State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee

OBJECTIVENeurosurgical services are increasingly recognized as essential components of surgical care worldwide. The degree of interest among neurosurgeons regarding international work, and the barriers to involvement in global neurosurgical outreach, are largely unexplored. The authors distributed a survey to members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Pediatric Neurosurgery to assess the state of global outreach among its members and to identify barriers to involvement.METHODSAn internet-based questionnaire was developed by the International Education Subcommittee of the AANS/CNS Joint Section on Pediatric Neurosurgery and distributed to pediatric neurosurgeons via the AANS/CNS Joint Section email contact list. Participants were surveyed on their involvement in global neurosurgical outreach, geographic location, nature of the participation, and barriers to further involvement.RESULTSA 35.3% response rate was obtained, with 116 respondents completing the survey. Sixty-one percent have performed or taught neurosurgery in a developing country, and 49% travel at least annually. Africa was the most common region (54%), followed by South America (30%), through 29 separate organizing entities. Hydrocephalus was the most commonly treated condition (88%), followed by spinal dysraphism (74%), and tumor (68%). Most respondents obtained follow-up through communications from local surgeons (77%). Seventy-one percent believed the international experience improved their practice, and 74% were very or extremely interested in working elsewhere. Interference with current practice (61%), cost (44%), and difficulty identifying international partners (43%) were the most commonly cited barriers to participation.CONCLUSIONSAny coordinated effort to expand global neurosurgical capacity begins with appreciation for the current state of outreach efforts. Increasing participation in global outreach will require addressing both real and perceived barriers to involvement. Creation and curation of a centralized online database of ongoing projects to facilitate coordination and involvement may be beneficial.

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Patient perceived barriers to surgical follow-up: Study of 6-month post-operative trichiasis surgery follow-up in Tanzania

PLoS ONE ◽

10.1371/journal.pone.0247994 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247994

Author(s):

Michael Saheb Kashaf ◽

Meraf A. Wolle ◽

Beatriz E. Muñoz ◽

Harran Mkocha ◽

Nicodemus Funga ◽

...

Keyword(s):

Surgical Care ◽

Perceived Barriers ◽

Study Patient ◽

Community Based ◽

Enabling Factors ◽

Middle Income ◽

Middle Income Countries ◽

Outcome Of Surgery ◽

Trachomatous Trichiasis

Background Post-surgical follow-up is a challenge in low- and middle-income countries. Understanding barriers to trachomatous trichiasis (TT) surgical follow-up can inform program improvements. In this study, patient perceived barriers and enabling factors to follow-up after TT surgery are identified. Methods A longitudinal study was carried out in a community-based cohort of persons who received TT surgery in Bahi district, Tanzania. Questionnaires were administered before TT surgery and again after the scheduled 6-month follow-up. Those who did not return were examined at their homes. Results At baseline, 852 participants were enrolled. Of these, 633 (74%) returned at 6 months and 128 (15%) did not and were interviewed at home. Prior to surgery, attenders were more likely to report familiarity with a community health worker (CHW) (22% vs. 14%; p = 0.01) and less likely to state that time constraints are a potential reason for failure to follow-up (66% vs. 74%; p = .04). At follow-up, non-attenders were more likely to endorse barriers pertaining to knowledge about the need for follow-up, lack of transportation, and satisfaction with surgery. There was no difference in post-operative TT between attenders and non-attenders (23% vs. 18% respectively; p = 0.25). Conclusions The outcome of surgery was not a barrier to follow-up. However, better integration of CHWs into their communities and work at coordinating post-surgical care may improve follow-up rates. Moreover, provision of transportation and implementation of effective reminder systems may address patient-perceived barriers to improve follow-up.

