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2.
World Neurosurg ; 133: 8-9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610426

RESUMO

BACKGROUND: Nepal has a critical shortage of health workers for achieving its projected sustainable development goals pertaining to its health sector. METHODS: To counteract this crisis and reduce the morbidity and mortality associated with untreated brain injuries secondary to inadequate access, it is pivotal to generate solutions through the establishment of improved educational and training objectives. Objectives must align themselves with achieving equitable access to neurologic health. To that end, the cadre of health professionals able to treat neurologic disease should be sharply skilled and increased in number. We outline potential sustainable solutions at the training level to address this public health problem. RESULTS: Demanding and limitless working hours, burnout, social stressors, and minimal monthly stipend likely contribute to limited applications for neurosurgery residency programs. Measures should be taken to improve participation and access to extracurricular nonwork activities so as to improve resident well-being and avoid burnout. Moreover, gender inequality has also become a matter of concern as there were no females among 31 new specialist registrations in neurosurgery in 2017 and only 5 female neurosurgeons in practice to date in Nepal as per the NMC registration. CONCLUSIONS: Every effort should be directed toward honing the "value of neurosurgeon" among residents and promoting and nurturing their capabilities thereby maximizing sustainability in our health care system.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Internato e Residência , Neurocirurgiões/provisão & distribução , Neurocirurgia/educação , Humanos , Nepal
3.
World Neurosurg ; 133: 127-134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568909

RESUMO

Aulus Cornelius Celsus lived in Rome during the reigns of Augustus and Tiberius. He developed the scientific Latin, and his work De Medicina was the first medical textbook to be written in Latin, and subsequently the first medical treatise to be printed. He perhaps was a simple medical writer rather than a real physician, but his contributions to medical knowledge are outstanding. He described the tetrad of inflammation (dolor, rubor, calor, tumor), coined the term cancer, and reported several revolutionary surgical techniques. His eighth book, almost entirely dedicated to dislocations and fractures, provides an extensive description of head injuries such as extradural hematomas, lesions distant from the impact point, and intracranial damage in cases with no overlying fractures. He also provided the first description of brain swelling exceeding the level of the skull, described several surgical indications and craniotomy techniques, recommended treatment for depressed fractures (which had been previously considered untreatable), and detailed the surgical instruments employed. De Medicina was based on the previous Greek medical knowledge, but Celsus also provided original innovations, personal observations, and even comments and criticisms. Despite the fact that he was almost forgotten during the Middle Age, most of his concepts and surgical advices remained in the medical background of the following 2 millennia.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Neurocirurgia/história , História Antiga , Humanos
4.
World Neurosurg ; 133: 104-111, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568917

RESUMO

OBJECTIVE: To investigate the extent to which restraint is used in neurosurgical care, under what circumstances, and how it is documented. METHODS: A cross-sectional study with a mixed-methods approach was used to identify neurosurgical inpatients subjected to restraint. The data were collected in 2 phases: (1) a study-specific questionnaire was distributed to nurses in which they identified if restraints had occurred during their shifts, and if so, which restraint and to which patient; and (2) scrutinizing of electronic medical records of patients identified by the questionnaires. Numeric data were analyzed using descriptive and analytic statistical methods, and textual data were analyzed using qualitative content analysis. The findings from the different data sources were compared and merged. RESULTS: Of the 517 patients admitted to the studied department during the study period, 58 (11%) were reported to have been subjected to restraint and most of the restraining events occurred in the neurointensive care unit. Most restraint measures were not documented in the electronic medical records. The identified patients were predominantly diagnosed with traumatic brain injury or subarachnoid hemorrhage. The qualitative content analysis showed the circumstances when restraints were used: when patients were considered a danger to self or others (theme) and which symptoms and behaviors (categories) were observed in relation to the use of restraint. CONCLUSIONS: Restraint in neurosurgical care is mostly used to prevent patients from harming themselves or others. Because of the lack of documentation, restraint measures cannot be openly assessed, thus putting patients' safety at risk.


Assuntos
Neurocirurgia , Segurança do Paciente , Padrões de Prática Médica , Restrição Física , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
World Neurosurg ; 133: e842-e849, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562965

RESUMO

BACKGROUND: Modern science and healthcare generate vast amounts of data, and, coupled with the increasingly inexpensive and accessible computing, a tremendous opportunity exists to use these data to improve care. A better understanding of data science and its relationship to neurosurgical practice will be increasingly important as we transition into this modern "big data" era. METHODS: A review of the literature was performed for key articles referencing big data for neurosurgical care or related topics. RESULTS: In the present report, we first defined the nature and scope of data science from a technical perspective. We then discussed its relationship to the modern neurosurgical practice, highlighting key references, which might form a useful introductory reading list. CONCLUSIONS: Numerous challenges exist going forward; however, organized neurosurgery has an important role in fostering and facilitating these efforts to merge data science with neurosurgical practice.


