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Sample records for surgical specialties neurosurgery

  1. Career satisfaction of surgical specialties.

    Science.gov (United States)

    Deshpande, Satish P; Deshpande, Sagar S

    2011-05-01

    To examine the factors that impact career satisfaction for various surgical specialties. An acute shortage of surgeons is anticipated in the future. Career dissatisfaction can make this already difficult situation worse. It is important to understand and address factors that influence career satisfaction of surgeons to prolong tenure of existing surgeons and understand anticipated needs of future surgeons. The Center for Studying Health System Change 2008 Health Tracking Physician Survey data were used in this study. Regression analysis was done to examine the impact of various practice-related factors, compensation-related factors, practice location, extent of minority patient, and various demographics on career satisfaction of various surgical specialties (n = 762). Among practice related factors, although threat of malpractice had a significant negative impact on career satisfaction, ability to provide quality care to patients and time with patients had a significant positive impact on career satisfaction of surgical specialists. Among compensation related factors, income and financial incentives to expand services had a significant positive impact on career satisfaction. Among practice location factors, those who primarily worked in medical schools were significantly more satisfied with their careers than others. Among minority factors, those treating a large proportion of Hispanic patients were significantly less likely to be satisfied with their careers. Ability to provide quality care, time with patients, income, and financial incentives had a significant positive impact on career satisfaction. Similarly, threat of malpractice and high proportion of Hispanic patients had a negative impact on career satisfaction.

  2. Operative Duration and Risk of Surgical Site Infection in Neurosurgery.

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    Bekelis, Kimon; Coy, Shannon; Simmons, Nathan

    2016-10-01

    The association of surgical duration with the risk of surgical site infection (SSI) has not been quantified in neurosurgery. We investigated the association of operative duration in neurosurgical procedures with the incidence of SSI. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. To control for confounding, we used multivariable regression models and propensity score conditioning. During the study period there were 94,744 patients who underwent a neurosurgical procedure and met the inclusion criteria. Of these patients, 4.1% developed a postoperative SSI within 30 days. Multivariable logistic regression showed an association between longer operative duration with higher incidence of SSI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16-1.20). Compared with procedures of moderate duration (third quintile, 40th-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 2.07; 95% CI, 1.86-2.31) of developing SSI. The shortest procedures (surgical registry, longer operative duration was associated with increased incidence of SSI for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management and to stratify patients with regard to SSI risk. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Pediatric neurosurgery: pride and prejudice.

    Science.gov (United States)

    Winston, K R

    2000-02-01

    Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

  4. NEUROSURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Two hundred and ten patients with hyper-tensive cerebral and cerebellar haemorrhagewere surgically treated with four patterns. Thepreoperative status graded as Ⅰ~Ⅴ stageswas improved among 151 cases, and 59 cases(28.0%) died. The authors concluded that indi-vidualized selection of available surgical pat-tern combined with CT findings according to

  5. Students to Surgeons: Increasing Matriculation in Surgical Specialties.

    Science.gov (United States)

    Grover, Karan; Agarwal, Prateek; Agarwal, Nitin; Tabakin, Marcia D; Swan, Kenneth G

    2016-12-01

    Introduction Our nation suffers from a shortage in surgeons. This deficiency must be addressed at the medical student level. Increasing faculty and resident interaction with junior students augments surgical interest. Our surgical interest group has recently redefined its role to address these concerns. Methods A multifocal approach has been implemented to increase interest in the surgical specialties. Each academic year, senior students recruit first and second year students to our group to establish early exposure. Members receive didactic presentations from surgical faculty, addressing various topics, on a biweekly basis. In addition, scrubbing, knot-tying, and suturing workshops address technical skills throughout the semester. Membership and match data were collated and analyzed. Results Over the past 5 years, the enrollment in the student interest group increased significantly from 112 to 150. Accordingly, we have observed a parallel increase in the number of students who have successfully matched into surgical residencies. A record number of students (37) from the class of 2013 matched into surgical specialties, representing an 85% increase over the last decade. After creating bylaws and electing societal officers, the group has been recognized by the school's Student Council and given financial support. At present, the group is fiscally solvent with support from the institution, surgery department, and faculty. Conclusion As the demand for surgeons increases so too does the need to increase student interest in surgery. Our school has been successful because of our surgical interest group, and we encourage other schools to adopt a similar approach. © The Author(s) 2016.

  6. Personality predictors of surgical specialties choice among students of nursing

    Directory of Open Access Journals (Sweden)

    Dorota Turska

    2017-01-01

    Full Text Available Background Holland’s theory of congruence, according to which one’s career choice is an expression of personality traits common to a given profession, constitutes a theoretical background for this research. The construct of the Distinct Surgical Personality (DSP is an exemplification of the idea of a congruent match between one’s personality and the requirements of the medical environment. In previous studies the authors revised their proposition concerning the DSP concept to include not only personality traits but also preferred values. This paper aims at verifying the proposition that this concept may also refer to students of nursing who select surgical specialties. Participants and procedure The study involved 163 students of nursing at the Medical University of Lublin aged 21-29 (M = 23.19, SD = 3.67. Students who opted for surgical specialities constituted the criterion group (N = 98. The study employed the Polish versions of the Personality Inventory NEO-FFI and the Schwartz Value Survey. Results There are two significant predictors of surgical specialties choice in nursing: a higher-level value of openness to change and extraversion. The tested model, which incorporates personality traits and preferred values, has proved congruent with the data, and allows for the proper classification of 79% of students who declared surgical specialties. Conclusions The results suggest the existence of a specific personality of surgical nurses. While clear adaptability to the specific environment has been determined, there are differences with respect to the concept of DSP, referring to doctors, widely discussed in the literature. In both cases these constructs look different, and are dependent on various types of professional activities within the therapeutic team.

  7. Risk of facial splashes in four major surgical specialties in a multicentre study.

    Science.gov (United States)

    Endo, S; Kanemitsu, K; Ishii, H; Narita, M; Nemoto, T; Yaginuma, G; Mikami, Y; Unno, M; Hen, R; Tabayashi, K; Matsushima, T; Kunishima, H; Kaku, M

    2007-09-01

    This study analyses the results of face-shield blood spatter contamination at six medical facilities to determine exposure risk when facial protection is not used. Blood spatter exposure was evaluated on the basis of overall incidence, location of spatter on face shields, surgical specialty, risk for operating room staff, length of surgery and volume of blood loss. Six hundred face shields were evaluated for blood spatter contamination by visual inspection as well as by staining with leucomalachite green. The face shield was divided into three regions: Orbital (O-region), Paraorbital (P-region) and Mask (M-region). Visual examination detected blood spatter contamination in 50.5% (303/600) of the face shields, whereas leucomalachite green staining detected blood contamination in 66.0% (396/600). Blood contamination was 36.6% (220/600) in the O-region, 37.8% (227/600) in the P-region and 57.0% (342/600) in the M-region. Among operating room staff, the incidence of blood spatter was greatest among lead surgeons at 83.5% (167/200), followed by the first assistant at 68.5% (137/200) and the scrub nurse at 46.0% (92/200). By specialty, cardiovascular surgery was at highest risk with an incidence of 75.3% (113/150) followed by neurosurgery at 69.3% (104/150), gastrointestinal at 60.0% (90/150) and orthopaedic surgery at 60.0% (90/150).

  8. Reconfigurable MRI-guided robotic surgical manipulator: prostate brachytherapy and neurosurgery applications.

    Science.gov (United States)

    Su, Hao; Iordachita, Iulian I; Yan, Xiaoan; Cole, Gregory A; Fischer, Gregory S

    2011-01-01

    This paper describes a modular design approach for robotic surgical manipulator under magnetic resonance imaging (MRI) guidance. The proposed manipulator provides 2 degree of freedom (DOF) Cartesian motion and 2-DOF pitch and yaw motion. Primarily built up with dielectric materials, it utilizes parallel mechanism and is compact in size to fit into the limited space of close-bore MRI scanner. It is ideal for needle based surgical procedures which usually require positioning and orientation control for accurate imaging plane alignment. Specifically, this mechanism is easily reconfigurable to over constrained manipulator structure which provides 2-DOF Cartesian motion by simple structure modification. This modular manipulator integrated with different end-effector modules is investigated for prostate brachytherapy and neurosurgery applications as preliminary evaluation.

  9. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

    Science.gov (United States)

    Sherrod, Brandon A.; Rocque, Brandon G.

    2017-01-01

    Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

  10. Sub-specialty training in head and neck surgical oncology in the European Union.

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    Manganaris, Argyris; Black, Myles; Balfour, Alistair; Hartley, Christopher; Jeannon, Jean-Pierre; Simo, Ricard

    2009-07-01

    Sub-specialty training in otorhinolaryngology and head and neck surgery (ORL-HNS) is not standardised across European Union (EU) states and remains diverse. The objective of this study was to assess the current status of sub-specialty training programmes in head and neck surgical oncology within the European Union (EU-15). A postal questionnaire was distributed to 41 representative members of the European Federation of Otorhinolaryngological Societies (EUFOS) in the specialty of ORL-HNS in 15 EU states. The questionnaire included questions regarding the sub-specialty practice, structure, length, access, examination procedures and certification, future developments and also a space for individual comments. Thirty-one respondents (75.6%) from major training centres in 15 different European countries replied. Overall, the data revealed major diversity for all aspects analysed, between and within the different European countries. Only four EU states had formal sub-specialty training in head and neck surgical oncology. This includes Finland, Germany, The Netherlands, and the United Kingdom. In the rest of EU states, the last year of residency programmes is often spent as an introduction to one of the sub-specialties. Sub-specialty training in head and neck surgical oncology within the EU at present is clearly underdeveloped. Issuing a European diploma in ORL-HNS could be an initial step towards assessing the skills acquired during specialist training within the different European countries and formalising specialist training. This would establish a uniform measure for evaluating candidacy for sub-specialty training both across the EU and for USA, Canada or Australia.

  11. Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

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    Davies, B M; Patel, H C

    2016-07-01

    Introduction Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. Methods We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination. Results SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02-0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24-1.5). Conclusions Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

  12. Factors Influencing the Selection of Surgical Specialty among Pakistani Medical Graduates

    Directory of Open Access Journals (Sweden)

    Avan B

    2003-01-01

    Full Text Available CONTEXT: The delineation between selection of surgery and non-surgery residency programmes could provide a pragmatic view of the influences on medical graduates' careers. This would also help coordinators and educators of residency programmes in surgery to further understand the dynamics of specialty selection. AIMS: To identify the different factors that influence the graduates to select surgical specialties in Pakistan. SETTINGS AND DESIGNS: A cross-sectional survey was conducted in 4 teaching hospitals of Karachi between July 1999 and January 2001. SUBJECTS and METHODS: A total of 455 residents in 1-5 years of residency programmes were contacted. Three hundred and forty-one residents consented to the interview. Residents who were registered both with the College of Physicians and Surgeons of Pakistan (CPSP and the Post Graduate Medical Education (PGME office of the selected hospitals were included in this study. STATISTICAL METHOD USED: Logistic regression analysis. RESULTS: Final multivariate analysis identified 4 factors that remained significantly associated with the selection of surgical specialty: deriving gratification from direct patient care (adjusted odds ratio [aOR] = 5.79; 95% confidence interval [CI]: 1.24, 26.99, procedure-based medical practice (aOR = 2.85; 95% CI: 1.23, 6.61, nature of clinical problems (aOR = 3.39; 95% CI: 1.47, 7.84, and lack of consideration of stress during professional work (aOR = 2.27, 95%CI: 1.25, 4.13. CONCLUSIONS: Direct patient care is perceived to be an integral part of surgery residency and immediate patient outcome is a positive influence in selecting surgical specialty. The inclination towards surgery appeared to be determined by the type of procedures and technical skills involved in its practice. The nature of clinical problems is an important determinant of the choice of specialty. Stress was not perceived to be an important influencing factor for those who decided to select surgical

  13. [Personality of medical students declaring surgical specialty choice in the context of prospective medical practice style].

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    Skrzypek, Michał; Turska, Dorota

    2015-01-01

    Specialty choice made by medical students takes into account the nature of future medical practice. Holland's congruence theory, according to which career choice is treated as an expression of personality characteristics common for all representatives of the same profession, has served as a theoretical background for own research on the subject matter. Spectacular exemplification of fit between mental resources--personality characteristics and working environment requirements, is the concept of distinct surgical personality (DSP), widely discussed in worldwide literature of the subject (although not in native one). The article offers an author's broadened perception of DSP conception encompassing not only personality characteristics, but also values preference. The research aims at verifying the hypothesis that a given personality constellation directs the choice of surgery as a prospective specialty made by medical students, as well as allows predicting the style of future vocational practice, characterized by dominant instrumental activities, with little emphasis on affective medical actions, typical for technique-oriented specialties. The study involved a total of 223 students of fourth year of medical studies at Medical University of Lublin. Students declaring their choice of surgical specialty constituted the criterion group (N = 93). The control group comprised of students who declared their choice of person-oriented specialties, aimed at work with patient approached holistically (N = 75), in accordance with dichotomous specialty division adopted for the research purposes. Polish adaptations of NEO Five-Factor Inventory (NEO-FFI) by Costa and McCrae and Schwartz Value Survey were applied. The use of multivariate logistic regression indicates three crucial predictions of surgical specialty choice: 'neuroticism' and 'agreeableness' (personality trials-negative predictors) and 'self-enhancement' (value meta-category - positive predictors), however the latter

  14. Surgical Specialty Residents More Likely to Receive the Arnold P. Gold Humanism and Excellence in Teaching Award.

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    Falcone, John L

    2015-01-01

    The Arnold P. Gold Humanism and Excellence in Teaching Awards are given by medical students to residents. The aim of this study is to evaluate the distribution of this award based on residency specialty. The hypothesis is that surgical residents more commonly receive this award. This was a retrospective study from 2004 to 2013. All award recipients were obtained from the Arnold P. Gold Foundation website. The specialties of award recipients were tabulated. The number of award winners per thousand specialty residents was estimated using the Accreditation Council for Graduate Medical Education Data Resource Book, adjusting for the number of awarding schools and resident specialties. All statistics used an α = 0.05. There were 2489 awards given during the study period, with 52.6% in medical specialties and 47.4% in surgical specialties (p = 0.45). The specialties most commonly awarded were General Surgery (22.3%), Internal Medicine (20.9%), and Obstetrics/Gynecology (20.4%). Adjusting for the number of eligible residents, there were 59.9 awards/1000 Obstetrics/Gynecology residents, 43.1 awards/1000 General Surgery residents, and 20.2 awards/1000 Internal Medicine residents (p Humanism and Excellence in Teaching Awards are more commonly given to surgical specialty residents. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Professional burnout syndrome in doctors of surgical specialties in Ukraine: causes, consequences, labor optimization ways.

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    Skurupii, Dmytro A; Kholod, Dmytro A; Sonnik, Evgen G

    The professional burnout syndrome (PBS) affects quality of medical care provision for people, which is acquires the special actuality in terms of reforming the health care system. To study ways to improve the efficiency of doctors of surgical specialties based on analyzes of PBS and its consequences. A survey of psychological tests and 62 surgical doctors was carried out. It was found out that the PBS reaches a peak after 11 to 15 years of working experience. Anesthesiologists have high levels of PBS, emotional exhaustion, cynicism, low desire for career growth, frequent misunderstanding with the administration, they prefer 8-hour working day, and relieve stress by sleeping and consuming alcohol. Obstetrician-gynecologists show moderate level of PBS and emotional exhaustion, high degree of cynicism, strong desire for career growth, frequent misunderstandings with patients and their relatives, prefer 8-hour working day, relieve stress by smoking and socializing with family and friends. Traumatic surgeons have moderate level of PBS, emotional exhaustion, high degree of cynicism, strong desire for career growth, frequent misunderstandings with their colleagues of related specialties, prefer the 24-hour working day, and reli eve their stress with alcohol and sports. Surgeons have moderate level of PBS, emotional exhaustion, low degree of cynicism, moderate desire for career growth, frequent misunderstandings with their colleagues of related specialties, prefer the 8-hour working day, and relieve stress by smoking and sleeping. PBS is most expressed in doctors having working experience of 11 to 15 years and in anesthesiologists. They get professional deformations. These features should be considered in course of organization of working process of medical teams.

  16. Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.

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    Leroux, Eric J; Morton, John M; Rivas, Homero

    2014-08-01

    To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

  17. Assessment of operative times of multiple surgical specialties in a public university hospital.

    Science.gov (United States)

    Costa, Altair da Silva

    2017-01-01

    To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urg

  18. Use of Google Glass to Enhance Surgical Education of Neurosurgery Residents: "Proof-of-Concept" Study.

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    Nakhla, Jonathan; Kobets, Andrew; De la Garza Ramos, Rafeal; Haranhalli, Neil; Gelfand, Yaroslav; Ammar, Adam; Echt, Murray; Scoco, Aleka; Kinon, Merritt; Yassari, Reza

    2017-02-01

    The relatively decreased time spent in the operating room and overall reduction in cases performed by neurosurgical trainees as a result of duty-hour restrictions demands that the pedagogical content within each surgical encounter be maximized and crafted toward the specific talents and shortcomings of the individual. It is imperative to future generations that the quality of training adapts to the changing administrative infrastructures and compensates for anything that may compromise the technical abilities of trainees. Neurosurgeons in teaching hospitals continue to experiment with various emerging technologies-such as simulators and virtual presence-to supplement and improve surgical training. The authors participated in the Google Glass Explorer Program in order to assess the applicability of Google Glass as a tool to enhance the operative education of neurosurgical residents. Google Glass is a type of wearable technology in the form of eyeglasses that employs a high-definition camera and allows the user to interact using voice commands. Google Glass was able to effectively capture video segments of various lengths for residents to review in a variety of clinical settings within a large, tertiary care university hospital, as well as during a surgical mission to a developing country. The resolution and quality of the video were adequate to review and use as a teaching tool. While Google Glass harbors the potential to dramatically improve both neurosurgical education and practice in a variety of ways, certain technical drawbacks of the current model limit its effectiveness as a teaching tool. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. [Usefulness of an online education platform for the medical and surgical emergencies specialty in Mexico].

    Science.gov (United States)

    Loria-Castellanos, Jorge

    2014-01-01

    Determine the usefulness of a Moodle-type education platform for knowledge development with residents in the medical and surgical emergencies (MSE) specialty. This quasi-experimental study compared the departmental evaluations of MSE residents in two Mexican hospital units after they did their academic work using different educational strategies. The control group used a traditional format (classroom-style teaching with guided discussion), while the comparison group had access to a variety of resources (forums, chat, wikis, downloaded files) on a Moodle-type platform. Nonparametric statistics were used. The study was conducted during the 2010 - 2011 and 2011 - 2012 academic years. Three versions of the course were made available online, geared to the academic level of the residents (first, second, or third year). There were statistically significant differences in the mid-year evaluations, and improvements were even greater in the evaluations at the end of the academic year, especially for the third-year residents. In both academic years, the mid-year evaluations reported that only one resident in the control group performed within the average range, while the majority were in the lower range. The resources most used with the platform Moodle were downloaded files (77%) and the forum (63%). Still, 46.4% of the residents said that they encountered some type of limitation when they used the platform, the main one being lack of time (76.9%). The Moodle-type education platform appears to be useful and to offer greater opportunities for knowledge development compared with the traditional strategies. It is recommended that educational strategies based on Moodle-type platforms be implemented for MSE and other medical specialties.

  20. Neurosurgery in Egypt: past, present, and future-from pyramids to radiosurgery.

    Science.gov (United States)

    El Gindi, Sayed

    2002-09-01

    THE CONTEMPORARY DEVELOPMENT of neurosurgery in Egypt is described, with reference to the ancient past and recent American and European influences. This article traces the steps taken by several leading Egyptian pioneers. Egypt, one of the key countries in the Middle East, has led the development of the specialty in the region and has maintained close ties with the international body of neurological surgeons and surgical societies.

  1. History of Neurosurgery in Palestine.

    Science.gov (United States)

    Darwazeh, Rami; Darwazeh, Mazhar; Sun, Xiaochuan

    2017-08-01

    Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. We collected information from various sources in either English or Arabic. The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Compassion Fatigue is Similar in Emergency Medicine Residents Compared to other Medical and Surgical Specialties

    Science.gov (United States)

    Bellolio, M. Fernanda; Cabrera, Daniel; Sadosty, Annie T.; Hess, Erik P.; Campbell, Ronna L.; Lohse, Christine M.; Sunga, Karmen L.

    2014-01-01

    Introduction Compassion fatigue (CF) is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM) resident physicians, including an assessment of contributing factors. Methods We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress), with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013), or did not work overnight (mean score 23.5 vs 21.3; p=0.022). EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048), and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012). Conclusion CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily night shifts and

  3. Compassion Fatigue is Similar in Emergency Medicine Residents Compared to other Medical and Surgical Specialties

    Directory of Open Access Journals (Sweden)

    M. Fernanda Bellolio

    2014-09-01

    Full Text Available Introduction: Compassion fatigue (CF is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM resident physicians, including an assessment of contributing factors. Methods: We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress, with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results: We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013, or did not work overnight (mean score 23.5 vs 21.3; p=0.022. EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048, and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012. Conclusion: CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily

  4. Slower Walking Speed Forecasts Increased Postoperative Morbidity and One-Year Mortality Across Surgical Specialties

    Science.gov (United States)

    Robinson, Thomas N; Wu, Daniel S; Sauaia, Angela; Dunn, Christina L; Stevens-Lapsley, Jennifer E; Moss, Marc; Stiegmann, Greg V; Gajdos, Csaba; Cleveland, Joseph C; Inouye, Sharon K

    2013-01-01

    Objective The purpose of this study was to determine the relationship between the timed up-and-go test and postoperative morbidity and one-year mortality, and to compare the timed up-and-go to the standard-of-care surgical risk calculators for prediction of postoperative complications. Methods In this prospective cohort study, patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of one-year follow-up were included. The timed up-and-go test was performed preoperatively. This timed test starts with the subject standing from a chair, walking ten feet, returning to the chair, and ends after the subject sits. Timed up-and-go results were grouped: Fast≤10 sec, Intermediate=11-14 sec, Slow≥15 sec. Receiver operating characteristic curves were used to compare the three timed-up-and-go groups to current standard-of-care surgical risk calculators at forecasting postoperative complications. Results This study included 272 subjects (mean age of 74±6 years). Slower timed up-and-go was associated with an increased postoperative complications following colorectal (fast-13%, intermediate-29% and slow-77%;ptimed up-and-go was associated with increased one-year mortality following both colorectal (fast-3%, intermediate-10% and slow-31%;p=0.006) and cardiac (fast-2%, intermediate-3% and slow-12%;p=0.039) operations. Receiver operating characteristic area under curve of the timed up-and-go and the risk calculators for the colorectal group was 0.775 (95% CI:0.670,0.880) and 0.554 (95% CI:0.499,0.609), and for the cardiac group was 0.684 (95% CI:0.603,0.766) and 0.552 (95% CI:0.477,0.626). Conclusions Slower timed up-and-go forecasted increased postoperative complications and one-year mortality across surgical specialties. Regardless of operation performed, the timed up-and-go compared favorably to the more complex risk calculators at forecasting postoperative complications. PMID:23979272

  5. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery

    Science.gov (United States)

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises. PMID:27445707

  6. Current Applications and Future Perspectives of the Use of 3D Printing in Anatomical Training and Neurosurgery.

    Science.gov (United States)

    Baskaran, Vivek; Štrkalj, Goran; Štrkalj, Mirjana; Di Ieva, Antonio

    2016-01-01

    3D printing is a form of rapid prototyping technology, which has led to innovative new applications in biomedicine. It facilitates the production of highly accurate three dimensional objects from substrate materials. The inherent accuracy and other properties of 3D printing have allowed it to have exciting applications in anatomy education and surgery, with the specialty of neurosurgery having benefited particularly well. This article presents the findings of a literature review of the Pubmed and Web of Science databases investigating the applications of 3D printing in anatomy and surgical education, and neurosurgery. A number of applications within these fields were found, with many significantly improving the quality of anatomy and surgical education, and the practice of neurosurgery. They also offered advantages over existing approaches and practices. It is envisaged that the number of useful applications will rise in the coming years, particularly as the costs of this technology decrease and its uptake rises.

  7. Robotics and neurosurgery.

    Science.gov (United States)

    Nathoo, Narendra; Pesek, Todd; Barnett, Gene H

    2003-12-01

    Ultimately, neurosurgery performed via a robotic interface will serve to improve the standard of a neurosurgeon's skills, thus making a good surgeon a better surgeon. In fact, computer and robotic instrumentation will become allies to the neurosurgeon through the use of these technologies in training, diagnostic, and surgical events. Nonetheless, these technologies are still in an early stage of development, and each device developed will entail its own set of challenges and limitations for use in clinical settings. The future operating room should be regarded as an integrated information system incorporating robotic surgical navigators and telecontrolled micromanipulators, with the capabilities of all principal neurosurgical concepts, sharing information, and under the control of a single person, the neurosurgeon. The eventual integration of robotic technology into mainstream clinical neurosurgery offers the promise of a future of safer, more accurate, and less invasive surgery that will result in improved patient outcome.

  8. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  9. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  10. Historical perspective on neurosurgery in Germany after World War II.

    Science.gov (United States)

    Collmann, Hartmut; Vitzthum, Hans-Ekkehart

    2008-11-01

    AFTER THE COLLAPSE of the Third Reich, the specialty of neurosurgery in Germany, although well developed in the late 1930s, had to start anew, and for decades to come, had to deal with the physical and political consequences of World War II. Because of the division of the country, neurosurgery developed separately in the two independent states. In West Germany, the evolution was promoted by a few personalities who represented different schools according to their own training: these "surgical neurologists" emphasized the neurological basis of neurosurgery and were represented by Traugott Riechert and the students of Otfrid Foerster, such as Arist Stender and Hans Kuhlendahl. In contrast, the "neurological surgeons" stressed their origins in general surgery. Their main proponent was Wilhelm Tönnis, who gained particular merit for promoting neurosurgical teaching, the development of new neurosurgical units, and the recognition of neurosurgery as an autonomous specialty. In East Germany, progress was delayed by a weak economy and a repressive political system. Yet several excellent neurosurgeons won international recognition, predominantly Georg Merrem, who came from the school of Fedor Krause. Following a worldwide trend, the number of neurosurgical units in West Germany increased dramatically from 18 in 1950 to 85 in 1988. In 2006, in the unified nation, 1200 certified neurosurgeons in 138 hospital departments and 75 private practices served 82 million people. Since its founding in 1949, the German Neurosurgical Society has promoted the idea of reconciliation and has focused on international collaboration in both science and education. This idea, shared by other European nations, eventually gave rise to the European Association of Neurosurgical Societies. At present, escalating costs in the health sector pose a problem to neurosurgical services and have led to reconsiderations about their structure and financing.

  11. Improving the communication between teams managing boarded patients on a surgical specialty ward

    Science.gov (United States)

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

    Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope

  12. Improving the communication between teams managing boarded patients on a surgical specialty ward.

    Science.gov (United States)

    Puvaneswaralingam, Shobitha; Ross, Daniella

    2016-01-01

    Transferring patients from the ward of their specialty or consultant is described as boarding. 1 Boarding patients is becoming increasingly prevalent due to greater pressure on hospital capacity. This practice compromises patient safety through delayed investigations, prolonged hospital stays, and increased risk of hospital-acquired infections. 1 2 We evaluated how regularly boarded patients were reviewed, and how effectively information regarding their management was communicated from their primary specialty to ward staff. We aimed to improve the frequency of patient reviews by ensuring that each patient was reviewed every weekday and increase communication between primary specialty, and medical and nursing teams by 20% from baseline during the data collection period. The project was based in the Otolaryngology ward in Ninewells Hospital, Dundee, where there was a high prevalence of boarded patients. Baseline data showed a clear deficit in communication between the primary specialty and ward staff with only 31% of patient reviews being communicated to ward doctors. We designed and implemented a communication tool, in the form of a sticker, to be inserted into patients' medical notes for use by the primary specialty. Implementation of the sticker improved communication between teams as stickers were completed in 93% of instances. In 88% of patient reviews, the junior doctor was informed of the management plan, showing a large increase from baseline. Through PDSA cycles, we aimed to increase the sustainability and reliability of the sticker; however, we faced challenges with sustainability of sticker insertion. We aim to engage more stakeholders to raise awareness of the problem, brainstorm solutions together, and review the production and implementation of stickers with senior hospital management to discuss the potential use of this tool within practice. There is potentially a large scope for utilisation of this communication tool on a local level, which we hope

  13. Neurosurgery in Lebanon: History, Development, and Future Challenges.

    Science.gov (United States)

    Fares, Youssef; Fares, Jawad

    2017-03-01

    Lebanon stands out as the one of the first countries in the Middle East and the Arab world to practice the medical specialty of neurosurgery. In addition, Lebanon has one of the best reputations for neurosurgery in this region. This article documents the history and current status of Lebanese neurosurgery. Residency and fellowship trainings are also highlighted, and political, socioeconomic, and academic challenges for the future of the profession are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery.

    Science.gov (United States)

    Lepänluoma, M; Takala, R; Kotkansalo, A; Rahi, M; Ikonen, T S

    2014-03-01

    The World Health Organization's surgical safety checklist is designed to improve adherence to operating room safety standards, and its use has been shown to reduce complications among surgical patients. The objective of our study was to assess the impact of the implementation of the checklist on safety-related issues in the operating room and on postoperative adverse events in neurosurgery. From structured questionnaires delivered to operating room personnel, answers were analyzed to evaluate communication and safety-related issues during 89 and 73 neurosurgical operations before and after the checklist implementation, respectively. From the analyzed operations, 83 and 67 patients, respectively, were included in a retrospective analysis of electronic patient records to compare the length of hospital stay, reported adverse events, and readmissions. In addition, the consistency of operating room documentation and patient records was assessed. Communication between the surgeon and the anesthesiologist was enhanced, and safety-related issues were better covered when the checklist was used. Unplanned readmissions fell from 25% to 10% after the checklist implementation (p = 0.02). Wound complications decreased from 19% to 8% (p = 0.04). The consistency of documentation of the diagnosis and the procedure improved. The use of the checklist improved safety-related performance and, contemporarily, reduced numbers of wound complications, and readmissions were observed.

  15. Application and evaluation of improved surgical aseptic technique curriculum in specialty nurse training in Henan Province

    Directory of Open Access Journals (Sweden)

    Bing Bai

    2016-09-01

    Conclusion: Novel surgical aseptic technique and application in the curriculum design of training for OR nurses should be developed to enhance their mastery of theoretical and practical skills and to modify their behaviors.

  16. The development of neurosurgery at the National Hospital for Neurology and Neurosurgery, Queen Square, London, England.

    Science.gov (United States)

    Powell, Michael; Kitchen, Neil

    2007-11-01

    The National Hospital for Neurology and Neurosurgery, Queen Square, London is one of the oldest clinical neuroscience hospitals in the world. It was formed from the fusion of itself with the Maida Vale Hospital in 1948. More recently, in 1996, it was incorporated into the University College London Hospitals group. It has had many distinguished neurosurgeons on its staff, whose history from Sir Victor Horsley to the present is described with particular reference to the development of the specialty of neurosurgery. The current neurosurgical staff and future developments of neurosurgery at the hospital are also elucidated.

  17. Robotics in child neurosurgery.

    Science.gov (United States)

    Giorgi, C; Sala, R; Riva, D; Cossu, A; Eisenberg, H

    2000-11-01

    We felt there was a need for a new device with "minimal invasive" tracking hardware, to be used in image-guided neurosurgery, and the system we designed to fill this need is now presented. It combines precision of movement, stability and self-positioning capabilities together with optically tracked registration and procedural control within the structure of a surgical microscope. The results are reduced setup time and minimal "distraction" from the procedure itself, factors of special relevance in child neurosurgery. The system is composed of a six-axis industrial robot suitable for use in the operating room, carrying a surgical microscope. Three progressive scan-synchronized infrared cameras mounted around the lenses of the scope are used to register the patient's position and track surgical instruments with reference to the registered space. Orientation of the microscope during surgery is obtained with a six-axis joystick used as a microscope handle. The system has been clinically used in 14 cases, and it has proven itself to be reliable, providing the expected performance advantages. The implementation of a tracked ultrasound or endoscope intraoperative imaging source is also described.

  18. Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol.

    Science.gov (United States)

    Tibbs, Sheila Marie; Moss, Jacqueline

    2014-11-01

    This quality improvement project was a 300-day descriptive preintervention and postintervention comparison consisting of a convenience sample of 18 gynecology surgical team members. We administered the Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) Teamwork Perception Questionnaire to measure the perception of teamwork. In addition, we collected data regarding rates of compliance (ie, huddle, time out) and measurable surgical procedure times. Results showed a statistically significant increase in the number of team members present for each procedure, 2.34 μ before compared with 2.61 μ after (P = .038), and in the final time-out (FTO) compliance as a result of a clarification of the definition of FTO, 1.05 μ before compared with 1.18 μ after (P = .004). Additionally, there was improvement in staff members' perception of teamwork. The implementation of team training, protocols, and algorithms can enhance surgical optimization, communication, and work relationships.

  19. Defining excellence in vascular neurosurgery.

    Science.gov (United States)

    Sanai, Nader; Spetzler, Robert F

    2010-01-01

    Success as a vascular neurosurgeon almost always begins with passion, an inherent love for the work that drives an insatiable desire for personal improvement. A personal definition of excellence in vascular neurosurgery includes several fundamental qualities: mastery of the basics, refinement of technique, advancement of technology, investigative study, advanced decision making, microsurgical innovation, a well-rounded surgical armamentarium, and a lifelong commitment to teaching. Ultimately, the reward for these efforts is the ability to influence generations to come, particularly as one follows the rising careers of former trainees, each redefining the term "excellence" in vascular neurosurgery.

  20. The future of regional anesthesia education: lessons learned from the surgical specialty.

    Science.gov (United States)

    Niazi, Ahtsham U; Peng, Philip W; Ho, Melissa; Tiwari, Akhilesh; Chan, Vincent W

    2016-08-01

    Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. Nevertheless, gaining expertise in ultrasound-guided regional anesthesia requires the acquisition of new cognitive and technical skills. In addition, due to a reduction in resident working hours and enforcement of labour laws and directives across various states and countries, trainees perform and witness fewer procedures. Together, these issues create challenges in the teaching and learning of ultrasound-guided regional anesthesia in the time-based model of learning. The challenges of teaching ultrasound-guided regional anesthesia are similar to those experienced by our surgical counterparts with the advent of minimally invasive surgery. In order to overcome these challenges, our surgical colleagues used theories of surgical skills training, simulation, and the concept of deliberate practice and feedback to shift the paradigm of learning from experience-based to competency-based learning. In this narrative review, we describe the theory behind the evolution of surgical skills training. We also outline how we can apply these learning theories and simulation models to a competency-based curriculum for training in ultrasound-guided regional anesthesia.

  1. Neurosurgery Education and Development program to treat hydrocephalus and to develop neurosurgery in Africa using mobile neuroendoscopic training.

    Science.gov (United States)

    Piquer, José; Qureshi, Mubashir Mahmood; Young, Paul H; Dempsey, Robert J

    2015-06-01

    OBJECT A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013. METHODS Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar. RESULTS From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar. CONCLUSIONS Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

  2. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada.

    Science.gov (United States)

    Malik, Atiqa; Bell, Chaim M; Stukel, Thérèse A; Urbach, David R

    2016-02-01

    The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%-5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%-5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%-1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19-0.23, p hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals.

  3. A retrospective analysis of patients referred for implant placement to a specialty clinic: indications, surgical procedures, and early failures.

    Science.gov (United States)

    Bornstein, Michael M; Halbritter, Sandro; Harnisch, Hendrik; Weber, Hans-Peter; Buser, Daniel

    2008-01-01

    This retrospective study analyzed the pool of patients referred for treatment with dental implants over a 3-year period in a referral specialty clinic. All patients receiving dental implants between 2002 and 2004 in the Department of Oral Surgery and Stomatology, University of Bern, were included in this retrospective study. Patients were analyzed according to age, gender, indications for implant therapy, location of implants, and type and length of implants placed. A cumulative logistic regression analysis was performed to identify and analyze potential risk factors for complications or failures. A total of 1,206 patients received 1,817 dental implants. The group comprised 573 men and 633 women with a mean age of 55.2 years. Almost 60% of patients were age 50 or older. The most frequent indication for implant therapy was single-tooth replacement in the maxilla (522 implants or 28.7%). A total of 726 implants (40%) were inserted in the esthetically demanding region of the anterior maxilla. For 939 implants (51.7%), additional bone-augmentation procedures were required. Of these, ridge augmentation with guided bone regeneration was performed more frequently than sinus grafting. Thirteen complications leading to early failures were recorded, resulting in an early failure rate of 0.7%. The regression analysis failed to identify statistically significant failure etiologies for the variables assessed. From this study it can be concluded that patients referred to a specialty clinic for implant placement were more likely to be partially edentulous and over 50 years old. Single-tooth replacement was the most frequent indication (> 50%). Similarly, additional bone augmentation was indicated in more than 50% of cases. Adhering to strict patient selection criteria and a standardized surgical protocol, an early failure rate of 0.7% was experienced in this study population.

  4. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications.

    Science.gov (United States)

    Keiner, Doerthe; Gaab, Michael R; Backhaus, Vanessa; Piek, Juergen; Oertel, Joachim

    2010-12-01

    Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.

  5. Neurosurgery in Würzburg until World War II.

    Science.gov (United States)

    Arnold, H; Collmann, H

    2012-01-01

    The institution of German neurosurgery as an autonomous surgical specialty, starting in Würzburg in 1934, is closely linked to the names of Fritz König and Wilhelm Tönnis. They were acting at a time when the global economic crisis and a consolidating Nazi dictatorship caused a cascade of alarming changes in political and social life. On the one hand it is fascinating to see how the restless work and energy of Tönnis managed to build up the first independent neurosurgical unit in Germany and to tighten efficient international connections all over the world within a few years. On the other hand-from a present-day perspective-it is difficult to understand how his strive towards a specialist's success, in contrast to that of Otfrid Foerster, was barely affected by the threatening political development, until the Second World War stopped his plans and ideas for many years.

  6. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  7. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

    Science.gov (United States)

    Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

    2017-01-01

    Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency

  8. Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery.

