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Yueh-Hsin L, Dadario NB, Tang SJ, Crawford L, Tanglay O, Dow HK, Young I, Ahsan SA, Doyen S, Sughrue ME. Discernible interindividual patterns of global efficiency decline during theoretical brain surgery. Sci Rep 2024; 14:14573. [PMID: 38914649 PMCID: PMC11196730 DOI: 10.1038/s41598-024-64845-4] [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: 07/14/2023] [Accepted: 06/13/2024] [Indexed: 06/26/2024] Open
Abstract
The concept of functional localization within the brain and the associated risk of resecting these areas during removal of infiltrating tumors, such as diffuse gliomas, are well established in neurosurgery. Global efficiency (GE) is a graph theory concept that can be used to simulate connectome disruption following tumor resection. Structural connectivity graphs were created from diffusion tractography obtained from the brains of 80 healthy adults. These graphs were then used to simulate parcellation resection in every gross anatomical region of the cerebrum by identifying every possible combination of adjacent nodes in a graph and then measuring the drop in GE following nodal deletion. Progressive removal of brain parcellations led to patterns of GE decline that were reasonably predictable but had inter-subject differences. Additionally, as expected, there were deletion of some nodes that were worse than others. However, in each lobe examined in every subject, some deletion combinations were worse for GE than removing a greater number of nodes in a different region of the brain. Among certain patients, patterns of common nodes which exhibited worst GE upon removal were identified as "connectotypes". Given some evidence in the literature linking GE to certain aspects of neuro-cognitive abilities, investigating these connectotypes could potentially mitigate the impact of brain surgery on cognition.
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Affiliation(s)
- Lin Yueh-Hsin
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Nicholas B Dadario
- Robert Wood Johnson Medical School, Rutgers University, 125 Paterson St, New Brunswick, NJ, 08901, USA
| | - Si Jie Tang
- School of Medicine, 21772 University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Lewis Crawford
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Onur Tanglay
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Hsu-Kang Dow
- School of Computer Science and Engineering, University of New South Wales (UNSW), Building K17, Sydney, NSW, 2052, USA
| | - Isabella Young
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Syed Ali Ahsan
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia
| | - Stephane Doyen
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia
| | - Michael E Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 19, Level 7 Prince of Wales Private Hospital, Randwick, Sydney, NSW, 2031, Australia.
- Omniscient Neurotechnology, Level 10/580 George Street, Sydney, NSW, 2000, Australia.
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Suite 3, Level 7 Barker St, Randwick, NSW, 2031, USA.
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Haward R, G R, Kalyan M. The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India. Cureus 2023; 15:e41910. [PMID: 37583728 PMCID: PMC10425167 DOI: 10.7759/cureus.41910] [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] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Context The proper usage of personal protective equipment (PPE) must be prioritised for health care workers (HCWs), where shortages and prolonged use of personal protective equipment can threaten safety in essential health services. Aims To evaluate the effect of personal protective equipment on the health and well-being of HCWs, physicians, nurses, and technicians on duty for COVID-19 rotational postings. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was conducted at a tertiary care centre in South India to assess the utilisation of personal protective equipment (PPE) during the second wave of COVID-19. A physical questionnaire was distributed to a total of 266 healthcare workers, aged 20 to 50, who had worked for a minimum of three consecutive days between May and August 2021. The objective of the study was to evaluate the effectiveness of PPE use among healthcare workers during the second wave of the COVID-19 pandemic. Statistical analysis The data analysis in this study was conducted using IBM Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp., Armonk, New York). The mean and standard deviation, or median, were used to present continuous variables, while frequency and percentage were used to present categorical variables. Furthermore, the minimum sample size required for this study was calculated to be 246 participants. Results The survey included 266 healthcare workers. The mean+/-SD of age was 28.18+/-5.64 and consisted of females (54.51%) and males (45.48%). The postings were in emergency (13.15%), intensive care unit (30.82%), and ward (56.01%), respectively. The HCWs who used PPE for four to seven days reported more symptoms than those who used it for one to three days. Discomforts experienced while wearing PPE were chest suffocation (49.62%), difficulty in performing intubation (36.09%), difficulty in seeing clearly (68.79%), dizziness (49.62%), excessive sweating (75.56%), micturition desire (52.63%), nausea (42.48%), retro-auricular pain (56.76%), stomach burns (27.44%), and thirst or dry throat (78.57%). The symptoms suffered after doffing were tiredness (69.17%), dry mouth (67.29%), dizziness (43.60%), headache (55.63%), chest suffocation (36.46%), dry skin (57.14%), reduced ability to concentrate (48.12%), dark-coloured urine (55.63%), reduced alertness (42.48%), and stomach burns (28.94%). The first thoughts after doffing were to drink water (68.42%), eat something (36.09%), clean yourself (61.27%), urinate (33.08%), and have some rest (29.32%), respectively. 