The lead article in this issue of The Ochsner Journal, “Somebody Will Pay,” is a very personal as well as professional view of ethical decisions in neonatal intensive care. Written by Dr. John Lantos, Associate Director of the MacLean Center for Clinical Medical Ethics, it is based on a presentation made at the annual Melinda Pouncey Memorial Lectureship. Although directed to critical decisions in the care of patients who are a few hours to days old, I believe that his comments have relevance for all physicians who are confronted with decisions about life and death.
Dr. Lantos' article is followed by a paper from Dr. Joseph Guarisco, Chairman of the Department of Emergency Medicine, in which he describes how computer technology has been put to use to streamline the operation of a busy emergency room. Cost savings extending from his reconfigured database have already more than paid for the needed hardware and software modifications, providing impetus for periodic updating of existing systems. In addition, the electronic physician notes that serve as the centerpiece for the system make patient records available at the time of transfer, eliminating the follow-up physicians' wait for medical record transcription and delivery.
We normally think of angioplasty and stenting as an option for coronary artery disease, but Dr. Steve Jenkins and colleagues in the Interventional Cardiology Section describe a multitude of other vascular occlusive disorders in which these nonsurgical techniques can be successfully applied. As the authors point out, the keystone to success lies with appropriate patient selection.
Dr. Rand Voorhies, Chairman of the Department of Neurosurgery, then describes a working classification and therapeutic strategy for neck pain that is based upon his extensive experience as a neurosurgeon. This is an extremely common entity, and, as he points out, the challenge for primary care physicians is to be able to recognize the more serious disorders that require early referral.
Many of us have been taught to draw blood cultures when patients present with community acquired pneumonias and an etiologic agent has not been identified. Dr. Hector Rodriquez Luna, a former Internal Medicine resident at Ochsner, and Dr. George Pankey, former head of the Section on Infectious Diseases, aptly argue that that this may not be the most appropriate approach in terms of cost effectiveness or impact on outcomes.
Recently, I received a call from my parents that my mother had taken a rather nasty fall at home, which fortunately did not result in any broken bones; however, it did incapacitate her for several weeks and resulted in untold misery. Moreover, it could have been easily prevented by attention to her limitations of gait and encouragement to use walking aids. Dr. Susan Vaught of our Metairie Clinic discusses the significant impact of falls in the elderly and provides a concise review of ways in which they can be prevented by attention to balance and gait testing.
Finally, in a continuing effort to present the basic science interests of our medical staff, Dr. Om Prakash (The Ochsner Journal's new Editor for the Under the Microscope Section) and Dr. Pankey provide a concise review of medical attempts to eradicate HIV infection, pointing out what the obstacles have been and how we may glimpse the future medical treatment of this dread infection.
As in past issues, these articles reflect the diverse interests of our medical staff, and we hope that you will not only find the information interesting but practical in its application.
- Ochsner Clinic and Alton Ochsner Medical Foundation
