• Ellegaard Kessler posted an update 6 months, 3 weeks ago

    Patients with 1 or more financial risk factors were more likely to use human insulin compared with patients without any financial risk factors (88.5% vs 76.7%; P = .014). There was no association between use of human vs analogue insulin on diabetic or other patient outcomes among patients regardless of financial risk.

    Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.

    Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.

    The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience.

    Prospective cohort study.

    We implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218).

    There was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all).

    Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics’ common wait areas could be reappropriated to increase the number of clinic exam rooms.

    Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics’ common wait areas could be reappropriated to increase the number of clinic exam rooms.This review is devoted to the modern method of monitoring of pupil diameter and reactivity in patients with acute brain injury. The authors present complete data on diagnostic and prognostic capabilities of automated infrared pupillometry, which should take its rightful place in comprehensive assessment of functional brain state in ICU patients. In authors’ opinion, clinical introduction of pupillometry will improve prediction of outcomes following acute brain injury and quality of neurological monitoring in patients with cerebral edema and intracranial hypertension.Cavernous malformations (CMs) of central nervous system are vascular malformations usually localized in the brain and rarely in the spinal cord. To date, these malformations are well studied. However, some problems of the management of this pathology are still unresolved. This is due to rare localization of intramedullary CMs in the spinal cord and difficult treatment of spinal pathology per se. Kynurenic acid concentration To date, about 1000 cases of spinal CM are described in the literature. This review is devoted to natural course of disease and postoperative outcomes. These data allow getting a complete picture of modern concepts of the treatment of spinal CMs and formulating the questions requiring further discussion.

    Retropleural and/or retrodiaphragmatic approach is one of the options for anterolateral access to the thoracic spine and thoracolumbar region. This technique has no disadvantages associated with thoracotomy or extensive tissue dissection following posterolateral approaches.

    Systematic analysis of foreign and national researches devoted to the possibility, safety and effectiveness of lateral retropleural approach to the thoracic spine and meta-analysis of the most common complications associated with this approach.

    Initial searching revealed 133 abstracts for further study. Inclusion criteria 1) available full-text version of the manuscript in English or Russian; 2) age of patients over 18 years; 3) description of lateral retropleural or retrodiaphragmatic approach complicated or not complicated by access-associated complications. According to these criteria, we enrolled 10 manuscripts.

    Meta-analysis showed high (10.6%) probability of pleural injury associated with surgical approach. Compared to endoscf this structure occurs in 10.6% of cases. Skin incision 7.1 cm and rib resection for at least 5 cm may be valuable to prevent plural damage.

    Minimally invasive anterolateral retropleural and/or retrodiaphragmatic approach to the thoracic spine and thoracolumbar junction for corpectomy and discectomy ensures effective spinal canal decompression and less incidence of complications following open or thoracoscopic thoracic spine surgery. Dissection of parietal pleura should be of special attention because injury of this structure occurs in 10.6% of cases. Skin incision 7.1 cm and rib resection for at least 5 cm may be valuable to prevent plural damage.The authors report a patient with recurrent bifocal germinoma of the optical nerves and chiasm after previous combined treatment. The tumor resulted progressive visual acuity loss despite subsequent therapy (glucocorticoid therapy, chemo- and radiotherapy). Differential diagnosis between tumor progression and consequences of radiotherapy was complicated by MRI negative pattern. Subsequent development of the process, signs of anterior visual pathway damage and tumor spread throughout the ventricular system and subarachnoid spaces according to neuroimaging data indicated recurrence of disease.The authors report resection of anaplastic convexital meningioma in a middle-aged woman complicated by expected massive blood loss. The most intense bleeding occurred at the final stage of resection and it was impossible to stop it with traditional approaches. The surgeon pressed a standard tachocomb plate moistened with a diluted solution of recombinant activated factor VII (coagil, Russia) to the most bleeding area for 5 minutes. Subsequently, surgeon replaced finger pressure with a permanent napkin. Hemostatic effect of recombinant activated factor VII following its systemic administration is well known and convincingly proven in many surgical areas including neurosurgery. However, we do not know any descriptions of its local application in neurosurgical patients.

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