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Florez-Perdomo WA, Reyes Bello JS, García-Ballestas E, Moscote-Salazar LR, Barthélemy EJ, Janjua T, Maurya VP, Agrawal A. "Aneurysmal Subarachnoid Hemorrhage and Cocaine Consumption: A Systematic Review and Metanalysis". World Neurosurg 2024; 184:241-252.e2. [PMID: 38072159 DOI: 10.1016/j.wneu.2023.12.020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND The use of cocaine can lead to a variety of neurologic complications, including cerebral vasoconstriction, ischemia, aneurysm formation, and aneurysm rupture. A previous study has shown that cocaine use is associated with an increased risk of subarachnoid hemorrhage (SAH). This study conducted a systematic review and meta-analysis of observational studies to assess the association between cocaine use and the risk of poor neurological outcomes and mortality in patients with SAH. METHODS A systematic review and meta-analysis were performed following the meta-analysis of observational studies in epidemiology (MOOSE) declaration for systematic reviews and the Cochrane Manual of Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs), nonrandomized clinical trials, and prospective and retrospective cohort studies that reported data about adults who suffered Aneurysmal Subarachnoid Hemorrhage (aSAH) after having consumed cocaine recreationally were included. Variables such as mortality, vasospasm, seizures, re-bleeding, and complications were analyzed. RESULTS After a thorough selection process, 14 studies involving 116,141 patients, of which 2227 had a history of cocaine consumption, were included in the analysis. There was a significant increase in overall unfavorable outcomes in aSAH patients with a history of cocaine use (OR 5.51 CI 95% [4.26-7.13] P = <0.0001; I2 = 78%), with higher mortality and poor neurologic outcomes. There were no significant differences in the risk of hydrocephalus, seizures, or re-bleeding. Cocaine use was found to increase the risk of vasospasm and overall complications. CONCLUSIONS This study insinuates that cocaine use is associated with worse clinical outcomes in aSAH patients. Despite the cocaine users did not exhibit a higher risk of certain complications such as hydrocephalus and seizures, they had an increased risk of vasospasm and overall complications. These findings highlight the importance of addressing the issue of cocaine consumption as a primary preventive measure to decrease the incidence of aSAH and improve patient outcomes.
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Affiliation(s)
- William Andres Florez-Perdomo
- Department of Neurocritical Care, Colombian Clinical Research Group in Neurocritical Care, Bogota, Colombia; Department of Research, European Stroke Organization (ESO), Basel, Switzerland.
| | - Juan Sebastian Reyes Bello
- Department of Neurocritical Care, Colombian Clinical Research Group in Neurocritical Care, Bogota, Colombia
| | - Ezequiel García-Ballestas
- Department of Neurocritical Care, Colombian Clinical Research Group in Neurocritical Care, Bogota, Colombia
| | | | - Ernest J Barthélemy
- Department of Neurosurgery, SUNY Downstate Health sciences University, Brooklin, New York, USA
| | - Tariq Janjua
- Department of Critical Care, Neurocritical Care Unit, Regions Hospital Saint Paul, Saint Paul, Minnessota, USA
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
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Asfaw ZK, Greisman JD, Comuniello B, Shlobin NA, Etienne M, Zuckerman SL, Laeke T, Al-Sharshahi ZF, Barthélemy EJ. Global Neurosurgery Advances From Trenches to Bedside: Lessons From Neurosurgical Care in War, Humanitarian Assistance, and Disaster Response. Mil Med 2024; 189:e532-e540. [PMID: 37261884 DOI: 10.1093/milmed/usad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION War has influenced the evolution of global neurosurgery throughout the past century. Armed conflict and mass casualty disasters (MCDs), including Humanitarian Assistance Disaster Relief missions, require military surgeons to innovate to meet extreme demands. However, the military medical apparatus is seldom integrated into the civilian health care sector. Neurosurgeons serving in the military have provided a pragmatic template for global neurosurgeons to emulate in humanitarian disaster responses. In this paper, we explore how wars and MCD have influenced innovations of growing interest in the resource-limited settings of global neurosurgery. METHODS We performed a narrative review of the literature examining the influence of wars and MCD on contemporary global neurosurgery practices. RESULTS Wartime innovations that influenced global neurosurgery include the development of triage systems and modernization with airlifts, the implementation of ambulance corps, early operation on cranial injuries in hospital camps near the battlefield, the use of combat body armor, and the rise of damage control neurosurgery. In addition to promoting task-shifting and task-sharing, workforce shortages during wars and disasters contributed to the establishment of the physician assistant/physician associate profession in the USA. Low- and middle-income countries (LMICs) face similar challenges in developing trauma systems and obtaining advanced technology, including neurosurgical equipment like battery-powered computed tomography scanners. These challenges-ubiquitous in low-resource settings-have underpinned innovations in triage and wound care, rapid evacuation to tertiary care centers, and minimizing infection risk. CONCLUSION War and MCDs have catalyzed significant advancements in neurosurgical care both in the pre-hospital and inpatient settings. Most of these innovations originated in the military and subsequently spread to the civilian sector as military neurosurgeons and reservist civilian neurosurgeons returned from the battlefront or other low-resource locations. Military neurosurgeons have utilized their experience in low-resource settings to make volunteer global neurosurgery efforts in LMICs successful. LMICs have, by necessity, responded to challenges arising from resource shortages by developing innovative, context-specific care paradigms and technologies.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jacob D Greisman
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Briana Comuniello
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Nathan A Shlobin
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mill Etienne
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt School of Medicine, Nashville, TN 37232, USA
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Zahraa F Al-Sharshahi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA
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Al-Sharshahi ZF, Aljuboori Z, Carrasquilla A, Malone A, Boulnemour K, Matti WE, Barthélemy EJ, Mirza FA. Neurosurgical trips to war zones: Mission (im)possible? Surg Neurol Int 2024; 15:32. [PMID: 38468655 PMCID: PMC10927170 DOI: 10.25259/sni_918_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/04/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Zahraa F. Al-Sharshahi
- Department of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, College of Medicine, Lexington, Kentucky, United States
| | - Zaid Aljuboori
- Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Danville, PA, United States
| | - Alejandro Carrasquilla
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Alexandra Malone
- Department of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, College of Medicine, Lexington, Kentucky, United States
| | - Keenan Boulnemour
- Department of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, College of Medicine, Lexington, Kentucky, United States
| | - Wamedh Esam Matti
- Department of Neurosurgery, Dr. Sa’ad AL-Witri Hospital for Neurosciences, Baghdad, Iraq
| | - Ernest J. Barthélemy
- Department of Surgery, Division of Neurosurgery, State University of New York Downstate Health Sciences University, New York, United States
| | - Farhan A. Mirza
- Department of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, College of Medicine, Lexington, Kentucky, United States
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Asfaw ZK, Laeke T, Aklilu AT, Sahlu A, Yibeltal M, Awano MM, Barthélemy EJ, Germano IM. Neurosurgery resident education in Ethiopia: a cross-sectional study, history, and future educational opportunities. J Neurosurg 2024; 140:576-584. [PMID: 37877988 DOI: 10.3171/2023.6.jns23485] [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: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE An adequate healthcare workforce characterizes high-quality health systems. Sustainable domestic neurosurgery training is critical to developing a local neurosurgical workforce in low- and middle-income countries (LMICs). This study evaluated how neurosurgical training is delivered in Ethiopia, provides a historical narrative of neurosurgery training in the nation, and proposes future educational opportunities. METHODS A mixed-methods design consisting of a semi-structured interview and a comprehensive survey was used to acquire data. The interview participants included neurosurgery program directors and faculty involved in resident education. The survey was sent to all current neurosurgery residents in Ethiopia. RESULTS Ethiopian neurosurgical service began in 1970, and neurosurgical education started in 2006 with the establishment of the Addis Ababa University (AAU) residency program. The survey response rate was 86%, with 69 of 80 eligible neurosurgery residents responding. Most respondents were male (93%), aged 20-25 years (62%), and enrolled in the AAU program (61%). The oldest medical schools affiliated with tertiary hospitals were the top feeder institutions for neurosurgery training. Seventy-one percent of respondents worked for more than 60 hours/week, and 52% logged at least 100 cases annually. Survey responses demonstrated a critical need to establish subspecialty training and harmonize the national training curriculum. CONCLUSIONS The history of Ethiopian neurosurgery training exemplifies how global neurosurgery efforts focused on capacity building can rapidly expand the local neurosurgical workforces of LMICs. Opportunities for neurosurgical education require initiatives promoting a subspecialized, diverse workforce that attains both the clinical and academic proficiency necessary for advancing neurosurgical care locally and globally.