81 (30.45%). The HCWs suffered skin injuries while wearing gloves. The time for restoring after a shift was 12 hours (37.59%), 24 hours (34.21%), 36 hours (11.65%), and 48 hours (16.59%). Pressure sores were reported on the forehead by 53 (19.92%) participants, the nose by 54 (20.30%), the cheek by 31 (11.65%), and behind the ear by 77 (65.71%) participants. The optimal size of PPE was experienced only by 76 (28.57%) participants, while 73 (27.44%) of them felt tight and 117 (43.98%) felt loose. Conclusions To minimise discomfort while managing infectious diseases, HCWs can adopt several practices like taking regular breaks, ensuring humane working hours, utilising high-quality PPE, and wearing properly fitting gear. By implementing these measures, HCWs can enhance their ability to handle infectious diseases effectively while prioritising their comfort and well-being.
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Affiliation(s)
- Raymond Haward
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Ridhima G
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Meenakshi Kalyan
- Internal Medicine, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
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Wu Z, Hu G, Cao B, Liu X, Zhang Z, Dadario NB, Shi Q, Fan X, Tang Y, Cheng Z, Wang X, Zhang X, Hu X, Zhang J, You Y. Non-traditional cognitive brain network involvement in insulo-Sylvian gliomas: a case series study and clinical experience using Quicktome. Chin Neurosurg J 2023; 9:16. [PMID: 37231522 DOI: 10.1186/s41016-023-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Patients with insulo-Sylvian gliomas continue to present with severe morbidity in cognitive functions primarily due to neurosurgeons' lack of familiarity with non-traditional brain networks. We sought to identify the frequency of invasion and proximity of gliomas to portions of these networks. METHODS We retrospectively analyzed data from 45 patients undergoing glioma surgery centered in the insular lobe. Tumors were categorized based on their proximity and invasiveness of non-traditional cognitive networks and traditionally eloquent structures. Diffusion tensor imaging tractography was completed by creating a personalized brain atlas using Quicktome to determine eloquent and non-eloquent networks in each patient. Additionally, we prospectively collected neuropsychological data on 7 patients to compare tumor-network involvement with change in cognition. Lastly, 2 prospective patients had their surgical plan influenced by network mapping determined by Quicktome. RESULTS Forty-four of 45 patients demonstrated tumor involvement (< 1 cm proximity or invasion) with components of non-traditional brain networks involved in cognition such as the salience network (SN, 60%) and the central executive network (CEN, 56%). Of the seven prospective patients, all had tumors involved with the SN, CEN (5/7, 71%), and language network (5/7, 71%). The mean scores of MMSE and MOCA before surgery were 18.71 ± 6.94 and 17.29 ± 6.26, respectively. The two cases who received preoperative planning with Quicktome had a postoperative performance that was anticipated. CONCLUSIONS Non-traditional brain networks involved in cognition are encountered during surgical resection of insulo-Sylvian gliomas. Quicktome can improve the understanding of the presence of these networks and allow for more informed surgical decisions based on patient functional goals.
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Affiliation(s)
- Zhiqiang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Guanjie Hu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bowen Cao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xingdong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zifeng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Nicholas B Dadario
- Robert Wood Johnson Medical School, Rutgers University, Newark, NJ, 08901, USA
| | - Qinyu Shi
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiao Fan
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yao Tang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhangchun Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiefeng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xia Zhang
- International Joint Research Center On Precision Brain Medicine, XD Group Hospital, Shaanxi Province, Xi'an, 710077, China
| | - Xiaorong Hu
- International Joint Research Center On Precision Brain Medicine, XD Group Hospital, Shaanxi Province, Xi'an, 710077, China.
| | - Junxia Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Institute for Brain Tumors, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China.
| | - Yongping You
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Institute for Brain Tumors, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China.
