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Ramsay IA, Govindarajan V, Elarjani T, Abdelsalam A, Silva M, Starke RM, Luther E. Impact of COVID-19 pandemic on treatment and outcomes of cerebral arteriovenous malformations. J Neurointerv Surg 2024; 16:318-322. [PMID: 37586818 DOI: 10.1136/jnis-2023-020735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND There has been a recent decrease in interventional management of cerebral arteriovenous malformations (AVMs). The objective of our study was to evaluate the changing patterns in management of AVMs in the first year of the COVID-19 pandemic. METHODS The National Inpatient Sample (NIS) database was used. From 2016 to 2020, patients with an International Classification of Diseases, 10th revision (ICD-10) diagnosis code for a cerebral AVM were included. An intervention was defined as ICD-10 code for surgical, endovascular, or stereotactic radiosurgery treatment. Odds ratios (ORs) were calculated using a logistic regression model with covariates deemed to be clinically relevant. RESULTS 63 610 patients with AVMs were identified between 2016 and 2020, 14 340 of which were ruptured. In 2020, patients had an OR of 0.69 for intervention of an unruptured AVM (P<0.0001) compared with 2016-19. The rate of intervention for unruptured AVMs decreased to 13.5% in 2020 from 17.6% in 2016-19 (P<0.0001). The rate of AVM rupture in 2020 increased to 23.9% from 22.2% in 2016-19 (P<0.0001). In 2020, patients with ruptured AVMs had an OR for inpatient mortality of 1.72 compared with 2016-19. Linear regression analysis from 2016 to 2020 showed an inverse relationship between intervention rate and rupture rate (slope -0.499, R2=0.88, P=0.019). CONCLUSION In 2020, the rate of intervention for unruptured cerebral AVMs decreased compared with past years, with an associated increase in the rate of rupture. Patients with ruptured AVMs also had a higher odds of mortality.
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Affiliation(s)
- Ian A Ramsay
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Silva
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Amsiguine N, El Houss S, Mouhssani M, Moatassim Billah N, Ittimad N. A rare case of a median nerve schwannoma: Case report. Radiol Case Rep 2024; 19:479-482. [PMID: 38046923 PMCID: PMC10692475 DOI: 10.1016/j.radcr.2023.09.105] [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] [Received: 06/17/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 12/05/2023] Open
Abstract
A median nerve schwannoma is an uncommon type of tumor that develops from Schwann cells in the peripheral nerves. We present a case report of a young prisoner with a rare median nerve schwannoma presenting as a swelling on the anterior aspect of the right wrist along the radial edge, with associated paresthesia and a positive Tinel's sign. The case was diagnosed using MRI which showed the target sign of biphasic contrast enhancement in both the mass's center and periphery as well as distinct encapsulation. The mass was managed with surgical excision which confirmed the mass to be a neurilemmoma. The radiological finding for neurinomas are not specific and the diagnosis cannot be established unless an excision is made, as neurinomas share common radiological signs with other peripheral nerve tumors and vascular tumors. This case highlights the importance of considering nerve sheath tumors, however rare, in the differential diagnosis of wrist masses, even in young patients with no history of trauma.
