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Wireko AA, Ahluwalia A, Ali SH, Shah MH, Aderinto N, Banerjee S, Roy S, Ferreira T, Tan JK, Berjaoui C, Guggilapu S, Quarshie LS, Bharadwaj HR, Adebusoye FT, Abdul-Rahman T, Atallah O. Insights into craniosynostosis management in low- and middle-income countries: A narrative review of outcomes, shortcomings and paediatric neurosurgery capacity. SAGE Open Med 2024; 12:20503121241226891. [PMID: 38249946 PMCID: PMC10798110 DOI: 10.1177/20503121241226891] [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: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Craniosynostosis, marked by premature cranial suture fusion, necessitates prompt intervention to avert developmental, neurological, and aesthetic issues. While high-income countries have advanced in managing this condition, low- and middle-income countries grapple with substantial healthcare access disparities. This narrative review explores current craniosynostosis management in low- and middle-income countries. The review focused on studies published between 2008 and 2023. The focus was neurosurgical outcomes, and the search utilised databases like PubMed, EMBASE, Google Scholar, the Cochrane Library and Scopus, incorporating specific keywords and phrases. An in-depth analysis of 21 included studies reveals noteworthy positive outcomes, including low mortality, successful corrections and sustained efficacy. These advancements stem from enhanced pre-operative strategies, surgical techniques and postoperative care. Nonetheless, challenges persist, encompassing complications, mortality, reoperations, and treatment disparities, particularly in low- and middle-income countries constrained by financial and expertise limitations. The enhancement of clinical practice and the formulation of effective policies in the future entail several key strategies. These include the reinforcement of specialised healthcare infrastructure and diagnostic capabilities, the ongoing training and retention of neurosurgeons, the improvement of funding mechanisms, and the promotion of equitable access. Additionally, a crucial focus is placed on fortifying paediatric neurosurgical care in low- and middle-income countries. The recommendations underscore the importance of collaborative initiatives, the development of specialised healthcare infrastructure, and the implementation of strategic policies to not only advance pediatric neurosurgical care but also to address existing gaps in management.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, Lautech Teaching Hospital, Ogbomosho, Nigeria
| | | | - Sakshi Roy
- School of Medicine, Queen’s University Belfast, Belfast, UK
| | - Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Saibaba Guggilapu
- Faculty of Medicine, Bangalore Medical College and Research Institute, Bangalore, India
| | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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2
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Vallejo FA, Schachner B, VanderVeer-Harris N, Torres AA, Weng J, Chang H, Bollo R, Ragheb J. A snapshot of contemporary leadership at pediatric neurosurgery fellowships. J Neurosurg Pediatr 2022; 30:532-537. [PMID: 36087318 DOI: 10.3171/2022.7.peds22133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many pathways to positions of leadership exist within pediatric neurological surgery. The authors sought to investigate common trends in leadership among pediatric neurosurgery fellowship directors (FDs) and describe how formalized pediatric neurosurgical training arrived at its current state. METHODS Fellowship programs were identified using the Accreditation Council for Pediatric Neurosurgery Fellowships website. Demographic, training, membership, and research information was collected via email, telephone, curricula vitae, and online searches. RESULTS The authors' survey was sent to all 35 identified FDs, and 21 responses were received. Response data were supplemented with curricula vitae and online data prior to analysis. FDs were predominantly male, self-identified predominantly as Caucasian, and had a mean age of 53 years. The mean duration from residency graduation until FD appointment was 13.4 years. The top training programs to produce future FDs were New York University and Washington University in St. Louis (residency) and Washington University in St. Louis (fellowship). CONCLUSIONS This study characterizes the current state of pediatric neurosurgery fellowship program leadership. The data serve as an important point of reference to compare with future leadership as well as contrast with neurosurgery and other surgical disciplines in general.
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Affiliation(s)
| | | | | | - Adrian A Torres
- 3Florida State University College of Medicine, Tallahassee, Florida
| | - John Weng
- 3Florida State University College of Medicine, Tallahassee, Florida
| | - Henry Chang
- 1University of Miami Miller School of Medicine, Miami
| | - Robert Bollo
- 4Division of Pediatric Neurosurgery, University of Utah, Salt Lake City, Utah
| | - John Ragheb
- 5Department of Neurosurgery, University of Miami Miller School of Medicine, Miami; and
- 6Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
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3
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Shlobin NA, Graffeo CS, Dornbos DL, Mukherjee D, Sivakumar W, Johnson J. The Committee on Advanced Subspecialty Training-accredited postgraduate neurosurgery fellowship application experience: a national survey. J Neurosurg 2022; 138:1124-1131. [PMID: 36087313 DOI: 10.3171/2022.7.jns22544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The neurosurgery fellowship application process is heterogenous. Therefore, the authors conducted a survey of individuals graduating from Committee on Advanced Subspecialty Training (CAST)-accredited fellowships in the past 5 years to examine 1) experiences with the fellowship application process, 2) perspectives on the process, 3) reasons for pursuing a given subspecialty and fellowship, and 4) post-fellowship practices. METHODS A survey querying demographics, experiences with and perspectives on the fellowship application process, and factors contributing to the pursuit of a given fellowship was distributed to individuals who had graduated from CAST-accredited fellowships in the past 5 years. The survey response period was May 22, 2021-June 22, 2021. RESULTS Of 273 unique individuals who had graduated from CAST-accredited fellowships in the past 5 years, 65 (29.7%) were included in this analysis. The most common postgraduate year (PGY) during which respondents applied for fellowship positions was PGY5 (43.8%), whereas the most common training level at which respondents accepted a fellowship position was PGY6 (46.9%), with a large degree of variability for both (range PGY4-PGY7). Only 43.1% respondents reported an application deadline for their fellowship. A total of 77.4% respondents received 1-2 fellowship position offers, and 13.4% indicated that there was a match process. In total, 64.5% respondents indicated that the fellowship offer timeline was mostly or very asynchronous. The time frame for applicants to decline or accept a fellowship offer was heterogeneous and mismatched among institutions. Respondents agreed that a more standardized application timeline would be beneficial (median response "agree"), and 83.1% of respondents indicated that PGY5 or PGY6 was the appropriate time to interview for a fellowship. CONCLUSIONS Respondents reported heterogeneous experiences in applying for a fellowship, indicated that a standardized application timeline including interviews at PGY5 or PGY6 would be beneficial, and preferred streamlining the fellowship application process.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - David L Dornbos
