Predictive model for preoperative risk calculation of cerebrospinal fluid leak after resection of midline craniofacial mass lesions.

Background: Complex anterior skull base defects produced by resection of mass lesions vary in size and configuration and may be extensive. We analyzed the largest single-center series of midline craniofacial lesions extending intra- and extracranially. The study aims at the development of a predictive model for preoperative measurement of the risk of the postoperative cerebrospinal fluid (CSF) leak based on patients' characteristics and surgical plans. Methods: 166 male and 149 female patients with mean age 40,5 years (1 year and - 81 years) operated for benign and tumor-like midline craniofacial mass lesions were retrospectively analyzed using logistic regression method (Ridge regression algorithm was selected). The overall CSF leak rate was 9.6%. The ROSE algorithm and 'glmnet' software suite in R were used to overcome the cohort's disbalance and avoid overtraining the model. Results: The most influential modifiable negative predictor of the postoperative CSF leak was the use of extracranial and combined approaches. Use of transbasal approaches, gross total resection, utilization of one or two vascularized flaps for skull base reconstruction were the foremost modifiable predictors of a good outcome. Criterium of elevated risk was established at 50% with a specificity of the model as high as 0.83. Conclusions: The performed study has allowed for identifying the most significant predictors of postoperative CSF leak and developing an effective formula to estimate the risk of this complication using data known for each patient. We believe that the suggested web-based online calculator can be helpful for decision making support in off-pattern clinical situations.

On a seamless transition from a running EPR system to a new one.

An approach is proposed to provide the transition from a running EPR system to a new one seamlessly and transparent for users. The essence of the approach is to use an industrial integration platform to build a transition platform for smooth transition.

Diagnostic games: from adequate formalization of clinical experience to structure discovery.

A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

A sustainability view on the EPR system of N.N. Burdenko Neurosurgical Institute.

This paper aims at the analysis of the "sustainability status" of an electronic patient record system developed at the Medical Informatics Laboratory of the N. N. Burdenko Neurosurgical Institute (EPR/NSI). It includes some of the principles that allowed a small team of developers to create a sustainable EPR system for a large medical institution with complicated diagnostic and treatment processes.

Electronic patient record for N.N. Burdenko Neurosurgical Institute: on the road to paperless patient record.

The paper is devoted to one of a number of highways of medical informatics: a road from traditional paper patient record (PPR) to future paperless patient record (PLPR). This road runs via modem electronic patient record (EPR), usually blending together electronic and paper technologies of gathering, storing, retrieving, presentation and legalization of data. The following is based on the experience of modelling, engineering, deployment, support and evolution of electronic patient record for N.N. Burdenko neurosurgical institute. Three basic facets of the problem will be discussed: technological, psychological and legal.