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Lim J, Aguirre AO, Rattani A, Baig AA, Monteiro A, Kuo CC, Siddiqi M, Im J, Housley SB, McPheeters MJ, Ciecierska SSK, Jaikumar V, Vakharia K, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Thrombectomy outcomes for acute ischemic stroke in lower-middle income countries: A systematic review and analysis. World Neurosurg X 2024; 23:100317. [PMID: 38511159 PMCID: PMC10950731 DOI: 10.1016/j.wnsx.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Abbas Rattani
- Department of Radiation Oncology, Tufts University Medical Center, Boston, MA, USA
| | - Ammad A. Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Justin Im
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Matthew J. McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Jason M. Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V. Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Kaakour AH, Rattani A. Current Ethical Considerations of Human Whole Eye Transplantation is Short-Sighted. Am J Bioeth 2024; 24:92-94. [PMID: 38635445 DOI: 10.1080/15265161.2024.2328278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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Rattani A, Mian Z, Farahani S, Ridge M, Uzamere T, Bajwa M. A systematic review of barriers to pursuing careers in medicine among Black premedical students. J Natl Med Assoc 2024; 116:95-118. [PMID: 38267334 DOI: 10.1016/j.jnma.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 01/26/2024]
Abstract
Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.
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Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, United States of America.
| | - Zoha Mian
- University of Louisville School of Medicine, A Building, Suite 110, 500 S. Preston Street, Louisville, KY 40204, United States of America
| | | | - Margaret Ridge
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH, 45229, United States of America
| | - Theodore Uzamere
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite W6104, Houston, TX, 77030, United States of America
| | - Moazzum Bajwa
- Department of Family Medicine at the University of California Riverside, 900 University Avenue Riverside, CA, 92521, United States of America
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Shahawy S, Al Kassab L, Rattani A. Ramadan Fasting and Pregnancy: An Evidence-Based Guide for the Obstetrician. Am J Obstet Gynecol 2023:S0002-9378(23)00169-2. [PMID: 36940770 DOI: 10.1016/j.ajog.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
Pregnant Muslim women may be religiously exempt from fasting during the Islamic month of Ramadan, especially if there is concern for undue hardship or harm to maternal or fetal health. However, several studies demonstrate that most women still choose to fast during pregnancy and avoid discussing fasting with their providers. A targeted literature review of published studies on fasting during Ramadan and pregnancy/maternal and fetal outcomes was performed. We generally found little to no clinically significant effect of fasting on neonatal birthweight or preterm delivery. Conflicting data exist on fasting and mode of delivery. Fasting during Ramadan has been mainly associated with signs and symptoms of maternal fatigue and dehydration, with a minimal decrease in weight gain. There is conflicting data regarding the association with gestational diabetes mellitus and insufficient data on maternal hypertension. Fasting may affect some antenatal fetal testing indices-including non-stress tests, lower amniotic fluid levels, and lower biophysical profile scores. Current literature on the long-term effects of fasting on offspring suggests possible adverse effects, but more data is required. The quality of evidence was negatively impacted by the variation in defining "fasting during Ramadan" in pregnancy; study size and design; and potential confounders. Therefore, in counseling patients, obstetricians should be prepared to discuss the nuances in the existing data while demonstrating cultural and religious awareness and sensitivity to foster a trusting relationship between patient and provider. We provide a framework for obstetricians and other prenatal care providers to aid in that effort and supplemental materials to encourage patients to seek clinical advice on fasting. Providers should engage patients in a shared decision-making process and offer them a nuanced a review of the evidence (including limitations) and individualized recommendations based on clinical experience and patient history. Finally, should certain patients choose to fast while pregnant, providers should offer medical recommendations, closer observation, and support to reduce harm and hardship while fasting.
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Affiliation(s)
- Sarrah Shahawy
- Department of Obstetrics & Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Abbas Rattani
- Department of Radiation Oncology, Tufts University Medical Center, Boston, MA, USA
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Germino EA, Saripalli AL, Taparra K, Rattani A, Pointer KB, Singh SA, Musunuru HB, Shukla UC, Vidal G, Pereira IJ, Williams VM, Elmore SNC, Franco I, Chaurasia AR, Rivera A. Tailored Mentorship for the Underrepresented and Allies in Radiation Oncology: The Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee Mentorship Experience. Int J Radiat Oncol Biol Phys 2023; 116:368-374. [PMID: 36787853 DOI: 10.1016/j.ijrobp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/22/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE There are limited opportunities for mentorship for underrepresented in medicine (URM) trainees and physicians in radiation oncology (RO). The purpose of this study was to create and evaluate a formal mentorship program open to URMs and allies with interests in diversity, equity, and inclusion. METHODS AND MATERIALS A mentorship program incorporating a virtual platform was designed by the Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee. It was structured to include 6 sessions over 6 months with matched mentor-mentee pairs based on responses to a publicized online interest form. A compilation of evidence-based guidelines was provided to optimize the mentorship relationship. Linked pre- and postprogram surveys were administered to collect demographic data, define baseline goals and level of support, and evaluate program satisfaction. RESULTS Thirty-five mentor-mentee pairs were matched; 31 mentees completed the preprogram survey and 17 completed the postprogram survey. Preprogram, only 3 mentees (9.7%) reported satisfaction with current mentorship and 5 (16%) reported mechanisms or mentorship in place at their program to support URMs. On the postprogram survey, mentees reported high satisfaction with areas of mentorship, mentor attributes, and the program overall. Opportunities for improvement include implementation of mechanisms to enhance communication with mentor-mentee pairs and maintain longitudinal engagement. CONCLUSIONS In the first tailored mentorship program in RO for URMs and those with diversity, equity, and inclusion interests, our results demonstrate that there is self-reported interest for better mentorship for URMs in RO, and that a nationwide structured mentorship program can address participants' goals with high satisfaction. Program expansion could provide URMs and allies in RO more opportunities for career development and promote a greater sense of community and inclusion within the field.
