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Shakir M, Irshad HA, Khowaja AH, Tahir I, Shariq SF, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Adjuvant therapy for brain tumors in LMICs: A systematic review of barriers and possible solutions. Clin Neurol Neurosurg 2024; 244:108460. [PMID: 39059287 DOI: 10.1016/j.clineuro.2024.108460] [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: 06/11/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Adjuvant therapy is an important tool in the arsenal of brain tumor management and can improve patients' outcomes significantly but low- and middle-income countries (LMICs) often face challenges in provision. Therefore, our study aims to highlight barriers and strategies to adjuvant therapy of brain tumors in low-resource settings. METHOD A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains. RESULTS 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs. CONCLUSION A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | - Izza Tahir
- Medical School, 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
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Aseged M, Kato Y, Getachew Lemma M. Exoscope as a financially viable solution for micro neurosurgery in low-middle-income countries. J Clin Neurosci 2024; 128:110788. [PMID: 39151223 DOI: 10.1016/j.jocn.2024.110788] [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: 06/27/2024] [Revised: 07/31/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
Operating microscope is a backbone for the development of micro neurosurgery. In resource-limited setups and low-income countries, the volume of annual microsurgical procedures is low due to lack of the required equipment, one of which is the operating microscope. The price of currently available operating microscopes makes it difficult to address this issue in resource-constrained areas and low-income countries. Exoscope with a relatively lower price and the same even better imaging qualities can be used as an option for this problem.
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Affiliation(s)
- Mikael Aseged
- Department of Neurosurgery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia; Department of Neurosurgery, Fujita Health University, Nagoya, Japan.
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Nagoya, Japan
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3
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Aganze JM, Lukwesa F, Muchai E, Kuol PP, Mittal G, Emhemed MS, Phiri EC, Adrien TDE. The future of neurosurgery in the democratic republic of congo: challenges and opportunities for early carrier researchers. Neurosurg Rev 2024; 47:401. [PMID: 39098952 DOI: 10.1007/s10143-024-02645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 07/21/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Josué Mwambali Aganze
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, DRC, Congo
| | - Fanwell Lukwesa
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- School of Medicine, The Copperbelt University, Kitwe, Zambia
| | - Emmanuel Muchai
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- College of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - Piel Panther Kuol
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- School of Medicine , Moi University, Eldoret, Kenya
| | - Gaurav Mittal
- Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
| | - Marwa SaedAli Emhemed
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Emmanuel Chileshe Phiri
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
- School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Tangmi Djabo Eric Adrien
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon.
- Faculty of Medicine, Université Technologique Bel Campus, Kinshasa, DRC, Congo.
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Farooq M, Farooq M, Atiq N, Ranjha KU, Karimov Z. Social media as a clinical, educational and networking tool for neurosurgeons: A systematic review of literature. J Clin Neurosci 2024; 126:256-264. [PMID: 38981365 DOI: 10.1016/j.jocn.2024.06.025] [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: 03/07/2024] [Revised: 06/14/2024] [Accepted: 06/29/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The use of social media has been drastic in the field of neurosurgery over the last two decades. Almost 70 % of neurosurgeons use social media platforms such as Facebook, X (formerly Twitter), YouTube, and Instagram for purposes of professional growth. This literature review aims to quantify the use of social media in the field of neurosurgery, its benefits, and implications. METHODS A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining tosocial media and neurosurgery.Mesh terms employed in the search strategy encompassed "Social Media", "neurosurgery", "education""benefits", "consequences"and related variations.Inclusion criteria involved studiesvaryingin methodology, includingobservational studies, case reports and comprehensive reviewsand investigatingvarious aspects of benefits and limitations of social media for neurosurgeons, encompassing its importance in community building, professional development, contribution to research and publications, mentorship, cultural diversity and other pertinent benefits. RESULTS The search yielded635articles, with437unique articles screened based on relevance. Following a meticulous screening process,86articles underwent full-text assessment, resulting in the inclusion of22articles meeting the eligibility criteria.Insights were derived onthebenefits of social media,its current limitationsas well astrends and demographics surrounding social media use in neurosurgery. CONCLUSION In todays modernized world, social media acts as a double-edged sword when it comes to neurosurgery; it offers unparalleled opportunities for collaboration, education, patient engagement, and support while demanding careful use and navigation to mitigate the risks associated with it.
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Affiliation(s)
- Minaam Farooq
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital Lahore, Pakistan.
| | - Mukarram Farooq
- Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Noor Atiq
- Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Kaleem Ullah Ranjha
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital Lahore, Pakistan
| | - Ziya Karimov
- Ege University Faculty of Medicine, Medicine Program, Izmir, Turkiye
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Farooq M, Khan H. Breaking barriers in neurosurgical training in LMICs: Augmented reality as a potential future? J Clin Neurosci 2024; 126:361-362. [PMID: 39047596 DOI: 10.1016/j.jocn.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Minaam Farooq
- Department of Neurological Surgery, King Edward Medical University, Mayo Hospital Lahore, Pakistan.
| | - Huzaifa Khan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
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Mukumbya B, Kitya D, Trillo-Ordonez Y, Sun K, Obiga O, Deng DD, Stewart KA, Ukachukwu AEK, Haglund MM, Fuller AT. The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda. PLoS One 2024; 19:e0305382. [PMID: 38913633 PMCID: PMC11195962 DOI: 10.1371/journal.pone.0305382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations. METHODS Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants. RESULTS Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable. CONCLUSION The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.
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Affiliation(s)
- Benjamin Mukumbya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David Kitya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yesel Trillo-Ordonez
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Keying Sun
- Duke Global Health Institute, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Oscar Obiga
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Di D. Deng
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
| | | | - Alvan-Emeka K. Ukachukwu
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Michael M. Haglund
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
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7
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Moawad MHED, Al-Jafari M, Taha AM, A'amar JW, Alsayed O, Fayad T, Sadeq MA, Albakri K, Serag I. Neuro-oncological research output in Africa: a scoping review of primary brain tumors. Neurol Sci 2024; 45:1945-1951. [PMID: 38146012 PMCID: PMC11021309 DOI: 10.1007/s10072-023-07272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND There is evidence that individuals of African ancestry, particularly those residing in Africa, suffer from an unfortunate amount of under-representation in cancer research worldwide. AIM We aimed to analyze current research output and potentially predict future trends in neuro-oncological research in Africa. Investigating deficits in the field will assist in identifying top-performing countries, which ones face challenges, and how to solve them. Therefore, targeted interventions can be applied to overcome these challenges. METHODS We conducted a systematic computer-based search on the following databases (PubMed, Scopus, Web of Science, and Embase) for research articles related to the neuro-oncological field in Africa. We aimed to retrieve any article published in the period between 1 January 2000 and 10 January 2023. RESULTS We included 200 eligible articles in our study. The output of neuro-oncological research has been increasing over the past two decades, peaking in 2019. Among the included articles, clinical practice issues constituted the majority (80%), while public health-related topics accounted for 20% of the publications. Regarding the type of neurological tumor, neuroblastoma was the most common, with 26 articles (13%), meningioma with 21 (10.5%), and glioma with 16 articles (8%). CONCLUSION The interest in African neuro-oncological research is increasing. Hence, there is a need for ongoing efforts to address issues with clinical practice and public health related to neurological tumors in the continent. Future studies should concentrate on filling in knowledge gaps and investigating novel methods for neuro-oncological conditions that affect African populations in terms of prevention, diagnosis, treatment, and management strategies.
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Affiliation(s)
- Mostafa Hossam El Din Moawad
- Faculty of Pharmacy Clinical Department, Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | | | - Omar Alsayed
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Taha Fayad
- Faculty of Oral and Dental Medicine, Sinai University, North Sinai, Egypt
| | - Mohammed Ahmed Sadeq
- Faculty of Medicine, Misr University for Science and Technology, 6th of October City, Egypt
| | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ibrahim Serag
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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8
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Young T, Tropeano MP, Cannizzaro D, Jelmoni AJM, Servadei F, Germano IM. The Current Landscape of Neurosurgical Oncology in Low-Middle-Income Countries (LMIC): Strategies for the Path Forward. World Neurosurg 2024; 184:e291-e298. [PMID: 38286320 DOI: 10.1016/j.wneu.2024.01.118] [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: 10/10/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To promote global equity in research, innovation, and care, sharing knowledge and grasping current benchmarks is crucial. Despite LIC/LMIC constituting around 80% of the global population, their contribution to neurosurgery research is less than 5%. This study aims to assess the status of neurosurgical oncology in LIC/LMIC using published data, offering strategic insights for progress. METHODS Conducting a retrospective bibliometric analysis via PubMed and Scopus databases, we documented reports published (2015-2021) by neurosurgical department-affiliated investigators in LICs/LMICs. World Bank classifications identified LIC and LMIC. Reviewed papers underwent further scrutiny based on independent and associated keyword lists. RESULTS Our systematic approach revealed 189 studies from LMIC in 10 neurosurgery journals. Of these, 53% were case reports, with 88% focusing on brain pathologies and 12% on the spine. Intra-axial brain tumors (45.8%), extra-axial/skull base (38.4%), and metastasis (3.68%) were prominent. Among noncase report publications, surgical technique and outcome were common themes. India, Egypt, and Tunisia led in publications, with 94% appearing in journals with an impact factor below 5. No papers originated from LIC. CONCLUSIONS This study reinforces existing findings that data from LMIC inadequately represent their populations, impeding a comprehensive understanding of their neurosurgical oncology landscape. Language barriers and data collection difficulties contribute to this gap. Addressing these challenges could significantly enhance progress in shaping the future of neurosurgical oncology in these regions.
