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There is an increasing recognition of the importance of predictive analytics in spine surgery. This, along with the addition of personalized treatment, can optimize treatment outcomes. The goal of this study was to examine the value of clinical, demographic, expectation, and cognitive appraisal variables in predicting outcomes after surgery.
This prospective longitudinal cohort study followed adult patients undergoing spinal decompression and/or fusion surgery for degenerative spinal conditions. The authors focused on predicting the numeric rating scale (NRS) for pain, based on past research finding it to be the most responsive of the spine patient-reported outcomes. Clinical data included type of surgery, adverse events, comorbidities, and use of pain medications. Demographics included age, sex, employment status, education, and smoking status. Data on expectations related to pain relief, ability to do household and exercise/recreational activities without pain, preventing future disability, and sleeping for clinical and demographic factors. Different expectations and appraisal processes played a role in long- versus short-range predictions, suggesting that cognitive adaptation is important and relevant to pain relief outcomes after spine surgery. These results underscore the importance of addressing how people think about QOL and surgery outcomes to maximize the benefits of surgery.
Nearly 40% of the variance in spine outcomes was accounted for by cognitive factors, after adjusting for clinical and demographic factors. Different expectations and appraisal processes played a role in long- versus short-range predictions, suggesting that cognitive adaptation is important and relevant to pain relief outcomes after spine surgery. These results underscore the importance of addressing how people think about QOL and surgery outcomes to maximize the benefits of surgery.
Late failure is a well-documented complication of cerebrospinal fluid shunt placement and, less commonly, endoscopic third ventriculostomy (ETV). However, standards regarding the frequency of clinical and radiological follow-up in these patients have not been defined. Here, the authors report on their survey of surgeons at sites for the Hydrocephalus Clinical Research Network (HCRN) or its implementation/quality improvement arm (HCRNq) to provide a cross-sectional overview of practice patterns.
A 24-question survey was developed using the Research Electronic Data Capture (REDCap) platform and was distributed to the 138 pediatric neurosurgeons across 39 centers who participate in the HCRN or HCRNq. Survey questions were organized into three sections 1) Demographics (5 questions), 2) Shunt Surveillance (12 questions), and 3) ETV Surveillance (7 questions).
A total of 122 complete responses were obtained, for an overall response rate of 88%. The majority of respondents have been in practice for more than 1elong follow-up increases with greater practice experience (p = 0.01). Overall, 67% of respondents obtain routine imaging studies in asymptomatic patients after an ETV, with "rapid" MRI the study of choice for most respondents.
While there is a general consensus among pediatric neurosurgeons across North America that hydrocephalus patients should have long-term follow-up after shunt placement, radiological surveillance is characterized by considerable variety, as is follow-up after an ETV. Future work should focus on evaluating whether any one of these surveillance protocols is associated with improved outcomes.
While there is a general consensus among pediatric neurosurgeons across North America that hydrocephalus patients should have long-term follow-up after shunt placement, radiological surveillance is characterized by considerable variety, as is follow-up after an ETV. Future work should focus on evaluating whether any one of these surveillance protocols is associated with improved outcomes.The psychological effects of disasters on children with disabilities are understudied, despite evidence towards increased risk for complications after other types of trauma exposure. This study investigated the experience of children and youth with disabilities exposed to the 2017 Northern California wildfires, with a particular focus on psychological reactions. In-depth interviews were conducted with parents of 14 children and youth with disabilities one year post-disaster. Thematic analysis was used to analyze the interviews. Parents described the wildfires as traumatic events for both themselves and their children. Children and youth exhibited stress, grief, and other emotional and behavioral reactions during evacuation, in the immediate aftermath, and one year post-disaster. Navigating disability-related needs, such as accessible housing, contributed to parent stress post-disaster. School and community-based mental health efforts are described, along with a call for increased attention to disaster-related reactions in children with developmental disabilities. Suggestions for improving preparedness and response efforts that better support children with disabilities and their families post-disaster are given.
Students with intellectual disabilities (ID) exhibit increased rates of problem behaviors compared to those without ID.
Given the evidence of peer influence in typical development, we examined the impact of classmates' characteristics on problem behaviors of students with ID. We expected higher levels of problem behaviors in special needs classrooms will influence individual development of such behaviors.
A longitudinal design with measurements at the beginning and the end of a school year was applied. Staff reported on problem behaviors of 1125 students with ID (69 % boys; age 11.30 years,SD = 3.75) attending 16 Swiss special needs schools.
The peer influence hypothesis was not supported for an overall problem behavior score. However, exploratory analyses suggested that peer influence did occur for the domains anxiety, problems in relating socially, and communication disturbances (not disruptive/antisocial, self-absorbed and other types of problem behaviors). selleck products The influence of classmates on anxiety was lower when there was more variability in anxiety within the classroom.