Trends in Surgical Case Volume during Humanitarian Aid Missions aboard United States Naval Ship Mercy

OBJECTIVE Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country. METHODS An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users. RESULTS Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1–3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5–7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5–8 electrodes and 17% reported median implants of 15–18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment. CONCLUSIONS SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

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Abstract 67: Cardiac Arrest and Surgical Case Volume, Household Income and Availability of Trauma and Cardiac Surgery Are Associated with Higher Risk-Standardized Survival After Cardiac Arrest Among University Hospital Consortium Institutions in 2012

Circulation ◽

10.1161/circ.130.suppl_2.67 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michael C Kurz ◽

John P Donnelly ◽

Henry E Wang

Keyword(s):

Cardiac Arrest ◽

Cardiac Surgery ◽

Household Income ◽

University Hospital ◽

Individual Risk ◽

P Value ◽

Case Volume ◽

Surgical Case ◽

Catchment Areas ◽

Cardiac Arrest Survival

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

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The Missionary Solution

Sharing the Burden ◽

10.1093/oso/9780190618605.003.0004 ◽

2019 ◽

pp. 80-110

Author(s):

Charlie Laderman

Keyword(s):

United States ◽

Civil Society ◽

Humanitarian Aid ◽

The United States ◽

Representative Government ◽

World War ◽

World War One ◽

Civilizing Mission ◽

American Missionaries ◽

The World

This chapter examines the attempt by American missionaries to help remold the Ottoman state into a constitutional political system in the aftermath of the 1909 Young Turk Revolution. It explains why Americans, who had long regarded their missionaries as humanitarian aid agents helping to support and uplift the Armenians through their mission stations, now looked to them to extend their “civilizing mission” across the Empire. It explores the growth of the Protestant missionary lobby in the United States and the ways in which it developed support for an attempt to build a civil society in the Ottoman Empire that would ensure security for the Armenians within a reformed Ottoman polity. It explains why missionaries and their supporters viewed this as part of a larger mission to spread Christian ideals and representative government around the world alongside British evangelists. Missionary dreams of a new Ottoman nation collapsed when, amidst World War One, the Ottoman Armenians faced wholesale destruction. This chapter concludes by exploring how Woodrow Wilson’s administration and the missionaries responded to this “Crime Against Humanity,” and why their determination to maintain American neutrality so infuriated Theodore Roosevelt. It examines how the missionary lobby pioneered an unprecedented relief operation, and worked in partnership with the leading British champion of the Armenians, James Bryce, to publicize the atrocities and plan for Armenia’s ultimate liberation from Ottoman rule.

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Correlation of Surgical Case Volume and Fellowship Training with Simulated Procedural Tasks

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2019.09.636 ◽

2019 ◽

Vol 26 (7) ◽

pp. S58-S59

Author(s):

V Palvia ◽

JA Doneza ◽

SS Mathews ◽

CJ Ascher-Walsh

Keyword(s):

Fellowship Training ◽

Case Volume ◽

Surgical Case ◽

Procedural Tasks

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Analysis of Neurosurgery Resident Operative Experience: Training Tomorrow's Neurosurgeon

Neurosurgery ◽

10.1093/neuros/nyz310_714 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Shahjehan Ahmad ◽

Bledi C Brahimaj

Keyword(s):

United States ◽

Medical Education ◽

Statistical Significance ◽

The United States ◽

Case Volume ◽

The Past ◽

Operative Experience ◽

Case Logs ◽

Adult Spine ◽

Neurological Surgery

Abstract INTRODUCTION The Accreditation Council for Graduate Medical Education (ACGME) maintains self-reported logs of cases completed by US residents. This study analyzes trends in the operative experience of neurosurgical residents within the context of national case trends in neurosurgery over the past decade. METHODS ACGME case logs from 2013 to 2018 were reviewed. Operative domains were categorized as adult cranial, adult spinal, pediatrics, and epilepsy. Mean operative volume was recorded, as well as cases performed as senior or lead surgeon. As a measure of US national operative trends, the PearlDiver database was queried for operative volume between 2007 and 2016. Statistical analysis was performed using linear regression, and statistical significance was set at P < .05. RESULTS During the study period, the total case volume for neurological surgery residents increased by 61 cases every residency year (P < .001). Cases logged as lead surgeon increased by 173 cases every year, while cases logged as senior surgeon decreased by 112 cases every year (P < .05). The operative volume for adult spine and cranial increased (P < .05), while that for extracranial vascular and pediatric decreased (P < .05). Brain tumor, transsphenoidal, radiosurgery, shunting, and epilepsy volume remained stable over the study period (P > .05). These resident operative trends paralleled trends nationwide where there were increases in adult cranial, adult spine, and epilepsy (P < .001) but decreases in pediatric cases (P < .05). CONCLUSION Over the past decade, neurosurgical residents have been completing an increasing number of cases every year in the majority of operative domains. While an increased experience is beneficial, what is more important is that the resident operative experience appears to closely mirror trends for commonly performed operations in the United States. This is reassuring for surgical educators that tomorrow's neurosurgeons will have the competency to meet our nation's neurosurgical needs.

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Update on Conflict and Diplomacy

Journal of Palestine Studies ◽

10.1525/jps.2018.47.3.135 ◽

2018 ◽

Vol 47 (3) ◽

pp. 135-171

Author(s):

Paul Karolyi

Keyword(s):

United States ◽

Humanitarian Aid ◽

The United States ◽

Donald Trump ◽

Palestinian Refugees ◽

Tel Aviv ◽

Palestinian Territories ◽

National Reconciliation ◽

Reconciliation Process ◽

The U.S

This update summarizes bilateral, multilateral, regional, and international events affecting the Palestinians and Israel during the quarter from 16 November 2017 to 15 February 2018. Highlights include: U.S. president Donald Trump pledged to move the U.S. embassy in Israel from Tel Aviv to Jerusalem and formally recognized Jerusalem as Israel's capital, reversing decades of U.S. policy. His decision provoked an international backlash, sparked a wave of protests and clashes in the occupied Palestinian territories, and compromised his own diplomatic efforts. The Israelis celebrated Trump's decision, while the Palestinians cited it as an illustration of the United States' pro-Israel bias and as the reason for their rejection of U.S. mediation in any future peace talks. Outraged, Trump ordered punitive cuts to U.S. humanitarian aid designated for Palestinian refugees, further undercutting any peace initiative, which advisors insisted was still under way. The Palestinians began pursuing a new, multilateral framework to continue the peace process. Amid these developments, the Palestinian national reconciliation process stalled once again.

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UNITED STATES ANNOUNCES ADDITIONAL HUMANITARIAN AID FOR VENEZUELANS IN COLOMBIA

Human Rights Documents Online ◽

10.1163/2210-7975_hrd-0136-20180022 ◽

2019 ◽

Keyword(s):

United States ◽

Humanitarian Aid

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