32 results on '"Dambrino, Robert"'
Search Results
2. The cost of a plastic surgery team assisting with cranioplasty
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Dambrino, Robert J., IV, Liles, D. Campbell, Chen, Jeffrey W., Chanbour, Hani, Koester, Stefan W., Feldman, Michael J., Chitale, Rohan V., Morone, Peter J., Chambless, Lola B., and Zuckerman, Scott L.
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- 2023
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3. Red blood cell distribution width in glioblastoma
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Kelly, Patrick D., Dambrino, Robert J., Guidry, Bradley S., Tang, Alan R., Stewart, Thomas G., Mistry, Akshitkumar, Morone, Peter J., and Chambless, Lola B.
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- 2022
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4. Lumbar Drain Use during Middle Fossa Approaches for Nonneoplastic Pathology of the Skull Base.
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Dambrino, Robert J., Wong, Gunther W., Tang, Alan R., Jo, Jacob, Yengo-Kahn, Aaron M., Lindquist, Nathan R., Freeman, Michael H., Haynes, David S., Tawfik, Kareem O., Chambless, Lola B., Thompson, Reid C., and Morone, Peter J.
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SKULL base , *RHINORRHEA , *CEREBROSPINAL fluid leak , *SEMICIRCULAR canals , *PATHOLOGY , *INTRACRANIAL hemorrhage - Abstract
Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol (n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05–2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25–2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48–4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant (p = 0.07). Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies. [ABSTRACT FROM AUTHOR]
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- 2024
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5. The impact of craniotomy for brain tumor case volume on patient safety indicators and in-hospital mortality
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Clark, Paul R., Dambrino, Robert J., Himel, Sean M., Smalley, Zachary S., Yimer, Wondwosen K., and Washington, Chad W.
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- 2020
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6. A Transcriptome-Wide Association Study of Vestibular Schwannoma.
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Dambrino, Robert J., Lin, Phillip, Bledsoe, Xavier, Liles, Campbell, Thompson, Reid C., Morone, Peter J., and Gamazon, Eric R.
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ACOUSTIC neuroma , *NEUROFIBROMATOSIS 2 , *GENETIC models , *GENE expression - Abstract
This article, published in the Journal of Neurological Surgery, explores the genetic underpinnings of vestibular schwannoma (VS), a type of brain tumor. The study conducted a transcriptome-wide association study (TWAS) using genetic models of gene expression to identify gene-level associations with VS. The researchers identified 63 novel genes with genetically-determined expression associations with VS, including DNPH1, which has been previously associated with tinnitus. These findings provide new insights into the biological mechanisms associated with VS and may lead to the development of targeted therapies for this condition. [Extracted from the article]
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- 2024
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7. The Management of Trigeminal Schwannoma: A Single-Institution Experience of 49 Cases.
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Dambrino, Robert J., Lindquist, Nathan R., Guahar, Fatima, Wong, Gunther, Freeman, Michael H., Chambless, Lola B., Kelly, Patrick D., and Tawfik, Kareem O.
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NEUROFIBROMATOSIS 2 , *ACADEMIC medical centers - Abstract
This article explores the management of trigeminal schwannomas, which are benign tumors that can develop along the trigeminal nerve. The study analyzes 49 cases of trigeminal schwannomas at a large academic medical center, examining patient demographics, tumor characteristics, treatment strategies, and associated complications. The findings reveal that management approaches varied, with some patients undergoing observation, microsurgery, or radiation therapy. The study suggests that subtotal resection may be a valuable strategy for managing large, growing, and symptomatic tumors, but it carries a higher risk of requiring additional intervention. [Extracted from the article]
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- 2024
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8. Repeat Surgery After Decompressive Craniectomy for Traumatic Intracranial Hemorrhage: Outcomes and Predictors
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Lan, Matthews, Dambrino, Robert J., IV, Youssef, Andrew, Yengo-Kahn, Aaron, Dewan, Michael C., Ehrenfeld, Jesse, Bonfield, Christopher M., and Zuckerman, Scott L.
