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Shakir M, Irshad HA, Khowaja AH, Tahir I, Shariq SF, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Information Management for the Neurosurgical Care of Brain Tumors: A Scoping Review of Literature from Low- and Middle-Income Countries. World Neurosurg 2024; 190:208-217. [PMID: 39032639 DOI: 10.1016/j.wneu.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Health care in developing countries often lacks adequate bookkeeping and national cancer registries, means of information that have proven to impact disease research and care. The true burden of brain tumors therefore remains unchecked and so does the extent of the problem. Therefore, this study aims to explore the challenges and potential strategies related to information management of brain tumors in low- and middle-income countries (LMICs). METHODS A comprehensive literature search conducted using databases such as PubMed, Scopus, Google Scholar, and Cumulated Index in Nursing and Allied Health Literature, without any language restrictions, from inception to October 20, 2022. Following screening and extraction of data, themes were generated using the information management domain of the National Surgical, Obstetric, and Anesthesia Plan framework. RESULTS The final analysis includes 23 studies that highlighted the challenges to managing information to the surgical care given to brain tumors in LMICs, including lack of proper hospital record system (43%), lack of national brain tumor registry (67%), lack of local management guidelines (10%), and low research output (33%). Some of the proposed strategies in the literature to address these barriers include improving data management systems (45%), developing a population-based brain tumor registry (64%), and formulating local treatment guidelines (9%) for the management of brain tumors. CONCLUSIONS In LMICs, improving patient outcomes and quality of life postneurosurgical intervention for brain tumors requires coordinated efforts to enhance information systems. The support of the government and public health professionals is vital in implementing strategies to achieve this goal.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Center of Oncological Research in Surgery, Aga Khan University, Karachi, Pakistan.
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Klazura G, Wong LY, Ribeiro LLPA, Kojo Anyomih TT, Ooi RYK, Berhane Fissha A, Alam SF, Daudu D, Nyalundja AD, Beltrano J, Patil PP, Wafford QE, Rapolti DI, Sullivan GA, Graf A, Veras P, Nico E, Sheth M, Shing SR, Mathur P, Langer M. Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review. J Surg Res 2024; 299:163-171. [PMID: 38759332 DOI: 10.1016/j.jss.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.
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Affiliation(s)
- Greg Klazura
- University of Illinois at Chicago, Chicago, Illinois
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford Hospital, Stanford, California.
| | | | | | | | - Aemon Berhane Fissha
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Syeda Fatema Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
| | | | - Poorvaprabha P Patil
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Akua Graf
- University of Illinois at Chicago, Chicago, Illinois
| | - Perry Veras
- Loyola Stritch School of Medicine, Maywood, Illinois
| | - Elsa Nico
- University of Illinois at Chicago, Chicago, Illinois
| | - Monica Sheth
- Loyola Stritch School of Medicine, Oak Park, Illinois
| | - Samuel R Shing
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Priyanka Mathur
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Monica Langer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
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Shakir M, Khowaja AH, Shariq SF, Irshad HA, Tahir I, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Financing of Neurosurgical Care for Brain Tumors in Low- and Middle-Income Countries: A Scoping Review of Barriers and Strategies. World Neurosurg 2024:S1878-8750(24)01027-1. [PMID: 38901484 DOI: 10.1016/j.wneu.2024.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Making neurosurgical care accessible to a larger portion of the population in low- and middle-income countries (LMICs) is integral due to the high mortality and morbidity associated with brain tumors. However, the high cost of care often makes it financially out of reach for many individuals. Therefore, this review aims to identify barriers to neurosurgical care of brain tumors in terms of financing in LMICs. METHODS Without restriction to language, a search of the literature was undertaken in a number of databases, including PubMed, Scopus, Google Scholar, and CINAHL, in order to find the most pertinent research involving financing of brain tumors in LMICs. The last day of the search was October 20, 2022. Following screening and data extraction, significant themes were found and categorized using thematic analysis. RESULTS A total of 28 studies were analyzed in this review. The review highlighted some of the barriers to providing surgical care of brain tumors in LMICs. In the cited studies, surgical expenses (41%), neuroimaging costs (30%), and care-related expenses (33%) were the primary concerns. Addressing these challenges involves cross-border collaboration (23%), transparent financing systems (46%), awake craniotomy (15%), cost-effective/reusable intra-operative supplies (8%), and optimizing resources in healthcare systems (8%). CONCLUSIONS This study explored barriers and challenges to financing neurosurgical care of brain tumors in LMICs. Government support and transparency in healthcare financing should be prioritized to ensure that all individuals have access to surgical care of brain tumors.