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Hitti FL, Widge AS, Riva-Posse P, Malone DA, Okun MS, Shanechi MM, Foote KD, Lisanby SH, Ankudowich E, Chivukula S, Chang EF, Gunduz A, Hamani C, Feinsinger A, Kubu CS, Chiong W, Chandler JA, Carbunaru R, Cheeran B, Raike RS, Davis RA, Halpern CH, Vanegas-Arroyave N, Markovic D, Bick SK, McIntyre CC, Richardson RM, Dougherty DD, Kopell BH, Sweet JA, Goodman WK, Sheth SA, Pouratian N. Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders. Brain Stimul 2023; 16:867-878. [PMID: 37217075 PMCID: PMC11189296 DOI: 10.1016/j.brs.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress. DESIGN The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here. CONCLUSION The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.
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Affiliation(s)
- Frederick L Hitti
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald A Malone
- Department of Psychiatry, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Maryam M Shanechi
- Departments of Electrical and Computer Engineering and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Sarah H Lisanby
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Elizabeth Ankudowich
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Srinivas Chivukula
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Aysegul Gunduz
- Department of Biomedical Engineering and Fixel Institute for Neurological Disorders, University of Florida, Gainesville, FL, USA
| | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Harquail Centre for Neuromodulation, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic and Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Winston Chiong
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer A Chandler
- Faculty of Law, University of Ottawa, Ottawa, ON, USA; Affiliate Investigator, Bruyère Research Institute, Ottawa, ON, USA
| | | | | | - Robert S Raike
- Global Research Organization, Medtronic Inc. Neuromodulation, Minneapolis, MN, USA
| | - Rachel A Davis
- Departments of Psychiatry and Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Cpl Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Dejan Markovic
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cameron C McIntyre
- Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian H Kopell
- Department of Neurosurgery, Center for Neuromodulation, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jensen I, Bretschneider A, Stiel S, Wegner F, Höglinger GU, Klietz M. Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists. Brain Sci 2022; 12:brainsci12060749. [PMID: 35741634 PMCID: PMC9221250 DOI: 10.3390/brainsci12060749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.
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Affiliation(s)
- Ida Jensen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
- Correspondence:
| | - Almut Bretschneider
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
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Peterson K, LaRoche S, Cummings T, Woodard V, Moise AM, Munger Clary H. Addressing the epilepsy surgery gap: Impact of community/tertiary epilepsy center collaboration. Epilepsy Behav Rep 2020; 14:100398. [PMID: 33313499 PMCID: PMC7720013 DOI: 10.1016/j.ebr.2020.100398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Collaboration agreements can improve epilepsy surgery referral volumes. Standardized referral pathways may help address epilepsy surgery gap. Internal and external process changes can improve referral process. Sociodemographic variables continue to influence referral completion.
To assess whether a formal collaboration between a non-surgical, community epilepsy center and a surgical, tertiary-care epilepsy center can improve patient progress throughout the pre-surgical referral process, and to elucidate predictors of referral completion among inter-center referrals. The inter-center referral process was tracked, and the number of patients completing surgical conference (primary outcome) and epilepsy surgery at the tertiary center were collected and compared in the 45-month immediate pre/post-collaboration periods. Demographic and clinical variables were collected on post-collaboration inter-center patient referrals to explore factors associated with completion of the referral process. Compared to the pre-collaboration period, the proportion of tertiary center epilepsy surgery conference patients referred from the community epilepsy center increased from 3/88 to 14/113 (263% increase, p = .01) during the post-collaboration period. The proportion of patients completing surgery via the community to tertiary referral process increased from 2/63 pre-collaboration to 8/71 post-collaboration (254% increase, p = .04). Referral completion was associated with higher seizure frequency, shorter travel distance, private insurance status and positive employment status (p < 0.05). Collaboration agreements between community and tertiary-care epilepsy centers may improve patient completion of the epilepsy surgery referral process. Implementation of similar programs at other centers may be beneficial in reducing the epilepsy surgery gap.
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Affiliation(s)
- Keyan Peterson
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | | | - Tiffany Cummings
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | - Valerie Woodard
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | | | - Heidi Munger Clary
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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Ricciardi C, Fiorillo A, Valente AS, Borrelli A, Verdoliva C, Triassi M, Improta G. Lean Six Sigma approach to reduce LOS through a diagnostic-therapeutic-assistance path at A.O.R.N. A. Cardarelli. TQM JOURNAL 2019. [DOI: 10.1108/tqm-02-2019-0065] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The rise of the mean age incremented the occurrence of femur fractures with respect to the past, leading thus to serious consequences, as regards morbidity and socio-economic impact. The direction of the A.O.R.N. Cardarelli of Naples has introduced a DTAP whose aim was the reduction of LOS. The paper aims to discuss this issue.
Design/methodology/approach
The aim of this paper is to analyze the introduction of DTAP, employing Lean Thinking and Six Sigma methodology based on the DMAIC cycle. To evaluate the effectiveness of DTAP, two groups of patients have been observed for 14 months (before and after the implementation of DTAP).
Findings
Statistical tests were performed on the groups and graphics were provided to visualize the decrease of LOS (29.9 per cent). The overall population was also divided in subgroups according to six variables potentially influencing LOS.
Research limitations/implications
Authors considered six variables of influences; yet, others could be taken into account in the future.
Practical implications
The decrease of costs due to the management of elderly patients with femur fracture, the optimization of care processes in hospitals and a faster recovery for patients is the tangible contribute of DTAP.
Originality/value
The implementation of DTAP allowed the hospital to obtain a significant reduction of LOS with a consequently decrease of costs alleviating the hospital and the society from the socio-economic burden and the morbidity of this pathology.
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