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1.
Ann R Coll Surg Engl ; 102(2): 144-148, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31755728

RESUMO

INTRODUCTION: Statutory duty of candour was introduced in November 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. However, it can be difficult to determine when the process should be implemented. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons. MATERIALS AND METHODS: All full (consultant) members of the Society of British Neurological Surgeons were electronically invited to participate in an online survey. Surgeons were presented with 15 cases and asked to decide in the case of each one whether they would trigger the process of duty of candour. Cases were stratified according to their likelihood and severity. RESULTS: In all, 106/357 (29.7%) members participated in the survey. Responses varied widely, with almost no members triggering the process of duty of candour in cases where adverse events were common (greater than 10% likelihood) and required only outpatient follow-up (7/106; 6.6%), and almost all members doing so in cases where adverse events were rare (less than 0.1% likelihood) and resulted in death (102/106; 96.2%). However, there was clear equipoise in triggering the process of duty of candour in cases where adverse events were uncommon (0.1-10% likelihood) and resulted in moderate harm (38/106; 35.8%), severe harm (57/106; 53.8%) or death (49/106; 46.2%). CONCLUSION: There is considerable nationwide variation in the interpretation of definitions regarding the threshold for duty of candour. To this end, we propose a framework for the improved application of duty of candour in clinical practice.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Segurança do Paciente/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Medicina Estatal/organização & administração , Estudos Transversais , Inglaterra , Implementação de Plano de Saúde , Humanos , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Neurocirurgiões/legislação & jurisprudência , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/legislação & jurisprudência , Neurocirurgia/organização & administração , Relações Médico-Paciente , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/organização & administração , Medicina Estatal/legislação & jurisprudência , Inquéritos e Questionários/estatística & dados numéricos
2.
Ann Otol Rhinol Laryngol ; 129(3): 230-237, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31635473

RESUMO

OBJECTIVE: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. METHODS: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. RESULTS: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI (P < .001), ASA class (P = .004), ethnicity (P = .008), operative time (P < .001), and reoperation (P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. CONCLUSIONS: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/estatística & dados numéricos , Duração da Cirurgia , Otorrinolaringologistas/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
3.
J Neurooncol ; 144(3): 529-534, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31368054

RESUMO

INTRODUCTION: Surgical management strategies for glioblastoma (GBM) may differ among neurosurgeons with initial biopsy of suspected tumors and the need for early re-resection of tumors within 30 days of initial surgery. This study was initiated by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Tumor Section's interest in understanding the rates at which pre- and post-resection procedures, specifically biopsies prior to definitive resection and early re-resections, are performed by U.S. neurosurgeons in the management of GBM. METHODS: A ten-question survey was distributed to members of the AANS/CNS Tumor Section. RESULTS: The survey response rate among AANS/CNS Tumor Section surgeons was approximately 16%. Results showed that a majority of respondents performed surgery on 11-25 GBM cases annually. Of those cases, most neurosurgeons claimed that biopsies are rarely performed prior to tumor resection, but in the < 10% of cases for which biopsies are done, common reasons are to confirm radiological findings or improve the treatment plan. Likewise, re-resections are rare, but in the < 5 cases most neurosurgeons performed annually, common reasons included incomplete initial resections, referrals for greater resection, or unspecified reasons. CONCLUSIONS: Further studies are needed to confirm the results of this study, which shows low rates of stereotactic and open biopsy and early re-resection procedures performed among neurosurgeons. These rates may help form guidelines in the treatment of GBM and encourage the use of surgical adjuncts that increase the extent of resection of these tumors, thereby reducing rates of early recurrence.


Assuntos
Glioblastoma/cirurgia , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Reoperação , Biópsia , Humanos , Prognóstico , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos
4.
World Neurosurg ; 131: e402-e407, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376559

