Cohesion Between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: A Scoping Review

Achieving Equity Through Global Neurosurgery Research

Since the release of the Lancet Commission on Global Surgery report in 2015, there has been an increase in the number of published papers on global neurosurgery, gaining widespread support from major neurosurgery journals. However, there remains no consensus on what may be considered part of global neurosurgery literature. Here, we propose that global neurosurgery research encompasses all scholarly work that measure, explore, or address inequity in the care of neurosurgical disease. We describe the growth of global neurosurgery research, cite landmark papers, and discuss barriers to participation, particularly among neurosurgeons in low- and middle-income countries. We introduce the 3Rs framework, advocating for global neurosurgery research that is rigorous, responsive, and responsible. This narrative review aims to guide young neurosurgeons and other researchers interested in the field, and to provide a framework through which global neurosurgery practitioners and advocates can evaluate previously accomplished work, paving the way toward neurosurgery that is timely, safe, and affordable to all.

Neuro-oncological research output in Africa: a scoping review of primary brain tumors

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.

hglobal-Index: A Novel Author-Level Measure of the Diffusion of Scientific Ideas Among High-, Low-, and Middle-Income Countries

OBJECTIVE

To describe an intuitive and useful method for measuring the global impact of a medical scholar's research ideas by examining cross-border citations (CBCs) of peer-reviewed neurosurgical publications.

METHODS

Publication and citation data for a random sample of the top 50 most academically productive neurosurgeons were obtained from Scopus Application Programming Interface. We characterized an author-level global impact index analogous to the widely used h-index, the hglobal-index, defined as the number of published peer-reviewed manuscripts with at least the same number of CBCs. To uncover socioeconomic insights, we explored the hglobal-index for high-, middle-, and low-income countries.

RESULTS

The median (interquartile range) number of publications and CBCs were 144 (62-255) and 2704 (959-5325), respectively. The median (interquartile range) h-index and hglobal-index were 42 (23-61) and 32 (17-38), respectively. Compared with neurosurgeons in the random sample, the 3 global neurosurgeons had the highest hglobal-indices in low-income countries at 17, 13, and 9, despite below-average h-index scores of 33, 38, and 19, respectively.

CONCLUSION

This intuitive update to the h-index uses CBCs to measure the global impact of scientific research. The hglobal-index may provide insight into global diffusion of medical ideas, which can be used for social science research, author self-assessment, and academic promotion.

Insights into head and neck cancer research in Egypt: A scoping review

BACKGROUND

Head and neck cancer (HNC) encompasses malignant tumors in areas like the oral cavity, pharynx, and larynx. This analysis identifies strengths and deficiencies in HNC research, aiming to improve published papers' quality, quantity, and diversity. It also encourages more participation from oncologists, particularly in Egypt, to bridge the gap with Western healthcare standards.

METHODS

A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and Embase. The goal was to gather research articles on HNC in Egypt published from January 1, 2000, to December 31, 2022.

RESULTS

From 2150 articles, 1329 were screened by title and abstract, leading to 193 for full-text review. Finally, 174 articles were included in the final analysis. 2020 saw the highest number of publications. The majority were primary research articles, with randomized controlled trials being prevalent. Most studies were clinical, focusing on radiotherapy, and involved adult patients, emphasizing service delivery. Publications were predominantly in non-Egyptian journals, with the Egyptian Journal of Radiology and Nuclear Medicine being the most frequent. Research was mainly conducted by Egyptian authors and at Cairo University.

CONCLUSION

The growing prevalence of HNC in Egypt underscores the need for more comprehensive research on its various aspects, including etiology, risk factors, and prevention. There's a call for increased research outputs at different Egyptian universities, multicenter studies, and international collaborations. This approach can improve the understanding and management of HNC, contributing to global discussions and advancing treatment and prevention strategies in Egypt.

Artificial intelligence in emergency medicine. A systematic literature review

Motivation and objective: Emergency medicine is becoming a popular application area for artificial intelligence methods but remains less investigated than other healthcare branches. The need for time-sensitive decision-making on the basis of high data volumes makes the use of quantitative technologies inevitable. However, the specifics of healthcare regulations impose strict requirements for such applications. Published contributions cover separate parts of emergency medicine and use disparate data and algorithms. This study aims to systematize the relevant contributions, investigate the main obstacles to artificial intelligence applications in emergency medicine, and propose directions for further studies.

METHODS

The contributions selection process was conducted with systematic electronic databases querying and filtering with respect to established exclusion criteria. Among the 380 papers gathered from IEEE Xplore, ACM Digital Library, Springer Library, ScienceDirect, and Nature databases 116 were considered to be a part of the survey. The main features of the selected papers are the focus on emergency medicine and the use of machine learning or deep learning algorithms.

