The persistent value of lesions in psychiatric neurosurgery.

Neurosurgery for intractable psychiatric conditions has seen a resurgence with the increasing use of deep brain stimulation (DBS). Although DBS promises reversible neuromodulation and has become more popular than older lesioning methods, lesioning might still be preferred in specific cases. Here, we review the evidence for DBS and lesions in the treatment of intractable neuropsychiatric conditions and consider the factors that favour the continued use of lesioning procedures in appropriately selected cases. Broadly, systemic factors including comparative effectiveness, cost, and ethical arguments support an ongoing role for lesioning. Such a role is also supported by practical considerations including patient experiences of this type of therapy, the relative intensity of follow-up care, access to sparse or specialised follow-up care, and relative infection risk. Overall, we argue that neurosurgical lesion procedures remain an important alternative to DBS and their continued availability is necessary to fulfil the imperatives of mental health parity and enhance access to effective mental health treatments. Nonetheless, the efficacy of DBS and recent advances in closed-loop stimulation and remote programming might provide solutions to some of the challenges associated with wider use of electrical neuromodulation. Concerns about the scarcity of high-level evidence for the efficacy of lesioning procedures as well as the potential irreversible adverse effects of lesioning remain to be addressed.

How All-Payer Claims Databases (APCDs) Can be Used to Examine Changes in Professional Spending: Experience from the Rhode Island APCD.

States are increasingly the focus of health care spending reform efforts given political deadlock at the federal level. Using the Rhode Island All-Payer Claims Database (APCD) from 2016 to 2019, a modified National Uniform Claim Committee (NUCC) provider taxonomy, and the 2021 Restructured BETOS Classification System (RBCS), we evaluate professional spending trends in commercial and Medicaid populations, identify specialties and clinical service categories driving trends, and examine price and volume contributions to spending changes. We found that professional spending from 2016-2019 in Medicaid is increasing faster than professional spending in commercial (5.2% vs. 2.7% annually). We also found that nurse practitioner and physician assistant evaluation and management (E&M), behavioral health services E&M, anesthesia, diagnostic radiology imaging, and orthopedic procedures were among the largest areas of spending increase during the study period in Rhode Island. Three-year trends showed heterogeneity in whether volume or price was primarily responsible for these spending increases.

Financial strain and depression in the U.S.: a scoping review.

While the association between assets and depression has been established, less is known about the link between financial strain and depression. Given rising financial strain and economic inequity due to the COVID-19 pandemic, understanding the role that financial strain plays in shaping population depression in the United States is particularly salient. We conducted a scoping review of the peer-reviewed literature on financial strain and depression published from inception through January 19, 2023, in Embase, Medline via PubMed, and PsycINFO, PsycArticles, SocINDEX, and EconLit via Ebsco. We searched, reviewed, and synthesized the literature on longitudinal studies on financial strain and depression conducted in the United States. Four thousand and four unique citations were screened for eligibility. Fifty-eight longitudinal, quantitative articles on adults in the United States were included in the review. Eighty-three percent of articles (n = 48) reported a significant, positive association between financial strain and depression. Eight articles reported mixed results, featuring non-significant associations for some sub-groups and significant associations for others, one article was unclear, and one article reported no significant association between financial strain and depression. Five articles featured interventions to reduce depressive symptoms. Effective interventions included coping mechanisms to improve one's financial situation (e.g., mechanisms to assist in finding employment), to modify cognitive behavior (e.g., reframing mindset), and to engage support (e.g., engaging social and community support). Successful interventions were tailored to participants, were group-based (e.g., they included family members or other job seekers), and occurred over multiple sessions. While depression was defined consistently, financial strain was defined variably. Gaps in the literature included studies featuring Asian populations in the United States and interventions to reduce financial strain. There is a consistent, positive association between financial strain and depression in the United States. More research is needed to identify and test interventions that mitigate the ill effects of financial strain on population's mental health.

Readability and quality of online information on total ankle arthroplasty.

The internet is a frequently utilized resource to acquire health information. This study aims to examine the readability and quality of online information pertaining to total ankle arthroplasty (TAA). "Ankle arthroplasty" OR "ankle replacement" was queried in three search engines, with the first 3 pages of results identified. The readability of sites was calculated using six readability algorithms: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index. Quality was assessed using the JAMA benchmark, Global Quality Score (GQS), and DISCERN instrument. A total of 62 relevant sites were analyzed. Sources were primarily physician-sponsored (50%) or academic (31%) websites. The mean readability indices were above the recommended sixth grade reading level, with an average grade level of across scoring tools of 13.22 ± 2.07. No sites were at or below a sixth grade reading level. Quality ratings were subpar across assessment tools: JAMA = 1.9 ± 1.0 (range, 1-4) out of 4; GQS = 3.4 ± 1.0 (range, 1-5) out of 5. DISCERN = 54.0 ± 11.2 (range, 31-75) out of 80. The readability and quality of online information regarding ankle arthroplasty is not optimal for the average patient, with improvement valuable in cultivating shared decision-making.

Readability of Online Foot and Ankle Surgery Patient Education Materials.

Background. Online health education resources are frequently accessed by patients seeking information on orthopaedic conditions and procedures. The objectives of this study were to assess the readability of information provided by the American Orthopaedic Foot and Ankle Society (AOFAS) and compare current levels of readability with previous online material. Methods. This study examined 115 articles classified as "Conditions" or "Treatments" on FootCareMD.org. Readability was assessed using the 6 readability assessment tools: Flesch Reading Ease, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Score, Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index, and the Automated Readability Index. Results. The mean readability score across all metrics ranged from 9.1 to 12.1, corresponding to a 9th- to 12th-grade reading level, with a mean FKGL of 9.2 ± SD 1.1 (range: 6.3-15.0). No articles were written below the recommended US sixth-grade reading level, with only 3 articles at or below an eighth-grade level. Treatment articles had higher mean readability grade levels than condition articles (P = .03). Conclusion. Although the volume and quality of the AOFAS resource Web site has increased, readability of information has worsened since 2008 and remains higher than the recommended reading level for optimal comprehension by the general population.Levels of Evidence: Level IV:Retrospective quantitative analysis.