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Tsow R, Pollock C, Mehta S, Turcott A, Kang R, Schmidt J. A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation. Brain Inj 2024; 38:539-549. [PMID: 38465902 DOI: 10.1080/02699052.2024.2327471] [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: 06/13/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
RESEARCH OBJECTIVES 1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury. DESIGN Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants. SETTING Four focus group sessions were conducted online through a video calling platform. PARTICIPANTS 22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database. RESULTS Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development. CONCLUSIONS This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.
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Affiliation(s)
- Rebecca Tsow
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Courtney Pollock
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Alyssa Turcott
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Ruthine Kang
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Julia Schmidt
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada a
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Krause KL, Brown A, Michael J, Mercurio M, Wo S, Bansal A, Becerril J, Khajuria S, Coates E, Andre Leveque JC. Implementation of the Modified Brain Injury Guidelines Might Be Feasible and Cost-Effective Even in a Nontrauma Hospital. World Neurosurg 2024:S1878-8750(24)00567-9. [PMID: 38608812 DOI: 10.1016/j.wneu.2024.04.004] [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: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The modified Brain Injury Guidelines (mBIG) provide a framework to stratify traumatic brain injury (TBI) patients based on clinical and radiographic factors in level 1 and 2 trauma centers. Approximately 75% of all U.S. hospitals do not carry any trauma designation yet could also benefit from these guidelines. To the best of our knowledge, this is the first report of applying the mBIG protocol in a community hospital without any trauma designation. METHODS All adult patients with a TBI in a single center from 2020 to 2022 were retrospectively classified into mBIG categories. The primary outcomes included neurological deterioration, progression on computed tomography of the head, and surgical intervention. Additional outcomes included the hospital costs incurred by the mBIG 1 and mBIG 2 groups. RESULTS Of the 116 included patients, 35 (30%) would have stratified into mBIG 1, 23 (20%) into mBIG 2, and 58 (50%) into mBIG 3. No patient in mBIG 1 had a decline in neurological examination findings or progression on computed tomography of the head or required neurosurgical intervention. Three patients in mBIG 2 had radiographic progression and one required surgical decompression. Two patients in mBIG 3 demonstrated a neurological decline and six had radiographic progression. Of the 21 patients who received surgical intervention, 20 were stratified into mBIG 3. Implementation of the mBIG protocol could have reduced costs by >$250,000 during the 2-year period. CONCLUSIONS The mBIG protocol can safely stratify patients in a nontrauma hospital. Because nontrauma centers tend to see more patients with minor TBIs, implementation could result in significant cost savings, reduce unnecessary hospital and intensive care unit resources, and reduce transfers to a tertiary institution.
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Affiliation(s)
- Katie L Krause
- Department of Neurosurgery, Virginia Mason Medical Center, Seattle, Washington, USA.
| | - Alisha Brown
- Department of Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Joshua Michael
- Department of Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Mike Mercurio
- Department of Neurology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Sean Wo
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Aiyush Bansal
- Department of Neurosurgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jordan Becerril
- Department of Internal Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Suheir Khajuria
- Department of Internal Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Evan Coates
- Department of Internal Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
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Camarano J, Lefever D, Kandregula S, Abushehab N, Benzil D, Huntoon K, Mazzola C, McGuire L, Heary R, Parr A, Hussain N, Perez-Cruet M, Shuer L, Stacy J, Guthikonda B. Utilization of Locum Tenens in Neurosurgery. World Neurosurg 2024; 184:e274-e281. [PMID: 38296044 DOI: 10.1016/j.wneu.2024.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Despite its rising popularity, little has been described about locum tenens employment (locums) in neurosurgery. This study provides the first nationwide overview of the locums neurosurgery experience. METHODS An anonymous online survey examined practice characteristics of respondents, extent of and satisfaction with locums, motivations for pursuing locums, case volumes, agencies used, compensation, and positive/negative aspects of experiences. Responses were collected between November 2020 and February 2021. RESULTS Response rate for the 1852 neurosurgeons who opened the survey request was 4.9%; 36 of 91 respondents had previously worked locums and were commonly motivated by compensation or transitioning to new jobs or retirement. In our response group, 92% of locums respondents had taken more than one position and 47% had taken more than 10. Neurosurgeons performing <200 cases/year were significantly more likely to have also worked locums than those performing >200 cases/year (41.6% locums, 12.7% non-locums, P = 0.001). Responses showed that 69% of locums respondents earned $2000-$2999/day and 16% earned >$3500/day. Nearly 78% of locums respondents were satisfied with their experience(s) and 86% would take another future locums position. Being in practice for >15 years was significantly associated with satisfaction with locums (P = 0.03). Reported flaws included unfamiliarity with hospitals, limited continuity of care, credentialing burdens, and inadequate travel compensation. CONCLUSIONS Locums is utilized by neurosurgeons across multiple practice types and may serve to complement workloads or "fill in gaps" between longer-term employment. Overall, locums neurosurgeons are well compensated, and the majority are satisfied with their experience(s). Inevitably, flaws still exist with locums employment, which may be the focus of organized efforts aiming to improve the experience.