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Affiliation(s)
- Elizabeth A Germino
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
| | - Anjali L Saripalli
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, California
| | - Abbas Rattani
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Kelli B Pointer
- Department of Radiation Oncology, Dartmouth Cancer Center, Hanover, New Hampshire
| | - Sarah A Singh
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Utkarsh C Shukla
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts
| | - Gabriel Vidal
- Department of Radiation Oncology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Ian J Pereira
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Vonetta M Williams
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shekinah N C Elmore
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Idalid Franco
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Avinash R Chaurasia
- Department of Radiation Oncology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Amanda Rivera
- Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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McKenzie G, Gaskins J, Rattani A, Oliver A, Southall W, Nakamura F, Yusuf M, Mistry A, Williams B, Woo S. Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases. J Neurooncol 2022; 160:591-599. [DOI: 10.1007/s11060-022-04178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
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McKenzie G, Gaskins J, Rattani A, Oliver A, Southall W, Nakamura F, Yusuf M, Mistry A, Williams B, Woo S. Single-Fraction vs. Fractionated Radiosurgery and the Development of Post-Treatment Hemorrhage for Intact Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rattani A, Gaskins J, McKenzie G, Scharf V, Broman K, Pisu M, Holder A, Schwartz D, Dunlap N, Yusuf M. Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Sarrah Shahawy
- Harvard Medical School, Division of Global Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Abbas Rattani
- University of Louisville Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY, USA; Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
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Sharma M, Ball T, Wang D, Ugiliweneza B, Rattani A, Woo S, Boakye M, Neimat JS, Williams B, Andaluz N. Incidence of repeat procedures and healthcare utilization following surgery, radiosurgery, and percutaneous procedures in elderly patients with trigeminal neuralgia. J Neurosurg 2022; 137:1-12. [PMID: 35090128 DOI: 10.3171/2021.12.jns211880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Management of trigeminal neuralgia (TN) in elderly patients poses significant challenges. The impact of different treatment modalities (surgery, radiosurgery [RS], and percutaneous techniques [PTs]) on healthcare utilization is not well defined in the management of TN in elderly patients. The aim of this study was to compare the long-term healthcare utilization metrics of different interventions in the management of elderly patients with TN. METHODS The MarketScan database was queried using the International Classification of Diseases, Ninth Revision and Current Procedural Terminology, from 2000 to 2016. TN patients ≥ 65 years of age managed using surgery, RS, and PTs with at least 5 years of follow-up after the index procedure were included. Outcomes analyzed were hospital admissions, outpatient services, and medication refills. RESULTS Of 993 patients, 43% (n = 430) underwent RS, 44% (n = 432) had PTs, and only 13% (n = 131) underwent surgery for TN. Overall, the median age of patients was 74 years old, 64% were females, 90% had Medicare insurance, and 17% had an Elixhauser index ≥ 3. Patients in the surgery group were younger (median age 71 years) with a higher comorbidity index (≥ 3; 24%) compared with patients undergoing RS and PTs (13% and 17%, respectively). At 1, 2, and 5 years after the index procedure, 41%, 48%, and 57% of patients in the PT cohort underwent any repeat procedure compared with 11%, 18%, and 29% for the RS cohort, and 6%, 9%, and 11% for the surgical cohort, respectively. Also, patients in the PT cohort incurred 1.8, 1.9, and 2.0 times the combined payment at 1, 2, and 5 years, respectively, compared with the surgery cohort. Similarly, patients who underwent RS for TN incurred 1.4, 1.5, and 1.5 times the combined payment at 1, 2, and 5 years, respectively, compared with the surgery cohort. At 5 years after the index procedure, combined payments for the PT cohort were $79,753 (IQR $46,013, $144,064) compared with $61,016 (IQR $27,114, $117,097) for the RS cohort and $41,074 (IQR $25,392, $87,952) for the surgery cohort (p < 0.0001). CONCLUSIONS PTs followed by RS were the common procedures used in the majority of elderly patients with TN. However, surgery for TN resulted in durable control with the least need for reoperations up to 5 years after the index procedure, followed by RS and PTs. PTs for TN resulted in the highest utilization of healthcare resources and need for reoperations at all time points. These findings should be considered in clinical decision-making when selecting appropriate treatment modalities in elderly patients with TN.
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Affiliation(s)
- Mayur Sharma
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Tyler Ball
- 2Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - Dengzhi Wang
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | | | - Abbas Rattani
- 3Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Kentucky; and
| | - Shiao Woo
- 3Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Kentucky; and
| | - Maxwell Boakye
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Joseph S Neimat
- 1Department of Neurosurgery, University of Louisville, Kentucky
| | - Brian Williams
- 1Department of Neurosurgery, University of Louisville, Kentucky
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Abstract
Innovation in ethics pedagogy has continued to evolve and incorporate other forms of storytelling aimed at improving student engagement and learning. The use of bioethics narratives in feature-length films, medical television shows, or short clips in the classroom has a well-established history. In parallel, screenplays present an opportunity for an active approach to ethical engagement. We argue that screenplays and screenwriting provide a rich supplement to current medical ethics teaching and serve as a strong form of reflective learning.
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Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL, 60153, USA.
| | - Abdul-Hadi Kaakour
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo St, Los Angeles, CA, 90033, USA
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, P.O. Box 016960 (M-825), Miami, FL, 33101, USA
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Yusuf M, Rattani A, Gaskins J, Oliver AL, Mandish SF, Burton E, May ME, Williams B, Ding D, Sharma M, Miller D, Woo S. Stereotactic radiosurgery for melanoma brain metastases: dose-size response relationship in the era of immunotherapy. J Neurooncol 2021; 156:163-172. [PMID: 34807342 PMCID: PMC8606626 DOI: 10.1007/s11060-021-03899-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/11/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE/OBJECTIVE(S) To determine, for intact melanoma brain metastases (MBM) treated with single-fraction stereotactic radiosurgery (SRS), whether planning parameter peripheral dose per lesion diameter (PDLDm, Gy/mm) and lesion control (LC) differs with versus without immunotherapy (IO). MATERIALS/METHODS We performed a retrospective analysis of patients with intact MBM treated with SRS from 2008 to 2019. Cox-frailty models were constructed to include confounders selected by penalized Cox regression models with a LASSO selector. Interaction effect testing was used to determine whether a significant effect between IO and PDLDm could be demonstrated with respect to LC. RESULTS The study cohort comprised 67 patients with 244 MBMs treated with SRS (30 patients with 122 lesions treated with both SRS and IO) were included. The logarithm of PDLDm was selected as a predictor of LC (HR 0.307, 95% CI 0.098-0.441), adjusting for IO receipt (HR 0.363, 95% CI 0.108-1.224). Interaction effect testing demonstrated a differential effect of PDLDm by IO receipt, with respect to LC (p = 0.048). Twelve-month LC rates for a 7.5 mm lesion receiving SRS (18 Gy) with IO versus without IO were 87.8% (95% CI 69.0-98.3%) versus 79.8% (95% CI 55.1-93.8%) respectively. CONCLUSION PDLDm predicted LC in patients with small MBMs treated with single-fraction SRS. We found a differential effect of dose per lesion size and LC by immunotherapy receipt. Future studies are needed to determine whether lower doses of single-fraction SRS afford similarly effective LC for patients with small MBMs receiving immunotherapy.
