David N. van der Goes
University of New Mexico
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Featured researches published by David N. van der Goes.
Pain | 2015
Kevin E. Vowles; Mindy L. McEntee; Peter Siyahhan Julnes; Tessa Frohe; John P. Ney; David N. van der Goes
Abstract Opioid use in chronic pain treatment is complex, as patients may derive both benefit and harm. Identification of individuals currently using opioids in a problematic way is important given the substantial recent increases in prescription rates and consequent increases in morbidity and mortality. The present review provides updated and expanded information regarding rates of problematic opioid use in chronic pain. Because previous reviews have indicated substantial variability in this literature, several steps were taken to enhance precision and utility. First, problematic use was coded using explicitly defined terms, referring to different patterns of use (ie, misuse, abuse, and addiction). Second, average prevalence rates were calculated and weighted by sample size and study quality. Third, the influence of differences in study methodology was examined. In total, data from 38 studies were included. Rates of problematic use were quite broad, ranging from <1% to 81% across studies. Across most calculations, rates of misuse averaged between 21% and 29% (range, 95% confidence interval [CI]: 13%-38%). Rates of addiction averaged between 8% and 12% (range, 95% CI: 3%-17%). Abuse was reported in only a single study. Only 1 difference emerged when study methods were examined, where rates of addiction were lower in studies that identified prevalence assessment as a primary, rather than secondary, objective. Although significant variability remains in this literature, this review provides guidance regarding possible average rates of opioid misuse and addiction and also highlights areas in need of further clarification.
Neurology | 2013
John P. Ney; David N. van der Goes; Marc R. Nuwer; Lonnie A. Nelson; Matthew Eccher
Objectives: To evaluate the effect of intensive care unit continuous EEG (cEEG) monitoring on inpatient mortality, hospital charges, and length of stay. Methods: A retrospective cross-sectional study was conducted using the Nationwide Inpatient Sample, a dataset representing 20% of inpatient discharges in nonfederal US hospitals. Adult discharge records reporting mechanical ventilation and EEG (routine EEG or cEEG) were included. cEEG was compared with routine EEG alone in association with the primary outcome of in-hospital mortality and secondary outcomes of total hospital charges and length of stay. Demographics, hospital characteristics, and medical comorbidity were used for multivariate adjustments of the primary and secondary outcomes. Results: A total of 40,945 patient discharges in the weighted sample met inclusion criteria, of which 5,949 had reported cEEG. Mechanically ventilated patients receiving cEEG were younger than routine EEG patients (56 vs 61 years; p < 0.001). There was no difference in the 2 groups in income or medical comorbidities. cEEG was significantly associated with lower in-hospital mortality in both univariate (odds ratio = 0.54, 95% confidence interval 0.45–0.64; p < 0.001) and multivariate (odds ratio = 0.63, 95% confidence interval 0.51–0.76; p < 0.001) analyses. There was no significant difference in costs or length of stay for patients who received cEEG relative to those receiving only routine EEG. Sensitivity analysis showed that adjusting for diagnosis-related groups (DRGs) for any neurologic diagnoses, DRGs for neurologic procedures, and specific DRGs for epilepsy/convulsions did not substantially alter the association of cEEG with reduced inpatient mortality. Conclusions: cEEG is favorably associated with inpatient survival in mechanically ventilated patients, without adding significant charges to the hospital stay.
Clinical Neurophysiology | 2012
John P. Ney; David N. van der Goes; Jonathan H. Watanabe
highlights Cost-effectiveness modeling of multimodal intraoperative neurophysiologic monitoring (IONM) for spinal surgery relies on assumptions based on pooled results of uncontrolled observational studies, with uncertainty evaluated through probabilistic sensitivity analysis of Monte Carlo simulation results. Multimodal IONM reduces the relative risk of post-operative neurological complications by an estimated 49.4% (p < 0.001) at a cost of
Neurology | 2015
John P. Ney; David N. van der Goes; Marc R. Nuwer
63,387 (95%CI
American Journal of Public Health | 2014
Donald L. Chi; David N. van der Goes; John P. Ney
61,939–
Journal of Clinical Neurophysiology | 2014
John P. Ney; David N. van der Goes
64,836) per neurological deficit averted. 2012 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology. The use of evoked potentials (EPs) and electromyograms (EMGs) in the operating room has increased in popularity over the past several decades, beginning with brainstem auditory EPs for acoustic neuroma resections to the most common usage today, neck and back surgeries. Intraoperative neurophysiologic monitoring (IONM) holds the promise of prevention of neurological complications by detecting evolving abnormalities and alerting the operating team to take actions to normalize the electrodiagnostic abnormality, including repositioning the patient, taking a different surgical approach, adjusting anesthesia, giving blood pressure support or waking the patient. By monitoring motor and somatosensory EPs with free run and triggered EMG, multimodal IONM may have greater diagnostic sensitivity than any single modality. However, the evidence for efficacy of IONM in spinal surgeries is scant, as seen in a recent systematic review (Fehlings et al., 2010), which concluded that IONM may be more helpful for complicated surgeries and recommended usage based on the discretion of the operating surgeon. Furthermore, multimodal IONM adds cost to already expensive procedures (average US cost of spinal fusion in 2007 was