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Dadario NB, Sughrue ME. Should Neurosurgeons Try to Preserve Non-Traditional Brain Networks? A Systematic Review of the Neuroscientific Evidence. J Pers Med 2022; 12:jpm12040587. [PMID: 35455703 PMCID: PMC9029431 DOI: 10.3390/jpm12040587] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 12/25/2022] Open
Abstract
The importance of large-scale brain networks in higher-order human functioning is well established in neuroscience, but has yet to deeply penetrate neurosurgical thinking due to concerns of clinical relevance. Here, we conducted the first systematic review examining the clinical importance of non-traditional, large-scale brain networks, including the default mode (DMN), central executive (CEN), salience (SN), dorsal attention (DAN), and ventral attention (VAN) networks. Studies which reported evidence of neurologic, cognitive, or emotional deficits in relation to damage or dysfunction in these networks were included. We screened 22,697 articles on PubMed, and 551 full-text articles were included and examined. Cognitive deficits were the most common symptom of network disturbances in varying amounts (36–56%), most frequently related to disruption of the DMN (n = 213) or some combination of DMN, CEN, and SN networks (n = 182). An increased proportion of motor symptoms was seen with CEN disruption (12%), and emotional (35%) or language/speech deficits (24%) with SN disruption. Disruption of the attention networks (VAN/DAN) with each other or the other networks mostly led to cognitive deficits (56%). A large body of evidence is available demonstrating the clinical importance of non-traditional, large-scale brain networks and suggests the need to preserve these networks is relevant for neurosurgical patients.
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Affiliation(s)
- Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Michael E. Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Omniscient Neurotechnology, Sydney, NSW 2000, Australia
- Correspondence:
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Kumar N, Rai A, Dutta P, Gupta P, Singh P, Mukherjee KK, Dhandapani S. Noncontiguous Radiation-Induced Brain Necrosis (RIBN) in a Patient with Aggressive Pituitary Adenoma and the Utility of Bevacizumab. Neurol India 2021; 69:1055-1057. [PMID: 34507446 DOI: 10.4103/0028-3886.325385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Narendra Kumar
- Department of Radiotherapy, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Rai
- Department of Endocrinology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakamya Gupta
- Department of Indian Council of Medical Research, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiology, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan K Mukherjee
- Department of Neurosurgery, Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Graduate Institute of Medical Education and Research, Chandigarh, India
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Koundal H, Dhandapani M, Thakur P, Dutta P, Walia R, Sahoo SK, Chhabra R, Dhandapani S. Effectiveness of dietary diabetes insipidus bundle on the severity of postoperative fluid imbalance in pituitary region tumours: A randomized controlled trial. J Adv Nurs 2021; 77:3911-3920. [PMID: 34028859 DOI: 10.1111/jan.14894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 01/31/2023]
Abstract
AIM To test the effectiveness of nurse-led dietary diabetes insipidus (DI) bundle on the severity of postoperative fluid imbalance in pituitary region tumours. DESIGN Blinded randomized controlled trial. METHODS Patients aged 18-65 operated for sellar-suprasellar tumours in an Indian tertiary care centre were enrolled through total enumeration sampling and underwent randomization with allocation concealment during Sep 2018-Feb 2019. Pre-operative DI, postoperative ventilation, renal failure or decompensated diabetes mellitus were excluded. Patients in the intervention group received a nurse-led DI bundle (validated by three Delphi rounds) with four dietary components: intake of only water during thirst and avoidance of the following-added salt, high-protein foods and caffeinated drinks. Treating clinicians and the investigator assessing outcome were blinded about enrolment. Urine output, serum sodium, vasopressin requirement and hospital stay were assessed as primary outcomes. The outcome measures were monitored daily till the 6th postoperative day. Analyses were performed on 'intention-to-treat' basis, irrespective of compliance. Independent t-test and Chi-square test were used. RESULTS Of the initial 63 patients, 50 fulfilling criteria were randomized to two groups and assessed over six days yielding 150 patient-days per group. There were no significant baseline differences between groups. The mean daily urine output was significantly lower in the DI bundle group than in control, both overall and among endonasal operated pituitary adenomas [3000.09(462.7) vs. 4095.71(896.4)ml & 2987.14(419.5) vs. 4064.73(1051)ml], with the greatest difference on the second postoperative day. Though hypernatraemia in controls became most prominent during days 2-3 and resolved in a week, it was significantly lower in the intervention group (12.7% vs. 30.7% overall, 11.4% vs. 29.4% endonasal adenomas). The need for vasopressin analogues and hospital stay were also significantly lower with DI bundle (p < 0.001). CONCLUSION This is probably the first ever report of dietary DI bundle among operated pituitary patients, which seem to flatten the DI trend with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. TRIAL REGISTRATION CTRI/2018/07/015127 of ICMR. IMPACT The nurse-led dietary DI bundle has effectively reduced the severity of DI among operated pituitary patients with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. Its implementation is simple and easy to carry out, especially in resource-constrained institutions, where continuous monitoring and repeated serum sodium estimation are difficult.
