Nitin Agarwal, MD

1) Video Integration for Surgical Improvement of Outcomes after Neurosurgery (VISION) 

Neurosurgical residents develop their skills through active, experiential learning that is followed by reflection and analysis. Although trainees are involved in the operating room, there are limited opportunities for self-assessment of their technical skills. Inspired by instant replay systems used in sports, a video feedback system will serve as a debriefing tool for residents following hands-on surgical training in the operating room. 

Through this innovative project, digital video editing, analysis, and playback software will be developed with such features as motion instant replay, coaching highlight tools, and event data logging. The goal is to increase the surgical skills and decrease any technical errors of trainees, which may ultimately improve patient outcomes. 

Outcomes also will be measured to evaluate usefulness, number of staff takeovers during the procedure, time commitment of participants, patient comprehension, and patient satisfaction. 

2) Defining the Severity of Perioperative Spinal Cord Injury: A Pilot Study to Establish Serum and Cerebrospinal Fluid Biomarkers 

This pilot study seeks to establish serum and cerebrospinal fluid biomarkers that may be reliably associated and utilized to track perioperative spinal cord injury. 

3) Efficacy of Intraoperative Trans-cranial Motor Evoked Potential (MEP) Recordings for Reducing Lumbar Plexopathy in L4-5 Extreme Lateral Lumbar Interbody Fusion (XLIF) 

This research project was designed with the intention to evaluate the efficacy of intraoperative trans-cranial motor evoked potential (MEP) recordings for reducing lumbar plexopathy in L4/5 eXtreme Lateral lumbar Interbody Fusion (XLIF). 

4) Treatment of Alzheimer’s Disease Utilizing Lumbar-Peritoneal Shunts: A Pilot Study to Assess Cerebrospinal Fluid Biomarkers along the Rostral-Caudal Concentration Gradient 

This research endeavor seeks to establish a rostral-caudal concentration gradient for cerebrospinal fluid biomarkers. Identification of this gradient with markers associated with Alzheimer’s disease will be utilized to establish a precedent to justify to the utilization of lumbar-peritoneal shunts as a therapeutic intervention for Alzheimer’s Disease. 

5) Assessment of Patient Comprehension to Improve Health Outcomes 

Informed consent is a critical part of patient care, but patients often do not understand the health care information presented to them. Patients frequently turn to the internet to get information from professional medical websites, but the readability of patient education resources often exceeds the reading ability of the average American adult. This disconnect can negatively impact patient understanding, leading to poor health outcomes and unnecessary hospital readmission. 

This project was designed to improve the readability and accessibility of UPMC patient education materials so patients can participate in shared decision making with a better understanding of disease processes and necessary treatments, and ability to follow physician instructions. It also aspired to identify the best way to educate patients about specific diseases and then create a teaching protocol for physicians to follow. 

Through this project, UPMC patient education materials were analyzed and patients assessed to determine their level of understanding of literature regarding their diagnosis, treatment, and prognosis. Patient ratings for accessibility, reliability, and usability of selected patient resources were obtained as a benchmark using several website quality assessment tools. During the next phase of the project, patients will be followed at scheduled clinical visits and reassessed to determine their level of understanding of their disease and how it impacts their health. Patient outcomes will be evaluated and followed over a period of three years. 

Information gathered from the analysis and evaluation were published in the Journal of Neurosurgery and in Dr. Agarwal’s 2016 book—co-authored with David R. Hansberry, MD, PhD, and Arpan Vaikunth—The Evolution of Health Literacy: Empowering Patients through Improved Education. 

Given the immediate impact revision of patient education materials may have on outcomes, the investigators hope to rapidly share and implement the project’s findings throughout the UPMC network. Ultimately, the investigators strive to create a national database for all disease conditions, providing patients access to accurate information pertaining to their health care needs.