Create a COVID-19 commission.

We need a definitive public reference for the history of events.

A pilot randomized trial of school-based administration of inhaled corticosteroids for at-risk children with asthma.

Objective: To investigate whether high adherence to inhaled corticosteroids (ICS) among disadvantaged urban public school children on public insurance with persistent asthma is achievable by having school nurses administer morning doses on each day that school is in session.

Design/methods: This was a pilot prospective randomized clinical trial of home versus school nurse-administered ICS among children on Medicaid enrolled in grades K-8. The primary outcome was the proportion of expected morning doses of ICS given to the intervention group in school over the 60-day treatment period.

Development of the Child Health Indicator Assessment (CHIA) in a community-based nurse-managed center.

A team comprised of one nurse administrator, three nurse clinicians, and two nurse researchers developed the Child Health Indicator Assessment (CHIA), an assessment tool that monitors all 10 of the Healthy People 2010 Leading Health Indicators in a pediatric nurse-managed practice. The CHIA is a survey to be administered in a clinic setting, which facilitates regular health maintenance history-taking on 10 key health indicators and provides annual prevalence data on the health of one clinic-based population. CHIA Part A solicits parent or adolescent self-report data at routine health supervision visits.

Percutaneous lumbar discectomy with a working endoscope and laser assistance.

The authors describe percutaneous disc surgery performed via the unilateral monoportal method with a C-arm image intensifier, a working endoscope, and an yttrium-aluminum-garnet laser in 300 patients at three community hospitals over a 6-year period. Visualizing the area of the annulus to be fenestrated, verifying the status of the nerve root, inspecting the cavity created, and monitoring laser hemostasis and vaporization all contributed to patient safety. Fewer than 2% of the cases required a second surgery.

Subgaleal shunting: a 20-year experience.

Object: The authors undertook a retrospective study to evaluate the effectiveness of diverting intracranial fluid into the subgaleal space for temporary absorption by the membranes of the scalp.

Methods: Eighty-one patients were treated over a 20-year period. There were 22 cases of hypertensive hydrocephalus, 52 cases of acute head trauma, and seven cases of chronic subdural hematoma.

The ethics of prophylactic antibiotics for neurosurgical procedures.

The prophylactic use of antibiotics has become a routine procedure in many areas of medicine. In neurosurgery, however, there is considerable debate over their use in the prevention of postoperative infection. We pose several ethical questions about antibiotic prophylaxis in a neurosurgical setting.

Continuing experience with subgaleal shunting.

Objective: To evaluate subgaleal shunting--the diversion of cerebrospinal fluid into the subgaleal space for temporary absorption by the membranes of the scalp.

Method: Eighty-one (81) patients were treated over a 20-year period. There were 22 cases of hypertensive hydrocephalus, 52 cases of acute head trauma, and 7 cases of chronic subdural hematoma.

CT-guided needle procedures for brain lesions: 20 years' experience.

Objective: To assess free-hand needle procedures with CT guidance for biopsy and drainage of brain lesions.

Method: A series of 184 operations was carried out on 120 patients over a 20-year period. Sixty (60) cases of suspected neoplasm were biopsied; 40 cases of intracerebral hemorrhage and 20 cases of intracranial suppuration underwent drainage.

Anterior cervical discectomy without fusion or instrumentation: 25 years' experience.

Objective: To assess a minimalist approach to anterior cervical discectomy without instrumentation or bone grafting.

Method: A total of 530 operations performed during a 25-year period were evaluated in terms of technique and patient outcome.

Results: Advantages included minimal blood loss, little tissue swelling, less narcotic requirement, fewer days in the hospital, and earlier return to customary activity.

Arthroscopic microdiscectomy: an alternative to open disc surgery.

Objective: To assess minimally invasive spinal surgery under endoscopic magnification and illumination (arthroscopic microdiscectomy) as a reliable alternative to open microsurgery for most herniated lumbar discs.

Method: A total of 600 cases are evaluated retrospectively in terms of patient selection and technique. One series of 300 operations was performed by a key academician in the development of arthroscopic microdiscectomy.

Lumboperitoneal shunts.

Background: To assess lumboperitoneal shunting as a simple method of relieving communicating hydrocephalus, treating pseudotumor cerebri, and resolving cerebrospinal fluid fistulae.

Method: Three neurosurgeons at different hospitals report their combined experience over a 20-year period.

Results: Ease of insertion of the device and low rate of complications were reported in a combined series of 107 patients.

Ethical issues in the history of prophylactic antibiotic use in neurosurgery.

There has always been controversy about the indications for prescribing antibiotics to prevent postoperative sepsis in patients undergoing cranial and spinal surgery. The earlier specialists in infectious diseases warned that the effectiveness of antimicrobial drugs was leading to indiscriminate administration for the prevention of wound infection. Three clinical researchers present a review of the history of prophylactic antibiotic use in neurosurgery, including their own work, and raise a number of ethical issues not previously discussed in the literature about: (1) scientific methodology; (2) random selection; (3) prospective study; (4) blinded control; (5) placebo medication; (6) professional equipoise; (7) statistical analysis; (8) informed consent; (9) utilitarian philosophy; and (10) managed care.

Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion.

Object: Bleeding into the brain parenchyma or ventricles is an infrequently reported complication in adults who undergo insertion of a ventriculoperitoneal (VP) shunt. The purpose of this study was to establish the incidence of delayed intracerebral hemorrhage secondary to ventricular cannulation during shunting procedures.

Methods: Over a 24-year period, in a series of 125 adult patients with hydrocephalus, postoperative computerized tomography scans were obtained in every case within 48 hours of shunt surgery performed by the same neurosurgeon.

Topical irrigation with polymyxin and bacitracin for spinal surgery.

Background: The purpose of the present study was to evaluate constant irrigation with saline containing 50,000 units each of polymyxin and bacitracin in a regimen of antimicrobial prophylaxis for clean spinal surgery at two community hospitals with a zero infection rate.

Methods: The focus was on the bactericidal effects of prophylactic topical antibiotics by assessing random contamination in neurosurgical wounds from: 1) the flora of the integument and nares of the operating team, 2) the surgical apparel, 3) the patient's skin, 4) air-borne organisms in the operating theater, and 5) the surgeon's gloves.

Results: Based on individual biotyping of bacteria and antimicrobial sensitivity testing, no consistent source or pattern could be uncovered for the organisms recovered from the operative site.

Soft disc herniation in patients with lumbar stenosis.

Over a period of 25 years, a surgical technique has evolved for removal of a soft disc herniation in patients with sciatica and lumbar stenosis demonstrated on neuroradiological studies. Initially emphasis was placed on decompression of the entire narrow spinal canal when there was evidence of single nerve root involvement and no history of neurogenic claudication. The author has performed 12 microsurgical discectomies since 1984 and eight percutaneous endoscopic discectomies over the past 6 years that have been successful in relieving radiculitis and radiculopathy in cases of a single herniated nucleus pulposus, even in the presence of a stenotic canal.