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Ali I Rae
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Kankam SB, Jalloh M, Osifalo O, Ndjamen P HF. Letter to the Editor: Exploring the Economic Implications of Neurosurgical Interventions in Low-to-Middle Income Healthcare Setting: A Correspondence. World Neurosurg 2024; 185:467-468. [PMID: 38741307 DOI: 10.1016/j.wneu.2024.02.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Harvard T.H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Mohamed Jalloh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Oluwafeyisola Osifalo
- Harvard T.H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Okon II, Akilimali A, Furqan M, Precious FK, Gbayisomore TJ, Atallah O, Erhayanmen MO, Christopher EC, Umutoni F, Nkeshimana M, Lucero-Prisno DE. Barriers to accessing neurosurgical care in low- and middle-income countries from Africa: editorial. Ann Med Surg (Lond) 2024; 86:1247-1248. [PMID: 38463130 PMCID: PMC10923368 DOI: 10.1097/ms9.0000000000001758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Inibehe I. Okon
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR Congo
- College of Medicine, University of Uyo, Akwa Ibom
| | - Aymar Akilimali
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR Congo
| | - Muhammad Furqan
- Faculty of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Tolulope J. Gbayisomore
- Data Intelligence and Innovation Unit, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | | | - Florence Umutoni
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR Congo
- Faculty of Medicine, University of Rwanda
| | - Menelas Nkeshimana
- Department of Health Workforce Development, Ministry of Health, Kigali, Rwanda
| | - Don E. Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Aderinto N. Letter: Building a Strong Neurosurgical Landscape in Africa: Leveraging Medical Students' Potential for Empowerment and Advancement. Neurosurgery 2023; 93:e144-e145. [PMID: 37695050 DOI: 10.1227/neu.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso , Nigeria
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Ferreira T, Awuah WA, Tan JK, Adebusoye FT, Ali SH, Bharadwaj HR, Aderinto N, Fernandes C, Zahid MJ, Abdul-Rahman T. The current landscape of intracranial aneurysms in Africa: management outcomes, challenges, and strategies-a narrative review. Neurosurg Rev 2023; 46:194. [PMID: 37548805 DOI: 10.1007/s10143-023-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa.
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Affiliation(s)
- Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
| | | | - Favour Tope Adebusoye
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine.
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | | | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
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8
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Mofatteh M, Mashayekhi MS, Arfaie S, Adeleye AO, Jolayemi EO, Ghomsi NC, Shlobin NA, Morsy AA, Esene IN, Laeke T, Awad AK, Labuschagne JJ, Ruan R, Abebe YN, Jabang JN, Okunlola AI, Barrie U, Lekuya HM, Idi Marcel E, Kabulo KDM, Bankole NDA, Edem IJ, Ikwuegbuenyi CA, Nguembu S, Zolo Y, Bernstein M. Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges. Neurosurgery 2023; 93:274-291. [PMID: 36961213 PMCID: PMC10319364 DOI: 10.1227/neu.0000000000002453] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Awake craniotomy (AC) is a common neurosurgical procedure for the resection of lesions in eloquent brain areas, which has the advantage of avoiding general anesthesia to reduce associated complications and costs. A significant resource limitation in low- and middle-income countries constrains the usage of AC. OBJECTIVE To review the published literature on AC in African countries, identify challenges, and propose pragmatic solutions by practicing neurosurgeons in Africa. METHODS We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review guidelines across 3 databases (PubMed, Scopus, and Web of Science). English articles investigating AC in Africa were included. RESULTS Nineteen studies consisting of 396 patients were included. Egypt was the most represented country with 8 studies (42.1%), followed by Nigeria with 6 records (31.6%). Glioma was the most common lesion type, corresponding