Surgical decision making in the setting of severe traumatic brain injury: A survey of neurosurgeons.PloS One 2020Surgical decision-making in severe traumatic brain injury (TBI) is complex. Neurosurgeons weigh risks and benefits of interventions that have the potential to both...
Surgical decision-making in severe traumatic brain injury (TBI) is complex. Neurosurgeons weigh risks and benefits of interventions that have the potential to both maximize the chance of recovery and prolong suffering. Inaccurate prognostication can lead to over- or under-estimation of outcomes and influence treatment recommendations.
To evaluate the impact of evidence-based risk estimates on neurosurgeon treatment recommendations and prognostic beliefs in severe TBI.
In a survey-based randomized experiment, a total of 139 neurosurgeons were presented with two hypothetical patient with severe TBI and subdural hematoma; the intervention group received additional evidence-based risk estimates for each patient. The main outcome was neurosurgeon treatment recommendation of non-surgical management. Secondary outcomes included prediction of functional recovery at six months.
In the first patient scenario, 22% of neurosurgeons recommended non-surgical management and provision of evidence-based risk estimates increased the propensity to recommend non-surgical treatment (odds ratio [OR]: 2.81, 95% CI: 1.21-6.98; p = 0.02). Neurosurgeon prognostic beliefs of 6-month functional recovery were variable in both control (median 20%, IQR: 10%-40%) and intervention (30% IQR: 10%-50%) groups and neurosurgeons were less likely to recommend non-surgical management when they believed prognosis was favorable (odds ratio [OR] per percentage point increase in 6-month functional recovery: 0.97, 95% confidence interval [CI]: 0.95-0.99). The results for the second patient scenario were qualitatively similar.
Our findings show that the provision of evidence-based risk predictions can influence neurosurgeon treatment recommendations and prognostication, but the effect is modest and there remains large variability in neurosurgeon prognostication.
Topics: Adult; Brain Injuries, Traumatic; Clinical Decision-Making; Female; Humans; Male; Middle Aged; Neurosurgeons; Neurosurgical Procedures; Surveys and Questionnaires
Academic versus non-academic neurosurgeons in China: a national cross-sectional study on workload, burnout and engagement.BMJ Open Oct 2019Chinese neurosurgery has made great progress during the past decades; yet, little is known about the working status of neurosurgeons. This study aimed to evaluate the...
Chinese neurosurgery has made great progress during the past decades; yet, little is known about the working status of neurosurgeons. This study aimed to evaluate the difference between academic and non-academic neurosurgeons, focusing on their professional burnout, job satisfaction and work engagement.
Cross-sectional nationwide survey.
The survey was conducted in China between 2017 and 2018.
A total number of 823 academic neurosurgeons and 379 non-academic neurosurgeons participated in this study.
Professional burnout, job satisfaction and work engagement were assessed using the Maslach Burnout Inventory, the Job Descriptive Index and the Utrecht Work Engagement Scale, respectively.
The majority of respondents were male (92.93%), less than 45 years old (85.27%) and married (79.53%). Chinese neurosurgeons worked 63.91±11.04 hours per week, and approximately 45% experienced burnout. Compared with non-academic respondents, academic neurosurgeons had longer working hours (p<0.01), higher income (p<0.01) and were less willing to get married (p<0.01). In addition, they showed a lower degree of burnout (p<0.01), a higher level of job satisfaction (p<0.01) and were more enthusiastic at work (p=0.015). Multivariate regression analyses indicated that divorced (OR 7.02, 95% CI 2.37 to 15.08) and workplace violence (OR 1.52, 95% CI 1.18 to 2.24) were associated with burnout for both academic and non-academic respondents. Long working hours (≥71 hours per week) and low annual income (<1 00 000 RMB) were risk factors for burnout among academic neurosurgeons. For non-academic neurosurgical surgeons (age 36-45 years), working as attending doctors, serving in public hospitals and having the first house-living child were all closely related to the incidence of burnout.
Chinese neurosurgeons are under significant stress particularly for the non-academic neurosurgeons. Offering better opportunities for training, promotion, higher income and safer working environments could be solutions to relieve burnout and improve career satisfaction and engagement.
TRIAL REGISTRATION NUMBER
ChiCTR1800014762. This article is not linked to a clinical trial.
Topics: Adult; Attitude of Health Personnel; Burnout, Professional; China; Female; Humans; Job Satisfaction; Male; Middle Aged; Neurosurgeons; Neurosurgery; Socioeconomic Factors; Surveys and Questionnaires; Work Engagement; Workload
Carotid Endarterectomy and Carotid Artery Stenting for Symptomatic Carotid Stenosis: An Experience of a Hybrid Neurosurgeon in a Developing Nation.Neurology IndiaStenosis of the ICA is an important cause of ischemic stroke and associated morbidity and mortality. Carotid artery stenting (CAS) and carotid endarterectomy (CEA) help...
