Face-to-face versus telehealth consultations during COVID-19 in australian general practice: comparison of medication prescribing

BackgroundThere has been a precipitous rise telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice.Design and SettingThis multisite, retrospective observational study used de-identified routinely collected electronic health data extracted from 806 general practices in Victoria and New South Wales (NSW), Australia between April-December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data are reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) Classification System level one groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13,608,216 consultations satisfied the inclusion criteria (61% face-to-face and 39% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication– a statistically significant difference (adjusted OR 1.38; 95% CI 1.379–1.381). The prescribing rate was greater for face-to-face vs telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared to telehealth consultations in the study population.

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Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312972 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1395-1400 ◽

Cited By ~ 2

Author(s):

Rashmi G Mathew ◽

Sahar Parvizi ◽

Ian E Murdoch

Keyword(s):

Cataract Surgery ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Risk Of Failure ◽

Increased Risk ◽

Significant Difference ◽

Measure Change ◽

Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

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Impact of blood group on survival following critical illness: a single-centre retrospective observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000426 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000426

Author(s):

Robert Slade ◽

Raza Alikhan ◽

Matt P Wise ◽

Lam Germain ◽

Simon Stanworth ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Blood Group ◽

Outcome Measure ◽

Tertiary Hospital ◽

Current Data ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Transfusion Requirements ◽

Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

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Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867412465022 ◽

2012 ◽

Vol 47 (3) ◽

pp. 271-275 ◽

Cited By ~ 79

Author(s):

Nayereh Khoraminya ◽

Mehdi Tehrani-Doost ◽

Shima Jazayeri ◽

Aghafateme Hosseini ◽

Abolghassem Djazayery

Keyword(s):

Vitamin D ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Outcome Measure ◽

Secondary Outcome ◽

Therapeutic Effects ◽

Secondary Outcome Measure ◽

Depression Severity ◽

Major Depressive ◽

Significant Difference

Objective: To compare the therapeutic effects of vitamin D3 plus fluoxetine and fluoxetine alone in patients with major depressive disorder. Methods: In the present double-blind, randomized, placebo-controlled trial, 42 patients with a diagnosis of major depressive disorder based on DSM-IV criteria were randomly assigned into two groups to receive daily either 1500 IU vitamin D3 plus 20 mg fluoxetine or fluoxetine alone for 8 weeks. Depression severity was assessed at 2-week intervals using the 24-item Hamilton Depression Rating Scale (HDRS) as a primary outcome measure and the 21-item Beck Depression Inventory (BDI) as a secondary outcome measure. Serum 25(OH) vitamin D was measured at baseline and after intervention. Results: Forty patients completed the trial. A two-way repeated-measures analysis of variance showed that depression severity based on HDRS and BDI decreased significantly after intervention, with a significant difference between the two groups. The vitamin D + fluoxetine combination was significantly better than fluoxetine alone from the fourth week of treatment. Conclusions: In the present 8-week trial, the vitamin D + fluoxetine combination was superior to fluoxetine alone in controlling depressive symptoms.

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What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis

BMJ Open ◽

10.1136/bmjopen-2018-024051 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024051 ◽

Cited By ~ 7

Author(s):

Peter F M Verhaak ◽

Derek de Beurs ◽

Peter Spreeuwenberg

Keyword(s):