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Affiliation(s)
- Zerubabbel K Asfaw
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tsegazeab Laeke
- 2Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Abenezer T Aklilu
- 2Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Abat Sahlu
- 2Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Mestet Yibeltal
- 2Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Mekdes Musie Awano
- 2Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Ernest J Barthélemy
- 3Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Isabelle M Germano
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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5
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Menna G, Kolias A, Esene IN, Barthélemy EJ, Hoz S, Laeke T, Veiga Silva AC, Longo-Calderón GM, Baticulon RE, Zabala JP, Hassani FD, El Abbadi N, Khan MM, Robertson FC, Thango N, Cheresem B, Ogando-Rivas E, Roumy LG, Karekezi C, Alamri A, Spena G, Cenzato M, Servadei F, Giussani CG, Nicolosi F. Reducing the Gap in Neurosurgical Education in LMICs: A Report of a Non-Profit Educational Program. World Neurosurg 2024; 182:e792-e797. [PMID: 38101536 DOI: 10.1016/j.wneu.2023.12.040] [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: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Central to neurosurgical care, neurosurgical education is particularly needed in low- and middle-income countries (LMICs), where opportunities for neurosurgical training are limited due to social and economic constraints and an inadequate workforce. The present paper aims (1) to evaluate the validity and usability of a cadaver-free hybrid system in the context of LMICs and (2) to report their learning needs and whether the courses meet those needs via a comprehensive survey. METHODS From April to November 2021, a non-profit initiative consisting of a series of innovative cadaver-free courses based on virtual and practical training was organized. This project emerged from a collaboration between the Young Neurosurgeons Forum of the World Federation of Neurological Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and UpSurgeOn, an Italian hi-tech company specialized in simulation technologies, creator of the UpSurgeOn Box, a hyper-realistic simulator of cranial approaches fused with augmented reality. Over that period, 11 cadaver-free courses were held in LMICs using remote hands-on Box simulators. RESULTS One hundred sixty-eight participants completed an online survey after course completion of the course. The anatomical accuracy of simulators was overall rated high by the participant. The simulator provided a challenging but manageable learning curve, and 86% of participants found the Box to be very intuitive to use. When asked if the sequence of mental training (app), hybrid training (Augmented Reality), and manual training (the Box) was an effective method of training to fill the gap between theoretical knowledge and practice on a real patient/cadaver, 83% of participants agreed. Overall, the hands-on activities on the simulators have been satisfactory, as well as the integration between physical and digital simulation. CONCLUSIONS This project demonstrated that a cadaver-free hybrid (virtual/hands-on) training system could potentially participate in accelerating the learning curve of neurosurgical residents, especially in the setting of limited training possibilities such as LMICs, which were only worsened during the COVID-19 pandemic.
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Affiliation(s)
- Grazia Menna
- Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI), University of Cambridge, Cambridge, UK.
| | - Angelos Kolias
- Clinical Senior Lecturer and Hon. Consultant Neurosurgeon, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Ernest J Barthélemy
- Division of Neurosurgery, Global Neurosurgery Laboratory, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Samer Hoz
- Department of Neurosurgery, Goodyear Microsurgery Lab, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tsegazeab Laeke
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ana Cristina Veiga Silva
- Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Neurosurgery, Hospital of Restauraçao, Recife, Pernambuco, Brazil
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | | | - Naija El Abbadi
- Department of Neurosurgery, International Cheikh Zaid Hospital, Abulcassis University of Health Sciences, Rabat, Morocco
| | - Muhammad Mukhtar Khan
- Specialist Neurosurgeon Northwest General Hospital & Research Centre, Peshawar, Pakistan
| | - Faith C Robertson
- Global Health & Global Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Beverly Cheresem
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Elizabeth Ogando-Rivas
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA; Brain Tumor Immunotherapy Program, University of Florida, Gainesville, Florida, USA
| | - Louis-Georges Roumy
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Giannantonio Spena
- Neurosurgery Unit, Department of Neuroscience, Alessandro Manzoni Hospital, Lecco, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Carlo Giorgio Giussani
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Federico Nicolosi
- Department of Neurosurgery, Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Barthélemy EJ, Lepard J, Hackenberg AEC, Ashby J, Baron RB, Cohen E, Corley J, Park KB. Advancing Global Neurotrauma Surveillance Through National Registries: A Response to Recent Commentaries. Int J Health Policy Manag 2023; 12:8288. [PMID: 38618780 PMCID: PMC10699825 DOI: 10.34172/ijhpm.2023.8288] [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: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Ernest J. Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jacob Lepard
- Emory Children’s Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna E. C. Hackenberg
- Technical University of Munich, Munich, Germany
- Department of Anaesthesiology, LMU University Hospital, Ludwig-MaximilianUniversity of Munich, Munich, Germany
| | - Joanna Ashby
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Rebecca B. Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ella Cohen
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Kee B. Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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7
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Garcia RM, Ghotme KA, Arynchyna-Smith A, Mathur P, Koning M, Boop F, Peterson D, Sheneman N, Johnson WD, Park KB, Griswold D, Aukrust CG, Barthélemy EJ, Ibbotson G, Blount JP, Rosseau GL. Global Neurosurgery: Progress and Resolutions at the 75th World Health Assembly. Neurosurgery 2023; 93:496-501. [PMID: 37010299 DOI: 10.1227/neu.0000000000002472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023] Open
Abstract
Neurosurgical advocates for global surgery/neurosurgery at the 75th World Health Assembly gathered in person for the first time after the COVID-19 pandemic in Geneva, Switzerland, in May 2022. This article reviews the significant progress in the global health landscape targeting neglected neurosurgical patients, emphasizing high-level policy advocacy and international efforts to support a new World Health Assembly resolution in mandatory folic acid fortification to prevent neural tube defects. The process of developing global resolutions through the World Health Organization and its member states is summarized. Two new global initiatives focused on the surgical patients among the most vulnerable member states are discussed, the Global Surgery Foundation and the Global Action Plan on Epilepsy and other Neurological Disorders. Progress toward a neurosurgery-inspired resolution on mandatory folic acid fortification to prevent spina bifida-folate is described. In addition, priorities for moving the global health agenda forward for the neurosurgical patient as it relates to the global burden of neurological disease are reviewed after the COVID-19 pandemic.
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Affiliation(s)
- Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía , Colombia
- Pediatric Neurosurgery, Department of Neurosurgery, Fundacion Santa Fe de Bogota, Bogota , Colombia
| | | | - Priyanka Mathur
- McGaw Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA
| | | | - Frederick Boop
- Division of Pediatric Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | | | | | - Walter D Johnson
- Center for Global Surgery, Loma Linda University, California , USA
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Harvard Medical School, Boston , Massachusetts , USA
| | - Dylan Griswold
- Stanford University School of Medicine, Stanford , California , USA
- NIHR Group on Neurotrauma, Cambridge , United Kingdom
| | - Camilla G Aukrust
- Department of Neurosurgery, Oslo University Hospital, Oslo , Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo , Norway
| | - Ernest J Barthélemy
- Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York , USA
| | | | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Gail L Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
- Barrow Neurological Institute, Phoenix , Arizona , USA
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Perez-Chadid DA, Veiga Silva AC, Asfaw ZK, Javed S, Shlobin NA, Ham EI, Libório A, Ogando-Rivas E, Robertson FC, Rayan T, Gandía-González ML, Kolias A, Barthélemy EJ, Esene I. Needs, Roles, and Challenges of Young Latin American and Caribbean Neurosurgeons. World Neurosurg 2023; 176:e190-e199. [PMID: 37187347 DOI: 10.1016/j.wneu.2023.05.026] [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: 03/22/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Barriers to neurosurgery training and practice in Latin American and Caribbean countries (LACs) have been scarcely documented. The World Federation of Neurosurgical Societies Young Neurosurgeons Forum survey sought to identify young neurosurgeons' needs, roles, and challenges. We present the results focused on Latin America and the Caribbean. METHODS In this cross-sectional study, we analyzed the Young Neurosurgeons Forum survey responses from LACs, following online survey dissemination through personal contacts, social media, and neurosurgical societies' e-mailing lists between April and November 2018. Data analysis was performed using Jamovi version 2.0 and STATA version 16. RESULTS There were 91 respondents from LACs. Three (3.3%) respondents practiced in high-income countries, 77 (84.6%) in upper middle-income countries, 10 (11%) in lower middle-income countries, and 1 (1.1%) in an unclassified country. The majority (77, or 84.6%) of respondents were male, and 71 (90.2%) were younger than 40. Access to basic imaging modalities was high, with access to computed tomography scan universal among the survey respondents. However, only 25 (27.5%) of respondents reported having access to imaging guidance systems (navigation), and 73 (80.2%) reported having access to high-speed drills. A high GDP per capita was associated with increased availability of high-speed drills and more time dedicated to educational endeavors in neurosurgery, such as didactic teaching and topic presentation (P < 0.05). CONCLUSIONS This survey found that neurosurgery trainees and practitioners of Latin America and the Caribbean face many barriers to practice. These include inadequate state-of-the-art neurosurgical equipment, a lack of standardized training curricula, few research opportunities, and long working hours.