    Science.gov (United States)

    Davies, Benjamin M; Jones, Anna; Patel, Hiren C

    2016-05-01

    Surgical site infection [SSI] increases mortality, morbidity and length of hospital stay. Peri-operative 'care bundles' have reduced SSI in some fields of surgery. The aim of this study was to determine the impact of bundle compliance on SSI in patients undergoing a craniotomy. Cohort study of patients [N=1253] undergoing a craniotomy over 17 months at a single centre. SSI was defined as arising within 30days of operation or 1year where an implant(s) remains. 'Bundle compliance' required administration of antibiotics 36°C. SSI incidence was compared between bundle compliant and non-compliant groups. Case mix adjustment was performed using binary logistic regression. Over the study period, 1253 procedures were carried out and 66 patients (5.3%) developed a SSI. The majority (38, 57.6%) of these cultured Staphyloccoccus species. Only the use of an implant was found to be an independent risk factor for SSI [AOR 2.5, p<0.005, 95%CI 1.4, 4.3]. The use of the bundle did not reduce the occurrence of SSI. An evidence-based bundle did not reduce SSI in this neurosurgical series. The use of an implant was an independent risk factor of its occurrence. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

    2016-09-01

    OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.029). CONCLUSIONS This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery

  10. Laser applications in neurosurgery

    Science.gov (United States)

    Cerullo, Leonard J.

    1985-09-01

    The "false start" of the laser in neurosurgery should not be misconstrued as a denial of the inherent advantages of precision and gentleness in dealing with neural tissue. Rather, early investigators were frustrated by unrealistic expectations, cumbersome equipment, and a general ignorance of microtechnique. By the early 70s, microneurosurgery was well established, surgical laser equipment for free hand and microlinked application had been developed, and a more realistic view of the limitations of the laser had been established. Consequently, the late 70s really heralded the renaissance of the laser in neurosurgery. Since then, there has been an overwhelming acceptance of the tool in a variety of clinical situations, broadly categorized in five groups. 1)|Perhaps the most generally accepted area is in the removal of extra-axial tumors of the brain and spinal cord. These tumors, benign by histology but treacherous by location, do not present until a significant amount of neurological compensation has already occurred. The application of additional trauma to the neural tissue, whether by further tumor growth or surgical manipulation, frequently results in irreversible damage. Here, the ability of the laser to vaporize tissue, in a fairly hemostatic fashion, without mechanical or thermal damage to sensitive surrounding tissues, is essential. 2)|The ability to incise delicate neural tissue with minimal spread of thermal destruction to adjacent functioning tissue makes the laser the ideal instrument when tumors deep under the surface are encountered in the brain or spinal cord. Thus, the second group of applications is in the transgression of normal neural structures to arrive at deeper pathological tissue. 3)|The third area of benefit for the laser in neurosurgery has been in the performance of neuroablative procedures, calling for deliberate destruction of functioning neural tissue in a controlled fashion. Again, the precision and shape confinement of the destructive

  11. Clinical application of keyhole techniques in minimally invasive neurosurgery

    Institute of Scientific and Technical Information of China (English)

    LAN Qing

    2006-01-01

    @@ With the development of modern neuroimaging and the improvement of surgical instruments or devices as well as operative skills, minimally invasive neurosurgery has been progressing rapidly with great changes in surgical concepts and methods.1 Based on these changes, anatomic research has been carried out to explore new surgical approaches dealing with anticipated microtrauma. These approaches have made or been making things possible. Keyhole microsurgery has evolved into an important subject of modern minimally invasive neurosurgery.

  12. [Competency-based Neurosurgery Residency Programme].

    Science.gov (United States)

    Lobato, Ramiro D; Jiménez Roldan, Luis; Alen, José F; Castaño, Ana M; Munarriz, Pablo M; Cepeda, Santiago; Lagares, Alfonso

    2016-01-01

    A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal. Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period. It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations. Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques. Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually

  13. The surgical experience of general surgery residents: an analysis of the applicability of the specialty program in General and Digestive Surgery.

    Science.gov (United States)

    Targarona Soler, Eduardo Ma; Jover Navalon, Jose Ma; Gutierrez Saiz, Javier; Turrado Rodríguez, Víctor; Parrilla Paricio, Pascual

    2015-03-01

    Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs. 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures

  14. Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country.

    Science.gov (United States)

    Shah, Adil A; Shakoor, Amarah; Zogg, Cheryl K; Oyetunji, Tolulope; Ashfaq, Awais; Garvey, Erin M; Latif, Asad; Riviello, Robert; Qureshi, Faisal G; Mateen, Arif; Haider, Adil H; Zafar, Hasnain

    2016-05-01

    Whether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia. Pediatric patients (pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of ≥1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons. A total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10-14.00]) and longer average LOS (7.98 vs. 5.61 days, p pediatric surgery. Pediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Simulating tumour removal in neurosurgery.

    Science.gov (United States)

    Radetzky, A; Rudolph, M

    2001-12-01

    In this article the software system ROBO-SIM is described. ROBO-SIM is a planning and simulation tool for minimally invasive neurosurgery. Different to the most other simulation tools, ROBO-SIM is able to use actual patient's datasets for simulation. Same as in real neurosurgery a planning step, which provides more functionality as up-to-date planning systems on the market, is performed before undergoing the simulated operation. The planning steps include the definition of the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track and doing virtual trepanations (virtual craniotomy). For use with an intra-operative active manipulator, which is guided by the surgeon during real surgery (robotic surgery), go- and non-go-areas can be defined. During operation, the robot restricts the surgeon from leaving these go-areas. After planning, an additional simulation system, which is understood as an extension to the planning step, is used to simulate whole surgical interventions directly on the patient's anatomy basing on the planning data and by using the same instruments as for the real intervention. First tests with ROBO-SIM are performed on a phantom developed for this purpose and on actual patient's datasets with ventricular tumours.

  16. Current state-of-the-art and future perspectives of robotic technology in neurosurgery.

    Science.gov (United States)

    Mattei, Tobias A; Rodriguez, Abraham Hafiz; Sambhara, Deepak; Mendel, Ehud

    2014-07-01

    Neurosurgery is one of the most demanding surgical specialties in terms of precision requirements and surgical field limitations. Recent advancements in robotic technology have generated the possibility of incorporating advanced technological tools to the neurosurgical operating room. Although previous studies have addressed the specific details of new robotic systems, there is very little literature on the strengths and drawbacks of past attempts, currently available platforms and prototypes in development. In this review, the authors present a critical historical analysis of the development of robotic technology in neurosurgery as well as a comprehensive summary of the currently available systems that can be expected to be incorporated to the neurosurgical armamentarium in the near future. Finally, the authors present a critical analysis of the main technical challenges in robotic technology development at the present time (such as the design of improved systems for haptic feedback and the necessity of incorporating intraoperative imaging data) as well as the benefits which robotic technology is expected to bring to specific neurosurgical subspecialties in the near future.

  17. History of Korean Neurosurgery.

    Science.gov (United States)

    Hwang, Sung-nam

    2015-08-01

    The year 2012 was the 50th anniversary of the Korean Neurosurgical Society, and in 2013, the 15th World Congress of Neurosurgery took place in Seoul, Korea. Thus, it is an appropriate occasion to introduce the world to the history of the Korean Neurosurgical Society and the foundation, development, and growth of Korean neurosurgery. Historical materials and pictures were collected and reviewed from the history book and photo albums of the Korean Neurosurgical Society. During the last 50 years, the Korean Neurosurgical Society and Korean neurosurgery have developed and grown enormously not only in quantity but also in quality. In every aspect, the turning point from the old to the new era of the Korean Neurosurgical Society and Korean neurosurgery was the year 1980. Copyright © 2015. Published by Elsevier Inc.

  18. Computers and neurosurgery.

    Science.gov (United States)

    Shaikhouni, Ammar; Elder, J Bradley

    2012-11-01

    At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. Just before that era, the transistor was invented in the late 1940s, and the integrated circuit was invented in the late 1950s. During this time, the first automated, programmable computational machines were introduced. The rapid progress in the field of neurosurgery not only occurred hand in hand with the development of modern computers, but one also can state that modern neurosurgery would not exist without computers. The focus of this article is the impact modern computers have had on the practice of neurosurgery. Neuroimaging, neuronavigation, and neuromodulation are examples of tools in the armamentarium of the modern neurosurgeon that owe each step in their evolution to progress made in computer technology. Advances in computer technology central to innovations in these fields are highlighted, with particular attention to neuroimaging. Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty

    Directory of Open Access Journals (Sweden)

    De Win G

    2013-05-01

    Full Text Available Gunter De Win,1,2 Siska Van Bruwaene,1 Christopher Allen,3 Dirk De Ridder2 1Centre for Surgical Technologies, 2Department of Urology, University Hospitals, KU Leuven, Leuven, Belgium; 3School of Arts and Sciences, University of Pennsylvania, PA, USA Background: Surgical simulation is becoming increasingly important in surgical education. Despite the important work done on simulators, simulator model development, and simulator assessment methodologies, there is a need for development of integrated simulators in the curriculum. In this paper, we describe the design of our evidence-based preclinical training program for medical students applying for a surgical career at the Centre for Surgical Technologies. Methods: Twenty-two students participated in this training program. During their final months as medical students, they received structured, proficiency-based endoscopy training. The total amount of mentored training was 18 hours and the training was organized into three training blocks. The first block focused on psychomotor training, the second block focused on laparoscopic stitching and suturing, and the third block on laparoscopic dissection techniques and hemostasis. Deliberate practice was allowed and students had to show proficiency before proceeding to the next training block. Students’ psychomotor abilities were tested before the course and after each training block. At the beginning of their careers as surgical registrars, their performance on a laparoscopic suturing task was compared with that of registrars from the previous year who did not have this training course. Student opinions about this course were evaluated using a visual analog scale. Results: All students rated the training course as useful and their psychomotor abilities improved markedly. All students performed deliberate practice, and those who participated in this course scored significantly (P < 0.0001 better on the laparoscopic suturing task than first year

  20. Pediatric neurosurgery--a golden decade.

    Science.gov (United States)

    Ciurea, A V; Vasilescu, G; Nuteanu, L

    1999-11-01

    Pediatric neurosurgery, once an annex of general neurosurgery, has evolved into a well-defined and complex medical specialty. The last 10 years have witnessed major advances in documentation of the minute details of CNS diseases of childhood, refinement of the specific means of action and better adaptation of therapeutic efforts to the requirements of a developing organism. Pediatric neurosurgeons are now increasingly involved in beneficial cooperation within complex medical teams. This fact has by no means diminished the importance of pediatric neurosurgery; rather, in such settings it has proved to have better effects in the struggle for stable long-lasting good results of multi-modal treatments covering all pathological entities. Progress in neurological surgery for patients in the pediatric age group has emerged from the development of supranational scientific structures and from that of specific concepts exchanging channels, so that today pediatric neurosurgeons belong to an extremely specialized medical corps, working in harmony across geographical and socio-economic national features in the interests of humankind's young generation's health.

  1. [Neurosurgery in the elderly patient: Geriatric neurosurgery].

    Science.gov (United States)

    González-Bonet, Luis Germán; Tarazona-Santabalbina, Francisco-José; Lizán Tudela, Luis

    2016-01-01

    Between 2000 and 2050, the proportion of the world's population over 60 years will double, and the number of people aged 80 and older will quadruple. Health professional training does not include instructions about specific care for older people. The World Health Organization maintains that all health providers should be trained on ageing issues. Thus, it is proposed to analyse the effect of ageing on Neurosurgery in our country. A retrospective historical cohort study was performed on individuals age 70 years or older admitted to the Neurosurgery or the Intensive Care Unit of our hospital, with neurosurgical disease, between two periods: 1999-2000 and 2010-2011. An analysis was made on variables such as: age, pathology, length of stay, comorbidity, performance status, re-admissions and mortality. Similar numbers of patients were admitted during the two periods: 409 and 413. However, there was an increase of 77.5% in patients older than 70 years: 80 versus 142. Statistically significant differences were observed in the Charlson Comorbidity Index, the admission Glasgow Coma Scale (GCS) score, length of stay, and re-admissions. Comorbidity and admission GCS score were particularly worse in the second period. Nevertheless, the mean length of stay was lower in that period, but showing more hospital re-admissions. After multivariate analysis, it was observed that re-admissions were associated with comorbidity, but not with early hospital discharge. No differences were found in performance status or mortality. A very considerable increase in percentage of patients older than 70 years old was found. There were no differences in performance status or mortality, which was probably due to the multidisciplinary management of these patients. The results of this study support the development of an interdisciplinary work group dedicated to Geriatric Neurosurgery. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  2. [The history of Spanish neurosurgery: the Valencian school: J.J. Barcia Goyanes].

    Science.gov (United States)

    Barcia-Mariño, Carlos; Rodríguez-Mena, Ruben

    2013-01-01

    Professor Juan José Barcia-Goyanes started neurosurgical practice from anatomy and neuropsychiatry in response to a vacancy at a department known as "Nervous diseases", in 1931 at Hospital General in Valencia, Spain. Since the first intervention, based on the methods and surgical instruments already used in Europe and the U.S.A., the neurosurgical practice became the mainstay of the department, from which other auxiliary specialties emerged, such as neuroradiology, neurophysiology, neuropathology and also new techniques such as stereotactic surgery, functional neurosurgery and palencephalography. This year, the department celebrates its 80th anniversary. The broad spectrum of Prof. Barcia's scientific work included fields like neurology, neurosurgery and psychiatry, as well as anthropology, medical thought, history of medicine, morphology and history of anatomical language in his work "Onomatologica anatomica nova", in addition to an interesting poetic work. He was a founding member of the Luso-Spanish Neurosurgical Society and the Neurosurgical Society of Levante. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  3. Image-guided neurosurgery--state of the art and outlook.

    Science.gov (United States)

    Samii, M; Brinker, T; Samii, A

    1999-09-03

    The surgical possibilities of image guided neurosurgery are presented and critically reviewed. Image guided neurosurgery may enable neurosurgeons to work more precisely than before, and thus reduce mortality and morbidity. However, before the technology achieves widespread acceptance, technical standards must be developed, the intraoperative localisation technology improved, and clinical indications and the cost/benefit ratio clarified. Nevertheless, image guided neurosurgery appears to herald an exciting future in which virtual reality and robotic surgery will emerge as modern techniques.

  4. Neurosurgery and pregnancy

    Directory of Open Access Journals (Sweden)

    Rajkumar Subramanian

    2014-01-01

    Full Text Available Pregnant patients rarely present with neurosurgical emergencies, but can cause significant morbidity and mortality to the mother and the foetus. Physiological changes of pregnancy in relevance to neurosurgery, effects of anaesthetic agents on the foetus, common neurosurgical emergencies, and anaesthetic implications both from obstetric and neurosurgical point of view are discussed in this review.

  5. Dr. Lenke Horvath (1917-1991): Creator of Pediatric Neurosurgery in Romania.

    Science.gov (United States)

    Mohan, Dumitru; Moisa, Horatiu Alexandru; Nica, Dan Aurel; Ciurea, Alexandru Vlad

    2016-04-01

    The development of neurosurgery as an independent specialty took place with great difficulty in Romania. In this respect, the most revered personalities are those of Professor Alexandru Moruzzi (1900-1957) (in Iasi) and Professor Dimitrie Bagdasar (1893-1946) (in Bucharest), who are the fathers of modern neurosurgery in Romania. Professor Bagdasar was schooled in Professor Harvey Cushing's clinic in Boston and is credited with creating the first completely independent neurosurgical unit in Romania. His legacy was carried on with honor by Professor Constantin Arseni (1912-1994), who, in 1975, tasked Dr. Lenke Horvath (1917-1991) with creating the first autonomous pediatric neurosurgery unit in Bucharest. This article is a small tribute to the founder of pediatric neurosurgery in Romania and one of the female pioneer neurosurgeons, who, by personal example of dedication and hard work, radically changed medical thinking and neurosurgery in Romania.

  6. 3D printing in neurosurgery: A systematic review.

    Science.gov (United States)

    Randazzo, Michael; Pisapia, Jared M; Singh, Nickpreet; Thawani, Jayesh P

    2016-01-01

    The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints.

  7. Thoracic surgery in the real world: does surgical specialty affect outcomes in patients having general thoracic operations?

    Science.gov (United States)

    Ferraris, Victor A; Saha, Sibu P; Davenport, Daniel L; Zwischenberger, Joseph B

    2012-04-01

    Most general thoracic operations in the United States are performed by general surgeons. Results obtained by those identified as general surgeons are often compared with those identified as thoracic surgeons. We interrogated the American College of Surgeons National Surgical Quality Improvement Project database over a 5-year period to compare outcomes in patients who underwent similar operations by surgeons identified as either thoracic surgeons or general surgeons. We employed propensity-score matching to minimize confounding when estimating the effect of surgeon identity on postoperative outcomes. During the study period, thoracic surgeons performed 3,263 major pulmonary or esophageal operations, and general surgeons performed 15,057 similar operations. Compared with patients operated on by general surgeons, patients operated on by thoracic surgeons had significant excess multivariate comorbidities, including insulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, concurrent pneumonia, congestive heart failure, previous cardiac surgery, dialysis-dependent renal failure, disseminated cancer, prior sepsis, and previous operation within 30 days. Likewise, patients in highest risk categories had operations performed by thoracic surgeons more commonly than by general surgeons. Unadjusted comparisons for mortality and serious morbidity showed significantly worse mortality and pulmonary complications in patients operated on by thoracic surgeons. However, with propensity matching according to surgeon type, thoracic surgeons had significantly fewer serious adverse outcomes compared with general surgeons, and this decreased morbidity occurred in a higher risk cohort. Our results show that patients operated on by thoracic surgeons have higher acuity compared with patients operated on by general surgeons. When patients are matched for comorbidities and serious preoperative risk factors, thoracic surgeons have improved outcomes, especially with regard to

  8. The history of neurosurgery at the University of Sao Paulo

    Directory of Open Access Journals (Sweden)

    Manoel Jacobsen Teixeira

    2014-03-01

    Full Text Available The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

  9. Surveillance for surgical site infection (SSI) after neurosurgery: influence of the US or Brest (France) National Nosocomial Infection Surveillance risk index on SSI rates.

    Science.gov (United States)

    Lietard, Claire; Thébaud, Véronique; Besson, Gérard; Lejeune, Benoist

    2008-11-01

    A total of 5,628 neurosurgical patients were observed in France to assess the occurrence of surgical site infection (SSI). Their risk of SSI was defined by calculating both the US National Nosocomial Infection Surveillance and the Brest National Nosocomial Infection Surveillance risk indexes. This study compares SSI rates stratified according to either the US or Brest (France) National Nosocomial Infection Surveillance risk index. The SSI rates were correlated with National Nosocomial Infection Surveillance data involving only local operation durations.

  10. [Changing the teaching of neurosurgery with information technology].

    Science.gov (United States)

    Moreau, Jean-Jacques; Caire, François; Kalamarides, Michel; Mireau, Etienne; Dauger, Frédéric; Coignac, Marie-Jo; Charlin, Bernard

    2009-10-01

    A digital campus is a distance learning site that uses the potential of information and communication technologies to disseminate and improve educational services. This website, with open and free access, is built from free software with Web 2.0 technology. It is hosted at the University of Limoges. It functions as a digital library, containing scanned books, slide shows, more than 200 hours of recorded courses and round tables accessible by streaming video. The site is indexed according to the users' needs, by level of knowledge, specialty, keywords, and supplementary MeSH terms. The campus is organized as the College of Neurosurgery (http://college.neurochirurgie.fr). The durability of this type of training (in existence for 9 years now) is made possible by a powerful and committed consortium: the French Society of Neurosurgery, which has created high-quality intellectual and scientific resources, the University of Limoges, the Dupuytren University Hospital Center in Limoges, the region of Limousin, and the French-language Virtual Medical University, which have provided logistic and financial support. To target appropriate levels at various users, we distinguished four groups: medical students, neurosurgery students, neurosurgeons (continuing medical education), and students in allied health fields. All areas of neurosurgery are concerned. All the courses, including tests for self-evaluation and scientific meetings (organized with information and communication technologies) are digitally recorded for the site. The principles that make it possible for a medical discipline to organize around an online project are: a pedagogical conception of projects built in the form of models reusable by other health specialties; a stronghold within professional societies of the relevant specialties able to create high-quality intellectual and scientific resources; an organization by educational levels that can be extended transversally to other health disciplines; and free

  11. Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery.

    Science.gov (United States)

    Wong, Judith M; Ziewacz, John E; Ho, Allen L; Panchmatia, Jaykar R; Kim, Albert H; Bader, Angela M; Thompson, B Gregory; Du, Rose; Gawande, Atul A

    2012-11-01

    As part of a project to devise evidence-based safety interventions for specialty surgery, we sought to review current evidence concerning the frequency of adverse events in open cerebrovascular neurosurgery and the state of knowledge regarding methods for their reduction. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. The authors performed a PubMed search using search terms "cerebral aneurysm", "cerebral arteriovenous malformation", "intracerebral hemorrhage", "intracranial hemorrhage", "subarachnoid hemorrhage", and "complications" or "adverse events." Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the reported adverse events. The review revealed hemorrhage-related hyperglycemia (incidence rates ranging from 27% to 71%) and cerebral salt-wasting syndromes (34%-57%) to be the most common perioperative adverse events related to subarachnoid hemorrhage (SAH). Next in terms of frequency was new cerebral infarction associated with SAH, with a rate estimated at 40%. Many techniques are advocated for use during surgery to minimize risk of this development, including intraoperative neurophysiological monitoring, but are not universally used due to surgeon preference and variable availability of appropriate staffing and equipment. The comparative effectiveness of using or omitting monitoring technologies has not been evaluated. The incidence of perioperative seizure related to vascular neurosurgery is unknown, but reported seizure rates from observational studies range from 4% to 42%. There are no standard guidelines for the use of seizure prophylaxis in these patients, and there remains a need for prospective studies to support such

  12. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    Science.gov (United States)

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  13. Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics; Neurochirurgie guidee par l'image. Concept global d'une tele-assistance chirurgicale a l'aide d'une robotique d'empechement

    Energy Technology Data Exchange (ETDEWEB)

    Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M. [Hopital d' Instruction des Armees du Val-de-Grace, 75 - Paris (France)

    2000-12-01

    Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

  14. Genealogy of training in vascular neurosurgery.

    Science.gov (United States)

    Chowdhry, Shakeel A; Spetzler, Robert F

    2014-02-01

    Remarkable advances and changes in the landscape of neurovascular disease have occurred recently. Concurrently, a paradigm shift in training and resident education is underway. This crossroad of unique opportunities and pressures necessitates creative change in the training of future vascular neurosurgeons to allow incorporation of surgical advances, new technology, and supplementary treatment modalities in a setting of reduced work hours and increased public scrutiny. This article discusses the changing landscape in neurovascular disease treatment, followed by the recent changes in resident training, and concludes with our view of the future of training in vascular neurosurgery.

  15. The legacy of nanotechnology: revolution and prospects in neurosurgery.

    Science.gov (United States)

    Khawaja, Ayaz Mahmood

    2011-01-01

    Nanotechnology has been an ever-growing field since the discovery of carbon fullerenes, and is being assimilated progressively into a variety of other disciplines including medical science. The association with neurosurgery had initially been less well characterized compared to other organ systems, but has recently offered promising future potential for a wide range of utilities including new therapeutic options for Glioblastoma Multiforme, neurprotection against oxidative stress, nerve nanorepair, nanodiagnosis of Alzheimer's disease, nanoimaging with nanoparticles and quantum dots, nanomanipulation of CNS with surgical nanobots, and nanoneuromodulation with nanofibres & nanowires. This article examines such potentials as well as others, of the utility of nanotechnology in Neurosurgery.

  16. Neurosurgery and Music; Effect of Wolfgang Amadeus Mozart.

    Science.gov (United States)

    Gasenzer, Elena Romana; Kanat, Ayhan; Neugebauer, Edmund

    2017-06-01

    The nervous system works like a great orchestra. Specifically, the music of Mozart with its "Mozart effect" is appropriate to use in neurosurgery. We investigated the relationship between Mozart's music and neurosurgery. We used digital catalogs like "PubMed" and the libraries of universities. Key words were "Wolfgang Amadeus Mozart" and "neurosurgery and music." In the first half of the 20th century, performing neurosurgery on some musicians, such as Maurice Ravel, Josef Hassid, and George Gershwin, resulted in a fatal outcome. The cause of this is probably that neurosurgery had not been developed yet in the first half of the 20th century. In the past 3 decades, the neurosurgical operations of musicians show that musicians have rich associations among auditory, somatic, and sensorial systems. It is clear that we have much to learn from studies about music and brain function that derive from our surgical experiences with patients. The neuronal plasticity of musicians' brains may be different from that of nonmusicians' brains. Musicians with enhanced motor skills have greater capacity for plasticity because of enriched interhemispheric connections. Listening to music and the effect of Mozart in neurosurgical practice, intensive care, or rehabilitation were documented in many studies. As authors, we mean something different: Its effectiveness should be studied. We concluded that in current neurosurgical practice, Mozart has an effect. More research and clinical studies are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. The 2009 devaluation of radiosurgery and its impact on the neurosurgery-radiation oncology partnership.

    Science.gov (United States)

    Heilbrun, M Peter; Adler, John R

    2010-07-01

    Neurosurgeons, radiation oncologists, and, increasingly, other surgical specialists recognize that radiosurgery is an important tool for managing selected disorders throughout the body. The partnership between neurosurgeons and radiation oncologists has resulted in collaborative studies that have established the clinical benefits of radiosurgery. Today, however, a range of political and financial issues is straining this relationship and thereby undermining the practice of radiosurgery. Neurosurgeons and radiation oncologists recently restricted the definition of radiosurgery to include only cranial- and spine-focused radiation treatments. Meanwhile, organized radiation oncology decided unilaterally that radiosurgery administered to other parts of the body would be termed stereotactic body radiation therapy. Finally, neurosurgical and radiation oncology coding experts developed new Current Procedural Terminology codes for cranial vault and spine radiosurgery, which were approved for use by the Relative Value Scale Update Committee as of 2009. The authors suggest that the neurosurgery strategy-which included 1) reasserting that all of the tasks of a radiosurgery procedure remain bundled, and 2) agreeing to limit the definition of radiosurgery to cranial vault and spine-has failed neurosurgeons who perform radiosurgery, and it may jeopardize patient access to this procedure in the future. The authors propose that all of the involved medical specialties recognize that the application of image-guided, focused radiation therapy throughout the body requires a partnership between radiation and surgical disciplines. They also urge surgeons to reexamine their coding methods, and they maintain that Current Procedural Terminology codes should be consistent across all of the different specialties involved in these procedures. Finally, surgeons should consider appropriate training in medical physics and radiobiology to perform the tasks involved in these specific procedures

  18. Neurosurgery and clinical engineering.

    Science.gov (United States)

    Salcman, M; Samaras, G M

    1978-01-01

    Modern technology has profoundly altered the clinical practice of neurosurgery. For a wide variety of conditions, patients are being implanted with active and passive devices or treated with advanced microsurgical instrumentation. After surgery, such patients are sent to modern intensive-care units employing the latest advances in patient monitoring and computer technology. We contend that the responsibilities of the Clinical Engineer extend beyond simple installation and maintenance of equipment and systems. It is essential that he take part in the continuing education of non-technical personnel who must make use of the equipment in ways that are meaningful in the care of the patient and to the progress of clinical science. This point is illustrated by our experience with a neurosurgical intensive-care unit. It is also the thesis of this paper that the design and maintenance of increasingly sophisticated biomedical systems will benefit from the use of an interdisciplinary approach at the very inception of a project. This approach is illustrated by our current development of a multibeam microwave hyperthermia system for possible use in the treatment of brain tumors.

  19. Minimalism in Art, Medical Science and Neurosurgery.

    Science.gov (United States)

    Ökten, Ali İhsan

    2016-12-21

    The word ''minimalism'' is a word derived from French the word ''minimum''. Whereas the lexical meaning of minimum is ''the least or the smallest quantity necessary for something'', its expression in mathematics can be described as ''the lowest step a variable number can descend, least, minimal''. Minimalism, which advocates an extreme simplicity of the artistic form, is a current in modern art and music whose origins go to 1960s and which features simplicity and objectivity. Although art, science and philosophy are different disciplines, they support each other from time to time, sometimes they intertwine and sometimes they copy each other. A periodic schools or teaching in one of them can take the others into itself, so, they proceed on their ways empowering each other. It is also true for the minimalism in art and the minimal invasive surgical approaches in science. Concepts like doing with less, avoiding unnecessary materials and reducing the number of the elements in order to increase the effect in the expression which are the main elements of the minimalism in art found their equivalents in medicine and neurosurgery. Their equivalents in medicine or neurosurgery have been to protect the physical integrity of the patient with less iatrogenic injury, minimum damage and the same therapeutic effect in the most effective way and to enable the patient to regain his health in the shortest span of time.

  20. Virtual endoscopy in neurosurgery: a review.

    Science.gov (United States)

    Neubauer, André; Wolfsberger, Stefan

    2013-01-01

    Virtual endoscopy is the computerized creation of images depicting the inside of patient anatomy reconstructed in a virtual reality environment. It permits interactive, noninvasive, 3-dimensional visual inspection of anatomical cavities or vessels. This can aid in diagnostics, potentially replacing an actual endoscopic procedure, and help in the preparation of a surgical intervention by bridging the gap between plain 2-dimensional radiologic images and the 3-dimensional depiction of anatomy during actual endoscopy. If not only the endoscopic vision but also endoscopic handling, including realistic haptic feedback, is simulated, virtual endoscopy can be an effective training tool for novice surgeons. In neurosurgery, the main fields of the application of virtual endoscopy are third ventriculostomy, endonasal surgery, and the evaluation of pathologies in cerebral blood vessels. Progress in this very active field of research is achieved through cooperation between the technical and the medical communities. While the technology advances and new methods for modeling, reconstruction, and simulation are being developed, clinicians evaluate existing simulators, steer the development of new ones, and explore new fields of application. This review introduces some of the most interesting virtual reality systems for endoscopic neurosurgery developed in recent years and presents clinical studies conducted either on areas of application or specific systems. In addition, benefits and limitations of single products and simulated neuroendoscopy in general are pointed out.

  1. 3D printing in neurosurgery: A systematic review

    Science.gov (United States)

    Randazzo, Michael; Pisapia, Jared M.; Singh, Nickpreet; Thawani, Jayesh P.

    2016-01-01

    Background: The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. Methods: An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Results: Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints. PMID:27920940

  2. In touch with robotics: neurosurgery for the future.

    Science.gov (United States)

    Nathoo, Narendra; Cavuşoğlu, M Cenk; Vogelbaum, Michael A; Barnett, Gene H

    2005-03-01

    The introduction of multiple front-end technologies during the past quarter century has generated an emerging futurism for the discipline of neurological surgery. Driven primarily by synergistic developments in science and engineering, neurosurgery has always managed to harness the potential of the latest technical developments. Robotics represents one such technology. Progress in development of this technology has resulted in new uses for robotic devices in our discipline, which are accompanied by new potential dangers and inherent risks. The recent surge in robot-assisted interventions in other disciplines suggests that this technology may be considered one of a spectrum of frontier technologies poised to fuel the development of neurosurgery and consolidate the era of minimalism. On a more practical level, if the introduction of robotics in neurosurgery proves beneficial, neurosurgeons will need to become facile with this technology and learn to harness its potential so that the best surgical results may be achieved in the least invasive manner. This article reviews the role of robotic technology in the context of neurosurgery.

  3. Artificial neural networks in neurosurgery.

    Science.gov (United States)

    Azimi, Parisa; Mohammadi, Hasan Reza; Benzel, Edward C; Shahzadi, Sohrab; Azhari, Shirzad; Montazeri, Ali

    2015-03-01

    Artificial neural networks (ANNs) effectively analyze non-linear data sets. The aimed was A review of the relevant published articles that focused on the application of ANNs as a tool for assisting clinical decision-making in neurosurgery. A literature review of all full publications in English biomedical journals (1993-2013) was undertaken. The strategy included a combination of key words 'artificial neural networks', 'prognostic', 'brain', 'tumor tracking', 'head', 'tumor', 'spine', 'classification' and 'back pain' in the title and abstract of the manuscripts using the PubMed search engine. The major findings are summarized, with a focus on the application of ANNs for diagnostic and prognostic purposes. Finally, the future of ANNs in neurosurgery is explored. A total of 1093 citations were identified and screened. In all, 57 citations were found to be relevant. Of these, 50 articles were eligible for inclusion in this review. The synthesis of the data showed several applications of ANN in neurosurgery, including: (1) diagnosis and assessment of disease progression in low back pain, brain tumours and primary epilepsy; (2) enhancing clinically relevant information extraction from radiographic images, intracranial pressure processing, low back pain and real-time tumour tracking; (3) outcome prediction in epilepsy, brain metastases, lumbar spinal stenosis, lumbar disc herniation, childhood hydrocephalus, trauma mortality, and the occurrence of symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid haemorrhage; (4) the use in the biomechanical assessments of spinal disease. ANNs can be effectively employed for diagnosis, prognosis and outcome prediction in neurosurgery.

  4. Estudo de vigilância epidemiológica da profilaxia do tromboembolismo venoso em especialidades cirúrgicas de um hospital universitário de nível terciário Study of epidemiological surveillance of venous thromboembolism prophylaxis in surgical specialties of a school tertiary referral hospital

    Directory of Open Access Journals (Sweden)

    Augusto Diogo-Filho

    2009-03-01

    tromboembolismo venoso, verifica-se adesão incompleta por parte dos profissionais médicos da especialidade, expondo os pacientes a complicações graves.CONTEXT: Postoperative venous thromboembolism is a frequent and severe disease that can lead to pulmonary embolism and post thrombotic syndrome. Although the venous thromboembolism prophylaxis is a proven strategy, an unsuitable indication is observed. OBJECTIVE: To verify the indication of prophylaxis with heparin among patients of several surgical specialties of a School Tertiary Referral Hospital. METHODS: It was accomplished a prospective study during 10 consecutive days in each month, from September to December of 2005, with 360 patients surgically treated in the specialties: General Surgery, Gynecology, Neurosurgery, Ortopedy and Traumatology, Urology and Angiology and Vascular Surgery, identifying risk factors for the development of venous thromboembolism (VTE and the use of heparin prophylaxis according to the recommendations of the Brazilian Society of Angiology and Vascular Surgery. RESULTS: Three hundred and fifty seven patients were evaluated, 24 (6,7%, 128 (35,9% and 205 (57,4% were included in low risk, medium risk and high risk for venous thromboembolism, respectively. One hundred and eighty four patients (51,5% of the sample received prophylactic heparin. Heparin was used in 73,3% of the patients of General Surgery, 16,7% of Gynecology, 50,0% of Neurosurgery, 32,5% of Ortopedy and Traumatology, 37,3% of Urology and 97,7% of Angiology and Vascular Surgery. Only 38,3% of medium risk and 64,4% of high risk patients received prophylactic heparin. Heparin was suitably used in 77,6% of medium risk and in 63,6% of high risk patients. Thrombocytopenia, minor bleeding and major bleeding occurred in 3 (1,6%, 12 (6,5% and 2 (1,1% of the patients, respectively. Thromboembolic complications occurred in 6 (1,7% cases. CONCLUSION: Although the indications of prophylactic heparin to venous thromboembolism are well known, we

  5. Number of Published Randomized Controlled Multi Center Trials Testing Pharmacological Interventions or Devices Is Increasing in Both Medical and Surgical Specialties

    DEFF Research Database (Denmark)

    Danielsen, Anne Kjaergaard; Okholm, Cecilie; Pommergaard, Hans-Christian;

    2014-01-01

    in 1995 to 1,273 in 2010, with a larger share of multicenter studies being performed in Europe and North America. The pharmacological interventions were primarily being tested in medical studies followed by the device tests predominantly in surgical studies. The number of included patients as well...

  6. Compact multi-spectral imaging system for dermatology and neurosurgery

    Science.gov (United States)

    Noordmans, Herke Jan; de Roode, Rowland; Verdaasdonk, Rudolf

    2007-03-01

    A compact multi-spectral imaging system is presented as diagnostic tool in dermatology and neurosurgery. Using an electronically tunable filter, a sensitive high resolution digital camera, 140 spectral images from 400 nm up to 720 nm are acquired in 40 s. Advanced image processing algorithms are used to enable interactive acquisition, viewing, image registration and image analysis. Experiments in the department of dermatology and neurosurgery show that multispectral imaging reveals much more detail than conventional medical photography or a surgical microscope, as images can be reprocessed to enhance the view on e.g. tumor boundaries. Using a hardware-based interactive registration algorithm, multi-spectral images can be aligned to correct for motion occurred during image acquisition or to compare acquisitions from different moments in time. The system shows to be a powerful diagnostics tool for medical imaging in the visual and near IR range.

  7. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    Science.gov (United States)

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

  8. A relational database in neurosurgery.

    Science.gov (United States)

    Sicurello, F; Marchetti, M R; Cazzaniga, P

    1995-01-01

    This paper describes teh automatic procedure for a clinical record management in a Neurosurgery ward. The automated record allows the storage, querying and effective management of clinical data. This is useful during the patient stay and also for data processing and analysis aiming at clinical research and statistical studies. The clinical record is problem-oriented. It contains a minimum data set regarding every patient and a data set which is defined by a classification nomenclature (using an inner protocol). The main parts of the clinical record are the following tables: PERSONAL DATA: contains the fields relating to personal and admission data of the patient. The compilation of some fields is compulsory because they serve as input for the automated discharge letter. This table is used as an identifier for patient retrieval. composed of five different tables according to the kind of data. They are: familiar anamnesis, physiological anamnesis, past and next pathology anamnesis, and trauma anamnesis. GENERAL OBJECTIVITY: contains the general physical information of a patient. The field hold default values, which quickens the compilation and assures the recording of normal values. NEUROLOGICAL EXAMINATION: contains information about the neurological status of the patient. Also in this table, ther are default values in the fields. COMA: contains standardized ata and classifications. The multiple choices are automated and driven and belong to homogeneous classes. SURGICAL OPERATIONS: the information recording is made defining the general kind of operation and then defining the peculiar kind of operation. INSTRUMENTAL EXAMINATIONS: some examination results are recorded in a free structure, while other ones (TAC, etc.) follow codified structure. In order to identify a pathology by means of TAC, it is enough to record three values corresponding to three variables. THis classification fully describes a lot of neurosurgical pathologies. DISCHARGE: contains conclusions

  9. Supplementary Educational Models in Canadian Neurosurgery Residency Programs.

    Science.gov (United States)

    Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R

    2017-03-01

    The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.

  10. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

    Science.gov (United States)

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

    2015-09-01

    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  11. The present and future of quality measures and public reporting in neurosurgery.

    Science.gov (United States)

    Bekelis, Kimon; McGirt, Matthew J; Parker, Scott L; Holland, Christopher M; Davies, Jason; Devin, Clinton J; Atkins, Tyler; Knightly, Jack; Groman, Rachel; Zyung, Irene; Asher, Anthony L

    2015-12-01

    Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare's Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet "generic" quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care

  12. Eloquent Brain, Ethical Challenges: Functional Brain Mapping in Neurosurgery.

    Science.gov (United States)

    Klein, Eran

    2015-06-01

    Functional brain mapping is an increasingly relied upon tool in presurgical planning and intraoperative decision making. Mapping allows personalization of structure-function relationships when surgical or other treatment of pathology puts eloquent functioning like language or vision at risk. As an innovative technology, functional brain mapping holds great promise but also raises important ethical questions. In this article, recent work in neuroethics on functional imaging and functional neurosurgery is explored and applied to functional brain mapping. Specific topics discussed in this article are incidental findings, responsible innovation, and informed consent.

