Neurosurgery
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Multiple national initiatives seek to curb spending to address increasing healthcare costs in the United States. The Choosing Wisely initiative is a popular initiative that focuses on reducing healthcare spending by setting guidelines to limit tests and procedures requested by patients and ordered by physicians. To reduce spending on neuroimaging, the Choosing Wisely initiative and other organizations have offered guidelines to limit neuroimaging for headaches. ⋯ If adopted by governing or funding organizations, these guidelines threaten to negatively affect the care and outcomes of patients with brain tumors, who frequently present with minimal symptoms or isolated headaches syndromes. As physicians grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, they must carefully balance the costs and benefits of discretionary services such as neuroimaging for headaches. By participating in the development of validated clinical decision rules on neuroimaging for headaches, neurosurgeons can advocate for their patients and improve their patients' outcomes.
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Multicenter Study Observational Study
Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study.
Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. ⋯ Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management.