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- 2020
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9. Neurosurgery Elective for Preclinical Medical Students with and without a Home Neurosurgery Program
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Dallas, Jonathan, Mummareddy, Nishit, Yengo-Kahn, Aaron M., Dambrino, Robert J., IV, Lopez, Alexander M., Chambless, Lola B., Berkman, Richard, Chitale, Rohan V., Bonfield, Christopher M., Offodile, Regina S., Durham, Susan, Wellons, John C., III, Thompson, Reid C., and Zuckerman, Scott L.
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- 2019
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10. Cost considerations for vestibular schwannoma screening and imaging: a systematic review.
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Koester, Stefan W., Bishay, Anthony E., Rogers, James L., Dambrino, Robert J., Liles, Campbell, Feldman, Michael, and Chambless, Lola B.
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ACOUSTIC neuroma ,MEDICAL screening ,ACOUSTIC reflex ,INTRACRANIAL tumors ,MAGNETIC resonance imaging - Abstract
Vestibular schwannomas (VS) account for approximately 8% of all intracranial neoplasms. Importantly, the cost of the diagnostic workup for VS, including the screening modalities most commonly used, has not been thoroughly investigated. Our aim is to conduct a systematic review of the published literature on costs associated with VS screening. A systematic review of the literature for cost of VS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The terms "vestibular schwannoma," "acoustic neuroma," and "cost" were queried using the PubMed and Embase databases. Studies from all countries were considered. Cost was then corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. The search resulted in an initial review of 483 articles, of which 12 articles were included in the final analysis. Screening criteria were used for non-neurofibromatosis type I and II patients who complained of asymmetric hearing loss, tinnitus, or vertigo. Patients included in the studies ranged from 72 to 1249. The currency and inflation-adjusted mean cost was $418.40 (range, $21.81 to $487.03, n = 5) for auditory brainstem reflex and $1433.87 (range, $511.64 to $1762.15, n = 3) for non-contrasted computed tomography. A contrasted magnetic resonance imaging (MRI) scan was found to have a median cost of $913.27 (range, $172.25–$2733.99; n = 8) whereas a non-contrasted MRI was found to have a median cost of $478.62 (range, $116.61–$3256.38, n = 4). In terms of cost reporting, of the 12 articles, 1 (8.3%) of them separated out the cost elements, and 10 (83%) of them used local prices, which include institutional costs and/or average costs of multiple institutions. Our findings describe the limited data on published costs for screening and imaging of VS. The paucity of data and significant variability of costs between studies indicates that this endpoint is relatively unexplored, and the cost of screening is poorly understood. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Lumbar Drain Use in Non-Neoplastic Indications for Middle Fossa Craniotomy.
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Dambrino, Robert J., Wong, Gunther W., Tang, Alan R., Jo, Jacob, Yengo-Kahn, Aaron M., Lindquist, Nathan R., Freeman, Michael, Haynes, David S., Tawfik, Kareem O., Chambless, Lola B., Thompson, Reid C., and Morone, Peter J.
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CRANIOTOMY - Published
- 2023
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12. Words matter: using natural language processing to predict neurosurgical residency match outcomes.
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Ortiz, Alexander V., Feldman, Michael J., Yengo-Kahn, Aaron M., Roth, Steven G., Dambrino, Robert J., Chitale, Rohan V., and Chambless, Lola B.
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- 2023
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13. In Reply to the Letter to the Editor Regarding “Does Plastic Surgery Involvement Decrease Complications After Cranioplasty? A Retrospective Cohort Study”
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Dambrino, Robert J., IV, Chanbour, Hani, Chen, Jeffrey W., Chitale, Rohan V., Morone, Peter J., Thompson, Reid C., and Zuckerman, Scott L.
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- 2024
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14. Examination of Standardized Letters of Recommendation Rating Scales Among Neurosurgical Residency Candidates During the 2020-2021 Application Cycle.
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Feldman, Michael J, Ortiz, Alexander V, Roth, Steven G, Dambrino, Robert J, Yengo-Kahn, Aaron M, Chitale, Rohan V, and Chambless, Lola B
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- 2021
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15. Relationship between patient safety indicator events and comprehensive stroke center volume status in the treatment of unruptured cerebral aneurysms.
