Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis

Background Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists. Methods We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines. Results Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42–62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37–54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods. Conclusion Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice. Systematic review registration PROSPERO CRD42019125628 Graphical abstract

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2

Background: Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic. Methods: An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents. Results: A response rate of 50% (132 of 264 residents’ members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001). Conclusion: This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Evidence of Specialty-Specific Gender Disparities in Resident Recruitment and Selection

ABSTRACT Background Specialty-specific gender disparities are multifactorial, yet one area that is lacking from this discussion is the impact of recruitment and selection. Objective Customized data reports were utilized to compare trends in the gender representation of applicants and residents within 11 surgical and medical specialties between 2013 and 2018. Methods Applicant data was obtained from the Electronic Residency Application Service (ERAS) and resident data from the Accreditation Council for Graduate Medical Education (ACGME). Eleven specialties with the highest number of applications per applicant were included (dermatology, emergency medicine, general surgery, neurological surgery, obstetrics and gynecology [OB/GYN], orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, radiology, urology). A Cochran–Armitage trend test assessed for changes in the proportion of females within the total applicant group and the corresponding matched resident group. A t test was utilized to compare the mean proportion of females for ERAS and ACGME data. Results Otolaryngology, plastic surgery, radiation oncology, and urology had no significant changes over the study period. Dermatology, general surgery, and orthopedic surgery demonstrated increased gender diversity in applicants over time, while OB/GYN demonstrated decreased gender diversity. General surgery and neurological surgery showed increased gender diversity in resident representation over time. Emergency medicine and radiology had increased gender diversity, and OB/GYN had decreased gender diversity in matched residents compared to applicants. Conclusions Our findings provide baseline data, but also illustrate evident gaps in our understanding and attempts to improve gender diversity. A multifaceted approach to obtaining and assessing data from all stages of residency recruitment and selection is necessary to support these efforts.

The application of augmented reality–based navigation for accurate target acquisition of deep brain sites: advances in neurosurgical guidance

OBJECTIVE The objective of this study is to quantify the navigational accuracy of an advanced augmented reality (AR)–based guidance system for neurological surgery, biopsy, and/or other minimally invasive neurological surgical procedures. METHODS Five burr holes were drilled through a plastic cranium, and 5 optical fiducials (AprilTags) printed with CT-visible ink were placed on the frontal, temporal, and parietal bones of a human skull model. Three 0.5-mm-diameter targets were mounted in the interior of the skull on nylon posts near the level of the tentorium cerebelli and the pituitary fossa. The skull was filled with ballistic gelatin to simulate brain tissue. A CT scan was taken and virtual needle tracts were annotated on the preoperative 3D workstation for the combination of 3 targets and 5 access holes (15 target tracts). The resulting annotated study was uploaded to and launched by VisAR software operating on the HoloLens 2 holographic visor by viewing an encrypted, printed QR code assigned to the study by the preoperative workstation. The DICOM images were converted to 3D holograms and registered to the skull by alignment of the holographic fiducials with the AprilTags attached to the skull. Five volunteers, familiar with the VisAR, used the software/visor combination to navigate an 18-gauge needle/trocar through the series of burr holes to the target, resulting in 70 data points (15 for 4 users and 10 for 1 user). After each attempt the needle was left in the skull, supported by the ballistic gelatin, and a high-resolution CT was taken. Radial error and angle of error were determined using vector coordinates. Summary statistics were calculated individually and collectively. RESULTS The combined angle of error of was 2.30° ± 1.28°. The mean radial error for users was 3.62 ± 1.71 mm. The mean target depth was 85.41 mm. CONCLUSIONS The mean radial error and angle of error with the associated variance measures demonstrates that VisAR navigation may have utility for guiding a small needle to neural lesions, or targets within an accuracy of 3.62 mm. These values are sufficiently accurate for the navigation of many neurological procedures such as ventriculostomy.