to 120 of 396 patients (30.3%), followed by epilepsy in 71 patients (17.9%). Awake-awake-awake was the most common protocol used in 7 studies (36.8%). Sixteen studies (84.2%) contained adult patients. The youngest reported AC patient was 11 years old, whereas the oldest one was 92. Nine studies (47.4%) reported infrastructure limitations for performing AC, including the lack of funding, intraoperative monitoring equipment, imaging, medications, and limited human resources. CONCLUSION Despite many constraints, AC is being safely performed in low-resource settings. International collaborations among centers are a move forward, but adequate resources and management are essential to make AC an accessible procedure in many more African neurosurgical centers.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Saman Arfaie
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Nathalie C. Ghomsi
- Neurosurgery Department, Felix Houphouet Boigny Unversity Abidjan, Cote d’Ivoire
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ahmed A. Morsy
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | - Ignatius N. Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed K. Awad
- Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Jason J. Labuschagne
- Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Ruan
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Yared Nigusie Abebe
- Department of Neurosurgery, Haramaya University Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia
| | | | - Abiodun Idowu Okunlola
- Department of Surgery, Federal Teaching Hospital Ido Ekiti and Afe Babalola University, Ado Ekiti, Nigeria
| | - Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hervé Monka Lekuya
- Department of Neurosurgery, Makerere University/Mulago Hospital, Kampala, Uganda
| | - Ehanga Idi Marcel
- Department of Neurosurgery, College of Surgeons of East, Central and Southern Africa/Mulago Hospital, Kampala, Uganda
| | - Kantenga Dieu Merci Kabulo
- Department of Neurosurgery, Jason Sendwe General Provincial Hospital, Lubumbashi, Democratic Republic of the Congo
| | - Nourou Dine Adeniran Bankole
- Department of Neurosurgery, Hôpital Des Spécialités, WFNS Rabat Training Center For Young, African Neurosurgeons, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Idara J. Edem
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Stephane Nguembu
- Department of Neurosurgery, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Yvan Zolo
- Global Surgery Division, University of Cape Town, Cape Town, South Africa
| | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Maddy K, Michel M, Bryant JP, Niazi TN. Tiny Brains, Mighty Futures: Addressing Global Health Disparities in Pediatric Neurosurgery. World Neurosurg 2023:S1878-8750(23)00823-9. [PMID: 37419700 DOI: 10.1016/j.wneu.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Krisna Maddy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelot Michel
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Jean-Paul Bryant
- Department of Neurological Surgery, Georgetown University, Washington, District of Columbia, USA
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Health System, Miami, Florida, USA
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Paiva ALC, Vitorino-Araujo JL, Lovato RM, Costa GHFD, Veiga JCE. An economic study of neuro-oncological patients in a large developing country: a cost analysis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1149-1158. [PMID: 36577414 PMCID: PMC9797276 DOI: 10.1055/s-0042-1758649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuro-oncological patients require specialized medical care. However, the data on the costs incurred for such specialized care in developing countries are currently lacking. These data are relevant for international cooperation. OBJECTIVE The present study aimed to estimate the direct cost of specialized care for an adult neuro-oncological patient with meningioma or glioma during hospitalization in the largest philanthropic hospital in Latin America. METHODS The present observational economic analysis describes the direct cost of care of neuro-oncological patients in Santa Casa de São Paulo, Brazil. Only adult patients with a common primary brain tumor were included. RESULTS Due to differences in the system records, the period analyzed for cost estimation was between December 2016 and December 2019. A group of patients with meningiomas and gliomas was analyzed. The estimated mean cost of neurosurgical hospitalization was US$4,166. The cost of the operating room and intensive care unit represented the largest proportion of the total cost. A total of 17.5% of patients had some type of infection, and 66.67% of these occurred in nonelective procedures. The mortality rate was 12.7% and 92.3% of all deaths occurred in emergency procedures. CONCLUSIONS Emergency surgeries were associated with an increased rate of infections and mortality. The findings of the present study could be used by policymakers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.