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Washington, Chad W., Taylor, L. Ian, Dambrino, Robert J., Clark, Paul R., and Zipfel, Gregory J.
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- 2018
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16. Role of PTP1B in POMC neurons during chronic high-fat diet: sex differences in regulation of liver lipids and glucose tolerance.
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Aberdein, Nicola, Dambrino, Robert J., do Carmo, Jussara M., Zhen Wang, Mitchell, Laura E., Drummond, Heather A., and Hall, John E.
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Protein tyrosine phosphatase 1B (PTP1B) is a negative regulator of leptin receptor signaling and may contribute to leptin resistance in diet-induced obesity. Although PTP1B inhibition has been suggested as a potential weight loss therapy, the role of specific neuronal PTP1B signaling in cardiovascular and metabolic regulation and the importance of sex differences in this regulation are still unclear. In this study, we investigated the impact of proopiomelanocortin (POMC) neuronal PTP1B deficiency in cardiometabolic regulation in male and female mice fed a high-fat diet (HFD). When compared with control mice (PTP1B flox/flox), male and female mice deficient in POMC neuronal PTP1B (PTP1B flox/flox/POMC-Cre) had attenuated body weight gain (males: -18%; females: -16%) and fat mass (males: -33%; female: -29%) in response to HFD. Glucose tolerance was improved by 40%, and liver lipid accumulation was reduced by 40% in PTP1B/POMC-Cre males but not in females. When compared with control mice, deficiency of POMC neuronal PTP1B did not alter mean arterial pressure (MAP) in male or female mice (males: 112 ± 1 vs. 112 ± 1 mmHg in controls; females: 106 ± 3 vs. 109 ± 3 mmHg in controls). Deficiency of POMC neuronal PTP1B also did not alter MAP response to acute stress in males or females compared with control mice (males: Δ32 ± 0 vs. Δ29 ± 4 mmHg; females: Δ22 ± 2 vs. Δ27 ± 4 mmHg). These data demonstrate that POMC-specific PTP1B deficiency improved glucose tolerance and attenuated diet-induced fatty liver only in male mice and attenuated weight gain in males and females but did not enhance the MAP and HR responses to a HFD or to acute stress. [ABSTRACT FROM AUTHOR]
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- 2018
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17. 423 Trends in Utilization of Standardized Letters of Recommendation in the 2021-2022 Neurosurgery Application Process.
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Feldman, Michael, Ortiz, Alex, Roth, Steven G., Dambrino, Robert J., Yengo-Kahn, Aaron Michael, Chitale, Rohan V., and Chambless, Lola Blackwell
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- 2023
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18. 405 Cost and Cost-Effectiveness in the Development of Brain Tumor Clinical Trials.
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Koester, Stefan Wolfgang, Chinard, Stephen, Ani, Chinonso, Liles, David Campbell, Dambrino, Robert J., Feldman, Michael, and Chambless, Lola Blackwell
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- 2023
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19. Platelet testing in flow diversion: a review of the evidence.
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Taylor, L. Ian, Dickerson, James C., Dambrino, Robert J., Kalani, M. Yashar S., Taussky, Philipp, Washington, Chad W., and Park, Min S.
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- 2017
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20. Do Neurosurgeons Receive More Patient Complaints Than Other Physicians? Describing Who Is Most at Risk and How We Can Improve.
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Dambrino, Robert J., Zuckerman, Scott, guidry, Bradley, Domenico, Henry, Thompson, Reid, Galloway, Mitchell, Pichert, James, and Cooper, William
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- 2022
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21. Operating Room Efficiency of Orthopedic Surgery During the COVID-19 Era.
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Koester, Stefan W., Chenard, Stephen, Ani, Chinonso, Moo Young, Justin, Liles, D. Campbell, Dambrino, Robert, Tiwari, Vikram, and Stephens, Byron F.
