Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Jun 2014
Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.
The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. ⋯ Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.
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J Clin Neurophysiol · Jun 2014
Comparative StudyApplication of subhairline EEG montage in intensive care unit: comparison with full montage.
Problems with the availability of standard EEG monitoring in the intensive care unit have led to the use of recordings that have limited spatial coverage. We studied the performance of limited coverage EEG compared with more traditional full-montage EEG. ⋯ The subhairline montage shows excellent specificity for detecting patients with seizure activity but has limited sensitivity. It has relatively poor performance for other EEG phenomena, but further applications in trending and assessing reactivity should be assessed in further studies.
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J Clin Neurophysiol · Apr 2014
ReviewComparative effectiveness analyses of intraoperative neurophysiological monitoring in spinal surgery.
Intraoperative neurophysiological monitoring for surgeries of the spine has been performed in clinical practice for several decades, but recent alterations in reimbursement schemes by third party payers have raised issues of the value of these procedures. Decision modeling using comparative effectiveness techniques holds the promise of evidence-based assessment of both cost and meaningful outcomes. In this article, we review the elements of comparative effectiveness analyses followed by a critical appraisal of the small but growing body of cost-effectiveness literature for intraoperative neurophysiological monitoring in spine.
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J Clin Neurophysiol · Feb 2014
Median nerve somatosensory evoked potential monitoring during carotid endarterectomy: does reference choice matter?
Median nerve somatosensory evoked potential monitoring is commonly used during carotid endarterectomy to permit selective shunting in only those patients who are determined to have inadequate collateral flow after carotid cross-clamping. The N20 component is recorded from the CPc (contralateral centroparietal) electrode; either CPi (ipsilateral centroparietal) or Fpz (forehead) can be used as the reference. ⋯ Although, as expected, the baseline N20 component was significantly larger when recorded with the CPc-Fpz derivation than with the CPc-CPi derivation (3.1 vs. 2.4 μV in the hemisphere ipsilateral to the clamped carotid, P < 0.001), there was no significant difference in the postclamp amplitude decline between the 2 derivations (8.7% vs. 8.6%, P = 0.82). It is concluded that CPc-Fpz is an acceptable derivation for recording postclamp hemispheric somatosensory evoked potential changes during carotid endarterectomy and may be advantageous because it provides a larger amplitude somatosensory evoked potential than the CPc-CPi derivation.
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Intraoperative neurophysiologic monitoring endeavors to preserve the integrity of the nervous system at a time of potential risk. The examination of language function in the operative setting is a unique task that requires a detailed and systematic approach to be carried out efficiently and reliably in this dynamic environment. ⋯ This technique requires a coordinated effort to testing, which is reliant on preoperative assessment and structured approach to functional cortical mapping by the surgical, anesthetic, and neurophysiology teams. Despite the intricate nature of this modality of testing, the accurate identification of language areas facilitates neurosurgeries for tumor and focal epilepsy syndromes in the dominant cerebral hemisphere, which depend on maximal margins of resection for best outcomes.