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Harrison DJ, Wu E, Singh R, Ghaith S, Suarez-Meade P, Brown NJ, Sherman WJ, Robinson MT, Lin MP, Lawton MT, Quinones-Hinojosa A. Primary and Specialist Palliative Care in Neurosurgery: A Narrative Review and Bibliometric Analysis of Glioblastoma and Stroke. World Neurosurg 2023; 180:e250-e257. [PMID: 37739173 DOI: 10.1016/j.wneu.2023.09.048] [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: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Due to the increased demand for palliative care (PC) in recent years, a model has been proposed to divide PC into primary PC and specialist PC. This article aimed to delineate the indications for primary and specialist PC within 2 common neurosurgical conditions-glioblastoma (GBM) and stroke. METHODS A systematic review and bibliometric analysis was conducted to better appreciate the practice trends in PC utilization for GBM and stroke patients using several databases. RESULTS There were 70 studies on PC for GBM, the majority of which related to patient preference (22 [31%]). During 1999-2022, there was significant growth in publications per year on this topic at a rate of approximately 0.3 publications per year (P < 0.01). There were 44 studies on PC for stroke, the majority of which related to communication strategies (14 [32%]). During 1999-2022, there was no significant growth in stroke publications per year (P = 0.22). CONCLUSIONS Due to the progressively disabling neurological course of GBM, we suggest that a specialty PC team be used in conjunction with the neurosurgical team early in the disease trajectory while patients are still able to communicate their preferences, goals, and values. In contrast, short-term and long-term stages of management of stroke have differing implications for PC needs, with the short-term stage necessitating adept, time-sensitive communication between the patient, family, and care teams. Thus, we propose that primary PC should be included as a core competency in neurosurgery training, among other stroke specialists.
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Affiliation(s)
| | - Emily Wu
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Summer Ghaith
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Nolan J Brown
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Wendy J Sherman
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Maisha T Robinson
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA; Division of Palliative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle P Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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Lee SH, Nam TM, Jang JH, Kim YZ, Kim KH, Ryu KH, Kim DH, Kwan BS, Lee H, Kim SH. Role of Neurosurgeons in the Treatment of Acute Ischemic Stroke in the Emergency Room. J Korean Neurosurg Soc 2023; 66:24-32. [PMID: 35974432 PMCID: PMC9837491 DOI: 10.3340/jkns.2022.0085] [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: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE With the recent increase in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the role of neurosurgeons in AIS treatment has become increasingly important. This study aimed to assess the outcomes of patients with AIS treated by neurosurgeons and neurologists in the emergency room (ER) of a tertiary hospital in South Korea. METHODS From January 2020 to June 2021, 536 patients with AIS within 24 hours of symptom onset were admitted to our hospital via the ER. Based on the type of doctors who provided initial care for AIS in the ER, patients were divided into two groups : (a) neurosurgeon group (n=119, 22.2%) and (b) neurologist group (n=417, 77.8%). RESULTS Intravenous tissue plasminogen activator (tPA) was administered in 82 (15.3%) of 536 patients (n=17 [14.3%] in the neurosurgeon group and n=65 [15.6%] in the neurologist group). The door-to-tPA time was not significantly different between both groups (median, 53 minutes; interquartile range [IQR], 45-58 vs. median, 54 minutes; IQR, 46-74; p=0.372). MT was performed in 69 patients (12.9%) (n=25, 36.2% in the neurosurgeon group and n=44, 63.8% in the neurologist group). The neurosurgeon group achieved a shorter door-to-puncture time than the neurologist group (median, 115 minutes; IQR, 107-151 vs. median, 162 minutes; IQR, 117-189; p=0.049). Good clinical outcomes (3-month modified Rankin Scale 0-2) did not differ significantly between the two groups (96/119 [80.7%] vs. 322/417 [77.2%], p=0.454). CONCLUSION The neurosurgeon group showed similar door-to-treatment time and clinical outcomes to the neurologist group in patients with AIS in the ER. This study suggests that neurosurgeons have comparable abilities to care for patients with AIS in the ER.
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Affiliation(s)
- Sang Hyuk Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Byung Soo Kwan
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyungon Lee
- Department of Neurosurgery, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea,Address for correspondence : Seung Hwan Kim Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Palyong-ro, Masanhoiwon-gu, Changwon 51353, Korea Tel : +82-55-233-6073, Fax : +82-55-233-6527, E-mail :
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Kim SH, Nam TM, Jang JH, Kim YZ, Kim KH, Kim DH, Lee H, Jin SC, Lee CH. Improving Door-To-Puncture Time in Mechanical Thrombectomy with Direct Care from a Neurointerventionalist in the Emergency Department. World Neurosurg 2021; 152:e455-e461. [PMID: 34144162 DOI: 10.1016/j.wneu.2021.05.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A shorter door-to-puncture time is an independent predictor of good clinical outcomes in patients with acute ischemic stroke (AIS) who undergo mechanical thrombectomy (MT). We recently initiated a protocol for direct care from neurointerventionalists (NIs) in the emergency department (ED) rather than from non-NI neurologists for patients with AIS. Our aim was to investigate whether NIs, as the first point-of-care physicians for stroke in the ED, could shorten door-to-puncture time compared to non-NI neurologists. METHODS From January 2020 to December 2020, 50 patients with AIS underwent MT at our hospital. Patients were divided into 2 groups based on the type of physician who provided initial care for stroke in the ED: (a) NI group (n = 20) and (b) non-NI group (n = 30). The door-to-puncture time was retrospectively analyzed. RESULTS The NI group had a significantly shorter door-to-puncture time than the non-NI group (135.2 ± 50.0 minutes vs. 167.2 ± 54.3 minutes, P = 0.040). A door-to-puncture time of ≤120 minutes was more frequently achieved in the NI group than in the non-NI group (55.0% vs. 23.3%, P = 0.022). Multivariable logistic regression analysis revealed that a door-to-puncture time of ≤120 minutes was independently associated with the NI group (adjusted odds ratio 4.098, 95% confidence interval 1.085-15.479, P = 0.037). CONCLUSIONS Our study showed that NIs, as the first point-of-care stroke physicians in the ED, were associated with shorter door-to-puncture times. We suggest that NIs should be at the forefront of care for patients with AIS in the acute setting by performing triage and deciding on and performing MT.
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Affiliation(s)
- Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyungon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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Felbaum DR, Dowlati E, Mai JC, Liu AH, Schuette AJ, Bell R, Armonda RA. Letter: Realistic Expectations for Incorporating Dual-Trained Neurosurgeons in a Call Schedule. Neurosurgery 2020; 87:E615-E616. [PMID: 32860029 DOI: 10.1093/neuros/nyaa375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ehsan Dowlati
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
| | - Jeffrey C Mai
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ai-Hsi Liu
- Department of Radiology MedStar Washington Hospital Center Washington, District of Columbia
| | - A Jesse Schuette
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Randy Bell
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Rocco A Armonda
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
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