FINDINGS AND DISCUSSION

The selected papers were classified into two branches: diagnostics-specific and triage-specific. The former ones are focused on either diagnosis prediction or decision support. The latter covers such applications as mortality, outcome, admission prediction, condition severity estimation, and urgent care prediction. The observed contributions are highly specialized within a single disease or medical operation and often use privately collected retrospective data, making them incomparable. These and other issues can be addressed by creating an end-to-end solution based on human-machine interaction.

CONCLUSION

Artificial intelligence applications are finding their place in emergency medicine, while most of the corresponding studies remain isolated and lack higher generalization and more sophisticated methodology, which can be a matter of forthcoming improvements.

Characteristics of the clinical and global neurosurgical research publications from Africa: A scoping review

Introduction

Scientific research has a direct, profound impact on healthcare systems worldwide. While an upward trend can be observed in the number of produced papers in the neurosurgical specialty, disparities still exist between African neurosurgeons on one side and between African neurosurgeons and neurosurgeons from high income countries, on the other.

Research question

This study aims to analyze neurosurgical research produced in Africa to identify gaps in the literature and provide recommendations for aspiring African neurosurgeons for essential research areas.

Materials and methods

Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were systematically searched for relevant articles on neurosurgery published by African authors. The three main inclusion criteria were: Articles published in the Neurosurgical field, articles published by African authors (whether first authors or co-authors) and articles published in Africa. Data extracted included the study design, scope, neurosurgical subspecialty, and the authors' nationalities.

Results

A total of 982 articles were included in the analysis. Of these articles, 889 (90.6%) were primary, 48 (4.9%) secondary, and 44 (4.5%) other types of research. Global Neurosurgery papers represent 7% of African neurosurgery research output. Most common primary studies included retrospective cohort (32.4%), case reports (28.3%), and prospective cohort (13.8%) studies. The most common secondary research articles were literature reviews (4.9%), letters to the editor (1.2%), and systematic reviews and meta-analyses (0.8%). Common research areas were neuro-oncology 242 (24.7%), spinal surgery 157 (16%), and cerebrovascular (14%). The most common nationalities of the first authors were Egyptian (32.4%), Moroccan (15%), and Nigerian (14.2%).

Discussion and conclusion

This study identifies increased African authorship in neurosurgical research in recent years. Nevertheless, many countries still lack representation in the neurosurgical research scene.Furthermore, a high percentage of the published papers is of low evidence. Therefore, we recommend that African neurosurgical researchers focus more on clinical trials and systematic reviews that directly translate to improving clinical practice. African neurosurgeons should also consider more collaboration between African authors.

Neurosurgery Research Productivity in Latin American and Caribbean Countries: A Bibliometric and Visualized Study

OBJECTIVES

Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean.

METHODS

A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures, and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer.

RESULTS

We identified 882 articles published in 271 journals. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9, and the average number of citations per document was 11.2. The author with the highest number of publications was Teixeira MJ (41 articles), and the University of Sao Paulo had the highest number of articles on this topic. WORLD NEUROSURGERY was the journal with the most publications (120 articles), and the study by Carney et al (2017) was the most cited (1175 citations). The country of corresponding authors with the most publications and the greatest number of total citations was Brazil. Surgery, and Management were the most used keywords plus; however, in the most recent articles Simulation and Guidelines were used.

CONCLUSIONS

In the past decade, there has been an increase in articles on neurosurgery in Latin America and the Caribbean. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine.

Increasing Equity in Medical Student Neurosurgery Education Through Distance Learning

OBJECTIVE

Addressing equitable opportunities for medical student (MS) education is important for minimizing disparities in neurosurgical care. However, international MSs, particularly from low- and middle-middle income countries (LMICs) may lack access to educational opportunities compared with their contemporaries in high-income countries. We compare the usefulness of virtual neurosurgery training camps (VNTC) between U.S. and international MSs.

METHODS

A survey assessing demographics, baseline interests, and ratings of usefulness was sent to attendees after the VNTC. Ratings were compared between international and U.S. MSs.