Stenosis of the ICA is an important cause of ischemic stroke and associated morbidity and mortality. Carotid artery stenting (CAS) and carotid endarterectomy (CEA) help to prevent impending or subsequent ischemic stroke in such patients.
Aim and Objective
To study the outcome and adverse events associated with CEA and CAS. To determine the generalization of results obtained with multicentric trials such as CREST, etc., by comparing the results obtained by a single neurosurgeon in a community setting.
Material and Methods
From Jan 2014-Dec 2017, 80 patients presented with symptomatic carotid stenosis. Out of these 80 patients, 65 underwent intervention; 34 patients underwent CEA and 31 patients underwent CAS. Pre-defined variables like age, sex, and degree of stenosis were assessed as potential risk factors, and the patients' clinical features, radiological imaging, and procedural complications were documented.
The primary outcome of procedure-related stroke, major adverse events (MAEs), and death at 30 days follow-up and long-term outcomes of restenosis at 1 year were analyzed. Peri-procedural stroke occurred in 2 cases (6.4%) of CAS; one suffered an ischemic stroke and other suffered a hemorrhagic stroke. Three cases of CEA suffered procedure-related events; one (2.9%) suffered TIA while the other two developed postoperative local hematoma without neurological deficit; one was treated conservatively while the other required re-exploration due to pressure symptoms. Restenosis occurred in one case that underwent CAS.
CAS and CEA are complementary approaches in treating symptomatic carotid stenosis even when performed by a single hybrid neurosurgeon as results obtained are commensurable to major studies like CREST.
Topics: Carotid Arteries; Carotid Stenosis; Developing Countries; Endarterectomy, Carotid; Humans; Neurosurgeons; Risk Factors; Stents; Stroke; Treatment Outcome
Neurosurgeons' experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis.BMJ Open Sep 2021Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by...
Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons' experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs.
This was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke's Reflexive Thematic Analysis supported by NVivo V.12.
In April-July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews).
The analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as 'the neurosurgical research potential in LMICs'. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons.
The geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.
Topics: Developing Countries; Humans; Income; Neurosurgeons; Neurosurgery; Poverty
Neurosurgeons' opinions on discussing sexual health among brain tumor patients: Room for improvement?Journal of Clinical Neuroscience :... Dec 2021As sexual health is an important aspect of general quality of life, discussing and treating sexual health issues should also be part of the oncological care given to...
As sexual health is an important aspect of general quality of life, discussing and treating sexual health issues should also be part of the oncological care given to patients. It is unknown to what extent neurosurgeons discuss sexual health issues with patients suffering from brain tumors.
A 25-question survey was sent to members of the Congress of Neurological Surgeons by email.
Of all neurosurgeons who replied, 59.1% never discussed sexual health with patients suffering from brain tumors. There was a trend of less discussing sexual health with older patients. Furthermore, discussing sexual health did not depend on the stage or type of brain tumor patients were suffering from. A majority of 57.7% of the neurosurgeons stated that patients themselves are responsible for discussing health and 41.6% think that neurosurgeons are responsible. The biggest barriers for avoiding discussing sexual health were that 'patients do not express sexual problems spontaneously', 'insufficient training/knowledge of the neurosurgeon' and 'insufficient time'. Furthermore, 59.1% stated they had insufficient/no knowledge about sexual health and 70% found it (slightly/very) important to screen for sexual health after meningioma surgery. About 63.1% wanted to extend their knowledge on sexual health.
Sexual health is an underexposed area in the neurosurgical care for patients suffering from brain tumors. There is a need for more awareness on recognizing and treating of sexual dysfunction after neurosurgery.
Topics: Attitude of Health Personnel; Brain Neoplasms; Humans; Neurosurgeons; Practice Patterns, Physicians'; Quality of Life; Sexual Health
Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan...Journal of Neurology, Neurosurgery, and... Apr 2020Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed...
Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts.
Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes.
The US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables.
15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25-75) was significantly associated with a lower survival (OR 4×10, 95% CI 1.61×10 to 110.6×10, p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001).
Presence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts.
Topics: Adult; Afghan Campaign 2001-; Brain Injuries, Traumatic; Female; Humans; Injury Severity Score; Iraq War, 2003-2011; Male; Military Personnel; Neurosurgeons; Neurosurgical Procedures; Retrospective Studies; Survival Rate; United Kingdom; United States
Neurology IndiaBeing a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion...
Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. During the last two decades, the exponential deployment of operative technology has resulted in a radical transformation, making a neurosurgeon trained four decades ago, run the risk of being outdated. Expectations from patients have reached an all time high level. Socioeconomic and medicolegal aspects cannot be brushed aside. It is universally accepted that in spite of increasing longevity in the educated upper middle class, the process of ageing per se continues relentlessly. When is enough enough? Is there a risk that a "senior, experienced" neurosurgeon may even become a liability to his patients some day? Should there be a mandatory time point at which a neurosurgeon should necessarily stop operating. The author reviews the published literature and opines that after the age of 65 years, all seniors should agree to their operating privileges being formally reviewed regularly every 2 years.
Topics: Age Factors; Humans; Neurosurgeons; Neurosurgery; Retirement; Teaching
PloS One 2017Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as neurosurgeons advance in their...
Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as neurosurgeons advance in their careers, they tend to narrow their practice and increase volumes in certain specific types of operations. Failing to test the type of procedures most relevant to the practitioner is a lost opportunity to improve the knowledge and practice of the individual neurosurgeon. In this study, we assess the neurosurgical community's appetite for designations of board-recognized Recognized Focused Practice (RFP). We administered a validated, online, confidential survey to 4,899 neurosurgeons (2,435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1,440 Diplomates certified prior to 1999 (grandfathered), and 1,024 retired Diplomates). We received 1,449 responses overall (30% response rate). A plurality of respondents were in practice 11-15 years (18.5%), in private practice (40%) and participate in MOC (61%). 49% of respondents felt that a RFP designation would not be helpful. For the 30% who felt that RFP would be helpful, 61.3% felt that it would support recognition by their hospital or practice, it would motivate them to stay current on medical knowledge (53.4%), or it would help attract patients (46.4%;). The most popular suggestions for RFP were Spine (56.2%), Cerebrovascular (62.9%), Pediatrics (64.1%), and Functional/Stereotactic (52%). A plurality of neurosurgeons (35.7%) felt that RFP should recognize neurosurgeons with accredited and non-accredited fellowship experience and sub-specialty experience. Ultimately, Recognized Focused Practice may provide value to individual neurosurgeons, but the neurosurgical community shows tepid interest for pursuing this designation.
Topics: Adult; Aged, 80 and over; Humans; Middle Aged; Neurosurgeons; United States
World Neurosurgery Aug 2020The goal of this survey was to determine factors associated with anxiety/depression among neurosurgeons during the coronavirus disease 2019 (COVID-19) pandemic.
The goal of this survey was to determine factors associated with anxiety/depression among neurosurgeons during the coronavirus disease 2019 (COVID-19) pandemic.
An online survey was performed of neurosurgeons worldwide, conducted over 3 weeks. Depression in neurosurgeons was assessed by Self-Reporting Questionnaire-20.
A total of 375 responses were received from 52 countries. Among all neurosurgeons, 34% felt tense, 32.5% were unhappy, 25% experienced insomnia, almost 20% had headaches, and 5% had suicidal ideation during the pandemic. Of participants, 14% had a score on Self-Reporting Questionnaire-20 consistent with depression. The likelihood of depression was significantly higher among those who did not receive guidance about self-protection from their institutions (odds ratio [OR], 2.47), those who did not feel safe with provided personal protective equipments (OR, 3.13), and those whose families considered their workplace unsafe (OR, 2.29). Depression was less likely in neurosurgeons who had minor concerns, compared with those with significant health concerns for their families (OR, 0.36). In multivariate analysis after controlling for effects of other covariates, odds of depression were significantly higher among neurosurgeons who did not feel safe with the provided personal protective equipment (OR, 2.43) and who were exposed to a COVID-19-positive colleague (OR, 2.54). Participants who had moderate concerns for their families had lesser odds of anxiety/depression than did those with significant concerns (OR, 0.28).
Based on the modifiable risk factors of depression in this study, it is recommended that the safety of neurosurgeons be ensured by providing appropriate safety measures for them to regain their confidence and hence reduce the incidence of depression.
Topics: Adult; Anxiety; Betacoronavirus; COVID-19; Coronavirus Infections; Depression; Humans; Mental Health; Neurosurgeons; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2; Surveys and Questionnaires
Neurosurgical simulator for training aneurysm microsurgery-a user suitability study involving neurosurgeons and residents.Acta Neurochirurgica Oct 2020Due to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The...
Due to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)-based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures.
MATERIALS AND METHODS
We developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4-15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants' clipping performance and a comparison between groups was done.
The proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods.
The integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.
Topics: Cerebral Arteries; Cerebrovascular Circulation; Clinical Competence; Humans; Internship and Residency; Intracranial Aneurysm; Microsurgery; Neurosurgeons; Neurosurgery; Printing, Three-Dimensional; Reproducibility of Results; Simulation Training