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Affiliation(s)
- Aline Lariessy Campos Paiva
- Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo SP, Brazil.,Hospital do Coração, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Neurosurgery Department, São Paulo SP, Brazil.,Address for correspondence Aline Lariessy Campos Paiva
| | - João Luiz Vitorino-Araujo
- Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo SP, Brazil.,Hospital do Coração, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Neurosurgery Department, São Paulo SP, Brazil.
| | - Renan Maximilian Lovato
- Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo SP, Brazil.,Hospital do Coração, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Neurosurgery Department, São Paulo SP, Brazil.
| | | | - José Carlos Esteves Veiga
- Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Neurosurgery Department, São Paulo SP, Brazil.
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11
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Assessing the Cost Burden of Pediatric Neurosurgery in Kaduna, Nigeria. World Neurosurg 2021; 152:e708-e712. [PMID: 34129976 DOI: 10.1016/j.wneu.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few studies have evaluated the cost burden borne by neurosurgical patients in the developing world and their potential implications for efficient and effective delivery of care. This study aims to assess the cost associated with obtaining pediatric neurosurgical care in a hospital in Kaduna. METHODS All patients younger than 15 years who had a neurosurgical operation from July to December 2019 were included in the study. The characteristics of the patients were obtained using a proforma while the cost data were retrieved from the accounts unit of the hospital. The direct cost was obtained from the billing records of the hospital. Indirect cost was obtained using a questionnaire. The data obtained were analyzed using SPSS version 25 for Windows. RESULTS A total of 27 patients were included in the study with a mean age of 7.2 years and a standard deviation of 4.95 years. The 2 most common procedures done were craniotomy for trauma and ventriculoperitoneal shunt insertion for hydrocephalus. The mean total cost of a neurosurgical procedure was $895.99. Intensive care unit length of stay was found to have a significant influence on the direct cost. The cost of surgery and investigation were the main contributors to the total cost of care with a mean of $618.3 and a standard deviation of $248.67. CONCLUSIONS The mean cost of pediatric neurosurgical procedures in our setting is $895.99, which is 40.18% of our gross domestic product per capita. The main drivers of cost are the cost of operation, investigations, and intensive care unit length of stay.
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Li H, Gu L. Intelligent data-driven in shanghai stock exchange options based on state space model. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-219079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current relevant models for the analysis of SSE options, whether for the study of theoretical algorithms or for the application of verification, are still at the beginning of the research stage. Based on this, this study combines the status quo of China’s SSE options to construct a state space model with certain flexibility and combines image processing technology to extract model features. At the same time, this study obtained the experimental data of this study through network data collection method and analyzed the performance of the algorithm by comparison method, recorded the data obtained by the model operation, and turned the result into a visually identifiable feature result through image processing. The research indicates that the state space model has certain effects in the analysis of SSE option and can provide theoretical reference for subsequent related research.
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Affiliation(s)
- Huahua Li
- College of Finance and Economics, ShandongUniversity of Science and Technology, Tai’an, Shandong, China
| | - Lihan Gu
- School of Economics and Management, TaishanUniversity, Tai’an, Shandong, China
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13
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Kanmounye US, Sebopelo LA, Keke C, Zolo Y, Senyuy WP, Endalle G, Takoukam R, Sichimba D, Nguembu S, Ghomsi N. Mapping Global Neurosurgery Research Collaboratives: A Social Network Analysis of the 50 Most Cited Global Neurosurgery Articles. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTSocial network analysis of bibliometric data evaluates the relationships between the articles, authors, and themes of a research niche. The network can be visualized as maps composed of nodes and links. This study aimed to identify and evaluate the relationships between articles, authors, and keywords in global neurosurgery. The authors searched global neurosurgery articles on the Web of Science database from inception to June 18, 2020. The 50 most cited articles were selected and their metadata (document coupling, co-authorship, and co-occurrence) was exported. The metadata were analyzed and visualized with VOSViewer (Centre for Science and Technology Studies, Leiden University, The Netherlands). The articles were published between 1995 and 2020 and they had a median of 4.0 (interquartile range [IQR] = 5.0) citations. There were 5 clusters in the document coupling and 10 clusters in the co-authorship analysis. A total of 229 authors contributed to the articles and Kee B. Park contributed the most to articles (14 publications). Backward citation analysis was organized into 4 clusters and co-occurrence analysis into 7 clusters. The most common themes were pediatric neurosurgery, neurotrauma, and health system strengthening. The authors identified trends, contributors, and themes of highly cited global neurosurgery research. These findings can help establish collaborations and set the agenda in global neurosurgery research.
