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Moreno-Oliveras L, Rodriguez-Mena R, Nahoda H, Chisbert-Genoves P, Ali Haji M, Llacer-Ortega JL, Piquer-Belloch J. Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania). World Neurosurg X 2023; 20:100222. [PMID: 37502101 PMCID: PMC10368924 DOI: 10.1016/j.wnsx.2023.100222] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
Objective Our main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures. Methods This is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted. Results The mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted. Conclusions Proper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.
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Affiliation(s)
- Luis Moreno-Oliveras
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Ruben Rodriguez-Mena
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Hadia Nahoda
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Pilar Chisbert-Genoves
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Mohamed Ali Haji
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Jose L. Llacer-Ortega
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Jose Piquer-Belloch
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
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Hackett AM, Adereti CO, Walker AP, Ozobu I, Petit J, Waldron KR, Rolle M. The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review. Brain Spine 2023; 3:101747. [PMID: 37383430 PMCID: PMC10293305 DOI: 10.1016/j.bas.2023.101747] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction Global access to electronic medical records (EMRs) continues to grow, however many countries including those within the Caribbean Community (CARICOM) lack access to this system. Minimal research investigating EMR use in this region exists. Research question How does limited EMR access impact neurosurgical care within the CARICOM? Materials and methods The Cochrane Library, EMBASE, Scopus, PubMed/MEDLINE databases, and grey literature were queried for studies addressing this issue within the CARICOM and low- and/or middle-income countries (LMICs). A comprehensive search for hospitals within the CARICOM was performed and responses to a survey inquiring about neurosurgery availability and EMR access within each facility were recorded. Results 26 out of 87 surveys were returned leading to a response rate of 29.0%. Among the survey respondents, 57.7% stated neurosurgery was provided at their facility; however, only 38.4% admitted to using an EMR system. Paper charting was the primary means of record keeping for the majority of the facilities (61.5%). The most frequently reported barriers stalling EMR implementation were financial limitations (73.6%) and poor internet access (26.3%). A total of 14 articles were included in the scoping review. Results from these studies suggest that limited EMR access contributes to suboptimal neurosurgical outcomes within the CARICOM and LMICs. Discussion and conclusion This paper is the first to address the impact that limited EMR has on neurosurgical outcomes in the CARICOM. The lack of research addressing this issue also highlights the need for ongoing efforts to increase research output focused on EMR accessibility and neurosurgical outcomes in these countries.
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Affiliation(s)
- Ashia M. Hackett
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Johnnie Petit
- Ross University School of Medicine, Miramar, FL, USA
| | | | - Myron Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Olmos M, Patel J, Kanter M, Karimi H, Kryzanski J. Evaluating the potential impact of spinal anesthesia use in lumbar surgery on global healthcare cost and climate change. Brain Spine 2023; 3:101754. [PMID: 37383465 PMCID: PMC10293309 DOI: 10.1016/j.bas.2023.101754] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Introduction Despite recent evidence demonstrating its safety and efficacy, spinal anesthesia remains a seldom-utilized anesthetic modality in lumbar surgical procedures. In addition, numerous clinical advantages, such as reduced cost, blood loss, operative time, and inpatient length of stay have been consistently demonstrated with spinal anesthesia over general anesthesia. Research question In this report we aim to examine the differences between spinal anesthesia and general anesthesia with regard to accessibility and climate impact and determine whether wider adoption of spinal anesthesia would have a meaningful impact on the global population. Materials and Methods: The climate impact of spinal fusions performed under spinal and general anesthesia were obtained from recent studies published in the literature. Cost of spinal fusions was obtained from an unpublished study performed at our institution. Volume of spinal fusions performed in several countries were ascertained from published reports. Data on cost and carbon emissions were extrapolated based on volume of spinal fusions in each of the nations. Results In the U.S., use of spinal anesthesia for lumbar fusions would have resulted in savings of 343 million dollars in 2015. A similar reduction in cost was seen with each country studied. Additionally, spinal anesthesia was associated with 12,352 kg carbon dioxide equivalents (CO2e) while general anesthesia produced 942,872 kg CO2e. Similar reduction in carbon emissions was seen with each country studied. Discussion and conclusion Spinal anesthesia is safe and effective for both simple and complex spine surgeries, it reduces carbon emissions, permits lower operative times, and decreases cost.
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Affiliation(s)
| | | | | | | | - James Kryzanski
- Corresponding author. Department of Neurosurgery, Tufts Medical Center, 800 Washington St. Boston, MA, 02111, USA.