Assuntos
Big Data , Neurocirurgia , Procedimentos Neurocirúrgicos , Humanos , Neurocirurgiões
6.
World Neurosurg ; 133: e535-e539, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562974

RESUMO

BACKGROUND: Neurosurgery is a notoriously difficult career to enter and requires medical students to engage in extracurricular activities to demonstrate their commitment to the specialty. The National Undergraduate Neuroanatomy Competition (NUNC) was established in 2013 as a means for students to display this commitment as well as academic ability. METHODS: A bespoke 22-item questionnaire was designed to determine career outcomes and the role of competition attendance in job applications. It was distributed using the SurveyMonkey website to the 87 attendees at the 2013 and 2014 competitions. RESULTS: Responses were received by 40 competitors (response rate, 46.0%). Twenty-four responders (60.0%) intended to pursue a career in either neurosurgery (n = 18) or neurology (n = 6). This included 10 responders (25.0%) who had successfully entered either neurosurgery (n = 9) or neurology (n = 1). The performance of these 10 was significantly better than the other responders (57.0 ± 13.6% vs. 46.5 ± 13.5% [n = 30]; P = 0.036). Seventeen responders (42.5%) either included their attendance at NUNC in a post-Foundation job application or intend to. CONCLUSIONS: The NUNC provides the opportunity for medical students to demonstrate their interest in neurosurgery. It has the potential to be used as a tool for recognizing medical students suitable for neurosurgery training.


Assuntos
Escolha da Profissão , Neurocirurgia , Competência Profissional , Estudantes de Medicina , Distinções e Prêmios , Humanos , Neuroanatomia
7.
World Neurosurg ; 133: 457-465, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31881580

RESUMO

Clinical neurosurgery is a complex specialty with multiple participants, including a variety of providers, patients, family members, and administrators, who interact in complex fashions. Modern-day patient care requires near-constant team communication of vital, detailed clinical information; any breakdown in this process can result in patient harm. Medical communication practices with patients impact mutual rapport as well as the overall physician-patient relationship. Enhanced relationship-centered communication techniques have been shown to improve patient compliance and may positively influence malpractice litigation rates. Neurosurgeons frequently interact with other health care providers and members of the hospital administration on matters relating to billing, compliance, and quality. Communication among the stakeholders is complicated, however, by the fact that the participants may be speaking a variety of different, mutually unintelligible "languages." We discuss the details of the various types of information exchanges in neurosurgery, the key players involved, and the vulnerabilities to breakdowns in the system. In addition, we review the multifaceted, systems-level issues in neurosurgical communication and related weaknesses.


Assuntos
Comunicação , Neurocirurgia , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Relações Profissional-Família , Humanos , Neurocirurgiões , Assistência Centrada no Paciente
8.
World Neurosurg ; 133: 466-473, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31881581

RESUMO

Communication issues play a major role within neurosurgery. There has been a growing awareness of the necessity of enhanced patient-centered communication between the physician and patient to improve patient satisfaction, compliance, and outcomes. In addition, the threat of malpractice litigation within neurosurgery is of particular concern, and improved communication may lead to some degree of risk mitigation. Within the neurosurgical and medical team, effective transmittal of vital clinical data is essential for patient safety. Despite the recent recognition of the critical role that communication plays in all aspects of medical care, multiple impediments hinder the improvement and use of effective techniques. We have identified 8 unique barriers to the advancement of communication practices: lack of recognition of the importance of communication skills; cognitive bias; sense that it "takes too much time"; cultural hierarchy within medicine; lack of formal communication skill training; fear that disclosure of medical errors will lead to malpractice litigation; the electronic medical record; and frequent shift changes and handoffs.


Assuntos
Comunicação , Neurocirurgia , Segurança do Paciente , Satisfação do Paciente , Relações Médico-Paciente , Humanos
9.
World Neurosurg ; 133: 474-482, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881582

RESUMO

Modern-day care of the neurosurgery patient has grown increasingly complex and typically involves a variety of medical team members. Proper communication and transmission of clinical data within the neurosurgery team is required for successful outcomes, especially within the operating room. Effective communication is also critical to the patient-physician relationship and can aid in improving rapport and possibly reducing malpractice lawsuit risk. In addition, interactions exist between practicing neurosurgeons and members of the administration, often focusing on reimbursement and quality issues. Although most physicians would agree that communication between all these stakeholders should improve, certain barriers are present, including the adoption of newer technologies and the lack of formal training. In this article, we review current and projected trends relating to the enhancement of neurosurgical communication at all levels.


