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ABSTRACT: Diversity and inclusion in higher education are a top priority for institutions. In 2020, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), in its 5 th edition of the Accreditation Standards for Physician Assistant Education, implemented a standard specifically designed to require programs to demonstrate their commitment to diversity and inclusion. Through a protocol-driven methodology, consistent with the ARC-PA's 4 key elements of analysis, one PA program demonstrates and explains how it examines ongoing compliance with diversity and inclusion within their program.
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Asistentes Médicos , Humanos , Asistentes Médicos/educación , Diversidad Cultural , AcreditaciónRESUMEN
ABSTRACT: Resistant hypertension affects about 17% of the US population. However, it is difficult to diagnose because of multiple factors that influence adequate treatment of BP, including patient lifestyle and comorbidities, improper therapeutic regimens, and secondary mechanisms. Possible causes of resistant hypertension include nonmodulator hypertension, which affects patients who have an inappropriate response to elevated sodium through the renin-angiotensin-aldosterone system. Early identification and frequent follow-up can help patients achieve BP goals more rapidly and may reduce morbidity and mortality associated with complications of hypertension, including cerebrovascular accident, cardiovascular disease, and kidney disease.
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Enfermedades Cardiovasculares , Hipertensión , Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Sistema Renina-AngiotensinaRESUMEN
ABSTRACT: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and causes changes in the cardiac muscle affecting ventricular, valvular, and cellular functions. Because HCM is an inherited disorder, all age groups are affected; however, it commonly presents in adolescents, especially athletes. Many patients are asymptomatic and undiagnosed, putting them at risk for sudden cardiac death. This article describes screening and management of patients with HCM.
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Cardiomiopatía Hipertrófica , Adolescente , Cardiomiopatía Hipertrófica/diagnóstico , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Humanos , Tamizaje MasivoRESUMEN
ABSTRACT: Brain metastases originate from other primary cancers within the body, most commonly lung, breast, and melanoma. Because patients with brain metastasis, stroke, or intracranial hemorrhage may present with similar acute neurologic symptoms, clinicians must have a high suspicion for brain metastasis and perform an immediate workup to rule out life-threatening conditions. This case report focuses on the clinical symptoms, diagnostics, and treatment options for brain metastasis in a patient with multiple malignancies.
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Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Neoplasias Esofágicas , Melanoma , Neoplasias Primarias Múltiples , Neoplasias de la Próstata , Cuero Cabelludo , Neoplasias Cutáneas , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/terapia , Irradiación Craneana/métodos , Dexametasona/administración & dosificación , Humanos , Levetiracetam/administración & dosificación , Imagen por Resonancia Magnética , Masculino , Enfermedades del Sistema Nervioso/etiología , Radiocirugia/métodos , Convulsiones/etiología , Convulsiones/prevención & control , Tomografía Computarizada por Rayos XRESUMEN
Adult attention deficit/hyperactivity disorder (ADHD) is a significant and prevalent disorder. ADHD can impair adults' quality of life, so clinicians in multiple specialties should be able to recognize and treat the disorder. Much of the current literature has focused on childhood ADHD. However, adult ADHD is a common comorbidity in patients with mental illness, and it is essential that patients diagnosed with the disorder are treated appropriately, which can significantly improve outcomes. Adults with untreated ADHD are more likely to have substance dependence, job instability, and an overall poorer quality of life. This article reviews the screening and assessment for adult ADHD along with pharmacologic and nonpharmacologic recommendations for the management of the disorder.