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Rodríguez-Mena R, Piquer-Martínez J, Llácer-Ortega JL, Haji MA, Idrissa-Ahmadsa S, Nahoda H, Young PH, Qureshi MM, García-Rubio MJ, Piquer-Belloch J. The NED foundation experience: A model of global neurosurgery. Brain Spine 2023; 3:101741. [PMID: 37383428 PMCID: PMC10293322 DOI: 10.1016/j.bas.2023.101741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Neurosurgery Education and Development (NED) Foundation (NEDF) started the development of local neurosurgical practice in Zanzibar (Tanzania) in 2008. More than a decade later, multiple actions with humanitarian purposes have significantly improved neurosurgical practice and education for physicians and nurses. Research question To what extent could comprehensive interventions (beyond treating patients) be effective in developing global neurosurgery from the outset in low and middle-income countries? Material and method A retrospective review of a 14- year period (2008-2022) of NEDF activities highlighting landmarks, projects, and evolving collaborations in Zanzibar was carried out. We propose a particular model, the NEDF model, with interventions in the field of health cooperation that have simultaneously aimed to equip, treat, and educate in a stepwise manner. Results 138 neurosurgical missions with 248 NED volunteers have been reported. In the NED Institute, between Nov 2014-Nov 2022, 29635 patients were seen in the outpatient clinics and 1985 surgical procedures were performed. During the course of NEDF's projects, we have identified three different levels of complexity (1, 2 and 3) that include the areas of equipment ("equip"), healthcare ("treat") and training ("educate"), facilitating an increase of autonomy throughout the process. Discussion and Conclusion In the NEDF's model, the interventions required in each action area (ETE) are coherent for each level of development (1, 2 and 3). When applied simultaneously, they have a greater impact. We believe the model can be equally useful for the development of other medical and/or surgical specialties in other low-resource healthcare settings.
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Affiliation(s)
- Ruben Rodríguez-Mena
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
| | - Jose Piquer-Martínez
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - José L. Llácer-Ortega
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
| | - Mohammed A. Haji
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Said Idrissa-Ahmadsa
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Hadia Nahoda
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Paul H. Young
- Section of Neurosurgery, Department of Surgery, St. Louis University, St. Louis, Missouri, USA
| | - Mahmood M. Qureshi
- Section of Neurosurgery, Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - María J. García-Rubio
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - José Piquer-Belloch
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
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Tzerefos C, Tasiou A, Fountas KN. Greek reflections on global neurosurgery. Brain Spine 2023; 3:101721. [PMID: 37383445 PMCID: PMC10293271 DOI: 10.1016/j.bas.2023.101721] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/05/2023] [Accepted: 02/22/2023] [Indexed: 06/30/2023]
Abstract
Introduction Large populations in middle- and low-income countries in Africa, Asia, and Central and South Americas face a dramatic neurosurgical crisis. However, large social groups in high-income countries face similar limited access to neurosurgical services. Proper identification of such a problem, analysis of the underlying causes, and proposal of potential solutions may not only address the problem at a national level, but may also provide valuable reflections on the efficient management of global neurosurgical crisis. Research question To evaluate if special social groups face similar problems in Greece. Material and methods The structure of the Greek health system was examined. The national census along with the registry of practicing neurosurgeons of the Greek National Society, as well as the national health map were searched. Results A series of socio-economic factors, language barriers, cultural and religion differences, geographical barriers, the COVID-19 pandemic aftermath, along with the inherent malfunctioning of the Greek health system have led to this national neurosurgical crisis. Discussion and conclusion An extensive redrawing of the Greek health map, reorganization of the national health system, along with adaptation of all recent advances in telemedicine may alleviate the health burden in these populations. The results of this local reformation may be applied to a global level for managing the ongoing health crisis. Moreover, the development of a European taskforce by the European Association of Neurosurgical Societies (EANS) may well facilitate the development of realistic and efficacious global solutions, and contribute to the global effort for providing high-quality neurosurgical services worldwide.
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Affiliation(s)
- Christos Tzerefos
- Corresponding author. Department of Neurosurgery, Building A, 3rd Floor, University Hospital of Larissa, Biopolis, Larissa, 41110, Greece.
