Preresidency Publication Productivity of U.S. Neurosurgery Interns

BACKGROUND

Research experience is believed to be an important component of the neurosurgery residency application process. One measure of research productivity is publication volume. The preresidency publication volume of U.S. neurosurgery interns and any potential association between applicant publication volume and the match results of top-ranked residency programs have not been well characterized.

OBJECTIVE

In this study, we sought to characterize the preresidency publication volume of U.S. neurosurgery residents in the 2018-2019 intern class using the Scopus database.

METHODS

For each intern, we recorded the total number of publications, total number of first or last author publications, total number of neuroscience-related publications, mean number of citations per publication, and mean impact factor of the journal per publication. Preresidency publication volumes of interns at the top-25 programs (based on a composite ranking score according to 4 different ranking metrics) were compared with those at all other programs.

RESULTS

We found that 82% of neurosurgery interns included in the analysis (190 interns from 95 programs) had at least 1 publication. The average number of publications per intern among all programs was 6 ± 0.63 (mean ± standard error of the mean). We also found that interns at top-25 neurosurgery residency programs tended to have a higher number of publications (8.3 ± 1.2 vs. 4.8 ± 0.7, P = 0.0137), number of neuroscience-related publications (6.8 ± 1.1 vs. 4.1 ± 0.7, P = 0.0419), and mean number of citations per publication (9.8 ± 1.7 vs. 5.7 ± 0.8, P = 0.0267) compared with interns at all other programs.

CONCLUSIONS

Our results provide a general estimate of the preresidency publication volume of U.S. neurosurgery interns and suggest a potential association between publication volume and matching in the top-25 neurosurgery residency programs.

Short-term reproducibility over time of right ventricular pulse pressure as a potential hemodynamic sensor for ventricular tachyarrhythmias

The implantable cardioverter defibrillator (ICD) has been shown to effectively terminate episodes of ventricular tachyarrhythmias. Multiple investigators have suggested that the incorporation of hemodynamic sensors may allow ICDs to differentiate between hemodynamically unstable and stable ventricular tachyarrhythmias (VT), as well as differentiate ventricular from supraventricular tachycardias. Right ventricular (RV) pulse pressure has been shown to possess acceptable characteristics as a sensor for incorporation in ICDs. We sought to determine the short-term reproducibility of RV pulse pressure measurements by comparing RV pulse pressure measured during two separate episodes of VT in each of ten study patients. The mean VT cycle length for VT episode 1 was 293 +/- 15 msec, and was 298 +/- 15 msec for VT episode 2 (P = NS). The decrease in mean arterial pressure was 40 +/- 7 mmHg in episode 1 and 37 +/- 7 mmHg in episode 2 (P = NS). The decrease in RV pulse pressure during episode 1 was -13 +/- 2 mmHg, and -12 +/- 2 during episode 2 (P = NS). The decrease in RV pulse pressure during episodes of VT at two different times during a single electrophysiology study is highly reproducible, suggesting that RV pulse pressure may be a reliable sensor over time.

Comparison of right ventricular impedance, pulse pressure and maximal dP/dt for determination of hemodynamic stability of ventricular arrhythmias associated with coronary artery disease

By monitoring hemodynamic parameters, a future generation of automatic implantable defibrillators will provide tiered therapy of ventricular arrhythmias according to the associated hemodynamic compromise. Changes in intracardiac impedance permit beat-to-beat assessment of ventricular volumes and make this parameter attractive as a rapid discriminator of hemodynamic compromise during arrhythmias. Beat-to-beat changes in right ventricular (RV) impedance were measured before, during and after 27 episodes of ventricular tachyarrhythmias induced in 17 men (64 +/- 7 years, mean +/- standard deviation; left ventricular ejection fraction 41 +/- 11%). Impedance was measured using a tripolar lead system and was compared to ventricular tachycardia cycle length, RV pulse pressure and maximum systolic RV dP/dt as indicators of systemic hemodynamic compromise. The average decreases in systolic blood pressure and mean arterial pressure during ventricular tachycardia were 48 +/- 23% and 46 +/- 26%, respectively (mean +/- standard deviation; p less than 0.001 for each). Right ventricular impedance decreased an average 39 +/- 22% from its baseline value (p less than 0.001) during ventricular tachycardia. The percent change in impedance from baseline during ventricular tachycardia correlated significantly with the percent decrease in systolic and mean arterial pressure (r = 0.45 and 0.42, respectively; both p less than 0.05). Right ventricular dP/dt correlated the most poorly of all parameters with changes in blood pressure while impedance X RV pulse pressure correlated best with changes in mean and systolic pressure (r greater than or equal to 0.82, p less than 0.001).

Usefulness of right ventricular pulse pressure as a potential sensor for hemodynamically unstable ventricular tachycardia

The automatic implantable cardioverter defibrillator has had a major impact on the management of patients with ventricular tachyarrhythmias. Future devices will offer tiered therapy for ventricular arrhythmias, based on a sensor capable of discriminating hemodynamically stable from unstable ventricular tachycardia (VT). We studied 27 patients with sustained VT/ventricular fibrillation during 70 episodes of sustained ventricular arrhythmias (greater than 30 seconds or requiring cardioversion). In this study, phasic arterial pressure (mm Hg), VT cycle length (ms) and right ventricular (RV) pulse pressure (mm Hg) were measured before, during the first 30 beats and after each episode of VT. During the first 10 beats of 23 episodes of unstable VT, the mean (+/- standard error of the mean) decrease in RV pulse pressure from baseline was 22 +/- 1.8 mm Hg; it was 13.8 +/- 2.4 mm Hg during the first 10 beats of 47 episodes of stable VT, (p = 0.01, stable vs unstable). For the next 20 beats of VT, RV pulse pressure decreased from baseline by 22 +/- 2.5 mm Hg during unstable and by 12.0 +/- 2.5 mm Hg during stable VT (p = 0.0001, stable vs unstable). The percent decrease of RV pulse pressure correlated well with the percent decrease in mean arterial pressure and percent decrease in systolic arterial pressure (r = 0.70; r = 0.69, respectively; p less than 0.001) during VT, but poorly with the VT cycle length (r = 0.27, p less than 0.05). The percent decrease in RV pulse pressure is a useful hemodynamic sensor for discriminating between stable and unstable VT.