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Affiliation(s)
| | - Lorraine Arabang Sebopelo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chiuyu Keke
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine, University of Zambia, Lusaka, Zambia
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Genevieve Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Régis Takoukam
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- School of Medicine, Copperbelt University, Kitwe, Zambia
| | - Stéphane Nguembu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nathalie Ghomsi
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Department, Felix Houphouet Boigny University, Abidjan, Côte d'Ivoire
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14
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Nwosu C, Spears CA, Pate C, Gold DT, Bennett G, Haglund M, Fuller A. Influence of Caretakers' Health Literacy on Delays to Traumatic Brain Injury Care in Uganda. Ann Glob Health 2020; 86:127. [PMID: 33102147 PMCID: PMC7546101 DOI: 10.5334/aogh.2978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a life-altering condition, and delays to care can significantly impact outcomes. In Uganda, where nurse shortages are prevalent, patients' family members are the primary caretakers of these patients and play an important role in ensuring patients' access to timely care. However, caretakers often have little or no knowledge of appropriate patient care. Caretakers' ability to navigate the healthcare system and find and use health information to support their patients can impact delays in seeking, reaching, and receiving care. Objectives This study seeks to determine the factors that impact TBI patient caretakers' health literacy and examine how these factors influence delays in care. Methods This study was carried out in the Mulago National Referral Hospital neurosurgical ward, where 27 adult caretakers were interviewed using semi-structured, in-depth, qualitative interviews. "The Three Delay Framework" was utilized to understand participants' experiences in seeking, reaching, and receiving care for TBI patients. Thematic content analysis and manual coding was used to analyze interview transcripts and identify overarching themes in participant responses. Findings The main health literacy themes identified were Extrinsic, Intrinsic and Health System Factors. Nine sub-themes were identified: Government Support, Community Support, Financial Burdens, Lack of Medical Resources, Access to Health Information, Physician Support, Emotional Challenges, Navigational Skills, and Understanding of Health Information. These components were found to influence the delays to care to varying degrees. Financial Burdens, Government Support, Emotional Challenges, Physician Support and Lack of Medical Resources were recurring factors across the three delays. Conclusion The health literacy factors identified in this study influence caretakers' functional health literacy and delays to care in a co-dependent manner. A better understanding of how these factors impact patient outcomes is necessary for the development of interventions targeted at improving a caretaker's ability to maneuver the healthcare system and support patients in resource-poor settings.
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Affiliation(s)
| | | | | | - Deborah T. Gold
- Duke University Medical Center, Departments of Psychiatry and Behavioral Sciences, Sociology, Psychology and Neuroscience, US
| | - Gary Bennett
- Duke University, Department of Psychology and Neuroscience, US
| | - Michael Haglund
- Duke University School of Medicine, US
- Duke Global Health Institute, US
- Duke Global Neurosurgery and Neurology, US
| | - Anthony Fuller
- Duke University School of Medicine, US
- Duke Global Health Institute, US
- Duke Global Neurosurgery and Neurology, US
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15
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Ham EI, Kim J, Kanmounye US, Lartigue JW, Gupta S, Esene IN, Park KB. Cohesion Between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: A Scoping Review. World Neurosurg 2020; 143:e88-e105. [PMID: 32673809 DOI: 10.1016/j.wneu.2020.06.237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. METHODS PubMed, CINAHL, and Embase were searched for GNS literature published from 1999 to 2019. Then, health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change. This items chart was subsequently used to categorize the GNS literature into health system domains. RESULTS A total 63 articles were determined to focus on a health system domain. Of these articles, 6 focused on multiple domains, yielding an adjusted total of 70 articles. Overall, the most represented health system domain was service delivery (21 articles), followed by workforce (19), infrastructure (15), financing (12) and information management (3). A total of 30 low- and middle-income countries (LMICs) were represented across all articles. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the articles. CONCLUSIONS This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system-focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.