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Affiliation(s)
| | - Ana Cristina Veiga Silva
- Neurosurgery Postgraduation Department, Neuropsychiatry and Behavioral Sciences (PosNeuro) Federal University of Pernambuco, Recife, Brazil
| | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Saad Javed
- Registrar, Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward I Ham
- Stony Brook School of Medicine, Stony Brook, New York, USA
| | - Adriana Libório
- Department of Neurosurgery, Ipanema Federal Hospital, Rio de Janeiro, Brazil
| | - Elizabeth Ogando-Rivas
- Department of Neurosurgery, Boston Medical Center, Boston University, Boston, Massachusetts, USA
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tarek Rayan
- Department of Neurosurgery, Alexandria University, Alexandria, Egypt
| | | | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital & University of Cambridge, Cambridge, United Kingdom; NIHR Global Health Research Group on Acquired Brain and Spine Injury, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Ignatius Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
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9
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Asfaw ZK, Barthélemy EJ, Tirsit A, Zhan S, Gizaw A, Hannah T, Yibeltal M, Laeke T, Germano IM. Current Neurosurgical Care in Ethiopia Using the Lens of the Lancet Global Health Commission on High-Quality Health Systems. Neurosurgery 2023; 93:137-143. [PMID: 36735274 DOI: 10.1227/neu.0000000000002388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Neurosurgery is a rapidly developing specialty in Ethiopia. Previous global neurosurgery studies have highlighted the need for synchronizing workforce increase with improving quality, access, and capacity to provide neurosurgical care. OBJECTIVE To evaluate Ethiopia's neurosurgical system and highlight the critical interventions required for the sustained development of Ethiopian neurosurgery as part of a high-quality health system (HQHS). METHODS A comprehensive survey was sent to all practicing neurosurgeons. Public databases on Ethiopian census reports and current road infrastructure were used for spatial analysis of neurosurgical access. RESULTS The survey response rate was 90% (45/50). Most respondents were men (95.6%), aged 30 to 40 years (82%), who worked at national referral hospitals (71%). The reported annual caseload per practicing neurosurgeon was >150 cases for 40% of urban and 20% of rural neurosurgeons. Head and spine neurotrauma and tumors were the most common neurosurgical indications. Computed tomography scanner was the most widely available diagnostic equipment (62%). 76% of respondents indicated the presence of postoperative rehabilitation care at their institutions. Thirteen percent and 27% of the nation lived within a 2-hour and 4-hour driving distance from a neurosurgical center, respectively. CONCLUSION The results highlight the need for vital improvements in neurosurgical capacity to sustain progress toward HQHS. Promoting sustained development in all components of HQHS can be achieved by diversifying the workforce and training residency candidates committed to practicing in underserved regions. Additional strategies might include establishing a national registry for neurosurgical data and implementing policy changes conducive to improving perihospital care and other health system components.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Abenezer Tirsit
- Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Serena Zhan
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abel Gizaw
- Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Theodore Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mestet Yibeltal
- Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Tsegazeab Laeke
- Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Ham EI, Perez-Chadid DA, Wang Z, Abdi H, Shlobin NA, Negida A, Barthélemy EJ, Thango N, Park KB, Esene IN. Authorship Disparities in International Neurosurgical Research Collaborations: A Bibliometric Analysis. World Neurosurg 2023:S1878-8750(23)00815-X. [PMID: 37348602 DOI: 10.1016/j.wneu.2023.06.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Edward I Ham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | | | - Zhe Wang
- Department of Neurological Surgery, The University of Chicago, Chicago, IL
| | - Hodan Abdi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ahmed Negida
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Ernest J Barthélemy
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Nqobile Thango
- Division of Neurosurgery, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
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11
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Javed S, Perez-Chadid D, Yaqoob E, Shlobin NA, Ham EI, Veerappan VR, Chemate S, Robertson FC, Cain S, Nicolosi F, Still ME, Jehan ZC, Lippa L, Gandia M, Veiga Silva AC, Baticulon RE, Thango N, Afsaw ZK, Jokonya L, Kolias A, Barthélemy EJ, Esene I. Needs, Roles and Challenges of Young Asian Neurosurgeons. World Neurosurg 2023:S1878-8750(23)00766-0. [PMID: 37302707 DOI: 10.1016/j.wneu.2023.05.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/22/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Asia has a marked shortage of neurosurgical care, with approximately 2.5 million critical cases left untreated. The Young Neurosurgeons Forum (YNF) of the World Federation of Neurosurgical Societies (WFNS) surveyed Asian neurosurgeons to identify the of research, education, and practice. METHODS A cross-sectional study using a pilot-tested e-survey was circulated to the Asian neurosurgical community from April to November 2018. Descriptive statistics were used to summarize variables pertaining to demographics and neurosurgical practices. Chi square test was utilized to explore the relation between World Bank income level and variables on neurosurgical practices. RESULTS A total of 242 responses were analyzed. Respondents were mostly from the low- and middle-income countries (70%). Most represented institutions were teaching hospitals (53%). >50% of the hospitals had between 25-50 neurosurgical beds. Access to an operating microscope (p=0.038) or image guidance system (p=0.001) appeared to increase in correlation to a higher World Bank income level. Limited opportunities for conducting research (56%) and hands-on operating opportunities (45%) were leading challenges in daily academic practice. The leading challenges were limited numbers of intensive care unit beds (51%), inadequate or absent insurance coverage (45%), and lack of organized peri-hospital care (43%). Inadequate insurance coverage decreased with increasing World Bank income levels (p<0.001). Organized peri-hospital care (p=0.001), regular MRI access (p=0.032), and equipment necessary for microsurgery (p=0.007) increased with higher World Bank income levels. CONCLUSION Improving neurosurgical care hinges on regional and international collaboration and national policies to ensure universal access to essential neurosurgical care.
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Affiliation(s)
- Saad Javed
- Registrar, Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan; WFNS GNC Secretariat Team Member.
| | | | - Eesha Yaqoob
- Assistant Professor, PhD Sociology, Department of Public Health, Health Services Academy, Ministry of National Health Services Regulations and Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edward I Ham
- Stony Brook School of Medicine, Stony Brook, New York, USA
| | | | - Sachin Chemate
- M.D., D.N.B., Consultant Neurosurgeon, Noble Hospitals, Pune, India
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Cain
- BSc (hons), MBBS, FRACS, Department of Neurosurgery, The Royal Melbourne Hospital ,Parkville, Victoria, Australia 3050
| | - Federico Nicolosi
- MD, Department of Medicine and Surgery, Neurosurgery Unit, University of Milano-Bicocca, Milan, Italy
| | - Megan Eh Still
- Registrar, Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan; WFNS GNC Secretariat Team Member
| | | | - Laura Lippa
- Department of Neurosurgery, ASST Ospedale Niguarda, Milano, Italy
| | | | - Ana Cristina Veiga Silva
- Neurosurgery department of Post Graduation Program in Neuropsychiatry and Behavioral Sciences (PosNeuro), Federal University of Pernambuco, Recife , Brazil
| | - Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Nqobile Thango
- Division of Neurosurgery, department of surgery, Neuroscience Institute, University of Cape Town
| | - Zerubabbel K Afsaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Angelos Kolias
- Department of Clinical Neurosciences, Cambridge, United Kingdom
| | - Ernest J Barthélemy
- MD, MPH, MA, Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ignatius Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
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12
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Barthélemy EJ, Diouf SA, Silva ACV, Abu-Bonsrah N, de Souza IAS, Kanmounye US, Gabriel P, Sarpong K, Nduom EK, Lartigue JW, Esene I, Karekezi C. Historical determinants of neurosurgical inequities in Africa and the African diaspora: A review and analysis of coloniality. PLOS Glob Public Health 2023; 3:e0001550. [PMID: 36962931 PMCID: PMC10021312 DOI: 10.1371/journal.pgph.0001550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The movement to decolonize global health challenges clinicians and researchers of sub-disciplines, like global neurosurgery, to redefine their field. As an era of racial reckoning recentres the colonial roots of modern health disparities, reviewing the historical determinants of these disparities can constructively inform decolonization. This article presents a review and analysis of the historical determinants of neurosurgical inequities as understood by a group of scholars who share Sub-Saharan African descent. Vignettes profiling the colonial histories of Cape Verde, Rwanda, Cameroon, Ghana, Brazil, and Haiti illustrate the role of the colonial legacy in the currently unmet need for neurosurgical care in each of these nations. Following this review, a bibliographic lexical analysis of relevant terms then introduces a discussion of converging historical themes, and practical suggestions for transforming global neurosurgery through the decolonial humanism promulgated by anti-racist practices and the dialogic frameworks of conscientization.
