Manpower for neurosurgery: Seeing ourselves as others see us

1977 ◽  
Vol 47 (6) ◽  
pp. 803-809 ◽  
Author(s):  
Eli Ginzberg
Keyword(s):  
Patient Care ◽  
Residency Training ◽  
National Health ◽  
Research Effort ◽  
Health Policies ◽  
Content Type ◽  
The Impact ◽  
National Health Policies ◽  
Fine Print

✓ The 1977 Cushing Orator looks at the question of neurosurgical manpower and its relation to national health policies, proposed or abandoned. The impact on residency training as well as patient care and research effort require constant monitoring by the profession, so that the specialty will continue to contribute significantly to human betterment.

Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction

2002 ◽  
Vol 96 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
Rupert Kett-White ◽  
Peter J. Hutchinson ◽  
Pippa G. Al-Rawi ◽  
Marek Czosnyka ◽  
Arun K. Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrospinal Fluid ◽  
Brain Tissue ◽  
Total Duration ◽  
Wilcoxon Test ◽  
Fisher Exact Test ◽  
Content Type ◽  
The Impact ◽  
Temporary Clipping ◽  
Fine Print

Object. The aim of this study was to investigate potential episodes of cerebral ischemia during surgery for large and complicated aneurysms, by examining the effects of arterial temporary clipping and the impact of confounding variables such as blood pressure and cerebrospinal fluid (CSF) drainage. Methods. Brain tissue PO2, PCO2, and pH, as well as temperature and extracellular glucose, lactate, pyruvate, and glutamate were monitored in 46 patients by using multiparameter sensors and microdialysis. Baseline data showed that brain tissue PO2 decreased significantly, below a mean arterial pressure (MAP) threshold of 70 mm Hg. Further evidence of its relationship with cerebral perfusion pressure was shown by an increase in mean brain tissue PO2 after drainage of CSF from the basal cisterns (Wilcoxon test, p < 0.01). Temporary clipping was required in 31 patients, with a mean total duration of 14 minutes (range 3–52 minutes), causing brain tissue PO2 to decrease and brain tissue PCO2 to increase (Wilcoxon test, p < 0.01). In patients in whom no subsequent infarction developed in the monitored region, brain tissue PO2 fell to 11 mm Hg (95% confidence interval 8–14 mm Hg). A brain tissue PO2 level below 8 mm Hg for 30 minutes was associated with infarction in any region (p < 0.05 according to the Fisher exact test); other parameters were not predictive of infarction. Intermittent occlusions of less than 30 minutes in total had little effect on extracellular chemistry. Large glutamate increases were only seen in two patients, in both of whom brain tissue PO2 during occlusion was continuously lower than 8 mm Hg for longer than 38 minutes. Conclusions. The brain tissue PO2 decreases with hypotension, and, when it is below 8 mm Hg for longer than 30 minutes during temporary clipping, it is associated with increasing extracellular glutamate levels and cerebral infarction.

Outcome after complex neurosurgery: the caregiver's burden is forgotten

1999 ◽  
Vol 91 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Dorothy A. Lang ◽  
Glenn Neil-Dwyer ◽  
John Garfield
Keyword(s):  
Quality Of Life ◽  
Major Change ◽  
Percutaneous Gastrostomy ◽  
Content Type ◽  
Petroclival Meningioma ◽  
Sf 36 ◽  
Permanent Neurological Deficit ◽  
The Impact ◽  
Fine Print