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Affiliation(s)
- Tirone Young
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Pia Tropeano
- Neurosurgical Unit, Department of Neurosciences, ASST Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Delia Cannizzaro
- Neurosurgical Unit, Department of Neurosciences, ASST Ovest Milanese - Legnano Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Alice J M Jelmoni
- Neurosurgical Unit, Department of Neurosciences, ASST Ovest Milanese - Legnano Hospital, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University, Milano, Italy
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Mpoyi Chérubin T, Augustin K, Jeff N, Goert M, Guelord M, Ramirez MDJE, Antoine B, Israël M, Pierre M, Michel K, Ziko P, Teddy K, Yassad O, Hakou M, Glennie N, Montemurro N. The Role of Ventriculocisternostomy in the Management of Hydrocephalus in Mali and the Democratic Republic of the Congo. Cureus 2024; 16:e59189. [PMID: 38807803 PMCID: PMC11130738 DOI: 10.7759/cureus.59189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Hydrocephalus continues to pose significant clinical challenges in neurosurgery. The primary goal of this study is to assess the feasibility of ventriculocisternostomy (VCS) within the provincial city of Kinshasa and Mali to optimize the management of patients afflicted with hydrocephalus. METHODS This investigation was hosted at two major urban healthcare facilities: the Initiative Plus Hospital Center, positioned in the bustling metropolis of Kinshasa, Democratic Republic of the Congo (DRC), and the Bamako Hospital, Republic of Mali. A prospective, analytical cohort study was executed from December 2022 to June 2023. RESULTS In the Mali group, seven patients underwent VCS, four patients were treated with VCS and spinal surgery, and one case was treated with VCS and biopsy. Similarly, in the Kinshasa group, 25 patients underwent VCS, whereas four patients were treated with VCS and spinal surgery. The median hospital stay was eight and 10 days for the Mali and the Kinshasa groups, respectively. CONCLUSION VCS emerges as a formidable alternative for hydrocephalus management in Mali and DRC, showcasing the potential to markedly ameliorate patient outcomes, economize healthcare expenditures, and fortify the local neurosurgical capacity.
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Affiliation(s)
| | | | - Ntalaja Jeff
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | - Mirenge Goert
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | - Metre Guelord
- Neurosurgery, Centre Hospitalier Initiative Plus, Kinshasa, COD
| | | | | | | | | | | | - Punga Ziko
- Neurosurgery, Université de Kinshasa, Kinshasa, COD
| | - Ketani Teddy
- Neurosurgery, Université de Kinshasa, Kinshasa, COD
| | - Ouhdiri Yassad
- Neurosurgery, Hôpital des Spécialités de Rabat, Rabat, MAR
| | - Medhi Hakou
- Neurosurgery, Hôpital des Spécialités de Rabat, Rabat, MAR
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Ahmed H, Furqan M, Okon II, Oduoye MO, Mitchell UO, Akpan U, Umutoni F, Bandyopadhyay S, Akilimali A, Nkeshimana M. The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review. Ann Med Surg (Lond) 2024; 86:2011-2015. [PMID: 38576995 PMCID: PMC10990298 DOI: 10.1097/ms9.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024] Open
Abstract
The availability and accessibility of neurosurgical care across Africa remains limited despite recent advancements. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit. Access to adequate facilities and equipment is also lacking. Barriers like poverty, conflicts, and distance from care centres negatively impact patients' ability to access services. However, training programs like the World Federation of Neurosurgical Societies Rabat Training Center have contributed to building local capacity. Use of technologies like neuro-endoscopy is expanding access to more cost-effective interventions for conditions such as hydrocephalus. Undergraduate medical education is also seeing a rise in African students interested in neurosurgery. Despite these advancements, workforce shortfalls, inadequate infrastructure, and challenges posed by geopolitical instability continue to hinder the provision of comprehensive neurosurgical care. Limited research and funding discourage experienced surgeons from practicing in their home countries. Increased international collaboration, support for education, and tackling of structural issues are needed to continue strengthening Africa's neurosurgical capacity and reducing the disease burden. This narrative review aims to provide an overview of the current state of neurosurgery on the continent, highlight achievements, and identify persisting challenges.
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Affiliation(s)
- Hassan Ahmed
- Faculty of medicine, University of Kordofan, Elobeid, Sudan
| | - Muhammad Furqan
- Faculty of medicine, King Edward Medical University, Lahore, Pakistan
| | - Inibehe Ime Okon
- Department of Research, Medical Research Circle (MedReC), Bukavu
| | | | | | - Usoro Akpan
- Faculty of medicine, University of Warwick, Coventry
| | - Florence Umutoni
- Department of Research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, University of Rwanda
| | - Soham Bandyopadhyay
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Aymar Akilimali
- Department of Research, Medical Research Circle (MedReC), Bukavu
| | - Menelas Nkeshimana
- Department of Health Workforce Development, Ministry of Health, Kigali, Rwanda
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11
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Harlyjoy A, Nathaniel M, Nugroho AW, Gunawan K. Traumatic tension pneumocephalus: a case report and perspective from Indonesia. Front Neurol 2024; 15:1339521. [PMID: 38385032 PMCID: PMC10879582 DOI: 10.3389/fneur.2024.1339521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment. Nevertheless, various possibilities for impedance in timely management, including patient-related barriers are commonly experienced in low-and middle-income countries setting. Here we presented a delay of management in traumatic tension pneumocephalus case due to initial refusal for emergency surgery. A 59-year-old male presented to the emergency department following a motorcycle accident fully alert with no neurological deficit. He acknowledged clear nasal discharge within 1 h after the initial trauma, but no rhinorrhea or otorrhea was present during physical examination. Head CT revealed extensive pneumocephalus with "Mount Fuji sign," anterior skull base fracture, and frontal sinus fracture. The patient initially refused immediate surgical intervention due to excellent clinical condition and financial scare. Acute decrease of consciousness occurred 40 h post-trauma: GCS of 6 with slight dilatation of both pupils (4 mm) and sluggish pupillary reflex. Emergency bifrontal craniotomy, subdural air drainage, and dura mater tear repair were performed afterwards. Postoperative care was uneventful, with rapid improvement of consciousness and follow-up head CT showing minimal subdural fluid collection and absence of remaining pneumocephalus. The patient was discharged from the hospital after 7 days with GCS of 15 and GOS of 5, proving the importance of overcoming barriers for delay in delivering neurotrauma care in low-and middle-income countries.
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Affiliation(s)
- Alphadenti Harlyjoy
- Department of Neurosurgery, University Indonesia Hospital, Depok, West Java, Indonesia
| | - Michael Nathaniel
- Department of Neurosurgery, University Indonesia Hospital, Depok, West Java, Indonesia
| | | | - Kevin Gunawan
- Department of Neurosurgery, University Indonesia Hospital, Depok, West Java, Indonesia
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12
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Yevudza WE, Buckman V, Darko K, Banson M, Totimeh T. Neuro-oncology access in Sub-Saharan Africa: A literature review of challenges and opportunities. Neurooncol Adv 2024; 6:vdae057. [PMID: 38994233 PMCID: PMC11237987 DOI: 10.1093/noajnl/vdae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Background Ensuring equitable access to treatments and therapies in the constantly evolving field of neuro-oncology is an imperative global health issue. With its unique demographic, cultural, socioeconomic, and infrastructure characteristics, Sub-Saharan Africa faces distinct challenges. This literature review highlights specific barriers to neuro-oncology care in the region and explores potential opportunities for enhancing access. Methods Predetermined keyword searches were employed to screen titles and abstracts using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Inclusion criteria were studies published between January 1, 2003, and June 20, 2023, specifically addressing the capacity and challenges of neuro-oncology in the Sub-Saharan African region. The data sources queried were PubMed and Google Scholar. Systematic reviews and meta-analyses were deliberately excluded. All authors conducted independent screening and structured data extraction meticulously. Results Our paper identified multiple challenges that impede access to quality treatment for brain tumors. These include constrained resources, insufficient training of healthcare professionals, certain cultural beliefs, and a general lack of awareness about brain tumors, all contributing to delayed diagnosis and treatment. Furthermore, the lack of detailed data on the incidence and prevalence of primary central nervous system tumors impairs the accurate assessment of disease burden and precise identification of areas requiring improvement. However, we discovered that ongoing research, advocacy, enhanced training, mentorship, and collaborative efforts present valuable opportunities for substantial progress in neuro-oncology access. Conclusions While we provide a glimpse of the current state, we hope these results will help stimulate dialogue and catalyze initiatives to surmount highlighted obstacles and improve neuro-oncology outcomes across Sub-Saharan Africa.
