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.

Doing what's right for the resuscitated.

Abstract: In the current issue of Catheterization and Cardiovascular Interventions, Kern and Rahman review the available data supporting percutaneous coronary intervention (PCI) in patients resuscitated from out-of-hospital cardiac arrest (OHCA). They tabulate the results of 17 reports with a total of 930 post-cardiac arrest (PCA) patients, who underwent early cardiac catheterization along with appropriate revascularization and another four case series in which a total of 150 PCA patients were treated with therapeutic hypothermia in addition to early coronary intervention. Survival-to-discharge rates were 60% in the first group and 70% in the second with very high rates (87% and 81%, respectively) of intact neurologic function among survivors. These are remarkably high figures when applied to a population whose expected survival has been only 25%, half of whom have significant neurologic impairment. The authors further point out the unreliability of chest pain and electrocardiographic abnormalities in predicting acute coronary occlusion as the inciting event in these patients. They conclude that the induction of mild therapeutic hypothermia and early coronary angiography/PCI should be strongly considered for all comatose PCA patients regardless of their postresuscitation electrocardiographic findings, a recommendation already made by the International Liaison Committee on Resuscitation in its 2008 Post-Cardiac Arrest Syndrome Consensus Statement [1]. Mounting evidence suggests that therapeutic hypothermia combined with early cardiac catheterization should be adopted as a systematic strategy for PCA patients. Two sentinel randomized-controlled trials published in 2002 [2,3] demonstrated benefits in mortality and neurologic outcome in survivors of OHCA who were treated with therapeutic hypothermia. The publication of these studies brought renewed vigor to the field of resuscitation science, which for decades had struggled for a method to better outcomes. In recent years, the concept of the ‘‘post-cardiac arrest syndrome’’ and how we might further improve this very high-risk subgroup’s odds of survival have received great attention [1]. Many national and international medical societies, including the American Heart Association (AHA), have updated their guidelines recommendations to incorporate therapeutic hypothermia in the treatment of OHCA [4], and a Policy Statement on Regional Systems of Care for OHCA issued by the AHA in January, 2010 specifically addresses the need for early PCI in this population [5]. So what are the obstacles? One is the persistent perception by institutions and physicians that the cardiac arrest survivor has a nearhopeless prognosis [6,7] and that decisions regarding further aggressive care such as coronary intervention should be delayed until the patient has demonstrated adequate promise of neurologic recovery. In fact, available data suggest that currently employed methods of neurologic prognostication are unreliable in the early stages of post-arrest care [6,8]. This is particularly true in patients treated with therapeutic hypothermia [9]. Kern and Rahman’s review of almost 1,100 patients, 150 of whom were treated with hypothermia, suggests significantly better-than-expected outcomes are achievable if these patients are managed aggressively. The solution to this obstacle is education of healthcare providers and hospitals on a national level to change the perception of OHCA from a diagnosis with uniformly negative outcomes to one of hope, which can be positively influenced by improvements in care. Another obstacle is the current enthusiasm for ‘‘score carding’’ for quality outcomes. Hospitals and

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

Abstract: The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

Novel Agents in Neuropathic Pain, the Role of Capsaicin: Pharmacology, Efficacy, Side Effects, Different Preparations

Abstract: Capsaicin is a natural substance used to treat neuropathic pain because of its ability to be used in a more direct form on patients and efficiently treat their pain without the amount of side effects seen in the use of oral medications. Currently, the treatments for neuropathic pain are, control of the underlying disease process, then focused on symptomatic relief with pharmacotherapy, topical analgesics, or other interventions. When all pharmacological agents fail to relieve the pain, interventional strategies can be considered, such as neural blocks, spinal cord stimulation, and intrathecal administered medications. The response to current treatment of neuropathic pain is only modest relief of symptoms. Multiple treatment options may be attempted, while ultimately leaving patients with refractory neuropathic pain. For these reasons, a better treatment approach to neuropathic pain is greatly needed. Overall, capsaicin has great potential for becoming a first- or second-line treatment for neuropathic pain, and for becoming a therapeutic option for many other neuropathic pain-related disease states.

Technology in Arthroplasty: Are We Improving Value?

Abstract: Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value. Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty.

Potential Benefits of Peroxynitrite

Abstract: Peroxynitrite (PN) is generated by the reaction of nitric oxide (NO) and superoxide in one of the most rapid reactions in biology. Studies have reported that PN is a cytotoxic molecule that contributes to vascular injury in a number of disease states. However, it has become apparent that PN has beneficial effects including vasodilation, inhibition of platelet aggregation, inhibition of inflammatory cell adhesion, and protection against ischemia/reperfusion injury in the heart. It is our hypothesis that PN may serve to inactivate superoxide and prolong the actions of NO in the circulation. This manuscript reviews the beneficial effects of PN in the cardiovascular system.