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Optimizing international neurosurgical outreach missions: 15-year appraisal of operative skill transfer in Lima, Peru

Surgical Neurology International ◽

10.25259/sni_241_2021 ◽

2021 ◽

Vol 12 ◽

pp. 425

Author(s):

Rahul Jandial ◽

Pranay Narang ◽

Jorge Daniel Brun ◽

Michael L. Levy

Keyword(s):

Video Conferencing ◽

Unmet Need ◽

Surgical Care ◽

Pediatric Neurosurgery ◽

Skill Transfer ◽

Strategic Design ◽

Resident Physicians ◽

International Pediatric ◽

Operative Skill

Background: While several medical outreach models have been designed and executed to alleviate the unmet need for international neurosurgical care, disparate strategies have evolved. There is a need to determine the optimal pediatric neurosurgical outreach model through which resources are efficiently utilized while imparting the largest possible impact on global health. This study evaluates the efficacy of an international pediatric neurosurgery outreach model at transferring operative skill in a sustainable and scalable manner in Lima, Peru over a 15-year duration. Methods: Three 1-week neurosurgical missions were carried out (2004–2006) in Lima, Peru to teach neuroendoscopic techniques and to provide equipment to host neurosurgeons, equipping the hosts to provide care to indigent citizens beyond the duration of the missions. Follow-up data were obtained over a 15 year span, with collaboration maintained over email, two in-person visits, and video-conferencing services. Results: Since the outreach missions in 2004–2006, the host neurosurgeons demonstrated sustainability of the neuroendoscopic instruction by independently performing neuroendoscopic operations on a growing caseload: at baseline, 0 cases were performed in 2003, but since 2012 and onwards, 40–45 cases have been performed annually. Scalability is illustrated by the fact that the institution established a rigorous neuroendoscopy training program to independently pass on the techniques to resident physicians. Conclusion: The described international pediatric neurosurgical outreach model, centered around teaching operative technique as opposed to solely providing care to citizens, allowed operative skill to be sustainably transferred to surgeons in Lima, Peru. Having served the neuroendoscopic needs of hundreds of citizens, the strategic design is replicable and should be mirrored by future medical endeavors seeking to substantially impact the deficit in global surgical care.

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Socioeconomic patient benefits of a pediatric neurosurgery telemedicine clinic

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.8.peds1925 ◽

2020 ◽

Vol 25 (2) ◽

pp. 204-208 ◽

Cited By ~ 2

Author(s):

Kelsey Hayward ◽

Sabrina H. Han ◽

Alexander Simko ◽

Hector E. James ◽

Philipp R. Aldana

Keyword(s):

Travel Time ◽

Cost Savings ◽

Transportation Cost ◽

Pediatric Neurosurgery ◽

University Of Florida ◽

Remote Location ◽

Socioeconomic Data ◽

The University ◽

Time Away

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

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Biomarkers of Acromegaly and Growth Hormone Action

Protein and Peptide Letters ◽

10.2174/0929866527666200420103816 ◽

2020 ◽

Vol 27 (12) ◽

pp. 1231-1245

Author(s):

Filippo Maffezzoni ◽

Teresa Porcelli ◽

Andrea Delbarba ◽

Letizia Pezzaioli ◽

Carlo Cappelli ◽

...

Keyword(s):

Growth Hormone ◽

Biological Markers ◽

Clinical Care ◽

Hormone Deficiency ◽

Surrogate Outcomes ◽

Current State ◽

Growth Hormone Action ◽

Igf I ◽

Definition Of

: Biological markers (biomarkers) play a key role in drug development, regulatory approval and clinical care of patients and are linked to clinical and surrogate outcomes. : Both acromegaly and Growth Hormone Deficiency (GHD) are pathological conditions related to important comorbidities that, in addition to having stringent diagnostic criteria, require valid markers for the definition of treatment, treatment monitoring and follow-up. GH and insulin-like growth factor-I (IGF-I) are the main biomarkers of GH action in children and adults while, in acromegaly, both GH and IGF-I are established biomarkers of disease activity. : However, although GH and IGF-I are widely validated biomarkers of GHD and acromegaly, their role is not completely exhaustive or suitable for clinical classification and follow-up. Therefore, new biological markers for acromegaly and GH replacement therapy are strongly needed. : The aim of this paper is to review and summarize the current state in the field pointing out new potential biomarkers for acromegaly and GH use/abuse.

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Current state of social media utilization in neurosurgery amongst European Association of Neurosurgical Societies (EANS) member countries

Acta Neurochirurgica ◽

10.1007/s00701-021-04939-4 ◽

2021 ◽

Author(s):

Aria Nouri ◽

Julien Haemmerli ◽

Alexandre Lavé ◽

Pia Vayssiere ◽

Paul Constanthin ◽

...