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Affiliation(s)
- Ernest J. Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
| | - Sylviane A. Diouf
- Center for the Study of Slavery & Justice, Brown University, Providence, Rhode Island, United States of America
| | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | | | - Ulrick Sidney Kanmounye
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Phabinly Gabriel
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kwadwo Sarpong
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Edjah K. Nduom
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jean Wilguens Lartigue
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
- Department of Surgery, Mirebalais University Hospital, Zanmi Lasante, Mirebalais, Haiti
| | - Ignatius Esene
- Department of Neurosurgery, Division of Neurosurgery, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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13
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McNeill IT, Carrasquilla A, Asfaw ZK, Barthélemy EJ, Mehr A, Townsend KD, Joseph A, Bederson JB, Butts GC, Germano IM. Breaking boundaries through Doctors Reaching Minority Men Exploring Neuroscience: a mentorship model to foster a pipeline for underrepresented minorities. J Neurosurg 2023; 138:533-539. [PMID: 35901743 DOI: 10.3171/2022.5.jns22196] [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: 01/23/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In 2015, the Association of American Medical Colleges report titled "Altering the Course: Black Males in Medicine" showed a decline in the number of Black men matriculating into medical school. To alter this trend, the authors' hypothesis was that formally exposing Black men to the clinical neurosciences during high school would enhance their chances of entering the physician workforce. For this reason, in 2007, the Doctors Reaching Minority Men Exploring Neuroscience (DR. MMEN) program was established at the Icahn School of Medicine at Mount Sinai. The program aimed to provide early exposure, mentorship, and inspiration to high school-age Black and Latinx men. The aim of this study was to evaluate the impact of the DR. MMEN program in the context of the recent race and ethnicity trends among medical school matriculants (MSMs). METHODS Association of American Medical Colleges data on MSMs stratified by race and ethnicity were reviewed for the period between 2015 and 2020. Data pertinent to the academic achievements of DR. MMEN participants, such as matriculation to college and/or medical school, were prospectively tracked and incorporated with mixed-methods exit assessment data. Qualitative responses were coded and analyzed using a thematic concept analysis method. RESULTS Over the study period, the increase of MSMs in the US was 1.0% and 1.7% for Black and Latinx individuals, respectively. Changes for the male MSM cohort were negligible: 0.3% for Black and 0.7% for Latinx. With respect to DR. MMEN, 42% of participants from 2017 to 2019 earned college scholarships, and 25% of students from the 2017-2018 cohort matriculated to a combined college-medical program. Survey data showed that 100% of DR. MMEN participants found the program useful. Analysis of qualitative data revealed that participants considered pursuing a career in neurosurgery or in another medical field. Diligence and a passion for medicine were identified as the top two most important lessons in the program, and witnessing patient satisfaction and observing a neurosurgery operation were described as the most important experiences. Participants considered availability to give advice and feedback and a passion for teaching as the principal attributes of their mentors. CONCLUSIONS Over the past 6 years, the slight increase in Black and Latinx MSMs has not been significant enough to remedy ethnoracial disparities among MSMs. In particular, Black male matriculation to medical school has remained stagnant. The DR. MMEN program is a promising model to inspire young scholars and improve diversity within neuroscience and medicine at large.
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Affiliation(s)
- Ian T McNeill
- 1Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, Connecticut
| | - Alejandro Carrasquilla
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zerubabbel K Asfaw
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ernest J Barthélemy
- 3Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Alyson Mehr
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenya D Townsend
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Joseph
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B Bederson
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gary C Butts
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabelle M Germano
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Asfaw ZK, Barthélemy EJ, Karekezi C. Letter to the Editor Regarding "The Scope, Growth, and Inequities of the Global Neurosurgery Literature: A Bibliometric Analysis.". World Neurosurg 2023; 170:248-249. [PMID: 36782409 DOI: 10.1016/j.wneu.2022.10.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda.
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15
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Barthélemy EJ, Hackenberg AEC, Lepard J, Ashby J, Baron RB, Cohen E, Corley J, Park KB. Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries. Int J Health Policy Manag 2022; 11:2373-2380. [PMID: 35021612 PMCID: PMC9818108 DOI: 10.34172/ijhpm.2021.167] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/05/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Injury is a major global health problem, causing >5 800 000 deaths annually and widespread disability largely attributable to neurotrauma. 89% of trauma deaths occur in low- and middle-income countries (LMICs), however data on neurotrauma epidemiology in LMICs is lacking. In order to support neurotrauma surveillance efforts, we present a review and analysis of data dictionaries from national registries in LMICs. METHODS We performed a scoping review to identify existing national trauma registries for all LMICs. Inclusion/ exclusion criteria included articles published since 1991 describing national registry neurotrauma data capture methods in LMICs. Data sources included PubMed and Google Scholar using the terms "trauma/neurotrauma registry" and country name. Resulting registries were analyzed for neurotrauma-specific data dictionaries. These findings were augmented by data from direct contact of neurotrauma organizations, health ministries, and key informants from a convenience sample. These data were then compared to the World Health Organization (WHO) minimum dataset for injury (MDI) from the international registry for trauma and emergency care (IRTEC). RESULTS We identified 15 LMICs with 16 total national trauma registries tracking neurotrauma-specific data elements. Among these, Cameroon had the highest concordance with the MDI, followed by Colombia, Iran, Myanmar and Thailand. The MDI elements least often found in the data dictionaries included helmet use, and alcohol level. Data dictionaries differed significantly among LMICs. Common elements included Glasgow Coma Score, mechanism of injury, anatomical site of injury and injury severity scores. Limitations included low response rate in direct contact methods. CONCLUSION Significant heterogeneity was observed between the neurotrauma data dictionaries, as well as a spectrum of concordance or discordance with the MDI. Findings offer a contextually relevant menu of possible neurotrauma data elements that LMICs can consider tracking nationally to enhance neurotrauma surveillance and care systems. Standardization of nationwide neurotrauma data collection can facilitate international comparisons and bidirectional learning among healthcare governments.
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Affiliation(s)
- Ernest J. Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Anna E. C. Hackenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Technical University of Munich, Munich, Germany
| | - Jacob Lepard
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna Ashby
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Rebecca B. Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ella Cohen
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Kee B. Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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16
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Hickman ZL, Spielman LA, Barthélemy EJ, Choudhri TF, Engelman B, Giwa AO, Greisman JD, Margetis K, Race M, Rahman J, Todor DR, Tsetsou S, Ullman JS, Unadkat P, Dams-O'Connor K. International Survey of Antiseizure Medication Use in Patients with Complicated Mild Traumatic Brain Injury: A New York Neurotrauma Consortium Study. World Neurosurg 2022; 168:e286-e296. [PMID: 36191888 DOI: 10.1016/j.wneu.2022.09.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Seizures and epilepsy after traumatic brain injury (TBI) negatively affect quality of life and longevity. Antiseizure medication (ASM) prophylaxis after severe TBI is associated with improved outcomes; these medications are rarely used in mild TBI. However, a paucity of research is available to inform ASM use in complicated mild TBI (cmTBI) and no empirically based clinical care guidelines for ASM use in cmTBI exist. We aim to identify seizure prevention and management strategies used by clinicians experienced in treating patients with cmTBI to characterize standard care and inform a systematic approach to clinical decision making regarding ASM prophylaxis. METHODS We recruited a multidisciplinary international cohort through professional organizational listservs and social media platforms. Our questionnaire assessed factors influencing ASM prophylaxis after cmTBI at the individual, institutional, and health system-wide levels. RESULTS Ninety-two providers with experience managing cmTBI completed the survey. We found a striking diversity of ASM use in cmTBI, with 30% of respondents reporting no/infrequent use and 42% reporting frequent use; these tendencies did not differ by provider or institutional characteristics. Certain conditions universally increased or decreased the likelihood of ASM use and represent consensus. Based on survey results, ASMs are commonly used in patients with cmTBI who experience acute secondary seizure or select positive neuroimaging findings; we advise caution in elderly patients and those with concomitant neuropsychiatric illness. CONCLUSIONS This study is the first to characterize factors influencing clinical decision making in ASM prophylaxis after cmTBI based on multidisciplinary multicenter provider practices. Prospective controlled studies are necessary to inform standardized guideline development.