  13. Challenges in contemporary academic neurosurgery.

    Science.gov (United States)

    Black, Peter M

    2006-03-01

    Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

  14. Navigation system for neurosurgery with PC platform.

    Science.gov (United States)

    Akatsuka, Y; Shibasaki, T; Saito, A; Kosaka, A; Matsuzaki, H; Asano, T; Furuhashi, Y

    2000-01-01

    This paper presents a navigation system for a surgical microscope and an endoscope which can be used for neurosurgery. In this system, a wireframe model of a target tumor and other significant anatomical landmarks are superimposed in real-time onto live video images taken from the microscope and the endoscope. The wireframe model is generated from a CT/MRI slice images. Overlaid images are simultaneously displayed in the same monitor using the picture-in-picture function so that the surgeon can concentrate on the single monitor during the surgery. The system measures the position and orientation of the patient using specially designed non-contact sensing devices mounted on the microscope and the endoscope. Based on this real-time measurement, the system displays other useful information about the navigation as well as the rendered wireframe. The accuracy of registration between the wireframe model and the actual live view is less than 2 mm. We tested this system in actual surgery several times, and verified its performance and effectiveness.

  15. Prophylactic antibiotics and anticonvulsants in neurosurgery.

    Science.gov (United States)

    Ratilal, B; Sampaio, C

    2011-01-01

    The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

  16. NEUROSURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    In order to study the thrombolytic effects ofstrepokinase (r-SK), 28 male Wistar rats wasembolised in the carotid artery. Regionalcerebral blood now (rCBF) was reduced by64% with life indexes unchanged 30 min afterembolization. After perfusion with r-SK andhuman plasminogen r-SK reperfusion revealed

  17. Neurosurgery

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Using the rabbit model of middle cerebralartery occlusion, we dissected the brainmitochondia of which Na+, K+-ATPase, Ca2+,Mg2+-ATPase activities were determined bybiochemical method and the contents ofmalondialdehyde (MDA) were measured by

  18. NEUROSURGERY

    African Journals Online (AJOL)

    observed significant changes between two surveys conducted in Germany in 1991 and 1997, ... haemorrhage disease (SAH), traumatic brain injury (TBI), decompressive ... the North American. Spine Society, while specific areas of management were .... The characteristics of this relationship are shown in Table 4. A further ...

  19. Renaissance Neurosurgery: Italy's Iconic Contributions.

    Science.gov (United States)

    Nanda, Anil; Khan, Imad Saeed; Apuzzo, Michael L

    2016-03-01

    Various changes in the sociopolitical milieu of Italy led to the increasing tolerance of the study of cadavers in the late Middle Ages. The efforts of Mondino de Liuzzi (1276-1326) and Guido da Vigevano (1280-1349) led to an explosion of cadaver-centric studies in centers such as Bologna, Florence, and Padua during the Renaissance period. Legendary scientists from this era, including Leonardo Da Vinci, Andreas Vesalius, Bartolomeo Eustachio, and Costanzo Varolio, furthered the study of neuroanatomy. The various texts produced during this period not only helped increase the understanding of neuroanatomy and neurophysiology but also led to the formalization of medical education. With increased understanding came new techniques to address various neurosurgical problems from skull fractures to severed peripheral nerves. The present study aims to review the major developments in Italy during the vibrant Renaissance period that led to major progress in the field of neurosurgery. Published by Elsevier Inc.

  20. Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals.

    Science.gov (United States)

    Schweizer, Marin L; Cullen, Joseph J; Perencevich, Eli N; Vaughan Sarrazin, Mary S

    2014-06-01

    Surgical site infections (SSIs) are potentially preventable complications that are associated with excess morbidity and mortality. To determine the excess costs associated with total, deep, and superficial SSIs among all operations and for high-volume surgical specialties. Surgical patients from 129 Veterans Affairs (VA) hospitals were included. The Veterans Health Administration Decision Support System and VA Surgical Quality Improvement Program databases were used to assess costs associated with SSIs among VA patients who underwent surgery in fiscal year 2010. Linear mixed-effects models were used to evaluate incremental costs associated with SSIs, controlling for patient risk factors, surgical risk factors, and hospital-level variation in costs. Costs of the index hospitalization and subsequent 30-day readmissions were included. Additional analysis determined potential cost savings of quality improvement programs to reduce SSI rates at hospitals with the highest risk-adjusted SSI rates. Among 54,233 VA patients who underwent surgery, 1756 (3.2%) experienced an SSI. Overall, 0.8% of the cohort had a deep SSI, and 2.4% had a superficial SSI. The mean unadjusted costs were $31,580 and $52,620 for patients without and with an SSI, respectively. In the risk-adjusted analyses, the relative costs were 1.43 times greater for patients with an SSI than for patients without an SSI (95% CI, 1.34-1.52; difference, $11,876). Deep SSIs were associated with 1.93 times greater costs (95% CI, 1.71-2.18; difference, $25,721), and superficial SSIs were associated with 1.25 times greater costs (95% CI, 1.17-1.35; difference, $7003). Among the highest-volume specialties, the greatest mean cost attributable to SSIs was $23,755 among patients undergoing neurosurgery, followed by patients undergoing orthopedic surgery, general surgery, peripheral vascular surgery, and urologic surgery. If hospitals in the highest 10th percentile (ie, the worst hospitals) reduced their SSI rates to the

  1. Choosing Your Medical Specialty

    Science.gov (United States)

    ... AMA provides to help members save money. Residency & Career Planning Find resources for a range of medical career ... Fellowships Back to top Home Life & Career Residency & Career Planning Choosing a Medical Specialty Back to top Choosing ...

  2. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India.

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, Vishwanathan; Gupta, Shakti Kumar

    2015-01-01

    Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Fisher's two-tailed t-test. Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.

  3. Smartphone use in neurosurgery? APP-solutely!

    OpenAIRE

    Michael Zaki; Doniel Drazin

    2014-01-01

    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on thei...

  4. A history of neurosurgery in Canada.

    Science.gov (United States)

    Weir, Bryce

    2011-03-01

    Canada existed for more than half a century before there were glimmerings of modern neurosurgical activity. Neurosurgery had advanced significantly in Europe and the United States prior to its being brought to Toronto and Montreal from American centers. The pioneers responsible for the rapid evolution in practice, teaching and research are described. The interplay of scientific, professional, demographic and economic forces with general historical trends has produced dramatic changes in the way that neurosurgery is now practiced.

  5. [Intraoperative monitoring of oxygen tissue pressure: Applications in vascular neurosurgery].

    Science.gov (United States)

    Arikan, Fuat; Vilalta, Jordi; Torne, Ramon; Chocron, Ivette; Rodriguez-Tesouro, Ana; Sahuquillo, Juan

    2014-01-01

    Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  6. Implementation of a Cross-specialty Training Program in Basic Laparoscopy

    DEFF Research Database (Denmark)

    Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette

    2015-01-01

    BACKGROUND AND OBJECTIVES: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the ...... laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up....

  7. Augmented reality in neurosurgery: a systematic review.

    Science.gov (United States)

    Meola, Antonio; Cutolo, Fabrizio; Carbone, Marina; Cagnazzo, Federico; Ferrari, Mauro; Ferrari, Vincenzo

    2016-05-07

    Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.

  8. Neurosurgery and elderly: analysis through the years.

    Science.gov (United States)

    Chibbaro, Salvatore; Di Rocco, F; Makiese, O; Mirone, G; Marsella, M; Lukaszewicz, A C; Vicaut, E; Turner, B; Hamdi, S; Spiriev, T; Di Emidio, P; Pirracchio, R; Payen, D; George, B; Bresson, D

    2010-04-01

    The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.

  9. Personality and specialty interest in medical students.

    Science.gov (United States)

    Hojat, Mohammadreza; Zuckerman, Marvin

    2008-01-01

    Research on the relationship between personality and specialty interest is important because of its implications in student career counseling and in forecasting future specialty distribution. This study was designed to test the following hypotheses: 1. Students interested in 'surgical' specialties would obtain higher scores on a measure of 'impulsive sensation seeking' and lower scores on a measure of 'neuroticism-anxiety'. 2. Students interested in 'hospital-based' specialties would score lower on a measure of 'sociability' whereas those interested in 'primary care' would score higher on this measure. In addition to these two hypotheses, gender differences on personality were also examined. Study participants were 1,076 students who matriculated at Jefferson Medical College between 2002 to 2006. A short version of the Zuckerman-Kuhlman personality questionnaire (ZKPQ) measuring five personality factors of 'impulsive sensation Seeking', 'neuroticism-anxiety', 'aggression-hostility', 'sociability', and 'activity' was completed by research participants at the beginning of medical school. Students were also asked to note their specialty interests. Multivariate statistical analyses confirmed the first and partially confirmed the second research hypotheses. Results also showed that men scored higher on 'impulsive sensation seeking,' and women outscored men in the 'neuroticism-Anxiety' and 'activity' scales. Findings suggest that information about the personalities of medical students can help to predict their career interests. Implications for career counseling are discussed.

  10. Clovis Vincent (1879-1947): founder of French neurosurgery and promoter of oncologic neurosurgery.

    Science.gov (United States)

    Karamanou, M; Androutsos, G; Lymperi, M; Stamboulis, E; Liappas, I; Lykouras, E

    2012-01-01

    The eminent neurologist Clovis Vincent decided to become neurosurgeon at an advanced age. His is considered the founder of French neurosurgery and the Europe's first neurosurgeon. He was mainly interested in pituitary tumors and his work on oncologic neurosurgery remains valuable.

  11. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review

    Science.gov (United States)

    Enchev, Yavor

    2015-01-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons’ self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  12. The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care.

    Science.gov (United States)

    Asher, Anthony L; Speroff, Ted; Dittus, Robert S; Parker, Scott L; Davies, Jason M; Selden, Nathan; Nian, Hui; Glassman, Steven; Mummaneni, Praveen; Shaffrey, Christopher; Watridge, Clarence; Cheng, Joseph S; McGirt, Mathew J

    2014-10-15

    National Prospective Observational Registry. Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery. All major health care stakeholders are now requiring objective data regarding the value of medical services. Surgical therapies for spinal disorders have faced particular scrutiny in recent value-based discussions, in large part due to the dramatic growth in the cost and application of these procedures. Reliable data are fundamental to understanding the value of delivered health care. Clinical registries are increasingly used to provide such data. The NQOD is a prospective observational registry designed to establish risk-adjusted expected morbidity and 1-year outcomes for the most common lumbar surgical procedures performed by spine surgeons; provide practice groups and hospitals immediate infrastructure for analyzing their 30-day morbidity and mortality and 3- and 12-month quality data in real-time; generate surgeon-, practice-, and specialty-specific quality and efficacy data; and generate nationwide quality and effectiveness data on specific surgical treatments. In its first 2 years of operation, the NQOD has proven to be a robust data collection platform that has helped demonstrate the objective quality of surgical interventions for medically refractory disorders of the lumbar spine. Lumbar spine surgery was found to be safe and effective at the group mean level in routine practice. Subgroups of patients did not report improvement using validated outcome measures. Substantial variation in treatment response was observed among individual patients. The NQOD is now positioned to determine the combined contribution of patient variables to specific clinical and patient-reported outcomes. These analyses will ultimately facilitate shared decision making and encourage efficient allocation of health care resources, thus

  13. Experimental new automatic tools for robotic stereotactic neurosurgery: towards "no hands" procedure of leads implantation into a brain target.

    Science.gov (United States)

    Mazzone, P; Arena, P; Cantelli, L; Spampinato, G; Sposato, S; Cozzolino, S; Demarinis, P; Muscato, G

    2016-07-01

    The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic "no hands" surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized "large white" pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery.

  14. Elective pediatric surgical care in a forward deployed setting: What is feasible vs. what is reasonable.

    Science.gov (United States)

    Neff, Lucas P; Cannon, Jeremy W; Charnock, Kathryn M; Farmer, Diana L; Borgman, Matthew A; Ricca, Robert L

    2016-03-01

    To describe the scope and outcomes of elective pediatric surgical procedures performed during combat operations. The care of patients in Operation Enduring Freedom (OEF) includes elective humanitarian surgery on Afghan children. Unlike military reports of pediatric trauma care, there is little outcome data on elective pediatric surgical care during combat operations to guide treatment decisions. All elective surgical procedures performed on patients≤16years of age from May 2012 through April 2014 were reviewed. Procedures were grouped by surgical specialty and were further classified as single-stage (SINGLE) or multi-stage (MULTI). The primary endpoint was post-operative complications requiring further surgery, and the secondary endpoint was post-operative follow up. A total of 311 elective pediatric surgical procedures were performed on 239 patients. Surgical specialties included general surgery, orthopedics, otolaryngology, ophthalmology, neurosurgery and urology. 178 (57%) were SINGLE while 133 (43%) were MULTI. Fifteen patients required 32 procedures for post-operative complications. Approximately half of all procedures were performed as outpatient surgery. Median length of stay for inpatient was 2.2days, and all patients survived to discharge. The majority of patients returned for outpatient follow-up (207, 87%), and 4 patients (1.7%) died after discharge. Elective pediatric surgical care in a forward deployed setting is feasible; however, limitations in resources for perioperative care and rehabilitation mandate prudent patient selection particularly with respect to procedures that require prolonged post-operative care. Formal guidance on the process of patient selection for elective humanitarian surgery in these settings is needed. Published by Elsevier Inc.

  15. A Master-Slave Haptic System for Neurosurgery

    Directory of Open Access Journals (Sweden)

    Vanni Zanotto

    2011-01-01

    Full Text Available In recent years, new surgical tools have been designed to improve treatment results and lower patient trauma. Nevertheless, the dexterity and accuracy required for the positioning of new tools are often unreachable, if surgeons are not assisted by suitable systems. Significant advantages are derived from the introduction of computer and robot technologies. For that reason, the interaction between robotic systems and surgeons today is producing new interest worldwide both in medical and engineering fields. In particular, medical robotics has found fruitful ground in neurosurgical applications, since the high functional density of the central nervous system requires strict accuracy constraints on tool positioning. As a matter of fact, the major benefits of robots, such as precision, accuracy and repeatability, make them ideal as neurosurgeons’ assistants. This paper presents a master-slave haptic robotic system for minimally invasive neurosurgery, which can aid surgeons in performing safer and more accurate stereotactic neurosurgical treatments. The design of the proposed system is based on LANS (Linear Actuator for NeuroSurgery, which has been developed by our Research Group. Experimental test aimed at showing the added value of the DAANS system over its predecessor, the effectiveness of conformational caps and of the added rotational degree of freedom are scheduled for the upcoming months.

  16. Experimental and clinical standards, and evolution of lasers in neurosurgery.

    Science.gov (United States)

    Devaux, B C; Roux, F X

    1996-01-01

    From initial experiments of ruby, argon and CO2 lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters--wavelength, fluence and mode--and on the exposed tissues optical and thermal properties--water and haemoglobin content, thermal conductivity and specific heat. CO2 and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 microns and 1.32 microns Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopic tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage. The choice of a laser in a

  17. Simulation and resident education in spinal neurosurgery.

    Science.gov (United States)

    Bohm, Parker E; Arnold, Paul M

    2015-01-01

    A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.

  18. Virtual reality training in neurosurgery: Review of current status and future applications

    Science.gov (United States)

    Alaraj, Ali; Lemole, Michael G.; Finkle, Joshua H.; Yudkowsky, Rachel; Wallace, Adam; Luciano, Cristian; Banerjee, P. Pat; Rizzi, Silvio H.; Charbel, Fady T.

    2011-01-01

    Background: Over years, surgical training is changing and years of tradition are being challenged by legal and ethical concerns for patient safety, work hour restrictions, and the cost of operating room time. Surgical simulation and skill training offer an opportunity to teach and practice advanced techniques before attempting them on patients. Simulation training can be as straightforward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced virtual reality (VR) simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. Methods: A PubMed review of the literature was performed for the MESH words “Virtual reality, “Augmented Reality”, “Simulation”, “Training”, and “Neurosurgery”. Relevant articles were retrieved and reviewed. A review of the literature was performed for the history, current status of VR simulation in neurosurgery. Results: Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and credential surgeons as technically competent. The number of published literature discussing the application of VR simulation in neurosurgery training has evolved over the last decade from data visualization, including stereoscopic evaluation to more complex augmented reality models. With the revolution of computational analysis abilities, fully immersive VR models are currently available in neurosurgery training. Ventriculostomy catheters insertion, endoscopic and endovascular simulations are used in neurosurgical residency training centers across the world. Recent studies have shown the coloration of proficiency with those simulators and levels of experience in the real world. Conclusion: Fully immersive technology is starting to be applied to the practice of

  19. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    Science.gov (United States)

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.

    Science.gov (United States)

    Vakharia, Vejay N; Vakharia, Nilesh N; Hill, Ciaran S

    2016-04-01

    Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Stereotactic imaging in functional neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Hidehiro

    2012-07-01

    Background: The birth of stereotactic functional neurosurgery in 1947 was to a great extent dependent on the development of ventriculography. The last decades have witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders. Initially, these procedures were largely based on the same imaging technique that had been used since the birth of this technique, and that is still used in some centers. The introduction of new imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided new potentials, but also new challenges for accurate identification and visualisation of the targets in the basal ganglia and the thalamus with an urge to thoroughly evaluate and optimize the stereotactic targeting technique, as well as evaluate accurately in stereotactic space the location and extent of stereotactic Radiofrequency (RF) lesions and the position of deep brain stimulation (DBS) electrodes. Aims: To study the differences between CT and MRI regarding indirect atlas coordinates in thalamic and pallidal procedures and to evaluate and validate visualisation of the pallidum and the subthalamic nucleus in view of direct targeting irrespective of atlas-derived coordinates. Furthermore, to evaluate the contribution of RF parameters on the size of stereotactic lesions, as well as the impact of size and location on clinical outcome. Method: The coordinates in relation to the landmarks of the 3{sup rd} ventricle of the targets in the pallidum and ventrolateral thalamus were compared between CT and MRI in 34 patients. In another 48 patients direct visualization of the pallidum was evaluated and compared to indirect atlas based targeting. The possibility and versatility of visualizing the Subthalamic Nucleus (STN) on short acquisition MRI were evaluated in a multicentre study, and the use of alternative landmarks in identification of the STN was demonstrated in another study. In 46 patients CT and

  2. Frameless image-guided neurosurgery in motion

    NARCIS (Netherlands)

    Woerdeman, P.A.

    2008-01-01

    The general objective of this thesis was the enhancement of image-guidance system use by optimizing “man-machine” interaction in frameless image-guided neurosurgery. Part I. The application of frameless stereotaxy in the neurosurgical practice We aimed to compare three patient-to-image registration

  3. Smartphone use in neurosurgery? APP-solutely!

    Directory of Open Access Journals (Sweden)

    Michael Zaki

    2014-01-01

    Conclusions: There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  4. Modernity and the emerging futurism in neurosurgery.

    Science.gov (United States)

    Apuzzo, M L

    2000-03-01

    This article discusses the emergence of neurosurgery in its 'modern' form during the second half of the 20th century and presents the apertures to the 21st century that are apparent in establishing an evolving futurism in the field. Factors of primary positive impetus and challenges are discussed.

  5. American College of Surgeons National Surgical Quality Improvement Program Pediatric: a phase 1 report.

    Science.gov (United States)

    Raval, Mehul V; Dillon, Peter W; Bruny, Jennifer L; Ko, Clifford Y; Hall, Bruce L; Moss, R Lawrence; Oldham, Keith T; Richards, Karen E; Vinocur, Charles D; Ziegler, Moritz M

    2011-01-01

    There has been a long-standing desire to implement a multi-institutional, multispecialty program to address surgical quality improvement for children. This report documents results of the initial phase of the American College of Surgeons National Surgical Quality Improvement Program Pediatric. From October 2008 to December 2009, patients from 4 pediatric referral centers were sampled using American College of Surgeons National Surgical Quality Improvement Program methodology tailored to children. A total of 7,287 patients were sampled, representing general/thoracic surgery (n = 2,237; 30.7%), otolaryngology (n = 1,687; 23.2%), orthopaedic surgery (n = 1,367; 18.8%), urology (n = 893; 12.3%), neurosurgery (n = 697; 9.6%), and plastic surgery (n = 406; 5.6%). Overall mortality rate detected was 0.3% and 287 (3.9%) patients had postoperative occurrences. After accounting for demographic, preoperative, and operative factors, occurrences were 4 times more likely in those undergoing inpatient versus outpatient procedures (odds ratio [OR] = 4.71; 95% CI, 3.01-7.35). Other factors associated with higher likelihood of postoperative occurrences included nutritional/immune history, such as preoperative weight loss/chronic steroid use (OR = 1.49; 95% CI, 1.03-2.15), as well as physiologic compromise, such as sepsis/inotrope use before surgery (OR = 1.68; 95% CI, 1.10-1.95). Operative factors associated with occurrences included multiple procedures under the same anesthetic (OR = 1.58; 95% CI, 1.21-2.06) and American Society of Anesthesiologists classification category 4/5 versus 1 (OR = 5.74; 95% CI, 2.94-11.24). Specialty complication rates varied from 1.5% for otolaryngology to 9.0% for neurosurgery (p Pediatric has the potential to identify outcomes of children's surgical care that can be targeted for quality improvement efforts. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. The Establishment and Development of Neurosurgery Services in Papua New Guinea.

    Science.gov (United States)

    Kaptigau, W Matui; Rosenfeld, Jeffrey V; Kevau, Ikau; Watters, David A

    2016-02-01

    Papua New Guinea (PNG) is a developing Pacific Nation of 7.3 million people. Although neurosurgery training was introduced to PNG in the year 2000, it was in 2003 that a neurosurgery service was established. Prior to this time, neurosurgery in PNG was performed by general surgeons, with some assistance from visiting Australian neurosurgeons. Neurosurgical training was introduced to PNG in 2000. The model involved a further 3 years of training for a surgeon who had already completed 4 years of general surgical training. We aim to review the output, outcomes and impact achieved by training the first national neurosurgeon. The data on activity (output) and outcomes were collected prospectively from 2003–2012. Ongoing mentoring and continuing professional development were provided through annual neurosurgical visits from Australia. There were serious limitations in the provision of equipment, with a lack of computerized tomographic or MR imaging, and adjuvant oncological services. There were 1618 neurosurgery admissions, 1020 neurosurgical procedures with a 5.74 % overall mortality. Seventy percent of cases presented as emergencies. There were improved outcomes, particularly for head injuries, whilst hydrocephalus was managed with an acceptable morbidity and revision rate. The training of a neurosurgeon resulted in PNG patients receiving a better range of surgical services, with a lower mortality. The outcomes able to be delivered were limited by late presentations of patients and lack of resources including imaging. These themes are familiar to all low- and middle-income countries (LMICs) and this may serve as a model for other LMIC neurosurgical services to adopt as they consider whether to establish and develop neurosurgical and other sub-specialist surgical services.

  7. One century after the description of the "sign": Joseph Babinski and his contribution to neurosurgery.

    Science.gov (United States)

    Lanzino, G; diPierro, C G; Laws, E R

    1997-04-01

    One hundred years ago, in 1896, Joseph Babinski published a preliminary report on "réflexe cutané plantaire" (cutaneous plantar reflex), which became widely known as the Babinski sign. However, Babinski did not view the description of the sign as his major achievement. Instead, he considered his greatest contribution to medicine to be his having "... indiqué la voie à Martel et à Vincent" (pointed the way to Thierry de Martel and Clovis Vincent, founders of French neurosurgery). Several of Babinski's manuscripts deal with neurosurgical problems. In 1900, 1 year before Alfred Fröhlich's description, Babinski gave the first account of the adiposogenital syndrome and its relation to pituitary-hypothalamic disorder. Many other original contributions ensued. These include a report on the relief of papilledema by surgical decompression in 1901, the successful removal (in collaboration with de Martel) of an intracranial meningioma in 1909, the description (again with de Martel) of a cerebellopontine angle tumor treated by surgical excision with good result in 1925, and several manuscripts concerning diagnosis and treatment of compressive spinal cord lesions. Babinski's dream to establish a department of neurosurgery became a reality shortly after his death. The Hôpital de la Pitie in Paris, where Babinski did most of his work, established the first French department of neurosurgery chaired by Babinski's pupil, Vincent.

  8. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

    Science.gov (United States)

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

    2017-05-01

    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  9. The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra.

    Science.gov (United States)

    Dabdoub, Carlos F; Dabdoub, Carlos B

    2013-09-25

    The practice of neurosurgery in Bolivia began thousands of years ago with skull trepanation. This procedure dates from the earliest period of the Tiwanaku culture, a preInca civilization. Neurosurgical development in Bolivia has its origins in the late 19(th) century and can be divided in two stages. At the beginning, before the advent of neurosurgery as a discipline, some general surgeons performed procedures on the skull and brain. Formal neurosurgery in Bolivia was developed with the arrival of neurosurgeons trained in the United States and some countries of South America. The Bolivian Neurosurgical Society was created in 1975. Nowadays, our national society has 74 members. It is affiliated with the World Federation of Neurosurgical Societies and the Latin American Federation of Neurosurgical Societies. Presently, neurosurgery in Bolivia is similar to that seen in developed countries. In this sense, government programs should dedicate more financial support to establish specialized healthcare centers where the management of complex central nervous system lesions could be offered. In contrast, we believe that encouraging the local training of young neurosurgeons is one of the most important factors in the development of neurosurgery in Bolivia or any other country.

  10. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India

    Directory of Open Access Journals (Sweden)

    Parmeshwar Kumar

    2015-01-01

    Full Text Available Context: Though intensive care units (ICUs only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher′s two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.

  11. Free-access open-source e-learning in comprehensive neurosurgery skills training

    Directory of Open Access Journals (Sweden)

    Payal Jotwani

    2014-01-01

    Full Text Available Background: Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. Materials and Methods: This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. ′Neurosurgery Education and Training School (NETS, e-learning platform′ has integration of web-based technologies like ′Content Management System′ for organizing the education material and ′Learning Management System′ for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Results: Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2; 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3; average 402 views per post. Conclusion: The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and

  12. Factors that impact medical student and house-staff career interest in brain related specialties.

    Science.gov (United States)

    Kamour, Abdulbaset H; Han, Dong Y; Mannino, David M; Hessler, Amy B; Kedar, Sachin

    2016-10-15

    There is a national shortage of physicians in brain related specialties (neurology, neurosurgery and psychiatry), with fewer students training in these specialties. This study explored socio-economic and experiential factors that determined medical trainees' interest in brain related specialties. Medical students and house-staff at a state university medical school completed a 46-item questionnaire sent as an anonymous email survey. Survey response rate was 22% (n=258). Eighty-eight (34.1%) trainees were interested in brain related specialties. Prior neuroscience experience (29.6%) and effective medical school neuroscience courses (23.9%) were identified as important by those interested in brain related specialties, while "neurophobia" was reported by 30% of those not interested. Multivariate regression model showed that effective college neuroscience course increased the likelihood for interest in brain related specialties (OR=2.28, 95% CI 1.22, 4.28). Factors which decreased the likelihood included parent's possessing professional degree (OR=0.37, 95% CI 0.17, 0.80), personal annual income>$50,000 (OR=0.40, 0.18, 0.87) and current debt level≥$100,000 (OR=0.33, 0.17, 0.64). The proportion of trainees interested in brain related specialties decreased from 51.7% (1st year medical students) to 27% (4th year students) and 25.3% among house-staff (χ(2) test of trend p=0.001). Socioeconomic (current personal debt and annual income) and experiential factors (college neuroscience course) influence a medical trainee's interest in brain related specialties. Career guidance and improved, better and early exposure to neurosciences may help mitigate trend for decreased interest in brain related specialties. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Art, passion, and neurosurgery: the role of the Society of Neurological Surgeons in academic neurosurgery.

    Science.gov (United States)

    Dempsey, Robert J

    2011-11-01

    Neurosurgery is at a crossroads in a time of economic uncertainty. It is also a time of remarkable potential for innovation resulting in dramatic improvement in the way neurosurgeons care for patients and the quality of outcomes. Analysis of this key time point of neurosurgical history is drawn from reflections for a presidential address to the Society of Neurological Surgeons. It is the author's opinion that the best of academic neurosurgery must and will accept this challenge by developing not only the research but also the creativity and art of what neurosurgeons do for maximal patient benefit in research, educational, and clinical missions.

  14. [The robotization of neurosurgery: state of the art and future outlook].

    Science.gov (United States)

    Benabid, A L; Hoffmann, D; Ashraf, A; Koudsie, A; Esteve, F; Le-Bas, J F

    1997-11-01

    Neurosurgery is by excellence a field of application for robots, based on multimodal image guidance. Specific motorized tools have been already developed and routinely applied in stereotaxy to position a probe holder or in conventional neurosurgery to hold a microscope oriented towards a given target. The potentialities of these approaches have triggered industrial developments currently commercially available. These systems use data bases, primarily coming from multimodal numerical images from X-ray radiology to magnetic resonance imaging. These spatially encoded data are transferred through digital networks to workstations where images can be processed and surgical procedures are preplanned, then transferred to the robotic systems to which they are connected. We have been using a stereotactic robot since 1989 and a microscope robot since 1995 in various surgical routine procedures. The future of these applications mainly rely on the technical progress in informatics, about image recognition to adapt the preplanning to the actual surgical situation, to correct brain shifts for instance, about image fusion, integrated knowledge such such as brain atlases, as well as virtual reality. The future developments, covering surgical procedure, research and teaching, will sure be far beyond our wildest expectations.

  15. Evolution in Practice: How has British Neurosurgery Changed in the Last 10 Years?

    Science.gov (United States)

    Tarnaris, A; Arvin, B; Ashkan, K

    2008-01-01

    INTRODUCTION Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. PATIENTS AND METHODS A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. RESULTS Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. CONCLUSIONS Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes. PMID:18765031

  16. Innovation in neurosurgery: less than IDEAL? A systematic review.

    Science.gov (United States)

    Muskens, I S; Diederen, S J H; Senders, J T; Zamanipoor Najafabadi, A H; van Furth, W R; May, A M; Smith, T R; Bredenoord, A L; Broekman, M L D

    2017-08-06

    Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms. The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework. Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b. The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.

  17. Surgical smartphone applications across different platforms: their evolution, uses, and users.

    Science.gov (United States)

    Kulendran, Myutan; Lim, Marcus; Laws, Georgia; Chow, Andre; Nehme, Jean; Darzi, Ara; Purkayastha, Sanjay

    2014-08-01

    There are a vast array of smartphone applications that could benefit both surgeons and their patients. To review and identify all relevant surgical smartphone applications available for the Apple iPhone iOS and Google Android platform based on their user group and subspecialty for which they were designed. Both the literature using PubMed and Google Scholar were searched using the following terms: application$, smartphone$, app$, app*, surgery, surgical, surg*, general surgery, general surg*, bariatric$, urology and plastic surgery, ortho*, orthop(a)edic, cardiac surgery, cardiothoracic, neurosurgery, and ophthalmology. The search yielded 38 articles of which 23 were eligible. Each of the key specialties was searched in the Apple iTunes App Store for iPhone iOS and the Google Play Android application store. In total, there were 621 surgical applications for Apple iPhone iOS and 97 identified on Android's Google Play. There has been a 9-fold increase in the number of surgical applications available for the Apple iPhone iOS from 2009 to 2012. Of these applications there were 126 dedicated to plastic surgery, 79 to orthopedics, 41 to neurosurgical, 180 to general surgery, 36 to cardiac surgery, 121 to ophthalmology, and 44 to urology. There was a wide range of applications ranging from simple flashcards to be used for revision to virtual surgery applications that provided surgical exposure and familiarization with common operative procedures. Despite the plethora of surgical applications available for smartphones, there is no taxonomy for medical applications. Only 12% were affiliated with an academic institution or association, which highlights the need for greater regulation of surgical applications. © The Author(s) 2014.

  18. Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys.

    Science.gov (United States)

    Goldacre, Michael J; Goldacre, Raph; Lambert, Trevor W

    2012-04-01

    To report doctors' rejection of specialties as long-term careers and reasons for rejection. Postal questionnaires. United Kingdom. Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification. Current specialty choice; any choice that had been seriously considered but not pursued (termed 'rejected' choices) with reasons for rejection. 2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of 'job content' was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns. There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes.

  19. Herbert Olivecrona: founder of Swedish neurosurgery.

    Science.gov (United States)

    Ljunggren, B

    1993-01-01

    Herbert Olivecrona (1891-1980) singlehandedly founded Swedish neurosurgery. At the International Congress in Neurology in Bern in August, 1931, Harvey Cushing invited the cream of the world's medical society to a private banquet. Among the 28 specially invited guests was Herbert Olivecrona. At 40 years old, Olivecrona took his seat with pioneers such as Otfrid Foerster, Percival Bailey, Hugh Cairns, Geoffrey Jefferson, and Sir Charles Sherrington. This suggests that Cushing was impressed by the Swedish aristocrat's didactic deeds when he visited the Serafimer Hospital in Stockholm 2 years earlier. During the mid-1920's, the radiologist Erik Lysholm greatly improved the technique of ventriculography and, challenged by Olivecrona, his diagnostic neuroradiology became of superior quality. In the early 1930's, utilizing technical innovations of his own, Lysholm became a master at demonstrating and localizing posterior fossa tumors, which Olivecrona then operated on. Olivecrona's clinic became the mecca to which many scholars, thirsting for more knowledge, went on a pilgrimage. The international reputation of the clinic was founded, not on epoch-making discoveries, but by the resolute and practical application of methods already launched elsewhere and the exemplary organization that Olivecrona had established in collaboration with Lysholm. In spite of hardships and primitive working conditions, the clinic at the Serafimer Hospital gradually developed into the ideal prototype for a modern neurosurgical department. Olivecrona trained many colorful personalities who later were to lay the foundation for neurosurgery in their home countries; these included Wilhelm Tönnis of Germany, Edvard Busch of Denmark, and Aarno Snellman of Finland. Olivecrona was a true pioneer who made major contributions in practically all fields of conventional neurosurgery.

  20. Smartphone use in neurosurgery? APP-solutely!

    Science.gov (United States)

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    Background: A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Methods: Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. Results: The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. Conclusions: There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps. PMID:25101208

  1. Smartphone use in neurosurgery? APP-solutely!

    Science.gov (United States)

    Zaki, Michael; Drazin, Doniel

    2014-01-01

    A number of smartphone medical apps have recently emerged that may be helpful for the neurosurgical patient, practitioner, and trainee. This study aims to review the current neurosurgery-focused apps available for the iPhone, iPad, and Android platforms as of December 2013. Two of the most popular smartphone app stores (Apple Store and Android Google Play Store) were surveyed for neurosurgery-focused apps in December 2013. Search results were categorized based on their description page. Data were collected on price, rating, app release date, target audience, and medical professional involvement in app design. A review of the top apps in each category was performed. The search resulted in 111 unique apps, divided into these 7 categories: 16 (14%) clinical tools, 17 (15%) conference adjunct, 27 (24%) education, 18 (16%) literature, 15 (14%) marketing, 10 (9%) patient information, and 8 (7%) reference. The average cost of paid apps was $23.06 (range: $0.99-89.99). Out of the 111 apps, 71 (64%) were free, 48 (43%) had reviews, and 14 (13%) had more than 10 reviews. Seventy-three (66%) apps showed evidence of medical professional involvement. The number of apps being released every year has been increasing since 2009. There are a number of neurosurgery-themed apps available to all audiences. There was a lack of patient information apps for nonspinal procedures. Most apps did not have enough reviews to evaluate their quality. There was also a lack of oversight to validate the accuracy of medical information provided in these apps.

  2. [The development of bariatric surgery and the role of the First Surgical Clinic of the General Medical School Hospital and the First Medical School of Charles University in Prague in this specialty].

    Science.gov (United States)

    Fried, M; Kasalický, M; Gürlich, R

    2001-10-01

    The authors discuss the development of bariatric surgery in Europe and the USA from its beginnings at the onset of the fifties. More detailed attention is paid in particular to the development of the method of gastric bandings and the role at the First Surgical Department in this field in "classical" as well as miniinvasive surgery. Results of gastric banding are summarized in 683 patients operated since 1983, in particular the numbers of early and late complications after laparotomies and laparoscopic operations, similarly as complications which are directly associated with gastric banding itself. In the conclusion it is stated that the First Surgical Department of the General Faculty Hospital and First Medical Faculty Charles University in Prague belong as regards their results in surgical treatment of obese subjects and the position in the field of bariatric surgery on an international scale to the foremost departments in this field worldwide.

  3. Intraspinal Pathology Associated With Pediatric Scoliosis: A Ten-year Review Analyzing the Effect of Neurosurgery on Scoliosis Curve Progression.

    Science.gov (United States)

    Jankowski, Pawel P; Bastrom, Tracey; Ciacci, Joseph D; Yaszay, Burt; Levy, Michael L; Newton, Peter O

    2016-10-15

    This was a retrospective study of patients with Chiari I (CM I) and Chiari II (CM II) malformations, tethered cord syndrome, and syringomyelia examining the effect of neurosurgery on scoliosis. The aim of this study was to determine the factors affecting spinal deformity progression in patients with diseases of the neural axis following neurosurgical management. There have been attempts to explain which factors influence the spinal deformity in diseases of the neural axis with varying results. Debate still exists as to the effectiveness of neurosurgery in curve stabilization. The medical records for patients treated over the past 10 years were reviewed. The spinal deformity surgical group consisted of patients who received surgery or progressed to surgical range (50°) and the nonsurgical group those who did not undergo fusion. Fifteen patients (eight females and seven males) with scoliosis who underwent neurosurgical intervention were identified. Ten had tethered cord, six CM II, four CM I, and 11 syrinx. Average age at the time of neurosurgery was 7 ± 4 years (range 0.7-14 yrs). Following neurosurgery, no patients experienced improvement in their curves (defined as >10° decrease in Cobb angle), eight patients experienced stabilization (10° increase). The group that went on to spinal deformity surgery possessed larger curves before neurosurgery (mean 42°, range 20°-63°) than the nonsurgical group (19°, range 15°-26°; P = 0.004). CM II patients had the greatest magnitude of curve progression, mean of 49°, compared with patients with CM I (6°) or tether cord without CM I or II (11°, P = 0.01). Neurosurgical intervention may prevent curve progression in patients with scoliosis and Cobb angles < 30° if they do not have a complex CM II malformation. Patients with CM II are at a higher risk of curve progression and undergoing spinal fusion than patients with CM I, tethered cord syndrome, or syringomyelia. 4.

  4. Mythological and Prehistorical Origins of Neurosurgery.

    Science.gov (United States)

    Nanda, Anil; Filis, Andreas; Kalakoti, Piyush

    2016-05-01

    Mythology has a cultural appeal, and the description of some neurosurgical procedures in the Hindu, Greek, Egyptian, and Chinese mythology has a bearing to the origins of our professions. The traces to some of our modern-day practices also can be linked back to the ancient prehistoric eras of the Siberian, Persian, and the Andean region. In this historical perspective, we briefly dwell into individual accounts through the prism of different cultures to highlight the development of neurosurgery in mythology and prehistoric era.