General Practice ◽

The Netherlands ◽

Selective Serotonin Reuptake Inhibitors ◽

Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Prescription Data ◽

Number Of Patients ◽

General Practices ◽

Antidepressant Use

ObjectivesAntidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing concern of large-scale antidepressant dependence. We aimed to assess the extent and determinants of chronic antidepressant prescribing among patient aged 18 years and older. We hypothesise a relatively large prevalence of chronic (>2 years) prescription.DesignA longitudinal observational study based on routinely registered prescription data from general practice.Setting189 general practices in the Netherlands.Participants326 025 patients with valid prescription data for all 5 years of the study.Outcome measuresPrimary outcome measure: the number of patients (N) receiving at least four antidepressant prescriptions in 2011, as well as during each of the four subsequent years. Secondary outcome measure: the above, but specified for selective serotonin reuptake inhibitors and for tricyclic antidepressants.ResultsAntidepressants were prescribed to almost 7% of our 326 025 participants each year. They were prescribed for depression (38%), anxiety (17%), other psychological disorders (20%) and non-psychological indications (25%). Antidepressants were prescribed in all 5 years to the 42% of the population who had at least four prescriptions dispensed in 2011. Chronic prescribing was higher among women than men, for those aged 45–64 years than for those aged >65 years and for those treated for depression or anxiety than for non-psychological indications (eg, neuropathic pain). Chronic prescribing also varied markedly among general practices.ConclusionChronic antidepressant use is common for depression and for anxiety and non-psychological diagnoses. Once antidepressants have been prescribed, general practitioners and other prescribers should be aware of the risks associated with long-term use and should provide annual monitoring of the continued need for therapy.

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Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial

BMJ ◽

10.1136/bmj.m4903 ◽

2021 ◽

pp. m4903

Author(s):

James O’Hara ◽

Deborah D Stocken ◽

Gillian C Watson ◽

Tony Fouweather ◽

Julian McGlashan ◽

...

Keyword(s):

Confidence Interval ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Primary Outcome ◽

Outcome Measure ◽

Randomised Trial ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Double Blind ◽

Significant Difference

Abstract Objective To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. Design Pragmatic, double blind, placebo controlled, randomised trial. Setting Eight ear, nose, and throat outpatient clinics, United Kingdom. Participants 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. Intervention Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. Main outcome measures Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. Results Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups—score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval −0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (−0.6 to 5.4 points). Conclusions No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up. Trial registration ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.

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Prospective, randomised controlled trial comparing intense endoscopic cleaning versus minimal intervention in the early post-operative period following functional endoscopic sinus surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215111000508 ◽

2011 ◽

Vol 125 (6) ◽

pp. 585-589 ◽

Cited By ~ 10

Author(s):

J M Fishman ◽

S Sood ◽

M Chaudhari ◽

P Martinez-Devesa ◽

L Orr ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Outcome Measure ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Minimal Intervention ◽

Post Operative Period ◽

Significant Difference ◽

Randomised Controlled

AbstractObjective:There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.Study design:Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.Main outcome measure:The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.Secondary outcome measure:Lund–MacKay symptom score before and after surgery.Results:There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.Conclusion:There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments.

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Comparative study on management of acute moderate and severe lateral ankle sprain using immobilization in below knee slab versus stirrup ankle brace

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i1.17208 ◽

2017 ◽

Vol 18 (1) ◽

pp. 10-16

Author(s):

Prawesh Singh Bhandari ◽

G. KC ◽

S. Uprety

Keyword(s):

Ankle Joint ◽

Outcome Measure ◽

Functional Improvement ◽

Secondary Outcome ◽

Lateral Ligament ◽

P Value ◽

Secondary Outcome Measure ◽

Joint Function ◽

Ankle Brace ◽

Significant Difference

Introduction: Amongst musculoskeletal injuries, ankle ligament sprains are the single most common sports injury. However, there often appears to be no common regimen for their management, with a wide spectrum of treatment options available. The purpose of this study is to determine the functional outcome of the ankle joint after a moderate or severe inversion injury, comparing standard treatment with a Below Knee Slab Splint against a Stirrup ankle brace.Method: Prospective study conducted at the emergency department at Tribhuvan University Teaching Hospital. Fifty patients presenting consecutively were randomized into two equal groups: one group was treated with Below Knee Slab Splint and the other with an Stirrup ankle brace. All patients were given a standardized advice sheet referring to rest, ice, compression, and elevation, NSAIDS and support. Patients were reviewed after 48–72 hours, 14 days, and 3 week. Primary outcome measure: Ankle joint function assessed at 3 week using the modified Karlsson scoring method (maximum score 90). Secondary outcome measure: The difference in ankle girth (swelling) at 3 weeks. Results: Twenty-five patients in Below Knee Slab Splint group and twenty-five patients in the stirrup ankle brace group. The age of the patients ranged from 16 to 55 years with the mean of 30.68±9.33 years.The difference in mean age in years was not different in both groups (P>0.05).The distribution of gender and occupation in both groups were homogeneous (P>0.05). The karlsson’s score mean for brace group is 79.8±5.3 and for other group is 72.0±10.3 (p-value: 0.002). Thus there was a significant difference in Karlssons score between the two groups showing better functional improvement in patients receiving Stirrup ankle brace. There is significant difference in the swelling of clients in between application of the brace (1.00±0.48 and slab (1.70±0.50) the at end of the third week with p value 0.000.Conclusion: The use of Stirrup ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at three weeks compared with standard management with aimmobilization in below knee posterior slab splint.JSSN 2015; 18 (1), Page: 10-16