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Affiliation(s)
- Mehran Yusuf
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abbas Rattani
- Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY, 40202, USA.
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | | | - Steven F Mandish
- Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY, 40202, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael E May
- Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY, 40202, USA
| | - Brian Williams
- Department of Neurosurgery, University of Louisville Hospital, Louisville, KY, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville Hospital, Louisville, KY, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville Hospital, Louisville, KY, USA
| | - Donald Miller
- Department of Medical Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Shiao Woo
- Department of Radiation Oncology, School of Medicine, University of Louisville Hospital, 529 S. Jackson St, Louisville, KY, 40202, USA
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Oliver A, Rattani A, Dunlap N. Improving the Radiation Oncology Black Workforce Pipeline: Learning From Early-Stage Career Initiatives. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oliver A, Rattani A, Dunlap N. Etiology of Black Exclusion in Radiation Oncology and Beyond: A Systematic Analysis of Early-Stage Career Barriers. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Reshko LB, Gaskins JT, Rattani A, Farley AA, McKenzie GW, Silva SR. Patterns of care and outcomes of radiotherapy or hormone therapy in patients with medically inoperable endometrial adenocarcinoma. Gynecol Oncol 2021; 163:517-523. [PMID: 34563365 DOI: 10.1016/j.ygyno.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The optimal treatment for medically inoperable endometrioid endometrial adenocarcinoma is unknown. The goal of this study was to evaluate the patterns of care and efficacy of radiotherapy (RT) or hormone therapy (HT) in the treatment of these patients. METHODS We performed a query of the National Cancer Database (NCDB) of patients with medically inoperable endometrioid adenocarcinoma of the endometrium diagnosed between 2004 and 2016 and treated with either RT or HT. A multivariate Cox regression model and propensity weighted analyses were used to evaluate overall survival after controlling for confounding variables. A multinomial logistic regression model was used to assess predictors of RT or HT use. RESULTS A total of 1036 patients were included in this cohort, and 73% (n = 759) were treated with RT alone. Patients who received definitive HT compared to RT were more likely to be older, diagnosed in the earlier years of this analysis, treated at lower-case volume centers, diagnosed with high-grade disease, or located outside of metropolitan areas. On multivariate analysis, treatment with HT alone versus RT alone was associated with significantly worse overall survival in the multivariate Cox model but not on propensity score weighted analysis. Interaction effect testing revealed that older patients and those treated at lower-volume centers had improved survival with RT compared to HT. CONCLUSIONS We identified factors associated with the receipt of RT or HT in medically inoperable endometrial cancer patients. Treatment with RT correlated with improved survival compared to HT in older patients and those treated at lower-volume centers.
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Affiliation(s)
- Leonid B Reshko
- Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, KY, United States of America
| | - Abbas Rattani
- Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America
| | - Alyssa A Farley
- Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America
| | - Grant W McKenzie
- Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America
| | - Scott R Silva
- Department of Radiation Oncology, University of Louisville, Louisville, KY, United States of America.
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Rattani A. A Critique of Contemporary Islamic Bioethics. J Bioeth Inq 2021; 18:357-361. [PMID: 33661476 DOI: 10.1007/s11673-021-10098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Last year marked a decade since the publication of the book "Islamic Biomedical Ethics" by religious studies professor Abdulaziz Sachedina in which he called for a critical and rigorous analytical approach to the ethical inquiry of biomedical issues from an Islamic perspective. Since the publication of this landmark work, some authors have continued to call into question the ways in which Islam as a religious tradition is engaged with in the secular bioethics literature. This paper describes common argumentative issues with current Islamic bioethics scholarship and offers general pearls and strategies to facilitate better engagement with religious approaches to bioethical issues.
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Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, University of Louisville, 529 S Jackson St, Louisville, KY, 40202, USA.
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Yusuf M, Gaskins JT, Rattani A, McKenzie G, Mandish S, Wall W, Farley A, Tennant P, Bumpous J, Dunlap NE. Immune status in merkel cell carcinoma: Relationships with clinical factors and independent prognostic value. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21509 Background: Immunosuppression (IS) is not currently considered in staging for Merkel cell carcinoma (MCC). We performed an analysis of the National Cancer Database (NCDB) to investigate immune status as an independent predictor of overall survival (OS) for patients with MCC and describe the relationship between immune status and other prognostic factors. Methods: The NCDB was queried for patients diagnosed with MCC from 2010 to 2016 with known immune status. Multivariable Cox proportional hazards models were used to define factors associated with OS. Adjuvant radiation and chemotherapy were treated as time-dependent predictors to limit immortal time bias. Secondary models were constructed to assess the association between IS etiology and OS. Multivariable logistic regression models were used to characterize relationships between immune status and other factors. Multiple imputation was used to minimize missing data bias. Results: The overall cohort included 3,882 patients (3,470 patients with known immunocompetence and 412 patients with known immunosuppression). Etiologies for profound IS included chronic lymphocytic leukemia (CLL, n = 118), Other including HIV/AIDS (n = 116), solid-organ transplant (n = 106), and Non-Hodgkin Lymphoma (NHL, n = 72). 2,864 patients (73.8%) underwent surgical nodal examination. The median follow-up time was 33 months (Interquartile Range: 18 to 55 months). The 3-year OS was lower for patients with IS (44.6%, CI 39.8-49.9%) compared to immunocompetent (IC) patients (68.7%, CI 67.1-70.4%, p < .0001). IS was associated with increased adjusted mortality hazard (HR 2.36, 95% CI 2.03-2.75). Etiology of IS was associated with OS ( p = .0015) with lowest 3-year OS (32.7%, CI 24.6%-43.5%) for patients with solid-organ transplantation. IS was associated with increased odds of greater nodal burden (OR 1.70, CI 1.37-2.11) and lymphovascular invasion (OR 1.58, CI 1.23-2.03). Conclusions: Immune status was independently prognostic for OS for patients with localized MCC. Etiology of IS may be associated with differential survival outcomes. Multiple adverse prognostic factors were associated with increased likelihood of IS. Immune status and potentially etiology of IS may be useful prognostic factors to consider for future MCC staging systems.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Neal E. Dunlap
- The James Graham Brown Cancer Center at University of Louisville, Louisville, KY
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Yusuf MB, Gaskins J, Rattani A, McKenzie G, Mandish S, Wall W, Farley A, Tennant P, Bumpous J, Dunlap N. Immune Status in Merkel Cell Carcinoma: Relationships With Clinical Factors and Independent Prognostic Value. Ann Surg Oncol 2021; 28:6154-6165. [PMID: 33852099 DOI: 10.1245/s10434-021-09944-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Immunosuppression (IS) currently is not considered in staging for Merkel cell carcinoma (MCC). An analysis of the National Cancer Database (NCDB) was performed to investigate immune status as an independent predictor of overall survival (OS) for patients with MCC and to describe the relationship between immune status and other prognostic factors. METHODS The NCDB was queried for patients with a diagnosis of MCC from 2010 to 2016 who had known immune status. Multivariable Cox proportional hazards models were used to define factors associated with OS. Secondary models were constructed to assess the association between IS etiology and OS. Multivariable logistic regression models were used to characterize relationships between immune status and other factors. RESULTS The 3-year OS was lower for the patients with IS (44.6%) than for the immunocompetent (IC) patients (68.7%; p < 0.0001). Immunosuppression was associated with increased adjusted mortality hazard (hazard ratio [HR], 2.36, 95% confidence interval [CI], 2.03-2.75). The etiology of IS was associated with OS (p = 0.0015), and patients with solid-organ transplantation had the lowest 3-year OS (32.7%). Immunosuppression was associated with increased odds of greater nodal burden (odds ratio [OR], 1.70; 95% CI, 1.37-2.11) and lymphovascular invasion (OR, 1.58; 95% CI, 1.23-2.03). CONCLUSIONS Immune status was independently prognostic for the OS of patients with localized MCC. The etiology of IS may be associated with differential survival outcomes. Multiple adverse prognostic factors were associated with increased likelihood of IS. Immune status, and potentially the etiology of IS, may be useful prognostic factors to consider for future MCC staging systems.