Journal of Medical Economics | 2018
David N. van der Goes; Richard Santos
24,600 (Elixhauser and Andrews, 2010)). The value of IONM in spinal procedures is in the avoidance of neurological deficits, based on IONM diagnostic characteristics, likelihood of preventing a post-operative injury following an IONM alert, and the baseline (a priori) rate of neurological complications from a given spinal operation. We created an economic decision model which incorporates the available evidence for these parameters. To account for uncertainty inherent in observational, nonrandomized data, the diagnostic characteristics of IONM and neurological complication rates for the eleven studies using multimodal IONM in spinal surgeries identified by Fehlings et al. (n = 2162) were pooled in a random effects meta-analysis to give estimates of average effect size and standard errors. This yielded a 5.0% baseline neurological complication rate for spinal surgeries (95% CI, 3.0– 7.0%), 94.3% sensitivity (95% CI, 92.3–96.3%) and 95.6% specificity (95% CI, 93.3–97.4%). The rate of prevention of post-operative deficits given an IONM alert has only been evaluated in a single study (Wiedemayer et al., 2002), which reported a 52.4% prevention rate (95%CI 37.3–67.3%) when actions were taken subsequent to IONM alerts compared to no actions taken. The per-operation cost of multimodal IONM for four-limb EMG, upper and lower extremity motor and somatosensory EPs and continuous IONM was calculated from 2009 Medicare reimbursement rates (national rating, global fee) for corresponding Current Procedure Terminology codes totaled
Journal of Medical Economics | 2018
Justin Whetten; David N. van der Goes; Huy Tran; Maurice L. Moffett; Colin Semper; Howard Yonas
1535. The cost-effectiveness outcome was the cost per undesirable consequence avoided, calculated as the mean expense of IONM divided by the difference in post-operative neurological deficit rates in spinal surgeries using IONM compared with those not using IONM. In the IONM usage arm of the model, the likelihood of preventing a neurological deficit is the baseline risk of neurological deficit for the surgery X diagnostic sensitivity of IONM X probability of prevention of neurological deficit given an IONM alert, where the post-operative neurological deficit rate in the non-IONM arm is equal to the baseline risk of neurological complications for the surgery. To incorporate uncertainty, we conducted a probabilistic sensitivity analysis (PSA) with Monte Carlo simulation. Probability
Neurology | 2012
John P. Ney; Marc R. Nuwer; Anup D. Patel; Eva K. Ritzl; Ronald G. Emerson; Stanley A. Skinner; Gary S. Gronseth; David N. van der Goes; Robert Minahan; Alan D. Legatt; Gloria M. Galloway; Jamie Lopez; Thoru Yamada; David Rippe
Objectives: To determine associations between intraoperative neurophysiologic monitoring (IOM) for spinal decompressions and simple fusions with neurologic complications, length of stay, and hospitalization charges. Methods: Adult discharges in the Nationwide/National Inpatient Sample (NIS) (2007–2012) with spinal decompressions and simple spinal fusions were included. Revision surgeries, instrumentations, complicated approaches, and tumor- and trauma-related surgeries were excluded. Extracted data included patient demographics, medical comorbidities, primary spinal surgery type, and hospital characteristics. Bivariate and multiple regression analyses using NIS survey design variables correlated IOM use with neurologic complications, hospital charges, and length of stay. Results: IOM was reported in 4.9% of an estimated 1.1 million discharges in the weighted sample. Discharges reporting IOM were more often privately insured (61% vs 57%, p < 0.001) and had slightly more comorbidities (25% vs 24% with 3+ comorbidities, p = 0.01). Spinal fusions more often reported IOM than decompressions. The IOM group had fewer neurologic complications (0.8% vs 1.4% of controls) with no difference in length of stay (3.0 days for each group), but increased hospital charges (39% greater). Multiple regression adjustment showed significant associations of IOM with fewer neurologic complications (odds ratio 0.60, 95% confidence interval [CI] 0.47, 0.76, p < 0.001), while the estimated percentage of hospital charges was sizably diminished from the unadjusted analysis (IOM effect +9%, 95% CI +4%, +13%, p < 0.001), and length of stay was reduced (IOM effect −0.26 days, 95% CI −0.42, −0.11, p < 0.001). Conclusions: IOM was associated with better clinical outcomes and some increased hospital charges among discharges of simple spinal fusions and laminectomies in a large, multiyear, nationally representative dataset.
Journal of Neurosurgery | 2013
John P. Ney; David N. van der Goes
OBJECTIVES We compared the incremental cost-effectiveness of 2 primary molar sealant strategies-always seal and never seal-with standard care for Medicaid-enrolled children. METHODS We used Iowa Medicaid claims data (2008-2011), developed a tooth-level Markov model for 10 000 teeth, and compared costs, treatment avoided, and incremental cost per treatment avoided for the 2 sealant strategies with standard care. RESULTS In 10 000 simulated teeth, standard care cost