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Inhibidores de Captación Adrenérgica/uso terapéutico , Atención Ambulatoria , Anfetaminas/uso terapéutico , Clorhidrato de Atomoxetina/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Estimulantes del Sistema Nervioso Central/uso terapéutico , Terapia Cognitivo-Conductual , Educación del Paciente como Asunto , Adulto , Anfetaminas/efectos adversos , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/etiología , Estimulantes del Sistema Nervioso Central/efectos adversos , Comorbilidad , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Humanos , Calidad de VidaRESUMEN
Kawasaki disease is an acute systemic febrile vasculitis of medium and small arteries, most often occurring in children under age 5 years. This condition is the most common cause of acquired heart disease in children in the developed world. The cause is unclear but is thought to be a hyperimmune reaction to an infectious agent. Diagnosis is clinical; the classic presentation includes persistent fever, lymphadenopathy, oral mucosal changes, conjunctivitis, and rash. Although the disease technically is self-limiting, treatment with IV immunoglobulin (IVIG) and high-dose aspirin is necessary to prevent cardiac complications, such as coronary artery aneurysm, pericarditis, or myocarditis. This article reviews the pathophysiology, clinical presentation, diagnosis, and treatment of Kawasaki disease.
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Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/terapia , Aspirina/administración & dosificación , Autoinmunidad , Preescolar , Aneurisma Coronario/etiología , Vasos Coronarios , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Lactante , Masculino , Síndrome Mucocutáneo Linfonodular/etiología , Síndrome Mucocutáneo Linfonodular/inmunología , Infarto del Miocardio/etiología , Miocarditis/etiología , Vasculitis/etiologíaRESUMEN
Reactive arthritis, also known as Reiter syndrome, is a spondyloarthropathy that typically follows a urogenital or gastrointestinal infection, and is characterized by conjunctivitis, urethritis, and arthritis. The frequency of reactive arthritis in the United States is estimated at 3.5 to 5 patients per 100,000. Physician assistants (PAs) can manage the condition; therefore, they should be familiar with the disease's signs and symptoms, diagnostic criteria, and treatment regimens. Without proper management, reactive arthritis can progress to a chronic destructive arthritis. Prompt recognition of the condition is key to early intervention and a better patient outcome with fewer complications.
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Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reactiva/diagnóstico , Artritis Reactiva/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Artritis Reactiva/etiología , Artritis Reactiva/fisiopatología , Conjuntivitis/fisiopatología , Gastroenteritis/complicaciones , Humanos , Inyecciones Intraarticulares , Infecciones del Sistema Genital/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Uretritis/fisiopatología , Infecciones Urinarias/complicacionesRESUMEN
Women with opioid use disorder who become pregnant are a particularly vulnerable population and require a comprehensive treatment approach for mother and fetus. Research is continuing on opioid use disorder, effects of opioid use on the fetus, and best treatment approaches. This article reviews current recommendations and guidelines for treatment.
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Analgésicos Opioides/administración & dosificación , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/terapia , Complicaciones del Embarazo/cirugía , Regionalización , Adolescente , Adulto , Buprenorfina/administración & dosificación , Terapia Cognitivo-Conductual , Femenino , Enfermedades Fetales/inducido químicamente , Enfermedades Fetales/prevención & control , Humanos , Metadona/administración & dosificación , Trastornos Relacionados con Opioides/diagnóstico , Asistentes Médicos , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones del Embarazo/diagnóstico , Rol Profesional , Adulto JovenRESUMEN
Stenosing flexor tenosynovitis, more commonly known as trigger finger, is one of the most common causes of hand pain and dysfunction. Clinicians must be able to identify the disorder, know the broad range of treatment options, and counsel patients on the treatment best suited for their condition. Awareness of the economic burden each option entails is central to optimizing treatment outcomes and patient satisfaction.
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Atrapamiento del Tendón/terapia , Costo de Enfermedad , Diagnóstico Diferencial , Tratamiento con Ondas de Choque Extracorpóreas , Femenino , Glucocorticoides/administración & dosificación , Costos de la Atención en Salud , Humanos , Persona de Mediana Edad , Procedimientos Ortopédicos , Satisfacción del Paciente , Modalidades de Fisioterapia , Índice de Severidad de la Enfermedad , Atrapamiento del Tendón/diagnóstico , Resultado del TratamientoRESUMEN
The purpose of this paper is to propose and qualify a novel funding mechanism for international neurosurgical nonprofits. The article first identifies and explains neurosurgeons' means for practicing in the developing world through a literature review. After this examination of the current funding methods for surgical care in low-income regions, the work transitions to an explanation of the applications and limitations of a new resource: the internal wealth of a developing country. This wealth may be leveraged by way of a for-profit hospital to create sustainable and domestic funding for nonprofit neurosurgical training. The applicability of the proposed mechanism extends beyond the field of neurosurgery to nonprofits in any health-related discipline. Factors influencing the viability of this mechanism (including local disease burden, economic trajectory, and political stability) are examined to create a baseline set of conditions for success.
