Neurosurgery
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Observational Study
Understanding Hospital Volume-Outcome Relationship in Severe Traumatic Brain Injury.
The hospital volume-outcome relationship in severe traumatic brain injury (TBI) population remains unclear. ⋯ High-volume hospitals might be associated with lower in-hospital mortality following severe TBI. However, this mortality reduction was not associated with lower risk of major complications or death following a major complication.
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The purpose of neurosurgical education is to teach the clinical knowledge and surgical skills necessary to become a neurosurgeon. Another goal is to inculcate the principles of the scientific method. ⋯ At the same time, our healthcare system is undergoing a rapid socioeconomic transition in organization and payment models, which traditionally has not been a focus of formal teaching. A 2008 survey conducted by the Council of State Neurosurgical Societies found that graduating residents felt inadequately prepared in areas like contract negotiation, practice evaluation, and management.
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Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI. ⋯ Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.
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This article describes guiding principles utilized in practice. It is descriptive of the evolution of one of the largest neurosurgical practices in the United States. The objective is to identify and effectively create leverage in neurosurgical practice and to describe principles instrumental in the growth of this practice. ⋯ Results demonstrate important strategies for creating and maintaining leverage, as well as principles that have enabled the practice to remain independent and continue to provide high-quality care. In conclusion, it is important to stay focused on potential sources of leverage, to gain advantage for the future, and maintain stability as healthcare changes occur. Quality data and outcomes will allow practice to continue to grow strategically.
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Radiation-based treatment options of large intracranial arteriovenous malformations (AVM) must balance the likelihood of obliteration with the risk of adverse radiation effects (ARE). ⋯ VS-SRS permitted large volume intracranial AVM to be treated with a low rate of ARE. Further study is needed on dose escalation and decreasing the treatment volume per stage to determine if this will increase the rate of obliteration with this technique.