bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume
Authors: Vadera Sumeet , Chan Alvin Y. , Mnatsankanyan Lilit , Sazgar Mona , Sen-Gupta Indranil , Lin Jack , Hsu Frank P. K. 
Published: May 2018

OBJECTIVESurgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.METHODSThe authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.RESULTSOver the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.CONCLUSIONSPartnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.
Analysis of cerebrovascular aneurysm treatment cost: retrospective cohort comparison of clipping, coiling, and flow diversion
Authors: Twitchell Spencer , Abou-Al-Shaar Hussam , Reese Jared , Karsy Michael , Eli Ilyas M. , Guan Jian , Taussky Philipp , Couldwell William T. 
Published: May 2018

OBJECTIVEWith the continuous rise of health care costs, hospitals and health care providers must find ways to reduce costs while maintaining high-quality care. Comparing surgical and endovascular treatment of intracranial aneurysms may offer direction in reducing health care costs. The Value-Driven Outcomes (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. In this study, the authors evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system.METHODSThe authors retrospectively reviewed surgical and endovascular treatment of ruptured and unruptured intracranial aneurysms from July 2011 to January 2017. Total cost (as a percentage of each patient’s cost to the system), subcategory costs, and potential cost drivers were evaluated and analyzed.RESULTSA total of 514 aneurysms in 469 patients were treated; 273 aneurysms were surgically clipped, 102 were repaired with coiling, and 139 were addressed with flow diverter placements. Middle cerebral artery aneurysms accounted for the largest portion of cases in the clipping group (29.7%), whereas anterior communicating artery aneurysms were most frequently involved in the coiling group (30.4%) and internal carotid artery aneurysms were the majority in the flow diverter group (63.3%). Coiling (mean total cost 0.25% ± 0.20%) had a higher cost than flow diversion (mean 0.20% ± 0.16%) and clipping (mean 0.17 ± 0.14%; p = 0.0001, 1-way ANOVA). Coiling cases cost 1.5 times as much as clipping and flow diversion costs 1.2 times as much as clipping. Facility costs were the most significant contributor to intracranial clipping costs (60.2%), followed by supplies (18.3%). Supplies were the greatest cost contributor to coiling costs (43.2%), followed by facility (40.0%); similarly, supplies were the greatest portion of costs in flow diversion (57.5%), followed by facility (28.5%). Cost differences for aneurysm location, rupture status, American Society of Anesthesiologists (ASA) grade, and discharge disposition could be identified, with variability depending on surgical procedure. A multivariate analysis showed that rupture status, surgical procedure type, ASA status, discharge disposition, and year of surgery all significantly affected cost (p < 0.0001).CONCLUSIONSFacility utilization and supplies constitute the majority of total costs in aneurysm treatment strategies, but significant variation exists depending on surgical approach, rupture status, and patient discharge disposition. Developing and implementing approaches and protocols to improve resource utilization are important in reducing costs while maintaining high-quality patient care.
Propensity-matched comparison of outcomes and cost after macroscopic and microscopic lumbar discectomy using a national longitudinal database
Authors: Pendharkar Arjun Vivek , Rezaii Paymon Garakani , Ho Allen Lin , Sussman Eric Scott , Purger David Arnold , Veeravagu Anand , Ratliff John Kevin , Desai Atman Mukesh 
Published: May 2018

OBJECTIVEThere has been considerable debate about the utility of the operating microscope in lumbar discectomy and its effect on outcomes and cost.METHODSA commercially available longitudinal database was used to identify patients undergoing discectomy with or without use of a microscope between 2007 and 2015. Propensity matching was performed to normalize differences between demographics and comorbidities in the 2 cohorts. Outcomes, complications, and cost were subsequently analyzed using bivariate analysis.RESULTSA total of 42,025 patients were identified for the “macroscopic” group, while 11,172 patients were identified for the “microscopic” group. For the propensity-matched analysis, the 11,172 patients in the microscopic discectomy group were compared with a group of 22,340 matched patients who underwent macroscopic discectomy. There were no significant differences in postoperative complications between the groups other than a higher proportion of deep vein thrombosis (DVT) in the macroscopic discectomy cohort versus the microscopic discectomy group (0.4% vs 0.2%, matched OR 0.48 [95% CI 0.26–0.82], p = 0.0045). Length of stay was significantly longer in the macroscopic group compared to the microscopic group (mean 2.13 vs 1.83 days, p < 0.0001). Macroscopic discectomy patients had a higher rate of revision surgery when compared to microscopic discectomy patients (OR 0.92 [95% CI 0.84–1.00], p = 0.0366). Hospital charges were higher in the macroscopic discectomy group (mean $19,490 vs $14,921, p < 0.0001).CONCLUSIONSThe present study suggests that the use of the operating microscope in lumbar discectomy is associated with decreased length of stay, lower DVT rate, lower reoperation rate, and decreased overall hospital costs.
Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores
Authors: Thakar Sumit , Rajagopal Niranjana , Mani Subramaniyan , Shyam Maya , Aryan Saritha , Rao Arun S. , Srinivasa Rakshith , Mohan Dilip , Hegde Alangar S. 
Published: May 2018