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Affiliation(s)
- W Elorm Yevudza
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Vincent Buckman
- University of Chicago Medical School Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kwadwo Darko
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Teddy Totimeh
- Department of Neurological Surgery, University of Ghana Medical Center, Accra, Ghana
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Okon II. A glimpse of practice of neurosurgery in Africa: Challenges and opportunities. BRAIN & SPINE 2023; 4:102720. [PMID: 38163000 PMCID: PMC10753432 DOI: 10.1016/j.bas.2023.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Inibehe Ime Okon
- Department of Research, Medical Research Circle (MedReC), Bukavu, People’s Republic of Congo
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Visconti-Lopez FJ, Saal-Zapata G. Global Research Trends of Neurosurgery: A Comprehensive Bibliometric and Visualized Analysis of Systematic Reviews. World Neurosurg 2023; 176:e345-e356. [PMID: 37244520 DOI: 10.1016/j.wneu.2023.05.061] [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: 04/07/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study aimed to determine the bibliometric characteristics of scientific articles on systematic reviews of neurosurgery worldwide. METHODS Bibliographic searches were performed in journals indexed by the Web of Science database until 2022, with no language restrictions. A total of 771 articles were ultimately included on the basis of predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis, which were performed using the bibliometrix package in R and VOSviewer, respectively. RESULTS The first publication was in 2002, and the number of publications increased over time, with the largest number of publications in 2021 (156 articles). The average number of citations per document was 17.36, and the annual growth rate was 6.82%. Nathan A. Shlobin was the author with the most published articles (19 articles). The most cited study was published by Jobst BC (2015). WORLD NEUROSURGERY was the journal with the most publications (51 articles). The country of corresponding authors with the most publications and the greatest number of total citations was the United States. The affiliations with the most articles were University of Toronto (67 articles) and Harvard Medical School (54 articles). CONCLUSIONS The increasing trend during the past 20 years, and especially in the past 2 years, highlights the advancements in various subspecialities in the field. Our analysis revealed that North American and Western European countries are at the forefront of the field. There is a poor output of publications, authors, and affiliations in Latin-American and African countries.
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Affiliation(s)
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Lima, Peru; Department of Interventional Neurosurgery, Clinica Angloamericana, Lima, Peru
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El-Sherif AM, Rashad A, Rabie MM, Hegazy M, Adel M, Albialy M, El-Shandawely M, Mahmoud EA. Resource utilization in management of spontaneous intracerebral hemorrhage without systemic risk factors. Does early surgical decompression matter? Clin Neurol Neurosurg 2023; 231:107829. [PMID: 37331206 DOI: 10.1016/j.clineuro.2023.107829] [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: 02/13/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Even though different subtypes of spontaneous ICH are frequently linked to a poor prognosis, their causes, pathological features, and prognoses vary. Atypical intracerebral hemorrhage is the subtype of spontaneous ICH that usually occurs due to an underlying localized vascular lesion. It is unrelated to systemic vascular risk factors, mostly affects children and young adults and is associated with a relatively good outcome. This fact should be considered when planning the evaluation and treatment. Investigating the cause of this subtype is fundamental to providing optimal management. However, if resources do not allow completing the investigations, the cause will be more difficult to discover. Treatment decisions will be made under stress to save the patient's life, especially with rapidly deteriorating patients. METHODS We described three cases of spontaneous ICH without systemic risk factors where the bleeding source could not be determined before surgery due to a lack of resources, preventing preoperative vascular investigation. Knowing that the atypical ICH has a distinct identity, regarding etiology and prognosis, encouraged the surgeons to resort to early surgical decompression as an alternative plan. We reviewed the literature searching for supporting evidence. RESULTS The results of treatment of the presented cases were satisfactory. The lack of reported similar cases was brought to light by a literature analysis that sought to provide backing for the proposed management strategy. In the end, we supplied two graphic organizers to help readers remember the different types and treatment of hemorrhagic stroke. CONCLUSION There isn't enough evidence to show that there are other ways to treat atypical intracerebral haemorrhage when resources are limited. The presented cases highlight the importance of decisionmaking in resource-constrained situations when patient outcomes can be improved.
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Affiliation(s)
- Ahmed M El-Sherif
- Al-Azhar University, Faculty of Medicine, Nasr City, 11651 Cairo, Egypt.
| | - Alaa Rashad
- Al-Azhar University, Faculty of Medicine, Nasr City, 11651 Cairo, Egypt
| | | | | | - Mostafa Adel
- Al-Azhar University, Faculty of Medicine, Al-Hussein Hospital, Egypt
| | - Mohammad Albialy
- Al-Azhar University, Faculty of Medicine, Nasr City, 11651 Cairo, Egypt
| | | | - Ehab Adel Mahmoud
- Uppsala University Hospital, Radiology Department, Neurointervention Unit, Sweden
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16
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Hilabi BS, Alghamdi SA, Almanaa M. Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries. Cureus 2023; 15:e37698. [PMID: 37081900 PMCID: PMC10112545 DOI: 10.7759/cureus.37698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 04/22/2023] Open
Abstract
Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.
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Kamil M, Muttaqin Z, Hanaya R, Arita K, Yoshimoto K. Bibliometric Analysis of the Neurosurgery Publication Productivity of Southeast Asia in 2011-2020. World Neurosurg 2023; 172:e490-e498. [PMID: 36681320 DOI: 10.1016/j.wneu.2023.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is a large disparity between the quality of neurosurgical research in developed and developing nations, including the Association of Southeast Asian Nations (ASEAN). Bibliometric analysis is an appropriate method for evaluating the quality of research in a geographic region. We analyzed the neurosurgery reports published by the ASEAN countries to highlight regional productivity in neurosurgery research. METHODS We performed a bibliometric analysis of neurosurgery reports from the ASEAN countries between 2011 and 2020. We described the publication number, study type, and field of study of the publication articles. In addition, we assessed the correlations between the neurosurgery research productivity of these countries and the neurosurgeon ratio, medical doctor ratio, per capita gross domestic product, and health expenditure per capita. RESULTS We identified 1939 neurosurgeons in the ASEAN region; 570 articles were published by neurosurgeons in the region between 2011 and 2020. Singaporean neurosurgeons were the most productive, with 177 articles, accounting for 31% of the total ASEAN neurosurgeon publications in the study period. However, there has been a rapid recent increase in the number of articles. Case reports and tumors were the dominant type and field of the articles, respectively. There was no significant correlation between the neurosurgical research productivity of the ASEAN countries and the neurosurgeon ratio, medical doctor ratio, per capita gross domestic product, and health expenditure per capita. CONCLUSIONS By analyzing the neurosurgery publications from ASEAN countries over the previous decade, we highlight the status of neurosurgical research in these countries.
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Affiliation(s)
- Muhammad Kamil
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Neurosurgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Neurosurgery, Izumi Regional Medical Center, Izumi, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Conti A, Magnani M, Zoli M, Kockro RA, Tuleasca C, Peschillo S, Umana GE, Tew SW, Jallo G, Garg K, Spetzler RF, Lafuente J, Chaurasia B. Social Media for Global Neurosurgery. Benefits and limitations of a groundbreaking approach to communication and education. BRAIN & SPINE 2023; 3:101728. [PMID: 37383446 PMCID: PMC10293234 DOI: 10.1016/j.bas.2023.101728] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction Social media have become ubiquitous and their role in medicine is quickly growing. They provide an open platform by which members share educational material, clinical experiences, and collaborate with educational equity. Research question To characterize the role of social media in neurosurgery, we analyzed metrics of the largest neurosurgical group (Neurosurgery Cocktail), collected relevant data about activities, impact and risks of this groundbreaking technology. Material and methods We extracted Facebook metrics from 60-day time sample, including users demographics and other platform-specific values such as active members and number of posts within 60 days. A quality assessment of the posted material (clinical case reports and second opinions) was obtained establishing four main quality-criteria: privacy violation; quality of imaging; clinical and follow up data. Results By December 2022, the group included 29.524 members (79.8% male), most (29%) between 35 and 44 years of age. Over 100 countries were represented. A total of 787 posts were published in 60 days with an average of 12.7 per day. In 173 clinical cases presented through the platform, some issue with privacy was recorded in 50.9%. The imaging was considered insufficient in 39.3%, clinical data in 53.8%; follow up data were missing in 60.7%. Discussion and conclusion The study provided a quantitative evaluation of impact, flaws and limitations of social medial for healthcare. Flaws were mostly data breach and insufficient quality of case reports. There are actions to correct these flaws that can be easily taken to provide a greater credibility and efficacy to the system.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Marcello Magnani
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Matteo Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Ralf A. Kockro
- Centre for Microneurosurgery, Hirslanden Hospital, Zurich, Switzerland
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
| | - Simone Peschillo
- Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Centre, Gamma Knife Centre, Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Seow Wan Tew
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - George Jallo
- Institute of Brain protection sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Kanwaljeet Garg
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jesus Lafuente
- Department of Neurosurgery, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Dahir S, Cotache-Condor C, Grimm A, Mohamed M, Rice H, Smith E, Ismail EA. Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000472. [PMID: 38328393 PMCID: PMC10848631 DOI: 10.1136/wjps-2022-000472] [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: 07/18/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023] Open
Abstract
Background Childhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide, particularly in low and middle-income countries. However, there are limited data on the disease prevalence and delays in care for pediatric neurosurgical conditions in very low-resource settings. This study aims to characterize the delays in access to care for pediatric neurosurgical conditions in Somaliland. Methods We performed a retrospective review of all children with congenital hydrocephalus and spina bifida admitted to the Edna University Hospital (EAUH) in Somaliland between 2011 and 2018. Patient demographics were analyzed with descriptive statistics and χ2 test statistics. We defined delays in care for each condition based on standard care in high-income settings. Univariate and multivariate logistic regression were performed to evaluate predictors of delay in care. Statistical significance was set at p<0.05. Results A total of 344 children were admitted to EAUH with neurosurgical conditions from 2011 to 2018. The most common condition was congenital hydrocephalus (62%). Delays in care were found for 90% of patients and were associated with the type of diagnosis and region. The longest delay among children with spina bifida was 60 months, while the longest delay for children with congenital hydrocephalus was 36 months. Children with congenital hydrocephalus or spina bifida traveling from foreign countries had the highest waiting time to receive care, with a median delay of 8 months (IQR: 5-11 months) and 4 months (IQR: 3-7 months), respectively. Conclusion We found significant delays in care for children with neurosurgical conditions in Somaliland. This country has an urgent need to scale up its surgical infrastructure, workforce, and referral pathways to address the needs of children with hydrocephalus and spina bifida.