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Affiliation(s)
- Edward I Ham
- Stony Brook School of Medicine, Stony Brook, New York, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Ulrick Sidney Kanmounye
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jean Wilguens Lartigue
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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16
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Rudolfson N, Dewan MC, Park KB, Shrime MG, Meara JG, Alkire BC. The economic consequences of neurosurgical disease in low- and middle-income countries. J Neurosurg 2019; 130:1149-1156. [PMID: 29775144 DOI: 10.3171/2017.12.jns17281] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the economic consequences of neurosurgical disease in low- and middle-income countries (LMICs). METHODS The authors estimated gross domestic product (GDP) losses and the broader welfare losses attributable to 5 neurosurgical disease categories in LMICs using two distinct economic models. The value of lost output (VLO) model projects annual GDP losses due to neurosurgical disease during 2015-2030, and is based on the WHO's "Projecting the Economic Cost of Ill-health" tool. The value of lost economic welfare (VLW) model estimates total welfare losses, which is based on the value of a statistical life and includes nonmarket losses such as the inherent value placed on good health, resulting from neurosurgical disease in 2015 alone. RESULTS The VLO model estimates the selected neurosurgical diseases will result in $4.4 trillion (2013 US dollars, purchasing power parity) in GDP losses during 2015-2030 in the 90 included LMICs. Economic losses are projected to disproportionately affect low- and lower-middle-income countries, risking up to a 0.6% and 0.54% loss of GDP, respectively, in 2030. The VLW model evaluated 127 LMICs, and estimates that these countries experienced $3 trillion (2013 US dollars, purchasing power parity) in economic welfare losses in 2015. Regardless of the model used, the majority of the losses can be attributed to stroke and traumatic brain injury. CONCLUSIONS The economic impact of neurosurgical diseases in LMICs is significant. The magnitude of economic losses due to neurosurgical diseases in LMICs provides further motivation beyond already compelling humanitarian reasons for action.
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Affiliation(s)
- Niclas Rudolfson
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 2Surgery and Public Health, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Michael C Dewan
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark G Shrime
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- 5Department of Otology and Laryngology, Harvard Medical School; and
| | - John G Meara
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 6Department of Plastic and Reconstructive Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Blake C Alkire
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 4Office of Global Surgery, Massachusetts Eye and Ear Infirmary
- 5Department of Otology and Laryngology, Harvard Medical School; and
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17
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Vaca SD, Kuo BJ, Nickenig Vissoci JR, Staton CA, Xu LW, Muhumuza M, Ssenyonjo H, Mukasa J, Kiryabwire J, Rice HE, Grant GA, Haglund MM. Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda. Neurosurgery 2019; 84:95-103. [PMID: 29490070 PMCID: PMC6292785 DOI: 10.1093/neuros/nyy004] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 02/16/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Significant care continuum delays between acute traumatic brain injury (TBI) and definitive surgery are associated with poor outcomes. Use of the "3 delays" model to evaluate TBI outcomes in low- and middle-income countries has not been performed. OBJECTIVE To describe the care continuum, using the 3 delays framework, and its association with TBI patient outcomes in Kampala, Uganda. METHODS Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June to 30 November 2016. Four time intervals were constructed along 5 time points: injury, hospital arrival, neurosurgical evaluation, computed tomography (CT) results, and definitive surgery. Time interval differences among mild, moderate, and severe TBI and their association with mortality were analyzed. RESULTS Significant care continuum differences were observed for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 h for interval 3 and 24 h for interval 4) and mild TBI patients (19 h for interval 3 and 96 h for interval 4). These postarrival delays were associated with mortality for mild (P = .05) and moderate TBI (P = .03) patients. Significant hospital arrival delays for moderate TBI patients were associated with mortality (P = .04). CONCLUSION Delays for mild and moderate TBI patients were associated with mortality, suggesting that quality improvement interventions could target current triage practices. Future research should aim to understand the contributors to delays along the care continuum, opportunities for more effective resource allocation, and the need to improve prehospital logistical referral systems.
