Current status of implementation of trauma registries' in LMICs & facilitators to implementation barriers: A literature review & consultation.

Background & objectives Many low- and middle- income countries (LMICs) have attempted to implement trauma registries with varying degrees of success. This study aimed to understand the registry implementation mechanism in LMICs better. Study objectives include assessment of the current use of trauma registries in LMICs, identification of barriers to the process and potential areas for intervention, and investigation of the registry implementation experience of key stakeholders in LMICs. Methods An initial narrative review of articles on trauma registry use in LMICs published in English between January 2017 and September 2023 was conducted. Key findings identified in this review were used to establish a theoretical framework from which an interview guide was subsequently developed. Expert consultation with key stakeholders in trauma registry implementation in two LMICs was conducted to assess the experience of registry implementation further. Results The presence of trauma registries in LMICs is limited. Key implementation barriers include funding concerns, uncoordinated administrative efforts, lack of human and physical resources (i.e., technology, equipment), and challenges in data management, analysis, and quality. Stakeholder interviews highlighted the importance of trauma registry development but echoed some obstacles, notably funding and data collection barriers. Interpretation & conclusions Barriers to registry implementation are ubiquitous and may contribute to the low uptake of registries in LMICs. One potential solution to these challenges is the application of the WHO International Registry for Trauma and Emergency Care. Future studies examining context-specific challenges to registry implementation and sustained utilization are required.

Addressing the oversight medical cases in low-middle-income countries: poor mention of shaken baby syndrome in Nigeria; reasons, challenges, and recommendations.

INTRODUCTION: Shaken baby syndrome (SBS) is a severe form of child abuse that results in a triad of clinical findings: subdural hematoma, retinal hemorrhages, and encephalopathy. These injuries can lead to significant brain damage, developmental delays, disabilities, or even death. In addition to these, other indicative signs include bruises, vomiting, full fontanelles, sleepiness, seizures, and fractures. METHODS: This paper reviews the existing literature on SBS in Nigeria, identifies the challenges contributing to its underrecognition, and provides evidence-based recommendations for improving diagnosis, management, and prevention strategies in the region. CONCLUSIONS: Despite the profound impact of SBS, its recognition and management are inadequate, particularly in low- and middle-income countries (LMICs) like Nigeria, due to limited diagnostic capabilities and documentation. Addressing these gaps is crucial for safeguarding the well-being of infants and young children in Nigeria.

Strength in silence: the journey of mothers raising children with hydrocephalus.

BACKGROUND: Raising a child with hydrocephalus can be very challenging, especially in low- and middle-income countries. In Pakistan, mothers being the primary caregivers for their hydrocephalic children are under tremendous stress. METHODS: This study explores the challenges faced by Pakistani mothers raising children with hydrocephalus, employing a qualitative methodology through focus group discussions comprising ten mothers of hydrocephalic babies at Tertiary Care Hospital in Pakistan. RESULTS: The findings highlight three main themes: emotional toll, social isolation, and financial strain. Mothers experience significant emotional stress due to societal stigma and a lack of support, particularly from their husbands and family. Social isolation is prevalent, as mothers fear sharing their burdens and face physical confinement due to their children's needs. Financial strain is another major issue, with high medical costs adding to their economic difficulties. CONCLUSION: The study emphasizes improved access to specialized care, awareness campaigns to reduce stigma, financial assistance, and stronger community support networks to support these mothers better. Addressing these unmet needs is crucial for empowering Pakistani mothers in their caregiving roles and improving the quality of life for their children with hydrocephalus.

Bridging the gap: enhancing TBI care in Pakistan's primary and secondary healthcare settings.

Traumatic Brain Injury (TBI) in Pakistan is predominantly caused by road traffic accidents, falls, and violence, resulting in approximately 300,000 new cases annually. Significant gaps exist in awareness, resources, and accessibility for effective TBI management, especially in primary care settings. To improve care, strategies include training healthcare providers, nationwide awareness campaigns, strengthening healthcare infrastructure, and establishing referral systems. Collaboration between government, NGOs, and international partners is crucial for enhancing TBI management.