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Organización de la Financiación/economía , Neurocirugia/economía , Organizaciones de Beneficencia/economía , Países en Desarrollo/economía , Equipos y Suministros/economía , Apoyo Financiero , Organización de la Financiación/métodos , Donaciones , Salud Global , Humanos , Renta , Cooperación Internacional , Comercialización de los Servicios de Salud/economía , Neurocirugia/educación , Organizaciones sin Fines de Lucro/economíaRESUMEN
OBJECTIVES: The purpose of this study was to identify rates and predictors of psychotropic medication polypharmacy among Medicaid-eligible children in South Carolina with autism spectrum disorder (ASD) from 2000 to 2008. METHODS: Population-based surveillance data were linked with state Medicaid records to obtain a detailed demographic, behavioral, educational, clinical, and diagnostic data set for all Medicaid-eligible 8-year-old children (n=629) who were identified and diagnosed with ASD using standardized criteria. Polypharmacy was defined as having interclass psychotropic medication claims overlapping for ≥30 consecutive days at any time during the 2-year study period. Multivariable logistic regression was used to model predictors of any polypharmacy, and for the three most common combinations. RESULTS: Overall, 60% (n=377) used any psychotropic medication, and 41% (n=153) of those had interclass polypharmacy. Common combinations were attention-deficit/hyperactivity disorder (ADHD) medications with an antidepressant (A/AD), antipsychotic (A/AP) or a mood stabilizer (A/MS). Black children had lower odds of any polypharmacy, as did those eligible for Medicaid because of income or being foster care versus those eligible because of disability. There were no significant associations between polypharmacy and social deficits in ASD for any combination, although children with communication deficits diagnostic of ASD had lower odds of any polypharmacy and A/AP polypharmacy. Children with argumentative, aggressive, hyperactive/impulsive, or self-injurious aberrant behaviors had higher odds of polypharmacy, as did children with diagnosed co-occurring ADHD, anxiety or mood disorders, or conduct/oppositional defiant disorder (ODD) in Medicaid records. CONCLUSIONS: Future research is warranted to investigate how child-level factors impact combination psychotropic medication prescribing practices and outcomes in ASD.
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Trastorno del Espectro Autista/tratamiento farmacológico , Trastornos de la Conducta Infantil/etiología , Polifarmacia , Psicotrópicos/uso terapéutico , Antidepresivos/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno del Espectro Autista/psicología , Niño , Femenino , Humanos , Masculino , Medicaid , Estados UnidosRESUMEN
A 26-year-old woman developed a left homonymous hemianopia 1 week after placement of a ventriculoperitoneal shunt through a right parieto-occipital approach. Computed tomography demonstrated a parenchymal cyst in the right occipital lobe. After shunt revision, there was concomitant resolution of the cyst and visual field defect over 1 month. The literature is reviewed regarding this unusual complication of ventriculoperitoneal shunt failure.
