45), 14.3 percent of patients had obstructions, 2.6 percent required adhesiolysis for obstructions, and 12.9 percent underwent additional open colorectal or general surgery. After other operations of intestine (ICD code 46), 17 percent of patients had obstructions, 3.1 percent required adhesiolysis for obstructions, and 20.2 percent underwent additional open colorectal or general surgery. After operations of rectum, rectosigmoid, and perirectal tissue (ICD code 48), 15.3 percent of patients had obstructions, 5.1 percent required adhesiolysis for obstructions, and 16.4 percent underwent additional open colorectal or general surgery. After other operations on the abdominal region (ICD code 54), 12.4 percent of patients had obstructions, 2.3 percent required adhesiolysis for obstructions, and 8.8 percent underwent additional open colorectal or general surgery. CONCLUSIONS: In this retrospective study of Medicare patients, we learned that bowel obstruction, adhesiolysis for obstructions, and additional abdominal surgery occurred more often after abdominal surgery than was previously published.