Utility of routine type and cross for anterior cervical discectomy and fusion: A retrospective review.

Background: Preoperative type and screen and type and cross are routinely obtained in patients undergoing elective cervical spine surgeries. This is despite low perioperative transfusion rates, particularly in patients undergoing anterior cervical discectomy and fusion (ACDF).

Methods: We conducted a retrospective cohort study at a single tertiary medical center of all patients 18 years of age or older undergoing elective ACDF for degenerative cervical spine disease between January 2016 and January 2021.

Cerebrospinal Fluid Drainage in Patients with Acute Spinal Cord Injury: A Multi-Center Randomized Controlled Trial.

Objective: The secondary phase of spinal cord injury (SCI) is characterized by ischemic injury. Spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), has arisen as a therapeutic target for improving outcomes. Cerebrospinal fluid drainage (CSFD) may reduce ITP and thereby increase SCPP.

Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma.

Objective: Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers.

Cardiac complications of malnutrition in adolescent patients: A narrative review of contemporary literature.

Eating disorders are common. Between 1% and 2% of adolescent females and 0.5% of males suffer from anorexia nervosa, bulimia nervosa, and binge eating disorder.

Variations in 2-Minute Walk Test outcomes for people with lower limb amputation in the outpatient clinic and research settings.

Background: This study determined the differences in 2-Minute Walk Test (2MWT) distances between people with lower limb amputations in clinical and research settings and described variations in test administration in various clinical settings.

Study Design: Retrospective Cross-sectional design.

Methods: The 2MWT for 290 patients with lower limb amputations were obtained from a medium-sized prosthetic company with locations within the central United States.

A tale of caution: prolonged bacteraemia after probiotic use in an immunocompetent child.

Introduction: as a probiotic supplement is increasingly used in both adult and paediatric patient populations. There is limited awareness about potential adverse effects.

Case Presentation: We report a case of prolonged (111 days) bacteraemia after brief probiotic use in a 17-month-old immunocompetent child, without a definite focus of infection and in the absence of predisposing risk factors or underlying co-morbidities.

A Stronger Safety Net : Community Health Centers 10 Years After the Affordable Care Act.

The Affordable Care Act made direct and indirect investments in community health centers. Ten years later, more North Carolinians benefit from a stronger primary care safety net that provides a broader scope of comprehensive services, but missed policymaking opportunities leave work to be done to achieve a healthier, more equitable state.

Neurosurgical resident research education: a survey of United States residency program directors.

Objective: The application of evidence-based medicine (EBM) has played an increasing role within neurosurgical education over the last several decades. The Accreditation Council for Graduate Medical Education (ACGME) has mandated that residents are now required to demonstrate academic productivity and mastery of EBM principles. The goal of this study was to assess how neurosurgery programs around the US are dealing with the challenges of fulfilling these program requirements from the ACGME in addition to standard neurosurgical education.

Independent Validation of the Colloid Cyst Risk Score to Predict Symptoms and Hydrocephalus in Patients with Colloid Cysts of the Third Ventricle.

Background: The Colloid Cyst Risk Score (CCRS) was devised to identify patients with symptomatic colloid cyst and stratify risk of hydrocephalus. The CCRS considers patient age, presence of headache, colloid cyst diameter, fluid-attenuated inversion recovery hyperintensity, and location within the third ventricle.

Objective: The purpose of this study was to independently evaluate the validity of the CCRS.

Communicating With Leadership: Behavioral Health and HIPAA in the Field.

It can be challenging for a general medical officer to determine a patient's fitness for duty in the field. Communicating with commanding officers can be difficult given a general medical officer's loyalties as both a physician and medical officer. We present a case of a junior officer that highlights these issues.

Is There an Association Between Physician Review Websites and Press Ganey Survey Results in a Neurosurgical Outpatient Clinic?

Objective: Recent studies suggest a poor association between physician review websites and the validated metrics used by the Centers for Medicare and Medicaid Services. The purpose of this study was to evaluate the association between online and outpatient Press Ganey (PG) measures of patient satisfaction in a neurosurgical department.

Methods: We obtained PG survey results from one large academic institution's outpatient neurosurgery clinic.

Reserved Bed Program Reduces Neurosciences Intensive Care Unit Capacity Strain: An Implementation Study.

Background: Neurosciences intensive care units (NICUs) provide institutional centers for specialized care. Despite a demonstrable reduction in morbidity and mortality, NICUs may experience significant capacity strain with resulting supraoptimal utilization and diseconomies of scale. We present an implementation study in the recognition and management of capacity strain within a large NICU in the United States.

Developing Physician Leadership in Hospital Policy Development: A Case Study of Resident-Driven Policy Initiatives in the Department of Neurosurgery at the University of Alabama at Birmingham.

The bulk of a resident's daily work is patient care related; however, other aspects of residency training are vital both to a resident's education and to the advancement of the field. Basic science and clinical research are the more common academic activities in which residents participate after completion of daily patient care objectives. Less frequently, residents participate in a process vital to the delivery of efficient, cost-effective, and safe patient care: hospital policy development.

Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit.

Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU.

Inadvertent Radial Head Inversion During Closed Reduction of a Pediatric Radial Neck Fracture.

Management of displaced pediatric radial neck fractures can be fraught with challenges. This unique case presents an 11-year-old female with a Salter-Harris type II radial neck fracture and how her radial head overturned 180° with the articular surface facing the radial shaft rather than the capitellum during closed manipulation under anesthesia. The malreduction subsequently required open reduction and highlights the importance of a careful stepwise approach to managing markedly displaced radial neck fractures.

Towards Evidence-Based Guidelines in Neurological Surgery.

Neurological surgery practice is based on the science of balancing probabilities. A variety of clinical guidance documents have influenced how we collectively practice our art since the early 20th century. The quality of the science within these guidelines varies widely, as does their utility in positively shaping our practice.

Predictors of Long-Term Exercise Capacity in Patients Who Have Had Lung Transplantation.

Introduction: Six-minute walk distance (6MWD) is a widely used surrogate for exercise capacity in patients both pre- and post-lung transplant. Multiple factors have been suggested to influence exercise capacity.

Research Questions: This study sought to determine the change in exercise capacity over time and factors that influence long-term exercise capacity.