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Affiliation(s)
- Najwa Amsiguine
- Department of Radiology, Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
| | - Salma El Houss
- Department of Radiology, Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
| | - Mohamed Mouhssani
- Department of neurosurgery, Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
| | | | - Nassar Ittimad
- Department of Radiology, Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
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3
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Kabangu JLK, Yekzaman BR, Heskett CA, Rouse AG, Chamoun RB. Neurosurgery Resident Attrition Rates Defy Trends and Decrease During COVID-19 Pandemic. World Neurosurg 2023; 179:e374-e379. [PMID: 37648202 DOI: 10.1016/j.wneu.2023.08.093] [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: 07/15/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE We sought to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on U.S. neurosurgery resident attrition. We report the changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic. METHODS Neurosurgery resident attrition data reported by the American Council of Graduate Medical Education for the academic year starting in July 2007 to the academic year ending in June 2022 were collected, and the rate of attrition was calculated. Individual postgraduate year program transfer rates were also calculated for the previous 7 consecutive academic years. The attrition rates for the academic years before the pandemic were compared with those during the pandemic. RESULTS A total of 465 residents did not graduate from neurosurgical training during the past 15 academic years, of which 3 years were at least partially during the COVID-19 pandemic, resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those before the pandemic (1.7% vs. 2.7%; P < 0.001), driven largely by a nearly twofold decrease in the withdrawal rate (0.67% vs. 1.2%; P = 0.003). Bivariate regression between the withdrawal and attrition rates showed a statistically significant correlation (r = 0.809; P < 0.001; r2 = 0.654). The first full year of the COVID-19 pandemic saw the most dramatic changes, with a z score for attrition of -1.9. Linear regression of the effect of training during the COVID-19 pandemic on attrition revealed a statistically significant difference (r = 0.563; P = 0.029; r2 = 0.317). The rate of withdrawal was most affected by training during the pandemic (r = 0.594; P = 0.010; r2 = 0.353). CONCLUSIONS A statistically significant decline occurred in the rate of neurosurgery resident attrition during the COVID-19 pandemic that was most notable during the first full academic year (2020-2021). These findings were largely driven by a decrease in residents withdrawing from training programs. This contrasts with the overall trend toward resignation among healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition toward a new normal. Future studies should examine trends in the attrition rates after the COVID-19 pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.
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Affiliation(s)
- Jean-Luc K Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | - Bailey R Yekzaman
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Cody A Heskett
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Adam G Rouse
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Roukoz B Chamoun
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Elarjani T, Lu VM, Berry KM, Eichberg DG, Ivan ME, Komotar RJ, Luther EM. Commentary: Invention of an Online Interactive Virtual Neurosurgery Simulator With Audiovisual Capture for Tactile Feedback. Oper Neurosurg (Hagerstown) 2023; 24:e232-e233. [PMID: 36701687 DOI: 10.1227/ons.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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5
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Kuo CC, Aguirre AO, Kassay A, Donnelly BM, Bakr H, Aly M, Ezzat AA, Soliman MA. A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training. SCIENTIFIC AFRICAN 2023; 19:e01504. [PMID: 36531434 PMCID: PMC9747235 DOI: 10.1016/j.sciaf.2022.e01504] [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: 10/28/2022] [Revised: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training. Methods We performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was presented as pooled odds ratio (OR) and 95% confidence intervals (CI). Results A total of 49 studies met the inclusion criteria, of which 12 (24.5%) were survey-based. The case volume of elective surgeries and non-elective procedures decreased by 70.4% (OR=0.296, 95%CI 0.210-0.418) and 68.2% (OR=0.318, 95%CI 0.193-0.525), respectively. A significant decrease was also observed in functional (OR=0.542, 95%CI 0.394-0.746), spine (OR=0.545, 95%CI 0.409-0.725), and skull base surgery (OR=0.545, 95%CI 0.409-0.725), whereas the caseloads for tumor (OR=1.029, 95%CI 0.838-1.263), trauma (OR=1.021, 95%CI 0.846-1.232), vascular (OR=1.001, 95%CI 0.870-1.152), and pediatric neurosurgery (OR=0.589, 95%CI 0.344-1.010) remained relatively the same between pre-pandemic and pandemic periods. The reduction in caseloads had caused concerns among residents and program directors in regard to the diminished clinical exposure, financial constraints, and mental well-being. Some positives highlighted were rapid adaptation to virtual educational platforms and increasing time for self-learning and research activities. Conclusion While COVID-19 has brought about significant disruptions in neurosurgical practice and training, this unprecedented challenge has opened the door for technological advances and collaboration that broaden the accessibility of resources and reduce the worldwide gap in neurosurgical education.
