Humphreyharris9907

Frailty indices may represent useful decision support tools to optimize modifiable drivers of quality and cost in neurosurgical care. selleck chemicals llc However, classic indices are cumbersome to calculate and frequently require unavailable data. Recently, a more lean 5-factor modified frailty index (mFI-5) was introduced, but it has not yet been rigorously applied to brain tumor patients.

To investigate the predictive value of the mFI-5 on length of stay (LOS), complications, and charges in surgical brain tumor patients.

We retrospectively reviewed data for brain tumor patients who underwent primary surgery from 2017 to 2018. Bivariate (ANOVA) and multivariate (logistic and linear regression) analyses assessed the predictive power of the mFI-5 on postoperative outcomes.

Our cohort included 1692 patients with a mean age of 55.5 yr and mFI-5 of 0.80. Mean intensive care unit (ICU) and total LOS were 1.69 and 5.24 d, respectively. Mean pulmonary embolism (PE)/deep vein thrombosis (DVT), physiological/metabolic derangement, respiratory failure, and sepsis rates were 7.2%, 1.1%, 1.6%, and 1.7%, respectively. Mean total charges were $42331. On multivariate analysis, each additional point on the mFI-5 was associated with a 0.32- and 1.38-d increase in ICU and total LOS, respectively; increased odds of PE/DVT (odds ratio (OR) 1.50), physiological/metabolic derangement (OR 3.66), respiratory failure (OR 1.55), and sepsis (OR 2.12); and an increase in total charges of $5846.

The mFI-5 is a pragmatic and actionable tool which predicts LOS, complications, and charges in brain tumor patients. It may guide future efforts to risk-stratify patients with subsequent impact on postoperative outcomes.

The mFI-5 is a pragmatic and actionable tool which predicts LOS, complications, and charges in brain tumor patients. It may guide future efforts to risk-stratify patients with subsequent impact on postoperative outcomes.

To conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain.

Grade the evidence for DRG stimulation.

An international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.

DRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies.

Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.

Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.

To conduct a systematic literature review of peripheral nerve stimulation (PNS) for pain.

Grade the evidence for PNS.

An international interdisciplinary work group conducted a literature search for PNS. Abstracts were reviewed to select studies for grading. Inclusion/exclusion criteria included prospective randomized controlled trials (RCTs) with meaningful clinical outcomes that were not part of a larger or previously reported group. Excluded studies were retrospective, had less than two months of follow-up, or existed only as abstracts. Full studies were graded by two independent reviewers using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.

Peripheral nerve stimulation was studied in 14 RCTs for a variety of painful conditions (headache, shoulder, pelvic, back, extremity, and trunk pain). Moderate to strong evidence supported the use of PNS to treat pain.

Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses.

Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses.

This study aimed to investigate the effectiveness of repeat cooled radiofrequency ablation (CRFA) in chronic posterior sacroiliac joint (SIJ) pain.

The electronic records of 41 adult patients who had successful CRFA were reviewed for duration of pain relief and utilization of medical care for six months before and after each CRFA procedure.

Academic, tertiary medical center.

Forty-one adult patients who had CRFA for chronic posterior SIJ pain.

A repeat ipsilateral CRFA ablation procedure provided 9.0 months of pain relief compared with 5.5 months after the first CRFA procedure (P = 0.0378). The total number of medical treatments decreased after the first CRFA procedure (from 343 to 201). The medical cost decreased by 51.0% after the first CRFA and by 70.4% after the repeated CRFA procedure.

Using repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients' utilization of medical services.

Using repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients' utilization of medical services.

We create an expandable combat wound classification coding system and a stratified standardized combat wound injury spectrum to support triage according to the treatment echelon and to provide the basis for the rapid and efficient classification of combat casualties. The coding system simultaneously assists in identifying injuries with a high incidence of fatality that require emergency treatment, and provides a framework for the triage of combat wounds in mass casualty situations.

The three-tiered treatment echelon consisting of battlefield on-site first aid, emergency treatment, and early treatment was used to design an expanded combat wound classification coding system according to the differential needs of combat wound treatment. The Herfindahl-Hirschman Index (HHI) index was used as the key indicator for injury spectrum ranking and was applied to select the key anatomical structures that require the highest priority treatment in the three treatment echelons. The combat wound classification codes were based on the results of consultations with selected experts and results from the HHI index calculations.