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Affiliation(s)
- Zachary L Hickman
- Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York New York Neurotrauma Consortium (NYNC), LLC, New York, New York, USA
| | - Lisa A Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany Engelman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Al O Giwa
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob D Greisman
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meaghan Race
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Jueria Rahman
- Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - D Roxanne Todor
- Department of Neurosurgery, NYC Health + Hospitals/Jacobi, Bronx, New York, USA
| | - Spyridoula Tsetsou
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie S Ullman
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Prashin Unadkat
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York New York Neurotrauma Consortium (NYNC), LLC, New York, New York, USA. kristen.dams-o'
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17
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Hoffman C, Härtl R, Shlobin NA, Tshimbombu TN, Elbabaa SK, Haglund MM, Rubiano AM, Dewan MC, Stippler M, Mahmud MR, Barthélemy EJ, Griswold DP, Wohns R, Shabani HK, Rocque B, Sandberg DI, Lafuente J, Dempsey R, Rosseau G. Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities. World Neurosurg 2022; 166:e404-e418. [PMID: 35868506 DOI: 10.1016/j.wneu.2022.07.030] [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: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships. METHODS The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees. RESULTS Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience. CONCLUSIONS The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.
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Affiliation(s)
- Caitlin Hoffman
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tshibambe N Tshimbombu
- Department of Neurosurgery, Geisel School of Medicine, Dartmouth University, Hannover, New Hampshire, USA
| | - Samer K Elbabaa
- Section of Pediatric and Fetal Neurosurgery, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology and Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrés M Rubiano
- Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martina Stippler
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria Kaduna, Nigeria; Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Dylan P Griswold
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | | | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Brandon Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David I Sandberg
- Division of Pediatric Neurosurgery, University of Texas Health Sciences Center, McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Robert Dempsey
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Asfaw ZK, Soto E, Yaeger K, Feng R, Carrasquilla A, Barthélemy EJ, Tabani H, Berkalieva A, Mazumdar M, McNeill IT, Germano IM. Racial and Ethnical Diversity Within the Neurosurgery Resident and Faculty Workforce in the United States. Neurosurgery 2022; 91:72-79. [PMID: 35384926 DOI: 10.1227/neu.0000000000001920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Promoting workplace diversity leads to a variety of benefits related to a broader range of perspectives and insights. Underrepresented in medicine (URiM), including African Americans, Latinx, and Natives (Americans/Alaskan/Hawaiians/Pacific Islanders), are currently accounting for approximately 40% of the US population. OBJECTIVE To establish a snapshot of current URiM representation within academic neurosurgery (NS) programs and trends within NS residency. METHODS All 115 NS residencies and academic programs accredited by the Accreditation Council for Graduate Medical Education in 2020 were included in this study. The National Residency Matching Program database was reviewed from 2011 to 2020 to analyze URiM representation trends over time within the NS resident workforce. The academic rank, academic and clinical title(s), subspecialty, sex, and race of URiM NS faculty (NSF) were obtained from publicly available data. RESULTS The Black and Latinx NS resident workforce currently accounts for 4.8% and 5.8% of the total workforce, respectively. URiM NSF are present in 71% of the Accreditation Council for Graduate Medical Education-accredited NS programs and account for 8% (148 of 1776) of the workforce. Black and Latinx women comprise 10% of URiM NSF. Latinx NSFs are the majority within the URiM cohort for both men and women. URiM comprise 5% of all department chairs. All are men. Spine (26%), tumor (26%), and trauma (17%) were the top 3 subspecialties among URiM NSF. CONCLUSION NS has evolved, expanded, and diversified in numerous directions, including race and gender representation. Our data show that ample opportunities remain to improve URiM representation within NS.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth Soto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rui Feng
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alejandro Carrasquilla
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Halima Tabani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Asem Berkalieva
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian T McNeill
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Barthélemy EJ, Affana CK, Asfaw ZK, Dams-O'Connor K, Rahman J, Jones S, Ullman J, Margetis K, Hickman ZL, Dangayach NS, Giwa AO. Racial and Socioeconomic Disparities in Neurotrauma: Research Priorities in the New York Metropolitan Area through a Global Neurosurgery Paradigm. World Neurosurg 2022; 165:51-57. [PMID: 35700861 DOI: 10.1016/j.wneu.2022.06.031] [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: 03/19/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
The New York Neurotrauma Consortium (NYNC) is a nascent multidisciplinary research and advocacy organization based in the New York Metropolitan Area (NYMA). It aims to advance health equity and optimize outcomes for traumatic brain and spine injury patients. Given the extensive racial, ethnic, and socioeconomic diversity of the NYMA, global health frameworks aimed at eliminating disparities in neurotrauma may provide a relevant and useful model for the informing research agendas of consortia like the NYNC. In this review, we present a comparative analysis of key health disparities in traumatic brain injury (TBI) that persist in the NYMA as well as in low- and middle-income countries (LMIC). Examples include: (a) inequitable access to quality care due to fragmentation of healthcare systems, (b) barriers to effective prehospital care for TBI, and (c) socioeconomic challenges faced by patients and their families during the subacute and chronic post-injury phases of TBI care. This review presents strategies to address each area of health disparity based on previous studies conducted in both LMIC and high-income country (HIC) settings. Increased awareness of healthcare disparities, education of healthcare professionals, effective policy advocacy for systemic changes, and fostering racial diversity of the trauma care workforce can guide the development of trauma care systems in the NYMA that are free of racial and related healthcare disparities.
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Affiliation(s)
- Ernest J Barthélemy
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California, USA.
| | | | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kristen Dams-O'Connor
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jueria Rahman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Salazar Jones
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Jamie Ullman
- New York Neurotrauma Consortium, Inc., New York, New York; Institute for Neurology and Neurosurgery at North Shore University Hospital
| | - Konstantinos Margetis
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Zachary L Hickman
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurosurgery, NYC Health + Hospitals/Elmhurst, Queens, New York
| | - Neha S Dangayach
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Al O Giwa
- New York Neurotrauma Consortium, Inc., New York, New York; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Asfaw ZK, Barthélemy EJ. Anti-racist Medical Education in the Transformation of Global Health. Trop Doct 2022; 52:245. [PMID: 35105194 DOI: 10.1177/00494755221077807] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zerubabbel K Asfaw
- 5925Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Ernest J Barthélemy
- Center for Health Equity in Surgery and Anesthesia, 7149University of California San Francisco, San Francisco, California, USA.,Department of Neurosurgery, 7149University of California San Francisco, San Francisco, California, USA
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21
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Roa JA, White S, Barthélemy EJ, Jenkins A, Margetis K. Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21533. [PMID: 36130572 PMCID: PMC9379649 DOI: 10.3171/case21533] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS Although this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.
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Affiliation(s)
- Jorge A. Roa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah White
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina; and
| | - Ernest J. Barthélemy
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Arthur Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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22
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Perera S, Hervey-Jumper SL, Mummaneni PV, Barthélemy EJ, Haddad AF, Marotta DA, Burke JF, Chan AK, Manley GT, Tarapore PE, Huang MC, Dhall SS, Chou D, Orrico KO, DiGiorgio AM. Do social determinants of health impact access to neurosurgical care in the United States? A workforce perspective. J Neurosurg 2022; 137:1-10. [PMID: 35472666 DOI: 10.3171/2021.10.jns211330] [Citation(s) in RCA: 2] [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: 06/01/2021] [Accepted: 10/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study attempts to use neurosurgical workforce distribution to uncover the social determinants of health that are associated with disparate access to neurosurgical care. METHODS Data were compiled from public sources and aggregated at the county level. Socioeconomic data were provided by the Brookings Institute. Racial and ethnicity data were gathered from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. Physician density was retrieved from the Health Resources and Services Administration Area Health Resources Files. Catchment areas were constructed based on the 628 counties with neurosurgical coverage, with counties lacking neurosurgical coverage being integrated with the nearest covered county based on distances from the National Bureau of Economic Research's County Distance Database. Catchment areas form a mutually exclusive and collectively exhaustive breakdown of the entire US population and licensed neurosurgeons. Socioeconomic factors, race, and ethnicity were chosen as independent variables for analysis. Characteristics for each catchment area were calculated as the population-weighted average across all contained counties. Linear regression analysis modeled two outcomes of interest: neurosurgeon density per capita and average distance to neurosurgical care. Coefficient estimates (CEs) and 95% confidence intervals were calculated and scaled by 1 SD to allow for comparison between variables. RESULTS Catchment areas with higher poverty (CE = 0.64, 95% CI 0.34-0.93) and higher prime age employment (CE = 0.58, 95% CI 0.40-0.76) were significantly associated with greater neurosurgeon density. Among categories of race and ethnicity, catchment areas with higher proportions of Black residents (CE = 0.21, 95% CI 0.06-0.35) were associated with greater neurosurgeon density. Meanwhile, catchment areas with higher proportions of Hispanic residents displayed lower neurosurgeon density (CE = -0.17, 95% CI -0.30 to -0.03). Residents of catchment areas with higher housing vacancy rates (CE = 2.37, 95% CI 1.31-3.43), higher proportions of Native American residents (CE = 4.97, 95% CI 3.99-5.95), and higher proportions of Hispanic residents (CE = 2.31, 95% CI 1.26-3.37) must travel farther, on average, to receive neurosurgical care, whereas people living in areas with a lower income (CE = -2.28, 95% CI -4.48 to -0.09) or higher proportion of Black residents (CE = -3.81, 95% CI -4.93 to -2.68) travel a shorter distance. CONCLUSIONS Multiple factors demonstrate a significant correlation with neurosurgical workforce distribution in the US, most notably with Hispanic and Native American populations being associated with greater distances to care. Additionally, higher proportions of Hispanic residents correlated with fewer neurosurgeons per capita. These findings highlight the interwoven associations among socioeconomics, race, ethnicity, and access to neurosurgical care nationwide.
