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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Kanmounye US, Robertson FC, Thango NS, Doe AN, Bankole NDA, Ginette PA, Ondoma S, Balogun JA, Opoku I, Jokonya L, Mbaye T, Shabhay ZA, Ashour AM, Silva ACV, Cheserem B, Karekezi C, Hassani FD, Mentri N, Laeke T, Aklilu AT, Sanoussi S, Musara A, Ntalaja J, Ssenyonga P, Bakhti S, El Abbadi N, Mahmud MR, El-Ghandour NMF, Al-Habib A, Kolias AG, Servadei F, Fieggen G, Qureshi M, Esene I. Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study. Front Surg 2021; 8:647279. [PMID: 34124134 PMCID: PMC8193351 DOI: 10.3389/fsurg.2021.647279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/22/2021] [Indexed: 01/30/2023] Open
Abstract
Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.
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Affiliation(s)
- Ulrick S Kanmounye
- Research Department, Association of Future Africa Neurosurgeons, Yaoundé, Cameroon
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Nqobile S Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Alvin Nah Doe
- Neurosurgery Sub-Unit, Department of Surgery, John F. Kennedy Medical Center, Monrovia, Liberia
| | - Nourou Dine Adeniran Bankole
- Neurosurgery Department, Centre Hospitalier Universitaire Ibn Sina Rabat- Mohamed V University of Rabat, Rabat, Morocco
| | - Pape Aicha Ginette
- Division of Neurosurgery, Felix Houphouet Boigny University of Abidjan, Abidjan, Côte d'Ivoire
| | - Solomon Ondoma
- Mercy One Neurosurgery, Mercy One Hospital of North Iowa, Mason, IA, United States
| | - James A Balogun
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Isabella Opoku
- Department of Neurosurgery, China International Neuroscience Institute (China-INI), Beijing, China
| | - Luxwell Jokonya
- Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Thioub Mbaye
- Department of Neurosurgery, Centre Hospitalier Universitaire Fann, Dakar, Senegal
| | - Zarina A Shabhay
- Division of Neurosurgery, Department of Surgery, Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Ahmed M Ashour
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | | | - Beverly Cheserem
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Béjaïa, Algeria
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenezer Tirsit Aklilu
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuila Sanoussi
- Department of Neurosurgery, Niamey National Hospital, Niamey, Niger
| | - Aaron Musara
- Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jeff Ntalaja
- Department of Neurosurgery, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Peter Ssenyonga
- Department of Neurosurgery, CURE Children's Hospital of Uganda, Mbale, Uganda
| | - Souad Bakhti
- Pediatric Neurosurgery Division, Department of Neurosurgery, Academic Hospital Mustapha Pacha, Algiers, Algeria
| | - Najia El Abbadi
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria, Nigeria
| | | | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Angelos G Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Graham Fieggen
- Division of Neurosurgery, Neurosciences Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Ignatius Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
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Robertson FC, Gnanakumar S, Karekezi C, Vaughan K, Garcia RM, Abou El Ela Bourquin B, Derkaoui Hassani F, Alamri A, Mentri N, Höhne J, Laeke T, Al-Jehani H, Moscote-Salazar LR, Al-Ahmari AN, Samprón N, Stienen MN, Nicolosi F, Fontoura Solla DJ, Adelson PD, Servadei F, Al-Habib A, Esene I, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery. World Neurosurg X 2020; 8:100084. [PMID: 33103110 PMCID: PMC7573643 DOI: 10.1016/j.wnsx.2020.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. METHODS An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. RESULTS In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. CONCLUSIONS Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.
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Affiliation(s)
- Faith C. Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Tsegazeab Laeke
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - Martin N. Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | | | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ignatius Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke’s Hospital, Cambridge, United Kingdom
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Gnanakumar S, Abou El Ela Bourquin B, Robertson FC, Solla DJF, Karekezi C, Vaughan K, Garcia RM, Hassani FD, Alamri A, Höhne J, Mentri N, Stienen M, Laeke T, Moscote-Salazar LR, Al-Ahmari AN, Al-Jehani H, Nicolosi F, Samprón N, Adelson PD, Servadei F, Esene IN, Al-Habib A, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. World Neurosurg X 2020; 8:100083. [PMID: 33103109 PMCID: PMC7573644 DOI: 10.1016/j.wnsx.2020.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. METHODS This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. RESULTS There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. CONCLUSIONS These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.
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Affiliation(s)
- Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Faith C. Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Martin Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Tsegazeab Laeke
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Ignatius N. Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
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