Reported Clinical and Financial Performance of Hospitals With Physician CEOs Compared to Those With Nonphysician CEOs.

Little work has been done comparing the performance of hospitals with physician CEOs versus nonphysician CEOs, despite the ease of identifying this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We performed a detailed analysis of several widely accepted measures of clinical and financial performance across a randomly selected group of U.S.

Novel Use of a Custom Fixation Plate in Pediatric Fibrous Dysplasia.

The authors present a case of a 11-year-old girl with fibrous dysplasia involving the nasal cavity and sphenoid sinus that potentially required a tracheostomy for anesthesia. The tumor was to be approached through both supraorbital and Le Fort I osteotomies. The tumor prevented nasal intubation, and the necessity of maxillomandibular fixation to reduce the osteotomized maxilla with traditional fixation prevented oral intubation.

Assessing the Economic Efficiency of Physician On-call Payments.

On-call services provided by physicians are critical to the function of a robust healthcare delivery system, but such services are not generally accounted for by standard physician productivity metrics, such as the work relative value unit (wRVU). There is significant diversity on how physicians are compensated, if at all, for these on-call services. Simultaneously, there exists a considerable shortage, particularly in the surgical subspecialties, for on-call coverage - most commonly in rural and underserved communities.

Death on the battlefield (2001-2011): implications for the future of combat casualty care.

Background: Critical evaluation of all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among US combat fatalities, is central to identifying gaps in knowledge, training, equipment, and execution of battlefield trauma care. The impetus to produce this analysis was to develop a comprehensive perspective of battlefield death, concentrating on deaths that occurred in the pre-medical treatment facility (pre-MTF) environment.

Methods: The Armed Forces Medical Examiner Service Mortality Surveillance Division was used to identify Operation Iraqi Freedom and Operation Enduring Freedom combat casualties from October 2001 to June 2011 who died from injury in the deployed environment.

Prevention of infections associated with combat-related central nervous system injuries.

Combat-related injuries to the central nervous system (CNS) are of critical importance because of potential catastrophic outcomes. Although the overall infection rate of combat-related CNS injuries is between 5% and 10%, the development of an infectious complication is associated with a very high morbidity and mortality. This review focuses on the prevention of infections related to injuries to the brain or the spinal cord and provides evidence-based medicine recommendations from military and civilian data for the prevention of infection from combat-related CNS injuries.

Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society.

Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data.

Executive summary: Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society.

Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data.

Warfare-related craniectomy defect reconstruction: early success using custom alloplast implants.

Background: Cranial bone defects secondary to decompression craniectomy associated with the Global War on Terror pose a unique reconstructive challenge. The objective of this study was to evaluate the outcome of alloplastic reconstruction using custom-designed implants for large craniectomy defects from warfare-related cranial trauma.

Methods: A review of injured personnel who underwent decompression craniectomy reconstruction and subsequent alloplastic cranial reconstruction in the National Capital Region was performed from 2003 to 2008 (n = 99).

Cranioplasty complications following wartime decompressive craniectomy.

Object: In support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom-Afghanistan (OEF-A), military neurosurgeons in the combat theater are faced with the daunting task of stabilizing patients in such a way as to prevent irreversible neurological injury from cerebral edema while simultaneously allowing for prolonged transport stateside (5000-7000 miles). It is in this setting that decompressive craniectomy has become a mainstay of far-forward neurosurgical management of traumatic brain injury (TBI). As such, institutional experience with cranioplasty at the Walter Reed Army Medical Center (WRAMC) and the National Naval Medical Center (NNMC) has expanded concomitantly.

Prevention and management of infections associated with combat-related central nervous system injuries.

Combat-related injuries to the central nervous system (CNS) are of critical importance because of potential catastrophic outcomes. Although the overall infection rate of combat-related CNS injuries is less than 5%, if an infection develops there is a very high associated morbidity and mortality. This review focuses on the management and prevention of infections related to injuries to the brain or the spinal cord.

Guidelines for the prevention of infection after combat-related injuries.

Management of combat-related trauma is derived from skills and data collected in past conflicts and civilian trauma, and from information and experience obtained during ongoing conflicts. The best methods to prevent infections associated with injuries observed in military combat are not fully established. Current methods to prevent infections in these types of injuries are derived primarily from controlled trials of elective surgery and civilian trauma as well as retrospective studies of civilian and military trauma interventions.

Rare giant cell ependymoma in an octogenarian. Case report and review of the literature.

Ependymomas are glial tumors that occur most often in children. In adults, ependymomas most often appear in the spinal cord. The World Health Organization recognizes several rare ependymoma subtypes, including the giant cell ependymoma of the terminal filum.

Weapons of mass destruction and the role of the neurosurgeon.

The desire to assist in a crisis should be tempered by a serious assessment of the technical preparation one has undertaken. Additionally, in the same way that a needs assessment is undertaken before prescribing a course of treatment, one should evaluate the actual staffing requirements of the situation. Many physician volunteers were turned away after the World Trade Center attacks because the overwhelming response of available medical personnel quickly exceeded the requirement.

Weapons of mass destruction: radiation.

The purpose of this review is to present a concise overview of the types of radiation, methods of dispersal, injury patterns, and treatment considerations in a scenario involving radiation-based weapons of mass destruction. Radiation-related casualties, although uncommon, are a potential threat because more nations and organizations are developing the technology for producing radioactive substances capable of being used as weapons.

Threat credibility and weapons of mass destruction.

Individual or collective preparedness for an attack involving weapons of mass destruction (WMD) must be based on an analysis of the threat. In threat assessment one takes many factors into account, including the physical and psychological parameters of the attacker. Although the potential devastation caused by WMD is significant, there are many limitations to the effective use of such weapons.

Visual disturbance associated with postoperative cerebellar mutism.

Cerebellar mutism is an uncommon complication of posterior fossa surgery. Manifestations include disturbances of articulation, prosody, and pitch, and, if severe, complete mutism. Symptoms are independent of recognizable cortical or brainstem injury, and recovery is variable, with permanent deficits frequently observed.

Credible threat: assessing the likelihood of a chemical or biologic attack.

Threat assessment for weapons of mass destruction is a complex task,requiring many assumptions. As a general rule, weapons of mass destruction are expensive, complex, and difficult-to-use weapons. It is not likely that any current terrorist group has the capability to strike the United States with a weapon capable of producing millions of casualties.