  5. Assessing residents' operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery.

    Science.gov (United States)

    Aldave, Guillermo; Hansen, Daniel; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

    2017-04-01

    OBJECTIVE The authors previously demonstrated the use of a validated Objective Structured Assessment of Technical Skills (OSATS) tool for evaluating residents' operative skills in pediatric neurosurgery. However, no benchmarks have been established for specific pediatric procedures despite an increased need for meaningful assessments that can either allow for early intervention for underperforming trainees or allow for proficient residents to progress to conducting operations independently with more passive supervision. This validated methodology and tool for assessment of operative skills for common pediatric neurosurgical procedures-external ventricular drain (EVD) placement and shunt surgery- was applied to establish its procedure-based feasibility and reliability, and to document the effect of repetition on achieving surgical skill proficiency in pediatric EVD placement and shunt surgery. METHODS A procedure-based technical skills assessment for EVD placements and shunt surgeries in pediatric neurosurgery was established through the use of task analysis. The authors enrolled all residents from 3 training programs (Baylor College of Medicine, Houston Methodist Hospital, and University of Texas-Medical Branch) who rotated through pediatric neurosurgery at Texas Children's Hospital over a 26-month period. For each EVD placement or shunt procedure performed with a resident, the faculty and resident (for self-assessment) completed an evaluation form (OSATS) based on a 5-point Likert scale with 7 categories. Data forms were then grouped according to faculty versus resident (self) assessment, length of pediatric neurosurgery rotation, postgraduate year level, and date of evaluation ("beginning of rotation," within 1 month of start date; "end of rotation," within 1 month of completion date; or "middle of rotation"). Descriptive statistical analyses were performed with the commercially available SPSS statistical software package. A p value skills. The learning curves

  6. Integrating multimodal information for intraoperative assistance in neurosurgery

    Directory of Open Access Journals (Sweden)

    Eisenmann U.

    2015-09-01

    Full Text Available Computer-assisted planning of complex neurosurgical interventions benefits from a variety of specific functions and tools. However, commercial planning- and neuronavigation systems are rather restrictive concerning the availability of innovative methods such as novel imaging modalities, fiber tracking algorithms or electrical dipole mapping. In this respect there is a demand for modular neurosurgical planning systems offering flexible interfaces for easy enhancement. Furthermore all relevant planning information should be available within neuron-avigation. In this work we present a planning system providing these capabilities and its suitability and application in a clinical setting. Our Multimodal Planning System (MOPS 3D offers a variety of tools such as definition of trajectories for minimally invasive surgery, segmentation of ROIs, integration of functional information from atlas maps or magnetoencephalography. It also supplies plugin interfaces for future extensions. For intraoperative application MOPS is coupled with the neuronavigation system Brainlab Vector Vision Cranial/ENT (VVC. We evaluated MOPS in the Department of Neurosurgery at the University Hospital Heidelberg. Surgical planning and navigation was performed in 5 frequently occurring clinical cases. The time necessary for planning was between 5 and 15 minutes including data import, segmentation and planning tasks. The additional information intraoperatively provided by MOPS 3D was highly appreciated by the neurosurgeons and the performance was satisfactory.

  7. Shining light on neurosurgery diagnostics using Raman spectroscopy.

    Science.gov (United States)

    Broadbent, Brandy; Tseng, James; Kast, Rachel; Noh, Thomas; Brusatori, Michelle; Kalkanis, Steven N; Auner, Gregory W

    2016-10-01

    Surgical excision of brain tumors provides a means of cytoreduction and diagnosis while minimizing neurologic deficit and improving overall survival. Despite advances in functional and three-dimensional stereotactic navigation and intraoperative magnetic resonance imaging, delineating tissue in real time with physiological confirmation is challenging. Raman spectroscopy is a promising investigative and diagnostic tool for neurosurgery, which provides rapid, non-destructive molecular characterization in vivo or in vitro for biopsy, margin assessment, or laboratory uses. The Raman Effect occurs when light temporarily changes a bond's polarizability, causing change in the vibrational frequency, with a corresponding change in energy/wavelength of the scattered photon. The recorded inelastic scattering results in a "fingerprint" or Raman spectrum of the constituent under investigation. The amount, location, and intensity of peaks in the fingerprint vary based on the amount of vibrational bonds in a molecule and their ensemble interactions with each other. Distinct differences between various pathologic conditions are shown as different intensities of the same peak, or shifting of a peak based on the binding conformation. Raman spectroscopy has potential for integration into clinical practice, particularly in distinguishing normal and diseased tissue as an adjunct to standard pathologic diagnosis. Further, development of fiber-optic Raman probes that fit through the instrument port of a standard endoscope now allows researchers and clinicians to utilize spectroscopic information for evaluation of in vivo tissue. This review highlights the need for such an instrument, summarizes neurosurgical Raman work performed to date, and discusses the future applications of neurosurgical Raman spectroscopy.

  8. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    Science.gov (United States)

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    . CONCLUSIONS The frequency of studies using HRQOL outcomes in pediatric neurosurgical research has not increased over the past 10 years. Within pediatric neurosurgery, high-quality studies and standardization are lacking, as compared with contemporary studies in Pediatrics. In general, although the HOQ, HUI, PedsQL, and SF-36 instruments are emerging as standards in pediatric neurosurgery, even greater standardization across the specialty is needed, along with the design and implementation of more rigorous studies.

  9. 21 CFR 882.4800 - Self-retaining retractor for neurosurgery.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Self-retaining retractor for neurosurgery. 882...-retaining retractor for neurosurgery. (a) Identification. A self-retaining retractor for neurosurgery is a self-locking device used to hold the edges of a wound open during neurosurgery. (b) Classification...

  10. Impact of Residents on Surgical Outcomes in High-Complexity Procedures.

    Science.gov (United States)

    Ferraris, Victor A; Harris, Jennifer W; Martin, Jeremiah T; Saha, Sibu P; Endean, Eric D

    2016-04-01

    There are different views on the effects of resident involvement on surgical outcomes. We hypothesized that resident participation in surgical care does not appreciably alter outcomes. We analyzed an American College of Surgeons NSQIP subset of inpatients having procedures with high complexity, including 4 surgical specialties (general surgery, cardiothoracic surgery, neurosurgery, and vascular surgery) with the highest mean work relative value units. We evaluated surgical outcomes in patients having procedures performed by the attending surgeon alone, or by the attending surgeon with assistance from at least one surgical resident (PGY1 to PGY≥6). Outcomes measures included operative mortality, composite morbidity, and failure to rescue (FTR). Propensity-score matching minimized the effects of nonrandom assignment of residents to procedures. In 266,411 patients, unmatched comparisons showed significantly higher operative mortality and composite morbidity rates, but decreased FTR, in operations performed with resident involvement. After propensity-score matching, there were small but significant resident-related increases in composite morbidity, but significant improvement in FTR. Senior-level resident involvement translated into improved outcomes, especially in cardiothoracic surgery procedures where >63.6% of procedures had PGY≥6 resident involvement. Resident involvement attenuated the significant worsening of operative mortality and FTR associated with multiple serious complications in individual patients. Measures of resource use increased modestly with resident involvement. We found substantial improvement in FTR with resident involvement, both in unmatched and propensity-matched comparisons. Senior-level resident participation seemed to attenuate, and even improve, surgical outcomes, despite slightly increased resource use. These results provide some reassurance about teaching paradigms. Copyright © 2016 American College of Surgeons. Published by

  11. Gender differences in specialty preference and mismatch with real needs in Japanese medical students

    Directory of Open Access Journals (Sweden)

    Harada Tadanari

    2010-02-01

    Full Text Available Abstract Background The shortage of doctors and maldistribution among specialties are of great concern in the Japanese health care system. This study investigated specialty preference in medical students of one university, and examined gender differences and compared their preference with real needs. Methods We conducted a self-administered questionnaire including specialty preference in all students of one medical university. Preference was assessed by the five-level probability of their future choice: 1 = very low, 2 = low, 3 = moderate, 4 = high, and 5 = very high. The proportion of 4 or 5 was calculated as the preference rate. The real needs (magnitude of doctor shortage in the prefecture were drawn from two different surveys. The relationship between the sex-specific preference rate by specialty and real needs was assessed by Spearman's correlation coefficient. Results Internal medicine showed the highest preference rate, followed by general surgery, pediatrics, and emergency medicine. There was no significant correlation between the preference rates of men and women (r = 0.27, p = 0.34. The preference rates for general surgery, orthopedics, neurosurgery, and emergency medicine were significantly higher in men than in women, while those of obstetrics & gynecology, pediatrics, and dermatology were significantly higher in women. The magnitude of doctor shortage by specialty from two surveys were significantly correlated with the total preference rate and men's preference rate (r = 0.54 to 0.74, but not with women's preference rate (r = 0.06 and 0.32. Conclusions This study elucidated not only gender differences in specialty preference but also the relationship to real needs. Critical gender differences and mismatch with real needs were found in women. In addition to traditional gender roles and insufficient support for women's participation in Japan, gender differences and mismatch influence the current and future maldistribution of

  12. Internship and Empathy: Variations Across Time and Specialties.

    Science.gov (United States)

    Avasarala, Sameer K; Whitehouse, Sarah; Drake, Sean M

    2015-10-01

    To assess whether any differences exist in Interpersonal Reactivity Index (IRI) scores among postgraduate year 1 (PGY-1) residents across specialties. PGY-1 residents representing 11 specialties at our academic institution were invited to take a Web-based IRI survey at three time points. The specialties were condensed into several binary groups for analysis: internal medicine (IM) versus non-IM; primary care (IM, family medicine) versus nonprimary care; emergency medicine (EM, including the combined IM/EM) versus non-EM; surgical specialties (general surgery, obstetrics and gynecology, otolaryngology, orthopedics, urology) versus nonsurgical specialties (EM, family medicine, IM, neurology, pathology, and psychiatry); men versus women; and age groups. A repeated-measures generalized-estimating equations approach was taken to analyze the effect of specialty and time on each of the four IRI subscales. Of 94 PGY-1 residents invited to participate at each time point, 74 (77.1%) completed the survey at least once. Response rates at each time point were similar (mean 47.9%). When comparing the IM (n=35) and non-IM (n=39) groups, the perspective-taking subscale was found to be significantly lower in the non-IM group (P=0.006). Among male (n=46) versus female residents (n=26), the personal-distress subscale was significantly different overall (P=0.041) but not among time points. No other significant differences were found between groups. The conglomerate subscale scores throughout the year did not show a dramatic change. Our study of IRI subscales in PGY-1 residents showed no major difference among specialties across 1 year except for IM residents, who scored significantly higher (more favorably) in the perspective-taking subscale. Contrary to previous studies, we did not observe a substantial decline in the empathic concern subscale IM residents over their first year.

  13. Emotional intelligence and medical specialty choice: findings from three empirical studies.

    Science.gov (United States)

    Borges, Nicole J; Stratton, Terry D; Wagner, Peggy J; Elam, Carol L

    2009-06-01

    Despite only modest evidence linking personality-type variables to medical specialty choice, stereotypes involving empathy and 'emotional connectedness' persist, especially between primary care providers and surgeons or subspecialists. This paper examines emotional intelligence (EI) and specialty choice among students at three US medical schools. Results from three independent studies are presented. Study 1 used the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) administered to a single cohort of 84 Year 4 medical students. Study 2 used the Trait Meta-Mood Scale (TMMS) and Davis' Interpersonal Reactivity Index (IRI) administered to three cohorts (n = 250) of Year 3 medical students. Study 3 used the Bar-On Emotional Quotient Inventory (EQ-I) administered to two cohorts of Year 1 medical students (n = 292). Results were linked to specialty choice data retrieved from the National Residency Match Program (NRMP). Classifications of specialty choice included: (i) primary care (family practice, internal medicine, paediatrics) versus non-primary care (all others), and (ii) primary care, hospital-based specialties (anaesthesiology, emergency medicine, pathology, radiology), and technical and surgical specialties (neurology, obstetrics and gynaecology, ophthalmology, and all surgical fields). Across all three studies - and using both classifications of specialty choice - no significant differences in EI were found between students entering primary care and non-primary care specialties. Limitations are acknowledged, and future directions for research involving EI are identified.

  14. Hand-tool-tissue interaction forces in neurosurgery for haptic rendering.

    Science.gov (United States)

    Aggravi, Marco; De Momi, Elena; DiMeco, Francesco; Cardinale, Francesco; Casaceli, Giuseppe; Riva, Marco; Ferrigno, Giancarlo; Prattichizzo, Domenico

    2016-08-01

    Haptics provides sensory stimuli that represent the interaction with a virtual or tele-manipulated object, and it is considered a valuable navigation and manipulation tool during tele-operated surgical procedures. Haptic feedback can be provided to the user via cutaneous information and kinesthetic feedback. Sensory subtraction removes the kinesthetic component of the haptic feedback, having only the cutaneous component provided to the user. Such a technique guarantees a stable haptic feedback loop, while it keeps the transparency of the tele-operation system high, which means that the system faithfully replicates and render back the user's directives. This work focuses on checking whether the interaction forces during a bench model neurosurgery operation can lie in the solely cutaneous perception of the human finger pads. If this assumption is found true, it would be possible to exploit sensory subtraction techniques for providing surgeons with feedback from neurosurgery. We measured the forces exerted to surgical tools by three neurosurgeons performing typical actions on a brain phantom, using contact force sensors, while the forces exerted by the tools to the phantom tissue were recorded using a load cell placed under the brain phantom box. The measured surgeon-tool contact forces were 0.01-3.49 N for the thumb and 0.01-6.6 N for index and middle finger, whereas the measured tool-tissue interaction forces were from six to 11 times smaller than the contact forces, i.e., 0.01-0.59 N. The measurements for the contact forces fit the range of the cutaneous sensitivity for the human finger pad; thus, we can say that, in a tele-operated robotic neurosurgery scenario, it would possible to render forces at the fingertip level by conveying haptic cues solely through the cutaneous channel of the surgeon's finger pads. This approach would allow high transparency and high stability of the haptic feedback loop in a tele-operation system.

  15. IBIS: an OR ready open-source platform for image-guided neurosurgery.

    Science.gov (United States)

    Drouin, Simon; Kochanowska, Anna; Kersten-Oertel, Marta; Gerard, Ian J; Zelmann, Rina; De Nigris, Dante; Bériault, Silvain; Arbel, Tal; Sirhan, Denis; Sadikot, Abbas F; Hall, Jeffery A; Sinclair, David S; Petrecca, Kevin; DelMaestro, Rolando F; Collins, D Louis

    2017-03-01

    Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.

  16. Overview of intraoperative MRI in neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Shiino, Akihiko; Matsuda, Masayuki [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  17. Life and Medical Ethics in Pediatric Neurosurgery

    Science.gov (United States)

    YAMASAKI, Mami

    2017-01-01

    Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child’s condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents’ religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future. PMID:28025426

  18. Interstitial laser thermotherapy in neurosurgery: a review.

    Science.gov (United States)

    Menovsky, T; Beek, J F; van Gemert, M J; Roux, F X; Bown, S G

    1996-01-01

    One of the most recent laser treatment modalities in neurosurgery is interstitial laser thermotherapy (ILTT). In this review, experimental and clinical studies concerning intracranial ILTT are discussed. Two methods for intra-operative control of the laser induced lesions are described; i.e., computer-controlled power delivery, using a thermocouple that is positioned interstitially at the periphery of the tumour to maintain the desired temperature at that point, and MRI, to visualise the extent of the thermal lesions induced by ILTT. The results show that ILTT using a Nd: YAG laser is easy and relatively effective in the treatment of small deep-seated brain tumours with minimal risk and complications. This review is concluded with suggestions for further improvement of this treatment modality.

  19. The internal medicine specialist and neurosurgery

    Directory of Open Access Journals (Sweden)

    A. Pizzini

    2013-05-01

    Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.

  20. Evolving virtual reality simulation in neurosurgery.

    Science.gov (United States)

    Schirmer, Clemens M; Mocco, J; Elder, J Bradley

    2013-10-01

    Virtual reality (VR) applications promise the safe, efficacious, and valid replication of scenarios encountered in modern neurosurgery, and a number of navigation- or dissection-related and endovascular simulators have been successfully deployed in the last 2 decades. Concurrently, neurosurgical training is changing, and VR simulations are expected to play a part in future training. To give an overview of currently available neurosurgical VR applications in the spectrum of desired applications and the outlook of the requirements to be met by future applications. The available literature was analyzed using structured Medline and PubMed searches. Relevant articles were retrieved and reviewed. When quantitative results were available, effect sizes were collated or estimated to check for publication bias. There has been a significant increase in publications concerning the use of VR in neurosurgery in the last 22 years (P < .001). Thirty-eight of 117 publications (32%) identified reported data regarding the use of a simulator by practitioners; 35 of these were reported as positive trials (92%). Twenty-two of 38 studies (58%) reported quantitative data with mostly small positive effect sizes (median, 1.41; interquartile range, 1.08-2). The use of VR simulators in endovascular surgery has the most robust basis, with 65% of studies reporting quantitative outcomes. Current neurosurgical VR applications focus on basic procedural skill acquisition and are valid and efficacious adjuncts to neurosurgical training. In the future, the development of complex procedural simulators, teamwork, and focus on validated measures will lead to robust framework of the use of VR over the entire career of a neurosurgeon.

  1. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Directory of Open Access Journals (Sweden)

    Phan PN

    2016-03-01

    Full Text Available Pho NH Phan,1 Keyur Patel,2 Amar Bhavsar,3 Vikas Acharya4 1Warwick Medical School, University of Warwick, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, 4Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK Abstract: Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies – this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in

  2. Defensive Medicine in U.S. Spine Neurosurgery.

    Science.gov (United States)

    Din, Ryan S; Yan, Sandra C; Cote, David J; Acosta, Michael A; Smith, Timothy R

    2017-02-01

    Observational cross-sectional survey. To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0

  3. [Research competencies in nursing specialties].

    Science.gov (United States)

    Oltra-Rodríguez, Enrique; Rich-Ruiz, Manuel; Orts-Cortés, María Isabel; Sánchez-López, Dolores; González-Carrión, Pilar

    2013-01-01

    Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Motivational interviewing and specialty pharmacy.

    Science.gov (United States)

    Berger, Bruce A; Bertram, Carl T

    2015-01-01

    It is well documented in substance abuse and health care literature that motivational interviewing is an evidenced-based and effective intervention for influencing patient behaviors and associated positive health outcomes. The introduction of motivational interviewing training in specialty pharmacy has great potential to increase patient and pharmacist satisfaction, maximize adherence rates, and improve health outcomes. This commentary examines the need for effective approaches for improving patient adherence and outcomes and briefly describes the history and efficacy of motivational interviewing. Case studies using traditional approaches to patient care and motivational interviewing are analysed, and real-world experience using motivational interviewing is presented in the form of a specialty pharmacy case study.

  5. ROBO-SIM: a simulator for minimally invasive neurosurgery using an active manipulator.

    Science.gov (United States)

    Radetzky, A; Rudolph, M; Starkie, S; Davies, B; Auer, L M

    2000-01-01

    This application report describes the software system ROBO-SIM, which is a planning and simulation tool for minimally invasive neurosurgery. Using actual patient's datasets, ROBO-SIM includes all planning steps necessary. These are; defining the trepanation point for entry into the skull and the target point within the depth of the brain, checking the surgical track, performing virtual trepanations (virtual craniotomy), and defining sanctioned volumes for use with an intra-operative active manipulator. With the additional simulation part, neurosurgeons are able to simulate whole surgical interventions directly on the patient's anatomy using the same instruments as for the real operation. First tests with ROBO-SIM are performed on actual patient's datasets with ventricular tumours.

  6. Specialty Guidelines for Forensic Psychology

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

  7. Specialty Guidelines for Forensic Psychology

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

  8. Specialty rattans of the ASEAN

    NARCIS (Netherlands)

    Baja-Lapis, A.C.

    2009-01-01

    This paper describes the uses and agricultural practices for 11 selected taxa of rattan in the ASEAN countries with special emphasis on specialty use for food and condiments, ornamentals and dyes. The listed species are Calamus discolor, Calamus manillensis, Calamus ornatus var. philippinensis, Cala

  9. Medical students' career indecision and specialty rejection: roads not taken.

    Science.gov (United States)

    Kassebaum, D G; Szenas, P L

    1995-10-01

    The authors used data from the AAMC Matriculating Student Questionnaire and Medical School Graduation Questionnaire to ascertain how closely the specialty or subspecialty choices of the 1991 and 1994 graduates of U.S. medical schools matched the preferences they had declared when they were matriculated; the extent to which these students strongly considered and then rejected choices that arose during medical school; and the graduation choices of the substantial number of students in both cohorts who were undecided about their careers when they entered medical school. Approximately 80% of the graduates in both classes rejected the specialty intentions they had declared when they began medical school. However, matriculation interests in the generalist specialties--family practice, general pediatrics, and general internal medicine--were more enduring for the 1994 cohort, while interests in the medical, surgical, and support specialties were less so. Large percentages of the 1991 and 1994 cohorts were undecided about their careers at matriculation (20.8% and 26.2%, respectively), and nearly the same proportions remained undecided at graduation. However, more of the graduates in the 1994 cohort who had initially been undecided reached decisions favoring one of the generalist specialties than was true for the 1991 cohort. Nearly half the 1994 graduates had strongly considered and then rejected an alternative to their matriculation interest that arose during medical school. Within the generalist specialties, both early and later interests in family practice were more durable than were those in general pediatrics and general internal medicine: for every student who retreated from tentative interest in family practice, another student's interest was reinforced or kindled.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. National survey on postoperative care and treatment circuits in neurosurgery.

    Science.gov (United States)

    Valero, R; Carrero, E; Fàbregas, N; Iturri, F; Saiz-Sapena, N; Valencia, L

    2017-10-01

    The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Sensors management in robotic neurosurgery: the ROBOCAST project.

    Science.gov (United States)

    Vaccarella, Alberto; Comparetti, Mirko Daniele; Enquobahrie, Andinet; Ferrigno, Giancarlo; De Momi, Elena

    2011-01-01

    Robot and computer-aided surgery platforms bring a variety of sensors into the operating room. These sensors generate information to be synchronized and merged for improving the accuracy and the safety of the surgical procedure for both patients and operators. In this paper, we present our work on the development of a sensor management architecture that is used is to gather and fuse data from localization systems, such as optical and electromagnetic trackers and ultrasound imaging devices. The architecture follows a modular client-server approach and was implemented within the EU-funded project ROBOCAST (FP7 ICT 215190). Furthermore it is based on very well-maintained open-source libraries such as OpenCV and Image-Guided Surgery Toolkit (IGSTK), which are supported from a worldwide community of developers and allow a significant reduction of software costs. We conducted experiments to evaluate the performance of the sensor manager module. We computed the response time needed for a client to receive tracking data or video images, and the time lag between synchronous acquisition with an optical tracker and ultrasound machine. Results showed a median delay of 1.9 ms for a client request of tracking data and about 40 ms for US images; these values are compatible with the data generation rate (20-30 Hz for tracking system and 25 fps for PAL video). Simultaneous acquisitions have been performed with an optical tracking system and US imaging device: data was aligned according to the timestamp associated with each sample and the delay was estimated with a cross-correlation study. A median value of 230 ms delay was calculated showing that realtime 3D reconstruction is not feasible (an offline temporal calibration is needed), although a slow exploration is possible. In conclusion, as far as asleep patient neurosurgery is concerned, the proposed setup is indeed useful for registration error correction because the brain shift occurs with a time constant of few tens of minutes.

  12. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    Science.gov (United States)

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan

    2017-01-01

    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  13. Specialty choices amongst graduating medical students in ...

    African Journals Online (AJOL)

    Specialty choices amongst graduating medical students in University of Calabar, ... Factors which influenced choice of specialty amongst the graduating ... interest in anaesthesia specialization, improvement of training facilities and provision of ...

  14. Accurate multi-robot targeting for keyhole neurosurgery based on external sensor monitoring.

    Science.gov (United States)

    Comparetti, Mirko Daniele; Vaccarella, Alberto; Dyagilev, Ilya; Shoham, Moshe; Ferrigno, Giancarlo; De Momi, Elena

    2012-05-01

    Robotics has recently been introduced in surgery to improve intervention accuracy, to reduce invasiveness and to allow new surgical procedures. In this framework, the ROBOCAST system is an optically surveyed multi-robot chain aimed at enhancing the accuracy of surgical probe insertion during keyhole neurosurgery procedures. The system encompasses three robots, connected as a multiple kinematic chain (serial and parallel), totalling 13 degrees of freedom, and it is used to automatically align the probe onto a desired planned trajectory. The probe is then inserted in the brain, towards the planned target, by means of a haptic interface. This paper presents a new iterative targeting approach to be used in surgical robotic navigation, where the multi-robot chain is used to align the surgical probe to the planned pose, and an external sensor is used to decrease the alignment errors. The iterative targeting was tested in an operating room environment using a skull phantom, and the targets were selected on magnetic resonance images. The proposed targeting procedure allows about 0.3 mm to be obtained as the residual median Euclidean distance between the planned and the desired targets, thus satisfying the surgical accuracy requirements (1 mm), due to the resolution of the diffused medical images. The performances proved to be independent of the robot optical sensor calibration accuracy.

  15. Can the transition process from foundation doctor to neurosurgical specialty trainee be improved through “learner-centered induction programs”?

    Directory of Open Access Journals (Sweden)

    Acharya V

    2015-10-01

    Full Text Available Vikas Acharya,1 Sami Mansour,2 Samuel M Amis,3 Amir Reyahi3 1Department of Neurosurgery, University Hospitals Coventry and Warwickshire, 2Warwick Medical School, University of Warwick, Coventry, 3Luton and Dunstable University Hospital, Luton, UK Abstract: The transition period from foundation program doctor to specialty trainee can be difficult for junior doctors. This difficult period often acts as a major obstacle for learning in the workplace. Existing induction programs are commonly seen as inadequate at easing this transition, and therefore, a pilot study intervention was undertaken to assess if the initiation of “learner-centered induction programs” could help improve the confidence, knowledge acquisition, and satisfaction of junior doctors as they begin specialty training in neurosurgery. Ethnographic and anecdotal evidences were collated from junior doctors, specialty trainees, and consultants in order to investigate if further work on this subject would be beneficial. All participants were working in the Department of Neurosurgery at University Hospital Coventry and Warwickshire, Coventry, UK, over a 4-week period in March/April 2015. A review of the relevant literature was also undertaken. This report found that despite the reservations around the increased organizational demands of induction programs of this nature, as well as concerns around a single junior doctor covering the ward alone during the induction period, feedback following the intervention was largely positive. Junior doctors appreciated being taught about their roles and responsibilities from their predecessors as well as deciding among themselves what topics they wanted covering. As a result, the induction sessions tended to focus on clinical skills rather than theoretical knowledge, which most of the junior doctors believed they could cover adequately in their own time. The junior doctors felt that they benefited from learning/refreshing their relevant practical

  16. da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety.

    Science.gov (United States)

    Marcus, Hani J; Hughes-Hallett, Archie; Cundy, Thomas P; Yang, Guang-Zhong; Darzi, Ara; Nandi, Dipankar

    2015-04-01

    The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.

  17. Schizophrenia and neurosurgery: A dark past with hope of a brighter future.

    Science.gov (United States)

    Agarwal, Prateek; Sarris, Christina E; Herschman, Yehuda; Agarwal, Nitin; Mammis, Antonios

    2016-12-01

    Schizophrenia is a chronic and progressive psychiatric disease that remains difficult to manage in the 21st century. Current medical therapies have been able to give reprieve and decrease incidence of psychotic episodes. However, as the disease progresses, patients can become ever more refractory to current pharmaceutical agents and the polypharmacy that is attempted in treatment. Additionally, many of these drugs have significant adverse effects, leaving the practitioner in a difficult predicament for treating these patients. The history of neurosurgery for schizophrenia, among other psychiatric diseases, has a very dark past. Therefore, this review examines peer-reviewed studies on the history of schizophrenia, its medical and surgical therapies, financial costs, and future directions for disease management. We highlight the historically poor relationship between neurosurgery and psychiatric disease and discuss current research in the understandings of schizophrenia. Guided by a strong code of ethics and new technology, including the use of stereotaxis and deep brain stimulation (DBS), the medical communities treating psychiatric disease are beginning to overcome the horrors of the past. DBS is currently being used with moderate success in the treatment of depression, obsessive compulsive disorder, Tourette's syndrome, and anorexia nervosa. With greater understanding of the neural circuitry of schizophrenia and the evolving role for DBS in psychiatric disease, the authors believe that schizophrenia, like other psychiatric diseases, can be treated with DBS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Neurosurgery during the Bronze Age: a skull trepanation in 1900 BC Greece.

    Science.gov (United States)

    Papagrigorakis, Manolis J; Toulas, Panagiotis; Tsilivakos, Manolis G; Kousoulis, Antonis A; Skorda, Despoina; Orfanidis, George; Synodinos, Philippos N

    2014-02-01

    Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Trepanation of the cranial vault was a widespread surgical procedure in antiquity and the most convincing evidence of the ancient origin of neurosurgery. The present study considers a case of trepanation from the Middle Bronze Age Greece (1900-1600 B.C.). The skull under study belongs to skeletal material unearthed from Kirra, Delphi (Central Greece). Macroscopic examination and palpation, as well as three-dimensional computed tomography, were used in this study. There is osteological evidence that the skull belongs to a man who died at 30-35 years of age. The procedure of trepanation was performed on the right parietal bone. Both macroscopic and computed tomography evaluation demonstrate an intravital bone reaction at the edges of the aperture. Projected on the right surface of the brain, the trepanation is located on the level of the central groove. The small dimensions and the symmetrical shape of this hole give us an indication that it was made by a metal tool. We conclude that this paleopathological case provides valuable information about the condition of life and the pre-Hippocratic neurosurgical practice in Bronze Age Greece. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Global health training among U.S. residency specialties: a systematic literature review

    Science.gov (United States)

    Hau, Duncan K.; Smart, Luke R.; DiPace, Jennifer I.; Peck, Robert N.

    2017-01-01

    ABSTRACT Background: Interest in global health training during residency is increasing. Global health knowledge is also becoming essential for health-care delivery today. Many U.S. residency programs have been incorporating global health training opportunities for their residents. We performed a systematic literature review to evaluate global health training opportunities and challenges among U.S. residency specialties. Methods: We searched PubMed from its earliest dates until October 2015. Articles included were survey results of U.S. program directors on global health training opportunities, and web-based searches of U.S. residency program websites on global health training opportunities. Data extracted included percentage of residency programs offering global health training within a specialty and challenges encountered. Results: Studies were found for twelve U.S. residency specialties. Of the survey based studies, the specialties with the highest percentage of their residency programs offering global health training were preventive medicine (83%), emergency medicine (74%), and surgery (71%); and the lowest were orthopaedic surgery (26%), obstetrics and gynecology (28%), and plastic surgery (41%). Of the web-based studies, the specialties with the highest percentage of their residency programs offering global health training were emergency medicine (41%), pediatrics (33%), and family medicine (22%); and the lowest were psychiatry (9%), obstetrics and gynecology (17%), and surgery (18%). The most common challenges were lack of funding, lack of international partnerships, lack of supervision, and scheduling. Conclusion: Among U.S. residency specialties, there are wide disparities for global health training. In general, there are few opportunities in psychiatry and surgical residency specialties, and greater opportunities among medical residency specialties. Further emphasis should be made to scale-up opportunities for psychiatry and surgical residency specialties

  20. [Virtual training in head- and neurosurgery].

    Science.gov (United States)

    Strauss, G; Trantakis, C; Nowatius, E; Falk, V; Maass, H; Cakmak, K; Strauss, E; Dietz, A; Meixensberger, J; Bootz, F; Kühnapfel, U

    2005-05-01

    Surgical skill requires training at close-to-reality scenarios. Conventional procedures (practical exercises, anatomical or animal cadavers) are increasingly in conflict with objective parameters (costs of OR, quality management, cadavers availability and cost). Surgical procedures can be covered by using Virtual Surgical Reality (VSR). We examined the principle of a VSR system and evaluated the results with 30 probands by the example of modified radical mastoidectomy and ventriculocisternostomy. Probands were divided in experienced (A) and non-experienced surgeons (B). The protocol included time of surgery, collisions and fatal injuries at altogether 15 passages (10 passages - break of 14 days - 5 passages). Additionally the Medical Level of Trust (LOT) describes the confidence into the surgical scenario and thus the quality by volume illustration, texture and haptic data feedback to the user. We used a numeric scale between 0 and 100 and the starting point of 50. The learning effect can be confirmed for both virtual scenarios. The mastoid scenario reaches a total confidence index LOT of 75. The ventricle scenario is evaluated with a total confidence index of 84. The necessary time for the opening of the antrum is reduced from 15.0 minutes (group A) and 22.5 minutes (group B) around 37 % to 9, 5 (group A) and around 56 % to 10.0 minutes (group B). The virtual haptic result was evaluated positive in both scenarios. VSR systems have the potential to revolutionize surgical training. All surgical experienced probands evaluated the VSR-scenario as near-to-reality. "Suspension of Disbelief" is the major condition for effective virtual reality training systems.

  1. Safety of topical vancomycin powder in neurosurgery

    Directory of Open Access Journals (Sweden)

    Kalil G Abdullah

    2016-01-01

    Full Text Available Surgical site infections (SSIs remain an important cause of morbidity following neurosurgical procedures despite the best medical practices. In addition, hospital infection rates are proposed as a metric for ranking hospitals safety profiles to guide medical consumerism. Recently, the use of topical vancomycin, defined as the application of vancomycin powder directly into the surgical wound, has been described in both cranial and spinal surgeries as a method to reduce SSIs. Early results are promising. Here, we provide a concise primer on the pharmacology, bacterial spectrum, history, and clinical indications of topical vancomycin for the practicing surgeon.

  2. Controlled Suction with Venous Catheter Irrigation in Neurosurgery: A Cost Effective Technique.

    Science.gov (United States)

    Panigrahi, Manas; Kumari, Manoranjitha; Vooturi, Sudhindra

    2017-01-01

    Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. We used a controlled suction cannula attached to a central suction system. A single lumen central venous catheter is passed through the keyhole of a controlled suction cannula, which is connected to a continuous irrigation system. The operative field was clean throughout the procedure, obviating the need for an assisting surgeon to irrigate into the deep operating field and, hence, reducing the duration of surgery. The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. [Influence of personality and learning styles in the choice of medical specialty].

    Science.gov (United States)

    Bitran, Marcela; Zúñiga, Denisse; Lafuente, Monserrat; Viviani, Paola; Mena, Beltrán

    2005-10-01

    Several studies indicate that doctors who work in the same area of the medical profession tend to behave somehow similarly. Thus, it has been suggested that personality relates to the medical specialty choice. However, it is not known whether people self-select into the medical specialties according to their personality or the professional practice in a particular field influences their behavior. To explore the possible association between the graduate's personality features and learning styles and their chosen specialty. The psychological preferences and learning styles of 65 students of the 2001-graduating cohort of the Pontificia Universidad Católica de Chile School of Medicine were evaluated with the Myers Briggs Type Indicator and the Kolb Learning Style Inventory, respectively. These variables were correlated with the information of their specialty choice or occupation two years after graduation. Graduates distributed unevenly in different areas of the medical profession. Surgical specialties concentrated a larger proportion of extraverted, intuitive and structured doctors, whereas in Pediatrics and Internal Medicine predominated intuitive and people-oriented MD's. Primary Care concentrated individuals with introverted, intuitive and flexible attitudes. Convergent learners (interested in problem-solving) preferred Surgery and Primary Care whereas Assimilator learners (abstract-reflexive) chose more frequently Internal Medicine, Pediatrics and Psychiatry. According to their personality and learning style, graduates tend to self-select into different medical specialties. This information may help medical graduates to guide their specialty choice process, and medical educators to develop learning experiences that take into account the individual differences of their residents.

  4. Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.

    Science.gov (United States)

    Liu, Jason B; Berian, Julia R; Ban, Kristen A; Liu, Yaoming; Cohen, Mark E; Angelos, Peter; Matthews, Jeffrey B; Hoyt, David B; Hall, Bruce L; Ko, Clifford Y

    2017-09-01

    To determine whether concurrently performed operations are associated with an increased risk for adverse events. Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P continuous self-regulation and proactive disclosure to patients.

  5. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.

  6. Personality predictors of surgical specialties choice among students of nursing

    National Research Council Canada - National Science Library

    Dorota Turska; Michał Skrzypek; Irena Wrońska; Teresa B. Kulik

    2017-01-01

    Background Holland’s theory of congruence, according to which one’s career choice is an expression of personality traits common to a given profession, constitutes a theoretical background for this research...

  7. Intraoperative 3D Ultrasonography for Image-Guided Neurosurgery

    NARCIS (Netherlands)

    Letteboer, Marloes Maria Johanna

    2004-01-01

    Stereotactic neurosurgery has evolved dramatically in recent years from the original rigid frame-based systems to the current frameless image-guided systems, which allow greater flexibility while maintaining sufficient accuracy. As these systems continue to evolve, more applications are found, and i

  8. Water balance disorders after neurosurgery: The triphasic response revisited

    NARCIS (Netherlands)

    E.J. Hoorn (Ewout); R. Zietse (Robert)

    2010-01-01

    textabstractWater balance disorders after neurosurgery are well recognized, but detailed reports of the triphasic response are scarce. We describe a 55-year-old woman, who developed the triphasic response with severe hyper- and hyponatraemia after resection of a suprasellar meningioma. The case illu

  9. Trigeminal neuralgia – a coherent cross-specialty management program

    DEFF Research Database (Denmark)

    Heinskou, Tone; Maarbjerg, Stine; Rochat, Per Bjørnstad

    2015-01-01

    BACKGROUND: Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim......: The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache and facial pain. Early high quality MRI ensured correct diagnosis and that the neurosurgeons...

  10. Few gender differences in specialty preferences and motivational factors: A cross-sectional Swedish study on last-year medical students

    NARCIS (Netherlands)

    Diderichsen, S.; Johansson, E.E.; Verdonk, P.; Lagro-Janssen, T.; Hamberg, K.

