Neurosurgery
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The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums. ⋯ We found variation in the case numbers to reach competency and that for some procedures (tumor, ACDF, PCF, discectomy/laminectomy, and PSF), most residents required more cases than the ACGME case minimums to achieve competency. The ACGME case minimums may not accurately reflect the number of cases required for neurosurgical residents to reach competency. To promote trainee-centered education, individualized, competency-based evaluation systems may be better determining readiness for graduation, including a system that builds off the established ACGME Milestones.
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Recovery after sport-related concussion is variable, and potential differences between team vs individual sport athletes are not fully understood. In a cohort of athletes with concussions, we sought to compare these groups across (1) symptom severity score, (2) individual symptom cluster scores, and (3) recovery metrics. ⋯ In the current single-center, pilot study of athletes with a sport-related concussion, individual sport athletes exhibited more emotional symptoms than team sport athletes. These preliminary data lend early support that individual sport athletes may be more at risk of emotional symptoms than team sport athletes after a sport-related concussion. Clinicians may use these findings to identify athletes who may be particularly vulnerable to emotional symptoms.
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Pyogenic spinal infections pose therapeutic challenges, with the optimal treatment approach remaining contentious. This study aimed to compare outcomes of conservative vs early surgical treatment (SuT) modalities in primary pyogenic spondylodiskitis through an international cohort analysis. ⋯ The study indicates that early surgical intervention may be more effective than conservative management in reducing mortality and hospital stay for patients with primary pyogenic spondylodiskitis. These findings highlight the need for prospective trials and more definitive treatment guidelines.
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Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor. ⋯ The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.