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Affiliation(s)
- Shukri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Andie Grimm
- Department of Public Health, Baylor University, Waco, TX, USA
| | | | - Henry Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, USA
| | - Emily Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, USA
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Raj Sharma M, Sedain G, Kafle P, Rajbhandari B, Bahadur Pradhanang A, Kumar Shrestha D, Singh Karki A, Chiluwal A. Clinical characteristics and outcome of patients with brain arteriovenous malformations from a university hospital in nepal. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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21
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Abu-Bonsrah N, Totimeh T, Kanmounye US, Banson M, Bandoh D, Sarpong K, Dadey D, Adam A, Nketiah-Boakye F, Dakurah T, Boakye M, Haizel-Cobbina J, Ametefe M, Bankah P, Groves ML. Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities. World Neurosurg 2022; 167:e953-e961. [PMID: 36064120 DOI: 10.1016/j.wneu.2022.08.120] [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: 07/13/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.
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Affiliation(s)
- Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Teddy Totimeh
- Department of Neurosurgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Dickson Bandoh
- Department of Neurosurgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, USA
| | - David Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Abass Adam
- Department of Neurosurgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Thomas Dakurah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Joseline Haizel-Cobbina
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mawuli Ametefe
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Patrick Bankah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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22
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Smith BG, Whiffin CJ, Esene IN, Karekezi C, Bashford T, Mukhtar Khan M, Fontoura Solla DJ, Indira Devi B, Paiva WS, Servadei F, Hutchinson PJ, Kolias AG, Figaji A, Rubiano AM. Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: A reflexive thematic analysis. PLoS One 2022; 17:e0274922. [PMID: 36121804 PMCID: PMC9484678 DOI: 10.1371/journal.pone.0274922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden of TBI cannot be accurately quantified. Objective To explore the specific contextual challenges of, and possible solutions to improve, long-term follow-up following TBI in low-resource settings. Methods A cross-sectional, pragmatic qualitative study, that considered knowledge subjective and reality multiple (i.e. situated within the naturalistic paradigm). Data collection utilised semi-structured interviews, by videoconference and asynchronous e-mail. Data were analysed using Braun and Clarke’s six-stage Reflexive Thematic Analysis. Results 18 neurosurgeons from 13 countries participated in this study, and data analysis gave rise to five themes: Clinical Context: What must we understand?; Perspectives and Definitions: What are we talking about?; Ownership and Beneficiaries: Why do we do it?; Lost to Follow-up: Who misses out and why?; Processes and Procedures: What do we do, or what might we do? Conclusion The collection of long-term outcome data plays an imperative role in reducing the global burden of neurotrauma. Therefore, this was an exploratory study that examined the contextual challenges associated with long-term follow-up in LMICs. Where technology can contribute to improved neurotrauma surveillance and remote assessment, these must be implemented in a manner that improves patient outcomes, reduces clinical burden on physicians, and does not surpass the comprehension, capabilities, or financial means of the end user. Future research is recommended to investigate patient and family perspectives, the impact on clinical care teams, and the full economic implications of new technologies for follow-up.
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Affiliation(s)
- Brandon G. Smith
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (BGS); (AGK)
| | - Charlotte J. Whiffin
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Ignatius N. Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Muhammad Mukhtar Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Northwest School of Medicine & Northwest General Hospital & Research Centre, Peshawar, Pakistan
| | - Davi J. Fontoura Solla
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Bhagavatula Indira Devi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - Wellingson S. Paiva
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (BGS); (AGK)
| | - Anthony Figaji
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Red Cross Children’s Hospital & University of Cape Town, Cape Town, South Africa
| | - Andres M. Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
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Letter to Editor: Challenges in Neurosurgery in Nepal: Perspective from a Lower-Middle-Income Country. World Neurosurg 2022; 164:453. [DOI: 10.1016/j.wneu.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/20/2022]
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Barthélemy EJ, Affana CK, Asfaw ZK, Dams-O'Connor K, Rahman J, Jones S, Ullman J, Margetis K, Hickman ZL, Dangayach NS, Giwa AO. Racial and Socioeconomic Disparities in Neurotrauma: Research Priorities in the New York Metropolitan Area through a Global Neurosurgery Paradigm. World Neurosurg 2022; 165:51-57. [PMID: 35700861 DOI: 10.1016/j.wneu.2022.06.031] [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: 03/19/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
The New York Neurotrauma Consortium (NYNC) is a nascent multidisciplinary research and advocacy organization based in the New York Metropolitan Area (NYMA). It aims to advance health equity and optimize outcomes for traumatic brain and spine injury patients. Given the extensive racial, ethnic, and socioeconomic diversity of the NYMA, global health frameworks aimed at eliminating disparities in neurotrauma may provide a relevant and useful model for the informing research agendas of consortia like the NYNC. In this review, we present a comparative analysis of key health disparities in traumatic brain injury (TBI) that persist in the NYMA as well as in low- and middle-income countries (LMIC). Examples include: (a) inequitable access to quality care due to fragmentation of healthcare systems, (b) barriers to effective prehospital care for TBI, and (c) socioeconomic challenges faced by patients and their families during the subacute and chronic post-injury phases of TBI care. This review presents strategies to address each area of health disparity based on previous studies conducted in both LMIC and high-income country (HIC) settings. Increased awareness of healthcare disparities, education of healthcare professionals, effective policy advocacy for systemic changes, and fostering racial diversity of the trauma care workforce can guide the development of trauma care systems in the NYMA that are free of racial and related healthcare disparities.
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Affiliation(s)
- Ernest J Barthélemy
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California, USA.
| | | | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kristen Dams-O'Connor
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jueria Rahman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Salazar Jones
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Jamie Ullman
- New York Neurotrauma Consortium, Inc., New York, New York; Institute for Neurology and Neurosurgery at North Shore University Hospital
| | - Konstantinos Margetis
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Zachary L Hickman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Neha S Dangayach
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Al O Giwa
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Kumar N, Katiyar V, Praneeth K, Sharma R, Narwal P, Raheja A, Tandon V, Mishra S, Garg K, Suri A, Chandra PS, Kale SS. Challenges and prospects of neurosurgical teleconsultations in a developing country: a reality check. Neurosurg Focus 2022; 52:E5. [DOI: 10.3171/2022.3.focus2247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The adoption of telemedicine became a necessity during the COVID-19 pandemic because patients found commuting to be difficult owing to travel restrictions. Initially, audio-based teleconsultations were provided. Later, on the basis of the feedback of patients and caregivers, the authors started to provide video-based teleconsultations via WhatsApp. The authors subsequently surveyed the patients and caregivers to determine their satisfaction levels with telemedicine services.
METHODS
An anonymized telephone survey of patients who had participated in teleconsultation was conducted with a structured questionnaire. The responses were analyzed and their correlations with the perceived benefits and limitations of audio and video teleconsultation were determined.