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Affiliation(s)
- Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Andrea Kassay
- Department of Neurosurgery, Western University, Windsor, Canada
| | - Brianna M. Donnelly
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | | | - Mohamed Aly
- Department of Radiology, National Heart Institute, Giza, Egypt
| | - Ahmed A.M. Ezzat
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A.R. Soliman
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA,Corresponding author at: Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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6
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Idowu O, Oshola H, Idowu J, Omosuyi A. A tropical tertiary neurosurgical centre response to COVID-19 pandemic and its effect on neurosurgical practices. Afr Health Sci 2022; 22:512-519. [PMID: 36910393 PMCID: PMC9993300 DOI: 10.4314/ahs.v22i3.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics.
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Affiliation(s)
- Olufemi Idowu
- Lagos State University College of Medicine, Surgery (Neurosurgery Unit).,Lagos State University Teaching Hospital, Surgery (Neurological Surgery Unity)
| | - Hammed Oshola
- Lagos State University Teaching Hospital, Surgery (Neurological Surgery Unity)
| | - Jeuel Idowu
- Lagos State University Teaching Hospital, Surgery (Neurological Surgery Unity)
| | - Ademola Omosuyi
- Lagos State University Teaching Hospital, Surgery (Neurological Surgery Unity)
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Zhang JK, Del Valle A, Ivankovic S, Patel N, Alexopoulos G, Khan M, Durrani S, Patel M, Tecle NE, Sujijantarat N, Jenson AV, Zammar SG, Huntoon K, Goulart CR, Wilkinson BM, Bhimireddy S, Britz GW, DiLuna M, Prevedello DM, Dinh DH, Mattei TA. Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100104. [PMID: 35224520 PMCID: PMC8856749 DOI: 10.1016/j.xnsj.2022.100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022]
Abstract
Background The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads. Methods A retrospective review of neurosurgical caseloads among seven residency programs between March 2019 and April 2020 was conducted. Cases were grouped by ACGME Neurosurgery Case Categories, subspecialty, and urgency (elective vs. emergent). Residents caseloads were stratified into junior (PGY1-3) and senior (PGY4-7) levels. Descriptive statistics are reported for individual programs and pooled across institutions. Results When pooling across programs, the 2019 monthly mean (SD) case volume was 214 (123) cases compared to 217 (129) in January 2020, 210 (115) in February 2020, 157 (81), in March 2020 and 82 (39) cases April 2020. There was a 60% reduction in caseload between April 2019 (207 [101]) and April 2020 (82 [39]). Adult spine cases were impacted the most in the pooled analysis, with a 66% decrease in the mean number of cases between March 2020 and April 2020. Both junior and senior residents experienced a similar steady decrease in caseloads, with the largest decreases occurring between March and April 2020 (48% downtrend). Conclusions Results from our multicenter study reveal considerable decreases in caseloads in the neurosurgical specialty with elective adult spine cases experiencing the most severe decline. Both junior and senior neurosurgical residents experienced dramatic decreases in case volumes during this period. With the steep decline in elective spine cases, it is possible that fellowship directors may see a disproportionate increase in spine fellowships in the coming years. In the face of the emerging Delta and Omicron variants, programs should pay attention toward identifying institution-specific deficiencies and developing plans to mitigate the negative educational effects secondary to such caseloads reduction.