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Double blinded randomized placebo-controlled comparative study between sucralfate ointment and lidocaine ointment after Milligan Morgan hemorrhoidectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20175111 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3822

Author(s):

Yahia Alkhateep ◽

Abdelmieniem Fareed

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Pain Intensity ◽

Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Secondary Outcome Measure ◽

Lidocaine Group ◽

Significant Difference ◽

Double Blinded

Background: Post haemorrhoidectomy pain and delayed wound healing are the most annoying drawbacks to the patients and the surgeons. Topical application of sucralfate or lidocaine may help in reducing postoperative pain and promoting wound healing after Milligan Morgan hemorrhoidectomy.Methods: This study was designed as a single-center double blinded randomized placebo controlled trial at the Department of general Surgery Menoufia University, immediately after Milligan Morgan Hemorrhoidectomy, a total of 150 patients were randomly assigned to receive either 10% Sucralfate ointment, 5% lidocaine ointment or placebo ointment (control group). The primary outcome measure was pain intensity measured by a visual analogue scale at different time points after hemorrhoidectomy and the secondary outcome measure was wound healing.Results: There was no significant difference in age, gender, and number of excised hemorrhoid piles between the two groups. At the 1st ,3rd and 7th days after surgery pain intensity was significantly lower in sucralfate group (4.18±0.82, 3.92±0.72, 3.56±0.67) when compared to lidocaine group (5.06±1.11, 4.70±0.84, 3.93±0.75) and placebo group (6.17±1.26, 5.42±0.98, 4.55±0.84). At the 21st and 28th days no significant difference in pain intensity between groups (p > 0.05) with better wound healing in sucralfate group (P<0.05).Conclusions: Sucralfate was able to reduce the acute postoperative pain and improve wound healing after hemorrhoidectomy, local anesthetic lidocaine could help in pain control but without effect on healing.

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Biceps Tenodesis versus Tenotomy at the Time of Manipulation and Lysis of Adhesions for Adhesive Capsulitis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00389 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0038

Author(s):

Jourdan M. Cancienne ◽

James E. Christensen ◽

David R. Diduch ◽

Stephen F. Brockmeier ◽

Brian C. Werner

Keyword(s):