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Affiliation(s)
- Mehran B Yusuf
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Abbas Rattani
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Grant McKenzie
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Steven Mandish
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Weston Wall
- Department of Dermatology, Medical College of Georgia, Augusta, GA, USA
| | - Alyssa Farley
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
| | - Jeffrey Bumpous
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
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Rattani A, Hyder AA. Operationalizing the Ethical Review of Global Health Policy and Systems Research: A Proposed Checklist. J Law Med Ethics 2021; 49:92-122. [PMID: 33966652 DOI: 10.1017/jme.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
There has been growing consensus to develop relevant guidance to improve the ethical review of global health policy and systems research (HPSR) and address the current absence of formal ethics guidance.
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Rattani A. Interpersonal Racism in the Healthcare Workplace: Examining Insidious Collegial Interactions Reinforcing Structural Racism. J Law Med Ethics 2021; 49:307-314. [PMID: 34924056 DOI: 10.1017/jme.2021.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The traumatic stress experienced by our black healthcare colleagues is often overlooked. This work contextualizes workplace racism, identifies some interpersonal barriers limiting anti-racist growth, and calls for solidarity.
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Rattani A, Hyder AA. Letter to the Editor. J Law Med Ethics 2021; 49:692-693. [PMID: 35006050 DOI: 10.1017/jme.2021.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Rattani A. Methodological Clarity in Religious Perspectives of Bioethical Issues: Lessons from Islamic Studies. Am J Bioeth 2020; 20:40-42. [PMID: 33196385 DOI: 10.1080/15265161.2020.1833098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Rattani A. Is Solidarity Possible in Global Health Policy and Systems Research? Am J Bioeth 2020; 20:67-69. [PMID: 32364483 DOI: 10.1080/15265161.2020.1745943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Rattani A, Riordan CP, Meara JG, Proctor MR. Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis. J Neurosurg Pediatr 2020; 26:105-112. [PMID: 32302983 DOI: 10.3171/2020.2.peds19522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES. METHODS The authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and z score. RESULTS Nineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient's sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p < 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or z scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up. CONCLUSIONS Endoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.
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Affiliation(s)
- Abbas Rattani
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,2Department of Surgery, Rush University Medical Center, Chicago, Illinois; and
| | | | - John G Meara
- 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,4Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
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Punchak M, Mbabazi Kabachelor E, Ogwal M, Nalule E, Nalwoga J, Ssenyonga P, Mugamba J, Rattani A, Dewan MC, Kulkarni AV, Schiff SJ, Warf B. The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants: A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial. Neurosurgery 2020; 85:E714-E721. [PMID: 31086941 DOI: 10.1093/neuros/nyz122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are currently no published data directly comparing postoperative seizure incidence following endoscopic third ventriculostomy (ETV), with/without choroid plexus cauterization (CPC), to that for ventriculoperitoneal shunt (VPS) placement. OBJECTIVE To compare postoperative epilepsy incidence for ETV/CPC and VPS in Ugandan infants treated for postinfectious hydrocephalus (PIH). METHODS We performed an exploratory post hoc analysis of a randomized trial comparing VPS and ETV/CPC in 100 infants (<6 mo old) presenting with PIH. Minimum follow-up was 2 yr. Variables associated with and the incidence of postoperative epilepsy were compared (intention-to-treat) using a bivariate analysis. Time to first seizure was compared using the Kaplan-Meier method, and the relative risk for the 2 treatments was determined using Mantel-Haenszel hazard ratios. RESULTS Seizure incidence was not related to age (P = .075), weight (P = .768), sex (P = .151), head circumference (P = .281), time from illness to hydrocephalus onset (P = .973), or hydrocephalus onset to treatment (P = .074). Irritability (P = .027) and vision deficit (P = .04) were preoperative symptoms associated with postoperative seizures. Ten (10%) patients died, and 20 (20%) developed seizures over the follow-up period. Overall seizure incidence was 9.4 per 100 person-years (9.4 and 9.5 for ETV/CPC and VPS, respectively; P = .483), with no significant difference in seizure risk between groups (hazard ratio, 1.02; 95% CI: 0.42, 2.45; P = .966). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo for VPS (P = .464). As-treated, per-protocol, and attributable-intervention analyses yielded similar results. CONCLUSION Postoperative seizure incidence following treatment of PIH was 20% within 2 yr, regardless of treatment modality.
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Affiliation(s)
- Maria Punchak
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,David Geffen School of Medicine, University of California, Los Angeles, California
| | | | | | | | | | | | | | - Abbas Rattani
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Meharry Medical College, School of Medicine, Nashville, Tennessee
| | - Michael C Dewan
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Steven J Schiff
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania
| | - Benjamin Warf
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,CURE Children's Hospital, Mbale, Uganda.,Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
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Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, Maywood, CA, USA
| | - Dalia Kaakour
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Raafay H Syed
- Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Abdul-Hadi Kaakour
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
In surveying the medical literature on Islamic principles of research ethics, it is apparent that attempts to identify ethical principles are replete with issues of standards and gaps in knowledge of the uses of scriptural sources. Despite this, attempts at creating an Islamic ethical framework for research ethics may improve current practices in research in Muslim-majority countries and contribute to the growing canon of secular bioethics. This paper aims to identify principles and considerations within Islam that (1) overlap with current corpora on research ethics, and (2) further informs the current research ethics discourse.