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Quistes/etiología , Lateralidad Funcional , Hemianopsia/etiología , Complicaciones Posoperatorias/fisiopatología , Derivación Ventriculoperitoneal/efectos adversos , Adulto , Femenino , Humanos , Aneurisma Intracraneal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECT: In Tanzania, there are 4 neurosurgeons for a population of 46 million. To address this critical shortage of neurosurgical care, the authors worked with local Tanzanian health care workers, neurosurgeons, the Ministry of Health and Social Welfare, and the Office of the President of Tanzania to develop a train-forward method for sustainable, self-propagating basic and emergency neurosurgery in resource-poor settings. The goal of this study was to assess the safety and effectiveness of this method over a 6-year period. METHODS: The training method utilizes a hands-on bedside teaching technique and was introduced in 2006 at a remote rural hospital in northern Tanzania. Local health care workers were trained to perform basic and emergency neurosurgical procedures independently and then were taught to train others. Outcome information was retrospectively collected from hospital records for the period from 2005 (1 year before method implementation) through 2010. Analysis of de-identified data included descriptive statistics and multivariable assessment of independent predictors of complications following a patient's first neurosurgical procedure. RESULTS: By 2010, the initial Tanzanian trainee had trained a second Tanzanian health care worker, who in turn had trained a third. The number of neurosurgical procedures performed increased from 18 in 2005 to an average of 92 per year in the last 3 years of the study period. Additionally, the number of neurosurgical cases performed independently by Tanzanian health care providers increased significantly from 44% in 2005 to 86% in 2010 (p < 0.001), with the number of complex cases independently performed also increasing over the same time period from 34% to 83% (p < 0.001). Multivariable analysis of clinical patient outcome information to assess safety indicated that postoperative complications decreased significantly from 2005 through 2010, with patients who had been admitted as training progressed being 29% less likely to have postoperative complications (OR 0.71, 95% CI 0.52-0.96, p = 0.03). CONCLUSIONS: The Madaktari Africa train-forward method is a reasonable and sustainable approach to improving specialized care in a resource-poor setting.
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Creación de Capacidad/métodos , Educación de Postgrado en Medicina/métodos , Neurocirugia/educación , Servicios de Salud Rural , Adolescente , Adulto , Creación de Capacidad/organización & administración , Países en Desarrollo , Educación de Postgrado en Medicina/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Bienestar Social , Tanzanía , Recursos Humanos , Adulto JovenRESUMEN
Medication adherence in children is poor, particularly among those with chronic or mental health disorders. However, adherence has not been fully assessed in autism spectrum disorders (ASDs). The validated proportion of days covered method was used to quantify adherence to psychotropic medication in Medicaid-eligible children who met diagnostic criteria for ASD between 2000 and 2008 (N = 628). Among children prescribed attention deficit hyperactivity disorder (ADHD) medications, antidepressants, or antipsychotics, 44, 40 and 52 % were adherent respectively. Aggressive behaviors and abnormalities in eating, drinking, and/or sleeping, co-occurring ADHD, and the Medication Regimen Complexity Index were the most significant predictors of adherence rather than demographics or core deficits of ASD. Identifying barriers to adherence in ASD may ultimately lead to improved treatment outcomes.
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Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastornos Generalizados del Desarrollo Infantil/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Psicotrópicos/uso terapéutico , Agresión/psicología , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Trastornos Generalizados del Desarrollo Infantil/complicaciones , Trastornos Generalizados del Desarrollo Infantil/psicología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Medicaid , Factores de Riesgo , Sueño , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period. METHODS: A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established. RESULTS: At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently. CONCLUSIONS: Neurosurgical care in Tanzania needs to address a diverse, unique disease burden. We found that local surgeons could be enabled to safely perform basic cranial and spinal neurosurgical procedures through immersive, 1-on-1 on-site collaborations, multidisciplinary courses, and educational visiting fellowships.