OBJECTIVEThe utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures.METHODSA decision-analytical model was used to assess the cost-effectiveness of TM for elective post–neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change.RESULTSThe overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy “dominates” that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center.CONCLUSIONSTM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post–neurosurgical care population in India. In the authors’ setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.
Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research
Authors: Wali Arvin R. , Brandel Michael G. , Santiago-Dieppa David R. , Rennert Robert C. , Steinberg Jeffrey A. , Hirshman Brian R. , Murphy James D. , Khalessi Alexander A. 
Published: May 2018

OBJECTIVEMarkov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research.METHODSThe PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs.RESULTSA total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided.CONCLUSIONSAs neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.
Virological and Immunological Responses to Raltegravir and Dolutegravir in the Gut-Associated Lymphoid Tissue of HIV-Infected Men and Women
Authors: Weber Michael D , Andrews Elizabeth , Prince Heather A , Sykes Craig , Rosen Elias P , Bay Camden , Shaheen Nicholas J , Madanick Ryan D , Dellon Evan S , Paris Kristina De , Nelson Julie AE , Gay Cynthia L , Kashuba Angela DM 
Published: May 2018

Background Raltegravir (RTG) and dolutegravir (DTG) have different pharmacokinetic patterns in the gastrointestinal tract. To determine if this results in pharmacodynamic differences, we compared HIV RNA, HIV DNA and immunological markers in gut-associated lymphoid tissue (GALT) of HIV-infected participants receiving RTG or DTG with tenofovir+emtricitabine (TDF/FTC). Methods GALT specimens from the terminal ileum, splenic flexure and rectum were obtained by colonoscopy at a single time point in 20 adults treated with RTG ( n=10) or DTG ( n=10) with HIV RNA <50 copies/ml. Flow cytometry, drug concentrations, and HIV RNA and DNA were analysed in tissue. CD4/8+ T-cells were tested for γδ TCR, and markers of T-cell activation and exhaustion. Data are reported as median (Q1–Q3). Results A total of 15 men and 5 women were enrolled. There was no difference in time since HIV diagnosis for those on RTG (9.5 [4–22] years) and DTG (17 [1–24] years; P=0.6), although time on RTG (5.4 [2.3–6.7] years) was greater than DTG (1.0 [0.1–1.5] years; P<0.001). Concentrations of RTG and DTG in rectal tissue were similar to previous reports: median tissue:plasma ratio was 11.25 for RTG and 0.44 for DTG. RNA:DNA ratios were 1.14 (0.18–5.10) for the RTG group and 0.90 (0.30–18.87) for the DTG group ( P=0.95). No differences ( P≥0.1) between CD4+ and CD8+ T-cell markers were found. Conclusions RTG produced higher tissue exposures than DTG, but no significant differences in GALT HIV RNA, DNA or most immunological markers were observed. ClinicalTrials.gov NCT02218320.
PGA×BSA: A Measure of Psoriasis Severity Tested in Patients with Active Psoriatic Arthritis and Treated with Certolizumab Pegol
Authors: Walsh Jessica A. , Arledge Terri , Nurminen Tommi , Peterson Luke , Stark Jeffrey 
Published: May 2018

Objective.The product of physician’s global assessment and body surface area (PGA×BSA) to assess psoriasis severity has previously been investigated in patients with psoriasis, with the aim of assessing PGA×BSA as an alternative to the time-consuming Psoriasis Area and Severity Index (PASI). Here, we investigate PGA×BSA as an alternative to PASI in patients with psoriatic arthritis (PsA).Methods.Analyses used data from the double-blind, placebo-controlled, RAPID-PsA trial (NCT01087788) that investigated the efficacy of certolizumab pegol (CZP) in patients with PsA. Outcomes assessed whether the PGA×BSA and PASI results were comparable, and whether these outcomes correlated with one another or with the Dermatology Life Quality Index (DLQI).Results.For CZP-treated patients, both PGA×BSA and PASI demonstrated similar sensitivities to treatment between baseline and Week 24, with mean improvements of 77.4% and 69.0%, respectively. Similar improvements were also seen with placebo (PGA×BSA: 3.2%, PASI: 6.1%). Achievement of 75% response criterion in PGA×BSA and PASI was attained by similar proportions of patients with CZP (PGA×BSA75: 59.0%, PASI75: 61.4%) and placebo (PGA × BSA75: 15.1%, PASI75: 15.1%). Cross tabulations showed high concordance between achievement of response outcomes in PGA×BSA and PASI (79.6–95.2%). Spearman correlations revealed strong correlations between PGA×BSA and PASI at baseline (r = 0.78; n = 225) and percentage improvement to Week 24 (r = 0.85; n = 186). Both outcomes were only moderately correlated with DLQI (r = 0.41–0.50; n = 179–249).Conclusion.PGA×BSA is sensitive to changes in skin manifestations in patients with PsA treated with CZP. Further, PGA×BSA correlates strongly with PASI, and achievement of 75% improvement was similar for PGA×BSA and PASI.
Mon cothérapeute chat
Authors: Brousselle André 
Published: May 2018