Antibiotic misuse in neurosurgery: a threat to patient safety and surgical outcomes.

Inappropriate antibiotic use in neurosurgery poses significant threats to global public health. Infections in neurosurgical patients can lead to devastating consequences, complicated by antibiotic-resistant bacteria. The CDC reports at least 2.8 million drug-resistant infections annually in the US, resulting in 35,000 deaths. Addressing this issue requires interdisciplinary approaches, engaging healthcare providers, researchers, policymakers, and the public. Understanding factors contributing to antibiotic misuse is essential in safeguarding the future of surgical procedures and protecting patient health.

Breaking barriers: Addressing gender disparity in neurosurgery.

Neurosurgery is still dominated by men, with only 16.7% of neurosurgeons being women and even fewer in leadership roles. This disparity affects research, patient care, and health policy. To enhance care and equity, addressing barriers for women through targeted mentorship, inclusive practices, and policy changes is essential. CORRESPONDENCE: Despite significant progress in medical education and practice, neurosurgery remains a male-dominated specialty. This gender disparity is not merely a reflection of societal biases but a systemic issue that affects both the professional advancement of women and the quality of care delivered to patients. As the global health community strives for equity, the underrepresentation of women in neurosurgery demands urgent attention.

Democratizing neurosurgical knowledge: a call for publishing reform.

Publishing a scientific article in good journals with good Impact factor has become very difficult these days. This is not all depend on the quality of article. Most of times it's the lack of ability to pay the article processing fee. In Low and middle income countries (LMIC) it becomes more difficult as the research is not supported by government and institutions. Here we delve into the real problems of research article publication in LMIC.

AI and neurosurgery: a new era of enhanced outcomes.

Artificial Intelligence (AI) is revolutionizing neurosurgery by enhancing diagnostic accuracy, surgical planning, and personalized patient care. Despite challenges like data privacy and bias, AI's integration promises to transform surgical outcomes and advance neurosurgical practice.

Probabilistic Approach to Multi-Stage Supplier Evaluation: Confidence Level Measurement in Ordinal Priority Approach.

A popular framework of the supplier selection process is usually characterized by problem definition, criteria formulation, supplier screening, and supplier selection. The literature review suggested limitations of this framework as it ignores the screening of criteria (beyond criteria weighing) and evaluators (buyers) and its inability to guide the supplier selection problems where a measure of confidence or trust is needed to confirm the reliability of the selected supplier. While extending de Boer's influential supplier selection framework, the current study argues that the supplier selection problem is not merely about ranking suppliers based on given criteria; instead, it involves evaluating criteria and evaluators as well. Guided by the theory of statistics and the Ordinal Priority Approach (OPA), the study pioneers a probabilistic approach of supplier evaluation and selection under incomplete information using a novel Confidence Level measure. The study suggests, the probability that a supplier shortlisted for selection is actually the optimum choice or not can be explained through a probability distribution, called W-distribution, therefore, confidently preventing the decision-makers from selecting the sub-optimum suppliers. The study presents a novel contribution to the theory of multiple-attribute decision-making through the OPA. The proposed approach can help build intelligent decision support systems to aid managers while providing them with early warning tools and suggestions to improve confidence in their selection.

Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches.