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (SICH) is of high mortality and morbidity. SICH in the basal ganglia is usually attributed to chronic hypertension. Postoperative rehemorrhage is a severe complication, and it is relative to surgical techniques. METHODS: A retrospective survey was conducted on 123 patients with basal ganglia SICH who received surgery from January 2015 to January 2019. Postoperative rehemorrhage within 24 hours was recorded. Preoperative clinical parameters, surgeon experience (<10 and >20 years), operation time, surgical approach, and hemostasis technique were recorded and analyzed. RESULTS: The total postoperative rehemorrhage rate was 12.2% (15/123). The univariable analysis showed general surgeons had a higher postoperative rehemorrhage rate than experienced surgeons (30.4% vs. 8.6%, respectively; P = 0.068). The operation time (minutes) in experienced surgeons was significantly longer (164.9 ± 53.5 vs. 137.7 ± 30.8, P = 0.016), but they had a higher chance to locate the responsible vessel (74.2% vs. 40.0%, P = 0.001), respectively. Logistic analysis indicated that experienced surgeons significantly reduced the risk of rehemorrhage (odds ratio [OR], 0.242; P = 0.021). Transsylvian approach was a protective factor for postoperative rehemorrhage (OR, 0.291; P = 0.045). CONCLUSIONS: Surgeons' experience plays the most important role in postoperative rehemorrhage. Surgeons with rich experience were willing to spend more time to achieve definitive hemostasis in operation. The use of a transsylvian approach can significantly reduce the rehemorrhage rate. Packing hemostasis with gelatin sponge may increase complications.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hemostasia Cirúrgica/métodos , Neurocirurgiões/estatística & dados numéricos , Procedimentos Neurocirúrgicos/métodos , Hemorragia Pós-Operatória/epidemiologia , Adulto , Craniectomia Descompressiva/métodos , Feminino , Esponja de Gelatina Absorvível , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , Estudos Retrospectivos
5.
World Neurosurg ; 130: 192-200, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295601

RESUMO

BACKGROUND: The need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs will be indispensable in alleviating the burden of neurological disease in low to middle income countries (LMICs). METHODS: We reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil, from 1999 to the present. We have described the epidemiology unique to the region and provided evidence of a sustainable practice in a LMIC. The challenges, limitations, and resources were explored. RESULTS: We have provided a historical vignette of the evolution of neurological surgery in the Brazilian Amazon, including the creation of a sustainable neurological surgery practice and accredited residency program. In addition, we assessed the neurological surgery burden and epidemiology unique to the region, with an emphasis on the community and indigenous health in this remote area. We also explored the future directions of this example, which could affect the international neurological surgery community. CONCLUSION: A sustainable neurosurgery practice and training program is possible in a LMIC. Training neurosurgeons in developing regions of LMICs is a sustainable method to decrease the morbidity and mortality of neurological diseases and prevent the misdistribution of physicians in a country. We encourage adaptation of sustainable neurological surgery practices in similar regions across the world to increase access to necessary neurosurgical care.


Assuntos
Internato e Residência , Neurocirurgiões , Neurocirurgia , Procedimentos Neurocirúrgicos/educação , Brasil , Países em Desenvolvimento , Saúde Global/educação , Humanos , Internato e Residência/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Saúde Pública
6.
World Neurosurg ; 129: 453-459, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31212029

RESUMO

BACKGROUND: Women constitute a minority (9.2%) of academic neurosurgeons. We previously found that women in academic medicine are disadvantaged in funding and career advancement opportunities. We hypothesized that women are also underrepresented at neurosurgical society conferences. METHODS: Programs from the 2014-2018 meetings of the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgery (AANS), and North American Skull Base Society (NASBS) were analyzed. Demographic data, including name, gender, and geographic region of practice, were collected for speaker, moderator, or leadership positions. χ2 statistical analysis was performed for difference in gender representation across all opportunity spots. RESULTS: In the period 2014-2018, there was no female presidents or honored guest at any academic meetings analyzed; 53.8% of executive committees comprised all men. Women often constituted a minority (<15%) of speakers and moderators at CNS, AANS, and NASBS meetings: speakers (% female, range), 8.6 (5.5-11.7), 13.6 (10.1-19.7), and 10.5 (5.6-16.6); moderators (% female, range), 7.8 (0-14.3), 23.0 (81.3-91.3), and 13.0 (8.6-18.7). Conference panels frequently comprised all men (58% CNS, 20.7% AANS, 61% NASBS). χ2 analysis found a disparity in male and female participation across all opportunity spots (P = 0.002). Additionally, female participants are often repeated, decreasing total number of unique women participating. There was no significant increase in female participation across the study period. CONCLUSIONS: In 2014-2018, underrepresentation of women in national neurosurgical conferences either matched or exceeded the baseline gender disparity seen in academic neurosurgery. We discussed potential causes of and strategies to address these findings.