Quantitative Prediction of the Location of Carotid Bifurcation and Neurovascular Structures in the Carotid Region: A Cross-Sectional Cadaveric Study

Introduction. The carotid region is encountered in vascular and neurological surgery and carries a potential for vascular and cranial nerve trauma. The carotid bifurcation is an especially important landmark and difficult to predict based on currently established landmarks. This study is a detailed analysis of the carotid region and proposes a novel methodology to predict the height of the bifurcation. Materials and Methods. Superficial and deep dissections were performed on the anterior triangle of the neck to expose the carotid region in twenty-one formalin-fixed donor cadavers. Musculoskeletal and neurovascular structures were assessed in relation to the carotid bifurcation and the medial border of the clavicle (MBC). Results. The carotid bifurcation occurred, on average, 11.4 mm higher on the left ( p < 0.001 ; 95% CI: 9.28, 13.54). The superior thyroid artery ( p < 0.001 ), facial vein ( p < 0.001 ), and cranial nerve XII ( p < 0.001 ) were all more distal on the left side when measured from the MBC while the angle of the mandible and stylohyoid muscle remained symmetric. Left- and right-sided vascular structures were symmetric when measured from the carotid bifurcation. Conclusions. Neurovascular structures within the carotid region are likely to be anatomically superior on the left side while vessels are likely to remain symmetric in relation to the carotid bifurcation. When measured from the MBC, the bifurcation height can be predicted by multiplying the distance between the MBC and mastoid process by 0.65 (right side) or 0.74 (left side). This novel methodological estimation may be easily learned and directly implemented in clinical practice.

Racial, ethnic, and gender diversity of applicants and matriculants to neurological surgery residency programs

OBJECTIVE The aim of this study was to identify trends in the demographic constitution of applicants and matriculants to neurological surgery based on race, ethnicity, and gender. METHODS The authors conducted a cross-sectional study using compiled demographic data obtained from the Association of American Medical Colleges. Trends analyzed included proportional changes in race, ethnicity, and gender of applicants and matriculants to neurosurgical residency programs from academic years 2010–2011 to 2018–2019. RESULTS A total of 5100 applicants and 2104 matriculants to neurosurgical residency programs were analyzed. No significant change in the percentage of overall women applicants (+0.3%, 95% CI −0.7% to 1.3%; p = 0.77) or in the percentage of women matriculants (+0.3%, 95% CI −2.2% to 2.9%; p = 0.71) was observed. For applicants, no change over time was observed in the percentages of American Indian or Alaska Native (AI/AN) men (0.0%, 95% CI −0.3% to 0.3%; p = 0.65); Asian men (−0.1%, 95% CI −1.2% to 1.1%; p = 0.97); Black or African American men (−0.2%, 95% CI −0.7% to 0.4%; p = 0.91); Hispanic, Latino, or of Spanish Origin men (+0.4%, 95% CI −0.8% to 1.7%; p = 0.26); White men (+0.5%, 95% CI −2.1% to 3.0%; p = 0.27); Asian women (+0.1,% 95% CI −0.9% to 1.1%; p = 0.73); Black or African American women (0.0%, 95% CI −0.6% to 0.5%; p = 0.30); Hispanic, Latino, or of Spanish Origin women (0.0%, 95% CI −0.4% to 0.4%; p = 0.71); and White women (+0.3%, 95% CI −1.1% to 1.7%; p = 0.34). For matriculants, no change over time was observed in the percentages of AI/AN men (0.0%, 95% CI −0.6% to 0.6%; p = 0.56); Asian men (0.0%, 95% CI −2.7% to 2.7%; p = 0.45); Black or African American men (−0.3%, 95% CI −1.4% to 0.8%; p = 0.52); Hispanic, Latino, or of Spanish Origin men (+0.6%, 95% CI −0.8 to 2.0%; p = 0.12); White men (−1.0%, 95% CI −5.3% to 3.3%; p = 0.92); Asian women (+0.1%, 95% CI −1.3% to 1.5%; p = 0.85); Black or African American women (0.0%, 95% CI −0.6% to 0.7%; p = 0.38); Hispanic, Latino, or of Spanish Origin women (−0.1%, 95% CI −0.7% to 0.5%; p = 0.46); and White women (+0.3%, 95% CI −2.4% to 3.0%; p = 0.70). CONCLUSIONS Despite efforts to diversify the demographic constitution of incoming neurosurgical trainees, few significant advances have been made in recent years. This study suggests that improved strategies for recruitment and cultivating early interest in neurological surgery are required to further increase the diversification of future cohorts of neurosurgical trainees.