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SAFETY standards , *OPERATING rooms , *ELECTIVE surgery , *ORTHOPEDIC surgery , *TIME , *RETROSPECTIVE studies , *FISHER exact test , *COMPARATIVE studies , *MEDICAL protocols , *DESCRIPTIVE statistics , *CHI-squared test , *EMERGENCY medical services , *COVID-19 pandemic , *PATIENT safety - Abstract
OBJECTIVE: The COVID-19 pandemic forced operating rooms (ORs) to adopt new safety protocols. Although these measures protected the health of patients and providers, their impact on OR efficiency remains unclear. Our objective was to further elucidate the effects of COVID-19 on orthopedic surgery OR efficiency. STUDY DESIGN: This was a retrospective study of 14,856 orthopedic surgeries performed between December 1, 2019, and October 31, 2021. METHODS: Institutional perioperative databases were used to identify relevant orthopedic surgeries. The onset of the COVID-19 period was set as March 12, 2020, when a state of emergency was declared in Tennessee. Both 90-day periods before and after this date were used for comparative analysis of the pre--COVID-19, peak-restrictions, and post--peak-restrictions time periods. Delay of first case start time and turnover time between cases were used as primary measures of efficiency. RESULTS: There were 1853 pre--COVID-19 cases, 1299 peak-restrictions cases, and 11,704 post--peak-restrictions cases analyzed. Delay of first case start time was found to be significantly different among the time periods (mean [SD] minutes, 7 [14] vs 8 [18] vs 7 [17], respectively; P < .001). Turnover time between cases was also significantly different among the time periods (62 [49] vs 66 [51] vs 64 [51]; P = .002). CONCLUSIONS: Although significant, there was minimal absolute change in orthopedic OR efficiency during the onset of the pandemic. These results suggest that the protocols enacted at our institution appropriately maintained orthopedic OR efficiency, even in the context of the rapidly increasing COVID-19 burden. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Letter to the Editor. Inadequate assessment of resident case volume generates more questions than answers.
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Liles C, Dambrino RJ, and Chambless LB
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- 2024
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23. Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation.
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Bishay AE, Lyons AT, Koester SW, Paulo DL, Liles C, Dambrino RJ, Feldman MJ, Ball TJ, Bick SK, Englot DJ, and Chambless LB
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Introduction: Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy., Methods: A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022., Results: Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country., Conclusion: Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
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- 2024
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24. Unsolicited Patient Complaints Following the 21st Century Cures Act Information-Blocking Rule.
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Dambrino RJ 4th, Domenico HJ, Graves JA, Buntin MJB, Martinez W, Rosenbloom ST, and Cooper WO
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- Humans, Retrospective Studies, Cohort Studies, Interrupted Time Series Analysis, Physicians
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Importance: The 21st Century Cures Act includes an information-blocking rule (IBR) that requires health systems to provide patients with immediate access to their health information in the electronic medical record upon request. Patients accessing their health information before they receive an explanation from their health care team may experience confusion and may be more likely to share unsolicited patient complaints (UPCs) with their health care organization., Objective: To evaluate the quantity of UPCs about physicians before and after IBR implementation and to identify themes in UPCs that may identify patient confusion, fear, or anger related to the release of information., Design, Setting, and Participants: This retrospective cohort study was conducted with an interrupted time-series analysis of UPCs spanning January 1, 2020, to June 30, 2022. The data were obtained from a single academic medical center, Vanderbilt University Medical Center, at which the IBR was implemented on January 20, 2021. Data analysis was performed from January 11 to July 15, 2023., Exposure: Implementation of the IBR on January 20, 2021., Main Outcomes and Measures: The primary outcome was the monthly rate of UPCs before and after IBR implementation. A qualitative analysis was performed for UPCs received after IBR implementation. The Wilcoxon rank-sum test was used to compare monthly complaints between the pre- and post-IBR groups. The Pearson χ2 test was used to compare proportions of complaints by UPC category between time periods., Results: The medical center received 8495 UPCs during the study period: 3022 over 12 months before and 5473 over 18 months after institutional IBR implementation. There was no difference in the monthly proportions of UPCs per 1000 patient encounters before (median, 0.81 [IQR, 0.75-0.88]) and after (median, 0.83 [IQR, 0.77-0.89]) IBR implementation (difference in medians, -0.02 [95% CI, -0.12 to 0.07]; P =.86). Segmented regression analysis revealed no difference in monthly UPCs (β [SE], 0.03 [0.09]; P =.72)., Conclusions and Relevance: In this cohort study, implementation of the Cures Act IBR was not associated with an increase in monthly rates of UPCs. These findings suggest that review of UPCs identified as IBR-specific complaints may allow clinicians and organizations to prepare patients that their test and procedure results may be available before clinicians are able to review them and respond.