Assuntos
Congressos como Assunto/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/estatística & dados numéricos , Médicas/estatística & dados numéricos , Feminino , Humanos , Masculino , Sociedades Médicas/estatística & dados numéricos
7.
World Neurosurg ; 129: 460-466, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132491

RESUMO

BACKGROUND: Almost one half of currently practicing physicians in Europe are women. Despite advances in access to training positions and the entry of women into neurosurgery, it has remained a male-dominated field, with an underrepresentation of female leaders. We designed a 2-part study to better understand the current situation of European female neurosurgeons. METHODS: The European Association of Neurosurgical Societies and its member societies were analyzed for female participation in leadership positions. Additionally, an online survey was designed, containing 33 questions about career choice, mentorship, family planning, and perceived obstacles, for women in neurosurgery. RESULTS: A total of 116 responses were received. Most female neurosurgeons lacked same-gender role models (76%), although most reported that having a female mentor would be important (58%). An overwhelming majority (86%) believe family planning takes on a more important role for women, and 72% reported worrying their career prospects could be negatively affected by their desire to have children. The greatest obstacle perceived was the prevailing inequality in opportunities (30%) and attaining leadership positions (24%). Most (81%) reported that women have different concerns regarding their career from men, and 72% also reported feeling at a disadvantage as a woman. Most (66%) also believe should be a "Women in Neurosurgery" committee within the European Association of Neurosurgical Societies. CONCLUSIONS: Unfortunately, a gender gap still exists in European neurosurgery. The extent thereof has not yet been systematically analyzed. Our project offers a glimpse into the inequalities and obstacles women perceive in our field; however, more comprehensive data are required.


Assuntos
Neurocirurgiões , Neurocirurgia , Médicas , Escolha da Profissão , Europa (Continente) , Feminino , Humanos , Liderança , Masculino , Mentores , Neurocirurgiões/estatística & dados numéricos
8.
Turk Neurosurg ; 29(2): 289-296, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30843598

RESUMO

AIM: To better understand the indications and the impact of antidepressant drugs on the field of neurosurgery in terms of risks and benefits in Turkey. MATERIAL AND METHODS: A national survey was conducted among neurosurgeons in current practice in Turkey to report routine prescription trends of antidepressant drugs. Gender, neurosurgical subspecialty, city, type of practice, years of experience, antidepressant agent, indications and reasons not to prescribe were ascertained. A brief review of literature was done to show clinical and research evidence. RESULTS: A total of 336 neurosurgeons took the survey; 53% of them prescribe antidepressants routinely, whereas 47% of them do not. Of the 72% non-prescribers prefer to refer their patients to a psychiatrist and 22% of them believe that antidepressants have no role in neurosurgery. Vascular and pediatric neurosurgeons as well as neurosurgeons at research hospitals showed the lowest prescription proportion, while general and brain tumor neurosurgeons and ones in private practice showed the highest prescription proportion. Surgeons with more than 20 year-experience had the lowest prescription proportion (43%). Type of practice and years of experience showed a statistically significant association with the prescription of antidepressant drugs across (p=0.002 and p=0.025, respectively). CONCLUSION: Type of practice and years of experience showed a statistically significant association with the proportion of antidepressants' prescribers in Turkish neurosurgery practice at the time of this survey. Non-prescriber neurosurgeons need to recognize the indications, whereas prescribers have to understand the risks of using antidepressants.


Assuntos
Antidepressivos/uso terapêutico , Neurocirurgiões/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Feminino , Humanos , Masculino , Neurocirurgia , Inquéritos e Questionários , Turquia
9.
World Neurosurg ; 126: 59-65, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30844530

