Surgical treatment of sleep apnea: association between surgeon/hospital volume with outcomes.

OBJECTIVES/HYPOTHESIS: To identify the association between surgeon/hospital volume with outcomes in surgical treatment for obstructive sleep apnea (OSA) in a nationally representative sample. We hypothesized that surgeons/hospitals with lower patient volumes would have: higher mortality rates, longer hospital length of stay (LOS), and higher postoperative complication rates and hospitalization charges. STUDY DESIGN: Secondary data analysis of the 2007 Nationwide Inpatient Sample database. METHODS: We selected 24,298 adults undergoing OSA surgery. The data analysis included trend test, regression, and multivariate models that were adjusted by demographic and clinical variables. RESULTS: The patients were mostly White (76.43%), male (78.26%), with a mean age of 46 years. Patients treated by surgeons with low volume of procedures (1 procedure/year) had significantly higher mortality rate (odds ratio [OR] 3.05; confidence interval [CI], 1.96-4.77), longer average LOS (increased until 8.16 hours), and higher hospitalization charges (increased up to $1701.75) versus medium- and high-volume surgeons (2-4 procedures/year; greater than/or equal to 5 procedures/year, respectively). Patients treated at hospitals with low volume of procedures (0-5/year) had significantly higher occurrence of oxygen desaturation (OR, 2.12; CI, 1.50-2.99), longer LOS (increased until almost 2 hours) and higher hospitalization charges (at least $951.50 more expensive) versus patients treated at high-volume hospitals (greater than/or equal to 18 procedures/year). CONCLUSION: Our investigation validates the hypothesis that lower volume standards (surgeon/hospital) are associated with increase of LOS following surgery to treat OSA, as well as lower surgeon volume associated with increase of mortality and hospitalization charges and lower hospital volume with occurrence of oxygen desaturation as postoperative complication.

Effects of age and gender on performance on Conners' Continuous Performance Test in Brazilian adolescents

The present study analyzed the effects of age and gender on performance on the Conners' Continuous Performance Test (CCPT II) in a sample of Brazilian adolescents aged 12-17 years. The sample consisted of 480 participants (210 boys) with a mean age of 14.34 years (SD ± 1.61 years) who were representative of the socioeconomic class distribution of the city of São Paulo, Brazil. The participants were prescreened for attention-deficit/hyperactivity disorder. The present results found effects of age and gender that were similar to other Brazilian age groups. Compared with males, female participants presented a lower rate of responding to non-target stimuli (i.e., commission errors), a greater ability to discriminate signals (d'), and fewer impulsive responses (i.e., less perseveration) but longer reaction times (Hit RT and Hit RT Std Error). A significant effect of age was found on RTs (Hit RT, Hit RT Sdt Error, Variability, Hit RT Block Change), commission errors, and perseveration. As age increased, the differences diminished. The present results may be useful for research and clinical studies with Brazilian adolescents.

Effects of age and gender on performance on Conners' Continuous Performance Test in Brazilian adolescents

The present study analyzed the effects of age and gender on performance on the Conners' Continuous Performance Test (CCPT II) in a sample of Brazilian adolescents aged 12-17 years. The sample consisted of 480 participants (210 boys) with a mean age of 14.34 years (SD ± 1.61 years) who were representative of the socioeconomic class distribution of the city of São Paulo, Brazil. The participants were prescreened for attention-deficit/hyperactivity disorder. The present results found effects of age and gender that were similar to other Brazilian age groups. Compared with males, female participants presented a lower rate of responding to non-target stimuli (i.e., commission errors), a greater ability to discriminate signals (d'), and fewer impulsive responses (i.e., less perseveration) but longer reaction times (Hit RT and Hit RT Std Error). A significant effect of age was found on RTs (Hit RT, Hit RT Sdt Error, Variability, Hit RT Block Change), commission errors, and perseveration. As age increased, the differences diminished. The present results may be useful for research and clinical studies with Brazilian adolescents.(AU)

Neuropsychological rehabilitation in a patient with ruptured anterior communicating artery aneurysm: 48 month outcomes.

The neurobehavioral impairments associated with aneurysms of the anterior communicating artery (ACoA) are severe amnesia, executive problems and personality changes. Although most patients achieve a favorable neurological outcome, those cognitive deficits usually prevent return to previous activities and levels of social integration. OBJECTIVES: To report the outcomes of a neuropsychological and behavioral intervention in a 55 year-old man with very severe memory and executive dysfunctions following ACoA aneurysm rupture. METHODS: Neuropsychological intervention focused in functional adjustment in everyday life was used, including individual sessions with the patient, discussion sessions with caregivers and also work with patient at home, aiming generalization of the rehabilitation strategies. Neuropsychological and functional assessments were conducted pre and post intervention. RESULTS: Important improvements were seeing in behavior and daily living performance after treatment. CONCLUSIONS: A neuropsychological rehabilitation approach focused on goals based on the family and caregivers necessities is an efficient manner in which to carry out cognitive rehabilitation in severe cases. The importance of a supportive family should be stressed.

Os prejuízos neuro-comportamentais associados a aneurismas de artéria comunicante anterior (ACoA) são amnésia severa, dificuldades executivas e alterações de personalidade. Embora muitos pacientes alcancem uma recuperação neurológica favorável, os prejuízos cognitivos acabam impedindo o retorno às atividades prévias e ao mesmo nível de integração social. OBJETIVOS: Relatar os resultados de uma intervenção neuropsicológica e comportamental junto a um homem de 55 anos, com dificuldades severas de memória e funções executivas secundárias a ruptura de aneurisma de ACoA. MÉTODOS: Foi empregada intervenção neuropsicológica com foco na adaptação funcional na vida diária. Foram realizadas sessões individuais com o paciente, sessões de discussão com cuidadores, além de trabalho com o paciente em casa, visando a generalização das estratégias de reabilitação. Foram realizadas avaliações neuropsicológica e funcional pré e pós-intervenção. RESULTADOS: Foram observadas melhoras importantes no comportamento e no desempenho da vida diária após o tratamento. CONCLUSÕES: reabilitação neuropsicológica com foco nas necessidades dos familiares e cuidadores revelou-se eficiente maneira de realizar a reabilitação neuropsicológica em casos graves. A importância do apoio da família deve ser ressaltada.