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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

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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Article ; Online: Anticoagulation Holiday: Resumption of Direct Oral Anticoagulants for Atrial Fibrillation in Patients with Index Traumatic Intracranial Hemorrhage.

Ghenbot, Yohannes / Arena, John D / Howard, Susanna / Wathen, Connor / Kumar, Monisha A / Schuster, James M

World neurosurgery: X

2022 Volume 17, Page(s) 100148

Abstract: Background: The optimal time to restart direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) after traumatic intracranial hemorrhage (tICH) is unknown. Physicians must weigh the risk of recurrent hemorrhage against ischemic ... ...

Abstract	Background: The optimal time to restart direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) after traumatic intracranial hemorrhage (tICH) is unknown. Physicians must weigh the risk of recurrent hemorrhage against ischemic stroke. We investigated rates of stroke while holding anticoagulation, hemorrhage after anticoagulation resumption, and factors associated with the decision to restart anticoagulation. Methods: Patients presenting to our level I trauma center for tICH while on a DOAC for NVAF were retrospectively reviewed over 2 years. Age, sex, DOAC use, antiplatelet use, congestive heart failure, hypertension, age, diabetes, previous stroke, vascular disease, sex score for stroke risk in NVAF, injury mechanism, bleeding pattern, Injury Severity Score, use of a reversal agent, Glasgow Coma Scale at 24 hours, hemorrhage expansion, neurosurgical intervention, Morse Fall Risk, DOAC restart date, rebleed events, and ischemic stroke were recorded to study rates of recurrent hemorrhage and stroke, and factors that influenced the decision to restart anticoagulation. Results: Twenty-eight patients sustained tICH while on a DOAC. Fall was the most common mechanism (89.3%), and subdural hematoma was the predominant bleeding pattern (60.7%). Of the 25 surviving patients, 16 patients (64%) restarted a DOAC a median 29.5 days after tICH. One patient had recurrent hemorrhage after resuming anticoagulation. One patient had an embolic stroke after 118 days off anticoagulation. Age >80, Injury Severity Score ≥16, and expansion of tICH influenced the decision to indefinitely hold anticoagulation. Conclusion: The low stroke rate observed in this study suggests that holding DOACs for NVAF for 1 month is sufficient to reduce the risk of stroke after tICH. Additional data are required to determine optimal restart timing.
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Journal Article
ISSN	2590-1397
ISSN (online)	2590-1397
DOI	10.1016/j.wnsx.2022.100148
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Article ; Online: Human Services and Behavioral Health Integration: A Model for Whole-Person Medicaid Managed Care.

Herschell, Amy D / Schuster, James M / Keyser, Donna J / Wasilchak, Deborah S / Neimark, Geoffrey B / Shaffer, Sherry L / Hurford, Matthew O

Psychiatric services (Washington, D.C.)

2023 Volume 74, Issue 9, Page(s) 996–1001

Abstract: A comprehensive, whole-person approach to individuals' health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania's managed Medicaid program, delegates responsibility for ... ...

Abstract	A comprehensive, whole-person approach to individuals' health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania's managed Medicaid program, delegates responsibility for Medicaid-funded behavioral health service management to individual counties or multicounty collaboratives. County administrators' programmatic and fiscal oversight of Medicaid-funded services allows them to create synergies between behavioral health and other human service delivery systems and to set priorities on the basis of local needs. This model supports access to community-based care, integration of general medical and behavioral health services, and programs that address social determinants of health.
MeSH term(s)	United States ; Humans ; Medicaid ; Managed Care Programs ; Mental Health Services ; Psychiatry ; Health Services Accessibility
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.20220478
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Article ; Online: Letter to the Editor: Pharmacogenomic testing is not ready for general use in psychiatry.

Severance, Alin J / Good, Chester B / Schuster, James M

Journal of psychiatric research

2019 Volume 114, Page(s) 210

MeSH term(s)	Depressive Disorder, Major ; Humans ; Pharmacogenetics ; Pharmacogenomic Testing ; Psychiatry ; Research Design
Language	English
Publishing date	2019-04-06
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2019.04.003
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Article ; Online: Racial disparities in short-term spinal fusion outcomes across 4263 consecutive patients.