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Bankole NDA, Ouahabi AE. Towards a collaborative-integrative model of education and training in neurosurgery in low and middle-income countries. Clin Neurol Neurosurg 2022; 220:107376. [PMID: 35878558 DOI: 10.1016/j.clineuro.2022.107376] [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: 05/19/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurosurgery inequity between High-Income Countries and Low- and Middle-Income Countries is striking. Currently, several models of education and training are available each has advantages and limitations. Our goal is to suggest an integrative model of Education and Training with international collaboration which will assure the most cost-effective Training Model. MATERIALS AND METHODS The authors reviewed the literature narratively and examined in broad stroke the different existing models of international education and training programs to analyze their strengths, limitations, and cost-effectiveness in addressing the needs of Neurosurgery in Low and middle-Income Countries. RESULTS Several international institutions have been involved in Education and Training in Global Neurosurgery. The most common models for international education include short-term surgical mission and boot camps, a full residency training program in HICs, and a full residency training Program in Local or regional World Federation of Neurosurgical Societies (WFNS) reference centers in Low and Middle-Income Countries, and online education. In Africa, both Local residency training centers and WFNS reference centers are available and provide full training programs in Neurosurgery. Among them, WFNS Rabat Training Center is the first established center in Africa in 2002. This program is supported by the WFNS Foundation and by the Africa 100 Project. Some of these education models face currently challenges such as sustainability, financial support, and ethical issues. CONCLUSION Training neurosurgeons from Low and Middle-Income countries in local and regional WFNS Training centers might be the most cost-effective model of training that helps close the gap in neurosurgery. This training Model is duplicable and may be integrated into a global cohesive and collaborative model of education with international institutions.
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Affiliation(s)
- Nourou Dine Adeniran Bankole
- Department of Neurosurgery, Hôpital Des Spécialités, WFNS Rabat Training Center for young, African neurosurgeons, Faculty of Medicine, Mohamed V University, Rabat, Morocco.
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Hôpital Des Spécialités, WFNS Rabat Training Center for young, African neurosurgeons, Faculty of Medicine, Mohamed V University, Rabat, Morocco.
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Denisova NP, Rzaev JA. Psychiatric mimics of neurosurgical disorders. Prog Brain Res 2022; 272:153-171. [PMID: 35667800 DOI: 10.1016/bs.pbr.2022.03.009] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Every year there are about 22.6 million people in need of neurosurgical care around the world, and one or several interventions are required to save lives and restore functional losses in more than half of these cases (13.8 million). Most neurosurgical interventions are performed in patients with traumatic brain and spinal cord injuries, strokes, central nervous system (CNS) tumors, hydrocephalus, and epilepsy. In addition to neurological symptoms, many CNS disorders are often accompanied by cognitive and/or behavioral changes. Physical and psychological symptoms can be intertwined as follows: 1) neurological symptoms may be manifested as a result of complex psychological processes; 2) psychological disorders may be manifested as neurological symptoms; 3) neurological disorders commonly cause secondary psychological responses; 4) psychological disorder may be induced more or less directly by an organic brain disease. In the present paper, we focus on the psychiatric conditions occurring in the patients with neurosurgical disorders who either get prepared for surgery or have already received it.
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Affiliation(s)
| | - Jamil A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russian Federation.
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Affiliation(s)
- Basant Kumar Misra
- P. D. Hinduja National Hospital and Medical Research Centre, Department of Neurosurgery and Gamma Knife Centre, V. S. Marg Mahim, Mumbai, Maharashtra, India.
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Punchak M, Mukhopadhyay S, Sachdev S, Hung YC, Peeters S, Rattani A, Dewan M, Johnson WD, Park KB. Neurosurgical Care: Availability and Access in Low-Income and Middle-Income Countries. World Neurosurg 2018; 112:e240-54. [PMID: 29325943 DOI: 10.1016/j.wneu.2018.01.029] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND An estimated 5 billion people worldwide lack access to basic surgical care. In particular, the vast majority of low-income and middle-income countries (LMICs) currently struggle to provide adequate neurosurgical services. Significant barriers exist, including limited access to trained medical, nursing, and allied health staff; lack of equipment; and availability of services at reasonable distance and at reasonable cost to patients. An accurate assessment of current neurosurgical capacity in LIMCs is an essential first step in tackling this deficit. OBJECTIVE To quantify the neurosurgical operational capacity and assess access to neurosurgical services in LMICs, by taking into account the location of workforce and services. METHODS A total of 141 LMICs were contacted and asked to report the number of currently practicing neurosurgeons, access to computed tomographic and magnetic resonance imaging, and availability of neurosurgical equipment (microscope, endoscope, bipolar diathermy, high-speed neurosurgical drill). A proposed World Federation of Neurosurgeons classification was used to stratify cities based on the level of neurosurgical care that could be provided. The data were geocoded and analyzed in Redivis (Redivis Inc.) to assess the percentage of the population covered within a 2-hour travel time of a city offering differing levels of neurosurgical care. RESULTS 68 countries provided complete data (response rate, 48.2%). Eleven countries reported having no practicing neurosurgeons. The average percentage of the population with access to neurosurgical services within a 2-hour window is 25.26% in sub-Saharan Africa, 62.3% in Latin America and the Caribbean, 29.64% in East Asia and the Pacific, 52.83% in South Asia, 79.65% in the Middle East and North Africa, and 93.3% in Eastern Europe and Central Asia. CONCLUSIONS There are several challenges to the provision of adequate neurosurgical services in low-resource settings. This study used mapping techniques to determine the current global neurosurgical workforce capacity and distribution. We have used our findings to identify areas for improvement. These include increasing and improving neurosurgical training programs worldwide, recruiting students and young physicians into the field, and retaining existing neurosurgeons within their home countries.
