Mechanisms of Peer Review and their Potential Impact on Neurosurgeons: A Pilot Survey

INTRODUCTION: Physician peer review is a universal practice among United States hospitals. While there are many commonalities in peer review procedures, many of them established by law, there is also much institutional variation which should be well understood by practicing neurosurgeons. METHODS: We conducted a 13-question pilot survey of a sample of five hospital systems with whom members of the CSNS-Medicolegal committee are affiliated. Survey questions were constructed to qualitatively assess three features of Hospital Peer Review: (1) committee composition and process, (2) committee outcomes, and (3) legal protections and ramifications RESULTS: The most common paradigm for physician peer review committee (PPRC) was an interdisciplinary group with representatives from most major medical and surgical subspecialties. Referrals for peer review inquiry could be made by any hospital employee and were largely anonymous. Most institutions included a pre-committee screening process conducted by the PPRC leadership. The most common outcomes of an inquiry were resolution with no further action or ongoing focused professional practice evaluation (FFPE). Only in rare circumstances were hospital privileges reported to be revoked or terminated. Members of the PPRC were consistently protected from retaliatory litigation related to peer review participation. The majority of hospitals had a multi-layered decision process and availability of appeal to minimize the potential for punitive investigations. DISCUSSION: According to a recent study, only 62% of hospitals consider their peer review process to be highly or significantly standardized. This pilot survey provides commentary of potential areas of commonality and variation among hospital peer review practices

Purification and Characterization of Progenitor and Mature Human Astrocytes Reveals Transcriptional and Functional Differences with Mouse

The functional and molecular similarities and distinctions between human and murine astrocytes are poorly understood. Here, we report the development of an immunopanning method to acutely purify astrocytes from fetal, juvenile, and adult human brains and to maintain these cells in serum-free cultures. We found that human astrocytes have abilities similar to those of murine astrocytes in promoting neuronal survival, inducing functional synapse formation, and engulfing synaptosomes. In contrast to existing observations in mice, we found that mature human astrocytes respond robustly to glutamate. Next, we performed RNA sequencing of healthy human astrocytes along with astrocytes from epileptic and tumor foci and compared these to human neurons, oligodendrocytes, microglia, and endothelial cells (available at http://www.brainrnaseq.org). With these profiles, we identified novel human-specific astrocyte genes and discovered a transcriptome-wide transformation between astrocyte precursor cells and mature post-mitotic astrocytes. These data represent some of the first cell-type-specific molecular profiles of the healthy and diseased human brain

Purification and Characterization of Progenitor and Mature Human Astrocytes Reveals Transcriptional and Functional Differences with Mouse

The functional and molecular similarities and distinctions between human and murine astrocytes are poorly understood. Here we report the development of an immunopanning method to acutely purify astrocytes from fetal, juvenile, and adult human brains, and to maintain these cells in serum-free cultures. We found that human astrocytes have similar abilities to murine astrocytes in promoting neuronal survival, inducing functional synapse formation, and engulfing synaptosomes. In contrast to existing observations in mice, we found that mature human astrocytes respond robustly to glutamate. We next performed RNA-sequencing of healthy human astrocytes along with astrocytes from epileptic and tumor foci, and compared these to human neurons, oligodendrocytes, microglia, and endothelial cells. With these profiles, we identified novel human-specific astrocyte genes, and discovered a transcriptome-wide transformation between astrocyte precursor cells and mature post-mitotic astrocytes. These data represent some of the first cell type-specific molecular profiles of the healthy and diseased human brain