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Affiliation(s)
- Silvia D Vaca
- Stanford University School of Medicine, Palo Alto, California
- Stanford Center for Innovation in Global Health, Palo Alto, California
| | - Benjamin J Kuo
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke University Global Health Institute, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
| | - Joao Ricardo Nickenig Vissoci
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
- Duke Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Catherine A Staton
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke-NUS Medical School, Singapore, Singapore
- Duke Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Linda W Xu
- Stanford Center for Innovation in Global Health, Palo Alto, California
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
| | | | | | - John Mukasa
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Joel Kiryabwire
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Gerald A Grant
- Stanford Center for Innovation in Global Health, Palo Alto, California
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina
- Duke University Global Health Institute, Durham, North Carolina
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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18
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Almeida JP, Velásquez C, Karekezi C, Marigil M, Hodaie M, Rutka JT, Bernstein M. Global neurosurgery: models for international surgical education and collaboration at one university. Neurosurg Focus 2018; 45:E5. [DOI: 10.3171/2018.7.focus18291] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.
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Affiliation(s)
- Joao Paulo Almeida
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
| | - Carlos Velásquez
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
- 2Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Claire Karekezi
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
| | - Miguel Marigil
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
| | - Mojgan Hodaie
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
| | - James T. Rutka
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
| | - Mark Bernstein
- 1Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Ontario, Canada; and
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19
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West JL, Fargen KM, Hsu W, Branch CL, Couture DE. A review of Big Data analytics and potential for implementation in the delivery of global neurosurgery. Neurosurg Focus 2018; 45:E16. [DOI: 10.3171/2018.7.focus18278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Global access to neurosurgical care is still a work in progress, with many patients in low-income countries not able to access potentially lifesaving neurosurgical procedures. “Big Data” is an increasingly popular data collection and analytical technique predicated on collecting large amounts of data across multiple data sources and types for future analysis. The potential applications of Big Data to global outreach neurosurgery are myriad: from assessing the overall burden of neurosurgical disease to planning cost-effective improvements in access to neurosurgical care, and collecting data on conditions which are rare in developed countries. Although some global neurosurgical outreach programs have intelligently implemented Big Data principles in their global neurosurgery initiatives already, there is still significant progress that remains to be made. Big Data has the potential to drive the efficient improvement of access to neurosurgical care across low- and medium-income countries.
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20
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Kuo BJ, Vaca SD, Vissoci JRN, Staton CA, Xu L, Muhumuza M, Ssenyonjo H, Mukasa J, Kiryabwire J, Nanjula L, Muhumuza C, Rice HE, Grant GA, Haglund MM. A prospective neurosurgical registry evaluating the clinical care of traumatic brain injury patients presenting to Mulago National Referral Hospital in Uganda. PLoS One 2017; 12:e0182285. [PMID: 29088217 PMCID: PMC5663334 DOI: 10.1371/journal.pone.0182285] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/14/2017] [Indexed: 01/14/2023] Open
Abstract
Background Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to Mulago National Referral Hospital (MNRH), Kampala, Uganda. Methods We used a prospective neurosurgical registry based on Research Electronic Data Capture (REDCap) to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results 563 TBI patients were enrolled from 1 June– 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3–5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3–82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.
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Affiliation(s)
- Benjamin J. Kuo
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, United States of America
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Duke-National University Singapore Medical School, Singapore, Singapore
| | - Silvia D. Vaca
- Stanford University School of Medicine, Palo Alto, California, United States of America
- Stanford Center for Innovation in Global Health, Palo Alto, California, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, United States of America
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, United States of America
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Linda Xu
- Stanford Center for Innovation in Global Health, Palo Alto, California, United States of America
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California, United States of America
| | | | | | - John Mukasa
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Joel Kiryabwire
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | - Lydia Nanjula
- Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
| | | | - Henry E. Rice
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gerald A. Grant
- Stanford Center for Innovation in Global Health, Palo Alto, California, United States of America
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California, United States of America
| | - Michael M. Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, United States of America
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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