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Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave., Maywood, IL, 60153, USA.
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, MD, 21093, USA
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
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Mukhopadhyay S, Punchak M, Rattani A, Hung YC, Dahm J, Faruque S, Dewan MC, Peeters S, Sachdev S, Park KB. The global neurosurgical workforce: a mixed-methods assessment of density and growth. J Neurosurg 2019:1-7. [PMID: 30611133 DOI: 10.3171/2018.10.jns171723] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn 2000, the global density of neurosurgeons was estimated at 1 per 230,000 population, which remains the most recent estimate of the global neurosurgeon workforce density. In 2004, the World Health Organization (WHO) estimated that there were 33,193 neurosurgeons worldwide, including trainees. There have been no updates to this estimate in the past decade. Moreover, only WHO region-level granularity regarding neurosurgeon distribution exists; country-level estimates are limited. The neurosurgery workforce is a crucial component to meeting the growing burden of neurosurgical diseases, which not only represent high absolute incidences and prevalences, but also represent correspondingly high disability-adjusted life years affecting hundreds of millions of people worldwide. Combining the lack of knowledge about the availability of the neurosurgical workforce and the increasing demand for neurosurgical services underscores the need for a system of neurosurgical workforce density surveillance.METHODSThis study involved 3 key steps: 1) global survey/literature review to obtain the number of working neurosurgeons per WHO-recognized country, 2) regression to interpolate any missing data, and 3) calculation of workforce densities and comparison to available historical data by WHO region.RESULTSData for 198 countries were collected (158) or interpolated (40). The global total number of neurosurgeons was estimated at 49,940. Overall, neurosurgeon density ranged from 0 to 58.95 (standardized to per 1,000,000 population) with a median of 3.56 (IQR 0.29-8.26). Thirty-three countries were found to have no neurosurgeons (zero). The highest density, 58.95, was in Japan, where 7495 neurosurgeons are taking care of a population of 127,131,800.CONCLUSIONSIn 2015, the Lancet Commission on Global Surgery estimated that 143 million additional surgical procedures are needed in low- and middle-income countries each year, and a subsequent study revealed that approximately 15% of those surgical procedures are neurosurgical. Based on our results, we can conclude that there are approximately 49,940 neurosurgeons currently, worldwide. The availability of neurosurgeons appears to have increased in all geographic regions over the past decade, with Southeast Asia experiencing the greatest growth. Such remarkable expansion should be assessed to determine factors that could play a role in other regions where the acceleration of growth would be beneficial.
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Affiliation(s)
- Swagoto Mukhopadhyay
- 1Program in Global Surgery and Social Change, Harvard Medical School.,2University of Connecticut Health Center, Farmington, Connecticut
| | - Maria Punchak
- 1Program in Global Surgery and Social Change, Harvard Medical School.,3David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Abbas Rattani
- 1Program in Global Surgery and Social Change, Harvard Medical School.,4Meharry Medical College, School of Medicine
| | - Ya-Ching Hung
- 1Program in Global Surgery and Social Change, Harvard Medical School.,5Massachusetts General Hospital
| | - James Dahm
- 1Program in Global Surgery and Social Change, Harvard Medical School.,6University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Serena Faruque
- 1Program in Global Surgery and Social Change, Harvard Medical School.,7Brigham and Women's Hospital; Boston, Massachusetts
| | - Michael C Dewan
- 1Program in Global Surgery and Social Change, Harvard Medical School.,8Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophie Peeters
- 1Program in Global Surgery and Social Change, Harvard Medical School.,3David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sonal Sachdev
- 1Program in Global Surgery and Social Change, Harvard Medical School.,9University of New South Wales, Sydney, New South Wales, Australia
| | - Kee B Park
- 1Program in Global Surgery and Social Change, Harvard Medical School
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Rattani A, Lim J, Mistry AM, Prablek MA, Roth SG, Jordan LC, Shannon CN, Naftel RP. Incidence of Epilepsy and Associated Risk Factors in Perinatal Ischemic Stroke Survivors. Pediatr Neurol 2019; 90:44-55. [PMID: 30409458 DOI: 10.1016/j.pediatrneurol.2018.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Epilepsy is a serious and often lifelong consequence of perinatal arterial ischemic stroke (PAIS). Variable incidences and risk factors for long-term epilepsy in PAIS have been reported. To determine the incidence of epilepsy in PAIS survivors and report factors associated with the risk of developing epilepsy, a meta-analysis and systematic review of prior publications was performed. METHODS We examined studies on perinatal or neonatal patients (≤28 days of life) with arterial ischemic strokes in which the development of epilepsy was reported. EMBASE and MEDLINE/PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A meta-analysis of 10 studies revealed a summary incidence of epilepsy in PAIS patients of 27.2% (95% confidence interval 16.6% to 41.4%) over a mean study duration of 10.4 years (range 1.5 to 17). More recent studies generally reported a lower epilepsy incidence. A systematic review identified seven possible risk factors for epilepsy in PAIS patients: hippocampal volume reduction, infarct on prenatal ultrasound, a modified Alberta Stroke Program Early Computed Tomography score ≥9, family history of seizures, cerebral palsy, and initial presentation with cognitive impairment or seizures. CONCLUSIONS About a third of children with PAIS will develop epilepsy. While seven possible risk factors have been reported, further research is warranted to confirm the strength of their association with the development of epilepsy.
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Affiliation(s)
- Abbas Rattani
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jaims Lim
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Akshitkumar M Mistry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc A Prablek
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Steven G Roth
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert P Naftel
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Härtl R, Bisson E, Park KB, Shrime MG. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume. Global Spine J 2018; 8:784-794. [PMID: 30560029 PMCID: PMC6293435 DOI: 10.1177/2192568218770769] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Meta-analysis-based calculation. OBJECTIVES Lumbar degenerative spine disease (DSD) is a common cause of disability, yet a reliable measure of its global burden does not exist. We sought to quantify the incidence of lumbar DSD to determine the overall worldwide burden of symptomatic lumbar DSD across World Health Organization regions and World Bank income groups. METHODS We used a meta-analysis to create a single proportion of cases of DSD in patients with low back pain (LBP). Using this information in conjunction with LBP incidence rates, we calculated the global incidence of individuals who have DSD and LBP (ie, their DSD has neurosurgical relevance) based on the Global Burden of Disease 2015 database. RESULTS We found that 266 million individuals (3.63%) worldwide have DSD and LBP each year; the highest and lowest estimated incidences were found in Europe (5.7%) and Africa (2.4%), respectively. Based on population sizes, low- and middle-income countries have 4 times as many cases as high-income countries. Thirty-nine million individuals (0.53%) worldwide were found to have spondylolisthesis, 403 million (5.5%) individuals worldwide with symptomatic disc degeneration, and 103 million (1.41%) individuals worldwide with spinal stenosis annually. CONCLUSIONS A total of 266 million individuals (3.63%) worldwide were found to have DSD and LBP annually. Significantly, data quality is higher in high-income countries, making overall quantification in low- and middle-income countries less complete. A global effort to address degenerative conditions of the lumbar spine in regions with high demand is important to reduce disability.