RESUMO

BACKGROUND: Medical publications reflect the development of training, research, and health services. No objective data are available regarding neurosurgical publications from Morocco. Bibliometrics were used to evaluate the contribution of Moroccan neurosurgeons (MONSs) in neurosurgical journals worldwide and to discuss the strategies that can be applied to increase the quantity and quality of publications on this subject. METHODS: A literature search of reports by MONSs was performed using the PubMed database. The number and quality of the reports were evaluated with the impact factor of the neurosurgical journals and the h-index of each first author. RESULTS: The data from 174 identified studies reported from 1989 to 2018 were analyzed. MONSs have continued to report more studies every year worldwide. However, their contribution to neurosurgical journals has been gradually declining since 2012. Scientific publishing was limited to a few great neurosurgical departments and a few academic neurosurgeons in Morocco. Most of the reports were case reports, reported in the French language, included in non-neurosurgical journals, from single centers, and without international collaboration. CONCLUSIONS: Academic neurosurgeons in Morocco should prepare their residents and young researchers on research methodology and medical writing. Moroccan neurosurgical research should be more focused on modern neurosurgical topics by highlighting our particularities. More high level of evidence studies should be reported in English-language neurosurgical journals with a high impact factor and good scientific reputation. MONSs should continue to collaborate more often with each other and with foreign centers to further improve the quality and number of international publications, regardless of the difficulties they face.


Assuntos
Bibliometria , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/tendências , Humanos , Fator de Impacto de Revistas , Escrita Médica , Marrocos , PubMed , Universidades
10.
World Neurosurg ; 126: 576-580, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910756

RESUMO

The World Federation of Neurosurgical Societies (WFNS) Rabat Training Center was established in 2002 following the efforts of Dr. Abdeslam El Khamlichi. This institution has paved the way to guide tremendous change and to improve neurosurgery training in Africa, especially Sub-Saharan Africa (SSA). The center has enabled so far the training of more than 58 neurosurgical candidates, from approximately 18 countries in SSA, including 30 neurosurgeons who are already back in their respective countries, establishing and improving neurosurgical care. It is clear that this is the first successful example of the WFNS in increasing the neurosurgical workforce in SSA by well-trained and competent neurosurgeons. Consequently, this experience is worth depicting. We reviewed the profile of the neurosurgeons trained in this center and shortly summarized their reestablishment in their respective countries and their challenges to provide neurosurgical care in such source-limited countries.


Assuntos
Neurocirurgiões/educação , Neurocirurgia/educação , Sociedades Médicas , África ao Sul do Saara , Emigração e Imigração , Feminino , Previsões , Fundações/organização & administração , Humanos , Cooperação Internacional , Masculino , Marrocos , Neurocirurgiões/estatística & dados numéricos , Neurocirurgiões/provisão & distribução , Neurocirurgia/organização & administração , Neurocirurgia/estatística & dados numéricos , Médicas/estatística & dados numéricos
11.
Psychogeriatrics ; 19(4): 310-319, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30723980

RESUMO

BACKGROUND: Dementia with Lewy bodies (DLB) is a progressive form of dementia, accompanied by a range of behavioural and psychological symptoms. The aim of this study was to identify current clinical practice for the treatment of DLB in Japan. METHODS: We conducted a survey of medical doctors engaged in the management of dementia in Japan. Participants were divided into two groups: psychiatrists (Group P) and neurologists or neurosurgeons (Group NS). Doctors completed a questionnaire and we analysed their responses to compare the two groups with regard to diagnosis and treatment of DLB, and in particular the treatment of behavioural and psychological symptoms of dementia (BPSD). RESULTS: Responses suggested that Group P conducted biomarker examinations less frequently and decided on their own therapeutic strategies more frequently than did Group NS. Both groups most frequently selected hallucinations/delusions as the symptoms given highest treatment priority. More than 70% of respondents in both groups reported having difficulties in treating BPSD. Atypical antipsychotics were more frequently prescribed by Group P, but were also prescribed in 70% of patients in Group NS. A third of patients received atypical antipsychotics for more than 1 year. CONCLUSIONS: The responses to this survey highlighted the difficulties faced by clinicians managing patients with DLB and identified the need to effectively treat BPSD in such patients.


Assuntos
Antipsicóticos/administração & dosagem , Delusões , Alucinações , Doença por Corpos de Lewy , Médicos/estatística & dados numéricos , Adulto , Delusões/diagnóstico , Delusões/tratamento farmacológico , Delusões/etiologia , Feminino , Alucinações/diagnóstico , Alucinações/tratamento farmacológico , Alucinações/etiologia , Humanos , Japão , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/diagnóstico , Doença por Corpos de Lewy/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neurologistas/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Inquéritos e Questionários
12.
Turk Neurosurg ; 29(5): 768-777, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30649805

