Acta neurochirurgica
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Acta neurochirurgica · Dec 2017
Disturbance of CT perfusion within 24 h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH.
Delayed cerebral ischemia (DCI) is a serious complication following aneurysmal SAH (aSAH) and remains a leading cause of morbidity and mortality. We investigated whether data from CT perfusion (CTP) within 24 h after onset are associated with DCI and its outcome. ⋯ The current findings suggest that disturbance of CT perfusion soon after the onset is associated with the WFNS grade but not with the development of DCI. Delayed cerebral ischemia may be solely caused by cerebral vasospasm due to a clot in the cistern, but not associated with early brain injury.
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Acta neurochirurgica · Dec 2017
Defensive medicine among neurosurgeons in the Netherlands: a national survey.
In defensive medicine, practice is motivated by legal rather than medical reasons. Previous studies have analyzed the correlation between perceived medico-legal risk and defensive behavior among neurosurgeons in the United States, Canada, and South Africa, but not yet in Europe. The aim of this study is to explore perceived liability burdens and self-reported defensive behaviors among neurosurgeons in the Netherlands and compare their practices with their non-European counterparts. ⋯ Relative to their American peers, Dutch neurosurgeons view their insurance premiums as less burdensome, their patients as a smaller legal threat, and their practice as less risky in general. They are sued less often and engage in fewer defensive behaviors than their non-European counterparts. The medico-legal climate in the Netherlands may contribute to this difference.
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Acta neurochirurgica · Dec 2017
Operating room waste: disposable supply utilization in neurointerventional procedures.
Operating rooms account for 70% of hospital waste, increasing healthcare costs and creating environmental hazards. Endovascular treatment of cerebrovascular pathologies has become prominent, and associated products highly impact the total cost of care. We investigated the costs of endovascular surgical waste at our institution. ⋯ This study shows the impact of neurointerventional waste on the total care costs for cerebrovascular patients. This might reflect the tendency to anticipate needs and emergencies in neurointervention. Responsible use of disposable material can be achieved by educating operators and nurses and creating operator preference cards.