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Affiliation(s)
| | | | - Abbas Rattani
- Harvard Medical School, Boston, MA, USA
- Meharry Medical College, Nashville, TN, USA
| | - Michael C. Dewan
- Harvard Medical School, Boston, MA, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger Härtl
- Weill Cornell Medical College, New York–Presbyterian Hospital, New York, NY,
USA
| | | | | | - Mark G. Shrime
- Harvard Medical School, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Dewan MC, Baticulon RE, Rattani A, Johnston JM, Warf BC, Harkness W. Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide. Neurosurg Focus 2018; 45:E13. [DOI: 10.3171/2018.7.focus18272] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.
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Affiliation(s)
- Michael C. Dewan
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ronnie E. Baticulon
- 2Department of Neurosurgery, University of the Philippines College of Medicine, Mabani, Ermita, Manila, Philippines
| | - Abbas Rattani
- 3Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - James M. Johnston
- 4Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Benjamin C. Warf
- 5Department of Neurological Surgery, Boston Children’s Hospital, Boston, Massachusetts; and
| | - William Harkness
- 6Department of Neurosciences, Institute for Child Health, London, United Kingdom
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H, Morcos JJ, Park KB. Estimating the Global Incidence of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review for Central Nervous System Vascular Lesions and Meta-Analysis of Ruptured Aneurysms. World Neurosurg 2018; 115:430-447.e7. [DOI: 10.1016/j.wneu.2018.03.220] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
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Robertson FC, Lepard JR, Mekary RA, Davis MC, Yunusa I, Gormley WB, Baticulon RE, Mahmud MR, Misra BK, Rattani A, Dewan MC, Park KB. Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide. J Neurosurg 2018:1-20. [PMID: 29905514 DOI: 10.3171/2017.10.jns17359] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVECentral nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity.METHODSA systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types.RESULTSThe search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease.CONCLUSIONSThis systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.
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Affiliation(s)
- Faith C Robertson
- 1Harvard Medical School.,2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Rania A Mekary
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - Matthew C Davis
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Ismaeel Yunusa
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - William B Gormley
- 1Harvard Medical School.,2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts.,5Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronnie E Baticulon
- 6University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Muhammad Raji Mahmud
- 7Department of Surgery, National Hospital Abuja, PMB 425, Federal Capital Territory, Nigeria
| | - Basant K Misra
- 8Department of Neurosurgery & Gamma Knife Radiosurgery, P. D. Hinduja National Hospital, Mahim, Mumbai, India
| | - Abbas Rattani
- 9Meharry Medical College, School of Medicine, Nashville, Tennessee.,10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
| | - Michael C Dewan
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and.,11Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
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Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY, Osorio-Fonseca E, Park KB. Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume. World Neurosurg 2018; 113:e345-e363. [DOI: 10.1016/j.wneu.2018.02.033] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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Dewan MC, Rattani A, Baticulon RE, Faruque S, Johnson WD, Dempsey RJ, Haglund MM, Alkire BC, Park KB, Warf BC, Shrime MG. Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective. J Neurosurg 2018:1-9. [PMID: 29749918 DOI: 10.3171/2017.10.jns17347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload.METHODSAn electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics-including case volume and perceived workload-were also captured.RESULTSEighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon's perceived workload (0-not busy, 100-overworked), respondents selected a mean workload of 75 (median 79).CONCLUSIONSWith a high level of confidence and strong concordance, neurosurgeons estimated that the vast majority of patients with central nervous system tumors, hydrocephalus, or neural tube defects mandate neurosurgical involvement. A significant proportion of other common neurological diseases, such as traumatic brain and spinal injury, vascular anomalies, and degenerative spine disease, demand the attention of a neurosurgeon-whether via operative intervention or expert counsel. These estimates facilitate measurement of the expected annual volume of neurosurgical disease globally.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | - Ronnie E Baticulon
- 4University of the Philippines College of Medicine-Philippine General Hospital, Manila, Republic of the Philippines
| | - Serena Faruque
- 5Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Walter D Johnson
- 6Emergency & Essential Surgical Care Programme Lead, World Health Organization, Geneva, Switzerland
| | - Robert J Dempsey
- 7Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Michael M Haglund
- 8Division of Global Neurosurgery and Neurology, Department of Neurosurgery and Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Blake C Alkire
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,9Office of Global Surgery and Health
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Benjamin C Warf
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,10Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,11Department of Otolaryngology, Massachusetts Eye and Ear Infirmary
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Dewan MC, Rattani A, Fieggen G, Arraez MA, Servadei F, Boop FA, Johnson WD, Warf BC, Park KB. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg 2018:1-10. [PMID: 29701548 DOI: 10.3171/2017.11.jns171500] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/10/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Worldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand. METHODS Results from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity. RESULTS Every year, an estimated 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon, of whom 13.8 million require surgery. Traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy constitute the majority of essential neurosurgical care worldwide. Approximately 23,300 additional neurosurgeons are needed to address more than 5 million essential neurosurgical cases-all in low- and middle-income countries-that go unmet each year. There exists a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps, particularly in Africa and Southeast Asia. CONCLUSIONS Each year, more than 5 million individuals suffering from treatable neurosurgical conditions will never undergo therapeutic surgical intervention. Populations in Africa and Southeast Asia, where the proportion of neurosurgeons to neurosurgical disease is critically low, are especially at risk. Increasing access to essential neurosurgical care in low- and middle-income countries via neurosurgical workforce expansion as part of surgical system strengthening is necessary to prevent severe disability and death for millions with neurological disease.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abbas Rattani
- 1Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,3Meharry Medical College School of Medicine, Nashville, Tennessee
| | - Graham Fieggen
- 4Department of Surgery, University of Cape Town, South Africa
| | - Miguel A Arraez
- 5Department of Neurosurgery, Carlos Haya University Hospital, Malaga, Spain