    2013-01-01

    BACKGROUND: Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. I

  11. Recording stereoscopic 3D neurosurgery with a head-mounted 3D camera system.

    Science.gov (United States)

    Lee, Brian; Chen, Brian R; Chen, Beverly B; Lu, James Y; Giannotta, Steven L

    2015-06-01

    Stereoscopic three-dimensional (3D) imaging can present more information to the viewer and further enhance the learning experience over traditional two-dimensional (2D) video. Most 3D surgical videos are recorded from the operating microscope and only feature the crux, or the most important part of the surgery, leaving out other crucial parts of surgery including the opening, approach, and closing of the surgical site. In addition, many other surgeries including complex spine, trauma, and intensive care unit procedures are also rarely recorded. We describe and share our experience with a commercially available head-mounted stereoscopic 3D camera system to obtain stereoscopic 3D recordings of these seldom recorded aspects of neurosurgery. The strengths and limitations of using the GoPro(®) 3D system as a head-mounted stereoscopic 3D camera system in the operating room are reviewed in detail. Over the past several years, we have recorded in stereoscopic 3D over 50 cranial and spinal surgeries and created a library for education purposes. We have found the head-mounted stereoscopic 3D camera system to be a valuable asset to supplement 3D footage from a 3D microscope. We expect that these comprehensive 3D surgical videos will become an important facet of resident education and ultimately lead to improved patient care.

  12. Foramen magnum meningioma’s management: the experience of the department of neurosurgery in Marrakesh

    Science.gov (United States)

    Hajhouji, Farouk; Lmejjati, Mohammed; Aniba, Khalid; Laghmari, Mehdi; Ghannane, Houssine; Benali, Said Ait

    2017-01-01

    Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer. PMID:28451020

  13. Foramen magnum meningioma's management: the experience of the department of neurosurgery in Marrakesh.

    Science.gov (United States)

    Hajhouji, Farouk; Lmejjati, Mohammed; Aniba, Khalid; Laghmari, Mehdi; Ghannane, Houssine; Benali, Said Ait

    2017-01-01

    Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.

  14. Neurosurgery Simulation Using Non-linear Finite Element Modeling and Haptic Interaction.

    Science.gov (United States)

    Lee, Huai-Ping; Audette, Michel; Joldes, Grand Roman; Enquobahrie, Andinet

    2012-02-23

    Real-time surgical simulation is becoming an important component of surgical training. To meet the real-time requirement, however, the accuracy of the biomechancial modeling of soft tissue is often compromised due to computing resource constraints. Furthermore, haptic integration presents an additional challenge with its requirement for a high update rate. As a result, most real-time surgical simulation systems employ a linear elasticity model, simplified numerical methods such as the boundary element method or spring-particle systems, and coarse volumetric meshes. However, these systems are not clinically realistic. We present here an ongoing work aimed at developing an efficient and physically realistic neurosurgery simulator using a non-linear finite element method (FEM) with haptic interaction. Real-time finite element analysis is achieved by utilizing the total Lagrangian explicit dynamic (TLED) formulation and GPU acceleration of per-node and per-element operations. We employ a virtual coupling method for separating deformable body simulation and collision detection from haptic rendering, which needs to be updated at a much higher rate than the visual simulation. The system provides accurate biomechancial modeling of soft tissue while retaining a real-time performance with haptic interaction. However, our experiments showed that the stability of the simulator depends heavily on the material property of the tissue and the speed of colliding objects. Hence, additional efforts including dynamic relaxation are required to improve the stability of the system.

  15. Neurosurgery simulation using non-linear finite element modeling and haptic interaction

    Science.gov (United States)

    Lee, Huai-Ping; Audette, Michel; Joldes, Grand R.; Enquobahrie, Andinet

    2012-02-01

    Real-time surgical simulation is becoming an important component of surgical training. To meet the realtime requirement, however, the accuracy of the biomechancial modeling of soft tissue is often compromised due to computing resource constraints. Furthermore, haptic integration presents an additional challenge with its requirement for a high update rate. As a result, most real-time surgical simulation systems employ a linear elasticity model, simplified numerical methods such as the boundary element method or spring-particle systems, and coarse volumetric meshes. However, these systems are not clinically realistic. We present here an ongoing work aimed at developing an efficient and physically realistic neurosurgery simulator using a non-linear finite element method (FEM) with haptic interaction. Real-time finite element analysis is achieved by utilizing the total Lagrangian explicit dynamic (TLED) formulation and GPU acceleration of per-node and per-element operations. We employ a virtual coupling method for separating deformable body simulation and collision detection from haptic rendering, which needs to be updated at a much higher rate than the visual simulation. The system provides accurate biomechancial modeling of soft tissue while retaining a real-time performance with haptic interaction. However, our experiments showed that the stability of the simulator depends heavily on the material property of the tissue and the speed of colliding objects. Hence, additional efforts including dynamic relaxation are required to improve the stability of the system.

  16. Synthetic Biology for Specialty Chemicals.

    Science.gov (United States)

    Markham, Kelly A; Alper, Hal S

    2015-01-01

    In this review, we address recent advances in the field of synthetic biology and describe how those tools have been applied to produce a wide variety of chemicals in microorganisms. Here we classify the expansion of the synthetic biology toolbox into three different categories based on their primary function in strain engineering-for design, for construction, and for optimization. Next, focusing on recent years, we look at how chemicals have been produced using these new synthetic biology tools. Advances in producing fuels are briefly described, followed by a more thorough treatment of commodity chemicals, specialty chemicals, pharmaceuticals, and nutraceuticals. Throughout this review, an emphasis is placed on how synthetic biology tools are applied to strain engineering. Finally, we discuss organism and host strain diversity and provide a future outlook in the field.

  17. Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

    Science.gov (United States)

    Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

    1999-01-01

    Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

  18. Consolidating Air Force Maintenance Occupational Specialties

    Science.gov (United States)

    2016-01-01

    Level Current Assigned Level (91% of Authorized Level) 11% -17% 16% -11% 23 4. Long-Run Cost and Readiness Implications of Air Force...Requirements and Readiness .............. 19 4. Long-Run Cost and Readiness Implications of Air Force Specialty Consolidation ................. 23 Cost ...Force Specialty Constructs After Taking into Account Retention ......................................................... 16 Table 4.1. Cost Impacts of

  19. Neurosurgery in Nigeria II - Evaluation of the perceptions of health personnel after the commencement of services in a new centre

    Directory of Open Access Journals (Sweden)

    Jude Kennedy C Emejulu

    2010-01-01

    Full Text Available Background: Prior to the commencement of neurosurgical services in our new centre, in 2006, the awareness of and perceptions about this specialty amongst the health workers were studied. One year after, having experienced first-hand the activities of the unit, these perceptions were again re-evaluated amongst the same workers to determine the impact of the unit on the opinions about the specialty. Methods and Materials: This study was carried out with a questionnaire designed with the 5-point Likert scale, and the respondents comprised of doctors, nurses, students, paramedics and administrators, randomly selected. The same questionnaire was used in the first study but was slightly modified for the present study. Results: Out of 400 questionnaires distributed randomly, 342 were completed and returned. Most of the respondents 282 (82.5% were aged 20 - 30years, mostly students 220 (64.3%, and majority 318 (93% have heard of neurosurgery prior to the establishment of our unit. The service need was rated very necessary by most 286(83.6%, availability of services in Nigeria rated inadequate by 177 (51.8%, and the quality of services rated fair 155(45.3%. The services in our centre were rated fair 138 (40.4% and lack of equipment/facilities was adjudged the greatest hindrance to practice 216 (63.2%, and majority 289 (84.5% strongly recommended that services continue. Conclusion: Neurosurgical services are still significantly inadequate in Nigeria, and though the establishment of new units has positively changed the perception of health workers about the specialty, provision of more manpower and modern facilities remains the major challenge.

  20. Psychiatric specialty training in Greece.

    Science.gov (United States)

    Margariti, M; Kontaxakis, V; Ploumpidis, D

    2017-01-01

    The reform and development of psychiatric services require, in addition to financial resources, reserves in specialized human resources. The role of psychiatrists in this process, and at reducing the consequences of mental morbidity is evident. Psychiatrists are required to play a multifaceted role as clinicians, as experts in multidisciplinary team environments and as advisors in the recognition of public needs in mental health issues, as teachers and mentors for students and other health professionals, as researchers in order to enrich our knowledge in the scientific field of psychiatry, and as public health specialists in the development of the mental health services system. This multifaceted role requires the continuous education of modern psychiatrists, but above all a broad, substantial and comprehensive training regime in the initial stage of their professional career, that is to say during specialization. Training in Psychiatry, as indeed has happened in all other medical specialties, has evolved considerably in recent decades, both in the content of education due to scientific advances in the fields of neurobiology, cognitive neuroscience, genetics, psychopharmacology, epidemiology and psychiatric nosology, and also because of advances in the educational process itself. Simple apprenticeship next to an experienced clinician, despite its importance in the clinical training of young psychiatrists, is no longer sufficient to meet the increased demands of the modern role of psychiatrists, resulting in the creation of educational programs defined by setting and pursuing minimum, though comprehensive educational objectives. This development has created the global need to develop organizations intended to supervise training programs. These organizations have various forms worldwide. In the European Union, the competent supervising body for medical specialties is the UEMS (European Union of Medical Specialities) and particularly in the case of the psychiatric

  1. Is surgical workforce diversity increasing?

    Science.gov (United States)

    Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B

    2007-03-01

    We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.

  2. Inspiring the next generation of Cardiothoracic Surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty.

    Science.gov (United States)

    Bridgeman, Andrew; Findlay, Ross; Devnani, Aroon; Lim, Diana; Loganathan, Krizun; McElnay, Philip; West, Douglas; Coonar, Aman

    2016-01-01

    There is believed to be declining interest in cardiothoracic surgical careers among UK medical students. Relative lack of undergraduate exposure to the specialty compared with other surgical specialties may be partly responsible. Using pre- and postintervention analysis, we assessed the ability of a student-led extracurricular engagement event to increase undergraduate interest in the specialty. Fifty-four students attended and 50 (93%) participated in the study. Of the total, 32% of delegates had identified a cardiothoracic mentor, with only 8 and 4% exposed to cardiac and thoracic surgery, respectively, compared with 50% exposed to other surgical specialties. Self-reported understanding of cardiothoracic training increased from 20 to 80% (P event; 77% of delegates reported increased interest in the specialty. We demonstrate that it is possible to provide a free-to-user event that increases engagement using a student-led design. Similar events could increase interest in the specialty and may improve recruitment rates. Current levels of cardiothoracic exposure are very low among UK students.

  3. Minimally invasive neurosurgery: the technical platform for translational medicine

    Institute of Scientific and Technical Information of China (English)

    ZHAO Ji-zong

    2009-01-01

    @@ Translational medicine, normally refers to a process for transitioning from the initial lab discovery to the patient's bedside with minimal disconnect and offers a comprehensive review of statistical design and methodology. It has been advocated repeatedly by worldwide medical scientists as the new prospect highlighting the transition for scientific achievements from laboratory results to clinical application in recent years. As for neurosurgery, it is generally acknowledged that it has been improving in basic research and clinical practice by bounds and leaps; however, the achievements in basic and clinical neurosurgical studies seem to be parallel with no intersection for mutual interaction.Minimally invasive neurosurgery is aimed at serving as the intersection platform for translational medicine.

  4. Cerenkov and radioluminescence imaging of brain tumor specimens during neurosurgery

    Science.gov (United States)

    Spinelli, Antonello Enrico; Schiariti, Marco P.; Grana, Chiara M.; Ferrari, Mahila; Cremonesi, Marta; Boschi, Federico

    2016-05-01

    We presented the first example of Cerenkov luminescence imaging (CLI) and radioluminescence imaging (RLI) of human tumor specimens. A patient with a brain meningioma localized in the left parietal region was injected with 166 MBq of Y90-DOTATOC the day before neurosurgery. The specimens of the tumor removed during surgery were imaged using both CLI and RLI using an optical imager prototype developed in our laboratory. The system is based on a cooled electron multiplied charge coupled device coupled with an f/0.95 17-mm C-mount lens. We showed for the first time the possibility of obtaining CLI and RLI images of fresh human brain tumor specimens removed during neurosurgery.

  5. The evolving role of the nurse practitioner in neurosurgery.

    Science.gov (United States)

    Rimel, R W; Langfitt, T W

    1980-12-01

    The authors examine the many important roles for the nurse practitioner in neurosurgery, including patient care in academic departments and private practice, and research and scholarship. The responsibilities of nurse practitioners in a hospital can be varied: they may take some responsibility for all patients on the neurosurgery service, or their assignment may be more specific, such as to the intensive care unit; or they may be assigned to all patients with a specified neurosurgical disorder, such as head injury of intractable pain. Nurse practitioners can become coordinators of clinical research programs, with responsibility for collecting and collating the data and assisting in data analysis and manuscript preparation. Detailed clinical protocols must be developed for nurse practitioners, and those protocols then become the basis for their employment and legal status. Licensure requirements vary greatly among states, and are continuing to change.

  6. Three-dimensional, computer simulated navigation in endoscopic neurosurgery

    Directory of Open Access Journals (Sweden)

    Roberta K. Sefcik, BHA

    2017-06-01

    Conclusion: Three-dimensional, frameless neuronavigation systems are useful in endoscopic neurosurgery to assist in the pre-operative planning of potential trajectories and to help localize the pathology of interest. Neuronavigation appears to be accurate to <1–2 mm without issues related to brain shift. Further work is necessary in the investigation of the effect of neuronavigation on operative time, cost, and patient-centered outcomes.

  7. Surgical research using national databases.

    Science.gov (United States)

    Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael

    2016-10-01

    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

  8. CT-MR image data fusion for computer assisted navigated neurosurgery of temporal bone tumors

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, Stefan Franz [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria)]. E-mail: stefan.nemec@meduniwien.ac.at; Donat, Markus Alexander [Department of Neurosurgery, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Mehrain, Sheida [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Friedrich, Klaus [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Krestan, Christian [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Matula, Christian [Department of Neurosurgery, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Imhof, Herwig [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria); Czerny, Christian [Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna (Austria)

    2007-05-15

    Purpose: To demonstrate the value of multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative work up of temporal bone tumors and to present, especially, CT and MR image fusion for surgical planning and performance in computer assisted navigated neurosurgery of temporal bone tumors. Materials and methods: Fifteen patients with temporal bone tumors underwent MDCT and MRI. MDCT was performed in high-resolution bone window level setting in axial plane. The reconstructed MDCT slice thickness was 0.8 mm. MRI was performed in axial and coronal plane with T2-weighted fast spin-echo (FSE) sequences, un-enhanced and contrast-enhanced T1-weighted spin-echo (SE) sequences, and coronal T1-weighted SE sequences with fat suppression and with 3D T1-weighted gradient-echo (GE) contrast-enhanced sequences in axial plane. The 3D T1-weighted GE sequence had a slice thickness of 1 mm. Image data sets of CT and 3D T1-weighted GE sequences were merged utilizing a workstation to create CT-MR fusion images. MDCT and MR images were separately used to depict and characterize lesions. The fusion images were utilized for interventional planning and intraoperative image guidance. The intraoperative accuracy of the navigation unit was measured, defined as the deviation between the same landmark in the navigation image and the patient. Results: Tumorous lesions of bone and soft tissue were well delineated and characterized by CT and MR images. The images played a crucial role in the differentiation of benign and malignant pathologies, which consisted of 13 benign and 2 malignant tumors. The CT-MR fusion images supported the surgeon in preoperative planning and improved surgical performance. The mean intraoperative accuracy of the navigation system was 1.25 mm. Conclusion: CT and MRI are essential in the preoperative work up of temporal bone tumors. CT-MR image data fusion presents an accurate tool for planning the correct surgical procedure and is a

  9. Neurosurgery at the Radcliffe Infirmary, Oxford: a history.

    Science.gov (United States)

    Aziz, T Z; Adams, C B

    1995-09-01

    Neurosurgery started in Oxford in 1938. In this article, we commence the story of Oxford neurosurgery with Thomas Willis and trace the historical thread through William Osler, Charles Sherrington, John Fulton, and Harvey Cushing to Hugh Cairns. The department in Oxford is renowned for the training of neurosurgeons. The initial stimulus for this was the abundance of neurosurgical and neurological expertise in Oxford during World War II with Cairns, and this tradition continued with Joe Pennybacker and his successors. The large and ever increasing work load ensures trainees a wide exposure to challenging neurosurgical problems. An increasing emphasis placed on research has resulted in the creation of two posts; each consists of half-time clinical neurosurgery and half-time research. Hugh Cairns organized the department along "Cushing lines." This organization still exists, allowing us to treat a large number of patients with relatively few beds and an average length of patient stay less than 6 days. We look to the future with confidence.

  10. Dento-maxillofacial radiology as a specialty

    Institute of Scientific and Technical Information of China (English)

    K?van?; Kamburo?lu

    2015-01-01

    This editorial discusses a relatively new specialty in dental and medical field namely dentomaxillofacial radiology. As a relatively newborn specialty it is obvious that there is a long way to go before dentomaxillofacial radiology is commonly known and respected by the society. All over the world, assigned committees work on the development of the training curriculum, determination of scientific and physical standards for institutions offering specialty training and arrangement of dental codes for reimbursement issues. Furthermore, adjustment of educational, scientific and legal regulations and prospective benefits are expected to boost this specialty’s attractiveness to colleagues’ worldwide.

  11. The history of neurosurgery at the University of Alabama at Birmingham.

    Science.gov (United States)

    Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N

    2014-10-01

    : The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.

  12. Knowledge modeling in image-guided neurosurgery: application in understanding intraoperative brain shift

    Science.gov (United States)

    Cohen-Adad, Julien; Paul, Perrine; Morandi, Xavier; Jannin, Pierre

    2006-03-01

    During an image-guided neurosurgery procedure, the neuronavigation system is subject to inaccuracy because of anatomical deformations which induce a gap between the preoperative images and their anatomical reality. Thus, the objective of many research teams is to succeed in quantifying these deformations in order to update preoperative images. Anatomical intraoperative deformations correspond to a complex spatio-temporal phenomenon. Our objective is to identify the parameters implicated in these deformations and to use these parameters as constrains for systems dedicated to updating preoperative images. In order to identify these parameters of deformation we followed the iterative methodology used for cognitive system conception: identification, conceptualization, formalization, implementation and validation. A state of the art about cortical deformations has been established in order to identify relevant parameters probably involved in the deformations. As a first step, 30 parameters have been identified and described following an ontological approach. They were formalized into a Unified Modeling Language (UML) class diagram. We implemented that model into a web-based application in order to fill a database. Two surgical cases have been studied at this moment. After having entered enough surgical cases for data mining purposes, we expect to identify the most relevant and influential parameters and to gain a better ability to understand the deformation phenomenon. This original approach is part of a global system aiming at quantifying and correcting anatomical deformations.

  13. [Modern day psychosurgery: a new approach to neurosurgery in psychiatric disease].

    Science.gov (United States)

    Pedrosa-Sánchez, M; Sola, R G

    To obtain an up to date review of the different possible surgical approaches in the management of certain psychiatric disorders that are refractory to conservative treatment (pharmacotherapy, psychotherapy, electroconvulsive therapy). In order to conduct this research we reviewed the work published by centres with the most experience in this type of surgery, mainly in North America and Europe, since its beginnings in the 1930s, with the controversy concerning prefrontal leucotomy, until the appearance of modern stereotactic techniques. We analyse the anatomophysiological bases, their main clinical indications, the surgical techniques used and their results, as well as perspectives for the future of this neurosurgical treatment. The most noteworthy progress in psychosurgery in recent years has been the combination of a more rigorous selection of patients and the higher degree of specificity with which treatment is performed on the brain structures involved in psychiatric disease. The most widely employed psychosurgical procedures at present are cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy and postero medial hypothalamotomy, with favourable responses in about 35 70% of cases. The psychiatric diagnoses where the best results are to be found are obsessive compulsive disorder, chronic anxiety states and major depression. Current progress in neuroimaging techniques, increased neurophysiological knowledge and the revolutionary neuromodulation techniques, especially deep brain stimulation, offer an even more promising future for psychiatric neurosurgery.

  14. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Science.gov (United States)

    Alva-Sánchez, Héctor; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús

    2014-11-01

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  15. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alva-Sánchez, Héctor, E-mail: halva@ciencias.unam.mx [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico); Reynoso-Mejía, Alberto [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F., Mexico and Departamento de Neuroimagen, Instituto Nacional de (Mexico); Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús [Departamento de Neuroimagen, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico)

    2014-11-07

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  16. Perioperative bioelectrical impedence analysis in neurosurgery.

    Science.gov (United States)

    El-Dawlatly, Abdelazeem A

    2005-10-01

    The use of bioelectrical impedence (BI) measurement to assess body composition has recently attracted the attention of anesthesiologists. Analysis of BI provides a non-invasive method to quantify fluid distribution in different body compartments. This study was designed to assess whether BI analysis reflects fluid depletion in neurosurgical patients with moderate blood loss. Six adult male patients scheduled for elective craniotomy under general anesthesia were studied. Exclusion criteria included patients with cardio-respiratory disease. BI analysis was performed at three stages, A, day before operation, B, during surgery and C, on the first postoperative day. Total body resistivity was measured by BI analysis with a four-terminal portable impedence analyzer. At each frequency, impedence was calculated as resistance (Rx)2 + reactance (Rc)2. The mean values of total body water (TBW) at stages A, B and C were 39.8 L (range: 33.1-46.7 L), 43.2 L (range: 33.1-66.2 L) and 36.8 L (range: 22.4-36.3 L) respectively with significant differences (P<0.05). The impedence at the three frequencies during stages A, B and C showed significant differences (P<0.05). In conclusion, we have found that in male neurosurgical patients multiple frequency BI measurements has reflected fluid balance perioperatively. Whether this observation remains true for other surgical procedures with massive blood loss, yet to be further investigated.

  17. Graduate education in general surgery and its related specialties and subspecialties in the United States.

    Science.gov (United States)

    Bell, Richard H

    2008-10-01

    Each year, approximately 1,000 graduating medical students enter training in general surgery and its related specialties and subspecialties in the United States. Traditionally, residents who want to practice vascular surgery, plastic surgery, thoracic surgery, and other specialties and subspecialties derived from general surgery have been required to complete five years of training in general surgery before embarking on further training. However, three phenomena have recently emerged that are changing the picture of surgical training: (1) proliferation of fellowships in subspecialties of general surgery, (2) increasing desire of subspecialties of general surgery for recognition as specialties in their own right, and (3) pressure to reduce or eliminate the traditional general surgery training required before specialization or subspecialization. In the meantime, and perhaps as a consequence of these changes, traditional general surgery has become less attractive as a specialty and there has been significant concern about the quality of training in general surgery. As a result of fewer trainees electing general surgery as a career, there is now increasing evidence of a shortage of surgeons who are able to handle a reasonably broad caseload of emergency care in general surgery and trauma.Many of these issues are currently being addressed by the profession. Among the initiatives underway are developing a standardized curriculum in general surgery, appropriately apportioning operative experience between residency and fellowship, considering alternative pathways for training in subspecialties, and developing a system for oversight of advanced surgical training fellowships. The system for governance of graduate surgical education in the United States is less centralized than in other countries. One initiative that has been undertaken to improve coordination of efforts between educational and regulatory bodies is the formation of the Surgical Council on Resident Education

  18. Physician empathy: definition, components, measurement, and relationship to gender and specialty.

    Science.gov (United States)

    Hojat, Mohammadreza; Gonnella, Joseph S; Nasca, Thomas J; Mangione, Salvatore; Vergare, Michael; Magee, Michael

    2002-09-01

    There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes. This study was designed to investigate the components of physician empathy, its measurement properties, and group differences in empathy scores. A revised version of the Jefferson Scale of Physician Empathy (with 20 Likert-type items) was mailed to 1,007 physicians affiliated with the Jefferson Health System in the greater Philadelphia region; 704 (70%) responded. Construct validity, reliability of the empathy scale, and the differences on mean empathy scores by physicians' gender and specialty were examined. Three meaningful factors emerged (perspective taking, compassionate care, and standing in the patient's shoes) to provide support for the construct validity of the empathy scale that was also found to be internally consistent with relatively stable scores over time. Women scored higher than men to a degree that was nearly significant. With control for gender, psychiatrists scored a mean empathy rating that was significantly higher than that of physicians specializing in anesthesiology, orthopedic surgery, neurosurgery, radiology, cardiovascular surgery, obstetrics and gynecology, and general surgery. No significant difference was observed on empathy scores among physicians specializing in psychiatry, internal medicine, pediatrics, emergency medicine, and family medicine. Empathy is a multidimensional concept that varies among physicians and can be measured with a psychometrically sound tool. Implications for specialty selection and career counseling are discussed.

  19. The impact of a patient education bundle on neurosurgery patient satisfaction

    Directory of Open Access Journals (Sweden)

    Tamara Kliot

    2015-01-01

    Full Text Available Background: As reimbursements and hospital/physician performance become ever more reliant on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS and other quality metrics, physicians are increasingly incentivized to improve patient satisfaction. Methods: A faculty and resident team at the University of California, San Francisco (UCSF Department of Neurological Surgery developed and implemented a Patient Education Bundle. This consisted of two parts: The first was preoperative expectation letters (designed to inform patients of what to expect before, during, and after their hospitalization for a neurosurgical procedure; the second was a trifold brochure with names, photographs, and specialty/training information about the attending surgeons, resident physicians, and nurse practitioners on the neurosurgical service. We assessed patient satisfaction, as measured by HCAHPS scores and a brief survey tailored to our specific intervention, both before and after our Patient Education Bundle intervention. Results: Prior to our intervention, 74.6% of patients responded that the MD always explained information in a way that was easy to understand. After our intervention, 78.7% of patients responded that the MD always explained information in a way that was easy to understand. "Neurosurgery Patient Satisfaction survey" results showed that 83% remembered receiving the preoperative letter; of those received the letter, 93% found the letter helpful; and 100% thought that the letter should be continued. Conclusion: Although effects were modest, we believe that patient education strategies, as modeled in our bundle, can improve patients′ hospital experiences and have a positive impact on physician performance scores and hospital ratings.

  20. Specialty distribution of physician assistants and nurse practitioners in North Carolina.

    Science.gov (United States)

    Fraher, Erin P; Morgan, Perri; Johnson, Anna

    2016-04-01

    Physician workforce projections often include scenarios that forecast physician shortages under different assumptions about the deployment of physician assistants (PAs) and nurse practitioners (NPs). These scenarios generally assume that PAs and NPs are an interchangeable resource and that their specialty distributions do not change over time. This study investigated changes in PA and NP specialty distribution in North Carolina between 1997 and 2013. The data show that over the study period, PAs and NPs practiced in a wide range of specialties, but each profession had a specific pattern. The proportion of PAs-but not NPs-reporting practice in primary care dropped significantly. PAs were more likely than NPs to report practice in urgent care, emergency medicine, and surgical subspecialties. Physician workforce models need to account for the different and changing specialization trends of NPs and PAs.

  1. Expectations for Endoscopic Training During Gynaecological Specialty Training - Results of a Germany-wide Survey.

    Science.gov (United States)

    Gabriel, L; Solomayer, E; Schott, S; Heesen, A von; Radosa, J; Wallwiener, D; Rimbach, S; Juhasz-Böss, I

    2016-12-01

    Question: Endoscopy is an integral part of surgical gynaecology and is playing an increasingly important role in ensuring adequate gynaecological training in the context of specialty training in general. At present, little is known about the expectations and notions of young junior doctors with respect to endoscopic training. For this reason, junior doctors throughout Germany were surveyed on this topic and asked to share their opinions. Methods: Using an anonymized standardized survey, the following information was elicited: importance of endoscopic training, willingness to take courses, expectations for instructors and the hospital, ideas about the number of required operations, both as a surgical assistant and as a surgeon, as well as satisfaction with the current status of training. The questionnaires were sent via the Young Forum (Junges Forum) of the German Society of Gynaecology and Obstetrics (DGGG) and the newsletter of the Working Group for Gynaecological Endoscopy (AGE). Results: The evaluation of the study was based on 109 completed questionnaires. The resident junior doctors were 31 years old on average and were in their third to fourth year of their specialty training on average. The majority of the participants (87 %) considered the learning of endoscopic techniques to be very important and advocated regular participation in endoscopy training courses. Among the participants, 48 % were prepared to invest up to €1500 of their own funds to attend courses up to twice a year during the entire specialty training period. The expectations of the instructors and institutions focused on technical expertise, the willingness and time for teaching and on the number and range of surgical procedures, followed by being granted leave for the courses and having costs covered for the courses. Thirty-eight per cent stated that their expectations had been completely or mostly met and 62 % said they had been met in part or inadequately. Eighty-three per cent of

  2. Expectations for Endoscopic Training During Gynaecological Specialty Training – Results of a Germany-wide Survey

    Science.gov (United States)

    Gabriel, L.; Solomayer, E.; Schott, S.; Heesen, A. von; Radosa, J.; Wallwiener, D.; Rimbach, S.; Juhasz-Böss, I.

    2016-01-01

    Question: Endoscopy is an integral part of surgical gynaecology and is playing an increasingly important role in ensuring adequate gynaecological training in the context of specialty training in general. At present, little is known about the expectations and notions of young junior doctors with respect to endoscopic training. For this reason, junior doctors throughout Germany were surveyed on this topic and asked to share their opinions. Methods: Using an anonymized standardized survey, the following information was elicited: importance of endoscopic training, willingness to take courses, expectations for instructors and the hospital, ideas about the number of required operations, both as a surgical assistant and as a surgeon, as well as satisfaction with the current status of training. The questionnaires were sent via the Young Forum (Junges Forum) of the German Society of Gynaecology and Obstetrics (DGGG) and the newsletter of the Working Group for Gynaecological Endoscopy (AGE). Results: The evaluation of the study was based on 109 completed questionnaires. The resident junior doctors were 31 years old on average and were in their third to fourth year of their specialty training on average. The majority of the participants (87 %) considered the learning of endoscopic techniques to be very important and advocated regular participation in endoscopy training courses. Among the participants, 48 % were prepared to invest up to €1500 of their own funds to attend courses up to twice a year during the entire specialty training period. The expectations of the instructors and institutions focused on technical expertise, the willingness and time for teaching and on the number and range of surgical procedures, followed by being granted leave for the courses and having costs covered for the courses. Thirty-eight per cent stated that their expectations had been completely or mostly met and 62 % said they had been met in part or inadequately. Eighty-three per cent of

  3. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  4. Gender awareness among physicians--the effect of specialty and gender. A study of teachers at a Swedish medical school.

    Science.gov (United States)

    Risberg, Gunilla; Hamberg, Katarina; Johansson, Eva E

    2003-10-27

    An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to

  5. Gender awareness among physicians – the effect of specialty and gender. A study of teachers at a Swedish medical school

    Directory of Open Access Journals (Sweden)

    Hamberg Katarina

    2003-10-01

    Full Text Available Abstract Background An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. Method Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. Results The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. Conclusions There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the

  6. Retractor-induced brain shift compensation in image-guided neurosurgery

    Science.gov (United States)

    Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

    2013-03-01

    In image-guided neurosurgery, intraoperative brain shift significantly degrades the accuracy of neuronavigation that is solely based on preoperative magnetic resonance images (pMR). To compensate for brain deformation and to maintain the accuracy in image guidance achieved at the start of surgery, biomechanical models have been developed to simulate brain deformation and to produce model-updated MR images (uMR) to compensate for brain shift. To-date, most studies have focused on shift compensation at early stages of surgery (i.e., updated images are only produced after craniotomy and durotomy). Simulating surgical events at later stages such as retraction and tissue resection are, perhaps, clinically more relevant because of the typically much larger magnitudes of brain deformation. However, these surgical events are substantially more complex in nature, thereby posing significant challenges in model-based brain shift compensation strategies. In this study, we present results from an initial investigation to simulate retractor-induced brain deformation through a biomechanical finite element (FE) model where whole-brain deformation assimilated from intraoperative data was used produce uMR for improved accuracy in image guidance. Specifically, intensity-encoded 3D surface profiles at the exposed cortical area were reconstructed from intraoperative stereovision (iSV) images before and after tissue retraction. Retractor-induced surface displacements were then derived by coregistering the surfaces and served as sparse displacement data to drive the FE model. With one patient case, we show that our technique is able to produce uMR that agrees well with the reconstructed iSV surface after retraction. The computational cost to simulate retractor-induced brain deformation was approximately 10 min. In addition, our approach introduces minimal interruption to the surgical workflow, suggesting the potential for its clinical application.

  7. Publication misrepresentation among neurosurgery residency applicants: an increasing problem.

    Science.gov (United States)

    Kistka, Heather M; Nayeri, Arash; Wang, Li; Dow, Jamie; Chandrasekhar, Rameela; Chambless, Lola B

    2016-01-01

    OBJECT Misrepresentation of scholarly achievements is a recognized phenomenon, well documented in numerous fields, yet the accuracy of reporting remains dependent on the honor principle. Therefore, honest self-reporting is of paramount importance to maintain scientific integrity in neurosurgery. The authors had observed a trend toward increasing numbers of publications among applicants for neurosurgery residency at Vanderbilt University and undertook this study to determine whether this change was a result of increased academic productivity, inflated reporting, or both. They also aimed to identify application variables associated with inaccurate citations. METHODS The authors retrospectively reviewed the residency applications submitted to their neurosurgery department in 2006 (n = 148) and 2012 (n = 194). The applications from 2006 were made via SF Match and those from 2012 were made using the Electronic Residency Application Service. Publications reported as "accepted" or "in press" were verified via online search of Google Scholar, PubMed, journal websites, and direct journal contact. Works were considered misrepresented if they did not exist, incorrectly listed the applicant as first author, or were incorrectly listed as peer reviewed or published in a printed journal rather than an online only or non-peer-reviewed publication. Demographic data were collected, including applicant sex, medical school ranking and country, advanced degrees, Alpha Omega Alpha membership, and USMLE Step 1 score. Zero-inflated negative binomial regression was used to identify predictors of misrepresentation. RESULTS Using univariate analysis, between 2006 and 2012 the percentage of applicants reporting published works increased significantly (47% vs 97%, p misrepresentations (33% vs 45%) also increased. In 2012, applicants with a greater total of reported works (p Misrepresentation is more common in applicants from unranked US medical schools and those with a greater number of

  8. Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

    Science.gov (United States)

    Ament, Jared D; Kim, Timothy; Gold-Markel, Judah; Germano, Isabelle M; Dempsey, Robert; Weaver, John P; DiPatri, Arthur J; Andrews, Russell J; Sanchez, Mary; Hinojosa, Juan; Moser, Richard P; Glick, Roberta

    2017-08-01

    The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery : What's the evidence?

    NARCIS (Netherlands)

    Liu, Weiming; Neidert, Marian Christoph; Groen, Rob J. M.; Woernle, Christoph Michael; Grundmann, Hajo

    To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the

  10. Evaluation of the impact of collaborative work by teams from the National Medical Residency Committee and the Brazilian Society of Neurosurgery. Retrospective and prospective study

    Directory of Open Access Journals (Sweden)

    Renato Antunes dos Santos

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Training for specialist physicians in Brazil can take place in different ways. Closer liaison between institutions providing this training and assessment and health care services may improve qualifications. This article analyzes the impact of closer links and joint work by teams from the National Medical Residency Committee (Comissão Nacional de Residência Médica, CNRM and the Brazilian Society of Neurosurgery (Sociedade Brasileira de Neurocirurgia, SBN towards evaluating these programs. DESIGN AND SETTING: Retrospective and prospective study, conducted in a public university on a pilot project developed between CNRM and SBN for joint assessment of training programs across Brazil. METHODS: The literature in the most relevant databases was reviewed. Documents and legislation produced by official government bodies were evaluated. Training locations were visited. Reports produced about residency programs were analyzed. RESULTS: Only 26% of the programs were immediately approved. The joint assessments found problems relating to teaching and to functioning of clinical service in 35% of the programs. The distribution of programs in this country has a strong relationship with the Human Development Index (HDI of the regions and is very similar to the distribution of specialists. CONCLUSION: Closer collaboration between the SBN and CNRM had a positive impact on assessment of neurosurgery medical residency across the country. The low rates of direct approval have produced modifications and improvements to the quality of teaching and care (services. Closer links between the CNRM and other medical specialties have the capability to positively change the structure and function of specialty training in Brazil.

  11. Factors affecting membership in specialty nursing organizations.

    Science.gov (United States)

    White, Mary Joe; Olson, Rhonda S

    2004-01-01

    A discouraging trend in many specialty nursing organizations is the stagnant or declining membership. The research committee of the Southeast Texas Chapter of the Association of Rehabilitation Nurses (ARN) collected data and studied this trend to determine what changes would be necessary to increase membership. Using Herzberg's motivational theory as a framework, a review of the literature was initiated. There were few current studies on this issue, but relevant information was found about nursing's emerging workforce, as well as implications of the growth of magnet hospitals, which affect whether nurses join specialty nursing organizations. A multifaceted data-collection approach using convenience samples was designed. First, relevant literature was reviewed. Second, a survey was sent by e-mail to other ARN chapters. Third, a telephone survey on other specialty organizations in the geographic region was completed. Finally, members of the local ARN chapter and four other specialty organizations, as well staff nurses in the geographic area, were given questionnaires to complete. Descriptive statistics and cross tabulations were used to determine why nurses do and do not join specialty organizations (N = 81). The most frequent reasons for joining an organization were to increase knowledge, benefit professionally, network, and earn continuing education units. Reasons for choosing not to participate were family responsibilities, lack of information about these organizations, and lack of time. Ways to reverse the decline in membership are discussed.

  12. Laser Nano-Neurosurgery from gentle manipulation to nano-incision of neuronal cells and scaffolds: an advanced neurotechnology tool.

    Directory of Open Access Journals (Sweden)

    Alessandro eSoloperto

    2016-03-01

    Full Text Available Current optical approaches are progressing far beyond the scope of monitoring the structure and function of living matter, and they are becoming widely recognized as extremely precise, minimally-invasive, contact-free handling tools. Laser manipulation of living tissues, single cells or even single-molecules is becoming a well-established methodology, thus founding the onset of new experimental paradigms and research fields. Indeed, a tightly focused pulsed laser source permits complex tasks such as developing engineered bioscaffolds, applying calibrated forces, transfecting, stimulating or even ablating single cells with subcellular precision, and operating intracellular surgical protocols at the level of single organelles. In the present review, we report the state of the art of laser manipulation in neuroscience, to inspire future applications of light-assisted tools in nano-neurosurgery.

  13. Augmented-reality integrated robotics in neurosurgery: are we there yet?

    Science.gov (United States)

    Madhavan, Karthik; Kolcun, John Paul G; Chieng, Lee Onn; Wang, Michael Y

    2017-05-01

    Surgical robots have captured the interest-if not the widespread acceptance-of spinal neurosurgeons. But successful innovation, scientific or commercial, requires the majority to adopt a new practice. "Faster, better, cheaper" products should in theory conquer the market, but often fail. The psychology of change is complex, and the "follow the leader" mentality, common in the field today, lends little trust to the process of disseminating new technology. Beyond product quality, timing has proven to be a key factor in the inception, design, and execution of new technologies. Although the first robotic surgery was performed in 1985, scant progress was seen until the era of minimally invasive surgery. This movement increased neurosurgeons' dependence on navigation and fluoroscopy, intensifying the drive for enhanced precision. Outside the field of medicine, various technology companies have made great progress in popularizing co-robots ("cobots"), augmented reality, and processor chips. This has helped to ease practicing surgeons into familiarity with and acceptance of these technologies. The adoption among neurosurgeons in training is a "follow the leader" phenomenon, wherein new surgeons tend to adopt the technology used during residency. In neurosurgery today, robots are limited to computers functioning between the surgeon and patient. Their functions are confined to establishing a trajectory for navigation, with task execution solely in the surgeon's hands. In this review, the authors discuss significant untapped technologies waiting to be used for more meaningful applications. They explore the history and current manifestations of various modern technologies, and project what innovations may lie ahead.

