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1.
Neurosurg Clin N Am ; 33(1): 1-5, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34801134

RESUMEN

The developing field of syndromic neurosurgery has significant challenges and opportunities in quality and safety. Quality care must be safe, effective, patient-centered, timely, efficient, and equitable; the Donabedian model focused on system structures, processes, and outcomes is a helpful framework to guide improvement in these areas. Ultimately, a successful syndromic neurosurgery program will bring together an interested multidisciplinary team of experts who will grow care through open communication and steady improvement efforts.


Asunto(s)
Neurocirugia , Comunicación , Humanos , Mejoramiento de la Calidad
2.
Scand J Trauma Resusc Emerg Med ; 29(1): 158, 2021 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-34727955

RESUMEN

BACKGROUND: We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). METHODS: The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. RESULTS: A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. CONCLUSIONS: In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Neurocirugia , Adulto , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Hospitales , Humanos , Unidades de Cuidados Intensivos
3.
Br J Hosp Med (Lond) ; 82(10): 1-7, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34726938

RESUMEN

Clinical academia aims to bridge the gap between clinicians and scientists, by combining academic activity with clinical practice. The term 'clinical academics' generally refers to clinicians who have protected time within their job plans for undertaking academic activities. Engagement with academic activity by trainees is not only essential to fulfil necessary curriculum competencies, but also allows them to explore areas of interest outside of clinical practice and develop advanced academic skills. This article provides an overview of different routes into academic neurosurgery, and discusses the advantages and difficulties in pursuing this career path. It also covers the differences between postgraduate research degrees and explores the different job plan models available at consultant level. Academic neurosurgery is a rewarding career and opportunities should be made available to those who wish to explore it further. Developing academic careers may have a positive impact on wider workforce planning strategies and improve the delivery of high-quality evidence-based neurosurgical care.


Asunto(s)
Neurocirugia , Médicos , Selección de Profesión , Consultores , Curriculum , Humanos , Recursos Humanos
4.
Chirurgia (Bucur) ; 116(eCollection): 1-9, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34749845

RESUMEN

Neurosurgery is a medical speciality that diagnoses and treats brain and spine pathologies of infants, children, and adults, having 2 components: clinical and surgical activities. The history of neurosurgery dates back to the Prehistoric Period when first trepanations took place. However, the extensive amount of information we use today was discovered and invented thanks to Joseph Lister (1827-1912), William T.G. Morton (1819-1868) and Pierre Paul Broca (1823-1880) who implemented systematic antisepsis rules, anaesthesia and, respectively, the localization of different areas of the brain. Nevertheless, professors such as Harvey Cushing (1869-1939) and Gazi Yasargil (n.1925) are responsible for the definition of neurosurgery as a stand-alone surgical specialty and the significant improvement of the surgical techniques. Moreover, Professor Dumitru Bagdasar (1893-1946) is the one responsible for the introduction of neurosurgery in Romania, training a "golden neurosurgeon team" who are remarked as the first neurosurgeons of Romania. Even though it is such a new medical field, a vast amount of theoretical and practical study is necessary. Therefore, a student needs dedication and lots of effort to achieve perfection in one of the most complex medical speciality, requiring more than 100 exams and over 14,900 hours of practice during the 6 years of medical school and 6 years of neurosurgical residency. Still, even if it seems a lot at first, the moral rewards stand out in the end due to the significant contrast between the preoperative and postoperative condition of the patient. Nevertheless, some of the students might be negatively influenced by family and friends through different myths that neurosurgery is a goal that is almost impossible to be achieved since the amount of practice and sacrifices it requires are a lot bigger than other medical specialities. In conclusion, neurosurgery accomplished to overcome the mystery of the human brain and developed at a fast pace. Today, neurosurgeons around the world treat more and more pathologies that seemed incurable and inoperable 100 years ago.


Asunto(s)
Neurocirugia , Niño , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Estudiantes , Resultado del Tratamiento
5.
Zhonghua Yi Xue Za Zhi ; 101(41): 3361-3364, 2021 Nov 09.
Artículo en Chino | MEDLINE | ID: mdl-34758538

RESUMEN

Epilepsy is a common neurological disease that seriously affects the health of the human population. The treatment of epilepsy has always been an important direction in the field of neurosurgery. New epilepsy theories and surgical treatment techniques contribute new direction of epilepsy surgical treatment in the future. This article aims to review the therapeutic advances in the treatment of epilepsy, including project of the brain networks, epileptic networks, the construction of epilepsy brain networks, and to explore the new branch of epilepsy surgery (brain-networks oriented epilepsy surgery), thereby providing a new precision treatment method for epileptic patients.