RESULTS
Three hundred respondents were included in the first round of surveys, of whom 250 (83.3%) consented to video teleconsultation. Among the respondents who participated in both audio and video teleconsultations (n = 250), paired analysis showed that video teleconsultation was perceived as better in terms of providing easier access to healthcare services (p < 0.001), saving time (p < 0.001), and satisfaction with the way patient needs were conveyed to healthcare providers (p = 0.023), as well as in terms of adequacy of addressing healthcare needs (p < 0.001) and consequently providing a higher rate of overall satisfaction (p < 0.001). For both audio and video teleconsultation, overall patient satisfaction was significantly related to only previous exposure to WhatsApp. However, for video consultation, longer call duration (p = 0.023) was an important independent factor. Video teleconsultation was preferable to face-to-face consultation irrespective of educational status, but higher education was associated with preference for video teleconsultation.
CONCLUSIONS
Both audio and video teleconsultation are viable cost-effective surrogates for in-person physical neurosurgical consultation. Although audio teleconsultation is more user-friendly and is not restricted by educational status, video teleconsultation trumps the former owing to a more efficient and satisfactory doctor-to-patient interface.
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Affiliation(s)
- Narendra Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kokkula Praneeth
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Narwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P. Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S. Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Arifin MT, Bunyamin J, Bakhtiar Y, Muttaqin Z. Impact of COVID-19 to Neurosurgical Education: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronavirus disease (COVID-19) has disrupted many aspects of healthcare and health education including medical education. Given that neurosurgical training requires direct patient contact, the social distancing policy due to COVID has impacted global neurosurgical education.
AIM: We are conducting a systematic review to determine the impact of COVID-19 on global neurosurgical education.
METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The literature search was conducted on three repositories (PubMed, MedRxiv, and bioRxiv) which subsequently screened by two independent reviewers.
RESULTS: Thirteen articles were processed for the systematic review. The impact of COVID-19 has been mainly negative to academic activity due to reduced case number and physical contact hours. Residents were also deployed to provide care for COVID-19-related workload. However, several studies reported a positive impact of COVID-19 on residents’ well-being such as increased personal time. Besides current residents, prospective medical students were also affected by COVID-19.
CONCLUSION: Neurosurgical program directors should initiate the introduction of a flexible policy to accommodate case reduction to meet the board standard and guard residents’ safety and well-being are required to ensure the sustainability of high-quality neurosurgical education.
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27
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Bocanegra-Becerra JE, Castillo-Huerta NM, Vilca-Salas MI. Letter to the Editor: The Establishment of a New Chapter in the Neurosurgical Care of Patients with Limited Resources in Peru. World Neurosurg 2022; 158:316-317. [DOI: 10.1016/j.wneu.2021.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
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28
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Global neurosurgery amongst the EANS community: Where are we at? BRAIN AND SPINE 2022; 2:100911. [PMID: 36248142 PMCID: PMC9559959 DOI: 10.1016/j.bas.2022.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022]
Abstract
Awareness of Global Neurosurgery opportunities is limited in the EANS and a minority have had previous experiences with such activities. Most training programs and job environments don't encourage participation in Global Neurosurgery and mentors are lacking. However, most European neurosurgeons and trainees remain interested in Global Neurosurgery and are willing to participate. Junior trainees is the group with the highest rate of interest for Global Neurosurgery. Barriers exist that may limit participation in Global Neurosurgery, and funding is the most relevant.
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29
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Lartigue JW, Dada OE, Haq M, Rapaport S, Sebopelo LA, Ooi SZY, Senyuy WP, Sarpong K, Vital A, Khan T, Karekezi C, Park KB. Emphasizing the Role of Neurosurgery Within Global Health and National Health Systems: A Call to Action. Front Surg 2021; 8:690735. [PMID: 34708069 PMCID: PMC8542676 DOI: 10.3389/fsurg.2021.690735] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Worldwide, neurological disorders are the leading cause of disability-adjusted life years lost and the second leading cause of death. Despite global health capacity-building efforts, each year, 22.6 million individuals worldwide require neurosurgeon's care due to diseases such as traumatic brain injury and hydrocephalus, and 13.8 million of these individuals require surgery. It is clear that neurosurgical care is indispensable in both national and international public health discussions. This study highlights the role neurosurgeons can play in supporting the global health agenda, national surgical plans, and health strengthening systems (HSS) interventions. Methods: Guided by a literature review, the authors discuss key topics such as the global burden of neurosurgical diseases, the current state of neurosurgical care around the world and the inherent benefits of strong neurosurgical capability for health systems. Results: Neurosurgical diseases make up an important part of the global burden of diseases. Many neurosurgeons possess the sustained passion, resilience, and leadership needed to advocate for improved neurosurgical care worldwide. Neurosurgical care has been linked to 14 of the 17 Sustainable Development Goals (SDGs), thus highlighting the tremendous impact neurosurgeons can have upon HSS initiatives. Conclusion: We recommend policymakers and global health actors to: (i) increase the involvement of neurosurgeons within the global health dialogue; (ii) involve neurosurgeons in the national surgical system strengthening process; (iii) integrate neurosurgical care within the global surgery movement; and (iv) promote the training and education of neurosurgeons, especially those residing in Low-and middle-income countries, in the field of global public health.
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Affiliation(s)
| | | | - Makinah Haq
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Sarah Rapaport
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Setthasorn Zhi Yang Ooi
- Cardiff University School of Medicine, University Hospital of Wales Main Building, Cardiff, United Kingdom
| | | | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, United States
| | - Anchelo Vital
- School of Medicine and Pharmacy, State University of Haiti, Port-au-Prince, Haiti
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
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30
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Waran V, Thillainathan R, Karuppiah R, Pickard JD. Equitable Access to State-of-the-Art Medical Technology-a Malaysian Mini-Public-Private Partnership Case Study. World Neurosurg 2021; 157:135-142. [PMID: 34687934 DOI: 10.1016/j.wneu.2021.10.112] [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: 09/01/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries. METHODS A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return. RESULTS CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19. CONCLUSIONS Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.
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Affiliation(s)
- Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Ravindran Karuppiah
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John D Pickard
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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31
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Adegboyega G, Zolo Y, Sebopelo LA, Dalle DU, Dada OE, Mbangtang CB, Tetinou F, Kanmounye US, Alalade AF. The Burden of Traumatic Brain Injury in Sub-Saharan Africa: A Scoping Review. World Neurosurg 2021; 156:e192-e205. [PMID: 34520864 DOI: 10.1016/j.wneu.2021.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the growing incidence of traumatic brain injury (TBI) in Sub-Saharan Africa, there is yet to be a study to map the current burden of the disease on the continent. This scoping review aims to outline the literature on TBI. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. A search string was developed to identify studies relating to TBI epidemiology, management, and outcomes. The search was applied to Medline, Embase, and Global Medicus Index. RESULTS In total, 107 studies were included in the final analysis. More than one half originated from South Africa. Seventy-five studies were published in 2013 or later. Studies recruited a median of 115 patients: 83.5 male and 31 female. TBI affected all age groups (range = 0-105 years) and sexes but was more common among young males aged 20-40. Road traffic accidents caused TBI in a median of 71 patients. Other major causes included assault (median = 39.5) and falls (median = 12.5). Craniectomies were the most commonly reported surgical treatment (18.7%) followed by burr holes (7.5%). Four studies (3.7%) reported delays in seeking neurotrauma care, with delays in reaching a neurotrauma facility and delays in receiving care being reported in 15 studies (14%) each. Glasgow Outcome Scale score was reported in 28 (26.1%) studies, whereas quality of life measures were reported in 2 (1%). Younger age was associated with favorable outcomes. CONCLUSIONS There is an increased need for TBI research, education, and training in Sub-Saharan Africa. This will aid stakeholders in optimizing patient management and outcome.
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Affiliation(s)
- Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Francklin Tetinou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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32
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Rubiano AM, Griswold DP, Jibaja M, Rabinstein AA, Godoy DA. Management of severe traumatic brain injury in regions with limited resources. Brain Inj 2021; 35:1317-1325. [PMID: 34493135 DOI: 10.1080/02699052.2021.1972149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs. OBSERVATIONS The principal mechanisms for sTBI in RLRs are road traffic injuries (RTIs) and violence. Limitations of care include suboptimal or non-existent pre-hospital care, overburdened emergency services, lack of trained human resources, and surgical and intensive care. Low-cost neuromonitoring systems are currently in testing, and formal neurotrauma registries are forming to evaluate both long-term outcomes and best practices at every level of care from hospital transport to the emergency department (ED), to the operating room and intensive care unit (ICU). CONCLUSIONS AND RELEVANCE The burden of sTBI is highest in RLRs. As working-age adults are the predominantly affected age-group, an increase in disability-adjusted life years (DALYs) generates a loss of economic growth in regions where economic growth is needed most. Four multi-institutional collaborations between high-income countries (HICs) and LMICs have developed evidence and consensus-based documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.