  14. From trephination to tailored resection: neurosurgery in Germany before World War II.

    Science.gov (United States)

    Buchfelder, Michael

    2005-03-01

    Evidence exists that trephination was performed in Germany as early as the Stone Age. Late medieval barber surgeons further developed instruments and techniques for this procedure. Various surgeons performed individual cranial operations before the 1870s, and neurosurgery evolved as a distinct discipline in Germany around 1934. Before the 20th century, most cranial operations in Germany, as in other European countries, were performed for trauma. Since approximately 1870, a few individuals with a devoted interest in surgery of the nervous system have developed operative techniques for the brain and spinal cord. Wilhelm Wagner, Fedor Krause, Ernst von Bergmann, and Otfrid Foerster were among these pioneers. Through independent research based on careful clinical observation, these physicians contributed significantly to an understanding of the pathophysiology of nervous system disorders that could be treated surgically. They designed techniques, such as those used for intracranial pressure regulation, and developed operative procedures, such as the osteoplastic flap of Wagner, and cortical stimulation, which was performed by Krause and Foerster.

  15. Health impact and economic analysis of NGO-supported neurosurgery in Bolivia.

    Science.gov (United States)

    Ament, Jared D; Greene, Kevin R; Flores, Ivan; Capobianco, Fernando; Salas, Gueider; Uriona, Maria Ines; Weaver, John P; Moser, Richard

    2014-04-01

    Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation. A non-governmental organization (NGO) supports spinal procedures in Bolivia (Solidarity Bridge), and the authors sought to determine its impact and cost-effectiveness. In a retrospective review of prospectively collected data, 19 patients were identified prior to spinal instrumentation and followed over 12 months. For inclusion, patients required interviewing prior to surgery and during at least 2 follow-up visits. All causes of spinal pathology were included. Sixteen patients met inclusion criteria and were therefore part of the analysis. Outcomes measured included assessment of activities of daily living, pain, ambulation, return to work/school, and satisfaction. Cost-effectiveness was determined by cost-utility analysis. Utilities were derived using the Health Utilities Index. Complications were incorporated into an expected value decision tree. Median (± SD) preoperative satisfaction was 2.0 ± 0.3 (on a scale of 0-10), while 6-month postoperative satisfaction was 7 ± 1.4 (p Bolivia appears to be cost-effective, especially when compared with the conventional $50,000/QALY benchmark and the WHO endorsed country-specific threshold of $16,026/QALY. However, with a gross domestic product per capita in Bolivia equaling $4800 per year and 30.3% of the population living on less than $2 per day, this cost continues to appear unrealistic. Additionally, the study has several significant limitations, namely its limited sample size, follow-up period, the assumption that patients not receiving surgical intervention would not make any clinical improvement, the reliance on the NGO for patient selection and sustainable practices

  16. Surgical Assisting

    Science.gov (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  17. Holland's Theory Applied to Medical Specialty Choice

    Science.gov (United States)

    Borges, Nicole J.; Savickas, Mark L.; Jones, Bonnie J.

    2004-01-01

    The present study tested the hypothesis that medical specialties classified as technique oriented or patient oriented would be distinguished by RIASEC code, with technique-oriented specialists resembling Investigative-Realistic types and patient-oriented specialists resembling Investigative-Social types. Using longitudinal data obtained from 447…

  18. Facial Specialty. Teacher Edition. Cosmetology Series.

    Science.gov (United States)

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This publication is one of a series of curriculum guides designed to direct and support instruction in vocational cosmetology programs in the State of Oklahoma. It contains seven units for the facial specialty: identifying enemies of the skin, using aromatherapy on the skin, giving facials without the aid of machines, giving facials with the aid…

  19. Personality Factors and Occupational Specialty Choice.

    Science.gov (United States)

    Borges, Nicole J.; Jones, Bonnie J.

    This study is a continuation of an earlier investigation of personality and medical specialty choice. The earlier study determined that personality differences existed among family practitioners, anesthesiologists, and general surgeons. Based on this initial research, an attempt was made to answer the question of how the personality factors of…

  20. Holland's Theory Applied to Medical Specialty Choice

    Science.gov (United States)

    Borges, Nicole J.; Savickas, Mark L.; Jones, Bonnie J.

    2004-01-01

    The present study tested the hypothesis that medical specialties classified as technique oriented or patient oriented would be distinguished by RIASEC code, with technique-oriented specialists resembling Investigative-Realistic types and patient-oriented specialists resembling Investigative-Social types. Using longitudinal data obtained from 447…

  1. Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.

    Science.gov (United States)

    Weinstock, Peter; Rehder, Roberta; Prabhu, Sanjay P; Forbes, Peter W; Roussin, Christopher J; Cohen, Alan R

    2017-07-01

    OBJECTIVE Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus. METHODS A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV. RESULTS A

  2. Orofacial pain emerging as a dental specialty.

    Science.gov (United States)

    Rosenbaum, R S; Friction, J R; Okeson, J P

    2001-01-01

    The emerging field of orofacial pain was considered by the American Dental Association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. Dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of

  3. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    Science.gov (United States)

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  4. Should women's health be a medical specialty?

    Science.gov (United States)

    Papazian, T

    1993-01-01

    The proponents of a new specialty in medicine focusing on women's health are concerned with women's total health needs, much like pediatrics is with children or geriatrics with old people. None of the 7 Lebanese physicians interviewed were aware of this issue. Among them there were 3 female doctors (a family physician, and endocrinologist, and a dermatologist) and 4 male doctors (2 surgeons, a gynecologist, and a cardiologist). The irrelevance of creating such a specialty in the Lebanese reality could be attributed to the absence of a feminist catalyst in Lebanon. All 7 physicians believed that medicine was providing comprehensive care equitably to men and women and argued that the creation of a new specialty would cause further division and segregation between the sexes. All the doctors said that the main reason for not including women in the trial testing of new drugs is fear of interfering with their reproductive system. Drugs may affect the menstrual cycle, the fetus, or the hormonal system and thus cause permanent damage. Because of cultural and traditional value systems, the endocrinologist claimed that in Lebanon men do not get a genital examination as part of a check-up by their general practitioner, and women are not examined if they do not request it themselves. All agreed that the family physician is the best person to provide comprehensive care and to refer the patient to a specialist. All the physicians with different specialties and backgrounds believed that the creation of a new specialty would be illogical or nonsensical. The fact that women doctors shared the opinion of male doctors was intriguing. It raised questions as to whether they had the same opinion or whether they reacted the same way because they belonged to the same community or because of the absence of an aggressive women's liberation movement in Lebanon.

  5. The prognostic value of histopathology on lingual nerve neurosensory recovery after micro-neurosurgery

    DEFF Research Database (Denmark)

    Hørberg, Mette; Reibel, Jesper; Kragelund, Camilla

    2016-01-01

    OBJECTIVE: Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery. MATERIALS AND METHODS: Retrospective...... case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation...

  6. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Science.gov (United States)

    Phan, Pho Nh; Patel, Keyur; Bhavsar, Amar; Acharya, Vikas

    2016-01-01

    Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies - this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments.

  7. The incidentaloma of the pituitary gland: Is neurosurgery required

    Energy Technology Data Exchange (ETDEWEB)

    Reincke, M.; Allolio, B.; Saeger, W.; Menzel, J.; Winkelmann, W. (Univ. of Cologne (West Germany))

    1990-05-23

    The authors describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up. The results suggest that the incidentaloma of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

  8. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

    Science.gov (United States)

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G

    2013-01-01

    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  9. A qualitative study on physicians' perceptions of specialty characteristics.

    Science.gov (United States)

    Park, Kwi Hwa; Jun, Soo-Koung; Park, Ie Byung

    2016-09-01

    There has been limited research on physicians' perceptions of the specialty characteristics that are needed to sustain a successful career in medical specialties in Korea. Medical Specialty Preference Inventory in the United States or SCI59 (specialty choice inventory) in the United Kingdom are implemented to help medical students plan their careers. The purpose of this study was to explore the characteristics of the major specialties in Korea. Twelve physicians from different specialties participated in an exploratory study consisting of qualitative interviews about the personal ability and emotional characteristics and job attributes of each specialty. The collected data were analysed with content analysis methods. Twelve codes were extracted for ability & skill attributes, 23 codes for emotion & attitude attributes, and 12 codes for job attributes. Each specialty shows a different profile in terms of its characteristic attributes. The findings have implications for the design of career planning programs for medical students.

  10. 76 FR 42112 - Specialty Crop Committee Stakeholder Listening Sessions

    Science.gov (United States)

    2011-07-18

    ...; ] DEPARTMENT OF AGRICULTURE Office of the Secretary Specialty Crop Committee Stakeholder Listening Sessions AGENCY: Research, Education, and Economics, USDA. ACTION: Notice of stakeholder listening sessions... Department of Agriculture announces two stakeholder listening sessions of the Specialty Crop Committee,...

  11. Emergency neurosurgery in Darwin: still the generalist surgeons' responsibility.

    Science.gov (United States)

    Luck, Tara; Treacy, Peter John; Mathieson, Matthew; Sandilands, Jessica; Weidlich, Stephanie; Read, David

    2015-09-01

    Royal Darwin Hospital (RDH) is the only major hospital for the 'Top End' of Northern Territory and Western Australia. As retrieval distances exceed 2600 km, resident generalist surgeons undertake all emergency neurosurgery. Retrospective clinical study from RDH records and review of prospectively collected datasets from RDH Intensive Care Unit and National Critical Care Trauma Response Centre for all emergency neurosurgery patients between 2008 and 2013. Data were obtained from 161 patients with 167 admissions (73% male, 39% indigenous) who underwent 195 procedures (33 per year), including burr hole, craniotomy, cerebral and posterior fossa craniectomy, elevation fracture and ventricular drain. Trauma accounted for 68%, with alcohol as a known factor in 57%. Subdural haematoma (SDH) accounted for 53%. Severity of head injury at presentation correlated with outcome (R(2) = 0.12, P 24 h (P = 0.023) and specific diagnoses of acute SDH (P = 0.006), acute-on-chronic SDH (P = 0.053) and infection (P = 0.052). Indigenous patients were younger (40 versus 55 years, P < 0.001) and more likely to have alcohol as a factor in trauma cases (71% versus 49%, P = 0.027). Time from injury to hospital was high for accidents at a remote location (12.9 versus 1.3 h, P < 0.001); however, Glasgow Outcome Scales (P = 0.13) were no different to accident at metropolitan Darwin. General surgeons at RDH perform a wide range of emergency neurosurgical procedures primarily for trauma. Factors contributing to poor outcomes included remote location of trauma and delay in reaching the hospital. Outcomes at 3 months appear acceptable. © 2015 Royal Australasian College of Surgeons.

  12. Image Fusion for Radiosurgery, Neurosurgery and Hypofractionated Radiotherapy.

    Science.gov (United States)

    Inoue, Hiroshi K; Nakajima, Atsushi; Sato, Hiro; Noda, Shin-Ei; Saitoh, Jun-Ichi; Suzuki, Yoshiyuki

    2015-03-01

    Precise target detection is essential for radiosurgery, neurosurgery and hypofractionated radiotherapy because treatment results and complication rates are related to accuracy of the target definition. In skull base tumors and tumors around the optic pathways, exact anatomical evaluation of cranial nerves are important to avoid adverse effects on these structures close to lesions. Three-dimensional analyses of structures obtained with MR heavy T2-images and image fusion with CT thin-sliced sections are desirable to evaluate fine structures during radiosurgery and microsurgery. In vascular lesions, angiography is most important for evaluations of whole structures from feeder to drainer, shunt, blood flow and risk factors of bleeding. However, exact sites and surrounding structures in the brain are not shown on angiography. True image fusions of angiography, MR images and CT on axial planes are ideal for precise target definition. In malignant tumors, especially recurrent head and neck tumors, biologically active areas of recurrent tumors are main targets of radiosurgery. PET scan is useful for quantitative evaluation of recurrences. However, the examination is not always available at the time of radiosurgery. Image fusion of MR diffusion images with CT is always available during radiosurgery and useful for the detection of recurrent lesions. All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment. Follow-up images are also able to register on this CT. Exact target changes, including volume, are possible in this fusion system. The purpose of this review is to describe the usefulness of image fusion for 1) skull base, 2) vascular, 3) recurrent target detection, and 4) follow-up analyses in radiosurgery, neurosurgery and hypofractionated radiotherapy.

  13. The incidence of postoperative meningitis in neurosurgery: An institutional experience

    Directory of Open Access Journals (Sweden)

    Dwarakanath Srinivas

    2011-01-01

    Full Text Available Introduction : Meningitis is the most dreaded cause of morbidity and mortality in neurosurgical patients. The reported incidence of postoperative meningitis is quite varied 0.5-8%. Material and Methods : The study cohort included all the patients who underwent neurosurgery at the department of neurosurgery, National Institute of Mental Health and Neurological Sciences, Bangalore, India over a period of seven years (2001 - 2007. Patients with culture positive meningitis were included for analysis. The incidence of postoperative meningitis was analyzed depending on the type of surgery performed and the microbiological profile of the organisms, and their sensitivity pattern. Results : Of the 18,092 patients who underwent neurosurgical procedures during the study period, 415 patients developed infection. The overall incidence of meningitis was 2.2%. The incidence of meningitis was high (7.7% in patients who had a pre-existing infection like post-pyogenic meningitis or tuberculosis hydrocephalus. The procedure mainly performed in this subgroup was shunt. The most common organisms causing meningitis were non-lactose fermenting Gram-negative bacillus followed by Pseudomonas and Klebsiella species. The methicillin-resistant Staphylococcus aureus strains were isolated in 2.6% of the patients. Ninety-one strains were multi-drug resistant, among which four strains were resistant to all antibiotics tested. The overall mortality in patients with meningitis was 5%. Conclusion : Meningitis remains one of the most dreaded complications of neurosurgical procedures and is common in patients with preexisting infection. Gram-negative organisms are the most common causative pathogens of postoperative meningitis.

  14. Numerical simulations of clinical focused ultrasound functional neurosurgery

    Science.gov (United States)

    Pulkkinen, Aki; Werner, Beat; Martin, Ernst; Hynynen, Kullervo

    2014-04-01

    A computational model utilizing grid and finite difference methods were developed to simulate focused ultrasound functional neurosurgery interventions. The model couples the propagation of ultrasound in fluids (soft tissues) and solids (skull) with acoustic and visco-elastic wave equations. The computational model was applied to simulate clinical focused ultrasound functional neurosurgery treatments performed in patients suffering from therapy resistant chronic neuropathic pain. Datasets of five patients were used to derive the treatment geometry. Eight sonications performed in the treatments were then simulated with the developed model. Computations were performed by driving the simulated phased array ultrasound transducer with the acoustic parameters used in the treatments. Resulting focal temperatures and size of the thermal foci were compared quantitatively, in addition to qualitative inspection of the simulated pressure and temperature fields. This study found that the computational model and the simulation parameters predicted an average of 24 ± 13% lower focal temperature elevations than observed in the treatments. The size of the simulated thermal focus was found to be 40 ± 13% smaller in the anterior-posterior direction and 22 ± 14% smaller in the inferior-superior direction than in the treatments. The location of the simulated thermal focus was off from the prescribed target by 0.3 ± 0.1 mm, while the peak focal temperature elevation observed in the measurements was off by 1.6 ± 0.6 mm. Although the results of the simulations suggest that there could be some inaccuracies in either the tissue parameters used, or in the simulation methods, the simulations were able to predict the focal spot locations and temperature elevations adequately for initial treatment planning performed to assess, for example, the feasibility of sonication. The accuracy of the simulations could be improved if more precise ultrasound tissue properties (especially of the

  15. 76 FR 66965 - Treasure Coast Specialty Pharmacy Decision and Order

    Science.gov (United States)

    2011-10-28

    ... Enforcement Administration Treasure Coast Specialty Pharmacy Decision and Order On September 14, 2011... Registration, BT9856002, issued to Treasure Coast Specialty Pharmacy, be, and it hereby is, revoked. I further order that any pending application of Treasure Coast Specialty Pharmacy, to renew or modify his...

  16. Career Specialty Choice: A Combined Research-Intervention Project

    Science.gov (United States)

    Leong, F.T.L.; Hardin, E.E.; Gaylor, M.

    2005-01-01

    This research describes and evaluates a workshop aimed at promoting career specialty choice and examines relationships between measured career specialty interests, work values, and personality type. Three consecutive classes of second-year medical students (N=161) participated in a two-session specialty choice workshop. All participants in the…

  17. Skill/Knowledge Commonalities in Selected Electronics Specialties.

    Science.gov (United States)

    1986-10-01

    their responses, an electronics principles usage profile was constructed for each specialty. Statistical analyses were performed on the profiles to...9 1 6 EPI Correlations Based on Percent Using for Wire Commnications Specialties. .. .. .. 10 7 Use of Electronics Principles by Wire...provides the opportunity for studying the actual overlap in electronics principles utilization among these specialties. Such a study would allow one

  18. 15 CFR 2011.204 - Entry of specialty sugars.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Entry of specialty sugars. 2011.204... UNITED STATES TRADE REPRESENTATIVE ALLOCATION OF TARIFF-RATE QUOTA ON IMPORTED SUGARS, SYRUPS AND MOLASSES Specialty Sugar § 2011.204 Entry of specialty sugars. An importer or the importer's agent...

  19. Recent trends in specialty pharma business model

    Directory of Open Access Journals (Sweden)

    Mannching Sherry Ku

    2015-12-01

    Full Text Available The recent rise of specialty pharma is attributed to its flexible, versatile, and open business model while the traditional big pharma is facing a challenging time with patent cliff, generic threat, and low research and development (R&D productivity. These multinational pharmaceutical companies, facing a difficult time, have been systematically externalizing R&D and some even establish their own corporate venture capital so as to diversify with more shots on goal, with the hope of achieving a higher success rate in their compound pipeline. Biologics and clinical Phase II proof-of-concept (POC compounds are the preferred licensing and collaboration targets. Biologics enjoys a high success rate with a low generic biosimilar threat, while the need is high for clinical Phase II POC compounds, due to its high attrition/low success rate. Repurposing of big pharma leftover compounds is a popular strategy but with limitations. Most old compounds come with baggage either in lackluster clinical performance or short in patent life. Orphan drugs is another area which has gained popularity in recent years. The shorter and less costly regulatory pathway provides incentives, especially for smaller specialty pharma. However, clinical studies on orphan drugs require a large network of clinical operations in many countries in order to recruit enough patients. Big pharma is also working on orphan drugs starting with a small indication, with the hope of expanding the indication into a blockbuster status. Specialty medicine, including orphan drugs, has become the growth engine in the pharmaceutical industry worldwide. Big pharma is also keen on in-licensing technology or projects from specialty pharma to extend product life cycles, in order to protect their blockbuster drug franchises. Ample opportunities exist for smaller players, even in the emerging countries, to collaborate with multinational pharmaceutical companies provided that the technology platforms or

  20. Recent trends in specialty pharma business model.

    Science.gov (United States)

    Ku, Mannching Sherry

    2015-12-01

    The recent rise of specialty pharma is attributed to its flexible, versatile, and open business model while the traditional big pharma is facing a challenging time with patent cliff, generic threat, and low research and development (R&D) productivity. These multinational pharmaceutical companies, facing a difficult time, have been systematically externalizing R&D and some even establish their own corporate venture capital so as to diversify with more shots on goal, with the hope of achieving a higher success rate in their compound pipeline. Biologics and clinical Phase II proof-of-concept (POC) compounds are the preferred licensing and collaboration targets. Biologics enjoys a high success rate with a low generic biosimilar threat, while the need is high for clinical Phase II POC compounds, due to its high attrition/low success rate. Repurposing of big pharma leftover compounds is a popular strategy but with limitations. Most old compounds come with baggage either in lackluster clinical performance or short in patent life. Orphan drugs is another area which has gained popularity in recent years. The shorter and less costly regulatory pathway provides incentives, especially for smaller specialty pharma. However, clinical studies on orphan drugs require a large network of clinical operations in many countries in order to recruit enough patients. Big pharma is also working on orphan drugs starting with a small indication, with the hope of expanding the indication into a blockbuster status. Specialty medicine, including orphan drugs, has become the growth engine in the pharmaceutical industry worldwide. Big pharma is also keen on in-licensing technology or projects from specialty pharma to extend product life cycles, in order to protect their blockbuster drug franchises. Ample opportunities exist for smaller players, even in the emerging countries, to collaborate with multinational pharmaceutical companies provided that the technology platforms or specialty medicinal

  1. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre

    2011-06-01

    Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome.

  2. Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors.

    Directory of Open Access Journals (Sweden)

    Ligia Correia Lima de Souza

    Full Text Available Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors.A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ(2 = 107.2. The choice mainly occurred during the internship period in medical school (n = 466; 38.7%. An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%, which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3 and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2. With regard to influential factors in controllable lifestyle specialties, "financial reason" (mean score ± standard deviation: 2.8 ± 1.0; median = 3 and "personal time" (3.1 ± 1.3; median = 4 were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both, and higher scores were observed for "curricular internship" (3.2 ± 1.1, median = 4 and "social commitment" (2.6 ± 1.3, median = 3.The present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the

  3. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery.

    Science.gov (United States)

    Pelargos, Panayiotis E; Nagasawa, Daniel T; Lagman, Carlito; Tenn, Stephen; Demos, Joanna V; Lee, Seung J; Bui, Timothy T; Barnette, Natalie E; Bhatt, Nikhilesh S; Ung, Nolan; Bari, Ausaf; Martin, Neil A; Yang, Isaac

    2017-01-01

    Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Electrochemical degradation of specialty chemical industry effluent.

    Science.gov (United States)

    Basha, C Ahmed; Soloman, P A; Velan, M; Miranda, Lima Rose; Balasubramanian, N; Siva, R

    2010-04-15

    Conventional wastewater treatment techniques are inefficient to manage large quantities of refractory organics discharged by specialty chemical industries. It is aimed in the present investigation to compare overall performance of the basic electrochemical reactor configurations such as batch, batch recirculation and continuous recycle reactors, in removing the organic part of wastewater from a medium-scale, specialty chemical industry. The effects of current density, supporting electrolyte concentration, electrolysis duration and fluid flow rate on the pollutant removal and energy consumption performances were critically evaluated. Continuous recycle reactor is found to be the better configuration, because of its flexibility of operation. Circulation flow rate and withdrawal flow rate enable control on transfer coefficients and treatment duration respectively. The ability of artificial neural network (ANN) in predicting the performance of the batch electrochemical treatment has also been demonstrated. 2009 Elsevier B.V. All rights reserved.

  5. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions.

    Science.gov (United States)

    Haider, Adil H; Schneider, Eric B; Sriram, N; Dossick, Deborah S; Scott, Valerie K; Swoboda, Sandra M; Losonczy, Lia; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A; Freischlag, Julie A

    2015-05-01

    Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012. We administered clinical vignettes, each with 3 management questions. Eight vignettes assessed the relationship between unconscious bias and clinical decision making. We performed ordered logistic regression analysis on the Implicit Association Test (IAT) scores and used multivariable analysis to determine whether implicit bias was associated with the vignette responses. Differential response times (D scores) on the IAT as a surrogate for unconscious bias. Patient management vignettes varied by patient race or social class. Resulting D scores were calculated for each management decision. In total, 215 clinicians were included and consisted of 74 attending surgeons, 32 fellows, 86 residents, 19 interns, and 4 physicians with an undetermined level of education. Specialties included surgery (32.1%), anesthesia (18.1%), emergency medicine (18.1%), orthopedics (7.9%), otolaryngology (7.0%), neurosurgery (7.0%), critical care (6.0%), and urology (2.8%); 1.9% did not report a departmental affiliation. Implicit race and social class biases were present in most respondents. Among all clinicians, mean IAT D scores for race and social class were 0.42 (95% CI, 0.37-0.48) and 0.71 (95% CI, 0.65-0.78), respectively. Race and class scores were similar across departments (general surgery, orthopedics, urology, etc), race, or age. Women demonstrated less bias concerning race (mean IAT D score, 0.39 [95% CI, 0.29-0.49]) and social class (mean IAT D score

  6. Barriers to specialty care and specialty referral completion in the community health center setting.

    Science.gov (United States)

    Zuckerman, Katharine E; Perrin, James M; Hobrecker, Karin; Donelan, Karen

    2013-02-01

    To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers. Two months after their child's specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors' offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥ 4 barriers was associated with incomplete referral. A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors' offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥ 4 barriers were more likely than those experiencing ≤ 3 barriers to have incomplete referral. Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals. Copyright © 2013 Mosby, Inc. All rights reserved.

  7. The history of neurosurgery in Anatolia and Turkey: the Turkish Neurosurgical Society.

    Science.gov (United States)

    Solaroglu, Ihsan; Acar, Feridun; Bavbek, Murad; Ture, Ugur; Beskonakli, Ethem

    2013-01-01

    Although the history of neurosurgery in Anatolia goes back ten thousand years, modern surgery began in Turkey in 1890. Neurosurgery in Turkey began in the first half of the 20th century. However, general surgeons began applying neurosurgical techniques back in the late 19th century. Most of these applications included procedures for craniocerebral traumas and infections. Dr. Cemil Topuzlu (1868-1958) is the founder of modern surgery in Turkey. Dr. Abdulkadir Cahit Tuner became the first neurosurgeon with a degree in Turkey in 1923. The first neurosurgery department was established in Istanbul in 1923, and the first training program began in the late 1940s. Currently there are almost 1200 neurosurgeons in Turkey and 75 training clinics at university hospitals and Training and Research Hospitals of the Ministry of Health provide neurosurgery training. The current state of neurosurgery in Turkey is parallel to that of the advanced Western countries. Apart from the application of neurosurgical procedures, there have been many scientific studies from Turkish neurosurgeons contributing to the total body of literature in neurosurgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. [Determinants of primary care specialty choice].

    Science.gov (United States)

    Pawełczyk, Agnieszka; Pawełczyk, Tomasz; Bielecki, Jan

    2007-03-01

    This paper analyzes and synthesizes the literature on primary care specialty choice. Motivation for choosing medicine and its impact on recruitment to different types of medical work has been presented. Factors that influence medical students and young doctors to change specialty preference have also been explored. Variables, such as gender, martial status, age, income expectations and prestige, that affect medical students' specialty selection decisions for primary care, have been examined. Personality profiles of primary care physician have been evaluated and the influence of communication skills and knowledge of social psychology on his/her work have been analyzed. It is presented that other traits, such as patient-centeredness, needs to serve society and value orientation, is also associated with increases in numbers of students choosing primary care. The analyze shows that the preference for primary care is connected with being interested in diverse patients and health problems and also with being people-orientated. A survey conducted into Polish medical students' attitudes to primary care and family medicine is presented. There is a negative perception of family medicine among Polish students and doctors because of its long work hours and less time for family, insufficient diagnostic possibilities and monotony It is chosen because of lack of other possibilities, difficulties in employment and opportunity to become 'a specialist' in short time.

  9. [A new specialty is born: Vascular medicine].

    Science.gov (United States)

    Laroche, J-P

    2016-05-01

    On the 4th of December 2015, the French authorities officially recognized the birth of a specialty in vascular medicine entitled CO-DES cardiology-vascular/vascular Medicine. France is the 7th country to obtain this specialty after Switzerland, Germany, Austria, Czech Republic, Slovakia and Slovenia, six countries in the EEC. It has taken years to achieve a long but exciting experience: we went from hopes to disappointments, sometimes with the blues, but lobbying helping… with sustained confidence. This article tells the story of 30 years of struggle to achieve this vascular medicine specialty. Gaston Bachelard wrote: "Nothing is obvious, nothing is given, all is built." For the construction of vascular medicine, we had to overcome many obstacles, nothing was given to us, everything was conquered. Beware "The specialist is one who knows more and more things about an increasingly restricted field, up to 'knowing everything about nothing"' recalled Ralph Barton Ferry, philosopher; so there is room for modesty and humility but also convictions. The physical examination will remain the basis of our exercise. But let us recall the contributions of all those vascular physicians who practiced in the past, together with those currently active, who built day after day, year after year, a vascular medicine of quality. It is because of the trust of our colleagues and our patients that we can occupy the place that is ours today.

  10. [Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders].

    Science.gov (United States)

    Teijeiro, Juan; Macías, Raúl J; Maragoto, Carlos; García, Iván; Alvarez, Mario; Quintanal, Nelson E

    2014-01-01

    Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  11. Specialty preferences: trends and perceptions among Saudi undergraduate medical students.

    Science.gov (United States)

    Mehmood, Syed Imran; Kumar, Ashish; Al-Binali, Ali; Borleffs, Jan C C

    2012-01-01

    The exploration of specialty choices by medical students is a hot debate as it affects several important determinants of health care delivery. This study was carried out to determine variation in specialty preferences during medical school training and the perceptions that affect students' specialty choice. A cross-sectional questionnaire-based study was performed on 590 students with a 93.22% response rate and covered queries on demography, specialty choices, and perceptions influencing specialty choices. Class-wise analysis of specialty choices was carried out. The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopedics, while most preferred by female students were surgery, followed by pediatrics and ophthalmology. Male students' emphasized factors like less competitive field, shortage of specialists, and diversity of patients while the prestige of specialty and teaching opportunities had a greater impact on female students. Surgery, internal medicine, pediatrics, orthopedics, and ophthalmology were the most preferred specialty choices. Gender preference was observed to affect choices of few specialties such as orthopedics and obstetrics/gynecology. Perceptions which have an impact on specialty selection of male and female students may reflect a different tempo of growing up in men and women.

  12. Max Brödel: his art, legacy, and contributions to neurosurgery through medical illustration.

    Science.gov (United States)

    Patel, Smruti K; Couldwell, William T; Liu, James K

    2011-07-01

    Max Brödel is considered the father of modern medical illustration. This report reviews his contributions to neurosurgery as a medical illustrator. Max Brödel, a young artist from Leipzig, Germany, was hired at Johns Hopkins Hospital in 1894, where he illustrated an operative textbook of gynecology for Howard A. Kelly. Although Brödel did not have any formal medical training, he quickly acquired knowledge of anatomy, pathology, physiology, and surgery. Brödel's extraordinary illustrations were characterized by an aerial perspective that conveyed the surgeon's operative viewpoint and precise surgical anatomy. He masterfully incorporated tissue realism with cross-sectional anatomy to accentuate concepts while maintaining topographical accuracy. Brödel's reputation spread quickly and resulted in collaborations with prominent surgeons, such as Cushing, Halsted, and Dandy. Cushing, who also possessed artistic talent, became a pupil of Brödel and remained a very close friend. In 1911, Brödel was appointed the director of the Department of Art as Applied to Medicine at Johns Hopkins, the first academic department of its kind in the world. For the next several decades, he trained generations of renowned medical illustrators. Just as Osler, Halsted, and Cushing passed their skills and knowledge to future leaders of medicine and surgery, Brödel did the same for the field of medical illustration. The advancement of neurosurgical education has been greatly facilitated by Max Brödel's artistic contributions. His unique ability to synthesize art and medicine resulted in timeless illustrations that remain indispensable to surgeons. The art produced by his legacy of illustrators continues to flourish in neurosurgical literature today.

  13. Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

    Directory of Open Access Journals (Sweden)

    Wilfred C Mezue

    2012-01-01

    Full Text Available Introduction: The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide. Materials and Methods: Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive. Results: Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors. Conclusion: The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

  14. Position statement from the Italian Society of Neurosurgery on the ARUBA Study.

    Science.gov (United States)

    Cenzato, Marco; Delitala, Alberto; Delfini, Roberto; Pasqualin, Alberto; Maira, Giulio; Esposito, Vincenzo; Tomasello, Francesco; Boccardi, Edoardo

    2016-03-01

    As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated with endovascular or radiotherapy treatments, alone or in combination. Only 18 patients (19%) had surgery. It is well known that a partial treatment of arteriovenous malformations (AVMs), as is often the case with endovascular therapy, may increase the risk of bleeding. The primary endpoint (death or symptomatic stroke) in the treated group was reached in 30.7%, i.e. almost one-third of the subjects. This has no comparison in the current surgical literature. Considering permanent and transient neurological deficits along with headaches and seizures all together in the same outcome evaluation parameter may be inappropriate and misleading. The graph with all results from the ARUBA Study, which claims to be the demonstration that natural history is better that treatment, clearly shows that what is assumed to be treated has not actually been treated. If death or stroke occur a few years from treatment, it only means that the disease was not cured and patients received a partial - therefore ineffective, if not dangerous - treatment. An effective treatment, as surgery is, must have a flat follow-up curve. The ARUBA Study shows that incomplete treatment leads to negative outcome, confirming that an integrated multidisciplinary strategy has to be plotted out before starting any treatment and that a complete exclusion of the AVM must be achieved.

  15. Establishing a generic training programme for future junior doctors: a role for neurosurgery within the framework of clinical neurosciences.

    OpenAIRE

    Nadarajah, Ramesh; Amin, Amit; Aldlyami, Ehabb; Kang, Niel; Wong, James Min-Leong; Selway, Richard; Gullan, Richard

    2005-01-01

    INTRODUCTION: To describe the opinion of junior doctors in neurosurgery in the UK and Eire about future reforms to training, and to relate this to the establishment of a generic neurosciences training programme. METHODS: A postal questionnaire survey of neurosurgery units in UK and Eire (36 units). All senior house officers (SHOs) taking part in a neurosurgery on-call rota during the 6 months between February and August 2003 (n=236); 190 respondents (response rate 81% overall, 90% neurosurger...

  16. [A new human machine interface in neurosurgery: The Leap Motion(®). Technical note regarding a new touchless interface].

    Science.gov (United States)

    Di Tommaso, L; Aubry, S; Godard, J; Katranji, H; Pauchot, J

    2016-06-01

    Currently, cross-sectional imaging viewing is used in routine practice whereas the surgical procedure requires physical contact with an interface (mouse or touch-sensitive screen). This type of contact results in a risk of lack of aseptic control and causes loss of time. The recent appearance of devices such as the Leap Motion(®) (Leap Motion society, San Francisco, USA) a sensor which enables to interact with the computer without any physical contact is of major interest in the field of surgery. However, its configuration and ergonomics produce key challenges in order to adapt to the practitioner's requirements, the imaging software as well as the surgical environment. This article aims to suggest an easy configuration of the Leap Motion(®) in neurosurgery on a PC for an optimized utilization with Carestream(®) Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, USA) using a plug-in (to download at: https://drive.google.com/?usp=chrome_app#folders/0B_F4eBeBQc3ybElEeEhqME5DQkU) and a video tutorial (https://www.youtube.com/watch?v=yVPTgxg-SIk).

  17. [Antiphospholipid antibody syndrome in pediatric neurosurgery: a hemostasis problem].

    Science.gov (United States)

    Bocquet, R; Blanot, S; Dautzenberg, M D; Pierre-Kahn, A; Carli, P

    1999-11-01

    The case of a 11-year-old boy under anticoagulant therapy for a familial antiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cerebrovascular malformation responsible for an intracerebral haematoma, is reported. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), three days before. Heparin was discontinued two hours prior to surgery to obtain a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned to normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danaparoid (Orgaran), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurrence due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the value but also the risks of anticoagulant therapy in neurosurgery, when patients are at high risk for thrombosis.

  18. Simulation training in neurosurgery: advances in education and practice

    Science.gov (United States)

    Konakondla, Sanjay; Fong, Reginald; Schirmer, Clemens M

    2017-01-01

    The current simulation technology used for neurosurgical training leaves much to be desired. Significant efforts are thoroughly exhausted in hopes of developing simulations that translate to give learners the “real-life” feel. Though a respectable goal, this may not be necessary as the application for simulation in neurosurgical training may be most useful in early learners. The ultimate uniformly agreeable endpoint of improved outcome and patient safety drives these investments. We explore the development, availability, educational taskforces, cost burdens and the simulation advancements in neurosurgical training. The technologies can be directed at achieving early resident milestones placed by the Accreditation Council for Graduate Medical Education. We discuss various aspects of neurosurgery disciplines with specific technologic advances of simulation software. An overview of the scholarly landscape of the recent publications in the realm of medical simulation and virtual reality pertaining to neurologic surgery is provided. We analyze concurrent concept overlap between PubMed headings and provide a graphical overview of the associations between these terms. PMID:28765716

  19. Using Electronic Noses to Detect Tumors During Neurosurgery

    Science.gov (United States)

    Homer, Margie L.; Ryan, Margaret A.; Lara, Liana M.; Kateb, Babak; Chen, Mike

    2008-01-01

    It has been proposed to develop special-purpose electronic noses and algorithms for processing the digitized outputs of the electronic noses for determining whether tissue exposed during neurosurgery is cancerous. At present, visual inspection by a surgeon is the only available intraoperative technique for detecting cancerous tissue. Implementation of the proposal would help to satisfy a desire, expressed by some neurosurgeons, for an intraoperative technique for determining whether all of a brain tumor has been removed. The electronic-nose technique could complement multimodal imaging techniques, which have also been proposed as means of detecting cancerous tissue. There are also other potential applications of the electronic-nose technique in general diagnosis of abnormal tissue. In preliminary experiments performed to assess the viability of the proposal, the problem of distinguishing between different types of cultured cells was substituted for the problem of distinguishing between normal and abnormal specimens of the same type of tissue. The figure presents data from one experiment, illustrating differences between patterns that could be used to distinguish between two types of cultured cancer cells. Further development can be expected to include studies directed toward answering questions concerning not only the possibility of distinguishing among various types of normal and abnormal tissue but also distinguishing between tissues of interest and other odorous substances that may be present in medical settings.

  20. Organizational readiness in specialty mental health care.

    Science.gov (United States)

    Hamilton, Alison B; Cohen, Amy N; Young, Alexander S

    2010-01-01

    Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia. To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies. EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline. At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed. The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters. Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the

  1. A cross-sectional study of aggression levels in physicians and orthopaedic surgeons: impact on specialty selection and training?

