Prediction of Lumbar Disc Herniation Patients' Satisfaction with the Aid of an Artificial Neural Network.

AIM: To identify key determinants of lumbar disc herniation (LDH) patients' satisfaction and to evaluate the efficiency of an artificial neural network (ANN) model to prognosticate satisfaction derived from the hospital stay in this specific patient group. MATERIAL AND METHODS: A single item question was used to assess patient satisfaction. Principal component analysis evaluated several aspects of care (15 items). An ANN encompassed all variables and its prediction ability was tested. The ANN performance was correlated to a binary logistic regression (BLR) model. RESULTS: Higher levels of satisfaction were reported by females, older patients, Greeks, and patients with elementary education staying in not rural areas. A history of a single previous hospitalisation was correlated with more satisfaction. The accuracy of ANN was 96% for satisfaction prediction outperforming the BLR model. CONCLUSION: Satisfactory health services are influenced by sex, age, nationality, and number of prior admissions. The self-perceived health state plays also a crucial role. The current study is the first one reporting on the capability of an ANN to accurately predict the satisfaction levels of LDH patients.

An atypical meningioma demystified and advanced magnetic resonance imaging techniques.

A 40-year-old male presented with visuospatial processing disturbances. Family history was free. Conventional and advanced magnetic resonance imaging (MRI) studies were performed. On T2 and fluid attenuation inversion recovery images, an increased signal intensity extra-axial lesion was demonstrated. Post-contrast scans depicted homogeneous intense contrast medium enhancement. T2* star sequence was negative for hemorrhagic or calcification foci. Diffusion-weighted imaging findings were indicative of malignant behavior and magnetic resonance venography confirmed superior sagittal sinus infiltration. Increased cerebral blood volume values were observed and peri-lesional oedema on perfusion-weighted imaging was also demonstrated. The signal intensity-time curve depicted the characteristic meningioma pattern. Spectroscopy showed increased choline and alanine levels, but decreased N-acetyl-aspartate levels. Conventional MRI is adequate for typical types of meningiomas. However, the more atypical ones, in which even the histopathologic specimen may demonstrate characteristics of typical meningioma, could be easier diagnosed with advanced MRI techniques.

Organizational issues in stroke treatment: The Swiss paradigm - Stroke units.

Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

Virtual reality implementation in neurosurgical practice: the "can't take my eyes off you" effect.

During the last few years, virtual reality (VR) has been increasingly implemented in the neurosurgical practice. The scope of this paper is to briefly outline the educational role of this novel technology in training surgeons. At the same time, the ability of VR workstations such as the Dextroscope® to consistently simulate the surgical trajectory to the lesion-target is highlighted. The authors shed light to the current applications of VR systems in the neurosurgical field by describing not only the advantages of those systems, but their principal drawbacks as well. It seems that VR has come to stay and it is already the new best friend of residents due to its "Can't take my eyes off you effect".

Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new: technical note and preliminary results.

AIM: Conventional ventricular catheters have proven to be ineffective in the drainage of the cerebrospinal fluid in the long run in terms of infection rates. Consequently, the development and clinical evaluation of new catheters is urgently needed. MATERIAL AND METHODS: We implanted a ventricular needle made of stainless steel in 3 neurosurgical patients in whom multiple conventional (silicon) ventricular catheters had been previously implanted. All of them developed persistent ventriculitis during the first 30 days post-admission. The infection did not respond to antibiotics neither intravenously nor intrathecally via conventional catheters. After the implantation of the needle, colistin mesilate sodium was administered (150,000 IU/day for 21 days) intrathecally, cerebrospinal fluid white blood cells were measured and cerebrospinal fluid cultures were obtained. RESULTS: Within 15 days after the implantation of the metal catheter, a significant decrease of the cerebrospinal fluid white blood cell count was noted and all cultures were negative. No operation related complications were observed. CONCLUSION: Our technique of a metal catheter implantation is safe and requires fewer reoperations. Moreover, it is cost-effective since metal catheters can be used for longer periods of time, can be reused in other patients, and are of low cost.

Giuseppe Gradenigo: Much more than a syndrome! Historical vignette.

BACKGROUND: Giuseppe Gradenigo (1859-1926), a legendary figure of Otology, was born in Venice, Italy. He soon became a pupil to Adam Politzer and Samuel Leopold Schenk in Vienna, demonstrating genuine interest in the embryology, morphology, physiopathology, as well as the clinical manifestations of ear diseases. In this paper, the authors attempt to highlight the major landmarks during Gradenigo's career and outline his contributions to neurosciences, which have been viewed as looking forward to the 20(th) century rather than awkward missteps at the end of the 19(th). METHODS: Several rare photographs along with many non-English, more than a century old articles have been meticulously selected to enrich this historical journey in time. RESULTS: It was after Gradenigo that the well-known syndrome consisting of diplopia and facial pain due to a middle ear infection was named. However, Gradenigo was much more than a syndrome. Surprisingly, despite the fact that he is considered a pioneer of the Italian Otology of the late 19(th) and early 20(th) century, little is written of his life and his notable achievements in the English literature. CONCLUSIONS: Even though his name lives on nowadays only in the eponym "Gradenigo's syndrome," his accomplishments are much wider and cast him among the emblematic figures of science. His inherent tendency for discovering the underlying mechanisms of diseases and his vision of guaranteeing quality of services, professional proficiency, respect, and dedication toward the patients is in fact what constitutes his true legacy to the next generations.

Patient satisfaction questionnaire and quality achievement in hospital care: the case of a Greek public university hospital.

The scope of this research has been to investigate the satisfaction of Greek patients hospitalized in a tertiary care university public hospital in Alexandroupolis, Greece, in order to improve medical, nursing and organizational/administrative services. It is a cross-sectional study involving 200 patients hospitalized for at least 24 h. We administered a satisfaction questionnaire previously approved by the Greek Health Ministry. Four aspects of satisfaction were employed (medical, hotel facilities/organizational, nursing, global). Using principal component analysis, summated scales were formed and tested for internal consistency with the aid of Cronbach's alpha coefficient. The non-parametric Spearman rank correlation coefficient was also used. The results reveal a relatively high degree of global satisfaction (75.125%), yet satisfaction is higher for the medical (89.721%) and nursing (86.432%) services. Moreover, satisfaction derived from the hotel facilities and the general organization was found to be more limited (76.536%). Statistically significant differences in participant satisfaction were observed (depending on age, gender, citizenship, education, number of previous admissions and self-assessment of health status at the first and last day of patients' stay) for the medical, nursing and hotel facilities/organizational dimension, but not for global satisfaction. The present study confirms the results of previously published Greek surveys.