Borja, Austin J / Gallagher, Ryan S / Karsalia, Ritesh / Chauhan, Daksh / Malhotra, Emelia G / Punchak, Maria A / Na, Jianbo / McClintock, Scott D / Schuster, James M / Malhotra, Neil R

Journal of neurosurgery. Spine

2024 , Page(s) 1–6

Abstract: Objective: Race plays a salient role in access to surgical care. However, few investigations have assessed the impact of race within surgical populations after care has been delivered. The objective of this study was to employ an exact matching protocol ...

Abstract	Objective: Race plays a salient role in access to surgical care. However, few investigations have assessed the impact of race within surgical populations after care has been delivered. The objective of this study was to employ an exact matching protocol to a homogenous population of spine surgery patients in order to isolate the relationships between race and short-term postoperative outcomes. Methods: In total, 4263 consecutive patients who underwent single-level, posterior-only lumbar fusion at a single multihospital academic medical center were retrospectively enrolled. Of these patients, 3406 patients self-identified as White and 857 patients self-identified as non-White. Outcomes were initially compared across all patients via logistic regression. Subsequently, White patients and non-White patients were exactly matched on the basis of key demographic and health characteristics (1520 matched patients). Outcome disparities were evaluated between the exact-matched cohorts. Primary outcomes were readmissions, emergency department (ED) visits, reoperations, mortality, intraoperative complications, and discharge disposition. Results: Before matching, non-White patients were less likely to be discharged home and more likely to be readmitted, evaluated in the ED, and undergo reoperation. After matching, non-White patients experienced higher rates of nonhome discharge, readmissions, and ED visits. Non-White patients did not have more surgical complications either before or after matching. Conclusions: Between otherwise similar cohorts of spinal fusion cases, non-White patients experienced unfavorable discharge disposition and higher risk of multiple adverse postoperative outcomes. However, these findings were not accounted for by differences in surgical complications, suggesting that structural factors underlie the observed disparities.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2023.12.SPINE23700
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Article ; Online: Case Series of Ultrasonic Navigated Osteotomy for the Treatment of Spinal Chordomas.

Detchou, Donald K / Glauser, Gregory / Dimentberg, Ryan / Schuster, James M / Malhotra, Neil R

World neurosurgery

2021 Volume 150, Page(s) e347–e352

Abstract: Background: Chordomas present challenges for en bloc surgical resection, which optimally reduces local recurrence and increases patient survival. Navigated ultrasonic osteotomy, also known as piezosurgery, provides a distinct advantage for achieving ... ...

Abstract	Background: Chordomas present challenges for en bloc surgical resection, which optimally reduces local recurrence and increases patient survival. Navigated ultrasonic osteotomy, also known as piezosurgery, provides a distinct advantage for achieving negative margins after en bloc resection. Methods: Eight consecutive patients with chordomas (2 cervical, 3 lumbar, and 3 sacral) treated with navigated ultrasonic osteotomy to achieve en bloc resection were identified from our institutional spine tumor database (2016-2019) and retrospectively reviewed. Results: En bloc resection, with negative margins, was achieved in all cases. Two patients (25%) were women, and mean age at surgery was 44 ± 11 years. Median estimated blood loss was 1000 mL (interquartile range: 263-1500 mL). Median length of hospital stay was 10 days (interquartile range: 3-19.5 days). Two patients required a revision procedure. Two patients had complications requiring readmission within the 30-day postoperative window. Mean duration of follow-up for the cohort was 900 ± 554 days. Conclusions: Navigated ultrasonic osteotomy is an effective surgical technique to achieve en bloc resection of chordomas with negative margins and disease-free survival. To date, this represents the first reported cohort of patients undergoing the procedure as described here. Future studies should include larger sample sizes for more robust clinical outcome data to further elucidate the benefits of piezosurgery for obtaining en bloc chordoma resection.
MeSH term(s)	Adult ; Blood Loss, Surgical ; Chordoma/diagnostic imaging ; Chordoma/surgery ; Cohort Studies ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Osteotomy/methods ; Reoperation ; Spinal Neoplasms/diagnostic imaging ; Spinal Neoplasms/surgery ; Surgery, Computer-Assisted/methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonics ; Ultrasonography
Language	English
Publishing date	2021-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.03.001
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Article ; Online: Behavioral Health Homes: The Authors Reply.