    Science.gov (United States)

    Barlow, T; Wight, A; Barlow, D

    2012-01-01

    Objectives To determine if current validated psychometric evaluations could determine a difference in basic behavioural characteristics between surgical and medical specialties. Design Cross-sectional study. Setting Two district general hospitals and one University teaching hospital in England, UK. Participants Internal medicine (16) and trauma and orthopaedic (20) consultants. Main outcome measures Aggression levels as assessed by the Buss and Warren questionnaire. The self-administered questionnaire assesses aggression in terms of physical, verbal, anger, hostility, indirect hostility and an overall assessment of aggression. Results All participants had aggression scores below the population average. We found a significant difference (P consultants scoring a mean of 61.1 (standard deviation [SD] 9.2) and physicians 51.3 (SD 9.5). When analysis of the five different subtypes of aggression was carried out, orthopaedic surgeons scored significantly higher in terms of verbal aggression (P = 0.005), hostility (P = 0.002) and indirect hostility (P = 0.03). Conclusion This study joins a growing evidence base for aspects of behaviour indicative of a given specialty. Aggression is a relatively stable behavioural characteristic from adolescence, and as such this is the first study of its type to suggest that the differences in behavioural characteristics seen between specialties are inherent, rather than learned. It is unclear if the differences observed represent an attraction of that specialty to the personality type or is required for success within the given specialty. Whether this can be used in terms of selection into higher specialty training, or influence training within specialties, requires further work. PMID:23476726

  2. Caveat emptor: joint ventures with specialty hospitals.

    Science.gov (United States)

    Kahn, Charles N

    2006-06-01

    A specialty hospital joint venture between a health system and physician investors may implicate anti-kickback and tax laws when physicians self-refer patients to the hospital, raising the issue of conflict of interest. Physician self-referral can motivate behavior, such as cherry-picking patients and increased utilization, which in turn leads to windfall profits for physician owners and weakens classic community hospitals. Hopitals can best serve the interests of patients and improve performance by building enduring partnerships with physicians.

  3. National healthcare spending in the U.S. and Japan: national economic policy and implications for neurosurgery.

    Science.gov (United States)

    Bean, James R

    2005-01-01

    Growth of national healthcare spending is a problem confronting national governments of all industrially advanced countries. Healthcare spending in the U.S. reached 13.9% of the Gross Domestic Product (GDP) in 2003, compared to only 8% in Japan. In the U.S., health insurance is voluntary, with 15% of the population uninsured. In Japan, health insurance is mandatory and virtually universal, with growth in national health costs about half the rate of growth in the U.S. U.S. healthcare costs are projected to reach 18.4% of GDP 2013. The predicted growth in health care costs is expected to cause strain on the federal budget and a growing inability of employers and employees to pay for private insurance. Different national policies are the reason for different national health care costs in the U.S. and Japan. The U.S. has higher healthcare prices for salaries, equipment, supplies, and pharmaceuticals as compared to Japan. Higher prices, higher service intensity and volume during hospitalization create higher total cost in the U.S. Price controls in Japan kept medical inflation low at 0.46%/yr from 1980-2000. Market-pricing mechanisms in the U.S. have proven ineffective in controlling national healthcare costs, while Japan's national fee and price control policies have kept national costs among the lowest within the Organization for Economic Cooperation and Development. To guide insurance coverage policy, neurosurgery and other highly technical specialties should better define the comparative health benefit of high price technical services by prospective outcome studies.

  4. Robotics in neurosurgery: state of the art and future technological challenges.

    Science.gov (United States)

    Zamorano, L; Li, Q; Jain, S; Kaur, G

    2004-06-01

    The use of robotic technologies to assist surgeons was conceptually described almost thirty years ago but has only recently become feasible. In Neurosurgery, medical robots have been applied to neurosurgery for over 19 years. Nevertheless this field remains unknown to most neurosurgeons. The intrinsic characteristics of robots, such as high precision, repeatability and endurance make them ideal surgeon's assistants. Unfortunately, limitations in the current available systems make its use limited to very few centers in the world. During the last decade, important efforts have been made between academic and industry partnerships to develop robots suitable for use in the operating room environment. Although some applications have been successful in areas of laparoscopic surgery and orthopaedics, Neurosurgery has presented a major challenge due to the eloquence of the surrounding anatomy. This review focuses on the application of medical robotics in neurosurgery. The paper begins with an overview of the development of the medical robotics, followed by the current clinical applications in neurosurgery and an analysis of current limitations. We discuss robotic applications based in our own experience in the field. Next, we discuss the technological challenges and research areas to overcome those limitations, including some of our current research approaches for future progress in the field.

  5. History of the Neurosurgery Department of Pontificia Universidad Catolica, Santiago, Chile.

    Science.gov (United States)

    Sfeir, Felipe; Villanueva, Pablo; Tagle, Patricio

    2017-01-01

    Pontificia Universidad Católica de Chile's medical school was founded in 1929. An interest in neurosurgical development arose in the minds of the Dean, Dr. Cristobal Espíldora, and the Chief of Surgery, Dr. Rodolfo Rencoret, in 1946. They encouraged and supported Dr. J. Ricardo Olivares to specialize in Neurosurgery with Professor H. Olivecrona in Stockholm, Sweden. The first neurosurgical procedure in the Hospital Clínico de la Universidad Católica was performed in 1950. Since then, intensive efforts have been made to develop neurosurgery and its science. As a result, it is now a center capable of achieving high-quality standards in vascular, oncologic, and endoscopic neurosurgery; stereotactic and radiosurgery; complex spine surgery; pediatric neurosurgery; and epilepsy surgery. This article tells the story of a university hospital neurosurgery service in a country at the southern end of the world and how it became one of the most important neurosurgical centers in Chile and South America.

  6. [Music therapy in different dental specialties].

    Science.gov (United States)

    Mehr, Katarzyna; Wyganowska-Swiatkowska, Marzena; Kowalkowska, Iwona; Kurhańska-Flisykowska, Anna; Piotrowski, Paweł

    2012-01-01

    Music is generally recognized as the best and, in parallel, the simplest medium of communication. The music therapy, applied in various spheres linked to a therapeutic process, is particularly valued in rehabilitation, medicine, humanities and social sciences. Present study aimed at determination of usefulness of selected techniques of music therapy in different dental specialties. The studies were conducted on 81 generally healthy patients aging 18 to 62 years. Various planned dental procedures were performed first time or were appraised by the patients as unpleasant ones. On the basis of pilot studies, a stable scheme of the visits was established. At the beginning of the studies, music therapy according to Kierył was conducted. Subsequently, basing on description of Schwabe, a form of regulatory individual music therapy was conducted. Depending on psychoemotional condition of the patient, music programming was based on ISO and LEVEL principles, taking into account musical preferences of the patient and his/her age. After every visit the patients filled questionnaires and appropriate results, together with results of studies performed by the dentist, were subjected to statistical analysis. 1. Results of the studies encourage application of musicotherapeutic techniques in different dental specialties. 2. Dental visit can be made attractive and patient's visits in dental office can be facilitated with no significant financial input or organizational.

  7. Phantom study and accuracy evaluation of an image-to-world registration approach used with electro-magnetic tracking system for neurosurgery

    Science.gov (United States)

    Li, Senhu; Sarment, David

    2015-12-01

    Minimally invasive neurosurgery needs intraoperative imaging updates and high efficient image guide system to facilitate the procedure. An automatic image guided system utilized with a compact and mobile intraoperative CT imager was introduced in this work. A tracking frame that can be easily attached onto the commercially available skull clamp was designed. With known geometry of fiducial and tracking sensor arranged on this rigid frame that was fabricated through high precision 3D printing, not only was an accurate, fully automatic registration method developed in a simple and less-costly approach, but also it helped in estimating the errors from fiducial localization in image space through image processing, and in patient space through the calibration of tracking frame. Our phantom study shows the fiducial registration error as 0.348+/-0.028mm, comparing the manual registration error as 1.976+/-0.778mm. The system in this study provided a robust and accurate image-to-patient registration without interruption of routine surgical workflow and any user interactions involved through the neurosurgery.

  8. Specialty choice among dental students in Ibadan, Nigeria

    Directory of Open Access Journals (Sweden)

    K K Kanmodi

    2017-03-01

    Full Text Available Background. The unequal distribution of workforce across dental specialties in Nigeria poses a significant problem in the delivery of specialists’ oral healthcare to the Nigerian population. Objectives. To determine dental specialties preferences among dental students at the University of Ibadan, Nigeria, and to explore the factors that influence their choices. Methods. We obtained ethical approval to conduct this study. Only the dental students who rotated through all the dental specialties were selected to participate in this questionnaire-based study. Data were analysed using SPSS version 16 (SPSS Inc., USA. Results. The majority of dental students at the University of Ibadan preferred the oral and maxillofacial surgery (OMS specialty above all other dental specialties, while prosthetic dentistry was least preferred. Of all the factors to take into consideration when choosing a dental specialty, personal interest was the only factor considered by nearly all respondents. Only male respondents considered prestige as an influencing factor in their choice of a specialty. Lifestyle and job description were factors considered by a higher proportion of the male respondents (10/13 than females (5/14. The mean age of the 27 respondents who participated in this study was 22.6 years, 52% of whom were females. Conclusion. OMS was the most preferred specialty among our respondents (n=8. Nearly all dental students chose residency training in the specialty that most appealed to them. The interest of dental students towards the least appealing dental specialties needs to be developed to solve the problem of skewed distribution of the dental workforce in Nigeria. Our findings suggest that this may be accomplished by changing dental students’ perceptions of certain specialties, building on male students’ interests in job security and private practice potential, and the female students’ interests in family-friendly specialties and increasing flexibility

  9. Functional neurosurgery for movement disorders: a historical perspective.

    Science.gov (United States)

    Benabid, Alim Louis; Chabardes, Stephan; Torres, Napoleon; Piallat, Brigitte; Krack, Paul; Fraix, Valerie; Pollak, Pierre

    2009-01-01

    Since the 1960s, deep brain stimulation and spinal cord stimulation at low frequency (30 Hz) have been used to treat intractable pain of various origins. For this purpose, specific hardware have been designed, including deep brain electrodes, extensions, and implantable programmable generators (IPGs). In the meantime, movement disorders, and particularly parkinsonian and essential tremors, were treated by electrolytic or mechanic lesions in various targets of the basal ganglia, particularly in the thalamus and in the internal pallidum. The advent in the 1960s of levodopa, as well as the side effects and complications of ablative surgery (e.g., thalamotomy and pallidotomy), has sent functional neurosurgery of movement disorders to oblivion. In 1987, the serendipitous discovery of the effect of high-frequency stimulation (HFS), mimicking lesions, allowed the revival of the surgery of movement disorders by stimulation of the thalamus, which treated tremors with limited morbidity, and adaptable and reversible results. The stability along time of these effects allowed extending it to new targets suggested by basic research in monkeys. The HFS of the subthalamic nucleus (STN) has profoundly challenged the practice of functional surgery as the effect on the triad of dopaminergic symptoms was very significant, allowing to decrease the drug dosage and therefore a decrease of their complications, the levodopa-induced dyskinesias. In the meantime, based on the results of previous basic research in various fields, HFS has been progressively extended to potentially treat epilepsy and, more recently, psychiatric disorders, such as obsessive-compulsive disorders, Gilles de la Tourette tics, and severe depression. Similarly, suggested by the observation of changes in PET scan, applications have been extended to cluster headaches by stimulation of the posterior hypothalamus and even more recently, to obesity and drug addiction. In the field of movement disorders, it has become

  10. Development of the surgical science examination of the Royal Australasian College of Surgeons surgical education and training programme: putting the chicken before the egg.

    Science.gov (United States)

    Martin, Jenepher; Blennerhassett, John; Hardman, David; Mundy, Julie

    2009-03-01

    Basic science knowledge is a foundational element of surgical practice. Increasing surgical specialization may merit a reconsideration of the 'whole-body' approach to basic science curriculum in favour of specialty specific depth. The conundrum of depth or breadth of basic science curriculum is currently being addressed by the Royal Australasian College of Surgeons, which introduced a new surgical education and training programme for nine surgical specialties in 2008. This paper describes an innovative solution to the design of a basic science curriculum in the nine different surgical specialty streams of this programme. The task was to develop a curriculum and rigorous assessment in basic sciences to meet the needs of the training programme, for implementation within the first year. A number of political/cultural and technical issues were identified as critical to success. To achieve a robust assessment within the required time frame attention was paid to engagement, governance, curriculum definition, assessment development, and implementation. The pragmatic solution to curriculum and assessment was to use the existing assessment items and blueprint to determine a new curriculum definition and assessment. The resulting curriculum comprises a generic component, undertaken by all trainees, and specialty specific components. In a time critical environment, a pragmatic solution to curriculum, applied with predetermined, structured and meticulous methodology, allowed explicit definition of breadth for the generic basic science curriculum for surgical training in Australia and New Zealand. Implicit definition of specialty specific-basic science curricula was through the creation of a blueprinted assessment.

  11. Validity of a cross-specialty test in basic laparoscopic techniques (TABLT)

    DEFF Research Database (Denmark)

    Thinggaard, Ebbe; Bjerrum, Flemming; Strandbygaard, Jeanett

    2015-01-01

    was shown to be reliable, with an intraclass correlation coefficient of 0·99 (P Pearson's r value of 0·73 (P ... correlation between the level of laparoscopic experience and performance score. A reasonable pass-fail standard was established using contrasting groups methods. CONCLUSION: TABLT can be used for the assessment of basic laparoscopic skills and can help novice surgical trainees in different specialties gain...... included novice, intermediate and experienced surgeons. All participants performed the TABLT test. Performance scores were calculated based on time taken and errors made. Evidence of validity was explored using a contemporary framework of validity. RESULTS: Some 60 individuals participated. The TABLT...

  12. MINOP: development of a miniaturized endoscopic operation system for neurosurgery

    Science.gov (United States)

    Guber, Andreas E.; Wieneke, Paul

    1996-04-01

    Within the framework of R&D activities in the field of microsystems technology, the Institute for Microstructure Technology of Karlsruhe Research Center among others has started to improve the functionality of existing medicotechnical instruments by increased integration of microtechnical components. On the basis of microsystems fabrication techniques, completely novel medical endoscope systems have become feasible. In cooperation with clinical, technical and industrial partners, a novel endoscopic operation system based on microsystems technology is being developed by the Institute for Microstructure Technology and the Aesculap AG company, Tuttlingen within the framework of the MINOP joint project. This new system shall be applied above all in the field of neurosurgery. This newly conceived endosystem is characterized by a multitude of novelties. It can perform a number of both sensor and actor functions. Due to its extremely small outer diameter, it can be applied through minute openings. As a result of the integrated microfluidic control system, the flexible endoscope can be moved to the actual site of operation on a previously specified path. This will allow future bi- and triportal neuro-endoscopic interventions for critical operations in the brain area. The different lumina of the flexible endoscope fulfill various functions. Via the optical fibers, laser radiation may be led to the distal end of the endoscope. Using microtechnical fabrication methods, special plastic microlenses have been produced. The working channel can be applied for rinsing and removal. Furthermore, the cleaning of the optics or the taking of tissue samples are possible. If required, another laser fiber can be driven forward through the working channel for selective therapy. For the first time, high-performance microinstruments have been developed on the basis of novel materials. These instruments can be applied either through the working channel or through an additional trocar.

  13. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

    Science.gov (United States)

    Nuttin, Bart; Wu, Hemmings; Mayberg, Helen; Hariz, Marwan; Gabriëls, Loes; Galert, Thorsten; Merkel, Reinhard; Kubu, Cynthia; Vilela-Filho, Osvaldo; Matthews, Keith; Taira, Takaomi; Lozano, Andres M; Schechtmann, Gastón; Doshi, Paresh; Broggi, Giovanni; Régis, Jean; Alkhani, Ahmed; Sun, Bomin; Eljamel, Sam; Schulder, Michael; Kaplitt, Michael; Eskandar, Emad; Rezai, Ali; Krauss, Joachim K; Hilven, Paulien; Schuurman, Rick; Ruiz, Pedro; Chang, Jin Woo; Cosyns, Paul; Lipsman, Nir; Voges, Juergen; Cosgrove, Rees; Li, Yongjie; Schlaepfer, Thomas

    2014-01-01

    Background For patients with psychiatric illnesses remaining refractory to ‘standard’ therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered ‘established’ in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety. PMID:24444853

  14. Specialty Preferences of Physicians and Medical Students

    Science.gov (United States)

    Gough, Harrison G.

    1975-01-01

    Family and internal medicine were rated high by the groups studied. Neurological and colon-rectal surgery were rated low. Males gave higher ratings to surgical specialities, whereas females express stronger preferences for obstetrics and gynecology. (Author/KE)

  15. The surgical management of spasticity.

    Science.gov (United States)

    Lazorthes, Y; Sol, J-C; Sallerin, B; Verdié, J-C

    2002-05-01

    Neurosurgery is only considered for severe spasticity following the failure of noninvasive management (adequate medical and physical therapy). The patients are carefully selected, based on rigorous multidisciplinary clinical assessment. In this we evaluate the contribution of the spasticity to the disability and any residual voluntary motor function. The goals for each patient are: (a) improvement of function and autonomy; (b) control of pain; and (c) prevention of orthopaedic disorders. To achieve these objectives, the surgical procedure must be selective and reduce the excessive hypertonia without suppressing useful muscle tone and limb functions. The surgical procedures are: (1) Classical neuro-ablative techniques (peripheral neurotomies, dorsal rhizotomies) and their modern modifications using microsurgery and intra-operative neural stimulation (dorsal root entry zone: DREZotomy). These techniques are destructive and irreversible, with the reduced muscle tone reflecting the nerve topography. It is mainly indicated when patients have localized spasticity without useful mobility. (2) Conservative techniques based on a neurophysiological control mechanism. These procedures are totally reversible. The methods involve chronic neurostimulation of the spinal cord or the cerebellum. There are only a few patients for whom this is indicated. Conversely, chronic intrathecal administration of baclofen, using an implantable pump, is well established in the treatment of diffuse spasticity of spinal origin. From reports in the literature, we critically review the respective indications in terms of function, clinical progression and the topographic extent of the spasticity.

  16. Perioperative posterior reversible encephalopathy syndrome in 2 pediatric neurosurgery patients with brainstem ependymoma.

    Science.gov (United States)

    Gephart, Melanie G Hayden; Taft, Bonnie P; Giese, Anne-Katrin; Guzman, Raphael; Edwards, Michael S B

    2011-03-01

    Posterior reversible encephalopathy syndrome (PRES) has been described in pediatric neurooncology patients, although it has not been documented perioperatively in pediatric neurosurgery patients not actively receiving chemotherapy. Recently at the authors' facility, 2 cases of PRES were diagnosed perioperatively in children with brainstem ependymoma. Both patients had presented with hypertension, altered mental status, and seizures and demonstrated MR imaging features consistent with PRES. The patients were treated with antiseizure and antihypertension medications, leading to improvement in both clinical symptoms and neuroimaging findings. These cases are the first to document PRES in perioperative pediatric neurosurgery patients not actively receiving chemotherapy. Both patients had ependymoma involving the brainstem, which may have led to intra- and perioperative hemodynamic instability (including hypertension) and predisposed them to this syndrome. An awareness of PRES in similar scenarios will aid in the prevention, diagnosis, and treatment of pediatric neurosurgery patients with this syndrome.

  17. Neurosurgery in Turkish poetry: three poets, two poems and two neurosurgeons.

    Science.gov (United States)

    Kahilogullari, Gokmen

    2015-01-01

    Poems are essential in art and vital organs in literature. Similarly, surgery (and neurosurgery) is also regarded to be an art in medicine. From Hippocrates to nowadays, there is a debate on whether medicine -especially surgery- is a kind of an art or a field of science or a combination of both. This close relation becomes clearer during the practice of surgery, especially in neurosurgery. Herein, the relation between Turkish poetry and Turkish neurosurgery is being presented by researching the interesting and exciting stories about three poets (Can Yücel, Hasan Hüseyin Korkmazgil, Nazım Hikmet), their poems; and two Turkish neurosurgeons (Gazi Yaşargil, Yücel Kanpolat).

  18. Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India

    Directory of Open Access Journals (Sweden)

    Ashish Suri

    2014-01-01

    Full Text Available Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

  19. BUSINESS DEVELOPMENT STRATEGY FOR SPECIALTY COFFEE

    Directory of Open Access Journals (Sweden)

    Vharessa Aknesia

    2015-01-01

    Full Text Available Specialty coffee is a coffee of premium quality that has been made through various stages of post-harvest processing and strictly controlled to produce distinctive taste of origins. PT Sinar Mayang Lestari is one of the companies that currently produce and develop specialty coffee type, Arabica Java Preanger. The objectives of the study are to examine competitive advantages and develop an alternative strategy that need to be done by PT Sinar Mayang Lestari for their business development. The research methods used are value chain analysis and VRIO framework to explore competitive advantage owned by the company. The result shows the company currently has a temporary competitive advantage of the technological resources and reputation. By using SWOT-AHP technique, the alternative strategies that can be done by company are as follows: 1 increasing the production of natural and honey coffee  type; 2 building coffee center in plantation site for sharing knowledge and innovation media to the farmers; 3 improving the competency of human resource in plantation, post harvest, and promoting area; 4 building management system gradually 5 forwarding integration by building roast and ground coffee business; and 6 maximizing the ability of the land and human resources through research and development.Keywords: competitive advantage, specialty coffee, SWOT-AHP, value chain, VRIOABSTRAKKopi special merupakan kopi dengan kualitas premium yang sudah melalui berbagai tahapan pengolahan pascapanen yang diawasi dengan ketat sehingga menghasilkan cita rasa yang khas sesuai dengan daerah asalnya. PT Sinar Mayang Lestari adalah salah satu perusahaan yang saatini memproduksi dan mengembangkan kopi spesial jenis Arabika Java Preanger. Tujuan dari penelitian ini adalah menganalisis keunggulan bersaing yang dimiliki dan mengembangkan alternative strategi yang perlu dilakukanoleh PT Sinar Mayang Lestari untuk pengembangan usahanya. Penelitian ini menggunakan analisis rantai

  20. [Problems in cardiology specialty training in Turkey].

    Science.gov (United States)

    Altun, Armağan

    2012-04-01

    Cardiology Specialty Training in our country should be made in accordance with the law numbered 1219 on the Practice of Medicine and Related Arts, and according to the Medical and Dental Specialist Training Regulation which is published according to the 9th article of this law. The duration of Cardiology Specialist Training has been defined as 4 years in our country. The European Society of Cardiology (ESC), European Union of Medical Specialists (UEMS), and the European Cardiology Section Foundation (ECSF) define the duration of Cardiology Specialist Training as 6 years. Therefore, insufficient Cardiology residency training occurs in our country due to the shortened length of time. In this report, the problems of the Cardiology Specialist Training in Turkey will be addressed under different headings.

  1. Dentistry's oldest specialty: orthodontics and dentofacial orthopedics.

    Science.gov (United States)

    George, Raymond

    2009-01-01

    The American Association of Orthodontists (AAO) has 15,500 members worldwide and is the oldest and largest of the recognized dental specialties. A strategic planning process has identified six key challenges, and this article describes the progress that is being made in the areas of (a) consumer education, (b) volunteer leadership development, (c) recruitment and retention of orthodontic educators, (d) relationships with ADA and other healthcare organizations, (e) the AAO's role in international orthodontics, and (f) advocacy. The AAO is working for freedom of choice in dental healthcare providers; fee-for-service dental care; orthodontic insurance coverage as a benefit of employment, with direct reimbursement as the preferred plan; self-referred access to specialists; private and public funding that promote quality orthodontic care; and the retention of tax deductibility of dental healthcare benefits, including orthodontic care.

  2. Constantin N. Arseni (1912-1994) centenary: the birth of modern neurosurgery in Romania.

    Science.gov (United States)

    Dinca, Eduard B; Banu, Matei; Ciurea, Alexandru V

    2014-01-01

    Prof. Dr. Constantin N. Arseni and his mentor, Prof. Dr. D. Bagdasar, are revered by later generations of doctors as the forefathers of Romanian neurosurgery. In 2012, we have celebrated 100 years since Prof. Arseni's birth in a small village within a deprived area of the country. Through his talents and perseveration, he rose to be a neurosurgical school creator and one of the most prominent figures in 20th-century Eastern European neurosurgery. This historical vignette is a modest tribute to his legacy and tells the story of his titanic endeavor.

  3. Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies.

    Science.gov (United States)

    Umansky, Felix; Black, Peter L; DiRocco, Concenzio; Ferrer, Enrique; Goel, Atul; Malik, Ghaus M; Mathiesen, Tiit; Mendez, Ivar; Palmer, James D; Juanotena, Jorge Rodriguez; Fraifeld, Shifra; Rosenfeld, Jeffrey V

    2011-01-01

    This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility. However, it is our intent that the fundamental principles enunciated here should serve as a guide in the day-to-day practice of neurosurgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Exploring challenges and solutions in the preparation of surgical patients

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Münter, Kristine Husum; Østergaard, Doris;

    2015-01-01

    guidelines and to identify challenges and solutions for correct preparation through interactive table simulation-based workshops involving the various professions and specialties. METHODS: Firstly, specific tasks in the hospital guidelines were monitored for all surgical procedures during one week. Secondly...... management system tasks, 26% of anaesthesia record tasks, 24% of medication tasks, 14% of blood test tasks and 12% of patient record tasks. In two workshops held for each of four specialties, a total of 21 participants mapped the preoperative patient journey with related responsibilities, tasks and written...... documentation. Furthermore, challenges and suggestions for solutions were identified. CONCLUSIONS: Completion of mandatory tasks for surgical patient preparation was poor. Workshops with table simulations actively involved the stakeholders from various professions and specialties in describing the patient...

  5. Specialty preferences : Trends and perceptions among Saudi undergraduate medical students

    NARCIS (Netherlands)

    Mehmood, Syed Imran; Kumar, Ashish; Al-Binali, Ali; Borleffs, Jan C. C.

    2012-01-01

    Background: The exploration of specialty choices by medical students is a hot debate as it affects several important determinants of health care delivery. This study was carried out to determine variation in specialty preferences during medical school training and the perceptions that affect student

  6. Gender bias in specialty preferences among Danish medical students

    DEFF Research Database (Denmark)

    Pedersen, Laura Erna Toftegaard; Skytte, Nanna Hasle Bak; Dissing, Agnete Skovlund

    2011-01-01

    Female medical students tend to prefer person-oriented specialties characterized by close doctor-patient contact and aspects of care. Conversely, male medical students tend to seek towards specialties with elements of autonomy, technology and "action" . Furthermore, female doctors will outnumber ...

  7. Specialty preferences : Trends and perceptions among Saudi undergraduate medical students

    NARCIS (Netherlands)

    Mehmood, Syed Imran; Kumar, Ashish; Al-Binali, Ali; Borleffs, Jan C. C.

    2012-01-01

    Background: The exploration of specialty choices by medical students is a hot debate as it affects several important determinants of health care delivery. This study was carried out to determine variation in specialty preferences during medical school training and the perceptions that affect

  8. Analysis of Enrollment Scale of Chinese Specialty Education

    Science.gov (United States)

    Hao, Jinmei; Li, Suke

    2017-01-01

    With the adjustment of industrial structure of China in recent years, the market urgently needs different levels of professionals. Specialty education is an important part of higher education in China, has its unique advantages. Through the analysis of the history data of specialty education in our country, the result shows that the specialty…

  9. Personality and Medical Specialty Choice: A Literature Review and Integration.

    Science.gov (United States)

    Borges, Nicole J.; Savickas, Mark L.

    2002-01-01

    Synthesizes studies categorized by medical specialties and using the following instruments into the Five Factor Model of personality: Adjective Check List, California Psychological Inventory, 16 Personality Factor Questionnaire, and Myers-Briggs Type Indicator. Suggests a loose association between personalty factors and medical specialties and…

  10. How price responsive is the demand for specialty care?

    Science.gov (United States)

    Maciejewski, Matthew L; Liu, Chuan-Fen; Kavee, Andrew L; Olsen, Maren K

    2012-08-01

    Outpatient visit co-payments have increased in recent years. We estimate the patient response to a price change for specialty care, based on a co-payment increase from $15 to $50 per visit for veterans with hypertension. A retrospective cohort of veterans required to pay co-payments was compared with veterans exempt from co-payments whose nonequivalence was reduced via propensity score matching. Specialty care expenditures in 2000-2003 were estimated via a two-part mixed model to account for the correlation of the use and level outcomes over time, and results from this correlated two-part model were compared with an uncorrelated two-part model and a correlated random intercept two-part mixed model. A $35 specialty visit co-payment increase had no impact on the likelihood of seeking specialty care but induced lower specialty expenditures over time among users who were required to pay co-payments. The log ratio of price responsiveness (semi-elasticity) for specialty care increased from -0.25 to -0.31 after the co-payment increase. Estimates were similar across the three models. A significant increase in specialty visit co-payments reduced specialty expenditures among patients obtaining medications at the Veterans Affairs medical centers. Longitudinal expenditure analysis may be improved using recent advances in two-part model methods. Published 2011. This article is a US Government work and is in the public domain in the USA.

  11. Exploring challenges and solutions in the preparation of surgical patients

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Münter, Kristine Husum; Østergaard, Doris;

    2015-01-01

    INTRODUCTION: Handover of surgical patients from ward to operating room is a sensible point for information and communication failures. Guidelines were developed for preparation of surgical patients. Our aim was to explore if patients are sufficiently prepared for surgery according to local......, workshops including table simulations involving the various professions and specialties were held. RESULTS: In total, 314 surgical procedures were performed of which 196 were eligible for analysis. Emergency procedures showed the poorest results with non-completed tasks comprising 58% of electronic patient...... documentation. Furthermore, challenges and suggestions for solutions were identified. CONCLUSIONS: Completion of mandatory tasks for surgical patient preparation was poor. Workshops with table simulations actively involved the stakeholders from various professions and specialties in describing the patient...

  12. Use of neurosurgical decision-making and damage-control neurosurgery courses in the Iraq and Afghanistan conflicts: a surgeon's experience.

    Science.gov (United States)

    Teff, Richard J

    2010-05-01

    A shortage of Coalition neurological surgeons in the Iraq conflict prompted a creative approach to standardized neurosurgical care in 2007. After formulation of theater-wide clinical pathway guidelines, a need for standardized triage and neurological resuscitation was identified. The object was to establish a simple, reproducible course for medics, forward surgical and emergency room personnel, and other critical care providers to quickly standardize the ability of all deployed health care personnel to provide state-of-the-art neurosurgical triage and damage-control interventions. The methods applied were Microsoft PowerPoint presentations and hands-on learning. The year-long project resulted in more than 100 individuals being trained in neurosurgical decision making and in more than 15 surgeons being trained in damage-control neurosurgery. At the year's conclusion, hundreds of individuals received exceptional neurosurgical care from nonneurosurgical providers and a legacy course was left for future deployed providers to receive ongoing education at their own pace.

  13. Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling.

    Science.gov (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Estabrooks, Carole A; Giovannetti, Phyllis B

    2011-01-01

    Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs. To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events). Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada. Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties. Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Impact of personality temperaments and characters on academic performance and specialty selection among a group of Egyptian medical graduates.

    Science.gov (United States)

    El Sheikh, Mona M; Shaker, Nermin M; Hussein, Hanan; Ramy, Hisham A

    2014-08-01

    The relationship between personality temperaments, academic achievement and specialty interest is important because of its implications in career counseling. To assess the effect of personality on academic performance and career selection and to study the impact of some sociodemographic factors on academic achievement and career choice of medical graduates. A total of 436 medical graduates of Ain Shams medical school were approached, out of which 331 participated. They were given a sociodemographic questionnaire, and the Temperament and Character Inventory-Revised (TCI-R; 240) for personality construct; they had to answer questions about academic achievement, ranking, scores and choice of medical specialty. Novelty seeking (NS1, NS2 and NS3) and self-transcendence (ST1 and ST2) were correlated with graduation ranking, (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively), that is, lower NS and ST had better academic outcome. Only high school score was associated with better achievement (p = .00). In specialty selection, females were significantly overrepresented in pediatrics and clinical pathology, whereas males were significantly predominating surgical specialties except for obstetrics and gynecology (p = .00). Students choosing patient-centered specialties had higher reward dependence (RD), persistence (PS) and cooperativeness (C); those choosing clinical pathology had highest harm avoidance (HA), whereas those choosing radiology had lowest HA and those choosing surgery had significantly higher self-directedness (SD3). Personality impacts academic achievement and specialty choice with other factors as gender and previous scholastic performance. © The Author(s) 2013.

  15. Do Legal Issues Deserve Space in Specialty Medical Journals ?

    Science.gov (United States)

    Nagpal, Neeraj

    2016-02-01

    Physicians and Internists in India have tended to brush under the carpet legal issues affecting their profession. Of concern to all Physicians is the judgment in a recent case where the NCDRC has stated that if MD Medicine Physicians write Physician & Cardiologist on their letterhead it is Quackery. What is MD Medicine degree holder in India qualified and trained to treat ? These are issues which need debate and that can only be initiated once we recognize that there is a problem. Either an MD Medicine is a cardiologist or he is not. If he is then it is the bounded duty of the Association of Physicians of India to challenge this judgment in a higher court of law and seek clear guidelines from MCI as well as Supreme Court on the issue. Editors of Specialty journals have a responsibility of selecting the best articles from those which are submitted to them to be published. Ultimately space in these journals is limited and hence the responsibility to select is enormous and simultaneously reason for rejection of an academic paper also has to be substantial. The question is "do issues which are not core to the specialty concerned deserve space in these?" Physicians and Internists in India have tended to brush under the carpet legal issues effecting their profession. Surgical specialties specially obstetricians and their associations have to some extent recognized the problem and taken steps to address the issue specially as regard PCPNDT Act.1 Physicians are more complacent and regard the Consumer Protection Act (CPA) 19862 and problems associated with it to primarily concern the surgical specialties. What is forgotten is that the maximum penalty of 6.08 crore plus interest of 5.5 cr has been awarded in case involving a patient treated primarily by a physician and on whom no surgical procedure was performed.3 It has also to be realized that there is no limit on the amount of compensation which can be asked for under CPA.2 Compensations have been awarded by National

  16. 3D printing in neurosurgery: A systematic review

    Directory of Open Access Journals (Sweden)

    Michael Randazzo

    2016-01-01

    Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints.

  17. Physician wages across specialties: informing the physician reimbursement debate.

    Science.gov (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L

    2010-10-25

    Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

  18. Battlefield Lessons: The Forward Air Surgical Team (FAST) Response

    Science.gov (United States)

    2011-02-24

    roster of diverse emergency and surgical specialties (emergency medicine, general surgery , orthopedic, oral - maxillofacial , ear- nose-throat, trauma, and...Forefront: The Army Forward Surgical Team,” Clinical Care Nursing North America , June, 2003, in PubMed.Gov, http://www.ncbi.nlm.nih.gov/pubmed/12755185...service members of the United States of America enjoy the latest aviation technology available. Sikorsky’s UH-60 “Blackhawk” is the most current

  19. Roots of neuroanatomy, neurology, and neurosurgery as found in the Bible and Talmud.

    Science.gov (United States)

    Tubbs, R Shane; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A; Wellons, John C; Oakes, W Jerry

    2008-07-01

    Historical observations and interpretations regarding the treatment of components of the nervous system can be found in the writings of the Bible and Talmud. A review of topics germane to modern neuroanatomy, neurology, and neurosurgery from these early, rich writings is presented herein. These historic writings provide a glimpse into the early understanding, description, and treatment of pathologies of the nervous system.

  20. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

    Science.gov (United States)

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D

    2014-01-01

    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  1. Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

    Science.gov (United States)

    Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela

    2016-01-01

    Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

  2. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery.

    Science.gov (United States)

    Morineau, T; Morandi, X; Le Moëllic, N; Jannin, P

    2013-03-01

    This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.

  3. Surgical rehearsal platform: potential uses in microsurgery.

    Science.gov (United States)

    Bambakidis, Nicholas C; Selman, Warren R; Sloan, Andrew E

    2013-10-01

    Surgical training has remained remarkably similar in many respects since the early days of halstedian training. Neurosurgery is a demanding field that requires extensive cognitive, perceptive, and technical training. Surgical simulation is a promising approach to facilitate acquiring proficiency in neurosurgical procedures. Simulation can permit mentoring trainees in a "safe" environment. By incorporating images that depict specific abnormalities in actual patients, simulation can provide realistic rehearsal for any given case for both novice and experienced surgeons in much the same way that data acquired from drones can be used to allow pilots to rehearse mission-critical maneuvers in a simulator before taking flight. Most neurosurgical simulators to date have focused on endovascular procedures, spinal procedures, temporal bone dissection, and stereotactic procedures. The use of simulator technology for microsurgery is in its infancy. This article describes a novel simulator technology developed by Surgical Theater LLC (http://www.surgicaltheater.net/home.html) called the Selman Surgical Rehearsal Platform. The platform shows promise for use in intracranial microvascular procedures, which require experience that is becoming increasingly limited for trainees who have to become proficient in more procedures in much less time than ever before.

  4. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  5. Commercial production of specialty chemicals and pharmaceuticals from biomass

    Energy Technology Data Exchange (ETDEWEB)

    McChesney, J.D. [Univ. of Mississippi, University, MS (United States)

    1993-12-31

    The chemical substances utilized in consumer products, and for pharmaceutical and agricultural uses are generally referred to as specialty chemicals. These may be flavor or fragrance substances, intermediates for synthesis of drugs or agrochemicals or the drugs or agrochemicals themselves, insecticides or insect pheromones or antifeedants, plant growth regulators, etc. These are in contrast to chemicals which are utilized in large quantities for fuels or preparation of plastics, lubricants, etc., which are usually referred to as industrial chemicals. The specific utilization of specialty chemicals is associated with a specific important physiochemical or biological property. They may possess unique properties as lubricants or waxes or have a very desirable biological activity such as a drug, agrochemical or perfume ingredient. These unique properties convey significant economic value to the specific specialty chemical. The economic commercial production of specialty chemicals commonly requires the isolation of a precursor or the specialty chemical itself from a natural source. The discovery, development and commercialization of specialty chemicals is presented and reviewed. The economic and sustainable production of specialty chemicals is discussed.

  6. Robotically-adjustable microstereotactic frames for image-guided neurosurgery

    Science.gov (United States)

    Kratchman, Louis B.; Fitzpatrick, J. Michael

    2013-03-01

    Stereotactic frames are a standard tool for neurosurgical targeting, but are uncomfortable for patients and obstruct the surgical field. Microstereotactic frames are more comfortable for patients, provide better access to the surgical site, and have grown in popularity as an alternative to traditional stereotactic devices. However, clinically available microstereotactic frames require either lengthy manufacturing delays or expensive image guidance systems. We introduce a robotically-adjusted, disposable microstereotactic frame for deep brain stimulation surgery that eliminates the drawbacks of existing microstereotactic frames. Our frame can be automatically adjusted in the operating room using a preoperative plan in less than five minutes. A validation study on phantoms shows that our approach provides a target positioning error of 0.14 mm, which exceeds the required accuracy for deep brain stimulation surgery.

  7. NEURONAVIGATION AND STEREOTAXY – HIGH TECH IN MODERN NEUROSURGERY

    OpenAIRE

    F.M. Gramada; Ianovici, N

    2006-01-01

    Image-guided neuronavigation utilizes the principle of stereotaxis. The brain is considered as a geometric volume, which can be divided by three imaginary intersecting spatial planes, orthogonal to each other (horizontal, frontal and sagital) based on the Cartesian coordinate system. Measuring its distance along these three intersecting planes can specify any point within the brain. Neuronavigation provides a precise surgical guidance by referencing this coordinate system of the brain with ...