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Neurocirugia/educación , Centros de Atención Terciaria/organización & administración , Adulto , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/cirugía , Trastornos de la Conciencia , Craneotomía , Crimen , Cuidados Críticos , Europa (Continente) , Femenino , Escala de Coma de Glasgow , Humanos , Hidrocefalia/cirugía , Unidades de Cuidados Intensivos , Cooperación Internacional , Intercambio Educacional Internacional , Masculino , Persona de Mediana Edad , Tanzanía , Tuberculoma Intracraneal/cirugía , Estados UnidosRESUMEN
STUDY DESIGN: Retrospective analysis of prospectively collected follow-up data for 2.9 years. OBJECTIVE: To determine the natural history of subsequent morphometric fracture rates at adjacent levels (one level above or below a previous known baseline fracture) in a large patient database. SUMMARY OF BACKGROUND DATA: The long-term risk and risk factors for adjacent-level vertebral fractures in patients with osteoporosis are unknown. METHODS: The fracture intervention trial is a large randomized, placebo-controlled trial of alendronate treatment for osteoporosis. Data from both bisphosphonate-treated and bisphosphonate-naive patients (N = 1950, vertebral fracture arm) was analyzed to detect incident morphometric fracture rates. RESULTS: During a mean follow-up of 2.9 years, 3.4% of patients in the alendronate group and 7.4% in the placebo group experienced adjacent-level vertebral fractures. The annual rate of adjacent-level vertebral fractures was 1.2% in the alendronate group, and 2.5% in the placebo group (overall, 1.8% per year in both groups combined). As expected, the thoracolumbar region (defined as T11, T12, and L1) seemed to be the most prone to new adjacent-level fractures. Among females with baseline prevalent fractures at the thoracolumbar junction, who subsequently experienced at least one new fracture anywhere along the spine (N = 124), 40.3% had a new adjacent-level fracture in this region. Older age at randomization, lower bone mineral density, inactivity, and placebo therapy were significantly associated with the development of adjacent-level fractures in univariate analysis (P ≤ 0.05). Multivariate analysis indicated decreased odds of adjacent-level fractures with bisphosphonate therapy and higher bone mineral density, and increased odds with older age at randomization (P ≤ 0.05). CONCLUSION: New vertebral fractures adjacent to prevalent fractures occurred relatively infrequently in this treatment trial of alendronate in females with osteoporosis, and were more common with older age at randomization, lower bone mineral density and placebo treatment.
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Alendronato/uso terapéutico , Densidad Ósea/fisiología , Fracturas de la Columna Vertebral/tratamiento farmacológico , Anciano , Alendronato/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Osteoporosis/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/etiologíaRESUMEN
"Multirecipients" are people who receive Supplemental Security Income (SSI) payments while living with other recipients (not including an SSI-eligible spouse). Using Social Security Administration records matched to Current Population Survey data for 2005, this article examines multirecipients' personal, family, household, and economic characteristics. I find that no more than 20 percent of the 2005 SSI population were multirecipients. Most multirecipients were adults, lived with one other recipient, and/or shared their homes with related recipients. Multirecipients were generally less likely to be poor than SSI recipients as a whole; but those who were children, lived with one other recipient, and/or shared their homes with a nonrecipient were more likely to be poor. Implementing sliding-scale SSI benefit reductions for children in multirecipient households would affect about 23 percent of multirecipients, or about 5 percent of all SSI recipients.
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Personas con Discapacidad/estadística & datos numéricos , Composición Familiar , Pobreza/estadística & datos numéricos , Seguridad Social/economía , Adolescente , Adulto , Anciano , Ayuda a Familias con Hijos Dependientes/economía , Ayuda a Familias con Hijos Dependientes/estadística & datos numéricos , Niño , Personas con Discapacidad/legislación & jurisprudencia , Humanos , Renta , Pobreza/economía , Seguridad Social/legislación & jurisprudencia , Seguridad Social/estadística & datos numéricos , Estados Unidos , United States Social Security Administration/economía , United States Social Security Administration/legislación & jurisprudencia , Adulto JovenRESUMEN
BACKGROUND: There remains no FDA approved medication for the treatment of cocaine dependence. Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine (NAC) may be useful in the treatment of the disorder. OBJECTIVE: The present report assessed the efficacy of NAC in the treatment of cocaine dependence. METHODS: Cocaine-dependent volunteers (n = 111) were randomized to receive daily doses of 1,200 mg of NAC, 2,400 mg of NAC, or placebo. Participants were followed for 8 weeks (up to three visits weekly). At each of these visits, urine samples were collected, along with self-reports of cocaine use. Urine samples were assessed for quantitative levels of benzoylecognine (ie, cocaine metabolite). RESULTS: Overall, the primary results for the clinical trial were negative. However, when considering only subjects who entered the trial having already achieved abstinence, results favored the 2,400 mg NAC group relative to placebo, with the 2,400 mg group having longer times to relapse and lower craving ratings. CONCLUSION: While the present trial failed to demonstrate that NAC reduces cocaine use in cocaine-dependent individuals actively using, there was some evidence it prevented return to cocaine use in individuals who had already achieved abstinence from cocaine. SCIENTIFIC SIGNIFICANCE: N-acetylcysteine may be useful as a relapse prevention agent in abstinent cocaine-dependent individuals.