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Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Armando Del Valle
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Sven Ivankovic
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Niel Patel
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Georgios Alexopoulos
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Maheen Khan
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Sulaman Durrani
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Mayur Patel
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | - Najib El Tecle
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
| | | | - Amanda V Jenson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, 77030, US
| | - Samer G Zammar
- Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, 17033, US
| | - Kristin Huntoon
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Carlos R Goulart
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, 13210, US
| | - Brandon M Wilkinson
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, 13210, US
| | - Sujit Bhimireddy
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, 77030, US
| | - Michael DiLuna
- Department of Neurosurgery, Yale University, New Haven, Connecticut, 06510, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Dzung H Dinh
- Department of Neurological Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, 61605, US
| | - Tobias A Mattei
- Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, 63104, US
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Permana GI, Faris M, Subagio EA, Bajamal AH. The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country. Surg Neurol Int 2022; 12:620. [PMID: 34992936 PMCID: PMC8720481 DOI: 10.25259/sni_708_2021] [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] [Received: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure. Methods: This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic). Results: A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05). Conclusion: The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Airlangga University, - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Airlangga University, - Dr. Soetomo General Academic Hospital, Surabaya, West Java, Indonesia
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Chen SY, Lo HY, Hung SK. What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis. BMC MEDICAL EDUCATION 2021; 21:618. [PMID: 34911503 PMCID: PMC8671601 DOI: 10.1186/s12909-021-03041-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/25/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles. METHODS A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. RESULTS In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field. CONCLUSIONS The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.
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Affiliation(s)
- Shou-Yen Chen
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences; Division of Medical Education, College of Medicine, Chang Gung University, 333, Taoyuan City, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan
| | - Shang-Kai Hung
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333, Taoyuan City, Taiwan.
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The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review. Neurosurg Rev 2021; 45:1101-1110. [PMID: 34623526 PMCID: PMC8497188 DOI: 10.1007/s10143-021-01664-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.
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11
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Garg K, Mishra S, Raheja A, Verma S, Tandon V, Agrawal S, Suri A, Chandra PS, Prada F, Servadei F, Kale SS, Srivastava P. Hybrid Workshops During the COVID-19 Pandemic-Dawn of a New Era in Neurosurgical Learning Platforms. World Neurosurg 2021; 157:e198-e206. [PMID: 34624519 PMCID: PMC8523585 DOI: 10.1016/j.wneu.2021.09.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
Background During the COVID-19 pandemic, disruption of surgical hands-on training has hampered the skills acquisition by budding neurosurgeons. Online and virtual classrooms have not been able to substitute the hands-on experience and learning via direct interaction with senior colleagues. To overcome these challenges, we organized a hybrid workshop where simulation-based learning modules, and direct and virtual interaction with surgeons during live surgeries or didactic lectures were utilized to help delegates in understanding the nuances of neurosurgery. Methods A 3-day hybrid workshop was held in March 2021, which was attended by 133 delegates. A structured questionnaire was utilized to record their feedback. Results An overwhelming majority of the respondents (94.1%, n = 64) found hybrid conferences to be better than an online conference. Most of the respondents (88.3%, n = 60) rated the utility of direct face-to-face interaction to be more satisfying as compared with online interaction with faculty during a webinar. Again, many the respondents (86.8%, n = 59) believed that similar hybrid events will be the new normal given the current situation of COVID-19 pandemic. A large majority (88.2%, n = 60) of the respondents reported that they will prefer a hybrid event over an online conference. Conclusions In this era of the COVID-19 pandemic, “hybrid” microneurosurgery workshops offer unique opportunities to enhance surgical skills acquisition by hands-on simulation-based learning and observing live surgical demonstrations, apart from 2-way interactions with experts under one roof. This may be a stepping stone for what lies ahead in the future of neurosurgical training.
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Affiliation(s)
- Kanwaljeet Garg
- 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
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- 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.