| | - Franco Servadei
- 6Department of Neurosurgery, Humanitas University and Research Institute, Milan, Italy
| | - Frederick A Boop
- 7Department of Neurological Surgery, University of Tennessee Health Sciences Center, LeBonheur Children's Hospital Neurosciences Institute, Semmes-Murphey Clinic, Memphis, Tennessee
| | - Walter D Johnson
- 8Emergency & Essential Surgical Care Programme Lead, World Health Organization, Geneva, Switzerland
| | - Benjamin C Warf
- 9Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and.,10CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Kee B Park
- 1Global Neurosurgery Initiative-Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, Fieggen G, Wellons JC, Park KB, Warf BC. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg 2018:1-15. [PMID: 29701543 DOI: 10.3171/2017.10.jns17439] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 10/18/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVEHydrocephalus is one of the most common brain disorders, yet a reliable assessment of the global burden of disease is lacking. The authors sought a reliable estimate of the prevalence and annual incidence of hydrocephalus worldwide.METHODSThe authors performed a systematic literature review and meta-analysis to estimate the incidence of congenital hydrocephalus by WHO region and World Bank income level using the MEDLINE/PubMed and Cochrane Database of Systematic Reviews databases. A global estimate of pediatric hydrocephalus was obtained by adding acquired forms of childhood hydrocephalus to the baseline congenital figures using neural tube defect (NTD) registry data and known proportions of posthemorrhagic and postinfectious cases. Adult forms of hydrocephalus were also examined qualitatively.RESULTSSeventy-eight articles were included from the systematic review, representative of all WHO regions and each income level. The pooled incidence of congenital hydrocephalus was highest in Africa and Latin America (145 and 316 per 100,000 births, respectively) and lowest in the United States/Canada (68 per 100,000 births) (p for interaction < 0.1). The incidence was higher in low- and middle-income countries (123 per 100,000 births; 95% CI 98-152 births) than in high-income countries (79 per 100,000 births; 95% CI 68-90 births) (p for interaction < 0.01). While likely representing an underestimate, this model predicts that each year, nearly 400,000 new cases of pediatric hydrocephalus will develop worldwide. The greatest burden of disease falls on the African, Latin American, and Southeast Asian regions, accounting for three-quarters of the total volume of new cases. The high crude birth rate, greater proportion of patients with postinfectious etiology, and higher incidence of NTDs all contribute to a case volume in low- and middle-income countries that outweighs that in high-income countries by more than 20-fold. Global estimates of adult and other forms of acquired hydrocephalus are lacking.CONCLUSIONSFor the first time in a global model, the annual incidence of pediatric hydrocephalus is estimated. Low- and middle-income countries incur the greatest burden of disease, particularly those within the African and Latin American regions. Reliable incidence and burden figures for adult forms of hydrocephalus are absent in the literature and warrant specific investigation. A global effort to address hydrocephalus in regions with the greatest demand is imperative to reduce disease incidence, morbidity, mortality, and disparities of access to treatment.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | - Rania Mekary
- 4Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, Massachusetts.,5Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurence J Glancz
- 6Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Ismaeel Yunusa
- 4Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, Massachusetts.,5Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronnie E Baticulon
- 7University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
| | - Graham Fieggen
- 8Departments of Surgery and Neurosurgery, University of Cape Town, South Africa
| | - John C Wellons
- 2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Benjamin C Warf
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and.,10CURE Children's Hospital of Uganda, Mbale, Uganda
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Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018:1-18. [PMID: 29701556 DOI: 10.3171/2017.10.jns17352] [Citation(s) in RCA: 1010] [Impact Index Per Article: 168.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVETraumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.METHODSOpen-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group.RESULTSRelevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs.CONCLUSIONSSixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,2Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | | | - Ronnie E Baticulon
- 5University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Ya-Ching Hung
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Maria Punchak
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,6David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amit Agrawal
- 7Department of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Amos O Adeleye
- 8Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan.,9Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.,10Office of Global Surgery and Health, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Andrés M Rubiano
- 11Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Jeffrey V Rosenfeld
- 12Department of Neurosurgery, Alfred Hospital.,14Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
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Rattani A, Dewan MC, Hannig V, Naftel RP, Wellons JC, Jordan LC. Cerebral hemorrhage in monozygotic twins with hereditary hemorrhagic telangiectasia: case report and hemorrhagic risk evaluation. J Neurosurg Pediatr 2017; 20:164-169. [PMID: 28524787 DOI: 10.3171/2017.3.peds16587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of monozygotic twins with hereditary hemorrhagic telangiectasia (HHT) who experienced cerebral arteriovenous malformation (AVM) hemorrhage at a very young age. The clinical variables influencing HHT-related AVM rupture are discussed, and questions surrounding the timing of screening and intervention are explored. This is only the second known case of monozygotic HHT twins published in the medical literature, and the youngest pair of first-degree relatives to experience AVM-related cerebral hemorrhage. Evidence guiding the screening and management of familial HHT is lacking, and cases such as this underscore the need for objective and validated protocols.
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Affiliation(s)
- Abbas Rattani
- School of Medicine, Meharry Medical College, Nashville
| | - Michael C Dewan
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, and
| | - Vickie Hannig
- Divisions of 3 Medical Genetics and Genomic Medicine and
| | - Robert P Naftel
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, and
| | - John C Wellons
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, and
| | - Lori C Jordan
- Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Abstract
With developed country governments and high resource institutions engaging in research in low- and middle-income countries (LMIC), we argue that these entities have a moral obligation to help build and strengthen research infrastructure and capacity so local scientists and institutions can adequately conduct studies to understand and resolve the health burdens in low and middle income countries. We explore the moral justifications and motivations behind engaging in research capacity strengthening in the health sector in LMIC at multiple levels. In highlighting these issues, this paper aims to initiate a global discourse around why capacity development in LMIC has a moral basis at the individual, institutional and system levels.