RESUMO

AIM: To conduct a scientometric assessment of the research activities of spinal fusion in various subspecialties carried out by different surgeons. MATERIAL AND METHODS: All articles regarding spinal fusion research on Web of Science from the year 1994 to 2015 were identified and analyzed in the following aspects: year of publication, publication journal, number of times cited, Hirsch index (H-index), spine surgeon specialty, and country/territory. RESULTS: A total of 15060 articles were identified, and the research productivity of spinal fusion has grown steadily over the last two decades. The average research productivity of spinal fusion each year was 109.09 ± 23.26 articles for cervical spine, 90.09 ± 52.56 articles for thoracic spine, and 304.91 ± 181.63 articles for lumbar. The research productivity of spinal fusion by neurosurgeons was 9474 articles published, while the orthopedic surgeons published 8263 articles. The average number of citations for spinal fusion articles was 19.61 times for neurosurgeons, and 20.36 times for orthopedic surgeons. In most countries neurosurgoens published more spinal fusion articles than orthopedic surgeons or at least the same amount, but orthopedic surgeons in China and Germany published far more spinal fusion articles ( > 100) than neurosurgeons. The United States published the greatest number of articles (6819/15060, 45.28%), followed by China (1280/15060, 8.50%) and Germany (1252/15060, 8.31%), and had the highest total citations (164378) and H-index (144). CONCLUSION: Neurosurgeons tend to publish more articles regarding spinal fusion, but orthopedic surgeons seem to have higher citations. North America, West Europe and East Asia were the most productive regions in spinal fusion research, and the United States made the most academic contributions to this area.


Assuntos
Bibliometria , Neurocirurgiões/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Fusão Vertebral , China , Humanos , Publicações/estatística & dados numéricos , Doenças da Coluna Vertebral/cirurgia , Estados Unidos
14.
Exp Clin Endocrinol Diabetes ; 127(1): 29-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30130806

RESUMO

BACKGROUND: Guidelines for patient behavior following transsphenoidal surgery do not exist. To gain generally recommendations, the German pituitary working group conducted a study among pituitary surgeons to elucidate their opinions and customs of patients' counselling. METHODS: Questions concerning daily activities, exertion of sports and work life were addressed. It was asked to provide the postoperative time interval after which specific activities can be resumed both after a routine or an extended approach. RESULTS: Fourteen pituitary surgeons returned the completed questionnaire. Following routine operations, washing the hair was allowed within one week, blowing the nose after 3, flying on an airplane and driving a car after one, lifting heavy weights after 4, playing wind instruments after 6, use of CPAP (continuous positive airway pressure) device after 3, permit leisure sports after 2 to 4 weeks (except for scuba diving). Competitive sports can be resumed after 6 weeks. Occupation with mental demands was considered feasible after 2 weeks, with physical labor after 4 weeks. After extended transsphenoidal surgery, the recommended time interval was roughly twice as long compared to the routine approach. Driving a car was allowed within the first 4 weeks after surgery by some pituitary surgeons, while others allow driving only after 3 months analogous to the regulations after craniotomy. The risk of scuba diving was considered high. CONCLUSIONS: The data of our study and the literature, and expert opinions from related scientific fields resulted in a consensus on recommendations for patients' conduct to minimize risks after transsphenoidal surgery.


Assuntos
Atividades Cotidianas , Exercício Físico , Neurocirurgiões , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/cirurgia , Guias de Prática Clínica como Assunto , Esportes , Cirurgia Endoscópica Transanal , Consenso , Alemanha , Humanos , Neurocirurgiões/normas , Neurocirurgiões/estatística & dados numéricos , Procedimentos Neurocirúrgicos/reabilitação , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Período Pós-Operatório , Guias de Prática Clínica como Assunto/normas , Osso Esfenoide/cirurgia , Cirurgia Endoscópica Transanal/reabilitação , Cirurgia Endoscópica Transanal/normas , Cirurgia Endoscópica Transanal/estatística & dados numéricos
15.
Neurocrit Care ; 30(1): 177-184, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30155587

RESUMO

BACKGROUND: We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease. METHODS: Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI). RESULTS: Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5-28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5-3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3-26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2-43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients' county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1-8.1). CONCLUSIONS: Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Neurologistas/estatística & dados numéricos , Neurociências/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Doenças do Sistema Nervoso , Estados Unidos
16.
World Neurosurg ; 123: e734-e739, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30579024