RESULTS

Thirty-three (27.7%) of 119 attendees were international MSs, of whom 24 (72.7%) were from LMICs. International MSs were more likely to hold an advanced degree (P = 0.0009), more likely to be MS3/MS4s (P = 0.0111) or postdoctoral (P < 0.0001), and less likely to be MS1/MS2s (P = 0.0059). After the VNTC, international MSs reported greater increase in interest in neurosurgery in general (P = 0.0009) and subspecialties of spine (P = 0.0002), peripheral nerve (P = 0.002), vascular (P = 0.0468), functional/epilepsy (P = 0.001), pediatric (P = 0.0285), and trauma/neurocritical care (P = 0.0067). International MSs reported greater post-VNTC willingness to pursue a career in neurosurgery (P = 0.0001), likelihood of taking a year off during medical school (P = 0.0363), and preparedness for subinternships (P = 0.0003). International MSs reported greater increases in awareness of burnout (P = 0.0157) and work-life balance in neurosurgery (P = 0.0249).

CONCLUSIONS

International MSs experience prolonged periods of education before applying to residency and have unmet informational needs. Distance learning is useful for international MSs. MS neurosurgery education, through online platforms, represents a long-term strategy for addressing disparities in neurosurgical care worldwide.

Basic and clinical research publications of Indonesian neurosurgeons: Where are we?

Background

With changes in European and the US academia and education systems, research has become a measurement to define academic productivity, as it is a crucial component in the process of becoming a well-trained neurosurgeon. In this recent study, we aimed to reveal the current status and challenges facing neurosurgical research in Indonesia.

Methods

An open-access PubMed MEDLINE database search was performed to reveal all articles published by Indonesian Neurosurgeons from 1980 to July 2021. The detail was extracted to the following parameters: academia center or city of the study, year of publication, study type, topic, journal, institution and Q status, first author, article citation, international collaboration, and the working field. These data were processed and examined.

Results

During 1980 and July 2021, a total of 242 PubMed-indexed papers were published from Indonesia. The number of publications started increasing significantly from 2010 to 2021, with an average of 19 papers per year since 2010. Most of the studies came from Bandung (22.7%), with Universitas Padjadjaran as the center of the study. According to the paper type, the majority of the articles were basic and clinical research (45.5%). The most common study type was case reports (33.5%). Neurotrauma (21.9%) was the most frequent topic followed by neuro-oncology (21.07%) and spine trauma (11.98%).

Conclusion

Published articles in the neurosurgery field in Indonesia has shown a higher, promising trend. Despite many challenges faced in the process, there was significant progress in the past few decades compared to the previous ones. A comprehensive deliberate plan and multidisciplinary effort that focuses on overcoming the problems regarding defining academic productivity is needed for further improvement of neurosurgical care in Indonesia.

Neurosurgery Research Output in Ethiopia: A Scoping Review

BACKGROUND

Neurosurgery-specific research plays a critical role in improving outcomes in patients with neurosurgical diseases. Despite the high burden of neurosurgical diseases in Ethiopia, little is known about types of neurosurgical research from Ethiopia. The goal of this scoping review is to assess the quantity and types of neurosurgical research published in peer-reviewed journals by authors from Ethiopia.

METHODS

PubMed, CINAHL, Embase, and Scopus were searched for Ethiopian neurosurgery literature published from 2001 to 2021. We selected articles based on the following criteria: articles must 1) discuss topics within neurosurgery and 2) focus on clinical practice and/or public health in Ethiopia. We collected data on research originality, study designs, and clinical versus public health research. The frequencies and percentages of categorical variables were reported. All analyses were conducted using Jamovi software.

RESULTS

Of the 362 results, 89 neurosurgical research articles were included in the final analysis. Of the 89 articles, case reports/series were most common (28.7%), followed by retrospective cohort (20.7%) and prospective cohort studies (18.4%). There were 8 literature reviews (9.2%) and 1 systematic review and meta-analysis (1.1%). No randomized controlled trial was found. Of all articles, 66 (75.9%) focused on clinical practice, and 21 (23.6%) were related to the public health aspect of neurosurgery. Forty-two articles (48.3%) included authors only from Ethiopia; 37 articles (42.5%) involved collaboration between Ethiopian and authors from another country, and 8 articles (9.2%) did not have Ethiopian authors.

CONCLUSIONS

Neurosurgery research from Ethiopia is lacking, despite its high disease burden. Case reports/series and cohort studies remain the mainstay, with few systematic reviews and no randomized controlled trial. International collaboration accounts for approximately half of Ethiopian neurosurgery research output. Further research support and infrastructure should be developed to encourage neurosurgery articles from Ethiopia.

Emphasizing the Role of Neurosurgery Within Global Health and National Health Systems: A Call to Action

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.

Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery

BACKGROUND

Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery.

METHODS

A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted.

RESULTS

We summarize pearls that all medical students interested in global neurosurgery should know.

DISCUSSION

To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.