Le chat peut-il se faire cothérapeute pendant les séances ? Il peut être envisagé comme faisant partie du cadre, ou d’un environnement winnicottien, ou comme miroir d’un bien-être narcissique. Toutefois, à d’autres moments, il sera objet libidinal, personne ou « jouet érotique ». Risque-t-il alors d’entrer dans le clivage mauvais humains/bons animaux, ce qui retirerait sa valeur bénéfique ? Nos questionnements s’appuieront sur le cas clinique d’une patiente.
Early Warning Score Communication Bundle: A Pilot Study
Authors: Gagne Cheryl , Fetzer Susan 
Published: May 2018

Background
Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers.

Objective
To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer.

Methods
After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation.

Results
Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002).

Conclusion
Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.
GUT COLONIZATION WITH CARBAPENEM RESISTANT ENTEROBACTERIACEAE ADVERSELY IMPACTS THE OUTCOME IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES: RESULTS OF A PROSPECTIVE SURVEILLANCE STUDY
Authors: CHAKRABARTI SUPARNO 
Published: May 2018

Background: Gut colonisation with Carbapenem Resistant Enterobacteriaceae (CRE) is a risk factor for CRE bacteremia and patients with haematological malignancies (HM) are at the highest risk of mortality.Methods: We conducted a prospective surveillance study of gut colonisation with CRE and its impact on the outcome on 225 consecutive patients of HM over 28 months. Results: The median age of the cohort was 46 years, majority with Acute Leukemia. 48 (21%) patients were colonized with CRE on admission (CAD). Another 46 patients were colonized with CRE in the hospital (CIH). The risk factors for CAD and CIH were diagnosis of acute leukemia and duration of hospital stay respectively. CRE accounted for 77% of non-relapse mortality (NRM). CRE bacteremia occurred only in colonized patients with 100% mortality. NRM was 35.3% in CIH group compared to 10.5% in the CAD group (p=0.0001). NRM was highest in those with AML and CIH (54.9% p=0.0001). On multivariate analysis, CIH was the most important risk factor for NRM (HR-7.2).Conclusion: Our data demonstrates that a substantial proportion of patients with HM are colonized with CRE without prior hospitalization, but those with nosocomial colonization have the highest risk of mortality, particularly in those with Acute Myeloid Leukemia.
PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW
Authors: Adjepong Kwame Ofori , Otegbeye Folashade , ADJEPONG Yaw Amoateng 
Published: May 2018

An estimated 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.
De digitale kooi: administratieve uitsluiting door informatiearchitectuur in de Basisregistratie Personen
Authors: Peeters Rik , Widlak Arjan 
Published: May 2018

The Digital Cage: Dysfunctional Bureaucracy Through IT-Innovation in the Dutch Civil Registry
The Dutch Municipal Personal Records Database is an IT-innovation that enables the use of the civil registry by hundreds of (semi-)public organisations. Literature review and a case study show how this ‘basis registration’ creates a deep tension between system and lifeworld: citizens who do not fit the system’s criteria lose their access to the major part of public services. The instrumental rationality of the system simplifies the use of addresses for service delivery to one single definition, turns the consequences of address mutations into a black box, and reduces the discretionary space of street-level bureaucrats to handle with social complexities and unintended consequences of the system. This type of IT-innovations can, therefore, come to resemble a ‘digital cage’: a highly disciplining system that hinges on hardware and software design instead of Weberian rules and procedures.
Slanker maar topzwaar, meer vrouwen maar vergrijsd: het veranderende gezicht van de rijksoverheid 2002-2015
Authors: Toshkov Dimiter , Schmidt Eduard , van den Berg Caspar 
Published: May 2018

Leaner but top heavy, more gender-balanced but more senior: The changing face of the Dutch civil service, 2000-2015.
This article analyses the transformations of the Dutch civil service over the last 15 years, during which numerous cutbacks and reorganizations took place. While existing research predominantly focused on changes in the total number of civil servants, we examine how the distribution of civil servants changed in terms of rank, gender and age. We theorize four methods for shrinking the government apparatus, and for each method, we identify the possible consequences for the composition of the central civil service in terms of hierarchical make-up and of age. Our results indicate that the total number of civil servants only slightly decreased, but the decrease affected differentially the various ranks of the civil service. While at the lower ranks the number of civil servants decreased strongly, at the upper ranks the number actually increased slightly. The number of women in the civil service increased, also in the higher echelons. Regarding the age distribution, we found considerable changes, with the modal age shifting upwards with up to ten years. Altogether, the civil service has become slightly smaller, more gender-balanced, and significantly more senior (both in terms of ranks and age). The results of this study show that it is important for researchers and practitioners to look beyond the trends in the total number of civil servants and explore the deeper changes within the civil service.