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Affiliation(s)
- Sudheesha Perera
- 1Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Shawn L Hervey-Jumper
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Ernest J Barthélemy
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Alexander F Haddad
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Dario A Marotta
- 3Alabama College of Osteopathic Medicine, Dothan, Alabama; and
| | - John F Burke
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Geoffrey T Manley
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Phiroz E Tarapore
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael C Huang
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Sanjay S Dhall
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Katie O Orrico
- 4Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, DC
| | - Anthony M DiGiorgio
- 2Department of Neurological Surgery, University of California, San Francisco, California
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23
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Mediratta S, Lepard JR, Barthélemy EJ, Corley J, Park KB. Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers. J Neurosurg 2021; 137:1-10. [PMID: 34952519 DOI: 10.3171/2021.9.jns21916] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet neurosurgical needs worldwide. Using Lancet Global Surgery metrics and the Three Delays framework, the authors of this study aimed to identify and characterize the most significant barriers to the delivery of neurotrauma care in LMICs from the perspective of local neurotrauma providers. METHODS The authors conducted a cross-sectional study through the dissemination of a web-based survey to neurotrauma providers across all World Health Organization geographic regions. Responses were analyzed with descriptive statistics and Kruskal-Wallis testing, using World Bank data to provide estimates of populations at risk. RESULTS Eighty-two (36.9%) of 222 neurosurgeons representing 47 countries participated in the survey. It was estimated that 3.9 billion people lack access to neurotrauma care within 2 hours. Nearly 3.4 billion were estimated to be at risk for impoverishing expenditure and 2.9 billion were at risk of catastrophic expenditure as a result of paying for care for neurotrauma injuries. Delays in seeking care were rated as slightly common (p < 0.001), those in reaching care were very common (p < 0.001), and those in receiving care were slightly common (p < 0.05). The most significant causes for delays were associated with reaching care, including geographic distance from a facility, lack of ambulance service, and lack of finances for travel. All three delays were correlated to income classification and geographic region. CONCLUSIONS While expanding the global neurosurgical workforce is of the utmost importance, the study data suggested that it may not be entirely sufficient in gaining access to care for the emergent neurosurgical patient. Significant income and region-specific variability exists with regard to barriers to accessing neurotrauma care. Highlighting these barriers and quantifying worldwide access to neurotrauma care using metrics from the Lancet Commission on Global Surgery provides essential insight for future initiatives aiming to strengthen global neurotrauma systems.
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Affiliation(s)
- Saniya Mediratta
- 1Faculty of Medicine, Imperial College London, South Kensington Campus, London
- 2NIHR Global Health Research Group on Neurotrauma, University of Cambridge, United Kingdom
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ernest J Barthélemy
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 5Department of Neurosurgery, Mount Sinai Health System, New York, New York; and
| | - Jacquelyn Corley
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 6Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Kee B Park
- 4Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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24
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Lepard J, Ammar A, Shlobin NA, Boyke AE, Berger C, Vital A, Rolle M, Corley J, Barthélemy EJ, Park KB. An Assessment of Global Neurotrauma Prevention and Care Delivery: The Provider Perspective. World Neurosurg 2021; 156:e183-e191. [PMID: 34560295 DOI: 10.1016/j.wneu.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/11/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neurotrauma is a leading cause of morbidity and mortality around the world. Assessment of injury prevention and prehospital care for neurotrauma patients is necessary to improve care systems. METHODS A 29-question electronic survey was developed based on the Enhancing the Quality and Transparency Of health Research (EQUATOR) checklist to assess neurotrauma policies and laws related to safety precautions. The survey was distributed to members of World Health Organization regions that were considered to be experienced medical authorities in neurosurgery and traumatic brain injury. RESULTS There were 82 (39%) responses representing 46 countries. Almost all respondents (95.2%) were within the neurosurgical field. Of respondents, 40.2% were from high-income countries (HICs), and 59.8% were from low- and middle-income countries (LMICs). Motor vehicle accidents were reported as the leading cause of neurotrauma, followed by workplace injury and assault. Of respondents, 84.1% reported having a helmet law in their country. HICs (4.38 ± 0.78) were ranked more likely than LMICs (2.88 ± 1.34; P = 0.0001) to enforce helmet laws on a scale of 1-10. Effectiveness of helmet laws was rated as 3.94 ± 0.95 out of 10. Measures regarding prehospital care varied between HICs and LMICs. Patients in HICs were more likely to use public emergency ambulance transportation (81.8% vs. 42.9%; P = 0.0004). All prehospital personnel having emergency training was also reported to be more likely in HICs than LMICs (60.6% vs. 8.7%; P = 0.0001). CONCLUSIONS When injuries occur, timely access to neurosurgical care is critical. A focus on prehospital components of the trauma system is paramount, and policymakers can use the information presented here to implement and refine health care systems to ensure safe, timely, affordable, and equitable access to neurotrauma care.
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Affiliation(s)
- Jacob Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam Ammar
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andre E Boyke
- Department of Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
| | - Connor Berger
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
| | - Anchelo Vital
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
| | - Myron Rolle
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
| | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard University, Boston, Massachusetts, USA
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25
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Lepard JR, Spagiari R, Corley J, Barthélemy EJ, Kim E, Patterson R, Venturini S, Still MEH, Lo YT, Rosseau G, Mekary RA, Park KB. Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003795. [PMID: 34534215 PMCID: PMC8486090 DOI: 10.1371/journal.pmed.1003795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.
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Affiliation(s)
- Jacob R. Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Ernest J. Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, United States of America
| | - Eliana Kim
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- University of California-San Francisco School of Medicine, San Francisco, California, United States of America
| | - Rolvix Patterson
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Sara Venturini
- Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Megan E. H. Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, United States of America
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Rania A. Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- School of Pharmacy, MCPHS University, Boston, Massachusetts, United States of America
| | - Kee B. Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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26
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Rosseau G, Kim EE, Barthélemy EJ, Yusuf M, Dahir SM, Tolessa CS, Yusuuf MA, Carter A, Vryhof D, Geelhoed GW, Shlobin NA. The Current State of Neurosurgery in Somaliland. World Neurosurg 2021; 153:44-51. [PMID: 34229101 DOI: 10.1016/j.wneu.2021.06.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/08/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical conditions account for as much as one third of the global burden of disease, yet 5 billion people worldwide do not have access to timely, affordable surgical care. These disparities in access to timely surgical care are most pronounced in low- and middle-income countries, where the availability of specialty surgical services such as neurosurgery are severely limited or completely absent. The African autonomous region of Somaliland, in the Horn of Africa, is one such region. METHODS Discussions were conducted with key individuals in Somaliland to ascertain the current state of neurosurgery in Somaliland. RESULTS The current state of neurosurgery in Somaliland was characterized. First, a background on the recent history of the republic and the surrounding region was furnished, which provides context for the challenging socioeconomic conditions in Somaliland. Brief biographical sketches were presented of local leaders and general surgeons who are actively working to improve economic and health conditions and who welcome opportunities to improve all health services, including neurosurgery. In addition, an overview was presented of new initiatives in capacity building in neurosurgery and sources of directed training and care in neurosurgery. CONCLUSIONS This article provides the first-ever assessment of current neurosurgery-related activity in Somaliland. The article provides recommendations to guide the international neurosurgery community in future contributions.
