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Jason P. Sheehan, Brian D. Kavanagh, Anthony Asher, and Robert E. Harbaugh

was $47,000, and some studies have costs as high as $85,000 per patient. 17 Bringing a new drug or device to the clinic requires $800 million to $2 billion, and RCTs are known to be a major driver in this cost. 17 Prospective, observational registries have become important initiatives for quality improvement and patient safety, and there is a newfound appreciation for the “medicine-based evidence” that can be derived from these studies. 7 A large prospectively collected patient database can also serve as a powerful tool for clinical research. Here, we summarize

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Zoher Ghogawala, Melissa R. Dunbar, and Irfan Essa

that many patients do not need a fusion given that only 30% of those treated with decompression alone go on to develop delayed instability manifesting as mechanical low-back pain that is often treated with fusion. The key question is how to initially identify the estimated 30% of the patient population that will develop instability following decompressive laminectomy alone. From registry data in the US, it appears that we performed a fusion on nearly 80% of these patients. Thus, there is an opportunity to tailor the surgical approach by understanding what patient

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Scott L. Parker, Matthew J. McGirt, Kimon Bekelis, Christopher M. Holland, Jason Davies, Clinton J. Devin, Tyler Atkins, Jack Knightly, Rachel Groman, Irene Zyung, and Anthony L. Asher

]), and the CMS Value-Based Payment Modifier (VM) program. The common denominator of these initiatives is that to avoid penalties, physicians must meet “generic” quality standards, which in the case of neurosurgery and many other medical specialties, are not pertinent to everyday clinical practice. Fortunately, recent developments in national quality reporting programs, such as the CMS Qualified Clinical Data Registry (QCDR) reporting option, have significantly enhanced and streamlined the ability of specialty groups to develop and report relevant measures of health

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Hugh K. Richards, Helen M. Seeley, and John D. Pickard

numbers approaching these levels have been reported in the literature. The UK Shunt Registry is a resource that has collected data on large numbers of shunt procedures since May 1995 and is capable of generating the substantial data sets required; therefore, we have used data collected by the registry to assess the effectiveness of AICs against shunt infection in a matched-pair study design. Methods The UK Shunt Registry collects data on shunt and shunt-related procedures in the British Isles. All the major neurosurgery centers contribute. Data are gathered on a

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Scott L. Zuckerman, Clinton J. Devin, Vincent Rossi, Silky Chotai, E. Hunter Dyer, John J. Knightly, Eric A. Potts, Kevin T. Foley, Erica F. Bisson, Steven D. Glassman, Praveen V. Mummaneni, Mohamad Bydon, and Anthony L. Asher

C linical registries have become a mainstay of neurosurgical research throughout the last decade. In 2012, the AANS in conjunction with the NeuroPoint Alliance (NPA) launched the Quality Outcomes Database (QOD), a registry effort that has grown into the largest North American cooperative data collection tool. The most robust arm of the QOD is the Spine Registry, drawing from 110 participating centers across 36 states, that tracks the quality of surgical care for common spinal procedures. 1 Registries are especially important given the unfeasibility of

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Michael A. Williams, Sean J. Nagel, Mark G. Luciano, Norman Relkin, Thomas J. Zwimpfer, Heather Katzen, Richard Holubkov, Abhay Moghekar, Jeffrey H. Wisoff, Guy M. McKhann II, James Golomb, Richard J. Edwards, and Mark G. Hamilton

and HCRN receive financial support from the Hydrocephalus Association, the largest patient-advocacy organization in the US for persons with hydrocephalus and their families. The first project of the AHCRN is a patient registry in which adults with all types of hydrocephalus are seen and evaluated with a standard set of examination methods. The purpose of the present study was to describe the demographics and characteristics of the first 517 patients enrolled at the 6 centers that were in the AHCRN in its first 2 years. Patients in the registry are followed

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Amar S. Shah, Peter T. Sylvester, Alexander T. Yahanda, Ananth K. Vellimana, Gavin P. Dunn, John Evans, Keith M. Rich, Joshua L. Dowling, Eric C. Leuthardt, Ralph G. Dacey, Albert H. Kim, Robert L. Grubb, Gregory J. Zipfel, Mark Oswood, Randy L. Jensen, Garnette R. Sutherland, Daniel P. Cahill, Steven R. Abram, John Honeycutt, Mitesh Shah, Yu Tao, and Michael R. Chicoine

from a multicenter mixed retrospective/prospective registry to evaluate the impact of iMRI on glioblastoma outcomes while controlling for known prognostic factors. Methods Study Design The IMRIS Multicenter iMRI Neurosurgery Database (I-MiND) registry is a REDCap (Research Electronic Data Capture) 27 registry of patients who have undergone neurosurgical procedures with or without iMRI. Data were collected retrospectively back to 1996 and have been accrued prospectively since 2008. Data include preoperative (demographics, comorbidities, and prior treatments

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Neurosurgical Forum: Letters to the editor To The Editor Pete N. Poolos , Jr. , M.D. Cleveland, Ohio 799 799 Dr. Gardner and I are trying to establish a syringomyelia registry for those cases that have been treated by the excision of a terminal ventricle. We are hoping to establish communication with all surgeons and through them to their patients concerning the long-term results of this operative procedure. A copy of the patient's history, operative note, and path report should be sent to this writer at the

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Matthew J. McGirt, Theodore Speroff, Robert S. Dittus, Frank E. Harrell Jr., and Anthony L. Asher

more valuable care. As these methods evolve, there exists an opportunity for physicians to impact the form and method by which the quality and value of health care is defined. In March 2012, the AANS launched the National Neurosurgery Quality and Outcomes Database (N 2 QOD) ( ). 2 The lumbar module was released as the initial 12-month pilot project to determine the feasibility of a nationwide, prospective longitudinal neurosurgical outcomes registry and assess the utility of its data. While the N 2 QOD lumbar spine pilot

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Clinical outcomes research in spine surgery: what are appropriate follow-up times?

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Oliver G. S. Ayling, Tamir Ailon, Greg McIntosh, Alex Soroceanu, Hamilton Hall, Andrew Nataraj, Christopher S. Bailey, Sean Christie, Alexandra Stratton, Henry Ahn, Michael Johnson, Jerome Paquet, Kenneth Thomas, Neil Manson, Y. Raja Rampersaud, and Charles G. Fisher

being studied. Given the increasing implementation and importance of clinical registries and the high cost of obtaining long-term follow-up data in clinical studies, 10 it is vital to ensure that the duration of follow-up is tailored to the pathology and the outcome dimension to ensure that treatments are effectively studied and reported. Precise determination of the required follow-up duration also enables appropriate patient counseling and monitoring of their recovery. The purpose of this study was to determine the follow-up time necessary to ensure that the