Articles: cations.
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: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. ⋯ However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.
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Review
Trends for Spine Surgery for the Elderly: Implications for Access to Healthcare in North America.
The proportion of the population over age 65 in the United States continues to increase over time, from 12% in 2000 to a projected 20% by 2030. There is an associated rise in the prevalence of degenerative spinal disorders with this aging population. This will lead to an increase in demand for both nonsurgical and surgical treatment for these disabling conditions, which will stress an already overburdened healthcare system. Utilization of spinal procedures and services has grown considerably. Comparing 1999 to 2009, lumbar epidural steroid injections have increased by nearly 900,000 procedures performed per year, while physical therapy evaluations have increased by nearly 1.4 million visits per year. We review the literature regarding the cost-effectiveness of spinal surgery compared to conservative treatment. Decompressive lumbar spinal surgery has been shown to be cost-effective in several studies, while adult spinal deformity surgery has higher total cost per quality-adjusted life year gained in the short term. With an aging population and unsustainable healthcare costs, we may be faced with a shortfall of beneficial spine care as demand for spinal surgery in our elderly population continues to rise. ⋯ QALY, quality-adjusted life year.
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The purpose of this study was to report our large, single-center experience of transabdominal ileal pouch-anal anastomoses (IPAA) redo surgery for a failed initial IPAA. ⋯ Patients with a failed ileoanal pouch may be offered redo pouch surgery with a high likelihood of success in terms of function and QOL.
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Low-level light therapy (LLLT) is clinically used to attenuate inflammation and improve tissue repair processes. We aimed to evaluate the effects of red LED light on inflammatory response in a whole blood in vitro model as well as in isolated granulocytes. ⋯ Our data suggest that the beneficial effects do not depend on the direct impact on leukocytes and their secretion of pro-inflammatory mediators. Also, our data disprove the hypothesis that LLLT can render some pro-inflammatory mediators harmless. Thus, more research studies are needed to understand the molecular mechanisms of LLLT and to standardize the clinical dosing and delivery protocols for light therapy to ensure the maximum efficacy and safety of photo-biomodulation.
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Patients with chronic kidney disease (CKD) requiring dialysis have a higher risk of sepsis and a 100-fold higher mortality. The severity of cardiac dysfunction predicts mortality among septic patients. Here we investigated the roles of pre-existing CKD on the cardiac outcome in mice with sepsis, and whether inhibition of IκB kinase (IKK) reduces the cardiac dysfunction in these animals. ⋯ Pre-existing CKD aggravates the cardiac dysfunction caused by LPS or CLP in mice; this may (at least in part) be due to increased cardiac activation of NF-κB and iNOS expression.(Figure is included in full-text article.).