The Ochsner journal
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The Ochsner journal · Jan 2014
ReviewClinical decision support alert appropriateness: a review and proposal for improvement.
Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. ⋯ The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety.
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The Ochsner journal · Jan 2014
ReviewFuture management of carotid stenosis: role of urgent carotid interventions in the acutely symptomatic carotid patient and best medical therapy for asymptomatic carotid disease.
Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture. In the 1990s, randomized trials demonstrated the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in both symptomatic and asymptomatic carotid disease. ⋯ CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA. Age is a critical variable in making informed choices regarding treatment of severe carotid artery stenosis.
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The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. ⋯ A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care.