The Ochsner journal
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The Ochsner journal · Jan 2012
Consolidated academic and research exposition: a pilot study of an innovative education method to increase residents' research involvement.
Internal medicine residents at the Ochsner Clinic Foundation stay engaged with clinical work and have difficulty initiating and completing research and publishing their scholarly activities. Commonly cited barriers include lack of knowledge about institutional research programs, lack of confidence regarding medical writing skills, lack of time, and failure to understand the value of research. The residency directors at Ochsner initiated the Consolidated Academic and Research Exposition (CARE) program to teach basic research skills and encourage residents' interest and productivity in research. ⋯ Ochsner's CARE program has appreciably enhanced internal medicine residents' interest in research-related activity, resulting in a significant increase in resident-authored research papers, abstracts, posters, and case reports being accepted at leading national medical conferences.
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The Ochsner journal · Jan 2012
Specialized ambulatory anesthesia teams contribute to decreased ambulatory surgery recovery room length of stay.
Many institutions have organized specialized groups of ambulatory surgery anesthesiologists with the aim of improving ambulatory surgery patient care and efficiency. We hypothesized that specialized ambulatory anesthesia teams produce better patient outcomes such as lower postoperative nausea and vomiting (PONV) rates, lower postoperative pain scores, and shorter postanesthesia care unit (PACU) lengths of stay (LOS). ⋯ The decreased PACU LOS for the study group's patients occurred despite the increased incidence of PONV. Ambulatory anesthesiologists contributed to decreased PACU LOS while practicing evidence-based anesthesia with regard to PONV and pain control. Ambulatory subspecialization may benefit institutions as a way to increase perioperative efficiency and improve surgeon and patient satisfaction.
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Over the past decade, the number of procedures performed in office-based settings by a variety of practitioners-including surgeons, gastroenterologists, ophthalmologists, radiologists, dermatologists, and others-has grown significantly. At the same time, patient safety concerns have intensified and include issues such as proper patient selection, safe sedation practices, maintenance of facilities and resuscitation equipment, facility accreditation and practitioner licensing, and the office staff's ability to deal with emergencies and complications. An urgent need exists to educate practitioners about safety concerns in the office-based setting and to develop various educational strategies that can meet the continued growth of these procedures. This review outlines educational needs and possible solutions such as simulation exercises and education during residency training.
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The Jehovah's Witnesses, a religious group of 7 million people in more than 200 countries, teaches its followers to not accept blood, resulting in potentially challenging and ethical dilemmas for anesthesiologists. In recent years, Jehovah's Witnesses changed certain elements of their approach to blood transfusion practice, including accepting autologous transfusions in certain circumstances. We examine mechanisms to resolve ethical conflicts, such as additional medical consultations with other involved physicians, surgeons, and anesthesiologists; short-term counseling or psychiatric consultation for patient and family; case management conferences; consultation with individuals trained in clinical ethics or a hospital-based ethics committee; and discussions with hospital administration. We also discuss treatment options, including certain blood products, anesthetic techniques, and pharmacological interventions.
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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.