Asunto(s)
Epilepsia , Neurocirugia , Encéfalo , Epilepsia/cirugía , Humanos , Procedimientos Neuroquirúrgicos
6.
Stud Health Technol Inform ; 287: 40-44, 2021 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-34795076

RESUMEN

Implementing the best research principles initiates an important shift in clinical research culture, improving efficiency and the level of evidence obtained. In this article, we share our own view on the best research practice and our experience introducing it into the scientific activities of the N.N. Burdenko National Medical Research Center of Neurosurgery (Moscow, Russian Federation). While being adherent to the principles described in the article, the percentage of publications in the international scientific journals in our Center has increased from 7% to 27%, with an overall gain in the number of articles by 2 times since 2014. We believe it is important that medical informatics professionals equally to medical experts involved in clinical research are familiar with the best research principles.


Asunto(s)
Investigación Biomédica , Neurocirugia , Hospitales , Procedimientos Neuroquirúrgicos , Federación de Rusia
8.
Neurosurg Focus ; 51(5): E5, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724638

RESUMEN

OBJECTIVE: Postoperative telephone calls are a simple intervention that can be used to improve communication with patients, potentially affecting patient safety and satisfaction. Few studies in the neurosurgical literature have examined the effect of a postoperative telephone call on patient outcomes, although several exist across all surgical specialties. The authors performed a systematic review and analyzed studies published since 2000 to assess the effect of a postoperative telephone call or text message on patient safety and satisfaction across all surgical specialties. METHODS: A search of PubMed-indexed articles was performed on June 12, 2021, and was narrowed by the inclusion criteria of studies from surgical specialties with > 50 adult patients published after 1999, in which a postoperative telephone call was made and its effects on safety and satisfaction were assessed. Exclusion criteria included dental, medical, and pediatric specialties; systematic reviews; meta-analyses; and non-English-language articles. Dual review was utilized. RESULTS: Overall, 24 articles met inclusion criteria. The majority reported an increase in patient satisfaction scores after a postoperative telephone call was implemented, and half of the studies demonstrated an improvement in safety or outcomes. CONCLUSIONS: Taken together, these studies demonstrate that implementation of a postoperative telephone call in a neurosurgical practice is a feasible way to enhance patient care. The major limitations of this study were the heterogeneous group of studies and the limited neurosurgery-specific studies.


Asunto(s)
Neurocirugia , Adulto , Niño , Humanos , Atención al Paciente , Satisfacción del Paciente , Periodo Posoperatorio , Teléfono
9.
Neurosurg Focus ; 51(5): E9, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724642

RESUMEN

In an era when healthcare "value" remains a much-emphasized concept, measuring and reporting the quality of neurosurgical care and costs remains a challenge for large multisite health systems. Ensuring cohesion in outcomes across multiple sites is important to the development of a holistic competitive marketing strategy that seeks to promote "brand" performance characterized by a superior quality of patient care. This requires mechanisms for data collection and development of a single uniform outcomes measurement system site wide. Operationalizing a true multidisciplinary effort in this space requires intersection of a vast array of information technology and administrative resources along with the neurosurgeons who provide subject-matter expertise relevant to patient care. To measure neurosurgical quality and safety as well as improve payor contract negotiations, a practice analytics dashboard was created to allow summary visualization of operational indicators such as case volumes, quality outcomes, and relative value units and financial indicators such as total hospital costs and charges in order to provide a comprehensive overview of the "value" of surgical care. The current version of the dashboard summarizes these metrics by site, surgeon, and procedure for nearly 30,000 neurosurgical procedures that have been logged into the Mayo Clinic Enterprise Neurosurgery Registry since transition to the Epic electronic health record (EHR) system. In this article, the authors sought to review their experience in launching this EHR-linked data-driven neurosurgical practice initiative across a large, national multisite academic medical center.


