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  1. Article ; Online: Manufactured scarcity and the allocation of scarce resources.

    Miranda, Stephen P / Clapp, Justin T

    Lancet (London, England)

    2024  Volume 403, Issue 10426, Page(s) 531–532

    MeSH term(s) Humans ; Health Care Rationing ; Health Resources ; Resource Allocation
    Language English
    Publishing date 2024-01-04
    Publishing country England
    Document type Letter
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(23)02888-X
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  2. Article ; Online: Commentary: Clinical Application of Saphenous Nerve Transfer for Sensory Reconstruction of the Sole After Sciatic Nerve Injury: A Case Series.

    Miranda, Stephen P / Zager, Eric L

    Operative neurosurgery (Hagerstown, Md.)

    2022  Volume 22, Issue 6, Page(s) e239–e240

    MeSH term(s) Humans ; Nerve Transfer ; Peripheral Nerve Injuries ; Sciatic Nerve/physiology ; Sciatic Nerve/surgery
    Language English
    Publishing date 2022-04-14
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1227/ons.0000000000000202
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  3. Article ; Online: Commentary: Radial Nerve Branch to Anterior Interosseous Nerve Transfer to Restore Finger Pinch: 2-Dimensional Operative Video.

    Miranda, Stephen P / Zager, Eric L

    Operative neurosurgery (Hagerstown, Md.)

    2022  Volume 22, Issue 6, Page(s) e277–e278

    MeSH term(s) Fingers/innervation ; Fingers/surgery ; Humans ; Nerve Transfer/methods ; Peripheral Nerves ; Radial Nerve/surgery
    Language English
    Publishing date 2022-04-14
    Publishing country United States
    Document type Journal Article ; Video-Audio Media ; Comment
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1227/ons.0000000000000241
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  4. Article ; Online: Learning to Drive - Early Exposure to End-of-Life Conversations in Medical Training.

    Miranda, Stephen P

    The New England journal of medicine

    2017  Volume 376, Issue 5, Page(s) 413–415

    MeSH term(s) Chronic Disease ; Clinical Clerkship ; Communication ; Education, Medical, Undergraduate/methods ; Female ; House Calls ; Humans ; Physician-Patient Relations ; Quality of Life ; Terminal Care
    Language English
    Publishing date 2017-02-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMp1609234
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  5. Article ; Online: Letter to the Editor Regarding "Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review".

    Miranda, Stephen P / Wathen, Connor / Schuster, James M / Petrov, Dmitriy

    World neurosurgery

    2022  Volume 166, Page(s) 291–293

    MeSH term(s) Brain Injuries, Traumatic ; Hemostasis ; Hemostatics/therapeutic use ; Humans ; Publications
    Chemical Substances Hemostatics
    Language English
    Publishing date 2022-09-28
    Publishing country United States
    Document type Systematic Review ; Letter ; Comment
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2022.04.040
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  6. Article ; Online: Early Shared Decision-Making for Older Adults with Traumatic Brain Injury: Using Time-Limited Trials and Understanding Their Limitations.

    Miranda, Stephen P / Morris, Rachel S / Rabas, Mackenzie / Creutzfeldt, Claire J / Cooper, Zara

    Neurocritical care

    2023  Volume 39, Issue 2, Page(s) 284–293

    Abstract: Older adults account for a disproportionate share of the morbidity and mortality after traumatic brain injury (TBI). Predicting functional and cognitive outcomes for individual older adults after TBI is challenging in the acute phase of injury. Given ... ...

    Abstract Older adults account for a disproportionate share of the morbidity and mortality after traumatic brain injury (TBI). Predicting functional and cognitive outcomes for individual older adults after TBI is challenging in the acute phase of injury. Given that neurologic recovery is possible and uncertain, life-sustaining therapy may be pursued initially, even if for some, there is a risk of survival to an undesired level of disability or dependence. Experts recommend early conversations about goals of care after TBI, but evidence-based guidelines for these discussions or for the optimal method for communicating prognosis are limited. The time-limited trial (TLT) model may be an effective strategy for managing prognostic uncertainty after TBI. TLTs can provide a framework for early management: specific treatments or procedures are used for a defined period of time while monitoring for an agreed-upon outcome. Outcome measures, including signs of worsening and improvement, are defined at the outset of the trial. In this Viewpoint article, we discuss the use of TLTs for older adults with TBI, their potential benefits, and current challenges to their application. Three main barriers limit the implementation of TLTs in these scenarios: inadequate models for prognostication; cognitive biases faced by clinicians and surrogate decision-makers, which may contribute to prognostic discordance; and ambiguity regarding appropriate endpoints for the TLT. Further study is needed to understand clinician behaviors and surrogate preferences for prognostic communication and how to optimally integrate TLTs into the care of older adults with TBI.
    MeSH term(s) Humans ; Aged ; Brain Injuries, Traumatic ; Decision Making, Shared ; Outcome Assessment, Health Care ; Time Factors
    Language English
    Publishing date 2023-06-22
    Publishing country United States
    Document type Editorial
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1007/s12028-023-01764-8
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    Zs.A 6538: Show issues Location:
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  7. Article ; Online: Prediction of intracranial pressure crises after severe traumatic brain injury using machine learning algorithms.