Schuster, James M / Reynolds, Charles F / Carney, Tracy

Health affairs (Project Hope)

2018 Volume 37, Issue 5, Page(s) 828

MeSH term(s)	Mental Health Services ; Patient-Centered Care
Language	English
Publishing date	2018-05-07
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2018.0365
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Article: A Prospective Phase I/II Clinical Trial of High-Dose Proton Therapy for Chordomas and Chondrosarcomas.

Dastgheyb, Sana S / Dreyfuss, Alexandra D / LaRiviere, Michael J / Mohiuddin, Jahan J / Baumann, Brian C / Shabason, Jacob / Lustig, Robert A / Dorsey, Jay F / Lin, Alexander / Grady, Sean M / O'Malley, Bert W / Lee, John Y K / Newman, Jason G / Schuster, James M / Alonso-Basanta, Michelle

Advances in radiation oncology

2024 Volume 9, Issue 5, Page(s) 101456

Abstract: Purpose: The purpose of this study was to evaluate the feasibility and safety of dose-escalated proton beam therapy for treating chordomas and chondrosarcomas of the skull base and spine. Methods: A prospective cohort of 54 patients (42 with chordomas ... ...

Abstract	Purpose: The purpose of this study was to evaluate the feasibility and safety of dose-escalated proton beam therapy for treating chordomas and chondrosarcomas of the skull base and spine. Methods: A prospective cohort of 54 patients (42 with chordomas and 12 with chondrosarcomas) was enrolled between 2010 and 2018. The primary endpoints were feasibility and <20% rate of acute grade ≥3 toxicity, and secondary endpoints included cancer-specific outcomes and toxicities. Patients were followed with magnetic resonance imaging or computed tomography at 3-month intervals. Proton beam therapy was delivered with doses up to 79.2 Gy using protons only, combination protons/intensity modulated radiation therapy (IMRT), or IMRT only. Results: Feasibility endpoints were met, with only 2 out of 54 patient radiation therapy plans failing to meet dosimetric constraints with protons, and 4 out of 54 experiencing a delay or treatment break >5 days, none for toxicities related to treatment. There were no grade 4 acute toxicities and 1 grade 3 acute toxicity (sensory neuropathy). The only 2 grade 3 late toxicities recorded, osteoradionecrosis and intranasal carotid blowout (mild and not emergently treated), occurred in a single patient. We report overall survival as 83% at 5 years, with local failure-free survival and progression-free survival rates of 72% and 68%, respectively. Five patients developed distant disease, and among the 9/54 patients who died, 4 deaths were not attributed to treatment or recurrence. Conclusions: Our findings suggest that high-dose proton therapy alone or in combination with IMRT is a safe and effective treatment option for chordomas and chondrosarcomas of the skull base and spine.
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2024.101456
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Article ; Online: Increased likelihood of psychiatric readmission with Medicaid expansion vs legacy coverage.

Hutchison, Shari L / Karpov, Irina O / Herschell, Amy D / Wasilchak, Deborah S / Hurford, Matthew O / Schuster, James M

The American journal of managed care

2021 Volume 27, Issue 11, Page(s) 488–492

Abstract: Objectives: To compare patterns of psychiatric hospitalization and readmission within 30 days for Medicaid expansion (expansion) vs previously insured (legacy) samples.: Study design: Retrospective analysis using Medicaid behavioral health service ... ...