Asunto(s)
Hospitales , Neurocirugia , Humanos , Procedimientos Neuroquirúrgicos , Sistema de Registros , Encuestas y Cuestionarios
11.
BMC Res Notes ; 14(1): 434, 2021 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-34838152

RESUMEN

OBJECTIVE: Colloid solutions are commonly used to maintain perioperative fluid homeostasis. In regard to perioperative infant-centered care, data about the impact of colloids are rare. New data suggest a possible positive effect of hydroxyethyl starch (HES) concerning blood brain barrier. Therefore we conduct a retrospective single center study of children scheduled for neurosurgery, age < five with a blood loss > 10% of body blood volume, receiving either 6% HES 130/0.4 or 5% human albumin (HA). RESULTS: Out of 913 patients, 86 were included (HES = 30; HA = 56). Compared to HES [16.4 ± 9.2 ml/kg body weight (mean ± SD)] HA group received more colloid volume (25.7 ± 11.3), which had more blood loss [HA 54.8 ± 45.0; HES 30.5 ± 30.0 (%) estimated blood volume] and higher fluid balances. Fibrinogen was decreased and activated partial thromboplastin time was elevated in HA group. Urinary output, creatinine and urea levels did not differ between the two groups. Serum calcium, total protein levels were lower in HES group. HA treated infants tended to have shorter ICU and hospital stays. We conclude that none of the investigated colloid solutions were without leverage to infants. Consequently randomized controlled trials about perioperative goal-directed fluid replacement of children undergoing (neuro)-surgery with major blood loss are needed.


Asunto(s)
Neurocirugia , Albúmina Sérica Humana , Niño , Fluidoterapia , Humanos , Derivados de Hidroxietil Almidón , Lactante , Sustitutos del Plasma/uso terapéutico , Estudios Retrospectivos
13.
No Shinkei Geka ; 49(5): 1093-1104, 2021 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-34615769

RESUMEN

Although surgical site infections(SSIs)are usually controllable, their occasional occurrence is unavoidable. SSIs in neurosurgery comprise surgical-wound infections and surgical-organ/space infections. Data from the Japan Nosocomial Infections Surveillance revealed an overall infection rate of 1.1% during the first half of 2020. Responses to two questionnaire-based surveys on SSI prevention and complications related to cranial implant/artificial bone revealed the real world situation in neurosurgery. In 2020, neurosurgical information was added to the practical guidelines concerning the proper use of prophylactic antibacterial drug for SSIs. COVID-19 hygiene control protocols may have reduced the incidence of SSIs. It may be prudent to continue this stringent hygiene control after the COVID-19 pandemic has abated. Information of medical material on SSI is presented in this article, including the Plus suture®, DuraGen®, DuraSeal®, Adherus®, ultra-high-molecular-weight polyethylene(SKULPIO®, CRANIOFIT-PE®), Bioglide® and Bactiseal® shunt systems, and olanexidine. Minimizing SSIs requires proper knowledge on infection control, taking care while performing neurosurgical procedures, and compassion for the patients. In addition, information and material must be updated over time.


Asunto(s)
COVID-19 , Neurocirugia , Humanos , Procedimientos Neuroquirúrgicos/efectos adversos , Pandemias , SARS-CoV-2 , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control
16.
BMJ Open ; 11(9): e046741, 2021 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-34593487

RESUMEN

INTRODUCTION: Antiplatelet therapy is commonly used in primary or secondary prevention of atherosclerotic and thrombotic diseases, such as coronary artery disease, transient ischaemic attack or stroke. Recent studies noted that antiplatelet therapy should be continued perioperatively in patients at high risk of thrombosis and low bleeding risk in orthopaedic, spinal or urological surgery. However, evidence in neurosurgery is lacking. Thus, we aim to conduct a systematic review and meta-analysis to assess whether the continuous use of antiplatelet drugs in neurosurgery increases the risk of perioperative bleeding. METHODS AND ANALYSIS: We will search PubMed, Cochrane Central Register of Controlled Trials and Embase using a strategy that combines the terms aspirin, bleeding/ischaemic and neurosurgery. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Cochrane risk of bias tool for randomised controlled studies and the Newcastle-Ottawa Scale for observational studies (including cohort studies, case-control studies, case series). Discrepancies will be resolved by consultation with a third researcher. We will conduct a systematic review and meta-analysis. If evidence suggests moderate statistical or clinical heterogeneity, we plan to investigate this heterogeneity by performing subgroup analyses and sensitivity analysis. ETHICS AND DISSEMINATION: No ethics approval will be sought as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42020202590.