Applying to residency: survey of neurosurgical residency applicants on virtual recruitment during COVID-19

OBJECTIVE The COVID-19 pandemic caused a significant disruption to residency recruitment, including a sudden, comprehensive transition to virtual interviews. The authors sought to characterize applicant experiences and perceptions concerning the change in the application, interview, and match process for neurological surgery residency during the 2020–2021 recruitment cycle. METHODS A national survey of neurosurgical residency applicants from the 2020–2021 application cycle was performed. This survey was developed in cooperation with the Society of Neurological Surgeons (SNS) and the American Association of Neurological Surgeons Young Neurosurgeons Committee (YNC) and sent to all applicants (n = 280) who included academic video submissions to the SNS repository as part of their application package. These 280 applicants accounted for 69.6% of the total 402 neurosurgical applicants this year. RESULTS Nearly half of the applicants responded to the survey (44.3%, 124 of 280). Applicants favored additional reform of the interview scheduling process, including a centralized scheduling method, a set of standardized release dates for interview invitations, and interview caps for applicants. Less than 8% of students desired a virtual-only platform in the future, though the majority of applicants supported incorporating virtual interviews as part of the process to contain applicant costs and combining them with traditional in-person interview opportunities. Program culture and fit, as well as clinical and research opportunities in subspecialty areas, were the most important factors applicants used to rank programs. However, subjective program "fit" was deemed challenging to assess during virtual-only interviews. CONCLUSIONS Neurosurgery resident applicants identified standardized interview invitation release dates, centralized interview scheduling methods, caps on the number of interviews available to each candidate, and regulated opportunities for both virtual and in-person recruitment as measures that could significantly improve the applicant experience during and effectiveness of future neurosurgery residency application cycles. Applicants prioritized program culture and "fit" during recruitment, and a majority were open to incorporating virtual elements into future cycles to reduce costs while retaining in-person opportunities to gauge programs and their locations.

The Research Status of Neurological Surgery Residents; A Survey of Iranian Residency Programs

Background: Research activities promote the appreciation for evidence-based medicine (EBM), quality patient care and clinical competence of resident physicians. We decided to investigate the research background of Iranian neurological surgery residents and their attitude toward research through a survey. Methods: This cross-sectional study was done on Iranian neurological surgery resident physicians between February and April 2020. We provided an online survey, including 13 questions, using Google form and then sent the link to survey via WhatsApp application. Following the first post, two more reminders were sent to the groups after 2 and 4 weeks. Results: Responses were received from 89 respondents from which about 88% used to spend two hours or less per week for research. Almost equal numbers of resident physicians chose academic position (n=43) or private practice (n=39) as their future job. Only seven respondents stated immigration for assumed future job position. Clinical research (47%) was the most frequent type of research done by participants and clinical research education (43.2%) during medical school was the most common way of obtaining research experience. Agreement with doing research during residency program (45.6%) was more than disagreement (22.4%) and neutral attitude (32%). Conclusion: There is a low tendency among Iranian neurological surgery residents for conducting research projects during their programs. Lack of a proper research curriculum, heavy clinical duties and consequent shortage of time as well as insufficient encouraging points, are the main reasons. Designing a research plan for residency programs may successfully increase the research involvement rate.

Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

IntroductionAneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. In the context of acute brain injury, frailty, sarcopaenia and osteopaenia have become increasing concerns. Multiple indices have been devised in various surgical specialties to predict outcome and guide management. In this study, we examined whether such markers have relevance towards outcomes from acute brain conditions, such as aSAH. MethodsAn observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]), temporalis (TMT) and zygoma thickness (markers of sarcopaenia and osteopaenia), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. ResultsTMT was the best performing marker in our cohort with an AUC of 0.82, Somers’ D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69, Somer’s D 0.40, Tau 0.16), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68, Somer’s D 0.43, Tau 0.17). After multivariate analysis, patients with TMT ≥5.5mm (defined as non-frail), were less likely to experience complications (OR 0.20 [0.06 – 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. ConclusionTMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes Trial registrationNot applicable

‘‘Entropy, Externality and Human Evolution’’ to ‘‘Radiator Theory of Brain’’: a Very Short Review

This review of the paper ‘‘Entropy, externality and human evolution’’ by G. Iurato and A.Yu. Khrennikov, for the Journal of Neuroscience and Neurological Surgery, is aimed to highlight the main neuroscience and paleo-neurology implications of the theoretical research conducted in such a work, above all in relation to the so-called Radiator Theory of evolution of the brain.