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Affiliation(s)
- Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
| | - Eliana E Kim
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Musa Yusuf
- Department of Emergency Medicine, Hargeisa Group Hospital, Hargeisa, Somaliland
| | | | | | | | - Ashley Carter
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Daniel Vryhof
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Glenn W Geelhoed
- Office of the Dean, George Washington University Medical Center, Washington, D.C., USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Lepard JR, Barthélemy EJ, Corley J, Nalwanga J, Dewan M. In Reply to the Letter to the Editor Regarding "The Resident's Role in Global Neurosurgery". World Neurosurg 2021; 146:433. [PMID: 33607753 DOI: 10.1016/j.wneu.2020.11.053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jacob R Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Juliet Nalwanga
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Michael Dewan
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
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28
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Asfaw ZK, Tirsit A, Barthélemy EJ, Mesfin E, Wondafrash M, Yohannes D, Ashagre Y, Park K, Laeke T. Neurosurgery in Ethiopia: A New Chapter and Future Prospects. World Neurosurg 2021; 152:e175-e183. [PMID: 34052452 DOI: 10.1016/j.wneu.2021.05.071] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inequitable access to surgical care is most conspicuous in low-income countries (LICs), such as Ethiopia, where infectious diseases, malnutrition, and other maladies consume the lion's share of the available health resources. The aim of this article was to provide an update on the current state of neurosurgery in Ethiopia and identify targets for future development of surgical capacity as a universal health coverage component in this East African nation. METHODS Publicly available data included in this report were gathered from resources published by international organizations. A PubMed search was used for a preliminary bibliometric analysis of scholarly output of neurosurgeons in Ethiopia and other low-income countries. Statistical analysis was used to determine the correlation between the number of neurosurgeons and academic productivity. RESULTS Neurosurgeon density has increased >20-fold from 0.0022 to 0.045 neurosurgeons per 100,000 population between 2006 and 2020. The increase in neurosurgeons was strongly correlated with an increase in total publications (P < 0.001) and the number of new publications per year (P = 0.003). Despite recent progress, the availability of neuroimaging equipment remains inadequate, with 38 computed tomography scanners and 11 magnetic resonance imaging machines for a population of 112.07 million. The geographic distribution of neurosurgical facilities is limited to 12 urban centers. CONCLUSIONS Ethiopian neurosurgery exemplifies the profound effect of international partnerships for training local surgeons on progress in low-income countries toward improved neurosurgical capacity. Collaborations that focus on increasing the neurosurgical workforce should synchronize with efforts to enhance the availability of diagnostic and surgical equipment necessary for basic neurosurgical care.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Abenezer Tirsit
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elam Mesfin
- Department of Neurosurgery, Mekelle University, Mekelle, Ethiopia
| | - Mulualem Wondafrash
- Department of Neurosurgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yordanos Ashagre
- Department of Neurosurgery, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kee Park
- Program in Global Surgery and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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29
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Barthélemy EJ, Thango NS, Höhne J, Lippa L, Kolias A, Germano IM. Resilience in the Face of the COVID-19 Pandemic: How to Bend and not Break. World Neurosurg 2020; 146:280-284. [PMID: 33249221 PMCID: PMC7836866 DOI: 10.1016/j.wneu.2020.11.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Nqobile S Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Laura Lippa
- Department of Neurosurgery, Ospedali Riuniti, Livorno, Italy
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; NIHR Global Health Research Group on Neurotrauma, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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30
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Iverson KR, Svensson E, Sonderman K, Barthélemy EJ, Citron I, Vaughan KA, Powell BL, Meara JG, Shrime MG. The Optimal Distribution of Surgery in Low- and MiddleIncome Countries: A Proposed Matrix for Determining Country-Level Organization of Surgical Services - A Response to the Recent Commentaries. Int J Health Policy Manag 2020; 11:544-546. [PMID: 32892522 PMCID: PMC9309958 DOI: 10.34172/ijhpm.2020.168] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Katherine R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,General Surgery Department, University of California Davis Medical Center, Sacramento, CA, USA
| | - Emma Svensson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Lund University, Lund, Sweden
| | - Kristin Sonderman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Kerry A Vaughan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany L Powell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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32
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Corley J, Barthélemy EJ, Lepard J, Alves JL, Ashby J, Khan T, Park KB. Corrigendum to 'Comprehensive Policy Recommendations for Head and Spine Injury Care in Low- and Middle-Income Countries' [World Neurosurgery 132 (2019), 434-436]. World Neurosurg 2020; 137:504. [PMID: 32147476 DOI: 10.1016/j.wneu.2020.02.046] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jacquelyn Corley
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Duke Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Ernest J Barthélemy
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Lepard
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, University of Alabama, Birmingham, Alabama, USA; Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jose Luis Alves
- Department of Neurosurgery, Centro Hospitalar e Universtário de Coimbra, Coimbra, Portugal
| | - Joanna Ashby
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Pakistan
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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33
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Shah AH, LaFortune Y, Ibrahim GM, Cajigas I, Ragheb M, Chen SH, Barthélemy EJ, Henry A, Ragheb J. Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of infantile hydrocephalus in Haiti. J Neurosurg Pediatr 2020; 25:1-6. [PMID: 31923887 DOI: 10.3171/2019.10.peds19433] [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: 08/05/2019] [Accepted: 10/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Untreated hydrocephalus poses a significant health risk to children in the developing world. In response to this risk, global neurosurgical efforts have increasingly focused on endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the management of infantile hydrocephalus in low- and middle-income countries (LMICs). Here, the authors report their experience with ETV/CPC at the Hospital Bernard-Mevs/Project Medishare (HBMPM) in Port-au-Prince, Haiti. METHODS The authors conducted a retrospective review of a series of consecutive children who had undergone ETV/CPC for hydrocephalus over a 1-year period at HBMPM. The primary outcome of interest was time to ETV/CPC failure. Univariate and multivariate analyses using a Cox proportional hazards regression were performed to identify preoperative factors that were associated with outcomes. RESULTS Of the 82 children who underwent ETV/CPC, 52.2% remained shunt free at the last follow-up (mean 6.4 months). On univariate analysis, the ETV success score (ETVSS; p = 0.002), success of the attempted ETV (p = 0.018), and bilateral CPC (p = 0.045) were associated with shunt freedom. In the multivariate models, a lower ETVSS was independently associated with a poor outcome (HR 0.072, 95% CI 0.016-0.32, p < 0.001). Two children (2.4%) died of postoperative seizures. CONCLUSIONS As in other LMICs, ETV/CPC is an effective treatment for hydrocephalus in children in Haiti, with a low but significant risk profile. Larger multinational prospective databases may further elucidate the ideal candidate for ETV/CPC in resource-poor settings.
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Affiliation(s)
- Ashish H Shah
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Yudy LaFortune
- 2Department of Neurological Surgery, Hospital Bernard-Mevs/Project Medishare, Port-au-Prince, Haiti
| | - George M Ibrahim
- 3Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Department of Surgery, Toronto, Ontario, Canada
| | - Iahn Cajigas
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Michael Ragheb
- 1Department of Neurological Surgery, University of Miami, Florida
- 6Division of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida
| | - Stephanie H Chen
- 1Department of Neurological Surgery, University of Miami, Florida
| | - Ernest J Barthélemy
- 4Department of Neurosurgery, Mount Sinai Health System, New York, New York
- 5Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; and
| | - Ariel Henry
- 2Department of Neurological Surgery, Hospital Bernard-Mevs/Project Medishare, Port-au-Prince, Haiti
| | - John Ragheb
- 4Department of Neurosurgery, Mount Sinai Health System, New York, New York
- 6Division of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida
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34
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Iverson KR, Svensson E, Sonderman K, Barthélemy EJ, Citron I, Vaughan KA, Powell BL, Meara JG, Shrime MG. Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries. Int J Health Policy Manag 2019; 8:521-537. [PMID: 31657175 PMCID: PMC6815989 DOI: 10.15171/ijhpm.2019.43] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/19/2018] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Background: While recommendations for the optimal distribution of surgical services in high-income countries (HICs) exist, it is unclear how these translate to resource-limited settings. Given the significant shortage and maldistribution of surgical workforce and infrastructure in many low- and middle-income countries (LMICs), the optimal role of decentralization versus regionalization (centralization) of surgical care is unknown. The aim of this study is to review evidence around interventions aimed at redistributing surgical services in LMICs, to guide recommendations for the ideal organization of surgical services. Methods: A narrative-based literature review was conducted to answer this question. Studies published in English between 1997 and 2017 in PubMed, describing interventions to decentralize or regionalize a surgical procedure in a LMIC, were included. Procedures were selected using the Disease Control Priorities’ (DCP3) Essential Surgery Package list. Intervention themes and outcomes were analyzed using a narrative, thematic synthesis approach. Primary outcomes included mortality, complications, and patient satisfaction. Secondary outcomes included input measures: workforce and infrastructure, and process measures: facility-based care, surgical volume, and referral rates. Results: Thirty-five studies were included. Nine (33%) of the 27 studies describing decentralization showed an improvement in primary outcomes. The procedures associated with improved outcomes after decentralization included most obstetric, gynecological, and family planning services as well as some minor general surgery procedures. Out of 8 studies on regionalization (centralization), improved outcomes were shown for trauma care in one study and cataract extraction in one study. Conclusion: Interventions aimed at decentralizing obstetric care to the district hospital and health center levels have resulted in mortality benefits in several countries. However, more evidence is needed to link service distribution to patient outcomes in order to provide recommendations for the optimal organization of other surgical procedures in LMICs. Considerations for the optimal distribution of surgical procedures should include the acuity of the condition for which the procedure is indicated, anticipated case volume, and required level of technical skills, resources, and infrastructure. These attributes should be considered within the context of each country.
