(Press-News.org) Charlottesville, VA (January 1, 2013). The January 2013 issue of Neurosurgical Focus is dedicated to the science of neurosurgical practice and is edited by Drs. Anthony L. Asher (Carolina Neurosurgery and Spine Associates & Carolinas Medical Center, Charlotte, NC), Paul C. McCormick (Columbia University College of Physicians and Surgeons, New York, NY), and Douglas Kondziolka (New York University, New York, NY). In this issue, eight papers tackle a new era in neurosurgical practice, in which there is a shift in health-care priorities (and what drives patterns of medical practice) from medical discoveries and technological innovations to relationships between patient safety and outcomes, quality of care, and the economic implications of keeping people healthy. In their Introduction, the editors speak of a parallel shift from an era in which medical knowledge was generated by a small percentage of researcher-physicians to a time in which most physicians will actively participate in the collection of new facts, their interpretation, and the generation of new knowledge. This activity will be made possible by physicians' ability to deposit, access, and compare clinical data in huge long-term prospective databases of medical disorders and treatments.
In the field of neurosurgery, several professional societies have joined together to advance the quality of patient care and to serve the research needs of neurosurgeons and other health-care stakeholders. To this end a national practice data collection, analysis, and reporting platform, the National Neurosurgery Quality and Outcomes Database (N2QOD), has been initiated. This issue of Neurosurgical Focus contains articles describing N2QOD as well as the overall new trend in professional neurosurgery—what the editors term the "science of neurosurgical practice"—from its beginnings to its projected future.
Specific topics in the January issue of Neurosurgical Focus include the following:
Health care reform, as exemplified in the Patient Protection and Affordable Care Act, according to Rachel Groman and Koryn Rubin, "aims to change the US health care system from one that rewards quantity to one that rewards better value through the use of performance measurement." The authors discuss current barriers to this shift toward better care as well as initiatives created by both the federal government and physician societies in ensuring accountability and delivery of high-quality care to patients.
Drs. Peter Angevine and Paul McCormick discuss the science and methods used to measure clinical practice. They also speak of the benefits accrued from physicians' ease of access to the extensive outcomes research contained in clinical registries.
In 1987 the Gamma Knife® first became available in North America, at the University of Pittsburgh, ushering in the practice of radiosurgery. Since that time Pitt has documented the techniques of this procedure and outcomes in patients who have undergone Gamma Knife surgery at that institution. Dr. Oren Berkowitz and colleagues review how the Pitt clinical registry evolved and how it has facilitated publication of numerous works on the Pitt experience, advancing knowledge of the techniques and outcomes of radiosurgery.
Dr. Matthew McGirt and colleagues describe an overview of their experience at the Vanderbilt Spine Center (Vanderbilt University Medical Center). Here outcomes data have been collected during routine spine care and recorded in a prospective fashion in a longitudinal registry. These data are used for learning and quality improvement; documentation of safety and effectiveness of care; and research into the comparative effectiveness of different procedures.
In March 2012, the National Neurosurgery Quality and Outcomes Database (N2QOD), sponsored by the American Association of Neurological Surgeons in cooperation with the Congress of Neurological Surgeons, Society of Neurological Surgeons, and American Board of Neurological Surgery, began enrolling patients in its pilot project, an Internet-based database of cases of lumbar spine disorders. When fully functional, the N2QOD will expand its coverage to all facets of neurosurgery and serve as a longitudinal outcomes registry that will provide neurosurgeons with "a quality measurement and feedback system that utilizes meaningful patient-centered data. . . . Providers will have the opportunity to learn which diseases, which patient groups, and which treatments are most effectively treated with surgery and identify areas for improving the quality of neurosurgical and spine care." Articles in this issue by Drs. Anthony Asher, Paul McCormick, and Matthew McGirt with their colleagues describe the development and overall purpose of the N2QOD, the pilot project, and regulatory considerations for prospective registries such as the N2QOD.
Dr. Nathan Selden and coworkers discuss the future of neurosurgical practice–based science as it relates to neurosurgical training and practice as well as to improvements in patient care delivery and compliance with regulatory mandates.
According to Dr. Asher, "Our specialty is now engaged in an unprecedented cooperative effort that aims to create a new integrative culture of neurosurgical practice for the purpose of improving care. Tremendous scientific and economic potential resides untapped within our routine clinical activities. The methods to realize that potential now exist. The promise of those methods can only be realized through concerted effort and organized action."
Asher adds: "If neurosurgeons choose to embrace practice science as an essential feature of modern neurosurgical practice, we will help meet the challenges of creating a sustainable healthcare system, and we will also define the relevance of neurosurgery within the broader realm of medicine and society."
### All papers are published online January 1, 2013 online in Neurosurgical Focus, Volume 34, Number 1 (http://thejns.org/toc/foc/34/1). Papers in Neurosurgical Focus are free to the public.
Disclosure: Funding information and potential conflicts of interest are listed at the end of each article.
For additional information, please contact:
Jo Ann M. Eliason, Communications Manager
Journal of Neurosurgery Publishing Group
One Morton Drive, Suite 200
Charlottesville, VA 22903
Email: jaeliason@thejns.org
Telephone 434-982-1209
Fax 434-924-2702
Neurosurgical Focus, an online-only, monthly, peer-reviewed journal, covers a different neurosurgery-related topic in depth each month and is available free to all readers at http://www.thejns.org. Enhanced by color images and video clips, each issue constitutes a state-of-the-art "textbook chapter" in the field of neurosurgery. Neurosurgical Focus is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons (http://www.aans.org), an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care.
