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 & Medicine. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Cardiac rehabilitation and cardiovascular disability: role in assessment and improving functional capacity: a position statement from the American Association of Cardiovascular and Pulmonary Rehabilitation.

Abstract: The Social Security Administration (SSA) oversees the disability determination process and the payment of disability benefits to Americans. According to recent SSA data, approximately 900 000 persons are receiving cardiovascular disability payments and about 145 000 adult claims for cardiovascular disability are processed by the SSA annually. An objective and comprehensive examination of functional capacity is an important part of the disability assessment process. This statement reviews various protocols for disability assessment of aerobic capacity, muscle function, and the physical requirements of job tasks. Cardiac rehabilitation programs are ideal settings for conducting comprehensive disability assessments of functional capacity in persons with cardiovascular disease. In addition, exercise training provided by cardiac rehabilitation programs can increase functional capacity in most patients.

Insulin-Like Growth Factor-I–Forkhead Box O Transcription Factor 3a Counteracts High Glucose/Tumor Necrosis Factor-α-Mediated Neuronal Damage: Implications for Human Immunodeficiency Virus Encephalitis

Abstract: In HIV patients, antiretroviral medications trigger metabolic abnormalities, including insulin resistance In addition, the inflammatory cytokine tumor necrosis factor-α (TNFα), which is elevated in human immunodeficiency virus encephalitis (HIVE), also induces insulin resistance and inflicts neuronal damage in vitro In differentiated PC12 cells and rat cortical neurons, high glucose (HG; 25 mM) triggers reactive oxygen species (ROS) accumulation, contributing to the retraction of neuronal processes, with only a minimal involvement of neuronal apoptosis In the presence of TNFα, HG-treated neurons undergo massive apoptosis Because mammalian homolog of the Forkhead family of transcription factors, Forkhead box O transcription factor 3a (FOXO3a), controls ROS metabolism, we asked whether FOXO3a could affect the fate of differentiated neurons in the paradigm of HIVE We observed FOXO3a nuclear translocation in HG-treated neuronal cultures, accompanied by partial loss of mitochondrial potential and gradual retraction of neuronal processes Addition of TNFα to HG-treated neurons increased expression of the FOXO-dependent proapoptotic gene Bim, which resulted in extensive apoptotic death Insulin-like growth factor-I (IGF-I) significantly lowered intracellular ROS, which was accompanied by IGF-I-mediated FOXO3a nuclear export and decrease in its transcriptional activity The clinical relevance of these findings is supported by detection of nuclear FOXO3a in TUNEL-positive cortical neurons from HIVE, especially in brain areas characterized by elevated TNFα

Improving sepsis outcomes for acutely ill adults using interdisciplinary order sets.

Abstract: PURPOSE/OBJECTIVE The objective of the study was to measure outcomes following implementation of standardized order sets for managing patients with severe sepsis/septic shock. BACKGROUND/RATIONALE Sepsis is a severe illness, affecting approximately 750 000 people in the United States, with mortality rates of 28% to 50%, and costing $17 billion each year. PROJECT DESCRIPTION An interdisciplinary team was created to improve early recognition and process of care in patients with severe sepsis/septic shock. Education was rolled out over 6 months, and sepsis "bundle" order sets were implemented. SETTING AND SAMPLE Adult patients (N = 674) with a diagnosis of severe sepsis or septic shock who were admitted to an emergency department or critical care unit at a 563-bed tertiary care teaching facility from May 2008 through October 2010 were included in data analysis. METHODS A plan, do, study, act methodology was used. Outcomes following project implementation were measured prospectively including appropriate recognition of patients with a diagnosis of sepsis, hospital site where the order set was initiated, and attainment of treatment goals within 6 hours of onset of severe sepsis/septic shock. FINDINGS When order set usage was analyzed, the use of order sets was significantly associated with meeting "6-hour goals" successfully (χ1 [n = 662] = 36.16, P < .001); order set usage explained 24% of the variation in meeting goals, R = 0.24, F1,661 = 38.51, P < .0001. CONCLUSIONS Order sets improved management of septic patients through effective change in delivery systems to support evidence-based medical care. IMPLICATIONS FOR PRACTICE Administrative support, team collaboration, and standardized order sets can lead to improved process of care.

Evaluation of Quality of Life Following Placement of Self-Expanding Plastic Stents as a Bridge to Surgery in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer

Abstract: Purpose.To determine whether self-expanding plastic stent (SEPS) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy (NAT) in patients with esophageal cancer. PatientsandMethods. Aprospective,dual-institution,singlearm, phase II (http://ClinicalTrials.gov: NCT00727376) evaluation of esophageal cancer patients undergoing NAT prior to resection. All patients had a self-expanding polymer stent placed prior to NAT. The European Organisation for ResearchandTreatmentofCancerQLQ-C30andQLQ-OG25, Functional Assessment of Cancer Therapy–Anorexia, and Functional Assessment of Cancer Therapy–General surveys were administered prior to stenting, within 1 week post-stent placement, and at the completion of neoadjuvant therapy. Results. Fifty-two patients were enrolled; 3 (5.8%) had stent migrations requiring replacement.There wereno instances of esophageal erosion or perforation. All patients received some form of neoadjuvant therapy.Thirty-six (69%) received chemoradiation;34(93%)ofthesepatientsreceivedtheplanneddose ofchemotherapy,and27(75%)receivedthefullplanneddoseof radiotherapy. There were 16 (31%) patients receiving chemotherapyalone;12 (74%) ofpatients in thechemotherapy-alone group completed the planned dose of therapy. Conclusion. Placement of SEPS appears to provide significant improvement in qualityof life relatedtodysphagia andeating restriction in patients with esophageal cancer undergoing neoadjuvant therapy. Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support. The Oncologist 2014;19:1–7

Frequency and significance of IgG4 immunohistochemical staining in liver explants from patients with primary sclerosing cholangitis.

Abstract: Dense tissue infiltrates of IgG4+ plasma cells >50/high-powered field (HPF) are purportedly highly specific for IgG4-related disease However, the frequency and significance of liver-infiltrating IgG4+ plasma cells in primary sclerosing cholangitis (PSC) applying these cut-offs has not been determined We sought to determine the incidence of intrahepatic IgG4-positive staining in PSC patients undergoing transplantation, correlating findings with clinical parameters Immunohistochemical staining was performed on liver explants obtained between 1991 and 2009 Of 122 explants obtained, hilar IgG4+ staining was found to be mild (10–29 IgG4+ cells/HPF) in 230%, moderate (30–50/HPF) in 90% and marked (>50/HPF) in 156% Marked hilar lymphoplasmacytic infiltration was significantly associated with marked hilar IgG4+ staining (P 50/HPF) hilar IgG4+ lymphoplasmacytic infiltration is frequently observed in PSC and associated with the presence of dominant biliary strictures However, unlike serum IgG4+, this does not seemingly associate with clinical disease course