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Affiliation(s)
- Katherine R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,General Surgery Department, University of California Davis Medical Center, Sacramento, CA, USA
| | - Emma Svensson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Lund University, Lund, Sweden
| | - Kristin Sonderman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Kerry A Vaughan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany L Powell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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35
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Hutchinson PJ, Kolias AG, Tajsic T, Adeleye A, Aklilu AT, Apriawan T, Bajamal AH, Barthélemy EJ, Devi BI, Bhat D, Bulters D, Chesnut R, Citerio G, Cooper DJ, Czosnyka M, Edem I, El-Ghandour NMF, Figaji A, Fountas KN, Gallagher C, Hawryluk GWJ, Iaccarino C, Joseph M, Khan T, Laeke T, Levchenko O, Liu B, Liu W, Maas A, Manley GT, Manson P, Mazzeo AT, Menon DK, Michael DB, Muehlschlegel S, Okonkwo DO, Park KB, Rosenfeld JV, Rosseau G, Rubiano AM, Shabani HK, Stocchetti N, Timmons SD, Timofeev I, Uff C, Ullman JS, Valadka A, Waran V, Wells A, Wilson MH, Servadei F. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement. Acta Neurochir (Wien) 2019; 161:1261-1274. [PMID: 31134383 PMCID: PMC6581926 DOI: 10.1007/s00701-019-03936-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. METHODS The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. RESULTS The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. CONCLUSIONS In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.
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Affiliation(s)
- Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Tamara Tajsic
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Abenezer Tirsit Aklilu
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - B Indira Devi
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Randall Chesnut
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Idara Edem
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece
| | - Clare Gallagher
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Corrado Iaccarino
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Mathew Joseph
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Tsegazeab Laeke
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oleg Levchenko
- Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Paul Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anna T Mazzeo
- Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Daniel B Michael
- Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Gail Rosseau
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andres M Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Nino Stocchetti
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy
- Neuroscience Intensive Care Unit, Department of Anaesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shelly D Timmons
- Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, London, UK
- Queen Mary University of London, London, UK
| | - Jamie S Ullman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Vicknes Waran
- Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam Wells
- Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark H Wilson
- Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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36
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Barthélemy EJ. The rise of clinical neuroscience in Haiti. Lancet 2019; 393:2490-2491. [PMID: 31232367 DOI: 10.1016/s0140-6736(19)30219-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ernest J Barthélemy
- Program in Global Surgery and Social Change, Harvard Medical School, MA 02115, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, USA; Haitian Foundation for the Development of Neurology and Neurosurgery, Port-au-Prince, Haiti.
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Barthélemy EJ, Spaggiari R, Corley J, Lepard JR, Staffa SJ, Iv V, Servadei F, Park KB. Injury-to-Admission Delay Beyond 4 Hours Is Associated with Worsening Outcomes for Traumatic Brain Injury in Cambodia. World Neurosurg 2019; 126:e232-e240. [PMID: 30825623 DOI: 10.1016/j.wneu.2019.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/15/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Cambodia, the most common victims of traumatic brain injury (TBI) are men 20-30 years of age involved in motor vehicle collision. Secondary injury sustained by these patients occurs during the time period between initial insult and hospital admission. Strengthening prehospital systems for TBI in low- and middle-income countries (LMICs) such as Cambodia is therefore a key element of the development agenda for universal health equity. We report a retrospective analysis of the relationship between prehospital delays and TBI outcomes among patients from a large government hospital in Cambodia. METHODS Data were collected from 3476 patients with TBI admitted to a major government hospital in Phnom Penh, Cambodia, from June 2013 to June 2018. Patients with missing data or those admitted >8 hours postinjury were excluded. Statistical analyses examined associations between injury-to-admission delay (IAD) and outcomes such as Glasgow Outcome Scale (GOS) score and length of stay (LOS). RESULTS A total of 2125 patients with TBI (76.85% men) were included. The median age was 27 years (interquartile range, 22-37 years). Injury severity at presentation included 1406 mild (66%), 464 moderate (22%), and 240 severe cases (11%). No Glasgow Coma Scale (GCS) data were available for 15 patients (1%). We found an inverse relationship between IAD and GOS score, most evidently for mild and moderate TBI (n = 1870; 88%). Regression analysis revealed a marked decrease in GOS score at the IAD >4-hour threshold. Each 30-minute delay in IAD was correlated with >2-hour increase in LOS for mild (P < 0.001) and moderate TBI (P < 0.001). CONCLUSIONS In a retrospective cohort of >2000 patients with TBI from Cambodia, we found that increasing IAD was associated with worsening outcome, especially beyond the 4-hour threshold. These data should inform development of prehospital guidelines for TBI care in LMICs.
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Affiliation(s)
- Ernest J Barthélemy
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | | | - Jacquelyn Corley
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Duke Department of Neurosurgery, Durham, North Carolina, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jacob R Lepard
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Massachusetts, USA
| | - Vycheth Iv
- Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | | | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Barthélemy EJ, Park KB, Johnson W. Neurosurgery and Sustainable Development Goals. World Neurosurg 2018; 120:143-152. [DOI: 10.1016/j.wneu.2018.08.070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/14/2022]
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Barthélemy EJ, Valtis YK, Cochran MF, Martineau L, Park K, Mendel JB, Warf B, Berkowitz AL. Patterns of Hydrocephalus in Rural Haiti: A Computed Tomography–Based Study. World Neurosurg 2018; 119:257-261. [DOI: 10.1016/j.wneu.2018.07.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
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Adnan AK, Alexopoulos A, Alo KM, Alterman RL, Amar A, Andrade P, Arulkumar S, Awad AJ, Baltuch G, Barolat G, Barthélemy EJ, Barua NU, Bennett ME, Bentley N, Bezchlibnyk YB, Bijanki KR, Bingaman W, Boggs JW, Boon P, Brouwer BA, Campos LW, Caparso A, Capozzo A, Chae J, Chang JW, Cheng J, Copenhaver D, Deer TR, Deogaonkar M, Dhar D, Dohmeier K, Dougherty DD, Durand DM, Foote K, Gilligan J, Gill SS, Gonzalez-Martinez J, Greenberg BD, Gross RE, H. Pourfar M, Hamani C, Hayek SM, Holtzheimer PE, Ilfeld BM, Jin H, Joosten B, Jung NY, Kim CH, Kim YG, Klehr M, Koch P, Kohl S, Kopell BH, Kramer D, Krames ES, Krishnan B, Krishna V, Kuhn J, Kyung-soo Hong J, Leonardo K, Leong MS, Li D, Linninger AA, Lipsman N, Liu C, Lozano AM, Mackow M, Malinowski MN, Mayberg HS, Mazzone P, Mehta AI, Mehta V, Mills-Joseph R, Nair D, North RB, Okun M, Patel NK, Patil PG, Pope JE, Poree LR, Prager JP, Raedt R, Rasouli JJ, Rasskazoff S, Rauck R, Reeves K, Rezai AR, Russin J, Sabersky A, Saulino M, Scarnati E, Schu S, Sharma M, Shipley J, Shirvalkar P, Slavin KV, Stanton-Hicks M, Stone S, Stuart WA, Sun B, Tangen K, Tepper SJ, van Kleef M, Vancamp T, Verrills P, Viselli F, Visser-Vandewalle V, Vitale F, Vonck K, Wang T, Wang X, Weiner RL, Widge AS, Wongsarnpigoon A, Y. Mogilner A, Yaeger KA, Yaksh TL, Yin D, Zeljic K, Zhang C, Zhan S. List of Contributors of Volume 2. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.01005-6] [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: 10/17/2022]
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