Comparing strategies for prehospital transport to specialty care after cardiac arrest.

Unlabelled: Outcomes are better when patients resuscitated from out-of-hospital cardiac arrest (OHCA) are treated at specialty centers. The best strategy to transport patients from the scene of resuscitation to specialty care is unknown.

Methods: We performed a retrospective cohort study.

Decreasing the Pedicle Screw Misplacement Rate in the Thoracic Spine With Robot-guided Navigation.

Study Design: A retrospective chart review.

Objective: The aim of this study was to evaluate the screw accuracy of thoracic pedicle screws placed with a robot-guided navigation system.

Summary Of Background Data: Thoracic pedicles are smaller in diameter than lumbar pedicles, making pedicle screw placement difficult.

Evaluating novel methods of outcome assessment following cardiac arrest.

Introduction: We compared novel methods of long-term follow-up after resuscitation from cardiac arrest to a query of the National Death Index (NDI). We hypothesized use of the electronic health record (EHR), and internet-based sources would have high sensitivity for identifying decedents identified by the NDI.

Methods: We performed a retrospective study including patients treated after cardiac arrest at a single academic center from 2010 to 2018.

Death and End-of-Life Care in Emergency Departments in the US.

Importance: There are more than 140 million annual visits to emergency departments (EDs) in the US. The role of EDs in providing care at or near the end of life is not well characterized.

Objective: To determine the frequency of death in the ED or within 1 month of an ED visit in an all-age, all-payer national database.

Fitting the reproduction number from UK coronavirus case data and why it is close to 1.

We present a method for rapid calculation of coronavirus growth rates and [Formula: see text]-numbers tailored to publicly available UK data. We assume that the case data comprise a smooth, underlying trend which is differentiable, plus systematic errors and a non-differentiable noise term, and use bespoke data processing to remove systematic errors and noise. The approach is designed to prioritize up-to-date estimates.

Between-hospital variability in organ donation after resuscitation from out-of-hospital cardiac arrest.

Introduction: Survival and recovery after out-of-hospital cardiac arrest (OHCA) varies between hospitals, with better outcomes associated with high-volume and specialty care. We evaluated if there is a similar relationship with organ donation after OHCA.

Methods: We studied a cohort of adults resuscitated from OHCA from 2010 to 2018, treated at one of 112 hospitals served by a regional organ procurement organization (OPO).

Frequency of Withdrawal of Life-Sustaining Therapy for Perceived Poor Neurologic Prognosis.

Unlabelled: To measure the frequency of withdrawal of life-sustaining therapy for perceived poor neurologic prognosis among decedents in hospitals of different sizes and teaching statuses.

Design: We performed a multicenter, retrospective cohort study.

Setting: Four large teaching hospitals, four affiliated small teaching hospitals, and nine affiliated nonteaching hospitals in the United States.

US Hospital Capacity Managers' Experiences and Concerns Regarding Preparedness for Seasonal Influenza and Influenza-like Illness.

Importance: The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems.

Objective: To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US.

Design, Setting, And Participants: In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US.

Inhibition of astrocyte hemichannel improves recovery from spinal cord injury.

Spinal cord injury (SCI) causes severe disability, and the current inability to restore function to the damaged spinal cord leads to lasting detrimental consequences to patients. One strategy to reduce SCI morbidity involves limiting the spread of secondary damage after injury. Previous studies have shown that connexin 43 (Cx43), a gap junction protein richly expressed in spinal cord astrocytes, is a potential mediator of secondary damage.

Association Between State Medicaid Expansion and Emergency Access to Acute Care Hospitals in the United States.

Importance: State decisions not to expand Medicaid under the Patient Protection and Affordable Care Act could reduce emergency access to acute care hospitals.

Objective: To determine the relationship between state Medicaid expansion and emergency access to acute care hospitals in the United States.

Design, Setting, And Participants: This cross-sectional study linked hospital-level data from the Centers for Medicare & Medicaid Services from 2007 to 2017 to US Census data for all 50 US states and the District of Columbia.

Suboccipital, Supracerebellar, Infratentorial Approach for Microsurgical Clipping of a Ruptured Tentorial, Straight Sinus Type Dural Arteriovenous Fistula.

Background: Dural arteriovenous fistulas (dAVFs) can often be successfully treated with endovascular embolization; however, surgery is occasionally still required.

Case Description: Herein, we discuss a 65-year-old male patient who presented with a Hunt-Hess IV subarachnoid hemorrhage, intraventricular hemorrhage, and cerebellar intracranial hemorrhage secondary to a ruptured Borden type III tentorial (straight sinus) dAVF. Angiography revealed supply from the left occipital and posterior meningeal arteries and direct drainage into the cerebellar cortical veins with venous aneurysms in both cerebellar hemispheres.

Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis.

Background: Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke.

Objective: To evaluate the impact of OSA with presentation, hospital course, and treatment outcomes of patients with subarachnoid hemorrhage (SAH).

Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution.

Background: In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation.

Methods: A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Association of Practitioner Interfacility Triage Performance With Outcomes for Severely Injured Patients With Fee-for-Service Medicare Insurance.

Importance: Despite evidence that treatment of severely injured patients at trauma centers is associated with reduced mortality, nearly half of all such patients are treated at nontrauma centers (undertriaged). Little is known about whether interfacility undertriage occurs because of practitioner decision-making or institutional and regional factors.

Objectives: To assess the associations between variation in triage practitioners at nontrauma centers and between practitioner-level variation and patient outcomes after injury.

Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Strategies to effect change in the ICU.

Purpose Of Review: To provide an update on implementation efforts in the care of critically ill patients, with a focus on work published in the last 2 years.

Recent Findings: Only half of surveyed members of the multidisciplinary care team in the ICU were aware of the Choosing Wisely campaign, and of those that were, approximately one-third reported no implementation of the recommendations. Barriers to implementation of the ABCDE bundle extend to beyond patient-level domains, and include clinician-related, protocol-related, and other domains.

Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better.

Object: Guidelines for the management of pediatric epidural hematoma (PEDH) remain poorly defined. Here we seek to characterize the disease course of PEDH in patients with presenting Glasgow Coma Scale (GCS) of 14+, and suggest high-risk characteristics for progression to surgery.

Methods: A prospectively maintained, single-institution, level-1 trauma hospital admission database was queried to identify patients ages 6 months to 18 years presenting with PEDH between 2006 and 2016.

Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery.

In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed.

Robot-Assisted Pedicle Screw Placement: Learning Curve Experience.

Objectives: To describe the learning curve of pedicle screw placement using robot-assisted spine surgery of an experienced neurosurgeon and 2 supervised neurosurgical fellows.

Methods: The first 120 cases of robot-assisted spine surgery at our institution were assessed. Patient variables included age, body mass index, and indication for surgery.

Role of follow-up CT scans in the management of traumatic pediatric epidural hematomas.

Introduction: Management of pediatric epidural hematoma (PEDH) ranges from observation to emergent craniotomy. Guidelines for management remain poorly defined. More so, serial CT imaging in the pediatric population is often an area of controversy given the concern for excessive radiation as well as increased costs.