Articles: outcome.
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The value of intraoperative neurophysiological monitoring (INM) during intramedullary spinal cord tumor surgery remains debated. This historical control study tests the hypothesis that INM monitoring improves neurological outcome. ⋯ The applied motor evoked potential methods seem to improve long-term motor outcome significantly. Early motor outcome is similar because of transient motor deficits in the INM group, which can be predicted at the end of surgery by the neurophysiological profile of patients.
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Objectives. To determine whether deep brain stimulation is an effective treatment for neuropathic pain of varied etiology. Material and Methods. Thirty-four patients with intractable neuropathic pain were prospectively studied using visual analog scores, McGill Pain Questionnaire, and Quality of Life Questionnaires (EUROQOL EQ-5D VAS, and SF-36 v-2). Patients had either deep brain stimulation of either the periventricular gray or ventroposterolateral nucleus of the thalamus, or both. ⋯ Health-related quality of life improved by 38%. Conclusions. Deep brain stimulation is an effective treatment for neuropathic pain. The factors that influence outcome, including etiology and site of stimulation, are discussed.
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Objectives. To study the impact of personality traits on the effect of neurostimulation in patients with chest pain and normal coronary arteries. Materials and Methods. Using the Dutch personality questionnaire, we retrospectively studied the personality traits in 33 patients treated with neurostimulation, either transcutaneous electrical nerve stimulation or spinal cord stimulation after 5 years. Neurostimulation was successful in 21 patients. ⋯ In univariate analyses, low scores at the "social inadequacy" scale and the use of calcium antagonists were associated with beneficial outcome of neurostimulation. In multivariate analysis low scores at the "social inadequacy" scale remained an independent predictor for beneficial neurostimulation outcome, when adjusted for other variables. Conclusion. Personality traits are a determining factor in the evaluation of neurostimulation for patients with chest pain and normal coronary arteries.
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This review focuses on recent advances in the treatment of traumatic brain injury (TBI) during 2004 and 2005. Injured brain is a very heterogeneous structure, significantly evolving over time. Implementation of multimodal neuromonitoring will certainly provide more insights into pathophysiology of TBI. ⋯ Hypertonic saline may become a preferred osmotherapeutic agent in severely head-injured patients, especially those with refractory intracranial hypertension. Benefit and indications for performing a decompressive craniectomy remain to be determined. Overall, individualized treatment respecting actual status of a patient's intra- and extracranial homeostasis should be the key principle of our current therapeutic approach toward severely head-injured patients.
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Critical care medicine · Mar 2006
Intensive care unit physician staffing: financial modeling of the Leapfrog standard.
To evaluate from a hospital's perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group's Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units. ⋯ Financial modeling of implementation of the IPS standard using conservative assumptions demonstrated cost savings to hospitals. Only under worst-case scenario assumptions did intensivist staffing result in additional cost to hospitals. These economic findings must be interpreted in the context of significant reductions in patient morbidity and mortality rates also associated with intensivist staffing. Given the magnitude of its clinical and financial impact, hospital leaders should be asking "how to" rather than "whether to" implement The Leapfrog Group's ICU Physician Staffing standard.