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Affiliation(s)
- Hemlata Koundal
- National Institute of Nursing Education (NINE), PGIMER, Chandigarh, India
| | - Manju Dhandapani
- National Institute of Nursing Education (NINE), PGIMER, Chandigarh, India
| | - Pratibha Thakur
- National Institute of Nursing Education (NINE), PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, PGIMER, Chandigarh, India
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Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021; 25:134-139. [PMID: 33707889 PMCID: PMC7922454 DOI: 10.5005/jp-journals-10071-23713] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the event of coronavirus disease-2019 (COVID-19) spread worldwide, frontline healthcare workers play a key role in the containment of this devastating pandemic, and to prevent the cross-transmission and gain confidence in battle with the pandemic, they are wearing personal protective equipment (PPE). AIM AND OBJECTIVE To explore the adverse health problems and skin reactions caused by the use of PPEs among the frontline nurses in the ICUs of COVID hospital. MATERIALS AND METHODS A cross-sectional study was conducted using an online-based questionnaire assessing the physical problems, and adverse skin reactions of PPEs were sent among the 150 frontline nurses in ICUs of COVID hospital. The collected data were analyzed using descriptive statistics. RESULTS We got 137 valid responses from frontline nurses, and the most common adverse health effects expressed by them were headache (73.4%), extreme sweating (59.6%), and difficulty in breathing (36.7%); 91.7% complained about the fogging of the goggle. Majority of frontline nurses expressed nasal bridge scarring (76.64%) and indentation and pain on the back of the ears (66.42%) as the adverse skin reactions after wearing N95 masks. The common skin problems identified due to double gloving of latex gloves were excessive skin soakage with sweat (70.07%) and skin chapping (19%). The protective clothing caused minimal adverse reactions, and excessive sweating (71.53%) was the most reported. CONCLUSION The healthcare workers wearing PPE for a prolonged period show significant adverse effects, so appropriate strategies should be taken to prevent the adverse effects by designing effective PPEs and education of preventive measures among healthcare workers. HOW TO CITE THIS ARTICLE Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021;25(2):134-139.
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Affiliation(s)
- Sinu Jose
- Department of Nursing, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Maneesha C Cyriac
- Department of Nursing, Bel-Air College of Nursing, Panchgani, Maharashtra, India
| | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Krishna S, Kakaizada S, Almeida N, Brang D, Hervey-Jumper S. Central Nervous System Plasticity Influences Language and Cognitive Recovery in Adult Glioma. Neurosurgery 2021; 89:539-548. [PMID: 33476391 DOI: 10.1093/neuros/nyaa456] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023] Open
Abstract
Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The interface between intrinsic brain tumors such as gliomas and functional cognitive networks are poorly understood. The ability to communicate effectively is critically important for receiving oncological therapies and maintaining a high quality of life. Although the propensity of gliomas to infiltrate cortical and subcortical structures and disrupt key anatomic language pathways is well documented, there is new evidence offering insight into the network and cellular mechanisms underpinning glioma-related aphasia and aphasia recovery. In this review, we will outline the current understanding of the mechanisms of cognitive dysfunction and recovery, using aphasia as an illustrative model.