Keyword(s):

Social Media ◽

European Association ◽

Medical Community ◽

Academic Productivity ◽

Online Search ◽

French Society ◽

Current State ◽

Market Shares ◽

Neurological Surgery

Abstract Background Social Media (SoMe) is becoming increasingly used in the medical community, and its use has been related with academic productivity. However, utilization of SoMe in the European neurosurgical community has not been assessed systematically. Methods An online search was undertaken to discover SoMe accounts of (1) national and related neurosurgical societies listed on the EANS website, (2) neurosurgical journals present on EANS website, (3) neurosurgery centers within EANS member countries, as listed on their website. SoMe accounts of Facebook, Twitter, YouTube, and Instagram were searched for journals and societies, and Twitter, Instagram, and Facebook for neurosurgery departments. The number of likes/followers/subscribers was recorded. Results Five (31%) neurosurgery journals had a SoMe presence. The highest number of followers, likes, and tweets was found for JNNP, and Journal of Neurological Surgery Part B had the most subscribers and video views. SoMe usage was identified for 11 national (28.2%) and 2 multi-national neurosurgical societies. From these, the French Society of Neurosurgery had the largest number of Facebook followers (> 2800) and Likes (> 2700), the Society of British Neurological Surgeons had the largest number of Twitter followers (> 2850), whereas EANS overall had the most followers on Twitter > 5100 and Facebook > 5450. A total of 87 SoMe neurosurgery center accounts were found on either Facebook, Instagram or Twitter, for 64 of 1000 centers (6.4%) in 22 of 40 different countries (55%). Of these 67% (n = 43/64) arose from 6 countries (England, Germany, Italy, Romania, Turkey, Ukraine). There were more Facebook accounts (n = 42) than Instagram accounts (n = 23) or Twitter accounts (n = 22). Conclusion SoMe use amongst neurosurgical societies and departments in Europe is very limited. From our perspective, explanations are lacking for the correlated numbers to the market shares of SoMe in the respective countries. Further research, including a survey, to follow up on this important topic should be undertaken among EANS members.

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Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments

CJEM ◽

10.1017/cem.2017.390 ◽

2017 ◽

Vol 20 (1) ◽

pp. 46-52 ◽

Cited By ~ 10

Author(s):

Lauren Lacroix ◽

Lisa Thurgur ◽

Aaron M. Orkin ◽

Jeffrey J. Perry ◽

Ian G. Stiell

Keyword(s):

At Risk ◽

Perceived Barriers ◽

Face Validity ◽

Opioid Overdose ◽

Emergency Physicians ◽

Web Based ◽

Health Crisis ◽

Canadian Association ◽

National Public Health

AbstractObjectivesRates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs.MethodsThis was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED.ResultsA total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit.ConclusionsCanadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.

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Surgical Care, Morbidity, Mortality and Follow-up after Nephrectomy for Renal Cancer with Extension of Tumor Thrombus into the Inferior Vena Cava: Retrospective Study Since 1990s

European Urology ◽

10.1016/j.eururo.2006.02.065 ◽

2006 ◽

Vol 50 (2) ◽

pp. 302-310 ◽

Cited By ~ 31

Author(s):

Jérôme Rigaud ◽

Jean-François Hetet ◽

Guillaume Braud ◽

Simon Battisti ◽

Loïc Le Normand ◽

...

Keyword(s):

Retrospective Study ◽

Inferior Vena Cava ◽

Renal Cancer ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Surgical Care

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A National Survey of Community Pharmacists on Smoking Cessation Services in Thailand

Pharmacy ◽

10.3390/pharmacy6030101 ◽

2018 ◽

Vol 6 (3) ◽

pp. 101 ◽

Cited By ~ 2

Author(s):

Surarong Chinwong ◽

Dujrudee Chinwong

Keyword(s):