RESUMO

BACKGROUND: The degree to which extended length of stay (LOS) after surgery represents patient illness or postoperative complications is unknown. The aim of this study was to investigate the influence of postoperative complications and patient comorbidities on variance in extended length of hospital stay after lumbar spine surgery. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program were analyzed from January 1, 2008, through December 31, 2014. Study participants were 23,102 patients undergoing a 1-level or 2-level lumbar decompression and fusion procedure. Multivariable logistic regression analysis was used to determine the odds ratio for risk-adjusted extended length of hospital stay, defined as patients with a hospital stay greater than the 75th percentile (LOS >5 days) for the cohort. The primary outcome was the extent to which extended LOS represented preoperative patient illness or postoperative complications. RESULTS: Of 23,102 participants, 3794 (16.42%) had extended LOS. Most patients (2849 patients; 75.10%) with extended LOS did not have a documented postoperative complication. Only a minority of patients with extended LOS had a history of comorbidities known to influence outcomes in patients undergoing spine surgery, including diabetes (24%), chronic obstructive pulmonary disease (7%), congestive heart failure (0.69%), myocardial infarction (0.20%), acute renal failure (0.26%), and stroke (2.23%). CONCLUSIONS: This study suggests that much of the variation in LOS after lumbar spine surgery is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference.


Assuntos
Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Lesão Renal Aguda/complicações , Adulto , Idoso , Procedimentos Clínicos , Descompressão Cirúrgica/estatística & dados numéricos , Complicações do Diabetes/complicações , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Neurocirurgiões/estatística & dados numéricos , Satisfação Pessoal , Padrões de Prática Médica/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/complicações , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fusão Vertebral/estatística & dados numéricos , Acidente Vascular Cerebral/complicações
17.
Neurosurgery ; 84(2): 537-543, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29566181

RESUMO

Recent legislation has changed quality reporting in neurological surgery. The present study summarizes the reporting of objectives and measures outlined by the Quality Payment Program (QPP) and assesses how practices are preparing to comply. In February 2017, 220 neurosurgical practices were surveyed regarding their adherence to quality reporting objectives and measures. Survey responders were asked to report infrastructure-level data including practice type and number of providers. Furthermore, we evaluated the reporting of quality and advancing care measures outlined by the QPP. Assessment of quality measures was focused on those related to neurosurgical patient management. A total of 27 responses were obtained. Practices consisted of 8 academic (30%), 16 physician-owned (59%), and 3 hospital-owned (11%) neurosurgical practices. Of the 27 total responders, 18 indicated their adherence to a host of quality and advancing care measures. Practice type was strongly associated with the number of quality measures performed (P = .020, Wilcoxon rank-sum test). Physician-owned practices reported performing a median of 5 quality measures (interquartile range, 4.5-9.5), while practices in academic and hospital-owned groups reported performing 12 quality measures (interquartile range, 9.5-13.5). Forty-five percent of physician-owned practices reported performing at least 6 quality measures, whereas 100% of academic and hospital-owned practices reported the same benchmark (P = .038, Fisher's exact test). Performance of advancing care measures was not associated with practice type. Compared to other practice types, the rate of quality reporting among physician-owned neurosurgical practices appears to be modest thus far, which may influence future reimbursement adjustments.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Neurocirurgia/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Humanos , Neurocirurgiões/normas , Neurocirurgiões/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
Neurosurg Focus ; 45(6): E14, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544330