- 3Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Debraj Mukherjee
- 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Walavan Sivakumar
- 5Department of Neurosurgery, Pacific Neuroscience Institute, Los Angeles; and
| | - Jeremiah Johnson
- 6Department of Neurosurgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California
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4
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Cofano F, Di Perna G, Zeppa P, Lanotte M, Garbossa D. Letter: Improving Surgical Skills During Residency: A Scheduled and Certified Approach With Virtual-Augmented Reality and Life-Like Simulators: Experience in a Single School of Neurosurgery. Neurosurgery 2022; 91:e71-e73. [DOI: 10.1227/neu.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
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Wilson CM, Brown NJ, Detchou DKE. Letter: Impact of Sub-Internship Cancellations in Neurosurgery During COVID-19. Neurosurgery 2021; 89:E201-E202. [PMID: 34192742 PMCID: PMC8344663 DOI: 10.1093/neuros/nyab232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chidinma M Wilson
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Nolan J Brown
- University of California, Irvine School of Medicine Irvine, California, USA
| | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
- Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
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Khan A, Mao JZ, Soliman MAR, Rho K, Hess RM, Reynolds RM, Riley JP, Mullin JP, Siddiqui AH, Levy EI, Pollina J. The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers. Surg Neurol Int 2021; 12:271. [PMID: 34221602 PMCID: PMC8248555 DOI: 10.25259/sni_240_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice. Methods Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories. Results Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases. Conclusion The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.
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Affiliation(s)
- Asham Khan
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jennifer Z Mao
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Mohamed A R Soliman
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States.,Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Kyungduk Rho
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Ryan M Hess
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Renée M Reynolds
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jonathan P Riley
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jeffrey P Mullin
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - John Pollina
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
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Kumar R, Hersh DS, Smith LGF, Gordon WE, Khan NR, Gienapp AJ, Gungor B, Herr MJ, Vaughn BN, Michael LM, Klimo P. Resident operative experience in pediatric neurosurgery across the United States. J Neurosurg Pediatr 2021; 27:716-724. [PMID: 33836496 DOI: 10.3171/2020.9.peds20518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgical residents receive exposure to the subspecialty of pediatric neurosurgery during training. The authors sought to determine resident operative experience in pediatric neurosurgery across Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgical programs. METHODS During 2018-2019, pediatric neurosurgical case logs for recent graduates or current residents who completed their primary pediatric exposure were collected from US continental ACGME training programs. Using individual resident reports and procedure designations, operative volumes and case diversity were analyzed collectively, according to training site characteristics, and also correlated with the recently described Resident Experience Score (RES). RESULTS Of the 114 programs, a total of 316 resident case logs (range 1-19 residents per program) were received from 86 (75%) programs. The median cumulative pediatric case volume per resident was 109 (IQR 75-161). Residents at programs with a pediatric fellowship reported a higher median case volume (143, IQR 96-187) than residents at programs without (91, IQR 66-129; p < 0.0001). Residents at programs that outsource their pediatric rotation had a lower median case volume (84, IQR 52-114) compared with those at programs with an in-house experience (117, IQR 79-170; p < 0.0001). The case diversity index among all programs ranged from 0.61 to 0.80, with no statistically significant differences according to the Accreditation Council for Pediatric Neurosurgery Fellowships designation or pediatric experience site (p > 0.05). The RES correlated moderately (r = 0.44) with median operative volumes per program. A program's annual pediatric operative volume and duration of pediatric experience were identified as significant predictive factors for median resident operative volume. CONCLUSIONS Resident experience in pediatric neurosurgery is variable within and between programs. Case volumes are generally higher for residents at programs with in-house exposure and an accredited fellowship, but case diversity is relatively uniform across all programs. RES provides some insight on anticipated case volume, but other unexplained factors remain.
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Affiliation(s)
| | - David S Hersh
- 2Department of Surgery, University of Connecticut School of Medicine, Farmington
- 3Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
| | - Luke G F Smith
- 4Department of Neurosurgery, The Ohio State University, Columbus, Ohio
| | | | | | - Andrew J Gienapp
- Departments of5Neurosurgery and
- 6Le Bonheur Children's Hospital, Memphis; and
| | | | - Michael J Herr
- 7Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis
| | | | - L Madison Michael
- Departments of5Neurosurgery and
- 6Le Bonheur Children's Hospital, Memphis; and
- 8Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Departments of5Neurosurgery and
- 6Le Bonheur Children's Hospital, Memphis; and
- 8Semmes Murphey, Memphis, Tennessee
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Guidotti Breting LM, Towns SJ, Butts AM, Brett BL, Leaffer EB, Whiteside DM. 2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees. Clin Neuropsychol 2020; 34:1284-1313. [PMID: 32842877 DOI: 10.1080/13854046.2020.1809712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.
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Affiliation(s)
| | - Stephanie J Towns
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Alissa M Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily B Leaffer
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas M Whiteside
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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