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- 2023
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25. Lumbar Drain Use during Middle Fossa Approaches for Nonneoplastic Pathology of the Skull Base.
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Dambrino RJ, Wong GW, Tang AR, Jo J, Yengo-Kahn AM, Lindquist NR, Freeman MH, Haynes DS, Tawfik KO, Chambless LB, Thompson RC, and Morone PJ
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Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol ( n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05-2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25-2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48-4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant ( p = 0.07). Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)
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- 2023
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26. Does Plastic Surgery Involvement Decrease Complications After Cranioplasty? A Retrospective Cohort Study.
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Dambrino RJ 4th, Chen JW, Chanbour H, Chitale RV, Morone PJ, Thompson RC, and Zuckerman SL
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- Humans, Retrospective Studies, Reoperation, Craniotomy adverse effects, Surgical Wound Infection epidemiology, Postoperative Complications epidemiology, Surgery, Plastic, Plastic Surgery Procedures adverse effects
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Objectives: To compare postoperative outcomes after cranioplasties performed by neurosurgery only (N) versus neurosurgery and plastic surgery combined (N+P)., Methods: A single-center, multisurgeon, retrospective cohort study was undertaken on all cranioplasties performed from November 2006 to December 2021. The primary exposure variable was operating team (N vs. N+P). The primary outcome was the need for reoperation. Secondary outcomes included surgical site infections, complications, length of stay (LOS), and length of drain placement., Results: Of 188 patients undergoing cranioplasty during the study period, 106 (56%) patients were in the N group, and 82 (44%) were in the N+P group. Patient demographics were similar between the 2 groups. For the primary outcome, a total of 20 (18.9%) reoperations were seen in the N group, and 13 (15.9%) in the N+P group (P = 0.708). However, the median time to reoperation was slightly longer in the N+P group in the survival analysis. Wound dehiscence (1.9% vs. 3.7%, P = 0.454), surgical site infection (5.7% vs. 9.8%, P = 0.289), and complication rate (30.2% vs. 32.9%, P = 0.688) did not differ between the 2 groups. Furthermore, the N group had less Jackson-Pratt drain use (58.5% vs. 85.4%, P < 0.001), earlier drain removal (1.9 ± 1.6 vs. 3.4 ± 3.9 days, P < 0.001), and shorter LOS (3.8 ± 5.9 vs. 4.7 ± 3.9 days, P < 0.001). On multivariate regression analysis controlling for age, body mass index, smoking, craniectomy type, reason for craniectomy, and graft type, N+P was associated with increased drain use (odds ratio = 4.90, 95% confidence interval 2.28-11.30, P < 0.001) and longer drain duration (β = 1.50, 95% confidence interval 0.43-2.60, P = 0.007)., Conclusions: Despite similar complication and reoperation rates between groups, reoperations in the N group occurred sooner, whereas the N+P group more commonly used drains and kept drains in for longer., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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27. Trends in utilization of standardized letters of recommendation in the 2021-2022 neurosurgery application process.