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Affiliation(s)
- Andres M Rubiano
- Professor of Neurosciences and Neurosurgery, Universidad El Bosque - Bogota, Colombia/Medical and Research Director, Meditech Foundation, Cali, Colombia.,Global Health Research Group in Neurotrauma, Neuroscience Department, University of Cambridge, Cambridge, UK
| | - Dylan P Griswold
- , Candidate, Stanford Medical School, Stanford, CA, USA.,, Cambridge, UK
| | - Manuel Jibaja
- , School of Medicine International University. Intensive Care Unit - Hospital Eugenio Espejo, Quito, Ecuador
| | - Alejandro A Rabinstein
- Critical Care, Professor of Neurology, Medical Director of the Neuroscience ICU -, Mayo Clinic, USA
| | - Daniel Agustin Godoy
- Medical Director Neurointensive Care Unit, Sanatorio Pasteur; Assistant Professor of Intensive Care-Hospital San Juan Bautista-, Catamarca, Argentina
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33
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Rubiano AM, Griswold DP, Adelson PD, Echeverri RA, Khan AA, Morales S, Sánchez DM, Amorim R, Soto AR, Paiva W, Paranhos J, Carreño JN, Monteiro R, Kolias A, Hutchinson PJ. International Neurotrauma Training Based on North-South Collaborations: Results of an Inter-institutional Program in the Era of Global Neurosurgery. Front Surg 2021; 8:633774. [PMID: 34395505 PMCID: PMC8358677 DOI: 10.3389/fsurg.2021.633774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students. Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science. Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative. Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.
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Affiliation(s)
- Andrés M. Rubiano
- INUB-Meditech Research Group, Neuroscience Institute, Universidad El Bosque, Bogota, Colombia
- Meditech Foundation, Valle-Salud IPS Clinical Network, Cali, Colombia
- Division of Neurosurgery, National Institute of Health Research (NIHR) Global Health Research Group in Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
| | - Dylan P. Griswold
- Division of Neurosurgery, National Institute of Health Research (NIHR) Global Health Research Group in Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - P. David Adelson
- Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Raul A. Echeverri
- Meditech Foundation, Valle-Salud IPS Clinical Network, Cali, Colombia
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
| | - Ahsan A. Khan
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurological Surgery Service, Aga Khan University, Karachi, Pakistan
| | - Santiago Morales
- Meditech Foundation, Valle-Salud IPS Clinical Network, Cali, Colombia
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
| | - Diana M. Sánchez
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Training Program, Universidad de Ciencias Médicas, Havana, Cuba
| | - Robson Amorim
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Program, Federal University of Amazonas, Manaus, Brazil
| | - Alvaro R. Soto
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Service, UROS Clinic, Neiva, Colombia
| | - Wellingson Paiva
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Service, University of São Paulo Medical School, São Paulo, Brazil
| | - Jorge Paranhos
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Service, Hospital Santa Casa, Sao Joao del Rei, Brazil
| | - José N. Carreño
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Service, Santa Fe Foundation Hospital, Bogota, Colombia
| | - Ruy Monteiro
- Meditech Foundation, Neurotrauma and Global Surgery Fellowship Program, Cali, Colombia
- Neurosurgery Service, Hospital Miguel Couto, Rio de Janeiro, Brazil
| | - Angelos Kolias
- Division of Neurosurgery, National Institute of Health Research (NIHR) Global Health Research Group in Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- Division of Neurosurgery, National Institute of Health Research (NIHR) Global Health Research Group in Neurotrauma, University of Cambridge, Cambridge, United Kingdom
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Chaurasia B, Umana GE, Scalia G, Barresi F, Yağmurlu K, Soldozy S, Deora H, Raudino G, Graziano F, Nicoletti GF, Cicero S, Maugeri R, Tomasi SO, Zileli M, Graffeo CS, Herrera RR, Shah A, Ha Y, Chaurasiya RK, Kim HS, Sameshima T, Borba L, Rotta JM, Chowdhury D, Chaurasia RK, Grotenhuis A, Linfante I, Sekhar LN. Largest neurosurgical social media group and its impact on communication and research. Br J Neurosurg 2021; 36:58-62. [PMID: 34236265 DOI: 10.1080/02688697.2021.1947978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery. METHODS Facebook and Twitter metrics were extracted through each respective platform's analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases. RESULTS On Facebook, as of January 2021, the group had a total of 25.590 members (87.6% male), most commonly (29%) between 35 and 44 years of age with over 100 countries were represented. As of January 2021, they had amassed 6457 followers on Twitter. During the last 28 d between December 2020 and January 2021, the account published 65 tweets that garnered a total of 196,900 impressions. Twelve articles were identified in our literature review on the use of social media within the neurosurgical community. CONCLUSIONS NC is one of the most widely utilized neurosurgical social media resources available. Sharing knowledge has been broadened thanks to the recent social media evolution, and NC has become a leading player in disseminating neurosurgical knowledge.
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Affiliation(s)
- Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Centre, Gamma Knife Centre, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | | | - Kaan Yağmurlu
- Department of Neuroscience and Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Sauson Soldozy
- Department of Neuroscience and Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neuroscience, Bangalore, India
| | | | - Francesca Graziano
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.,Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | | | - Salvatore Cicero
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Centre, Gamma Knife Centre, Catania, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | | | - Mehmet Zileli
- Neurosurgery Department, Ege University, Izmir, Turkey
| | | | - Roberto R Herrera
- Neurosurgical Department, Belgrano Adventist Clinic, Buenos Aires, Argentina
| | - Abidha Shah
- Department of Neurosurgery, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal cord Institute, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | | | - Hyeun-Sung Kim
- Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul, Korea
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Japan
| | - Luis Borba
- Department of Neurosurgery, Federal University of Parana, Curitiba, Brazil
| | - Jose Marcus Rotta
- Department of Neurosurgery, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - Dhiman Chowdhury
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Andre Grotenhuis
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Italo Linfante
- Interventional Neuroradiology, Endovascular Neurosurgery, Baptist Hospital, Miami, FL, USA
| | - Laligam N Sekhar
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
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35
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Boyke AE, Shlobin NA, Sharma V, Detchou DKE, Rolle M. Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals. Neurosurgery 2021; 89:E171-E172. [PMID: 34114022 DOI: 10.1093/neuros/nyab199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andre E Boyke
- Albert Einstein College of Medicine Bronx, New York, USA
| | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
| | | | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Myron Rolle
- Program in Global Surgery and Social Change Harvard Medical School Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kissani N, Nafia S, El Khiat A, Bengamara N, Maiga Y, Sogoba Y, Ahmed A Ibrahim E, Agbetou M, Massi Daniel G, Assogba K, Matar Gaye N, Kuate Tegueu C, Hussein Ragab A, Razafimahefa J, Wilmshurst J, Naidoo A, Jabang JN, Watila M. Epilepsy surgery in Africa: state of the art and challenges. Epilepsy Behav 2021; 118:107910. [PMID: 33744795 DOI: 10.1016/j.yebeh.2021.107910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Epilepsy is an important public health problem representing 0.6% of the global burden of disease that particularly impacts people living in the lowest income countries where epilepsy incidence may be 10 fold more than in the developed world. The battery of treatments designed to counteract the clinical manifestations of this disease are various and range from a wide spectrum of antiseizure medicationand specific diets, to surgical techniques for resection of the epileptogenic focus. The aim of our study was to describe the State of the art of Epilepsy Surgery (ES) in Africa and examine ways to deal with the high surgical treatment gap. METHODOLOGY In an observational study, we prospectively disseminated questionnaires via email or directly administered to main epileptologists and neurologists involved in epilepsy care, in key African countries. We also conducted a literature search using PubMed, Google scholar on ES in all the African countries. RESULTS We received responses from the majority of African countries, which allowed us to identify 3 levels of care for ES in African countries, a first level that uses ES with invasive presurgical evaluation, a second level that uses ES but without invasive presurgical evaluation, and a third level that does not use ES, and we summarized these results on a map. DISCUSSION This paper studied the availability of ES as a treatment modality in several African countries. We aimed to establish optimal pathways for initiating ES with noninvasive Electroencephalography and readily available investigations. This could be achieved through collaboration with epilepsy programs in developed countries directly or by using telemedicine.