The science of neurosurgical practice
2013-01-01
ELSE PRESS RELEASES FROM THIS DATE:
Second impact syndrome: A devastating injury to the young brain
2013-01-01
Charlottesville, VA (January 1, 2013). Physicians at Indiana University School of Medicine and the Northwest Radiology Network (Indianapolis, Indiana) report the case of a 17-year-old high school football player with second impact syndrome (SIS). A rare and devastating traumatic brain injury, SIS occurs when a person, most often a teenager, sustains a second head injury before recovery from an earlier head injury is complete. To the best of the authors' knowledge, this is the first reported case in which imaging studies were performed after both injuries, adding new knowledge ...
Differences in generic pill characteristics may lead to interruptions in essential medication use
2013-01-01
Boston, MA—Generic medications currently account for over 70 percent of prescriptions dispensed. However, while generic drugs are clinically bioequivalent to the brand-name version, they often differ in their physical characteristics, such as color and shape. Researchers from Brigham and Women's Hospital (BWH) have found that some patients who receive generic drugs that vary in their color are over 50 percent more likely to stop taking the drug, leading to potentially important and potentially adverse clinical effects.
The study will be published electronically on December ...
Did Lucy walk, climb, or both?
2013-01-01
Much has been made of our ancestors "coming down out of the trees," and many researchers view terrestrial bipedalism as the hallmark of "humanness." After all, most of our living primate relatives—the great apes, specifically—still spend their time in the trees. Humans are the only member of the family devoted to the ground, living terrestrial rather than arboreal lives, but that wasn't always the case.
The fossil record shows that our predecessors were arboreal habitués, that is, until Lucy arrived on the scene. About 3.5 million years ago in Africa, this new creature, ...
Annals of Internal Medicine tip sheet for 1 Jan. 2013
2013-01-01
1. Distributing Naloxone to Heroin Users May be a Cost-effective Way to Reduce Overdose Deaths
Distributing naloxone to heroin users to use to reverse overdose may be a cost-effective strategy to reduce overdose-related mortality. Opioid overdose is a leading cause of accidental death in the United States and accounts for half of the mortality among heroin users. Naloxone is a short-acting opioid antagonist that can reverse opioid overdose. Researchers developed computer models to estimate the cost-effectiveness of distributing naloxone to heroin users for use at witnessed ...
Houston, we have another problem
2013-01-01
As if space travel was not already filled with enough dangers, a new study out today in the journal PLOS ONE shows that cosmic radiation – which would bombard astronauts on deep space missions to places like Mars – could accelerate the onset of Alzheimer's disease.
"Galactic cosmic radiation poses a significant threat to future astronauts," said M. Kerry O'Banion, M.D., Ph.D., a professor in the University of Rochester Medical Center (URMC) Department of Neurobiology and Anatomy and the senior author of the study. "The possibility that radiation exposure in space may ...
Late-life depression associated with prevalent mild cognitive impairment, increased risk of dementia
2013-01-01
CHICAGO – Depression in a group of Medicare recipients ages 65 years and older appears to be associated with prevalent mild cognitive impairment and an increased risk of dementia, according to a report published Online First by Archives of Neurology, a JAMA Network publication.
Depressive symptoms occur in 3 percent to 63 percent of patients with mild cognitive impairment (MCI) and some studies have shown an increased dementia risk in individuals with a history of depression. The mechanisms behind the association between depression and cognitive decline have not been ...
Economic environment during infancy linked with substance use, delinquent behavior in adolescence
2013-01-01
CHICAGO – The larger economic environment during infancy may be associated with subsequent substance use and delinquent behavior during adolescence, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.
The current economic crisis has received much attention from policy makers, although the focus has been on short-term effects, while the long-term influences of such financial crises, especially on young children, have generally not been examined, according to the study background.
Seethalakshmi Ramanathan, M.B.B.S., ...
As climate warms, bark beetles march on high-elevation forests
2013-01-01
MADISON – Trees and the insects that eat them wage constant war. Insects burrow and munch; trees deploy lethal and disruptive defenses in the form of chemicals.
But in a warming world, where temperatures and seasonal change are in flux, the tide of battle may be shifting in some insects' favor, according to a new study.
In a report published today (Dec. 31, 2012) in the Proceedings of the National Academy of Sciences, a team of scientists from the University of Wisconsin-Madison reports a rising threat to the whitebark pine forests of the northern Rocky Mountains as ...
Jackson Laboratory researchers provide definitive proof for receptor's role in synapse development
2013-01-01
Jackson Laboratory researchers led by Associate Professor Zhong-wei Zhang, Ph.D., have provided direct evidence that a specific neurotransmitter receptor is vital to the process of pruning synapses in the brains of newborn mammals.
Faulty pruning at this early developmental stage is implicated in autism-spectrum disorders and schizophrenia. The definitive evidence for N-methyl-D-aspartate receptor (NMDAR) in pruning has eluded researchers until now, but in research published in the Proceedings of the National Academy of Sciences, Zhang's lab had serendipitous help in ...
Jellyfish experts show increased blooms are a consequence of periodic global fluctuations
2013-01-01
Scientists have cast doubt on the widely held perception that there has been a global increase in jellyfish.
Blooms, or proliferations, of jellyfish can show a substantial, visible impact on coastal populations – clogged nets for fishermen, stinging waters for tourists, even choked cooling intake pipes for power plants – and recent media reports have created a perception that the world's oceans are experiencing trending increases in jellyfish. Now, a new multinational collaborative study, involving the University of Southampton, suggests these trends may be overstated, ...