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Affiliation(s)
- Joseph Camarano
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
| | - Devon Lefever
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Sandeep Kandregula
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Nimer Abushehab
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Deborah Benzil
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kristin Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Catherine Mazzola
- Division of Pediatric Neurological Surgery, Goryeb Children's Hospital, Morristown, New Jersey, USA
| | - Laura McGuire
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago Illinois, USA; Department of Neurological Surgery, University of Illinois Chicago, Chicago Illinois, USA
| | - Robert Heary
- Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Namath Hussain
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Lawrence Shuer
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jason Stacy
- Division of Neurosurgery, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
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Gupta S, Aukrust CG, Bhebhe A, Winkler AS, Park KB. Neurosurgery and the World Health Organization Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders 2022-2031. Neurosurgery 2024:00006123-990000000-01020. [PMID: 38224233 DOI: 10.1227/neu.0000000000002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024] Open
Abstract
The World Health Organization's Intersectoral Global Action Plan (IGAP) on Epilepsy and Other Neurological Diseases 2022-2031 is a holistic, interdisciplinary, and intersectoral plan with a strong focus on equity and human rights. The IGAP was unanimously approved by all World Health Organization Member States at the 75th World Health Assembly in May 2022 and provides a framework for researchers and clinicians to study and address national and global inadequacies in the evaluation and management of people suffering from neurological disorders and their prevention. While IGAP has applied epilepsy as an entry point for other neurological disorders, advocacy by neurologists and neurosurgeons has broadened it to include diseases with a large and growing global health footprint such as stroke, hydrocephalus, traumatic brain injury, and brain and spine cancers. The IGAP is important to neurosurgeons globally because it provides the first ever roadmap for comprehensively addressing unmet neurological and neurosurgical care in low- and middle-income countries. Furthermore, it creates an opportunity for neurologists and neurosurgeons to scale up services for neurological diseases in tandem. As such, it provides a structure for the neurosurgery community to become involved in global health initiatives at all levels.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Camilla G Aukrust
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Arnold Bhebhe
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Andrea S Winkler
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Lorents A, Colin ME, Bjerke IE, Nougaret S, Montelisciani L, Diaz M, Verschure P, Vezoli J. Human Brain Project Partnering Projects Meeting: Status Quo and Outlook. eNeuro 2023; 10:ENEURO.0091-23.2023. [PMID: 37669867 PMCID: PMC10481639 DOI: 10.1523/eneuro.0091-23.2023] [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: 03/19/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
As the European Flagship Human Brain Project (HBP) ends in September 2023, a meeting dedicated to the Partnering Projects (PPs), a collective of independent research groups that partnered with the HBP, was held on September 4-7, 2022. The purpose of this meeting was to allow these groups to present their results, reflect on their collaboration with the HBP and discuss future interactions with the European Research Infrastructure (RI) EBRAINS that has emerged from the HBP. In this report, we share the tour-de-force that the Partnering Projects that were present in the meeting have made in furthering knowledge concerning various aspects of Brain Research with the HBP. We describe briefly major achievements of the HBP Partnering Projects in terms of a systems-level understanding of the functional architecture of the brain and its possible emulation in artificial systems. We then recapitulate open discussions with EBRAINS representatives about the evolution of EBRAINS as a sustainable Research Infrastructure for the Partnering Projects after the HBP, and also for the wider scientific community.
