Implementation of an Enhanced Recovery After Spine Surgery program at a large cancer center: a preliminary analysis.

This study describes the implementation of a multimodal, multidisciplinary, evidence-based ERAS program in oncologic spine surgery, identifies and measures several relevant postoperative recovery outcomes, and demonstrates the feasibility and potential benefit of the program in improving analgesia and decreasing opioid consumption. The study underscores the importance of defining and capturing meaningful, patient-specific, and patient-reported outcomes, and constant evaluation and monitoring of a group's compliance with the program. The study represents the steppingstone for evaluation and improvement of a young ERAS program for spine surgery and serves as a roadmap for further initiatives and larger-scale studies.

Scalp blocks for brain tumor craniotomies: A retrospective survival analysis of a propensity match cohort of patients.

To test the association between the use of scalp blocks for malignant brain tumor craniotomy and survival. This is a retrospective study conducted in a tertiary academic center. Demographic, intraoperative and survival data from 808 adult patients with malignant brain tumors was included in the analysis. Patients were divided in those who received an Intraoperative use of scalp block or not. The progression free survival (PFS) and overall survival (OS) rates were compared in patients who had and had not scalp blocks. Kaplan-Meier method was used for time-to-event analysis including recurrence free survival and overall survival. Multivariate analyses before and after propensity score matching were conducted to test the association between different covariates including scalp blocks with PFS and OS. Five hundred and ninety (73%) of the patients had a scalp block. Before PSM, patients with a scalp block were more likely to have an ASA physical status of 3-4, recurrent tumors and receive adjuvant radiation. Patients with scalp block showed no significant reduction in intraoperative opioids. After adjusting for significant covariates, the administration of a scalp block was not associated with an increase in PFS (HR, 95%CI = 0.98, 0.8-1.2, p = 0.892) or OS (HR, 95%CI = 1.02, 0.82-1.26, p = 0.847) survival. This retrospective study suggests that the use of scalp blocks during brain tumor surgery is not associated with patients' longer survival.

Supply chain management in the clinical laboratory.

Between 15 and 45 percent of a clinical laboratory's operating budget is spent on supplies. Given the size of this expenditure, laboratory managers must pay close attention to the supply chain and develop effective strategies to manage their inventory. Areas that need analysis include the carrying cost of supplies, the cost to generate a purchase order, methods to efficiently count supplies on hand, processes to ensure that lot number items are used before their expiration, and detailed analysis of the inventory. At the University of California-San Francisco Medical Center, we investigated options to manage our inventory and implemented a computerized system. The system required modifications to existing practices, which initially seemed unwieldy. However, after a relatively short learning curve, the improvement to operations has been significant, with a reduction in wasted reagents, fewer staff hours used to count supplies, and the ability to provide prompt analysis of the inventory for audits and discussions with administration. Focusing on the supply chain has allowed us to reduce inventory expenses by approximately 8 percent, reduce waste, given us a more focused understanding of our operations, and provided us with the ability to analyze our inventory easily.

Performance characteristics of a microsphere immunoassay using recombinant HCV proteins as a confirmatory assay for the detection of antibodies to the hepatitis C virus.

BACKGROUND: The detection of antibody to hepatitis C virus (HCV) is an important assay for the identification of individuals infected with this virus. However, the confirmation of antibody positivity remains problematic. Currently none of the screening or confirmatory assays provide quantitation of the antibodies present. A microsphere assay was designed to provide improved confirmation. METHODS: Microspheres of 3.6 mum in diameter coated with NeutraAvidin were used to capture biotinylated HCV recombinant proteins. A phycoerythrin goat anti-human immunoglobulin G (IgG) was used to detect specific antibody captured to the microsphere. A human IgG calibrator was designed that was internal to each sample in the microsphere assay. RESULTS: Detection of HCV-specific antibody using these microspheres was straightforward in most samples, with the lower detection limit set at 0.01 microg equivalents of human IgG per milliliter. In antibody-positive samples, the HCV antibody levels ranged from 0.09 to 55 microg equivalents of IgG per milliliter. Forty-nine of the 54 samples (91%) previously identified as having an indeterminate serologic pattern were negative in the microsphere assay. CONCLUSIONS: The microspheres and biotinylated HCV proteins were stable for longer than 8 months when stored at 2 degrees C to 8 degrees C and coating of the microspheres was reproducible with an interassay coefficient of variation less than 10%. Avidin-coated microspheres provide an easy solid support on which to design an assay provided the capture reagent being used can be biotinylated effectively. Confirmation of antibody to HCV can be performed using this assay format.