RESUMO

OBJECTIVEPapers from 2002 to 2017 have highlighted consistent unique socioeconomic challenges and opportunities facing military neurosurgeons. Here, the authors focus on the reserve military neurosurgeon who carries the dual mission of both civilian and military responsibilities.METHODSSurvey solicitation of current active duty and reserve military neurosurgeons was performed in conjunction with the AANS/CNS Joint Committee of Military Neurosurgeons and the Council of State Neurosurgical Societies. Demographic, qualitative, and quantitative data points were compared between reserve and active duty military neurosurgeons. Civilian neurosurgical provider data were taken from the 2016 NERVES (Neurosurgery Executives Resource Value and Education Society) Socio-Economic Survey. Economic modeling was done to forecast the impact of deployment or mobilization on the reserve neurosurgeon, neurosurgery practice, and the community.RESULTSSeventy-five percent (12/16) of current reserve neurosurgeons reported that they are satisfied with their military service. Reserve neurosurgeons make significant contributions to the military's neurosurgical capabilities, with 75% (12/16) having been deployed during their career. No statistically significant demographic differences were found between those serving on active duty and those in the reserve service. However, those who served in the reserves were more likely to desire opportunities for improvement in the military workflow requirements compared with their active duty counterparts (p = 0.04); 92.9% (13/14) of current reserve neurosurgeons desired more flexible military drill programs specific to the needs of practicing physicians. The risk of reserve deployment is also borne by the practices, hospitals, and communities in which the neurosurgeon serves in civilian practice. This can result in fewer new patient encounters, decreased collections, decreased work relative value unit generation, increased operating costs per neurosurgeon, and intangible limitations on practice development. However, through modeling, the authors have illustrated that reserve physicians joining a larger group practice can significantly mitigate this risk. What remains astonishing is that 91.7% of those reserve neurosurgeons who were deployed noted the experience to be rewarding despite seeing a 20% reduction in income, on average, during the fiscal year of a 6-month deployment.CONCLUSIONSReserve neurosurgeons are satisfied with their military service while making substantial contributions to the military's neurosurgical capabilities, with the overwhelming majority of current military reservists having been deployed or mobilized during their reserve commitments. Through the authors' modeling, the impact of deployment on the military neurosurgeon, neurosurgeon's practice, and the local community can be significantly mitigated by a larger practice environment.


Assuntos
Escolha da Profissão , Medicina Militar/educação , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/estatística & dados numéricos , Custos e Análise de Custo , Humanos , Militares/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Médicos
19.
J Neurosurg Spine ; 30(2): 279-288, 2018 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-30497169

RESUMO

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018-January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients' perception of care are important in the future of performance-based medicine.


Assuntos
Competência Clínica/estatística & dados numéricos , Neurocirurgiões/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Mídias Sociais , Feminino , Humanos , Masculino , Neurocirurgia , Fatores de Tempo , Listas de Espera
20.
Hormones (Athens) ; 17(3): 373-381, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29971605

RESUMO

BACKGROUND: Worldwide variations exist in the diagnosis and management of patients with acromegaly. For such a rare condition, the knowledge and perception of physicians would most likely direct the care of patients. However, the adherence of physicians in non-Western regions to guidelines for the diagnosis and management of acromegaly has not been previously ascertained. METHODS: An online survey was conducted to assess the perceptions and practice of physicians regarding acromegaly diagnosis and management as per international guidelines. An electronic questionnaire containing key questions was mailed, initially to physicians in Saudi Arabia (KSA) and later to other countries in the Middle East and North Africa (MENA) region. Additional questions were included to ensure the relevance of the respondents' replies. The responses were captured and summarized anonymously. Descriptive comparisons were made with two similar international and national surveys from other regions. RESULTS: Two hundred forty-seven doctors responded to the survey. Of these, 155 (64.5%) fulfilled the inclusion criteria and, in particular, confirmed having treated acromegaly patients in the previous 12 months, and they constituted the basis of this study. The three most common referring specialties for patients were internists (44; 28.4%), neurosurgeons (46; 29.6%), and family medicine physicians (42; 27.1%), respectively. The combination of growth hormone (GH) nadir during the oral glucose tolerance test (OGTT) and elevated insulin-like growth factor-1 (IGF-1) levels was used by 99 physicians (63.9%) to diagnose acromegaly. The main determinant for treatment choice was tumor mass characteristics confirmed by 117 respondents (75.5%) with neurosurgery as first treatment choice confirmed by 124 respondents (80%). Combined measurement of IGF-1 and GH levels after OGTT at 3 months after surgery was the most widely used criterion for assessment of surgical outcomes, confirmed by 82 physicians (52.9%). The biggest barriers to optimal management of acromegaly as perceived by 38.1% and 35.5% of the respondents were high cost of medications and lack of physicians' awareness, respectively. CONCLUSIONS: The majority of the surveyed physicians reported variable adherence to the international acromegaly guidelines. Clearly, higher awareness is needed among physicians for early diagnosis and timely referral for specialist management.


Assuntos
Acromegalia/diagnóstico , Acromegalia/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , África do Norte , Pesquisas sobre Serviços de Saúde , Humanos , Medicina Interna/estatística & dados numéricos , Oriente Médio , Neurocirurgiões/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos
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