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Affiliation(s)
- Saritha Krishna
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nyle Almeida
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Dhandapani M, Dhandapani S. Challenges posed by COVID-19 and neurosurgical nursing strategies in developing countries. Surg Neurol Int 2020; 11:441. [PMID: 33408926 PMCID: PMC7771480 DOI: 10.25259/sni_677_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Neurosurgical patients with stroke, trauma, and brain tumors can be among the victims of the COVID-19 pandemic in developing countries, which need to be managed efficiently. Methods: This is an overview of neurosurgical nurses’ challenges and strategies in the current COVID-19 pandemic environment in developing countries. Results: Here, we reviewed the unique challenges of providing neurosurgical nursing services during the COVID-19 pandemic in developing countries. We address specific issues such as transferring neurosurgical patients, allocating medical supplies, prioritizing neurosurgical services, COVID-19 testing protocols, and patient triage (emergent vs. urgent vs. delayed surgery). Teleconsultation, telenursing services for outpatient treatment, follow-up and virtual teaching strategies associated with neurosurgical nursing are discussed. Conclusion: Neurosurgical nursing during the COVID-19 pandemic in developing countries requires transparent planning, implementation, and careful consideration of various telemedicine strategies.
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Affiliation(s)
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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10
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Dhandapani S, Narayanan R, Jayant SS, Sahoo SK, Dutta P, Walia R, Chhabra R, Singh A, Verma R, Gupta R, Virk RS, Dhandapani M, Bhagat H, Bhansali A, Mukherjee KK, Gupta SK. Endonasal endoscopic versus microscopic transsphenoidal surgery in pituitary tumors among the young: A comparative study & meta-analysis. Clin Neurol Neurosurg 2020; 200:106411. [PMID: 33338824 DOI: 10.1016/j.clineuro.2020.106411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/08/2020] [Accepted: 11/28/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The transsphenoidal approach presents unique challenges in young, with scanty literature. This study compares the outcome of pituitary tumors among young in our center between endoscopic(EES) and microscopic(MTS) transsphenoidal surgery, with a meta-analysis. METHODS Patients within 20 years were studied for their surgical approach to a favorable outcome of endocrine remission (ER) (functioning) or Gross/Near-Total resection (nonfunctioning), besides the need for retreatment. Relevant studies were pooled and analyzed according to PRISMA guidelines. RESULTS Out of 64 young patients with pituitary tumors, 48 underwent transsphenoidal surgery using MTS(33) or EES(15). Of these, 21, 14, 5, and 8 had Cushing's, somatotropinomas, prolactinomas, and non-secreting tumors, respectively. Mean symptom duration was 28months, with weight gain(50 %) and visual complaints(29 %) most prevalent. Hypogonadism(21 %) was the most frequent endocrinopathy. The mean tumor volume was 3.8 cm3. Over mean follow-up of 4.4years, favorable outcome was significantly higher after EES than MTS(78.6 % vs. 46.7 %)(odds ratio 4.18, p = 0.05). EES's better outcome was homogeneous across subgroups of age and tumor type, with no significant subgroup difference. Symptom duration was significantly higher among those who required retreatment(p = 0.05), while ER had a non-significant association with tumor volume(p = 0.07). Overall, 40 %, 27 %, 17 %, and 8% were on hydrocortisone, thyroxine, sex hormone, and desmopressin, respectively, at follow-up with no significant difference between EES and MTS. In pooled analysis of literature, both favorable outcome(74 % vs. 48 %,p = 0.02) and retreatment rate(8% vs. 37 %,p = 0.004) were significantly better with EES than MTS. CONCLUSION Among young patients with pituitary tumors, the favorable outcome and retreatment rates are better with endonasal endoscopy and associated with symptom duration and tumor volume.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Rajasekhar Narayanan
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Satyam Singh Jayant
- Dept. of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sushant K Sahoo
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Dept. of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Dept. of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Roshan Verma
- Dept. of ENT, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rijuneeta Gupta
- Dept. of ENT, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ramandeep Singh Virk
- Dept. of ENT, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Manju Dhandapani