| | - Siddharth Agrawal
- Department of Ophthalmology, King George's Medical University, Lucknow, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Francesco Prada
- Neurosurgery Unit, Department of Neuroscience, Ospedale A. Manzoni, ASST Lecco, Italy; Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA; Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milano, Italy
| | - S S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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12
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Letter to the Editor Regarding "Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center". World Neurosurg 2021; 154:181. [PMID: 34583478 PMCID: PMC8461640 DOI: 10.1016/j.wneu.2021.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022]
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13
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Azab MA, Azzam AY. Impact of COVID-19 pandemic on the management of glioma patients around the world. An evidence-based review. BRAIN DISORDERS 2021; 2:100012. [PMID: 33997826 PMCID: PMC8106822 DOI: 10.1016/j.dscb.2021.100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background The coronavirus pandemic has affected many health care services worldwide since the emergence of the first case in Wuhan. Surgical neuro-oncology care is a fundamental part of hospital services, making it susceptible to strategic changes amid the COVID-19 pandemic. Methods An electronic search on several databases (PubMed/Medline, Scopus, and Google Scholar) from the beginning of the pandemic to the end of 2020, each paper was reviewed independently. The publication inclusion and exclusion criteria were done using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results Eight studies were found to be eligible for our meta-analysis. Most of the studies were on a retrospective basis, except one which was retrospective and prospective. An overall of 951 glioma patients’ were included for surgical admission from the beginning of the pandemic until 2020. Seventy-four patients' had mortality outcomes, and 250 patients had complications for both surgical admitted and non-surgical admitted purposes. Conclusions To our knowledge, we made the first systematic review and meta-analysis regarding the management of glioma patients’ during the pandemic of COVID-19. Our main findings are that the number of surgical admissions for glioma patients’ did not significantly differ between COVID-19 negative and COVD-19 positive cases; however, surprisingly, we found that both overall complications and mortality outcomes were more significant COVID-19 negative patients’ from the reported studies.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Ahmed Y Azzam
- October 6 University Faculty of Medicine, Giza, Egypt
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14
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Sahin B, Hanalioglu S. The Continuing Impact of Coronavirus Disease 2019 on Neurosurgical Training at the 1-Year Mark: Results of a Nationwide Survey of Neurosurgery Residents in Turkey. World Neurosurg 2021; 151:e857-e870. [PMID: 33974985 DOI: 10.1016/j.wneu.2021.04.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic has led to a significant transformation in medical practice and training. This nationwide survey study aims to evaluate the 1-year impact of the pandemic on training of neurosurgical residents. METHODS A 38-question Web-based survey was sent to 356 neurosurgery residents. Two hundred and thirty-five participated in the study (66% response rate), representing more than half of all neurosurgical residents in the country. RESULTS Assignment to direct COVID-19 medical care was common (85.5%). Many of the neurosurgery residents (37.9%) were tested positive for COVID-19. Almost half of the respondents reported a decrease in work hours. Most participants (84.3%) reported a decline in total operative case volume (mean change, -29.1% ± 1.6%), largely as a result of a decrease in elective (-33.2% ± 1.6%) as opposed to emergency cases (-5.1% ± 1.8%). For theoretic education, most respondents (54.9%) indicated a negative impact, whereas 25.1% reported a positive impact. For practical training, most respondents (78.7%) reported an adverse effect. A decrease in elective surgical case volume predicted a positive impact on theoretic training but a negative impact on practical training. Research productivity was reported by 33.2% to have decreased and by 23% to have increased. Forty-two percent indicated an increase in concerns about their training and career, with a negative impact on practical training being the most important predictor. Most (57.4%) had considered extending residency training to overcome negative effects of the pandemic. CONCLUSIONS COVID-19 has had a significant impact on neurosurgical practice and training. Effective measures should be used to mitigate these effects and better prepare for the future challenges.