    Petrov, Dmitriy / Miranda, Stephen P / Balu, Ramani / Wathen, Connor / Vaz, Alex / Mohan, Vinodh / Colon, Christian / Diaz-Arrastia, Ramon

    Journal of neurosurgery

    2023  Volume 139, Issue 2, Page(s) 528–535

    Abstract: Objective: Avoiding intracranial hypertension after traumatic brain injury (TBI) is a foundation of neurocritical care, to minimize secondary brain injury related to elevated intracranial pressure (ICP). However, this approach at best is reactive to ... ...

    Abstract Objective: Avoiding intracranial hypertension after traumatic brain injury (TBI) is a foundation of neurocritical care, to minimize secondary brain injury related to elevated intracranial pressure (ICP). However, this approach at best is reactive to episodes of intracranial hypertension, allowing for periods of elevated ICP before therapies can be initiated. Accurate prediction of ICP crises before they occur would permit clinicians to implement preventive strategies, minimize total time with ICP above threshold, and potentially avoid secondary injury. The objective of this study was to develop an algorithm capable of predicting the onset of ICP crises with sufficient lead time to enable application of preventative therapies.
    Methods: Thirty-six patients admitted to a level I trauma center with severe TBI (Glasgow Coma Scale score < 8) between April 2015 and January 2019 who underwent continuous intraparenchymal ICP monitor placement were retrospectively identified. Continuous ICP data were extracted from each monitoring period (range 4-96 hours of monitoring). An ICP crisis was treated as a binary outcome, defined as ICP > 22 mm Hg for at least 75% of the data within a 5-minute interval. ICP data preceding each ICP crisis were grouped into four total data sets of 1- and 2-hour epochs, each with 10- to 20-minute lead-time intervals before an ICP crisis. Crisis and noncrisis events were identified from continuous time-series data and randomly split into 70% for training and 30% for testing, from a subset of 30 patients. Machine learning algorithms were trained to predict ICP crises, including light gradient boosting, extreme gradient boosting, and random forest. Accuracy and area under the receiver operating characteristic curve (AUC) were measured to compare performance. The most predictive algorithm was optimized using feature selection and hyperparameter tuning to avoid overfitting, and then tested on a validation subset of 5 patients. Precision, recall, F1 score, and accuracy were measured.
    Results: The random forest model demonstrated the highest accuracy (range 0.82-0.88) and AUC (range 0.86-0.88) across all four data sets. Further validation testing revealed high precision (0.76), relatively low recall (0.46), and overall strong predictive performance (F1 score 0.57, accuracy 0.86) for ICP crises. Decision curve analysis showed that the model provided net benefit at probability thresholds above 0.1 and below 0.9.
    Conclusions: The presented model can provide accurate and timely forecasts of ICP crises in patients with severe TBI 10-20 minutes prior to their occurrence. If validated and implemented in clinical workflows, this algorithm can enable earlier intervention for ICP crises, more effective treatment of intracranial hypertension, and potentially improved outcomes following severe TBI.
    MeSH term(s) Humans ; Retrospective Studies ; Intracranial Pressure ; Brain Injuries, Traumatic/complications ; Algorithms ; Intracranial Hypertension/etiology ; Intracranial Hypertension/complications
    Language English
    Publishing date 2023-01-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2022.12.JNS221860
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  8. Article ; Online: The Device for Intraventricular Entry guide: a novel solution to a perpetual problem.

    Spadola, Michael / Muhammad, Najib / Ajmera, Sonia / Jabarkheel, Rashad / Tomlinson, Samuel / Miranda, Stephen P / Grady, M Sean / Schuster, James / Blue, Rachel

    Journal of neurosurgery

    2023  Volume 140, Issue 5, Page(s) 1501–1506

    Abstract: Objective: The authors designed a low-profile device for reliable ventricular access and prospectively studied its safety, efficacy, and accuracy at a large academic center.: Methods: A novel device for ventricular entry, the Device for ... ...