- Dept. of NINE, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Hemant Bhagat
- Dept. of Anesthesia, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Dept. of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanchan K Mukherjee
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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11
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Jose S, Dhandapani M, Cyriac MC. Burnout and Resilience among Frontline Nurses during COVID-19 Pandemic: A Cross-sectional Study in the Emergency Department of a Tertiary Care Center, North India. Indian J Crit Care Med 2020; 24:1081-1088. [PMID: 33384515 PMCID: PMC7751034 DOI: 10.5005/jp-journals-10071-23667] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic had a massive impact on healthcare systems, increasing the risks of psychological distress in health professionals. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job and is defined by the three dimensions of emotional exhaustion, cynicism, and personal inefficacy. METHODOLOGY A cross-sectional descriptive design was used to assess the burnout and resilience among frontline nurses in the emergency department of a tertiary care center in North India during COVID-19 pandemic. The sample consisted of 120 frontline nurses working in the emergency department, selected by a simple random sampling method. Data were collected using the Maslach burnout inventory-general survey and the Connor-Davidson Resilience Scale. RESULTS The nurses in the emergency during pandemic experienced a moderate-to-severe level of burnout in emotional exhaustion (29.13 ± 10.30) and depersonalization (12.90 ± 4.67) but mild-to-moderate level of burnout in reduced personal accomplishment (37.68 ± 5.17) and showed a moderate to a high level of resilience (77.77 ± 12.41). The two metrics of burnout viz., emotional exhaustion and personal inefficacy had a significantly negative correlation with resilience among the frontline nurses in the emergency (r = 0.25, p < 0.05 and r = 0.31, p < 0.01, respectively). A significant negative correlation has been identified between burnout and resilience that informs the role of resilience in alleviating burnout during this pandemic. CONCLUSION Effective interventions for improving resilience are needed to relieve nurses' burnout and workplace stressors. Also, the administration should ensure a healthy workplace and adopt a positive attitude and harmonious relationship with the frontline workers in the mitigation of the pandemic. HOW TO CITE THIS ARTICLE Jose S, Dhandapani M, Cyriac MC. Burnout and Resilience among Frontline Nurses during COVID-19 Pandemic: A Cross-sectional Study in the Emergency Department of a Tertiary Care Center, North India. Indian J Crit Care Med 2020;24(11):1081-1088.
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Affiliation(s)
- Sinu Jose
- Department of Nursing, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Devi Y, Khan S, Rana P, Dhandapani M, Ghai S, Gopichandran L, Dhandapani S. Cognitive, Behavioral, and Functional Impairments among Traumatic Brain Injury Survivors: Impact on Caregiver Burden. J Neurosci Rural Pract 2020; 11:629-635. [PMID: 33144802 PMCID: PMC7595773 DOI: 10.1055/s-0040-1716777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Background The burden of cognitive, behavioral, and functional impairments after traumatic brain injury (TBI) is still not highlighted much, but its impact on caregivers is socio-economically relevant. The objectives of the study were to assess cognitive, behavioral, and functional impairments in patients of TBI and its impact on caregiver burden. Materials and Methods A descriptive cross-sectional study was conducted using a total enumeration sampling technique. Mini-mental status examination, neuropsychiatric inventory and Rappaport's disability rating scale were used to assess patients' cognitive, behavioral, and functional impairments, respectively. Zarit Caregiver Burden Scale was executed to quantify the caregiver burden. Results Fifty patients of TBI and their caregivers were enrolled. Among these, 24% had moderate cognitive impairments. Among behavioral symptoms, 40% had agitation, 24% had depression, 18% had anxiety, and 16% had irritability. Moderate functional disability was reported by 18% of the patients, while 2% reported severe functional disability. Moderate to severe caregiver burden was reported by 8% of caregivers. Patients' behavioral ( r = 0.507, p < 0.001), functional ( r = 0.473, p = 0.001), and cognitive ( r = -0.438, p = 0.001) impairments had significant correlations with caregiver burden. Conclusion Patients develop cognitive, behavioral, and functional disability after TBI. The caregiver burden increases significantly with cognitive dysfunction, behavioral symptoms, and impaired functional status of patients. Therefore, appropriate support is to be provided to caregivers as well as patients.