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Affiliation(s)
- Balkan Sahin
- Department of Neurosurgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Sisli, Istanbul, Turkey
| | - Sahin Hanalioglu
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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15
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Letter to the Editor Regarding "Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs". World Neurosurg 2021; 146:411-413. [PMID: 33607741 DOI: 10.1016/j.wneu.2020.10.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
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16
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Letter to the Editor Regarding "'Staying Home'-Early Changes in Patterns of Neurotrauma in New York City During the COVID-19 Pandemic". World Neurosurg 2021; 146:407-409. [PMID: 33607739 DOI: 10.1016/j.wneu.2020.10.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
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17
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Basil G, Luther E, Burks JD, Govindarajan V, Urakov T, Komotar RJ, Wang MY, Levi AD. The Focused Neurosurgical Examination During Telehealth Visits: Guidelines During the COVID-19 Pandemic and Beyond. Cureus 2021; 13:e13503. [PMID: 33786212 PMCID: PMC7992292 DOI: 10.7759/cureus.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To provide guidelines to healthcare workers for performing a focused neurological examination via telemedicine during the coronavirus disease-2019 (COVID-2019) pandemic. METHODS We reviewed our department's outpatient clinic visits after the implementation of a telemedicine protocol in response to the COVID-19 crisis. Crossover rates from telehealth to in-person visits were evaluated and guidelines for performing a telemedicine neurological exam were created based on the consensus of 16 neurosurgical attending providers over a four-month period. RESULTS From March 23, 2020 to July 20, 2020, some 2157 telehealth visits were performed in our department. Some 26 were converted to in-person visits by the provider request with the most cited reason for conversion being the need for a more detailed patient evaluation. Based on these experiences, we created a graphical tutorial to address the key components of the neurological exam with adaptations specific to the telehealth visit. CONCLUSIONS In response to the global coronavirus pandemic, telemedicine has become an integral part of neurosurgeons' daily practice. Telemedicine failures remain low but primarily occur due to a need for more comprehensive evaluations. We provide guidelines for the neurosurgical exam during telehealth visits in an effort to assuage some of these issues.
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Affiliation(s)
- Gregory Basil
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Evan Luther
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Joshua D Burks
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Vaidya Govindarajan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Timur Urakov
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Michael Y Wang
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Allan D Levi
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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Abstract
Background Coronavirus disease (COVID-19) has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally. Methods The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched. Results The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees. Conclusions The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-020-02404-5.
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19
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Sharma AK, Gandhoke CS, Nayak N. Effect of coronavirus disease 2019 pandemic on case volume, spectrum, and perioperative coronavirus disease 2019 incidence in neurosurgical patients: An experience at a tertiary care center in India. Surg Neurol Int 2020; 11:390. [PMID: 33274110 PMCID: PMC7708959 DOI: 10.25259/sni_701_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background The volume and spectrum of neurosurgical procedures being performed during the coronavirus disease 2019 (COVID-19) pandemic have significantly changed as compared to the pre-COVID-19 period. The objective of this study is to examine this change and draw useful conclusions. Methods We collected data retrospectively of all patients who attended outpatient clinics and who were operated at our institute under the department of neurosurgery from October 23, 2019, to August 23, 2020. These data were then divided into two groups (pre-COVID period and during the COVID pandemic) and compared. Results Out of the 388 surgeries performed, 284 surgeries were performed during the pre-COVID period, and 104 surgeries were performed during the COVID pandemic. During this ongoing COVID pandemic, the total number of surgeries performed by the department of neurosurgery decreased significantly by 63.38%, the proportion of routine surgeries performed decreased from 50.35% to 19.23% and the proportion of minor cases increased from 19.72% to 30.77%. The Outpatient Clinic Workflow decreased by 72.3% as compared to the pre-COVID period, and the perioperative COVID-19 reverse transcription-polymerase chain reaction positive incidence in our neurosurgical patients was 11.71%. Conclusion This paper highlights the drastic reduction in the operative workflow and the outpatient clinic workflow during the ongoing corona pandemic which will have significant collateral damages in the long run. We will have to strike the right balance between providing our patients with the best medical treatment while limiting the spread of the COVID-19 infection.
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Affiliation(s)
- Anil Kumar Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Nitish Nayak
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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20
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Goyal N, Chaturvedi J, Chandra PP, Raheja A. Letter to the Editor Regarding "Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large United States Academic Medical Center". World Neurosurg 2020; 146:420-422. [PMID: 33229250 PMCID: PMC7666569 DOI: 10.1016/j.wneu.2020.10.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India.
| | - Jitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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