Abstract	Objectives: To compare patterns of psychiatric hospitalization and readmission within 30 days for Medicaid expansion (expansion) vs previously insured (legacy) samples. Study design: Retrospective analysis using Medicaid behavioral health service claims. Methods: We identified 24,044 individuals with hospitalizations in calendar years 2017 and 2018 within the network of a behavioral health managed care organization in Pennsylvania. Logistic regression was used to examine factors associated with readmission. Results: Individuals covered under expansion (n = 7747) vs legacy (n = 16,297) were older and more likely to be male and European American, with higher rates of cooccurring mental health (MH) and substance use disorder (SUD) diagnoses, as well as lower rates of MH and SUD services in the 30 days prior and any prior MH hospitalization. A higher proportion of individuals with expansion vs legacy status were readmitted (11.3% vs 9.0%; P < .0001). Controlling for factors associated with readmission, regression showed an increased likelihood of readmission for expansion vs legacy status (adjusted odds ratio [AOR], 1.23; 95% CI, 1.12-1.35; P < .0001). Increased risk for readmission was also found across populations for male patients (AOR, 1.12; 95% CI, 1.02-1.22; P = .0124), those with prior MH hospitalizations (AOR, 1.65; 95% CI, 1.51-1.81; P < .0001) or other behavioral health services (AOR, 1.14; 95% CI, 1.03-1.26; P = .0142), those with longer hospitalization episodes (AOR, 1.01; 95% CI, 1.00-1.01; P < .0001), and those with cooccurring SUD (AOR, 1.58; 95% CI, 1.44-1.74; P < .0001). Conclusions: Individuals with coverage through Medicaid expansion compared with legacy coverage have an increased risk of psychiatric readmission and may warrant targeted interventions that also address service utilization and cooccurring SUD.
MeSH term(s)	Female ; Hospitalization ; Humans ; Male ; Medicaid ; Patient Readmission ; Retrospective Studies ; Substance-Related Disorders ; United States
Language	English
Publishing date	2021-11-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2021.88776
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Zs.A 5353: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Use of the LACE+ index to predict readmissions after single-level lumbar fusion.

Borja, Austin J / Glauser, Gregory / Strouz, Krista / Ali, Zarina S / McClintock, Scott D / Schuster, James M / Yoon, Jang W / Malhotra, Neil R

Journal of neurosurgery. Spine

2021 Volume 36, Issue 5, Page(s) 722–730

Abstract: Objective: Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to ...

Abstract	Objective: Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to predict readmission but has not been tested in a large, homogeneous spinal fusion population. The present study evaluated use of the LACE+ score for outcome prediction after lumbar fusion. Methods: LACE+ scores were calculated for all patients (n = 1598) with complete information who underwent single-level, posterior-only lumbar fusion at a single university medical system. Logistic regression was performed to assess the ability of the LACE+ score as a continuous variable to predict hospital readmissions within 30 days (30D), 30-90 days (30-90D), and 90 days (90D) of the index operation. Secondary outcome measures included ED visits and reoperations. Subsequently, patients with LACE+ scores in the bottom decile were exact matched to the patients with scores in the top 4 deciles to control for sociodemographic and procedural variables. Results: Among all patients, increased LACE+ score significantly predicted higher rates of readmissions in the 30D (p < 0.001), 30-90D (p = 0.001), and 90D (p < 0.001) postoperative windows. LACE+ score also predicted risk of ED visits at all 3 time points and reoperations at 30-90D and 90D. When patients with LACE+ scores in the bottom decile were compared with patients with scores in the top 4 deciles, higher LACE+ score predicted higher risk of readmissions at 30D (p = 0.009) and 90D (p = 0.005). No significant difference in hospital readmissions was observed between the exact-matched cohorts. Conclusions: The present results suggest that the LACE+ score demonstrates utility in predicting readmissions within 30 and 90 days after single-level lumbar fusion. Future research is warranted that utilizes the LACE+ index to identify strategies to support high-risk patients in a prospective population.
Language	English
Publishing date	2021-12-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2021.9.SPINE21705
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