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Wilson TA, Rodgers S, Tanweer O, Agarwal P, Lieber BA, Agarwal N, McDowell M, Devinsky O, Weiner H, Harter DH. Tuberous Sclerosis Health Care Utilization Based on the National Inpatient Sample Database: A Review of 5655 Hospitalizations. World Neurosurg 2016; 91:97-105. [PMID: 27025453 DOI: 10.1016/j.wneu.2016.03.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Tuberous sclerosis complex (TSC) has an incidence of 1/6000 in the general population. Overall care may be complex and costly. We examine trends in health care utilization and outcomes of patients with TSC over the last decade. METHODS The National Inpatient Sample (NIS) database for inpatient hospitalizations was searched for admission of patients with TSC. RESULTS During 2000-2010, the NIS recorded 5655 patients with TSC. Most patients were admitted to teaching hospitals (71.7%). Over time, the percentage of craniotomies performed per year remained stable (P = 0.351). Relevant diagnoses included neuro-oncologic disease (5.4%), hydrocephalus (6.5%), and epilepsy (41.2%). Hydrocephalus significantly increased length of stay and hospital charges. A higher percentage of patients who underwent craniotomy had hydrocephalus (29.8% vs. 5.3%; P < 0.001), neuro-oncologic disease (43.5% vs. 3.4%; P < 0.001), other cranial diseases (4.2% vs. 1.2%; P < 0.001), and epilepsy (61.4% vs. 40.1%; P < 0.001). CONCLUSIONS Our study identifies aspects of inpatient health care utilization, outcomes, and cost of a large number of patients with TSC. These aspects include related diagnoses and procedures that contribute to longer length of stay, increased hospital cost, and increased in-hospital mortality, which can inform strategies to reduce costs and improve care of patients with TSC.
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Affiliation(s)
- Taylor A Wilson
- Department of Neurosurgery, New York University, New York, New York, USA.
| | - Shaun Rodgers
- Department of Neurosurgery, New York University, New York, New York, USA
| | - Omar Tanweer
- Department of Neurosurgery, New York University, New York, New York, USA
| | - Prateek Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryan A Lieber
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael McDowell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Orrin Devinsky
- Department of Neurosurgery, New York University, New York, New York, USA; Division of Epilepsy, Department of Neurology, New York University, New York, New York, USA
| | - Howard Weiner
- Department of Neurosurgery, New York University, New York, New York, USA
| | - David H Harter
- Department of Neurosurgery, New York University, New York, New York, USA
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McComb JG, Da Silva SL. Neurosurgical care of pediatric brain tumor patients in a rehabilitation unit. J Pediatr Rehabil Med 2014; 7:323-31. [PMID: 25547884 DOI: 10.3233/prm-140302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As brain tumor patients are transferred to a rehabilitation unit in a stable condition, subsequent neurosurgical involvement is needed to address later developing complications. Problems of cerebrospinal fluid circulation are the most common and include shunt malfunction. Infection is the next in frequency, with wound and shunt infection the most likely. Bleeding rarely occurs, especially acutely, and is more apt to be seen with chronic subdural hematomas.
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Affiliation(s)
- J Gordon McComb
- Division of Neurosurgery, Children's Hospital Los Angeles, CA, USA Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Coburger J, Leng LZ, Rubin DG, Mayaya G, Medel R, Ngayomela I, Ellegala D, Durieux ME, Nicholas J, Härtl R. Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years. World Neurosurg 2014; 82:e1-8. [PMID: 23023049 DOI: 10.1016/j.wneu.2012.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period. METHODS A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established. RESULTS At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently. CONCLUSIONS Neurosurgical care in Tanzania needs to address a diverse, unique disease burden. We found that local surgeons could be enabled to safely perform basic cranial and spinal neurosurgical procedures through immersive, 1-on-1 on-site collaborations, multidisciplinary courses, and educational visiting fellowships.
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