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Affiliation(s)
- Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience. Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco; Department of Neurology. University Teaching, Hospital Mohammed VI, Marrakesh, Morocco.
| | - Sanaa Nafia
- Laboratory of Clinical and Experimental Neuroscience. Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Abdelaati El Khiat
- Laboratory of Clinical and Experimental Neuroscience. Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | | | - Youssouf Sogoba
- Neurosurgery Department, Hospital Gabriel Touré, Bamako, Mali
| | - Eetedal Ahmed A Ibrahim
- Neurology Department. Alneelain University, National Centre for Neurological Centre, Khartoum, Sudan
| | | | | | - Komi Assogba
- Neurology Department, University Hospital, Campus of Lome, Togo
| | | | | | | | | | - Jo Wilmshurst
- Head of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Ansuya Naidoo
- Head of Clinical Unit and Consultant Neurologist (Greys Academic Hospital) Clinical Lecturer, South Africa
| | - John N Jabang
- Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Musa Watila
- Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria
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Nussbaum E, Graupman P, Lacey M, Harrison A, Lowary J, Touchette J, Nussbaum L. Transport of patients with giant disfiguring cranial tumors from Africa to the US for collaborative multidisciplinary treatment. Surg Neurol Int 2021; 12:175. [PMID: 34084603 PMCID: PMC8168801 DOI: 10.25259/sni_923_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/05/2021] [Indexed: 11/04/2022] Open
Abstract
Background Giant disfiguring cranial tumors are exceptionally rare and develop over the course of many years, typically in patients who lack access to medical care. Here, we describe four patients who were flown to our center for treatment by a multidisciplinary surgical team, who had previously been turned down for treatment at multiple international centers in Africa, Europe, and the United States (US) due to complexity and financial concerns. The case series describes socioeconomic implications and the feasibility of offering such care to patients from outside the US. Case Descriptions Four patients with giant skull disfiguring tumors were flown internationally and treated by a surgical team consisting of a complex cranial neurosurgeon, a craniofacial reconstructive plastic surgeon, and an oculoplastic surgeon. All patients underwent aggressive surgical therapy with the aim of complete tumor removal and simultaneous cranial reconstruction. A patient with osteogenic sarcoma underwent two additional resections in 3 years, with delayed reconstruction. They returned home but ultimately succumbed to the disease. A patient with ossifying fibroma required two follow-up procedures for cosmetic reconstruction and sought asylum in the US, where they remain today. Two additional patients, one with a giant plexiform neurofibroma and one with a cerebellopontine angle meningioma, achieved good results and returned to Africa 1 month and 3 weeks after surgery, respectively. Conclusion Resection of giant disfiguring cranial tumors and reconstruction of the impacted region requires an experienced multidisciplinary team. These cases can be managed by transporting such patients from areas without access to medical care to specialized centers able to provide excellent care.
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Affiliation(s)
- Eric Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
| | - Patrick Graupman
- Department of Neurosurgery, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Martin Lacey
- Department of Craniofacial and Plastic Surgery, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Andrew Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, United States
| | - Jodi Lowary
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
| | | | - Leslie Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
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Ferraris KP, Golidtum JP, Zuñiga BKW, Bautista MCG, Alcazaren JC, Seng K, Navarro JE. Recapitulating the Bayesian framework for neurosurgical outpatient care and a cost-benefit analysis of telemedicine for socioeconomically disadvantaged patients in the Philippines during the pandemic. Neurosurg Focus 2020; 49:E14. [DOI: 10.3171/2020.9.focus20695] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn the Philippines during recent months, a neurosurgical center that caters primarily to socioeconomically disadvantaged patients has encountered unprecedented changes in practice patterns brought about by the COVID-19 pandemic. In particular, the usual task of outpatient care has shifted to the telemedicine format, bringing along all of its attendant advantages and gargantuan challenges. The authors sought to determine the responsiveness of this telemedicine setup to the needs of their disadvantaged patients and explored the application of Bayesian inference to enhance the use of teleconsultation in daily clinical decision-making.METHODSThe authors used the following methods to assess the telemedicine setup used in a low-resource setting during the pandemic: 1) a cross-sectional survey of patients who participated in a medical consultation via telemedicine during the 16-week period from March 16, 2020, to July 15, 2020; 2) a cost-benefit analysis of the use of telemedicine by patients; and 3) a case illustration of a Bayesian approach application unique to the teleconsultation scenario.RESULTSOf the 272 patient beneficiaries of telemedicine in a 16-week period, 57 responded to the survey. The survey responses regarding neurosurgical outpatient care through telemedicine yielded high ratings of utility for the patients and their caregivers. According to 64% of respondents, the affordability of the telemedicine setup also prevented them from borrowing money from others, among other adverse life events prevented. There were realized financial gains on the part of the patients in terms of cost savings and protection from further impoverishment. The benefit-cost ratio was 3.51 for the patients, signifying that the benefits outweighed the costs. An actual teleconsultation case vignette was reported that is meant to be instructive and contributory to the preparedness of the neurosurgeon on the provider end of the service delivery.CONCLUSIONSTelemedicine holds promise as a viable and safe method for health service delivery during the pandemic. In the setting of a health system that is continually challenged by shortages of resources, this study shows that an effective telemedicine setup can come with high benefit-cost ratios and quality of care, along with the assurance of patient satisfaction. The potential for high-quality care can be enhanced by the inclusion of the Bayesian framework to the basic toolkit of remote clinical assessment. When confronted with choices in terms of differential diagnosis and tests, the rigor of a simple application of the Bayesian framework can minimize costs arising from uncertainties.
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Affiliation(s)
- Kevin Paul Ferraris
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Jared Paul Golidtum
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Brian Karlo W. Zuñiga
- 2Health Sciences Program, School of Science and Engineering, Loyola Schools, Ateneo de Manila University, Quezon City
| | - Maria Cristina G. Bautista
- 3Department of Economics, Finance and Accounting, Graduate School of Business, Professional Schools, Ateneo de Manila University, Makati; and
| | - Jose Carlos Alcazaren
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Kenny Seng
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
- 4Division of Neurosurgery, Department of Neurosciences, University of the Philippines–Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
| | - Joseph Erroll Navarro
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
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Niquen-Jimenez M, Wishart D, Garcia RM, Shlobin NA, Steinle J, Weiss H, Reynolds RA, Lam S, Rosseau G. A Bibliographic Analysis of the Most Cited Articles in Global Neurosurgery. World Neurosurg 2020; 144:e195-e203. [PMID: 32829020 PMCID: PMC7895493 DOI: 10.1016/j.wneu.2020.08.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. The aim of this study is to identify the most frequently cited articles in global neurosurgery through a bibliographic review to characterize articles and trends around this growing topic. METHODS The top most-cited articles in global neurosurgery were determined by searching the Web of Science database using a priori search terms. Articles with at least 5 citations were selected, and there were no time period or language restrictions. The data were extracted from each included article and all characteristics were summarized. RESULTS A total of 932 articles were identified using the search terms; 69 articles fulfilled inclusion criteria and 17 articles were selected that had more than 5 citations. The articles' number of citations ranged from 6 to 98 for the most-cited article. Authors from, or affiliated with, 14 countries contributed to the 17 articles, and the country that had the greatest representation was the United States. The main topic discussed was surgical capacity, the second topic was the treatment of different neurosurgical conditions, and volunteerism was the third topic. CONCLUSIONS There is currently a deficit in both the amount of literature surrounding the topic of global neurosurgery and how much that literature is cited. Developing innovative ways to increase academic productivity within, or in collaboration with, low-middle income countries is essential to contribute to global neurosurgery.
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Affiliation(s)
- Milagros Niquen-Jimenez
- Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Danielle Wishart
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern Medicine, Chicago, Illinois, USA; Institute for Global Health, Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA.
| | - Nathan A Shlobin
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julia Steinle
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Hannah Weiss
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rebecca A Reynolds
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandi Lam
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Neurological Surgery, Northwestern Medicine, Chicago, Illinois, USA; Division of Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Andrews RJ. In Reply to the Letter to the Editor Regarding "What's in a Name? 'Global Neurosurgery' in the 21st Century". World Neurosurg 2020; 143:646. [PMID: 33167163 DOI: 10.1016/j.wneu.2020.08.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Russell J Andrews
- World Federation of Neurosurgical Societies, Los Gatos, California, USA.
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Agrawal A, Shrivastava A, Mishra R, Raj S, Chouksey P. Letter to the Editor Regarding "What's in a Name? 'Global Neurosurgery' in the 21st Century". World Neurosurg 2020; 143:644-645. [PMID: 33167162 PMCID: PMC10016377 DOI: 10.1016/j.wneu.2020.08.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India.
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
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Silva ACV, de Oliveira Farias MA, Bem LS, Valença MM, de Azevedo Filho HRC. Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years. Neurotrauma Rep 2020; 1:93-99. [PMID: 34223535 PMCID: PMC8240881 DOI: 10.1089/neur.2020.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Decompressive craniectomy (DC) effectively reduces intracranial pressure (ICP), but is not considered to be a first-line procedure. We retrospectively analyzed sociodemographic, clinical, and surgical characteristics associated with the prognosis of patients who underwent DC to treat traumatic intracranial hypertension (ICH) at the Restauração Hospital (HR) in Recife, Brazil between 2015 and 2016, and compared the clinical features with surgical timing and functional outcome at discharge. The data were collected from 131 medical records in the hospital database. A significant majority of the patients were young adults (age 18-39 years old; 75/131; 57.3%) and male (118/131; 90.1%). Road traffic accidents, particularly those involving motorcycles (57/131; 44.5%), were the main cause of the traumatic event. At initial evaluation, 63 patients (48.8%) were classified with severe traumatic brain injury (TBI). Pupil examination showed no abnormalities for 91 patients (71.1%), and acute subdural hematoma was the most frequently observed lesion (83/212; 40%). Glasgow Outcome Scale (GOS) score was used to categorize surgical results and 51 patients (38.9%) had an unfavorable outcome. Only the Glasgow Coma Scale (GCS) score on admission (score of 3-8) was more likely to be associated with unfavorable outcome (p-value = 0.009), indicating that this variable may be a determinant of mortality and prognostic of poor outcome. Patients who underwent an operation sooner after injury, despite having a worse condition on admission, presented with clinical results that were similar to those of patients who underwent surgery 12 h after hospital admission. These results emphasize the importance of early DC for management of severe TBI. This study shows that DC is a common procedure used to manage TBI patients at HR.