Object. The goals of this study were twofold: 1) to determine outcome, including quality of life, in patients who have undergone surgery for petroclival meningioma in which a standard skull base approach was used; and 2) to assess the impact of the patients' surgical treatment on their caregivers.Methods. Seventeen patients (13 women and four men ranging in age from 29 to 63 years) who underwent a transpetrosal approach for a petroclival meningioma during a 5-year period were prospectively included in this study. Pre- and postoperative data including adverse events were noted. The patients were assessed at 3, 6, and 12 months postoperatively, and annually thereafter, and they completed a postoperative SF-36 questionnaire. In addition, each patient's caregiver was interviewed to determine the effect of the patient's illness on the caregiver's life and responsibilities.Twenty-two operations were performed. A new permanent neurological deficit developed in five patients and in eight a temporary deficit or exacerbation of existing deficits occurred. Two patients underwent surgery to create a facial—hypoglossal nerve communication; five required a temporary percutaneous gastrostomy and/or tracheostomy; three required a shunt; and one underwent successful squint surgery. At 1 year postoperatively 13 patients had made a good or moderate recovery, three were severely disabled, and one had died—outcomes in keeping with other studies. By contrast, responses to the SF-36 questionnaire showed that, in all eight of its categories, between 43% and 75% of surviving patients were functioning below accepted norms. Fifty-six percent of caregivers experienced a major change in lifestyle and 38% experienced a major change with respect to their work.Conclusions. After transpetrosal excision of a petroclival meningioma, the quality of life for the patient is worse than that indicated in surgeons' reported results. The impact on the patient's caregiver is profound—a burden perhaps not fully appreciated by the surgeon.

scholarly journals An investigation into the relationship between materialism and green purchase behavior in Vietnam and Taiwan

2019 ◽  
Vol 21 (2) ◽  
pp. 247-258
Author(s):  
Nguyen Thi Tuyet Mai
Keyword(s):  
Purchase Intention ◽  
Structural Equation ◽  
Research Effort ◽  
Purchase Behavior ◽  
Equation Modeling ◽  
Green Products ◽  
Content Type ◽  
Important Relationship ◽  
Materialistic Values ◽  
The Impact

Purpose The purpose of this paper is to investigate the impact of materialistic values on purchase intention (PI) toward green products among consumers in Vietnam and Taiwan, two Asian countries with different levels of economic development. Design/methodology/approach This research employs the extended theory of planned behavior (TPB) with an integration of materialism. To serve the purpose of this study, two consumer surveys were conducted in Hanoi (Vietnam) and Taipei (Taiwan). The structural equation modeling was employed to test the proposed model and hypotheses. Findings This study examined the impact of some antecedents of green PI among consumers in Vietnam and Taiwan, focusing on the indirect impact of materialistic values (through attitude). All five hypotheses received support from the Vietnam data, confirming the significant impacts of materialistic values (i.e. success and happiness) on attitude, and all three antecedents from the TPB model (i.e. attitude, subjective norms and perceived behavioral control) as positive predictors of green PI. For the Taiwan data, the findings were similar to those from the Vietnam data, except insignificant impact of success value on attitude toward buying green products. Originality/value This research is expected to contribute to the extant literature by enriching the knowledge of the interesting and important relationship between materialistic values and green purchase behavior among consumers in two Asian markets where, to the author’s best understanding, only modest research effort has been given to explore this topic.

Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage?

1998 ◽  
Vol 88 (2) ◽  
pp. 272-276 ◽  
Author(s):  
Joanna M. Wardlaw ◽  
Ruth Offin ◽  
Graham M. Teasdale ◽  
Evelyn M. Teasdale
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Controlled Trial ◽  
Positive Contribution ◽  
Content Type ◽  
Delayed Ischemic Neurological Deficit ◽  
Ultrasound Monitoring ◽  
The Impact ◽  
Fine Print

Object. In this prospective observational study, the authors assess the impact of routine transcranial Doppler (TCD) ultrasound monitoring on the diagnosis, management, and outcome of delayed ischemic neurological deficit complicating subarachnoid hemorrhage (SAH). Methods. Over a 10-month period 186 patients admitted to a regional neurosciences center were included in the study. Three times a week, routine TCD examinations performed by neuroradiographers made an important positive contribution to the diagnosis of delayed ischemic neurological deficit in 72% of patients with this complication and led to altered management for the benefit of the patient in 43%. In 9% of patients with recent SAH, it was believed that the outcome might have been better if the TCD result had been acted upon appropriately. The TCD results did not adversely influence management or outcome and were generally accurate when compared with those obtained on angiography. Conclusions. A routine TCD service provided by neuroradiographers is accurate and useful in diagnosing and managing elevated blood velocities and ischemic neurological deficit following SAH. In addition, it is possible that if the information gleaned from TCD findings was used more often in patient management, outcome might be improved; however, a randomized controlled trial is necessary to assess both these points definitively.

