Articles: outcome.
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Patients receiving standard treatment for chronic subdural hematoma have a high risk of treatment failure. The effect of adjunctive middle meningeal artery embolization on the risk of treatment failure in this population remains unknown. ⋯ Among patients with symptomatic chronic subdural hematoma, adjunctive middle meningeal artery embolization resulted in a lower risk of treatment failure than standard treatment alone, without resulting in an increased incidence of disabling stroke or death in the short term. Further study of longer-term safety outcomes is warranted. (Funded by Balt USA; STEM ClinicalTrials.gov number, NCT04410146.).
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Observation stays in Medicare have grown over the last 15 years, yet limited research exists on how observation may impact outcomes for older adults. ⋯ Among Medicare beneficiaries hospitalized for fewer than 5 days, observation stay was associated with higher rates of 30-day unplanned hospital returns compared to inpatient admission. However, we simultaneously observed lower out-of-pocket costs among those hospitalized under an observation stay. The mixed results suggest that additional research and engagement with relevant parties is needed to optimize observation stay policy.
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Pituitary neoplasms account for 15% of all intracranial neoplasms and affect 20% of the population. ⋯ Despite advancements in endoscopic endonasal pituitary surgery, disparities in access and outcomes persist across racial, socioeconomic, and insurance groups. These findings underscore the need for targeted interventions to address these inequalities and ensure equitable access to quality care.
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Evidence available to clinicians and patients to inform treatment decisions is ideally produced by randomised controlled trials (RCT). The objective of this study was to assess the extent to which Neurosurgical practice is supported by RCT-level evidence. ⋯ The RCT level evidence supporting Neurosurgical practice is varied and the outcomes tested remain predominantly heterogenous. There remain important Neurosurgical conditions where treatment strategies are not underpinned by high quality evidence. Pragmatic RCTs, well-designed observational studies as well as robust audit and registry processes may provide the real-world evidence for treatment decisions in Neurosurgical care.