Overregulation of Health Care: Musings on Disruptive Innovation Theory

Disruptive innovation theory provides one lens through which to describe how regulations may stifle innovation and increase costs. Basing their discussion on this theory, Curtis and Schulman consider some of the effects that regulatory controls may have on innovation in the health sector

Основы самостоятельной профессионально-прикладной физической подготовки студентов медицинских вузов

ВГМУЛЕЧЕБНАЯ ФИЗКУЛЬТУРАФИЗИЧЕСКАЯ КУЛЬТУРА ЛЕЧЕБНАЯФИЗИЧЕСКАЯ ПОДГОТОВКАРассматриваются вопросы для самостоятельного изучения основ профессионально-прикладной физической подготовки будущих работников в сфере медицинского обслуживания населения

Neurofilament levels, disease activity and brain volume during follow-up in multiple sclerosis

BACKGROUND: There is a need for clinically useful biomarkers of disease activity in clinically isolated syndrome (CIS) and relapsing remitting MS (RRMS). The aim of this study was to assess the correlation between neurofilament light chain (NFL) in cerebrospinal fluid (CSF) and serum and the relationship between NFL and other biomarkers, subsequent disease activity, and brain volume loss in CIS and RRMS. METHODS: A panel of neurodegenerative and neuroinflammatory markers were analyzed in repeated CSF samples from 41 patients with CIS or RRMS in a prospective longitudinal cohort study and from 22 healthy controls. NFL in serum was analyzed using a single-molecule array (Simoa) method. “No evidence of disease activity-3” (NEDA-3) status and brain volume (brain parenchymal fraction calculated using SyMRI®) were recorded during 4 years of follow-up. RESULTS: NFL levels in CSF and serum correlated significantly (all samples, n = 63, r 0.74, p < 0.001), but CSF-NFL showed an overall stronger association profile with NEDA-3 status, new T2 lesions, and brain volume loss. CSF-NFL was associated with both new T2 lesions and brain volume loss during follow-up, whereas CSF-CHI3L1 was associated mainly with brain volume loss and CXCL1, CXCL10, CXCL13, CCL22, and MMP-9 were associated mainly with new T2 lesions. CONCLUSIONS: Serum and CSF levels of NFL correlate, but CSF-NFL predicts and reflects disease activity better than S-NFL. CSF-NFL levels are associated with both new T2 lesions and brain volume loss. Our findings further add to the accumulating evidence that CSF-NFL is a clinically useful biomarker in CIS and RRMS and should be considered in the expanding NEDA concept. CSF-CXCL10 and CSF-CSF-CHI3L1 are potential markers of disease activity and brain volume loss, respectively

Should neurosurgeons continue to work in the absence of personal protective equipment during the COVID-19 era?

The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Ethical triage during the COVID-19 pandemic:a toolkit for neurosurgical resource allocation

Background The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. Methods In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. Results We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. Conclusions This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Effect of resting pressure on the estimate of cerebrospinal fluid outflow conductance

<p>Abstract</p> <p>Background</p> <p>A lumbar infusion test is commonly used as a predictive test for patients with normal pressure hydrocephalus and for evaluation of cerebrospinal fluid (CSF) shunt function. Different infusion protocols can be used to estimate the outflow conductance (<it>C</it>_out) or its reciprocal the outflow resistance (<it>R</it>_out), with or without using the baseline resting pressure, <it>P</it>_r. Both from a basic physiological research and a clinical perspective, it is important to understand the limitations of the model on which infusion tests are based. By estimating <it>C</it>_out using two different analyses, with or without <it>P</it>_r, the limitations could be explored. The aim of this study was to compare the <it>C</it>_out estimates, and investigate what effect <it>P</it>_rhad on the results.</p> <p>Methods</p> <p>Sixty-three patients that underwent a constant pressure infusion protocol as part of their preoperative evaluation for normal pressure hydrocephalus, were included (age 70.3 ± 10.8 years (mean ± SD)). The analysis was performed without (<it>C</it>_{excl Pr}) and with (<it>C</it>_{incl Pr}) P_r. The estimates were compared using Bland-Altman plots and paired sample <it>t</it>-tests (<it>p </it>< 0.05 considered significant).</p> <p>Results</p> <p>Mean <it>C</it>_out for the 63 patients was: <it>C</it>_{excl Pr}= 7.0 ± 4.0 (mean ± SD) μl/(s kPa) and <it>C</it>_{incl Pr} = 9.1 ± 4.3 μl/(s kPa) and <it>R</it>_out was 19.0 ± 9.2 and 17.7 ± 11.3 mmHg/ml/min, respectively. There was a positive correlation between methods (r = 0.79, n = 63, <it>p </it>< 0.01). The difference, Δ<it>C</it>_out= -2.1 ± 2.7 μl/(s kPa) between methods was significant (<it>p </it>< 0.01) and Δ<it>R</it>_outwas 1.2 ± 8.8 mmHg/ml/min). The Bland-Altman plot visualized that the variation around the mean difference was similar all through the range of measured values and there was no correlation between Δ<it>C</it>_outand <it>C</it>_out.</p> <p>Conclusions</p> <p>The difference between <it>C</it>_outestimates, obtained from analyses with or without <it>P</it>_r, needs to be taken into consideration when comparing results from studies using different infusion test protocols. The study suggests variation in CSF formation rate, variation in venous pressure or a pressure dependent <it>C</it>_outas possible causes for the deviation from the CSF absorption model seen in some patients.</p