    Abstract Objective: The authors designed a low-profile device for reliable ventricular access and prospectively studied its safety, efficacy, and accuracy at a large academic center.
    Methods: A novel device for ventricular entry, the Device for Intraventricular Entry (DIVE) guide, was designed and created by the first and senior authors. Fifty patients undergoing external ventricular drainage (EVD) or shunt placement were prospectively enrolled for DIVE-assisted catheter placement at a single academic center. The primary outcome was the catheter tip location on postprocedural CT. Secondary outcomes included number of catheter passes, clinically significant hemorrhages, and procedure-related infections.
    Results: Fifty patients were enrolled. Indications included subarachnoid hemorrhage, intraventricular hemorrhage, traumatic brain injury, hydrocephalus, pseudotumor, and postsurgical wound drainage. In total, 76% (38/50) of patients underwent right-sided placement and 24% (12/50) underwent left-sided placement. All 100% (50/50) of patients had successful cannulation with an average of 1.06 passes. Postprocedural head CT confirmed ipsilateral frontal horn or third ventricle placement (Kakarla grade 1) in 92% (46/50) of patients and placement in the contralateral lateral ventricle in 8% (4/50) (Kakarla grade 2). There were no clinically significant track hemorrhages or procedural infections.
    Conclusions: This single-center prospective study investigated the safety and efficacy of DIVE-assisted ventricular access. In total, 100% of procedures had successful ventricular cannulation, with 92% achieving Kakarla grade 1, with an average of 1.06 passes without any clinical complications.
    MeSH term(s) Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Adult ; Cerebral Ventricles/surgery ; Cerebral Ventricles/diagnostic imaging ; Hydrocephalus/surgery ; Ventriculostomy/methods ; Drainage/instrumentation ; Drainage/methods ; Cerebrospinal Fluid Shunts/instrumentation ; Cerebrospinal Fluid Shunts/methods ; Young Adult ; Equipment Design ; Tomography, X-Ray Computed ; Catheterization/methods ; Brain Injuries, Traumatic/surgery
    Language English
    Publishing date 2023-11-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2023.8.JNS23693
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  9. Article ; Online: Should I See You Again Soon? A Multispecialty Assessment of the Impact and Burden of Preoperative History and Physical Update Visits.

    Soegaard Ballester, Jacqueline M / Ginzberg, Sara P / Finn, Caitlin B / Passman, Jesse / Miranda, Stephen P / Blue, Rachel / Stein, Jacob / Mahmoud, Najjia N / Kelz, Rachel R / Wachtel, Heather

    Journal of the American College of Surgeons

    2024  

    Abstract: Background: Federal regulations require a history and physical (H&P) update performed ≤30 days before a planned procedure. We evaluated the utility and burdens of H&P update visits by determining impact on operative management, suitability for ... ...

    Abstract Background: Federal regulations require a history and physical (H&P) update performed ≤30 days before a planned procedure. We evaluated the utility and burdens of H&P update visits by determining impact on operative management, suitability for telehealth, and visit time and travel burden.
    Study design: We identified H&P update visits performed in our health system during 2019 for 8 surgical specialties. As available, up to 50 visits per specialty were randomly selected. Primary outcomes were a) interval changes in history, exam, or operative plan between the initial and updated H&P notes and b) visit suitability for telehealth, as determined by two independent physician reviewers. Clinic time was captured, and round-trip driving time and distance between patients' home and clinic ZIP codes were estimated.
    Results: We identified 8,683 visits and 362 were randomly selected for review. Documented changes were most commonly identified in histories (60.8%), but rarely in physical exams (11.9%) and operative plans (11.6%). 99.2% of visits were considered suitable for telehealth. Median clinic time was 52 minutes (IQR:33.8-78), driving time was 55.6 minutes (IQR:35.5-85.5), and driving distance was 20.2 miles (IQR:8.5-38.4). At the health system level, patients spent an estimated aggregate 7,000 hours (including 4,046 hours of waiting room and travel time) and drove 142,273 miles to attend in-person H&P update visits in 2019.
    Conclusion: Given their minimal impact on operative management, regulatory requirements for in-person H&P updates should be reconsidered. Flexibility in update timing and modality might help defray the substantial burdens these visits impose on patients.
    Language English
    Publishing date 2024-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000001068
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  10. Article ; Conference proceedings: Red Pill or Blue Pill: Assessing Health Utilities Using the Standard Gamble among Patients with Trigeminal Neuralgia

    Ajmera, Sonia / Miranda, Stephen P. / Blue, Rachel / Romeo, Dominic / Ramayya, Ashwin / Lee, John

    Journal of Neurological Surgery Part B: Skull Base

    2023  Volume 84, Issue S 01

    Event/congress 32nd Annual Meeting North American Skull Base Society, JW Marriott Tampa Water Street, Tampa, Florida, United States, 2023-02-17
    Language English
    Publishing date 2023-02-01
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article ; Conference proceedings
    ZDB-ID 2654269-9
    ISSN 2193-634X ; 2193-6331
    ISSN (online) 2193-634X
    ISSN 2193-6331
    DOI 10.1055/s-0043-1762190
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