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Feldman MJ, Ortiz AV, Roth SG, Dambrino RJ, Yengo-Kahn AM, Chitale RV, and Chambless LB
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- Humans, Cross-Sectional Studies, Reproducibility of Results, Retrospective Studies, Personnel Selection, Neurosurgery, Internship and Residency
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Objective: Standardized letters of recommendation (SLORs) were introduced during the 2020-2021 neurosurgery residency application cycle, but suffered from poor interrater reliability and grade inflation. Changes were made to the SLOR template and utilization patterns in response to these shortcomings. The authors examined the second year of SLOR utilization. They hypothesized that grade inflation and interrater reliability would be improved from the first iteration. They also hypothesized that increased numbers of letters by single writers would correlate with broader rating distributions., Methods: This cross-sectional study analyzed all SLORs submitted to a single neurosurgery residency program over the 2021-2022 cycle. Data from 7 competency domains and the overall rating were recorded and stratified by academic category of the letter writer. Interrater reliability was evaluated using Krippendorff's alpha. The frequency of letters written was evaluated using the Kruskal-Wallis H test., Results: Ninety percent of SLORs rated applicants among the top 25%, but there was a significant decrease in the usage of the top 1% and top 2%-5% ratings. Interrater reliability was poor across all competencies. Writers who completed 1 SLOR rated applicants higher and had a narrower range than those who completed multiple SLORs., Conclusions: Changes in the format and subsequent utilization patterns of SLORs have slightly decreased grade inflation; however, interrater reliability remains poor. The most wide-ranging evaluators submitted the highest number of SLORs, suggesting that future evaluation and usage of SLORs should emphasize letter-writer characteristics and numbers of SLORs written. Overall, SLORs have been well and broadly accepted with subtle improvements in the second year of utilization.
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- 2022
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28. Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma.
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Guidry BS, Tang AR, Thomas H, Thakkar R, Sermarini A, Dambrino RJ 4th, Yengo-Kahn A, Chambless LB, Morone P, and Chotai S
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- Aftercare, Follow-Up Studies, Humans, Patient Discharge, Retrospective Studies, Risk Factors, United States, Hematoma, Subdural, Acute surgery, Patient Readmission
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Background: Loss to follow-up (LTF) and unplanned readmission are barriers to recovery after acute subdural hematoma evacuation. The variables associated with these postdischarge events are not fully understood., Objective: To determine factors associated with LTF and unplanned readmission, emphasizing socioeconomic status (SES)., Methods: A retrospective analysis was conducted of surgical patients with acute subdural hematoma managed operatively from 2009 to 2019 at a level 1 regional trauma center. Area Deprivation Index (ADI), which is a neighborhood-level composite socioeconomic score, was used to measure SES. Higher ADI corresponds to lower SES. To decrease the number of covariates in the model, principal components (PCs) analysis was used. Multivariable logistic regression analyses of PCs were performed for LTF and unplanned readmission., Results: A total of 172 patients were included in this study. Thirty-six patients (21%) were LTF, and 49 (28%) patients were readmitted; 11 (6%) patients were both LTF and readmitted ( P = .9). The median time to readmission was 10 days (Q1: 4.5, Q3: 35). In multivariable logistic regression analyses for LTF, increased ADI and distance to hospital through PC2 (odds ratio [OR] 1.49; P = .009) and uninsured/Medicaid status and increased length of stay through PC4 (OR 1.73; P = .015) significantly contributed to the risk of LTF. Unfavorable discharge functional status and nonhome disposition through PC3 were associated with decreased odds of unplanned readmission (OR = 0.69; P = .028)., Conclusion: Patients at high risk for LTF and unplanned readmissions, as identified in this study, may benefit from targeted resources individualized to their needs to address barrier to follow-up and to ensure continuity of care., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)
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- 2022
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29. Words matter: using natural language processing to predict neurosurgical residency match outcomes.
