The Ochsner journal
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The Ochsner journal · Jan 2013
Stimulators of soluble guanylyl cyclase: future clinical indications.
Soluble guanylyl cyclase (sGC) is expressed in mammalian cytoplasm and catalyzes the synthesis of the second messenger guanosine 3',5'-monophosphate (cGMP) involved in important physiological functions such as relaxation of vascular smooth muscle, inhibition of platelet aggregation, modulation of inflammation, and control of vascular permeability. sGC is the intracellular receptor for nitric oxide (NO) and the active moiety in traditional organic nitrate therapy, recently as an inhalant in the intensive care unit and experimentally in improving microcirculatory flow in shock. However, dysfunction of the heme moiety on sGC occurs in a number of cardiovascular diseases, which reduces NO effectiveness. ⋯ Animal and early clinical studies have shown that sGC stimulator agents have great promise for treating cardiopulmonary disorders and may also have a role in modulating the inflammatory response observed in perioperative care.
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The Ochsner journal · Jan 2012
Teaching palliative care in the intensive care unit: how to break the news.
Palliative care education is often lacking in graduate medical education curricula. Studies show that many physicians are uncomfortable discussing end-of-life issues with patients and providing palliative care to dying patients and their families. We used a case-based approach to improve resident confidence in delivering bad news, discussing poor prognoses, explaining the dying process, and providing palliative care in the intensive care unit. ⋯ Using a multidisciplinary team to teach a structured curriculum that includes a case-based debriefing improves house officer confidence in discussing end-of-life care and providing palliative care to patients in the intensive care setting.
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The Ochsner journal · Jan 2012
All the World's a Stage: Integrating Theater and Medicine for Interprofessional Team Building in Physician and Nurse Residency Programs.
To facilitate the delivery of excellent patient care, physician-nurse teams must work in a collaborative manner. We found that venues for the joint training of physician-nurse teams to foster collaboration are insufficient. ⋯ The learners felt the physician-nurse team training experience was exceptionally valuable for its authenticity.
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The Ochsner journal · Jan 2012
Acute respiratory distress following ultrasound-guided supraclavicular block.
Brachial plexus blocks have become very common for patients undergoing upper extremity surgery. We report a case in which the patient developed ipsilateral phrenic nerve paralysis and acute respiratory failure following supraclavicular nerve block. ⋯ Phrenic nerve injury leading to respiratory distress is a rare complication of supraclavicular brachial plexus block. Anesthesiologists should be ready for emergency intubation when performing this kind of block.
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The Ochsner journal · Jan 2012
Presence of anesthesia resident trainees in day surgery unit has mixed effects on operating room efficiency measures.
Three competing goals at academic medical centers are to increase efficiency, to optimize clinical care, and to train residents. The goal of this project was to compare day surgery operating room (OR) efficiency measures for anesthesiologists working alone, working with residents, and working with certified nurse anesthetists in a tertiary multisubspecialty teaching hospital to determine if trainees significantly impact OR efficiency. ⋯ The pairing of anesthesiology residents with anesthesia staff has mixed effects on OR efficiency measures in a day surgery unit.