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Affiliation(s)
- Adnan A Hyder
- Adnan A. Hyder, M.D., Ph.D., M.P.H., is a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and Associate Director of the Johns Hopkins Berman Institute of Bioethics. He obtained his M.P.H. and Ph.D. degrees from Johns Hopkins University in Baltimore, Maryland, and his M.D. from Aga Khan University in Karachi, Pakistan. Abbas Rattani, M.Be., is a second year M.D. student at Meharry Medical College. He received his Masters in Bioethics from the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania. Bridget Pratt, Ph.D., is a research fellow at the Nossal Institute for Global Health and Centre for Health Equity in the School of Population and Global Health at the University of Melbourne. She is Associate Faculty in the Department of International Health at Johns Hopkins Bloomberg School of Public Health
| | - Abbas Rattani
- Adnan A. Hyder, M.D., Ph.D., M.P.H., is a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and Associate Director of the Johns Hopkins Berman Institute of Bioethics. He obtained his M.P.H. and Ph.D. degrees from Johns Hopkins University in Baltimore, Maryland, and his M.D. from Aga Khan University in Karachi, Pakistan. Abbas Rattani, M.Be., is a second year M.D. student at Meharry Medical College. He received his Masters in Bioethics from the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania. Bridget Pratt, Ph.D., is a research fellow at the Nossal Institute for Global Health and Centre for Health Equity in the School of Population and Global Health at the University of Melbourne. She is Associate Faculty in the Department of International Health at Johns Hopkins Bloomberg School of Public Health
| | - Bridget Pratt
- Adnan A. Hyder, M.D., Ph.D., M.P.H., is a professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and Associate Director of the Johns Hopkins Berman Institute of Bioethics. He obtained his M.P.H. and Ph.D. degrees from Johns Hopkins University in Baltimore, Maryland, and his M.D. from Aga Khan University in Karachi, Pakistan. Abbas Rattani, M.Be., is a second year M.D. student at Meharry Medical College. He received his Masters in Bioethics from the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania. Bridget Pratt, Ph.D., is a research fellow at the Nossal Institute for Global Health and Centre for Health Equity in the School of Population and Global Health at the University of Melbourne. She is Associate Faculty in the Department of International Health at Johns Hopkins Bloomberg School of Public Health
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Biffi A, Rattani A, Anderson CD, Ayres AM, Gurol EM, Greenberg SM, Rosand J, Viswanathan A. Delayed seizures after intracerebral haemorrhage. Brain 2016; 139:2694-2705. [PMID: 27497491 DOI: 10.1093/brain/aww199] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/20/2016] [Indexed: 12/29/2022] Open
Abstract
Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants ε2/ε4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P < 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of ≥ 1 APOE ε4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.
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Affiliation(s)
- Alessandro Biffi
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 3 Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge MA, USA
| | - Abbas Rattani
- 4 School of Medicine, Meharry Medical College, Nashville, TN, USA
| | - Christopher D Anderson
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 3 Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge MA, USA 5 Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA 6 Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alison M Ayres
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Edip M Gurol
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 7 Division of Stroke, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 7 Division of Stroke, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 3 Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge MA, USA 5 Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA 6 Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- 1 Division of Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA 7 Division of Stroke, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Bachani AM, Rattani A, Hyder AA. A Scoping Study on the Ethics of Health Systems Research. Dev World Bioeth 2016; 16:124-132. [PMID: 27038160 DOI: 10.1111/dewb.12117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022]
Abstract
Currently, health systems research (HSR) is reviewed by the same ethical standards as clinical research, which has recently been argued in the literature to be an inappropriate standard of evaluation. The issues unique to HSR warrant a different review by research ethics committees (RECs), as it does not impose the same risks to study participants as other types of clinical or public health research. However, there are limited tools and supporting documents that clarify the ethical considerations. Therefore, there is a need for additional reflection around ethical review of HSR and their consideration by RECs. The purpose of this paper is to review, understand, and synthesize the current state of literature and practice to inform these deliberations and the larger discourse on ethics review guidelines for HSR. This paper presents a review of the literature on ethics of HSR in the biomedical, public health, and implementation research to identify ethical considerations specific to HSR; and to identify examples of commonly available guidance and/or tools for the ethical review of HSR studies. Fifteen articles were identified on HSR ethics issues, and forty-two international academic institutions were contacted (of the responses (n=29), no institution had special ethical guidelines for reviewing HSR) about their HSR ethics review guidelines. There appears to be a clear gap in the current health research ethics discourse around health systems research ethics. This review serves as a first step (to better understand the current status) towards a larger dialogue on the topic.
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Wassenaar D, Rattani A. What Makes Health Systems Research in Developing Countries Ethical? Application of the Emanuel Framework for Clinical Research to Health Systems Research. Dev World Bioeth 2016; 16:133-139. [DOI: 10.1111/dewb.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dasgupta I, Bollinger J, Mathews DJH, Neumann NM, Rattani A, Sugarman J. Patients' attitudes toward the donation of biological materials for the derivation of induced pluripotent stem cells. Cell Stem Cell 2014; 14:9-12. [PMID: 24388172 DOI: 10.1016/j.stem.2013.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although academics have raised ethical issues with iPSCs, patients' perspectives on them and their attitudes toward donating biological materials for iPSC research are unclear. Here, we provide such information to aid in developing policies for consent, collection, and use of biological materials for deriving iPSCs based on patient focus groups.
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Affiliation(s)
- Ishan Dasgupta
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205 USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205 USA; Genetics and Public Policy Center, Johns Hopkins University, Washington, D.C., 20036 USA
| | - Debra J H Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205 USA; School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Neil M Neumann
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; Medical Scientist Training Program, Johns Hopkins University, Baltimore, MD 212105, USA
| | - Abbas Rattani
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205 USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205 USA; School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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Hyder AA, Rattani A. Changing the discourse on health systems research: response to open peer commentaries on "ethical review of health systems research in low- and middle-income countries: a conceptual exploration". Am J Bioeth 2014; 14:W1-W2. [PMID: 24521342 DOI: 10.1080/15265161.2014.881212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hyder AA, Rattani A, Krubiner C, Bachani AM, Tran NT. Ethical review of health systems research in low- and middle-income countries: a conceptual exploration. Am J Bioeth 2014; 14:28-37. [PMID: 24521334 DOI: 10.1080/15265161.2013.868950] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that health systems research (HSR) involves different aims, approaches, and methodologies as compared to more traditional clinical trials, the ethical issues present in HSR may be unique or particularly nuanced. This article outlines eight pertinent ethical issues that are particularly salient in HSR and argues that the ethical review process should be better tailored to ensure more efficient and appropriate oversight of HSR with adequate human protections, especially in low- and middle-income countries. The eight ethical areas we discuss include the nature of intervention, types of research subjects, units of intervention and observation, informed consent, controls and comparisons, risk assessment, inclusion of vulnerable groups, and benefits of research. HSR involving human participants is necessary to ensure health systems strengthening and quality of care and to guide public policy intelligently. Health systems researchers must carefully define their intent and goals and openly clarify the values that may influence the premises and design of protocols. As new types of population-level research activities become more commonplace, it is critical that institutional review board (IRB) and research ethics committee (REC) review processes evolve to evaluate these research protocols in ways that address the nuanced features of these studies.
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