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Ortiz AV, Feldman MJ, Yengo-Kahn AM, Roth SG, Dambrino RJ, Chitale RV, and Chambless LB
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- Humans, Natural Language Processing, School Admission Criteria, Clinical Competence, Personnel Selection, Internship and Residency, Neurosurgery
- Abstract
Objective: Narrative letters of recommendation (NLORs) are considered by neurosurgical program directors to be among the most important parts of the residency application. However, the utility of these NLORs in predicting match outcomes compared to objective measures has not been determined. In this study, the authors compare the performance of machine learning models trained on applicant NLORs and demographic data to predict match outcomes and investigate whether narrative language is predictive of standardized letter of recommendation (SLOR) rankings., Methods: This study analyzed 1498 NLORs from 391 applications submitted to a single neurosurgery residency program over the 2020-2021 cycle. Applicant demographics and match outcomes were extracted from Electronic Residency Application Service applications and training program websites. Logistic regression models using least absolute shrinkage and selection operator were trained to predict match outcomes using applicant NLOR text and demographics. Another model was trained on NLOR text to predict SLOR rankings. Model performance was estimated using area under the curve (AUC)., Results: Both the NLOR and demographics models were able to discriminate similarly between match outcomes (AUCs 0.75 and 0.80; p = 0.13). Words including "outstanding," "seamlessly," and "AOA" (Alpha Omega Alpha) were predictive of match success. This model was able to predict SLORs ranked in the top 5%. Words including "highest," "outstanding," and "best" were predictive of the top 5% SLORs., Conclusions: NLORs and demographic data similarly discriminate whether applicants will or will not match into a neurosurgical residency program. However, NLORs potentially provide further insight regarding applicant fit. Because words used in NLORs are predictive of both match outcomes and SLOR rankings, continuing to include narrative evaluations may be invaluable to the match process.
- Published
- 2022
- Full Text
- View/download PDF
30. An Examination of Standardized Letters of Recommendation Rating Scales Among Neurosurgical Residency Candidates During the 2020-2021 Application Cycle.
- Author
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Feldman MJ, Ortiz AV, Roth SG, Dambrino RJ, Yengo-Kahn AM, Chitale RV, and Chambless LB
- Subjects
- Cross-Sectional Studies, Humans, Personnel Selection, Reproducibility of Results, Retrospective Studies, Internship and Residency
- Abstract
Background: Letters of recommendation (LORs) are historically an important, though subjective, component of the neurosurgery residency application process. Standardized LORs (SLORs) were introduced during the 2020 to 2021 application cycle. The intent of SLORs is to allow objective comparison of applicants and to reduce bias., Objective: To examine the utility of SLORs during this application cycle. We hypothesized that "grade inflation" and poor inter-rater reliability, as described by other specialties using SLORs, would limit the utility of SLORs in their current form., Methods: This cross-sectional study analyzed all SLORs submitted to a single neurosurgery residency program over the 2020 to 2021 cycle. Data from 7 competency domains and the overall rating were recorded and stratified by academic category of letter writer. Inter-rater reliability was evaluated using Krippendorff's alpha., Results: One or more SLORs was submitted as part of 298 of 393 applications (76%). Approximately 58.3% of letters written by neurosurgery chairpersons rated a given applicant as being within the top 5% across all competencies. Approximately 44.4% of program director letters similarly rated applicants as amongst the top 5%, while 73.2% and 81.4% of letters by other neurosurgeons and general surgery evaluators, respectively, rated applicants in the top 5%. Inter-rater reliability was poor (<0.33) in all rating categories, including overall (α = 0.18)., Conclusion: The utility of the first iteration of SLORs in neurosurgery applications is undermined by significant "grade inflation" and poor inter-rater reliability. Improvements are necessary for SLORs if they are to provide meaningful information in future application cycles., (© Congress of Neurological Surgeons 2021.)
- Published
- 2021
- Full Text
- View/download PDF
31. Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve.