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Affiliation(s)
- Yashodha Devi
- Department of Nursing, Indraprastha Apollo Hospital, Delhi, India
| | - Sahiba Khan
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Rana
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manju Dhandapani
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Gopichandran L, C K, G V, M J, Srivastava A, Vanamail P, Dhandapani M. Factors Influencing Pain Dimensions in Patients with Chronic Tension-Type Headache: An Exploratory Survey. Pain Manag Nurs 2020; 21:441-448. [PMID: 32241733 DOI: 10.1016/j.pmn.2020.02.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 10/13/2019] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic tension type headache (CTTH) is one of the common cause of hospital visits among adolescents and adults. Chronic tension type headache produces pain, sleep disturbances, and disability among patients leading to a poor quality of life. Knowledge pattern of headache and various associated factors will aid appropriate management. AIMS To identify the headache dimensions and their various influencing factors among patients of chronic tension-type headache. METHODS Using consecutive sampling techniques, 169 patients with chronic tension-type headache were recruited in this cross-sectional survey. Approval was obtained from the Institute's Ethics Committee. The Wong-Baker Foundation Pain intensity scale was used to assess the pain severity. RESULTS A pain severity score of 6 out of 10 was reported by 56% of the patients, and the mean pain score reported by the patients was 6.62 ± 1.16. The mean weekly headache frequency was 4.95 ± 0.38, and the mean daily headache duration was 8.68 ± 1.68 hours. Significantly more patients who are married, patients who had a duration of illness less than two years, and patients who were treated with only analgesics reported higher headache severity. Higher headache frequency was reported by significantly more patients who were male, married, from a nuclear family, educated, unskilled laborers or employed, urban inhabitants, or only on analgesics, or had illness duration less than two years. Headache duration was significantly higher in patients who were unskilled laborers or only on analgesics, or had illness duration less than two years. CONCLUSIONS Patients with chronic tension-type headache experience moderate to high severity of headache, along with substantial duration and frequency, an outcome that was associated with various lifestyle-related factors that can result in stress. Lifestyle modification and nonpharmacological management are thus essential to reduce the severity, frequency, and duration of headache in patients with a chronic tension-type headache and medication overuse.
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Affiliation(s)
| | - Kanniammal C
- College of Nursing, Sri Ramaswami Memorial (SRM) University, Chennai, India
| | - Valli G
- Mednakshi Ammal Dental College, Meenakshi University, Chennai, India
| | - Jaideep M
- Mednakshi Ammal Dental College, Meenakshi University, Chennai, India
| | - Achal Srivastava
- Neurology Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P Vanamail
- Obstetrics and Gynecology (OBG) Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manju Dhandapani
- National Institute of Nursing Education (NINE), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Belousov A, Titov S, Shved N, Garbuz M, Malykin G, Gulaia V, Kagansky A, Kumeiko V. The Extracellular Matrix and Biocompatible Materials in Glioblastoma Treatment. Front Bioeng Biotechnol 2019; 7:341. [PMID: 31803736 PMCID: PMC6877546 DOI: 10.3389/fbioe.2019.00341] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
During cancer genesis, the extracellular matrix (ECM) in the human brain undergoes important transformations, starting to resemble embryonic brain cell milieu with a much denser structure. However, the stiffness of the tumor ECM does not preclude cancer cells from migration. The importance of the ECM role in normal brain tissue as well as in tumor homeostasis has engaged much effort in trials to implement ECM as a target and an instrument in the treatment of brain cancers. This review provides a detailed analysis of both experimental and applied approaches in combined therapy for gliomas in adults. In general, matrix materials for glioma treatment should have properties facilitating the simplest delivery into the body. Hence, to deliver an artificial implant directly into the operation cavity it should be packed into a gel form, while for bloodstream injections matrix needs to be in the form of polymer micelles, nanoparticles, etc. Furthermore, the delivered material should mimic biomechanical properties of the native tissue, support vital functions, and slow down or stop the proliferation of surrounding cells for a prolonged period. The authors propose a two-step approach aimed, on the one hand, at elimination of remaining cancer cells and on the other hand, at restoring normal brain tissue. Thereby, the first bioartificial matrix to be applied should have relatively low elastic modulus should be loaded with anticancer drugs, while the second material with a higher elastic modulus for neurite outgrowth support should contain specific factors stimulating neuroregeneration.