Asunto(s)
Neurocirugia , Inhibidores de Agregación Plaquetaria , Adulto , Aspirina/efectos adversos , Humanos , Metaanálisis como Asunto , Inhibidores de Agregación Plaquetaria/efectos adversos , Literatura de Revisión como Asunto , Revisiones Sistemáticas como Asunto
17.
BMJ Open ; 11(10): e048270, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34598983

RESUMEN

INTRODUCTION: Delirium is a neurocognitive disorder characterised by an acute and temporary decline of mental status affecting attention, awareness, cognition, language and visuospatial ability. The underlying pathophysiology is driven by neuroinflammation and cellular oxidative stress.Delirium is a serious complication following neurosurgical procedures with a reported incidence varying between 4% and 44% and has been associated with increased length of hospital stay, increased amount of reoperations, increased costs and mortality.Perioperative music has been reported to reduce preoperative anxiety, postoperative pain and opioid usage, and attenuates stress response caused by surgery. We hypothesize that this beneficial effect of music on a combination of delirium eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes. METHODS: This protocol concerns a single-centred prospective randomised controlled trial with 6 months follow-up. All adult patients undergoing a craniotomy at the Erasmus Medical Center in Rotterdam are eligible. The music group will receive recorded music through an overear headphone before, during and after surgery until postoperative day 3. Patients can choose from music playlists, offered based on music importance questionnaires administered at baseline. The control group will receive standard of clinical careDelirium is assessed by the Delirium Observation Scale and confirmed by a delirium-expert psychiatrist according to the DSM-5 criteria. Risk factors correlated with the onset of delirium, such as cognitive function at baseline, preoperative anxiety, perioperative medication use, depth of anaesthesia and postoperative pain, and delirium-related health outcomes such as length of stay, daily function, quality of life (ie, EQ-5D, EORTC questionnaires), costs and cost-effectiveness are collected. ETHICS AND DISSEMINATION: This study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Center Rotterdam, The Netherlands, approved this protocol. Results will be disseminated via peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBERS: NL8503 and NCT04649450.


Asunto(s)
Delirio , Música , Neurocirugia , Adulto , Delirio/etiología , Delirio/prevención & control , Humanos , Procedimientos Neuroquirúrgicos , Estudios Prospectivos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
18.
J Clin Neurosci ; 93: 137-140, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34656237

RESUMEN

BACKGROUND: Small studies are prone to lower methodological quality and publication bias, and are more likely to report greater beneficial effects. A meta-epidemiological study was undertaken to investigate and quantify the impact of small study effects on meta-analyses in the neurosurgical literature. METHODS: A PubMed search was used to procure meta-analyses from Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica and Journal of Neurotrauma. Outcome data were extracted from meta-analyses the effect of study size was estimated by calculating the ratio of odds ratios (RORs) between small and large studies. RESULTS: 16 meta-analyses of 229 primary studies and 90,629 patients were included. All but two included pooled outcomes were significantly different from 1. On average small studies did not demonstrate greater beneficial effects, with an estimated pooled ROR of 1.32 (95% CI, 0.89 to 1.75). Stratification by meta-analysis effect size and heterogeneity yielded similar findings. CONCLUSIONS: The absence of small study effects in meta-analyses of neurosurgical studies may reflect widespread poor quality of the neurosurgical literature affecting both large and small studies, rather than an absence of publication bias.


Asunto(s)
Neurocirugia , Estudios Epidemiológicos , Humanos , Procedimientos Neuroquirúrgicos , Oportunidad Relativa , Sesgo de Publicación
19.
J Clin Neurosci ; 93: 200-205, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34656248

RESUMEN

Although the three-dimensional (3D) printing technology has spread in the field of neurosurgery, the use of 3D print models concerning glioma surgery has rarely reported. For glioma surgery, some preoperative and intraoperative assistive methods have been developed to avoid injury to the cortex and fiber that are related to the neurological function. Furthermore, in order to perform preoperative simulation of glioma surgery, we created a 3D print model using a multi-material 3D printer that provided the flexibility of adjusting the color, hardness, and translucency of each structure arbitrarily. The use of 3D print model was demonstrated in one case involving an intramedullary tumor in the right temporal lobe. The tumor, optic radiation, brain parenchyma, tentorium, ventricle, and sinus were constructed in a single model in one printing process. Design of the degree of resection, insertion of the fence-post, and tumor resection paying attention to the optic radiation were simulated preoperatively using this model. The surgery was performed generally as the simulation and gross total removal of the tumor was achieved. This model was useful for understanding the degree of resection, adequate insertion of the fence-post, and the relationship of the tumor with other important structures. A variety of printing materials contributed to make the model realistic and to understand anatomical relationship. In conclusion, the 3D print model can supplement an image of some portions that are not visible perioperatively and serve as a preoperative assistant modality.


Asunto(s)
Glioma , Neurocirugia , Simulación por Computador , Glioma/diagnóstico por imagen , Glioma/cirugía , Humanos , Imagenología Tridimensional , Procedimientos Neuroquirúrgicos , Impresión Tridimensional
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