- Author
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Dambrino RJ, Zuckerman SL, Guidry BS, Domenico HJ, Thompson RC, Galloway MB, Pichert JW, and Cooper WO
- Subjects
- Cohort Studies, Female, Humans, Male, Malpractice trends, Neurosurgeons trends, Quality of Health Care trends, Retrospective Studies, Risk Factors, Neurosurgeons standards, Patient Satisfaction, Physician-Patient Relations, Quality of Health Care standards
- Abstract
Objective: The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons., Methods: Patient and family complaint reports among 36,265 physicians, including 423 neurosurgeons, 8292 other surgeons, and 27,550 nonsurgeons who practiced at 33 medical centers (22 academic and 11 regional) from January 1, 2014, to December 31, 2017, were coded with a previously validated Patient Advocacy Reporting System (PARS) algorithm., Results: Among 423 neurosurgeons, 93% were male, and most (71%) practiced in academic medical centers. Neurosurgical subspecialties included general practice (25%), spine (25%), tumor (16%), vascular (13%), functional (10%), and pediatrics (10%). Neurosurgeons had more average total UPCs per physician (8.68; 95% CI 7.68-9.67) than nonsurgeons (3.40; 95% CI 3.33-3.47) and other surgeons (5.01; 95% CI 4.85-5.17; p < 0.001). In addition, a significantly higher percentage of neurosurgeons received at least one UPC (71.6%; 95% CI 67.3%-75.9%) than did nonsurgeons (50.2%; 95% CI 49.6%-50.8%) and other surgeons (58.2%; 95% CI 57.1%-59.3%; p < 0.001). Factors most associated with increased average UPCs were younger age, measured as median medical school graduation year (1990.5 in the 0-UPC group vs 1993 in the 14+-UPC group, p = 0.009) and spine subspecialty (13.4 mean UPCs in spine vs 7.9 mean UPCs in other specialties, 95% CI 2.3-8.5, p < 0.001). No difference in complaints was seen in those who graduated from non-US versus US medical schools (p = 0.605). The most common complaint types were related to issues surrounding care and treatment, communication, and accessibility, each of which was significantly more common for neurosurgeons than other surgical specialties (p < 0.001)., Conclusions: Neurosurgeons were more likely to generate UPCs than other surgical specialties, and almost 3 out of 4 neurosurgeons (71.6%) had at least one UPC during the study period. Prior studies have shown that feedback to physicians about behavior can result in fewer UPCs. These results suggest that neurosurgeons have opportunities to reduce complaints and potentially improve the overall quality of care delivered.
- Published
- 2020
- Full Text
- View/download PDF
32. Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality.
- Author
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Dickerson JC, Harriel KL, Dambrino RJ, Taylor LI, Rimes JA, Chapman RW, Desrosiers AS, Tullis JE, and Washington CW
- Abstract
Objective: Deep vein thrombosis (DVT) is a major focus of patient safety indicators and a common cause of morbidity and mortality. Many practices have employed lower-extremity screening ultrasonography in addition to chemoprophylaxis and the use of sequential compression devices in an effort to reduce poor outcomes. However, the role of screening in directly decreasing pulmonary emboli (PEs) and mortality is unclear. At the University of Mississippi Medical Center, a policy change provided the opportunity to compare independent groups: patients treated under a prior paradigm of weekly screening ultrasonography versus a post-policy change group in which weekly surveillance was no longer performed., Methods: A total of 2532 consecutive cases were reviewed, with a 4-month washout period around the time of the policy change. Criteria for inclusion were admission to the neurosurgical service or consultation for ≥ 72 hours and hospitalization for ≥ 72 hours. Patients with a known diagnosis of DVT on admission or previous inferior vena cava (IVC) filter placement were excluded. The primary outcome examined was the rate of PE diagnosis, with secondary outcomes of all-cause mortality at discharge, DVT diagnosis rate, and IVC filter placement rate. A p value < 0.05 was considered significant., Results: A total of 485 patients met the criteria for the pre-policy change group and 504 for the post-policy change group. Data are presented as screening (pre-policy change) versus no screening (post-policy change). There was no difference in the PE rate (2% in both groups, p = 0.72) or all-cause mortality at discharge (7% vs 6%, p = 0.49). There were significant differences in the lower-extremity DVT rate (10% vs 3%, p < 0.01) or IVC filter rate (6% vs 2%, p < 0.01)., Conclusions: Based on these data, screening Doppler ultrasound examinations, in conjunction with standard-of-practice techniques to prevent thromboembolism, do not appear to confer a benefit to patients. While the screening group had significantly higher rates of DVT diagnosis and IVC filter placement, the screening, additional diagnoses, and subsequent interventions did not appear to improve patient outcomes. Ultimately, this makes DVT screening difficult to justify.
- Published
- 2019
- Full Text
- View/download PDF
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