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Affiliation(s)
- Andrei Belousov
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Sergei Titov
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.,School of Natural Sciences, Far Eastern Federal University, Vladivostok, Russia
| | - Nikita Shved
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.,A.V. Zhirmunsky National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Vladivostok, Russia
| | - Mikhail Garbuz
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Grigorii Malykin
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.,A.V. Zhirmunsky National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Vladivostok, Russia
| | - Valeriia Gulaia
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Alexander Kagansky
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Vadim Kumeiko
- School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.,School of Natural Sciences, Far Eastern Federal University, Vladivostok, Russia.,A.V. Zhirmunsky National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Vladivostok, Russia
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15
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Mahak C, Shashi, Yashomati, Hemlata, Manisha N, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of Utilization of Rehabilitation Services among Stroke Survivors. J Neurosci Rural Pract 2018; 9:461-467. [PMID: 30271034 PMCID: PMC6126306 DOI: 10.4103/jnrp.jnrp_25_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The current study was conducted with the objective to assess the utilization of rehabilitation services and factors affecting nonutilization of rehabilitation services among the stroke survivors. MATERIALS AND METHODS The current study was carried out in the Neuro Outpatient Department of a tertiary care hospital in India. It was a descriptive study. Consecutive 55 stroke survivors who had met the inclusion and exclusion criteria were recruited in this study. Self-structured rehabilitation tool was used to collect the data. RESULTS Data were analyzed using the descriptive and inferential statistics. Majority of the patients comprised 70.9% of males and 29.1% of females. Among participants, 70.90% were aware about rehabilitation, 67% were utilizing rehabilitation services, whereas 33% were not utilizing rehabilitation services. In the current study, certain reasons were found behind not utilizing rehabilitation services. There were 83.3% of participants who had lack of awareness about rehabilitation services and 61.1% of participants who had no availability of rehabilitation services. Only 45.5% of rural inhabitants were utilizing rehabilitation services as compared to 81.2% of urban inhabitants and 83.23% of suburban inhabitants. CONCLUSION Rehabilitation is of utmost importance. Hemiparesis, difficulty in performing activity of daily living, difficulty in performing social activities, and difficulty in reasoning were the most common problems faced by people suffering stroke after discharge from the hospital. There was lack of awareness and utilization of rehabilitation services by patients among Indian stroke population. Hence, health workers have an immense role in educating, motivating, and ensuring that rehabilitation services in rural inhabitants.
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Affiliation(s)
- Chandel Mahak
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Shashi
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Yashomati
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Hemlata
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Nagi Manisha
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Ghai Sandhya
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Manju Dhandapani
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Prakash P, Dhandapani M, Ghai S, Singh NV, Dhandapani S. Quality of Life Among Children Who Had Undergone Ventriculoperitoneal Shunt Surgery. J Pediatr Neurosci 2018; 13:189-194. [PMID: 30090133 PMCID: PMC6057189 DOI: 10.4103/jpn.jpn_118_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunting is the most common neurosurgical treatment for hydrocephalus. In spite of significant developments in the technology and design of shunt systems, shunt surgery is still associated with morbidity. AIM To identify the problems faced by children on VP shunt and assess their quality of life (QOL). SETTING AND DESIGN A cross-sectional exploratory study. MATERIALS AND METHODS A total of 31 children on VP shunt were selected through consecutive sampling technique, and hydrocephalus outcome questionnaire was used to collect the data, with the converted metric score ranging from 0 to 1. Hydrocephalus due to stroke, hemorrhage, and malignant tumors was excluded. RESULTS The mean age of patients was 11.51 ± 4.26 years. Headache and generalized pain were the common problems experienced (42%). The mean score of QOL was 0.67 ± 0.21. Among the three domains, cognitive domain was the most affected. Among the clinicoradiological factors, multiple surgeries (P = 0.02) had the most significant impact on QOL. CONCLUSION Children who underwent VP shunt face various health-related problems in different domains and low QOL. Although cognitive domain was the most affected, multiple surgeries had the most significant impact on QOL. Appropriately focused interventions and holistic management are essential to improve the QOL of children undergoing VP shunt.
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Affiliation(s)
- Priyanka Prakash
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Manju Dhandapani
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Neena V. Singh
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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