PURPOSE: The study aims to evaluate the comprehensive relationship between patient satisfaction and five dimensions of health care service quality in Pakistani public/private health care sectors, using a novel grey relational analysis (GRA) models and the Hurwicz criteria of decision making under uncertainty. DESIGN/METHODOLOGY/APPROACH: Data were collected from private and public health care facilities of Pakistan through an improved SERVQUAL instrument. Deng's GRA, absolute GRA, and the second synthetic GRA models were applied to address the problem under study. FINDINGS: Grey relational analysis models revealed that reliability and responsiveness are most strongly predicting patient satisfaction in public and private health care sectors, respectively. The Hurwicz criteria showed that patients are more likely to be satisfied from private health care facilities. LIMITATIONS/IMPLICATIONS: Limitations of SERVQUAL model are also the limitations of the study; eg, the study suggests that because of the absence of "cost," which is a key quality indicator of Pakistani public sector health care facilities, the model was unable to comprehensively evaluate the health care situation in light of the observations of price-focused Pakistani patients. The study recommends tailoring of SERVQUAL model for the resource-scant and underdeveloped countries where people's evaluation of the quality of the hospitals is likely to be influenced by the price of services. ORIGINALITY/VALUE: The study is a pioneer in health care evaluation of public and private sectors of Lahore and Rawalpindi while using GRA models, in general, and the second synthetic GRA model, in particular. It presents an alternative method to the statistical way of analyzing data by successfully demonstrating the use of grey methods, which can make reasonable decisions even through small samples.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations.

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

ARA 290, a nonerythropoietic peptide engineered from erythropoietin, improves metabolic control and neuropathic symptoms in patients with type 2 diabetes.

Although erythropoietin ameliorates experimental type 2 diabetes with neuropathy, serious side effects limit its potential clinical use. ARA 290, a nonhematopoietic peptide designed from the structure of erythropoietin, interacts selectively with the innate repair receptor that mediates tissue protection. ARA 290 has shown efficacy in preclinical and clinical studies of metabolic control and neuropathy. To evaluate the potential activity of ARA 290 in type 2 diabetes and painful neuropathy, subjects were enrolled in this phase 2 study. ARA 290 (4 mg) or placebo were self-administered subcutaneously daily for 28 d and the subjects followed for an additional month without further treatment. No potential safety issues were identified. Subjects receiving ARA 290 exhibited an improvement in hemoglobin A(1c) (Hb A(1c)) and lipid profiles throughout the 56 d observation period. Neuropathic symptoms as assessed by the PainDetect questionnaire improved significantly in the ARA 290 group. Mean corneal nerve fiber density (CNFD) was reduced significantly compared with normal controls and subjects with a mean CNFD >1 standard deviation from normal showed a significant increase in CNFD compared with no change in the placebo group. These observations suggest that ARA 290 may benefit both metabolic control and neuropathy in subjects with type 2 diabetes and deserves continued clinical evaluation.

Carving a Path to the Brain: A Study on Neurosurgery Career Choices.

BACKGROUND: Medical students often face challenges in choosing a career path due to limited exposure to specialized fields like neurosurgery. Understanding their perceptions and experiences is crucial in addressing the gaps in neurosurgical education and inspiring future neurosurgeons. METHODS: A cross-sectional study was conducted involving 461 medical students, utilizing convenience sampling. Data collection employed a validated, self-administered tool. Statistical analysis in SPSS Version 25 included t-tests and chi-square tests, comparing scores based on age, gender, year of study, and exposure to the formal neurosurgical rotations in their institute. Significance value was set at P < 0.05. RESULTS: In the study of 461 medical students, 79.8% identified with the 19-23 age group, and 63.8% affirmed neurosurgery exposure. Medical students' perceptions included: 167 (36.3%) students found neurosurgery teaching sufficient; 164 (35.6%) disagreed that obtaining neurosurgical history is difficult; 224 (48.6%) agreed on neurosurgical disease complexity; and 250 (54.2%) found these diseases challenging and interesting. A majority of 183 (39.7%) respondents agreed that neurosurgical diseases had poor outcomes. Regarding training for neurosurgical surgery, 205 (44.5%) participants strongly agreed on its length, and 215 (46.7%) consented to extensive operating hours. However, 167 (36.3%) strongly disagreed about the ample job prospects in Pakistan. CONCLUSIONS: Enhancing neurosurgery education with quality, consistency, and adaptability is essential to bridge gaps and inspire future neurosurgeons. These findings guide improvements in educational programs, preparing a skilled workforce to meet evolving health-care demands.