Intracranial bone marrow transplantation after traumatic brain injury improving functional outcome in adult rats

2001 ◽  
Vol 94 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Asim Mahmood ◽  
Dunyue Lu ◽  
Yi Li ◽  
Jae Li Chen ◽  
Michael Chopp
Keyword(s):  
Traumatic Brain Injury ◽  
Bone Marrow ◽  
Brain Injury ◽  
Motor Function ◽  
Glial Fibrillary Acid Protein ◽  
Protein Markers ◽  
Adult Rats ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. The authors tested the hypothesis that intracranial bone marrow (BM) transplantation after traumatic brain injury (TBI) in rats provides therapeutic benefit. Methods. Sixty-six adult Wistar rats, weighing 275 to 350 g each, were used for the experiment. Bone marrow prelabeled with bromodeoxyuridine (BrdU) was harvested from tibias and femurs of healthy adult rats. Other animals were subjected to controlled cortical impact, and BM was injected adjacent to the contusion 24 hours after the impact. The animals were killed at 4, 7, 14, or 28 days after transplantation. Motor function was evaluated both before and after the injury by using the rotarod test. After the animals had been killed, brain sections were examined using hemotoxylin and eosin and immunohistochemical staining methods. Histological examination revealed that, after transplantation, BM cells survived, proliferated, and migrated toward the injury site. Some of the BrdU-labeled BM cells were reactive, with astrocytic (glial fibrillary acid protein) and neuronal (NeuN and microtubule-associated protein) markers. Transplanted BM expressed proteins phenotypical of intrinsic brain cells, that is, neurons and astrocytes. A statistically significant improvement in motor function in rats that underwent BM transplantation, compared with control rats, was detected at 14 and 28 days posttransplantation. Conclusions. On the basis of their findings, the authors assert that BM transplantation improves neurological outcome and that BM cells survive and express nerve cell proteins after TBI.

The impact of minimally invasive cervical spine surgery

2004 ◽  
Vol 1 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Tim E. Adamson
Keyword(s):  
Cervical Spine ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Cervical Radiculopathy ◽  
Foraminal Stenosis ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
The Impact ◽  
Safe Treatment Option ◽  
Fine Print

✓ Since 1997, cervical endoscopic laminoforaminotomy (CELF) has been an effective and safe treatment option for unilateral cervical radiculopathy secondary to disc herniation or foraminal stenosis. The development of the surgical technique is reviewed and recent outcomes discussed. Its impact is addressed in relation to the patient and surgeon.

Residency training in neurological surgery, 1934–1984: evolution over 50 years of trial and tribulation

1984 ◽  
Vol 61 (6) ◽  
pp. 999-1004 ◽  
Author(s):  
Byron Cone Pevehouse
Keyword(s):  
United States ◽  
Socioeconomic Factors ◽  
Residency Training ◽  
American Association ◽  
The United States ◽  
Neurosurgical Training ◽  
Professional Liability ◽  
Content Type ◽  
Neurological Surgery ◽  
Fine Print

✓ The President of the American Association of Neurological Surgeons (AANS) reviews formal neurosurgical training in the United States from its inception with one program in 1934 to 1984, with 94 programs and 650 residents. He reports on the 1st year's experience with a national neurosurgical residency matching plan. He presents realistic remedies for today's professional liability dilemma and analyzes socioeconomic factors that have led to the complex challenges facing neurosurgeons in this decade, relating the importance of the AANS mission and goals in resolving these issues.

Sign in / Sign up

Export Citation Format

Share Document