Outcome Measure ◽

Adhesive Capsulitis ◽

Secondary Outcome ◽

Categorical Variables ◽

Secondary Outcome Measure ◽

Biceps Tenodesis ◽

Biceps Tenotomy ◽

Increased Risk ◽

Significant Difference ◽

Chi Square Analysis

Objectives: Although rare in the treatment of adhesive capsulitis, arthroscopic lysis of adhesions and manipulation under anesthesia (LOA/MUA) may be necessary if the patient fails conservative therapy. Patients at the time of surgery often have biceps tendon, superior labrum anterior to posterior (SLAP) pathology, or other pathology requiring concurrent treatment. Common treatments for these can include biceps tenodesis or tenotomy. Some surgeons believe that concomitant repairs at the time of LOA/MUA can cause increased stiffness post-operatively due to need for immobilization or protection, possibly leading to poorer outcomes and potentially needing further interventions such as repeat injections or repeat LOA/MUA. The goal of this study was to compare patients who underwent LOA/MUA with biceps tenodesis to those who underwent LOA/MUA with biceps tenotomy. We hypothesized that biceps tenodesis at the time of LOA/MUA did not lead to an increased risk for further intervention in the form of post-operative injections for pain or stiffness or repeat LOA/MUA compared to biceps tenotomy. Methods: A retrospective review of consecutive LOA/MUA for adhesive capsulitis performed by 5 surgeons at a single center from 2010-2016 was performed. All included patients were required to have a minimum of 1 year of follow-up, and be a minimum 2 years post-procedure. Exclusion criteria included prior biceps tenodesis, surgery within six months prior to LOA/MUA, prior infection, prior shoulder fracture or fracture fixation, and concomitant rotator cuff repair. Patients without any biceps surgery (tenotomy or tenodesis) were also excluded. The primary outcome measure was a postoperative injection in the ipsilateral shoulder for recurrent adhesive capsulitis, pain or residual stiffness. The secondary outcome measure was a repeat LOA/MUA. Statistical analysis was completed in SPSS using a chi-square analysis for categorical variables and a student’s t-test for continuous variables. Results: Fifty-five patients were included in the study. Thirty-three patients underwent biceps tenotomy, and 22 patients underwent biceps tenodesis at the time of arthroscopic LOA/MUA. The average age in the tenotomy group was 53 years and 47 years in the tenodesis group (p = 0.383). There was no significant difference in the percentage of males in the tenodesis group (59%) versus tenotomy (48%) (p = 0.440). Average body mass index (BMI) was not significantly different between the two groups (p = 0.329). No patients from either group underwent repeat LOA/MUA. Of those patients who received a biceps tenotomy, 39% had an injection for pain or stiffness post-operatively compared to 18% for biceps tenodesis, which was not significant (p=0.17). Table 1 summarizes the outcomes in both groups. Conclusion: Patients who underwent biceps tenodesis with concurrent arthroscopic LOA/MUA for adhesive capsulitis did not have a higher rate of postoperative injections or repeat LOA/MUA compared to patients who underwent biceps tenotomy at the time of LOA/MUA. [Table: see text]

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Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999

Journal of Neurosurgery ◽

10.3171/2014.10.jns132436 ◽

2015 ◽

Vol 122 (2) ◽

pp. 240-249 ◽

Cited By ~ 33

Author(s):

Gabrielle Lynch ◽

Karina Nieto ◽

Saumya Puthenveettil ◽

Marleen Reyes ◽

Michael Jureller ◽

...

Keyword(s):

Medical School ◽

Outcome Measure ◽

Board Certification ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Attrition Rates ◽

Private Medical School ◽

Significant Difference ◽

International Alumni ◽

Lost To Follow Up

OBJECT The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended. METHODS The study follows a cohort of 1361 individuals who matched into a neurosurgery residency program through the SF Match Fellowship and Residency Matching Service from 1990 to 1999. The main outcome measure was achievement of board certification as documented in the American Board of Neurological Surgery Directory of Diplomats. A secondary outcome measure was documentation of practicing medicine as verified by the American Medical Association DoctorFinder and National Provider Identifier websites. Overall, 10.7% (n = 146) of these individuals were women. Twenty percent (n = 266) graduated from a top 10 medical school (24% of women [35/146] and 19% of men [232/1215], p = 0.19). Forty-five percent (n = 618) were graduates of a public medical school, 50% (n = 680) of a private medical school, and 5% (n = 63) of an international medical school. At the end of the study, 0.2% of subjects (n = 3) were deceased and 0.3% (n = 4) were lost to follow-up. RESULTS The total residency completion rate was 86.0% (n = 1171) overall, with 76.0% (n = 111/146) of women and 87.2% (n = 1059/1215) of men completing residency. Board certification was obtained by 79.4% (n = 1081) of all individuals matching into residency between 1990 and 1999. Overall, 63.0% (92/146) of women and 81.3% (989/1215) of men were board certified. Women were found to be significantly more at risk (p < 0.005) of not completing residency or becoming board certified than men. Public medical school alumni had significantly higher board certification rates than private and international alumni (82.2% for public [508/618]; 77.1% for private [524/680]; 77.8% for international [49/63]; p < 0.05). There was no significant difference in attrition for graduates of top 10–ranked institutions versus other institutions. There was no difference in number of years to achieve neurosurgical board certification for men versus women. CONCLUSIONS Overall, neurosurgery training attrition rates are low. Women have had greater attrition than men during and after neurosurgery residency training. International and private medical school alumni had higher attrition than public medical school alumni.

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