Assuntos
Comunicação , Neurocirurgia/tendências , Competência Clínica , Humanos , Imperícia , Relações Médico-Paciente
10.
Artigo em Russo | MEDLINE | ID: mdl-31825380

RESUMO

In recent decades, spinal surgery has changed significantly. The active use of modern knowledge of anatomy, various diagnostic modules, specialized surgical equipment and high-tech tools has made it possible to transform classical surgical techniques into a new area of spinal neurosurgery - minimally invasive spine surgery (MISS). Its main goals are to reduce damage to the skin and adjacent tissues, significantly reduce the level of pain, reduce the duration of inpatient treatment and fully restore functional status in the shortest possible time. This article reflects the main criteria for MISS compliance and types of surgical interventions, provides information on the advantages of minimally invasive surgical technologies and their possible disadvantages. Currently, the use of MISS is observed in all areas of vertebrology - for degenerative diseases, tumors, inflammatory and traumatic lesions of the spine. At the same time, minimizing surgical aggression while maximizing the achievement of goal becomes the main rule of modern spinal surgery.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Neurocirurgia , Procedimentos Neurocirúrgicos
14.
World Neurosurg ; 128: xxvi, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31675778
15.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 728-733, nov. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185564

RESUMO

Los hemangiomas infantiles son los tumores benignos más frecuentes en la población pediátrica. Cuando afectan al área lumbar y perineal, algunos casos pueden asociarse a alguna malformación subyacente como una disrafia espinal oculta. El manejo de estos hemangiomas carece de consenso. Describimos 3 casos de niños con hemangiomas lumbosacros y perineales con anomalías en la resonancia magnética y revisamos la literatura para valorar qué pruebas y en qué momento se deben realizar para completar el estudio en estos pacientes. Por lo general, se solicita una ecografía lo más precozmente posible, ya que esta técnica no es posible realizarla una vez que los elementos espinales posteriores se han osificado, lo que generalmente ocurre a los 6 meses de edad. La resonancia magnética es la prueba de referencia para diagnosticar una disrafia espinal oculta. De acuerdo con la literatura, la edad media para este examen debe ser alrededor de los 6 meses, cuando la formación de grasa en el filum terminale se ha visto incrementada. En nuestra opinión, se debería realizar una resonancia magnética a los 6 meses de edad en todos los niños con hemangioma lumbar o perineal, independientemente del tamaño de la lesión, la ausencia de síntomas neurológicos o los resultados de la ecografía


Cutaneous hemangiomas are the most frequent benign tumors in children. When they affect the lumbar and perineal area some cases can be associated with an occult spinal dysraphism. The management of these hemangiomas lack consensus. We report 3 cases of children with lumbosacral and perineal hemangiomas with magnetic resonance image abnormalities and we review the literature to find out the type and timing of tests that should be performed to complete the study in these patients. Ultrasound is typically requested as young as possible, as this imaging technique is not possible 11 the posterior spinal elements have ossified. MRI is the gold standard for diagnosing occult spinal dysraphism. According to the literature, the mean age for MRI screening should be around 6 months, when the fat formation in the filum terminale is expanded. In our opinion, an MRI scan should be performed at 6 months of age in every children with lumbar or perineal hemangioma regardless the lesion size, neurological symptoms or the ultrasound results


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Hemangioma/diagnóstico por imagem , Hemangioma/tratamento farmacológico , Espectroscopia de Ressonância Magnética/métodos , Plexo Lombossacral/diagnóstico por imagem , Plexo Lombossacral/patologia , Disrafismo Espinal/diagnóstico por imagem , Propranolol/administração & dosagem , Neurocirurgia
17.
World Neurosurg ; 131: xix-xx, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31658583

Assuntos
Neurocirurgia , Humanos
20.
World Neurosurg ; 130: 593-607, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31581409

RESUMO

Stereotactic radiosurgery is a modern discipline that emerged after World War II. It represents a synthesis of an approach to patient care that was not immediately embraced by either neurosurgeons or radiation oncologists, but which has been shown, time and again, to be advantageous for the treatment of intracranial pathology. Indeed, stereotactic radiosurgical techniques are now being rapidly adapted and adopted for the treatment of extracranial malignant and benign disease. Any examination of the individuals, devices, and technological advances that permitted stereotactic radiosurgery to become a preferred approach for patient care cannot be absolutely comprehensive but can provide insights into the evolution of the specialty and potential future prospects for further improvements in patient care. As Shakespeare wrote in The Tempest, "What's past is prologue."


Assuntos
Neurocirurgia/história , Radiocirurgia/história , História do Século XX , Humanos , Neuronavegação/história , Neuronavegação/instrumentação , Neurocirurgia/instrumentação , Radiocirurgia/instrumentação
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