Neurosurgery
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Recent efforts to improve health care quality have focused on variations in outcomes such as 30-day readmissions (30d-R). Pay-for-performance programs hold providers accountable to reduce these variations, with the assumption that variations are due to discretionary practices of providers and can be influenced by changes in reimbursement. We examined variations in length of stay (LOS) and 30d-R among the surgeons for elective lumbar spine surgery for degenerative conditions to determine if these outcomes are a valid target for pay for performance programs. ⋯ We found significant variations in LOS by surgeon after adjusting for patient characteristics and type of surgery. This suggests that surgeon practice varies and impacts length of stay. Yet, we found no variation in 30d-R by surgeon, implying that surgeon practice variation does not affect 30d-R. Thus, pay-for-performance programs aimed at providers are unlikely to improve 30d-R.
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Occipital nerve stimulation (ONS) is utilized to manage chronic migraine (CM) symptoms. Our knowledge of neural activity evoked during optimal (O-ONS) and suboptimal ONS (S-ONS) is limited, and, in this study, we aim to elucidate the differences in central activation patterns during these stimulation conditions using functional positron emission tomography (PET) imaging. ⋯ Difference in central activation by optimal and suboptimal ONS for migraine in this study echoes functional imaging studies demonstrating persistent dysfunctional activity in pons, as well as increased activity during headache attacks in orbitofrontal area, anterior cingulate cortex, and insular/temporal area involved in anticipation and fear/anxiety toward perceived pain. Cerebellum was also previously found to be involved in pain modulation. Occipital nerve stimulation seems to decrease migraine-related headache intensity by modulating activity in areas involved in processing the affective, emotional, and cognitive aspects of pain as well as the anticipation of pain.
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Brain-machine interface neuroprosthetic arms for people with upper limb impairment are developing quickly, but could be improved through intelligent computer-vision-based assistance. Grasping and manipulating objects requires very accurate control of a prosthetic arm and hand, and is required for these limbs to eventually be used clinically. With the computer helping to stabilize the hand during grasping, the user's control would not need to be as accurate, and they would be free to concentrate on the larger goals of the arm movements. ⋯ By integrating brain-machine interface-based high-level control with computer-vision-based low-level control of a robotic arm, people with tetraplegia showed improved functional use of the arm. This result highlights the importance of combining neuroscience- and robotic-based assistive technologies to create a highly flexible and effective neuroprosthetic arm for people with upper limb impairment.
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Operative management of adult spinal deformity (ASD) repeatedly demonstrates improvements in health-related quality of life over nonoperative treatment. However, little is reported regarding the quality-adjusted life-year (QALY) improvements following surgical correction of ASD. The purpose of this study was to evaluate the QALY increases following the operative treatment of ASD compared with nonoperative treatment. ⋯ The operative treatment of ASD results in significant increases in QALYs gained at minimum 2 years postoperatively as well as at the 1-, 2-, and 3-year time points compared with nonoperative management.
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Surgical costs are very high, but most surgeons have little knowledge of their operating room (OR) costs. A recent study of orthopedic surgeons found that their cost estimates for commonly used orthopedic devices ranged from 1.8% to 24.6 times the actual price. The goal of OR SCORE is to determine whether a price transparency initiative will reduce costs in the surgical departments at University of California San Francisco (UCSF). ⋯ To the best of our knowledge, there are no publications demonstrating cost reduction through a price transparency initiative directed at surgeons, and our work represents one of the first attempts to do this.