World Neurosurg
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Review Case Reports
The science of medical decision making: neurosurgery, errors, and personal cognitive strategies for improving quality of care.
During the last 2 decades, there has been a shift in the U. S. health care system towards improving the quality of health care provided by enhancing patient safety and reducing medical errors. Unfortunately, surgical complications, patient harm events, and malpractice claims remain common in the field of neurosurgery. ⋯ There are an increasing number of publications in the medical literature in which authors address cognitive errors in diagnosis and treatment and strategies for reducing such errors, but these are for the most part absent in the neurosurgical literature. The purpose of this article is to highlight the complexities of medical decision making to a neurosurgical audience, with the hope of providing insight into the biases that lead us towards error and strategies to overcome our innate cognitive deficiencies. To accomplish this goal, we review the current literature on medical errors and just culture, explain the dual process theory of cognition, identify common cognitive errors affecting neurosurgeons in practice, review cognitive debiasing strategies, and finally provide simple methods that can be easily assimilated into neurosurgical practice to improve clinical decision making.
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Review Historical Article
Hypothermia for acute spinal cord injury--a review.
Spinal cord injury (SCI) is a catastrophic neurological event with no proven treatments that protect against its consequences. Potential benefits of hypothermia in preventing/limiting central nervous system injury are now well known. There has been an interest in its potential use after SCI. This article reviews the current experimental and clinical evidence on the use of therapeutic hypothermia in patients with SCI. ⋯ There is robust experimental and some clinical evidence that hypothermia is beneficial in acute SCI. Larger, multicenter trials should be initiated to further study the usefulness of systemic hypothermia in SCI.
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To objectively mark out abnormal areas of magnetic resonance imaging (MRI), positron emission tomography (PET), and electrocorticography (ECoG) using neuronavigation so as to 1) enhance the accuracy of margins of the epileptogenic zone and 2) understand the relationships of all the three modalities with each other. ⋯ Multimodal imaging and ECoG using this method seems to provide a better objective localization of the epileptogenic foci.
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Comparative Study
A comparison of cell-cycle markers in skull base and sacral chordomas.
Despite refinement of surgical techniques and adjuvant radiotherapy, the prognosis for patients with a chordoma remains poor. Identification of prognostic factors related to tumor biology might improve this assessment and result in molecular markers for targeted therapy. Limited studies have been performed to unravel the impact of cell-cycle markers in chordoma, and those performed have shown inconclusive results. In the current study, we aimed to discover the impact of cyclin-dependent kinase 4 (CDK4) expression and its relation to prognosis and other cell-cycle markers in chordoma. ⋯ Our results show that the expression of CDK4 and p53 are related to cell proliferation capacity and worse outcome in patients with chordoma.
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The cerebellum is an uncommon location for arteriovenous malformations (AVM) with unique angioarchitecture compared to the cerebrum. We evaluate the outcomes of radiosurgery in a cohort of cerebellar AVMs and assess the effect of infratentorial location by comparing them to a matched cohort of supratentorial AVMs. ⋯ Radiosurgery is an effective treatment modality for cerebellar AVMs with relatively limited adverse events. Infratentorial location did not affect radiosurgery outcomes.