Browsing by Subject "Spine"
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Item Neurosurgery in Resource-Poor Settings: Improving Access to Surgical Education and Outcomes Analysis of Spine Surgery in a Training Hospital in Cambodia(2019-03-26) Still, Megan Elizabeth Hermann; Bagley, Carlos; Patel, Toral; Lega, Bradley C.BACKGROUND: Access to basic surgical care, and neurosurgery in particular, has historically been a neglected topic in the global health sphere. However, up to 30% of the global burden of disease is surgical in nature and great strides have been made in the past few years to spotlight and begin to rectify the huge gap in access to safe, timely, and affordable surgical care around the globe. Spine pathology is a common reason for admission to neurosurgical units in low- and middle- income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality of life scores have been reported in LMICs. OBJECTIVE: This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling. METHODS: This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital, in Phnom Penh (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with p<0.1 were entered into multivariate logistic regression models. RESULTS: 773 patients were included. 46 patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (p=0.009) or Sihanoukville (p=0.036), and delay to evaluation of over one year (p=0.027) were significant predictive factors of postoperative complications and ASIA A injury (p=0.020) was a predictive factor of poor outcome. CONCLUSION: Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, ASIA A injuries, and lumbar-level surgery may be especially susceptible to complications and post-operative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs. Additionally, various groups are working towards equality and training in neurosurgery around the globe using different approaches towards education.Item [Southwestern News](1994-11-01) Donovan, JenniferItem Tumor Segmentation of Whole-Body Magnetic Resonance Imaging in Neurofibromatosis Type 1 Patients: Tumor Burden Correlates(2017-01-17) Heffler, Michael A.; Chhabra, Avneesh; Le, Lu Q.; Xi, YinPURPOSE: To use software segmentation of whole body MRI (WBMRI) to quantitate total body tumor volume (tumor burden) in patients with Neurofibromatosis type 1 (NF1) and examine associations between demographic factors and tumor burdens. METHODS: Patients with NF1 underwent WBMRI, and the images were reviewed by a board-certified radiologist for tumors. Each tumor was classified as superficial or internal, and discrete or plexiform. Tumors were then segmented by a trained assistant using a semi-automated software-based tool (SliceOMatic, TomoVision, Québec, Canada). Segmentation times were recorded. Segmentation yielded the total quantity and tumor burden of superficial, internal, and plexiform tumors. Correlations between the segmentation data and patient demographic factors were examined. RESULTS: 15 patients were included (42.3 +/- 13.6 years, 10 female, 5 male). Segmentation time ranged from 20 to 60 minutes, and yielded 2328 tumors (1582 superficial, 746 internal, and 23 plexiform). One tumor (0.04%) was malignant, all others were benign. The number of tumors per patient ranged from 14 to 397. Tumor burden ranged from 6.95 cm3 to 571 cm3. Individual tumor volume ranged from 0.0120 cm3 to 298 cm3. Significant correlation was found between total volume of superficial tumors and height (ρ = 0.5966, p < 0.02). Male patients had larger overall tumor burdens (p < 0.05) and larger superficial tumor burdens (p < 0.03). Patients with a negative family history of NF1 tended to have more tumors (p < 0.05). CONCLUSION: Segmentation of WBMRI in patients with NF1 is possible and can elucidate meaningful relationships between disease phenotype and demographic factors.Item UTSW Perioperative Optimization of Senior Health: Initiatives to Reduce Delirium After Spine Surgery(2020-01-21) Deme, Palvasha Reddy; Bagley, Carlos A.; Wingfield, Sarah A.; Pernik, Mark Nicholas; Nguyen, Madelina L.; Ayala, Gabriela; Chorostecki, Jessica; Serias, Mae; Opute, Amaka; Hall, KristenINTRODUCTION: The UT Southwestern Perioperative Optimization of Senior Health (UTSW POSH) program is a multidisciplinary approach involving surgery, geriatrics, and anesthesia in an effort to reduce morbidity in high-risk elderly patients undergoing elective surgery. Modeled after the original POSH program developed at Duke University, one goal of the UTSW POSH program is to prevent delirium, an often-unrecognized source of adverse outcomes. In this two phase project, a validated chart review tool was used to determine delirium rates in UTSW POSH patients undergoing spine surgery. Concurrently, an initiative began to educate postoperative nurses about delirium risk assessment, recognition and management. As part of the initiative, nurses implemented a standardized screening tool (the 4 A's Test or 4AT) with the goal of increasing recognition of postoperative delirium in older adults undergoing spine surgery. METHODS: The records of 148 elderly patients who had undergone elective spine surgery were retrospectively reviewed. A chart review-based method was utilized to retrospectively identify delirium by applying CAM criteria. For intervention, nurses on the neurosurgical floor were asked to attend a 45-minute educational session conducted by a geriatric health care provider. Surveys regarding delirium knowledge were administered before and after each session. Three Registered Nurses became nurse champions to implement the 4AT and facilitate change in nursing workflow. Patient charts were audited using an EMR Reporting Tool to monitor rates of delirium screening. RESULTS: The incidence of delirium found in UTSW POSH patients through chart review was 11.6%. A greater proportion of nurses (76.07%) answered delirium knowledge questions correctly post-intervention as compared to pre-intervention (67.86%). The chi-square test showed the impact of nursing education was statistically significant (p = 0.0167, CI = 0.4763-0.9294). Daily delirium screening rates improved from 0% at baseline to 81.6% in a randomly selected 5-day period 7 weeks post-intervention. CONCLUSION: The incidence of delirium found in UTSW POSH patients was lower than most published rates, however there is still room for improvement. A delirium initiative utilizing nurse champions can be effective in educating nurses about delirium and initiating screening on a postoperative neurosurgical floor. Programs that provide multidisciplinary, specialized perioperative care for high-risk elderly patients may be effective in reducing the incidence of postoperative delirium.