Smoking Cessation ◽

Community Pharmacists ◽

Cross Sectional Study ◽

Postal Questionnaire ◽

Pharmaceutical Product ◽

Perceived Barriers ◽

Cross Sectional ◽

Smoking Cessation Services ◽

First Time

Providing smoking cessation services is one role of community pharmacists in Thailand. This cross-sectional study aimed to investigate activities and barriers related to smoking cessation services provided in community pharmacies in Thailand, as well as to compare these activities and barriers between those pharmacists providing and those not providing smoking cessation services. A postal questionnaire was conducted to collect information from community pharmacists across Thailand. In all, 413 valid responses were received from 5235 questionnaires, giving a 7.9% response rate. Of the 413 respondents, 152 (37%) pharmacists provided smoking cessation services in their pharmacy. The activities of smoking cessation services varied. Time for counseling each smoker varied, a mean of 15.1 ± 10.9 min (range 1–60) per person for the first time, and 8.9 ± 6.7 min (range 1–30) for each follow-up visit. Community pharmacists, providing smoking cessation services, were more likely to have pharmacist assistants, be a member of the Thai Pharmacy Network for Tobacco Control, and have more than 1 pharmacist on duty. The most dispensed pharmaceutical product for smoking cessation was nicotine gum. Their most perceived barriers were being unable to follow-up and inadequate staff. In conclusion, only a minority of community pharmacists in Thailand are engaged in smoking cessation activities, even though some perceived barriers existed.

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Analysis of the specific common competences of the Degree Courses in Speech Therapy and on the ability to apply in the didactic systems

Journal of Advanced Health Care ◽

10.36017/jahc2010-001 ◽

2020 ◽

Author(s):

Paterniti Maria Rosa ◽

Bua Alberto ◽

La Tona Federico ◽

Vitale Chiara

Keyword(s):

Data Analysis ◽

Healthcare Professional ◽

Speech Therapy ◽

Labor Law ◽

Health Professions ◽

Clinical Activity ◽

Current State ◽

Corporate Organization ◽

Training Courses

Law 11 January 2018 n. 3 places the attention of the Health Professions on the specific common skills, which must be evident in the didactic systems to protect the Profession. The purpose of this work is to identify which skills are always present among the training objectives of the Degree Courses in Speech Therapy, and which instead become "specific" for our profession. The data analysis was conducted on 27 Degree Courses in Speech Therapy present in Italy, using the portal "Universitaly" and evaluating the SUA cards of the various Degree Courses. The analysis of the data revealed that: basic skills were insufficient for the areas of labor law and corporate organization; transversal skills are well defined and almost always present; the transversal technical-professional skills appeared insufficient for the areas of management and research. The results are useful in order to standardize the framework of the speech therapist's skills. The advantage of having specific well-defined and above all homogeneous skills between the various universities, as well as being an essential tool for clinical activity, is a demonstration of a suitable conduct to protect both the healthcare professional and the patient. In light of what emerged from the results of this study, it is hoped that the analysis carried out can be a tool to allow the universities concerned to follow up on the current state of the CDL in speech therapy, so as to guarantee common and homogeneous training courses throughout the National territory.

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The support of multipath routing in IPv6-based internet of things

International Journal of Electrical and Computer Engineering (IJECE) ◽

10.11591/ijece.v10i2.pp2208-2220 ◽

2020 ◽

Vol 10 (2) ◽

pp. 2208

Author(s):

Ibrahim S. Alsukayti

Keyword(s):

Internet Of Things ◽

Routing Protocol ◽

Task Force ◽

Multipath Routing ◽

Network Routing ◽

Network Architectures ◽

Energy Balancing ◽

Current State ◽

Research Findings

The development of IPv6-based network architectures for Internet of Things (IoT) systems is a feasible approach to widen the horizon for more effective applications, but remains a challenge. Network routing needs to be effectively addressed in such environments of scarce computational and energy resources. The Internet Engineering Task Force (IETF) specified the IPv6 Routing Protocol for Low Power and Lossy Network (RPL) to provide a basic IPv6-based routing framework for IoT networks. However, the RPL design has the potential of extending its functionality to a further limit and incorporating the support of advanced routing mechanisms. These include multipath routing which has opened the doors for great improvements towards efficient energy balancing, load distribution, and even more. This paper fulfilled a need for an effective review of recent advancements in Internet of Things (IoT) networking. In particular, it presented an effective review and provided a taxonomy of the different multipath routing solutions enhancing the RPL protocol. The aim was to discover its current state and outline the importance of integrating such a mechanism into RPL to revive its potentiality to a wider range of IoT applications. This paper also discussed the latest research findings and provided some insights into plausible follow-up researches.

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