Image Guidance for Ventricular Shunt Surgery: An Analysis of Hospital Charges.

BACKGROUND: Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery. OBJECTIVE: To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN). METHODS: Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department. RESULTS: Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively. CONCLUSION: From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.

Developing a laboratory model of smoking lapse targeting stress and brief nicotine deprivation.

Stress plays a significant role in the maintenance of, and relapse to, smoking. The current study aims to develop a human laboratory model examining stress-precipitated tobacco lapse following brief nicotine deprivation. Daily smokers (N = 48; 50% female) who were nicotine deprived for 3 hr received a personalized imagery induction (stress or neutral, within-subject, counterbalanced) on 2 separate days. Following imagery induction, participants were instructed that they could smoke or receive monetary reinforcement ($0.25, $0.50, $1.00; between-subjects) for every 5 min they chose to delay tobacco self-administration during a 50-min delay period. After the delay period, participants engaged in a 1-hr ad libitum smoking period. Tobacco craving and mood were assessed throughout. The primary aim was to determine whether stress imagery would reduce the ability to resist following a brief nicotine deprivation in a laboratory setting. A secondary goal identified which level of monetary reinforcement highlighted the effect of stress on reduced ability to resist smoking (i.e., resisting ∼25 min of the 50-min window). Overall, stress versus neutral imagery decreased the ability to resist smoking, increased craving and negative mood states, decreased positive mood, but did not change ad libitum smoking. Increased monetary reinforcement increased the ability to resist smoking. Planned comparisons examining lapse behavior within each monetary condition demonstrated that $0.50 produced the only significant difference between stress and neutral imagery, demonstrating target model behavior. Findings highlight that stress negatively impacts smoking lapse behavior and can be effectively modeled in the human laboratory with a brief, 3-hr deprivation window. (PsycINFO Database Record

Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit.

BACKGROUND: Patients in the progressive care unit typically experience high levels of pain and anxiety and exhibit difficulty sleeping. OBJECTIVE: To determine whether either clinical massage or guided imagery could reduce pain and anxiety and improve sleep. METHODS: This study included 288 inpatients on 2 floors of a progressive care unit. On 1 floor, each patient was offered daily a 15-minute complimentary clinical massage, whereas the patients on the other floor were provided access to a 30-minute guided-imagery recording. Patients were asked to rate their pain and anxiety levels immediately before and after the massage intervention or were asked whether the guided-imagery intervention was helpful for pain, anxiety, or insomnia. RESULTS: The massage intervention showed an immediate and significant reduction in self-reported pain and anxiety (P < .001); likewise, a significant number of patients self-reported that guided imagery helped alleviate pain, anxiety, and insomnia (P < .001). CONCLUSION: The results of this study indicate that clinical massage and guided imagery can benefit patients in the progressive care unit.

Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial.

BACKGROUND: Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective. METHODS/DESIGN: One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1-3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a six-week, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations). DISCUSSION: The results of this study will provide evidence on the effectiveness of this mental practice-based rehabilitation training, as well as the cost-effectiveness. TRIAL REGISTRATION: Current Controlled Trials [ISRCTN33487341).

A study of efficacy and cost-effectiveness of guided imagery as a portable, self-administered, presurgical intervention delivered by a health plan.

BACKGROUND: Previous research indicates that immersive, mind-body interventions can improve the quality of a patient's surgical experience and clinical outcomes. OBJECTIVE: To describe the Blue Shield of California Presurgical Guided Imagery Program, assess its impact on surgical outcomes, patient satisfaction, and cost savings. METHOD: Analysis of survey data conducted pre- and post-surgery among 905 eligible health plan members. Retrospective analysis of medical claims for a subset of 126 hysterectomy patients was compared with that of similar patients who did not use guided imagery for differences in length of stay and charges billed. RESULTS: The intervention yielded an adoption rate of 74%. Patients who used the guided imagery intervention reported significantly reduced anxiety and high levels of satisfaction. A trend toward shorter hospital stays (8% reduction, P=.07) was also observed in the imagery group, as well as reduced pharmaceutical costs (14% reduction, P=.181). In total, there was a 14% reduction in mean total charges billed per procedure in the imagery patients, amounting to an average savings of $2003 per procedure. Although it was not possible to isolate differential cost of lab and imaging fees for the purposes of this study, it is likely these factors played a part in the billing differential as well. DISCUSSION: Health plans are well positioned to deliver guided imagery tools for patient self-management prior to scheduled surgery. While mind-body interventions are increasingly linked to cost savings and improved outcomes in a variety of clinical settings, a randomized controlled trial should be conducted to firmly establish their efficacy.

Strategies for implementing a guided imagery program to enhance patient experience.

The patient in acute care settings can have severe emotional and physical stresses that are also experienced by family and significant others. The experience in a hospital has often been described as overwhelming; it can evoke feelings of fear, anger, helplessness, and isolation. Guided imagery, one of the most well-studied complementary therapies, is used increasingly to improve patients' experiences and healthcare outcomes. More and more, patients are relying on the use of guided imagery to provide a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay. This article provides a brief review of the research base for guided imagery and broad indications for its use. It describes key elements of the therapy and outlines steps to implement a program of guided imagery that can be used in variety of settings.