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Affiliation(s)
- Ana Cristina Veiga Silva
- Department of Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
| | | | - Luiz Severo Bem
- Neurosurgery Department, Restauração Hospital, Recife, Brazil
| | - Marcelo Moraes Valença
- Department of Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
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Gnanakumar S, Abou El Ela Bourquin B, Robertson FC, Solla DJF, Karekezi C, Vaughan K, Garcia RM, Hassani FD, Alamri A, Höhne J, Mentri N, Stienen M, Laeke T, Moscote-Salazar LR, Al-Ahmari AN, Al-Jehani H, Nicolosi F, Samprón N, Adelson PD, Servadei F, Esene IN, Al-Habib A, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. World Neurosurg X 2020; 8:100083. [PMID: 33103109 PMCID: PMC7573644 DOI: 10.1016/j.wnsx.2020.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. METHODS This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. RESULTS There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. CONCLUSIONS These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.
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Affiliation(s)
- Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Faith C. Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Martin Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Tsegazeab Laeke
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Ignatius N. Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
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Geospatial Mapping of International Neurosurgical Partnerships and Evaluation of Extent of Training and Engagement. World Neurosurg 2020; 144:e898-e907. [PMID: 32992055 DOI: 10.1016/j.wneu.2020.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the presence, extent, and temporality of transnational neurosurgical partnerships, to understand and inform measures to address neurosurgical deficiencies in low- and middle-income countries (LMICs). METHODS A Web search was conducted to identify actors from high-income countries (HICs) participating in neurosurgical delivery and/or capacity-building with LMICs from 2010 to 2018. Descriptive data on current neurosurgical partnerships were collected from published case reports, literature reviews, reports from academic institutions, and information on stakeholder Web pages. The level of training and engagement of each partnership was separately graded based on prespecified criteria, in which grade 3 represented partnerships that have most extensive training and engagement, and grade 1, the least extent. Data were analyzed using descriptive statistics and geospatially depicted on ArcMap GIS software. RESULTS A total of 123 unique HIC-LMIC partnerships were described. Of these partnerships, 85 (69%) are derived from HICs in North America, followed by Europe, with 23 (19%). The most common LMIC partners were from Africa (n = 56, 45%) and Latin America (n = 32, 26%). In addition, most partnerships provided services in pediatric neurosurgery (88%). The most frequent engagement classifications were grade 2 (35%) or 1 (36%). Similarly, for training, the most common classifications were grade 1 (40%) or 2 (30%). CONCLUSIONS A robust network of HIC-LMIC partnerships exists with varying degrees of engagement and training activities. Several regions are particularly suitable for growth and development. Systematic consolidation and indexing of transnational neurosurgical partnerships aim to enhance resource allocation and present opportunities for future partnership.
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First Report of Traumatic Brain Injury in Luanda, Angola. World Neurosurg 2020; 143:e362-e364. [PMID: 32730976 DOI: 10.1016/j.wneu.2020.07.152] [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: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a global problem and is the greatest contributor to death and disability among all trauma-related injuries worldwide. Road traffic accidents are an important cause of TBI. The purpose of this paper is to present the first data on TBI in Angola. METHODS This was a retrospective study of the clinical and radiologic profile of patients admitted to the intensive care unit of a tertiary hospital in Luanda, Angola, from January 2018 to December 2018. The medical records of patients with moderate and severe TBI admitted to the intensive care unit were reviewed. The inclusion criteria were adult patients who suffered from TBI. The exclusion criteria were incomplete medical records, pediatric age, and mild TBI. RESULTS We included 29 patients (6 female) with a mean age of 31 years. Of them, 31% visited the hospital without an ambulance (using private or commercial vehicles), 58.6% suffered from severe TBI, and the mortality rate in our sample was 34.5%. Road accident was the most frequent cause of trauma. CONCLUSIONS This first report of TBI in Angola reveals major problems with TBI management, road accident prevention, prehospital management, and loss of lives of young patients.
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Uche EO, Ryttlefors M, Tisell M. Scaling Up Global Collaborations for Neurosurgical Education and Care Capacity Development in West Africa: Are There Low-Hanging Fruits Where It Tolls? World Neurosurg 2020; 139:512-518. [DOI: 10.1016/j.wneu.2020.04.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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Tropeano MP, Spaggiari R, Ileyassoff H, Mabunda DJD, Anania CD, Costa F, Fornari M, Sharif S, Zileli M, Park KB, Servadei F. Traumatic Spine Injury: Which Discrepancy Between the Research Output and the Actual Burden of the Disease? World Neurosurg 2020; 142:e117-e125. [PMID: 32592959 DOI: 10.1016/j.wneu.2020.06.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Traumatic spinal injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries. The aim of this study is to compare the epidemiological estimates of TSI with the corresponding amount of published papers for different regions. METHODS A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical World Health Organization regions. A "publication-to-volume ratio" was obtained by comparing the average number of documents per year with the number of TSI cases across each region. RESULTS A total of 2304 articles were detected from 2008 to 2018. The major publishing regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71, 3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). The United States is the most publishing country in AMR-US/Can (86.0%), and Germany in EUR (22.4%). In 2018, EUR published 36.6% of papers versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. The highest publication ratios of 4.63 and 2.68 were found for AMR-US/Can and EUR, respectively. The other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03), and AFR (0.01). CONCLUSIONS A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrate the need for increased inclusiveness in guidelines generation from high-income countries including collection and analysis from low- and middle-income countries.
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Affiliation(s)
| | | | - Hernán Ileyassoff
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Carla D Anania
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Francesco Costa
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Franco Servadei
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
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48
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Kato Y, Liew BS, Sufianov AA, Rasulic L, Arnautovic KI, Dong VH, Florian IS, Olldashi F, Makhambetov Y, Isam B, Thu M, Enkhbayar T, Kumarasinghe N, Bajamal AH, Nair S, Sharif S, Sharma MR, Landeiro JA, Yampolsky CG, El-Ghandour NMF, Hossain AM, Sim S, Chemate S, Burhan H, Feng L, Andrade H, Germano IM. Review of global neurosurgery education: Horizon of Neurosurgery in the Developing Countries. Chin Neurosurg J 2020; 6:19. [PMID: 32922948 PMCID: PMC7398343 DOI: 10.1186/s41016-020-00194-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/13/2020] [Indexed: 01/19/2023] Open
Abstract
Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competence-based programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato—one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.
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Affiliation(s)
- Y Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - B S Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Sungai Buloh, Selangor Malaysia
| | - A A Sufianov
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation, Tyumen, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - L Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K I Arnautovic
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, TN USA
| | - V H Dong
- Neurosurgery Center of Viet Duc university hospital, Hanoi, Vietnam
| | - I S Florian
- Department of Neurosurgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Cluj County Romania
| | - F Olldashi
- Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania
| | | | - B Isam
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation, Tyumen, Russia
| | - M Thu
- Neurosurgical Centre, Yangon General Hospital, Yangoon, Myanmar
| | - Ts Enkhbayar
- Mongolian Neurosurgical Society, Ulaabaatar, Mongolia
| | | | - A H Bajamal
- Department of Neurosurgery, Dr Soetomo General Hospital, Airlangga University, Surabaya, Indonesia
| | - S Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - S Sharif
- Institute of Postgraduate Studies and Medical Sciences, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - M R Sharma
- Department of Neurosurgery, TU Teaching Hospital, Kathmandu, Nepal
| | - J A Landeiro
- Department of Neurosurgery, Universidade Federal Fluminense, Niterói, Brazil
| | - C G Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N M F El-Ghandour
- Department of Neurosurgery, Faculty of Medicine, Cairo University, 81 Nasr Road, Nasr City, Cairo, Egypt
| | - A M Hossain
- Bangladesh Society of Neurosurgeons, Dhaka, Bangladesh
| | - S Sim
- Khema Clinic, 18 Street, Phnom Penh, 528 Cambodia
| | - S Chemate
- DNB Neurosurgery, Apollo Hospital, Chennai, India
| | - Hira Burhan
- Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - L Feng
- China International Neuroscience Institute, Beijing, China
| | - H Andrade
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
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49
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Lippa L, Kolias A. Meeting the need: capacity building and social responsibility in neurosurgery. Acta Neurochir (Wien) 2020; 162:983-984. [PMID: 32170390 DOI: 10.1007/s00701-020-04285-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Lippa
- Neurosurgery Department, Ospedali Riuniti di Livorno, Livorno, Italy.
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK
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50
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Germano IM. Book Review. World Neurosurg 2020. [DOI: 10.1016/j.wneu.2020.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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