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Acetilcisteína/uso terapéutico , Sistema de Transporte de Aminoácidos y+/efectos de los fármacos , Trastornos Relacionados con Cocaína/tratamiento farmacológico , Acetilcisteína/efectos adversos , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Pruebas Psicológicas , Prevención Secundaria , Resultado del TratamientoRESUMEN
BACKGROUND: Commercial closed-suctions drainage systems are commonly used in the United States and many other countries for use in neurosurgical cases. However, in Tanzania and other developing nations with fewer resources, these are not available. This report explores another option for a closed-system drainage system utilizing inexpensive supplies found commonly in hospitals around the world. METHODS: Sterile IV-tubing is cut, inserted into the wound, and brought out through an adjacent puncture incision. For suction, an empty plastic bottle can be attached to the tubing. RESULTS: The IV-tubing closed-suction drainage system was applied in both cranial and spinal neurosurgical procedures, including as subdural, subgaleal, epidural, and suprafacial drains. It maintained suction and was an adequate substitute when commercial drains are unavailable. CONCLUSIONS: This report illustrates how sterile IV-tubing can be adapted for use as a closed-drainage system. It utilizes inexpensive supplies commonly found in many hospitals throughout the world and can be applied to both cranial and spinal neurosurgical procedures.
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CONTEXT: There is considerable interest in translating laboratory advances in neuronal regeneration following spinal cord injury (SCI). A multimodality approach has been advocated for successful functional neuronal regeneration. With this goal in mind several biomaterials have been employed as neuronal bridges either to support cellular transplants, to release neurotrophic factors, or to do both. A systematic review of this literature is lacking. Such a review may provide insight to strategies with a high potential for further investigation and potential clinical application. OBJECTIVE: To systematically review the design strategies and outcomes after biomaterial-based multimodal interventions for neuronal regeneration in rodent SCI model. To analyse functional outcomes after implantation of biomaterial-based multimodal interventions and to identify predictors of functional outcomes. METHODS: A broad PubMed, CINHAL, and a manual search of relevant literature databases yielded data from 24 publications; 14 of these articles included functional outcome information. Studies reporting behavioral data in rat model of SCI and employing biodegradable polymer-based multimodal intervention were included. For behavioral recovery, studies using severe injury models (transection or severe clip compression (>16.9 g) or contusion (50 g/cm)) were categorized separately from those investigating partial injury models (hemisection or moderate-to-severe clip compression or contusion). RESULTS: The cumulative mean improvements in Basso, Beattie, and Bresnahan scores after biomaterial-based interventions are 5.93 (95% CI = 2.41 - 9.45) and 4.44 (95% CI = 2.65 - 6.24) for transection and hemisection models, respectively. Factors associated with improved outcomes include the type of polymer used and a follow-up period greater than 6 weeks. CONCLUSION: The functional improvement after implantation of biopolymer-based multimodal implants is modest. The relationship with neuronal regeneration and functional outcome, the effects of inflammation at the site of injury, the prolonged survival of supporting cells, the differentiation of stem cells, the effective delivery of neurotrophic factors, and longer follow-up periods are all topics for future elucidation. Future investigations should strive to further define specific factors associated with improved functional outcomes in clinically relevant models.