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Affiliation(s)
| | | | - Ingvild Elise Bjerke
- Neural Systems Laboratory, Institute of Basic Medical Sciences, University of Oslo, Oslo 0372, Norway
| | - Simon Nougaret
- Institut de Neurosciences de la Timone, Unité Mixte de Recherche 7289, Aix Marseille Université, Centre National de la Recherche Scientifique, Marseille 13005, France
| | - Luca Montelisciani
- Cognitive and Systems Neuroscience Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam 1098XH, The Netherlands
| | - Marissa Diaz
- Institute for Advanced Simulation (IAS), Jülich Supercomputing Centre (JSC), Forschungszentrum Jülich GmbH, Jülich 52428, Germany
| | - Paul Verschure
- Donders Center for Neuroscience (DCN-FNWI), Radboud University, Nijmegen 6500HD, The Netherlands
| | - Julien Vezoli
- Ernst Strügmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt am Main 60528, Germany
- Institut National de la Santé et de la Recherche Médicale Unité 1208, Stem Cell and Brain Research Institute, Université Claude Bernard Lyon 1, Bron 69500, France
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Cheng A, Tsow R, Schmidt J. Understanding the Barriers of Implementing a Self-Awareness Assessment in Occupational Therapy Practice within a Brain Injury Population: An Exploratory Study. Occup Ther Int 2023; 2023:3933995. [PMID: 37265857 PMCID: PMC10232193 DOI: 10.1155/2023/3933995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Background Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. Aims (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. Materials and Methods A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. Results 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Conclusion Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.
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Affiliation(s)
- Anika Cheng
- Graduate Program in Occupational Therapy, University of British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
| | - Rebecca Tsow
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
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Moyer JD, Lee P, Bernard C, Henry L, Lang E, Cook F, Planquart F, Boutonnet M, Harrois A, Gauss T. Machine learning-based prediction of emergency neurosurgery within 24 h after moderate to severe traumatic brain injury. World J Emerg Surg 2022; 17:42. [PMID: 35922831 PMCID: PMC9351267 DOI: 10.1186/s13017-022-00449-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Machine Learning-based models to establish to predict the need for neurosurgery procedure within 24 h after moderate to severe TBI. Methods Retrospective multicenter cohort study using data from a national trauma registry (Traumabase®) from November 2011 to December 2020. Inclusion criteria correspond to patients over 18 years old with moderate or severe TBI (Glasgow coma score ≤ 12) during prehospital assessment. Patients who died within the first 24 h after hospital admission and secondary transfers were excluded. The population was divided into a train set (80% of patients) and a test set (20% of patients). Several approaches were used to define the best prognostic model (linear nearest neighbor or ensemble model). The Shapley Value was used to identify the most relevant pre-hospital variables for prediction. Results 2159 patients were included in the study. 914 patients (42%) required neurosurgical intervention within 24 h. The population was predominantly male (77%), young (median age 35 years [IQR 24–52]) with severe head injury (median GCS 6 [3–9]). Based on the evaluation of the predictive model on the test set, the logistic regression model had an AUC of 0.76. The best predictive model was obtained with the CatBoost technique (AUC 0.81). According to the Shapley values method, the most predictive variables in the CatBoost were a low initial Glasgow coma score, the regression of pupillary abnormality after osmotherapy, a high blood pressure and a low heart rate. Conclusion Machine learning-based models could predict the need for emergency neurosurgery within 24 h after moderate and severe head injury. Potential clinical benefits of such models as a decision-making tool deserve further assessment. The performance in real-life setting and the impact on clinical decision-making of the model requires workflow integration and prospective assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00449-5.
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Affiliation(s)
- Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Patrick Lee
- Capgemini Invent, Insight Driven Enterprise, Focused on Data and Artificial Intelligence Services, Paris, France
| | - Charles Bernard
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Lois Henry
- Department of Anesthesiology and Critical Care, Lille, France
| | - Elodie Lang
- Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabrice Cook
- Department of Anesthesiology and Critical Care, Hôpital Henri Mondor, Créteil, France
| | - Fanny Planquart
- Department of Anesthesiology and Critical Care, Strasbourg, France
| | - Mathieu Boutonnet
- Intensive Care Unit, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France.,Val de Grace Academy, Place Alphonse Laveran, 75005, Paris, France
| | - Anatole Harrois
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Tobias Gauss
- Déchocage- Bloc des urgences, Pole Anesthésie- Réanimation, CHU Grenoble Alpes, La Tronche, France
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