  8. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery

    Science.gov (United States)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2006-03-01

    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  9. Collaboration between paediatric surgery and other medical specialties in Nigeria

    Directory of Open Access Journals (Sweden)

    Philemon E Okoro

    2012-01-01

    Full Text Available Background: The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. Materials and Methods: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. Results: Forty-seven respondents were included in the survey. Forty-five (95.7% respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%, lack of awareness of the need for collaboration 32 (68.1%, tendency to apportion blames for bad outcome 13 (27.7%, and mutual suspicion 8 (17%. Conclusion: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

  10. Best practices in specialty pharmacy management.

    Science.gov (United States)

    Patterson, Courtney J

    2013-01-01

    Specialty pharmacy is a growing area of research, utilization, and cost. Because of the unique nature of the diseases treated by specialty pharmaceuticals, such as cancer and rheumatoid arthritis, novel management approaches are needed. Advocate Physician Partners (APP) is an entity within the Advocate Health Care Health System in the Chicago and the central Illinois area. It coordinates the care management and managed care contracting between the Advocate Health Care System and more than 4,000 physicians on the medical staffs of Advocate hospitals. APP has experienced a per-member-per-month (PMPM) increase of less than  3% in oncology intravenous medications spend in 2012. This spend refers to the intravenous medications covered under the medical benefits for APP's health maintenance organization (HMO) population. The spend has consistently been less than national projections, and we believe this is tied to the adoption of several key best practices. Prior to instituting the best practices, the yearly percentage increases for oncology spending were 5.52% (2007 to 2008), 9.39% (2008 to 2009), and 5.29% (2009 to 2010). After instituting best practices during the first quarter of 2011, the increases in PMPM were 3.11% (2010 to 2011) and 2.11% (2011 to 2012), which were below previous years. To describe the best practices of specialty pharmacy management adopted by APP, specifically (a) establishing a content expert and governing bodies, (b) ensuring compliance with policies, and (c) providing educational resources. APP has several key result areas (KRAs). One KRA was compliance with appropriate utilization of intravenous oncology protocols for its HMO population. The protocols for each medication outline the appropriate indication and patient population. These protocols were developed and reviewed by the APP Pharmacy and Technology (PT) committee. The PT-approved indications reflect FDA indications and indications found in national guidelines. The APP KRA target

  11. Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology

    Directory of Open Access Journals (Sweden)

    K. V. S. Hari kumar

    2012-01-01

    Full Text Available Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr′s disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.

  12. Theme: Staying Current--Small Animals and Specialty Crops.

    Science.gov (United States)

    Knight, James A.; And Others

    1986-01-01

    Six theme articles examine ways that vocational agriculture teachers can keep current, including related hobbies, resource persons, beekeeping as a supervised occupational experience, specialty crops such as fruits and nuts, an inservice poultry project, and trade and industry organizations. (SK)

  13. 75 FR 42431 - Onyx Specialty Papers, Inc; Notice Soliciting Applications

    Science.gov (United States)

    2010-07-21

    ..., Counsel for Onyx Specialty Papers, Inc., Van Ness Feldman, PC, 1050 Jefferson Street, NW., Suite 700... Regulations. Questions concerning this notice should be directed to Robert Bell, (202) 502-6062 or...

  14. career motivation and specialty choice of veterinary medical ...

    African Journals Online (AJOL)

    Analysis of the responses of 90 clinical veterinary students of the Usmanu ... as none of the students sampled wanted to specialize in these areas. KEY WORDS: Students, Veterinary Medicine, Career Motivation, Specialty Choice, Sokoto.

  15. Fiber Fabrication Facility for Non-Oxide and Specialty Glasses

    Data.gov (United States)

    Federal Laboratory Consortium — FUNCTION: Unique facility for the research, development, and fabrication of non-oxide and specialty glasses and fibers in support of Navy/DoD programs. DESCRIPTION:...

  16. Specialty Engineering Supplement to IEEE-15288.1

    Science.gov (United States)

    2015-05-15

    MISSILE SYSTEMS CENTER TAILORING SPECIALTY ENGINEERING SUPPLEMENT TO IEEE -15288.1 APPROVED FOR PUBLIC RELEASE; DISTRIBUTION...IS UNLIMITED 1 Tailoring of IEEE 15288.1: Specialty Engineering Supplement. 1. Intent of this Tailoring Document This tailoring document is...historically deemed valuable to mission assurance/success of high-reliability space systems. This tailoring document supplements IEEE 15288.1-2015 Annex E

  17. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery : an animal model

    NARCIS (Netherlands)

    Kalmar, A. F.; De Ley, G.; Van Den Broecke, C.; Van Aken, J.; Struys, M. M. R. F.; Praet, M. M.; Mortier, E. P.

    2009-01-01

    During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption. In a newly presented rat model

  18. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery : an animal model

    NARCIS (Netherlands)

    Kalmar, A. F.; De Ley, G.; Van Den Broecke, C.; Van Aken, J.; Struys, M. M. R. F.; Praet, M. M.; Mortier, E. P.

    2009-01-01

    During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption. In a newly presented rat model

  19. Relationship between patient complaints and surgical complications

    Science.gov (United States)

    Murff, H J; France, D J; Blackford, J; Grogan, E L; Yu, C; Speroff, T; Pichert, J W; Hickson, G B

    2006-01-01

    Background Patient complaints are associated with increased malpractice risk but it is unclear if complaints might be associated with medical complications. The purpose of this study was to determine whether an association exists between patient complaints and surgical complications. Methods A retrospective analysis of 16 713 surgical admissions was conducted over a 54 month period at a single academic medical center. Surgical complications were identified using administrative data. The primary outcome measure was unsolicited patient complaints. Results During the study period 0.9% of surgical admissions were associated with a patient complaint. 19% of admissions associated with a patient complaint included a postoperative complication compared with 12.5% of admissions without a patient complaint (p = 0.01). After adjusting for surgical specialty, co‐morbid illnesses and length of stay, admissions with complications had an odds ratio of 1.74 (95% confidence interval 1.01 to 2.98) of being associated with a complaint compared with admissions without complications. Conclusions Admissions with surgical complications are more likely to be associated with a complaint than surgical admissions without complications. Further research is necessary to determine if patient complaints might serve as markers for poor clinical outcomes. PMID:16456204

  20. Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility.

    Science.gov (United States)

    Giordano, Mario; Samii, Amir; Lawson McLean, Anna C; Bertalanffy, Helmut; Fahlbusch, Rudolf; Samii, Madjid; Di Rocco, Concezio

    2017-01-01

    OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8-15 years) over an 8-year period (2007-2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The

  1. Feasibility of diffusion tractography for the reconstruction of intra-thalamic and cerebello-thalamic targets for functional neurosurgery: a multi-vendor pilot study in four subjects

    Directory of Open Access Journals (Sweden)

    Andras Jakab

    2016-07-01

    Full Text Available Functional stereotactic neurosurgery by means of deep brain stimulation or ablation provides an effective treatment for movement disorders, but the outcome of surgical interventions depends on the accuracy by which the target structures are reached. The purpose of this pilot study was to evaluate the feasibility of diffusion tensor imaging (DTI based probabilistic tractography of deep brain structures that are commonly used for pre- and perioperative targeting for functional neurosurgery. Three targets were reconstructed based on their significance as intervention sites or as a no-go area to avoid adverse side effects: the connections propagating from the thalamus to (1 primary and supplementary motor areas, (2 to somatosensory areas and the cerebello-thalamic tract. We evaluated the overlap of the reconstructed connectivity based targets with corresponding atlas based data, and tested the inter-subject and inter-scanner variability by acquiring repeated DTI from four volunteers, and on three MRI scanners with similar sequence parameters.Compared to a 3D histological atlas of the human thalamus, moderate overlaps of 35-50% were measured between connectivity- and atlas based volumes, while the minimal distance between the centerpoints of atlas and connectivity targets was 2.5 mm. The variability caused by the MRI scanner was similar to the inter-subject variability, except for connections with the postcentral gyrus where it was higher. While cerebello-thalamic tractography resolved the anatomically correct trajectory of the tract individually, high volumetric variability was found across subjects and between scanners. DTI can be applied in the clinical, preoperative setting to reconstruct the cerebello-thalamic tract and to localize subdivisions within the lateral thalamus. In our pilot study, such subdivisions moderately matched the borders of the ventrolateral-posteroventral (VLpv nucleus and the ventral-posterolateral (VPL nucleus. Limitations

  2. Development of neurosurgery in Germany: comparison of data collected by polls for 1997, 2003, and 2008 among providers of neurosurgical care.

    Science.gov (United States)

    Steiger, Hans J; Krämer, Michael; Reulen, Hans J

    2012-01-01

    To deduce structural trends in neurosurgery in Germany by comparison of data derived from polls conducted by the Deutsche Gesellschaft für Neurochirurgie (DGNC) in 1997, 2003 and 2008. The questionnaires of the different polls probed a comparable set of issues. The data from the responding sample were extrapolated to the nationwide average or sum and compared between the different time periods. The number of identified neurosurgical departments increased from 146 to 201 during the years 1997-2008 largely as a result of the new foundation of numerous private groups. Nationwide total neurosurgical bed capacity and intensive care unit bed capacity increased modestly over the time period. The extrapolated total number of neurosurgical operations increased from 196,341 to 319,295. Although cranial and spinal neurosurgery remain the dominant subspecialties, the number of functional neurosurgical procedures and operations for pain increased more than proportionally. Outpatient procedures were established during the time period and corresponded in 2008 to a substantial proportion of the surgical volume. The total number of residents and board-certified neurosurgeons increased during the period 1997-2008 from 1513 to 1961. The proportion of residents decreased during 1997-2003 and then increased again. The number of neurosurgical operations increased in Germany proportionally to the economic growth of other service branches over the time period. Private organizations developed more than neurosurgical departments at university and other general hospitals. Work density measured as operations per physician increased during the period 1997-2008. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. 16 CFR 300.18 - Use of name of specialty fiber.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Use of name of specialty fiber. 300.18... specialty fiber. (a) In setting forth the required fiber content of a product containing any of the specialty fibers named in Section 2(b) of the Act, the name of the specialty fiber present may be used...

  4. Choosing surgery as a specialty: opinions of medical students about surgery and surgeons.

    Science.gov (United States)

    Borracci, Raúl A; Ferraina, Pedro; Arribalzaga, Eduardo B; Poveda Camargo, Ricardo L

    2014-11-01

    Since the number of applicants to residencies in general surgery in Argentina seems to be decreasing, we designed this work with the objective of studying the factors considered undesirable by students when choosing surgery as a specialty. Between March and April 2012, one-hundred students were surveyed with a structured questionnaire with true/false binary answers in an observational case-control design. The survey contained 26 statements that made reference to characteristics of surgery as a specialty, or about the personality and lifestyle of surgeons, as they could be perceived by students. As a control group the same survey was applied to 20 surgeons who were in contact with the students and that could represent a role model for them during their rotation in surgery. Comparison between students and surgeons showed no difference in most answers, except in «surgery has poor reimbursement» (OR: 8,9; P=.0001), «there is not enough job demand» (OR: 8,1; P=.015), «surgery restrains intellectual development» (OR: 17,5; P=.014), «surgeons have too many non-scheduled activities» (OR: 9,36; P=.024), «they have a limited patient-physician relationship» (OR: 3,61; P=.009), «they have little time for family» (OR: 4,27; P=.036) and «they are exposed to infectious diseases» (OR: 5,90; P=.007). Women would be as interested as men in working as surgeons; a remarkable fact when considering that the surgical specialties have been predominantly filled by men. The fact that surgeons mostly coincide with the views of students means that role models should be reviewed to promote vocations. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  5. Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery.

    Science.gov (United States)

    Hart, Michael G; Ypma, Rolf J F; Romero-Garcia, Rafael; Price, Stephen J; Suckling, John

    2016-06-01

    Neuroanatomy has entered a new era, culminating in the search for the connectome, otherwise known as the brain's wiring diagram. While this approach has led to landmark discoveries in neuroscience, potential neurosurgical applications and collaborations have been lagging. In this article, the authors describe the ideas and concepts behind the connectome and its analysis with graph theory. Following this they then describe how to form a connectome using resting state functional MRI data as an example. Next they highlight selected insights into healthy brain function that have been derived from connectome analysis and illustrate how studies into normal development, cognitive function, and the effects of synthetic lesioning can be relevant to neurosurgery. Finally, they provide a précis of early applications of the connectome and related techniques to traumatic brain injury, functional neurosurgery, and neurooncology.

  6. Parenteral Admixture Compatibility in Neurosurgery Ward in Prof. Dr. Margono Soekarjo Regional Public Hospital

    Directory of Open Access Journals (Sweden)

    Laksmi Maharani

    2014-03-01

    Full Text Available Parenteral admixtures (intravenous admixtures have been done commonly in hospitals. However, it has a possibility of failures, like incompatibilities and changes in drug stabilities. The aim of this study was to determine the rate of drug incompatibilities in mixing parenteral preparations in neurosurgery ward in Prof. Dr. Margono Soekarjo Regional Public Hospital which undergo physical incompatibility observed in organoleptic. This study was a prospective descriptive research for one month period. Data were collected and analyzed descriptively. The results showed that from 667 parenteral admixtures in neurosurgery ward in Prof Dr Margono Soekarjo Hospital in February 2010, there were 0.45% potential incompatibility and 2.55% actual incompatibility happened. Actual incompatibility shown as crystal 0.17%, sediment 0.17%, and 2.04% was non-permanent haze in phenytoin and sodium chloride or ringer lactate admixtures.

  7. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  8. History of neurosurgery in Sher-I-Kashmir Institute of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2015-01-01

    Full Text Available Sher-i-Kashmir Institute of Medical Sciences (SKIMS is the only tertiary care institute in the state of Jammu and Kashmir. The department of neurosurgery was established nearly three decades ago and continues to be the leader in providing high quality neurosurgical services in the region. The article provides an insight into the genesis of the department and its sustained growth over these years. It also describes the plans for its future development.

  9. The Opioid-sparing Effect of Perioperative Dexmedetomidine plus Sufentanil Infusion during Neurosurgery: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Shiyu Su

    2016-10-01

    Full Text Available Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and postoperative infusions of dexmedetomidine (DEX plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg–1 for 10 min, then adjusted to 0.3 μg·kg–1·h–1 until incision suturing and Group ND (no DEX infusion during surgery. Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg–1·h–1 plus DEX 0.02 μg·kg–1·h–1, Group ND: sufentanil 0.02 μg·kg–1·h–1 in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity (Visual Analogue Scale [VAS], Ramsay sedation scale (RSS and Bruggemann comfort scale (BCS were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P0.05.Conclusions: DEX (0.02 μg·kg–1·h–1 plus sufentanil (0.02 μg·kg–1·h–1 could reduce postoperative opioid consumption and concerning

  10. Influence of intraoperative magnetic resonance imaging used in neurosurgery on anesthesia

    Directory of Open Access Journals (Sweden)

    Mao-wei GONG

    2011-09-01

    Full Text Available Objective To observe the influcences of intraoperative magnetic resonance imaging(iMRI used in neurosurgery on anesthesia.Methods Sixty patients with glioma were randomly divided into two groups(30 each,the patients in iMRI group underwent craniotomy and glioma ablation under the guidance of iMRI and functional neuro-navigation,and in N group with the functional neuro-navigation only.The patients’ general status and concerning parameters were observed and recorded,including anesthesia duration,preparation time for surgery,duration of surgery,blood loss,volume of fluid administration,number of patients who needed blood transfusion,preoperative and postoperative hemoglobin,postoperative body temperature,dosage of muscle relaxant,and the unforeseen incidents related to iMRI and anesthesia.Results No significant differences existed between the two groups(P > 0.05 in patients’ general status,anesthesia duration,blood loss,volume of fluid administration,numbers of patients who needed blood transfusion,preoperative and postoperative hemoglobin,and body temperature.However,the preparation time for and duration of surgery were longer,the dosage of muscle relaxant was larger in iMRI group than in N group(P < 0.05.No inadvertent incident related to iMRI and anesthesia occurred in both groups.Conclusions The application of iMRI in neurosurgery may improve the accuracy in operative manipulation and make the tumor resection more thorough,but it may prolong duration of surgery.Other perimoperative care related to iMRI surgery is similar to that of traditional functional neuro-navigation surgery.Besides the basic rules of neurosurgery anesthetic management for neurosurgery,anesthetist should focus on anesthetic adjustment for a long operation.

  11. Neurosurgery in the realm of 10(-9), part 1: stardust and nanotechnology in neuroscience.

    Science.gov (United States)

    Elder, James B; Liu, Charles Y; Apuzzo, Michael L J

    2008-01-01

    Nanotechnology as a science has evolved from notions and speculation to emerge as a prominent combination of science and engineering that stands to impact innumerable aspects of technology. Medicine in general and neurosurgery in particular will benefit greatly in terms of improved diagnostic and therapeutic capabilities. The recent explosion in nanotechnology products, including diverse applications such as beauty products and medical contrast agents, has been accompanied by an ever increasing volume of literature. Recent articles from our institution provided an historical and scientific background of nanotechnology, with a purposeful focus on nanomedicine. Future applications of nanotechnology to neuroscience and neurosurgery were briefly addressed. The present article is the first of two that will further this discussion by providing specific details of current nanotechnology applications and research related to neuroscience and clinical neurosurgery. This article also provides relevant perspective in scale, history, economics, and toxicology. Topics of specific importance to developments or advances of technologies used by neuroscientists and neurosurgeons are presented. In addition, advances in the field of microelectromechanical systems technology are discussed. Although larger than nanoscale, microelectromechanical systems technologies will play an important role in the future of medicine and neurosurgery. The second article will discuss current nanotechnologies that are being, or will be in the near future, incorporated into the armamentarium of the neurosurgeon. The goal of these articles is to keep the neuroscience community abreast of current developments in nanotechnology, nanomedicine, and, in particular, nanoneurosurgery, and to present possibilities for future applications of nanotechnology. As applications of nanotechnology permeate all forms of scientific and medical research, clinical applications will continue to emerge. Physicians of the

  12. Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis

    OpenAIRE

    Wang, Vincent Y.; Chin, Cynthia T.; Lu, Daniel C.; Smith, Justin S.; Chou, Dean

    2010-01-01

    Free-hand thoracic pedicle screw placement is becoming more prevalent within neurosurgery residency training programs. This technique implements anatomic landmarks and tactile palpation without fluoroscopy or navigation to place thoracic pedicle screws. Because this technique is performed by surgeons in training, we wished to analyze the rate at which these screws were properly placed by residents by retrospectively reviewing the accuracy of resident-placed free-hand thoracic pedicle screws u...

  13. Factors influencing the choice of specialty of Australian medical graduates.

    Science.gov (United States)

    Harris, Mary G; Gavel, Paul H; Young, Jeannette R

    2005-09-19

    To identify the relative importance of extrinsic determinants of doctors' choice of specialty. A self-administered postal questionnaire. Australian vocational training programs. 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.

  14. Intra-operative micro-electrode recording in functional neurosurgery: Past, present, future.

    Science.gov (United States)

    Maiti, Tanmoy K; Konar, Subhas; Bir, Shyamal; Kalakoti, Piyush; Nanda, Anil

    2016-10-01

    The field of functional neurosurgery has experienced a rise, fall and lastly a renaissance over the past 75years. Micro-electrode recording (MER) played a key role during this eventful journey. However, as the intra-operative MRI continues to evolve, a pertinent question about the utility of MER has been raised in recent years. In this article, we critically review these current controversies. The English literature is reviewed and the complex technique of MER is discussed in a simplified manner. The improvement of neuroimaging and its application in functional neurosurgery, especially in deep brain stimulation, is discussed. Finally, the current controversies and technical advances which can direct the future are reviewed. The results of existing meta-analyses addressing the controversies are summarized. Wide variations of pre-operative and intra-operative targeting methods have been described in the literature. Though functional neurosurgery is generally safe, complications do occur and multiple passes during MER can certainly add to the risk of inadvertent hemorrhage and infection. Additionally, the recent introduction of newer MRI modalities has ensured better delineation of the target. However, MER is still useful to address brain shift, for mapping of newer targets, for ablative surgeries and in centers without an intra-operative imaging facility. In the current scenario, it is nearly impossible to conduct a prospective study to decide the utility of MER. The importance of MER may further diminish in the future as a routine procedure, but its role as a gold standard procedure may still persist.

  15. Aura of technology and the cutting edge: a history of lasers in neurosurgery.

    Science.gov (United States)

    Ryan, Robert W; Spetzler, Robert F; Preul, Mark C

    2009-09-01

    In this historical review the authors examine the important developments that have led to the availability of laser energy to neurosurgeons as a unique and sometimes invaluable tool. They review the physical science behind the function of lasers, as well as how and when various lasers based on different lasing mediums were discovered. They also follow the close association between advances in laser technology and their application in biomedicine, from early laboratory experiments to the first clinical experiences. Because opinions on the appropriate role of lasers in neurosurgery vary widely, the historical basis for some of these views is explored. Initial enthusiasm for a technology that appears to have innate advantages for safe resections has often given way to the strict limitations and demands of the neurosurgical operating theater. However, numerous creative solutions to improve laser delivery, power, safety, and ergonomics demonstrate the important role that technological advances in related scientific fields continue to offer neurosurgery. Benefiting from the most recent developments in materials science, current CO(2) laser delivery systems provide a useful addition to the neurosurgical armamentarium when applied in the correct circumstances and reflect the important historical advances that come about from the interplay between neurosurgery and technology.

  16. Candida infection of the central nervous system following neurosurgery: a 12-year review.

    LENUS (Irish Health Repository)

    O'Brien, Deirdre

    2012-02-01

    BACKGROUND: Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome. METHODS: All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review. RESULTS: Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%. CONCLUSIONS: Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure.

  17. Laser neurosurgery: A systematic analysis of magnetic resonance-guided laser interstitial thermal therapies.

    Science.gov (United States)

    Lagman, Carlito; Chung, Lawrance K; Pelargos, Panayiotis E; Ung, Nolan; Bui, Timothy T; Lee, Seung J; Voth, Brittany L; Yang, Isaac

    2017-02-01

    Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel minimally invasive modality that uses heat from laser probes to destroy tissue. Advances in probe design, cooling mechanisms, and real-time MR thermography have increased laser utilization in neurosurgery. The authors perform a systematic analysis of two commercially available MRgLITT systems used in neurosurgery: the Visualase® thermal therapy and NeuroBlate® Systems. Data extraction was performed in a blinded fashion. Twenty-two articles were included in the quantitative synthesis. A total of 223 patients were identified with the majority having undergone treatment with Visualase (n=154, 69%). Epilepsy was the most common indication for Visualase therapy (n=8 studies, 47%). Brain mass was the most common indication for NeuroBlate therapy (n=3 studies, 60%). There were no significant differences, except in age, wherein the NeuroBlate group was nearly twice as old as the Visualase group (p<0.001). Frame, total complications, and length-of-stay (LOS) were non-significant when adjusted for age and number of patients. Laser neurosurgery has evolved over recent decades. Clinical indications are currently being defined and will continue to emerge as laser technologies become more sophisticated. Head-to-head comparison of these systems was difficult given the variance in indications (and therefore patient population) and disparate literature.

  18. Atrial natriuretic factor: is it responsible for hyponatremia and natriuresis in neurosurgery?

    Science.gov (United States)

    Gasparotto, Ana Paula Devite Cardoso; Falcão, Antonio Luis Eiras; Kosour, Carolina; Araújo, Sebastião; Cintra, Eliane Araújo; de Oliveira, Rosmari Aparecida Rosa Almeida; Martins, Luiz Claudio; Dragosavac, Desanka

    2016-01-01

    Objective To evaluate the presence of hyponatremia and natriuresis and their association with atrial natriuretic factor in neurosurgery patients. Methods The study included 30 patients who had been submitted to intracranial tumor resection and cerebral aneurism clipping. Both plasma and urinary sodium and plasma atrial natriuretic factor were measured during the preoperative and postoperative time periods. Results Hyponatremia was present in 63.33% of the patients, particularly on the first postoperative day. Natriuresis was present in 93.33% of the patients, particularly on the second postoperative day. Plasma atrial natriuretic factor was increased in 92.60% of the patients in at least one of the postoperative days; however, there was no statistically significant association between the atrial natriuretic factor and plasma sodium and between the atrial natriuretic factor and urinary sodium. Conclusion Hyponatremia and natriuresis were present in most patients after neurosurgery; however, the atrial natriuretic factor cannot be considered to be directly responsible for these alterations in neurosurgery patients. Other natriuretic factors are likely to be involved. PMID:27410411

  19. Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia.

    Science.gov (United States)

    Chidambaram, Swathi; Nair, M Nathan; Krishnan, Shyam Sundar; Cai, Ling; Gu, Weiling; Vasudevan, Madabushi Chakravarthy

    2015-12-01

    Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. A retrospective analysis was conducted of the medical records of all 363 neurosurgical cases performed between June 1, 2012, and June 30, 2013, at a neurosurgical center in South Asia. Data from all operative neurosurgical cases during the 13-month period were included. Cerebrospinal fluid (CSF) analysis indicated that 71 of the 363 surgical cases had low CSF glucose or CSF leukocytosis. These 71 cases were categorized as PCNSIs. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n = 5), Escherichia coli (n = 1), or Klebsiella pneumoniae (n = 1). The data suggest a higher rate of death (P = 0.031), a higher rate of CSF leak (P < 0.001), and a higher rate of cranial procedures (P < 0.001) among the infected patients and a higher rate of CSF leak among the patients with culture-positive infections (P = 0.038). This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The understanding and operative treatment of cerebral palsy at the turn of the twentieth century: Harvey Cushing's early forays into pediatric neurosurgery.

    Science.gov (United States)

    Dmetrichuk, Jennifer M; Pendleton, Courtney; Ahn, Edward S; Quiñones-Hinojosa, Alfredo

    2011-09-01

    At the turn of the twentieth century, cerebral palsy and its treatment were not well understood, and a variety of treatment modalities were tested with only limited success. Following IRB approval and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896-1912. Eight patients who received a diagnosis consistent with cerebral palsy and were treated surgically by Dr. Cushing were selected for further analysis and are described here. A total of eight patients underwent operative intervention for treatment of symptoms consistent with cerebral palsy. Of these, seven were male; the mean age was 4.9 years (range, 1.5 to 12). Five patients underwent decompressive craniotomies, one underwent tenotomies, one underwent transection of the spinal nerve roots, and one underwent primary transection of the spinal nerve roots with secondary tenotomies. Four representative cases are reported here. Cushing's contributions to pediatric neuro-oncology have been previously described, but his endeavors in non-oncologic realms remain largely unknown. Although Cushing employed previously described operative approaches for the treatment of cerebral palsy, parents brought their children to him from across the nation, in an era when long distance travel was tedious, and a financial burden. These cases serve to emphasize Cushing's interest in improving patient quality of life, and his broad contributions to pediatric neurosurgery.

  1. Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results.

    Science.gov (United States)

    Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L

    2010-08-01

    Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.

  2. Parsing abnormal grain growth in specialty aluminas

    Science.gov (United States)

    Lawrence, Abigail Kremer

    Grain growth in alumina is strongly affected by the impurities present in the material. Certain impurity elements are known to have characteristic effects on abnormal grain growth in alumina. Specialty alumina powders contain multiple impurity species including MgO, CaO, SiO2, and Na 2O. In this work, sintered samples made from alumina powders containing various amounts of the impurities in question were characterized by their grain size and aspect ratio distributions. Multiple quantitative methods were used to characterize and classify samples with varying microstructures. The grain size distributions were used to partition the grain size population into subpopulations depending on the observed deviation from normal behavior. Using both grain size and aspect ratio a new visual representation for a microstructure was introduced called a morphology frequency map that gives a fingerprint for the material. The number of subpopulations within a sample and the shape of the distribution on the morphology map provided the basis for a classification scheme for different types of microstructures. Also using the two parameters a series of five metrics were calculated that describe the character of the abnormal grains in the sample, these were called abnormal character values. The abnormal character values describe the fraction of grains that are considered abnormal, the average magnitude of abnormality (including both grain size and aspect ratio), the average size, and variance in size. The final metric is the correlation between grain size and aspect ratio for the entire population of grains. The abnormal character values give a sense of how different from "normal" the sample is, given the assumption that a normal sample has a lognormal distribution of grain size and a Gaussian distribution of aspect ratios. In the second part of the work the quantified measures of abnormality were correlated with processing parameters such as composition and heat treatment conditions. A

  3. Neurosurgery and the anatomy of reading: a practical review.

    Science.gov (United States)

    Greenblatt, S H

    1977-01-01

    Tumors and vascular malformations in the posterior parts of the dominant hemisphere are frequently associated with preoperative alexias, and surgical maneuvers in these areas may cause the appearance of this neurobehavioral deficit as an operative complication. Lesions of the dominant (left) angular gyrus are associated with the syndromes of alexia with agraphia. Alexia without agraphia results from lesions of the pathways which conduct visual information from the calcarine areas to the left angular gyrus (splenium of the corpus callosum, left lingual and fusiform gyri, left transverse and vertical occipital fasciculi). A brief bedside examination (outlined in the text) provides useful pre- and postoperative localizing information. Fresh cadaver studies of the brain in situ have shown that the approximate center of the left angular gyrus area is found by first locating a point 9 cm forward along the midline from the inion and then moving 4 1/4 cm laterally. These measurements define a point which is a few centimeters medial and posterior to the center of the parietal eminence.

  4. Autostereoscopic 3D visualization and image processing system for neurosurgery.

    Science.gov (United States)

    Meyer, Tobias; Kuß, Julia; Uhlemann, Falk; Wagner, Stefan; Kirsch, Matthias; Sobottka, Stephan B; Steinmeier, Ralf; Schackert, Gabriele; Morgenstern, Ute

    2013-06-01

    A demonstrator system for planning neurosurgical procedures was developed based on commercial hardware and software. The system combines an easy-to-use environment for surgical planning with high-end visualization and the opportunity to analyze data sets for research purposes. The demonstrator system is based on the software AMIRA. Specific algorithms for segmentation, elastic registration, and visualization have been implemented and adapted to the clinical workflow. Modules from AMIRA and the image processing library Insight Segmentation and Registration Toolkit (ITK) can be combined to solve various image processing tasks. Customized modules tailored to specific clinical problems can easily be implemented using the AMIRA application programming interface and a self-developed framework for ITK filters. Visualization is done via autostereoscopic displays, which provide a 3D impression without viewing aids. A Spaceball device allows a comfortable, intuitive way of navigation in the data sets. Via an interface to a neurosurgical navigation system, the demonstrator system can be used intraoperatively. The precision, applicability, and benefit of the demonstrator system for planning of neurosurgical interventions and for neurosurgical research were successfully evaluated by neurosurgeons using phantom and patient data sets.

  5. Intraoperative complications in pediatric neurosurgery: review of 1807 cases.

    Science.gov (United States)

    van Lindert, Erik J; Arts, Sebastian; Blok, Laura M; Hendriks, Mark P; Tielens, Luc; van Bilsen, Martine; Delye, Hans

    2016-09-01

    OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.

  6. Multimodal correlation and intraoperative matching of virtual models in neurosurgery

    Science.gov (United States)

    Ceresole, Enrico; Dalsasso, Michele; Rossi, Aldo

    1994-01-01

    The multimodal correlation between different diagnostic exams, the intraoperative calibration of pointing tools and the correlation of the patient's virtual models with the patient himself, are some examples, taken from the biomedical field, of a unique problem: determine the relationship linking representation of the same object in different reference frames. Several methods have been developed in order to determine this relationship, among them, the surface matching method is one that gives the patient minimum discomfort and the errors occurring are compatible with the required precision. The surface matching method has been successfully applied to the multimodal correlation of diagnostic exams such as CT, MR, PET and SPECT. Algorithms for automatic segmentation of diagnostic images have been developed to extract the reference surfaces from the diagnostic exams, whereas the surface of the patient's skull has been monitored, in our approach, by means of a laser sensor mounted on the end effector of an industrial robot. An integrated system for virtual planning and real time execution of surgical procedures has been realized.

  7. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    Science.gov (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  8. Physical anthropology and the dental and medical specialties.

    Science.gov (United States)

    Krogman, W M

    1976-11-01

    The rise of two sub-specialties in Physical Antrhopology traces back to the Anatomy Departments of Schools of Medicine in Germany and France during the nineteenth century. The study of human diversity in bones and bodies was largely by medically-trained anatomists. There developed Medical Antropology and Dental Anthropology, employing osteometry and craniometry on the skeleton, somatometry and cephalometry on the living body. As a result cross-sectional studies gave way to longitudinal studies and X-ray techniques were added to purely mensurational procedures. In Medical Anthropology the specialties most directly concerned are pediatrics, plastic surgery, endocrinology, and orthopaedics. In Dental Anthropology the specialties most directly concerned are pedodontics, orthodontics, oral surgery, and prosthodontics. The contributions of Physical Anthropology to each is discussed.

  9. Consequences of Participating in Multidisciplinary Medical Team Meetings for Surgical, Nonsurgical, and Supporting Specialties

    NARCIS (Netherlands)

    Molleman, Eric; Broekhuis, Manda; Stoffels, Renee; Jaspers, Frans

    2010-01-01

    This study examines the consequences for medical specialists of participating in multidisciplinary medical team meetings in terms of perceived clinical autonomy, domain distinctiveness, and professional accountability. These consequences may influence their willingness to cooperate and the quality o

  10. Don't all veins look alike? Comprehensively attending to diversity within the vascular surgical specialty.

    Science.gov (United States)

    Hancock, Ange-Marie; Hancock, Charles R

    2010-04-01

    Prior research has established diversity as a topic of empirical analysis in the vascular surgery literature. Building on the work of previously published articles on diversity in the Journal of Vascular Surgery and elsewhere, this article engages in a broad discussion of diversity in two interrelated arenas: educational/workplace diversity and culturally competent care. Interdisciplinary review of the literature indicates that diversity is often thought of as an end-state to be accomplished. A more fruitful way to encompass the changing aspects of diversity work is to think of diversity as a set of processes that can be adjusted based on a set of interrelated goals that matter differently to different groups. In considering diversity as a process, an approach to diversity emerges that considers both independent effects of gender and race/ethnicity as well as interactive effects between the two variables to address future trends in medical education. Such trends are diagnosed and multiple courses of intervention are offered as reasonable options for future efforts. A comprehensive definition of diversity will be established in order to encompass two different arenas in which diversity concerns arise: educational diversity and culturally competent patient care. Second, a discussion of the rationales for attention to diversity among vascular surgeons will provide different avenues into a conversation about diversity in the profession. In so doing, three successful efforts will be briefly discussed: the Ohio State University's MED-Path program, the Keck School of Medicine's chair-centered approach to diversity in residency training, and the American Association of Orthopedic Surgeons' (AAOS) approach to culturally competent care. Copyright 2010. Published by Mosby, Inc.

  11. Competency Revalidation Study of Specialty Practice in Sports Physical Therapy

    Science.gov (United States)

    Thein-Nissenbaum, Jill; Bartlett, Lynn; Woodall, William R.; Reinking, Mark F.; Wallmann, Harvey W.; Mulligan, Edward P.

    2009-01-01

    Purpose The primary purpose of this study was to revalidate the competencies that define the practice of sports physical therapy. Additionally, the study allowed for the comparison of responses of board certified specialists in sports physical therapy to respondents who were not specialists. Methods A survey instrument based the on American Board of Physical Therapy Specialties practice analysis template and The Guide to Physical Therapist Practice was developed by the Sports Specialty Council and a panel of subject matter experts in sports physical therapy. The instrument was sent to 630 physical therapists, 315 of whom were board certified specialists in sports physical therapy and 315 of whom were randomly selected members of the Sports Physical Therapy Section who were not board certified specialists in sports physical therapy. Two hundred and thirty seven subjects returned completed surveys for a 41% response rate. One hundred and fifty eight respondents were sports specialists Results The survey results were reviewed by the Sports Specialty Council and another panel of subject matter experts. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of sports physical therapy. Survey results were also used to develop the sports physical therapy specialty board examination blue print. A number of significant comparisons between the specialists and non-specialists were identified. Conclusion The competency revalidation process culminated in the publication of the Sports Physical Therapy Description of Specialty Practice. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialist in sports physical therapy. PMID:21509106

  12. Design and implementation of population-based specialty care programs.

    Science.gov (United States)

    Botts, Sheila R; Gee, Michael T; Chang, Christopher C; Young, Iris; Saito, Logan; Lyman, Alfred E

    2017-09-15

    The development, implementation, and scaling of 3 population-based specialty care programs in a large integrated healthcare system are reviewed, and the role of clinical pharmacy services in ensuring safe, effective, and affordable care is highlighted. The Kaiser Permanente (KP) integrated healthcare delivery model allows for rapid development and expansion of innovative population management programs involving pharmacy services. Clinical pharmacists have assumed integral roles in improving the safety and effectiveness of high-complexity, high-cost care for specialty populations. These roles require an appropriate practice scope and are supported by an advanced electronic health record with disease registries and electronic surveillance tools for care-gap identification. The 3 specialty population programs described were implemented to address variation or unrecognized gaps in care for at-risk specialty populations. The Home Phototherapy Program has leveraged internal partnerships with clinical pharmacists to improve access to cost-effective nonpharmacologic interventions for psoriasis and other skin disorders. The Multiple Sclerosis Care Program has incorporated clinical pharmacists into neurology care in order to apply clinical guidelines in a systematic manner. The KP SureNet program has used clinical pharmacists and data analytics to identify opportunities to prevent drug-related adverse outcomes and ensure timely follow-up. Specialty care programs improve quality, cost outcomes, and the patient experience by appropriating resources to provide systematic and targeted care to high-risk patients. KP leverages an integration of people, processes, and technology to develop and scale population-based specialty care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  13. Women otolaryngologist representation in specialty society membership and leadership positions.

    Science.gov (United States)

    Choi, Sukgi S; Miller, Robert H

    2012-11-01

    To determine the proportion of female otolaryngologists in leadership positions relative to their number in the specialty, their membership in various otolaryngology organizations, and age. Cross-sectional analyses of otolaryngology organization membership with a subgroup analysis on female membership and leadership proportion comparing 5-year male/female cohort groups. Information on the number of members and leaders was obtained from various specialty societies by direct communication and from their Web sites between June and December 2010. The number of female and male otolaryngologists and their age distribution in 5-year age groups was obtained from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Statistical analyses were used to determine whether women had proportional membership and leadership representation in various specialty societies. Additionally, female representation in other leadership roles was analyzed using the male/female ratio within the 5-year cohort groups. Female otolaryngologists were found to constitute approximately 11% of practicing otolaryngologists. The American Society of Pediatric Otolaryngology had a higher proportion of female members (22%) compared to five other societies. When the gender composition within each organization was taken into account, female representation in specialty society leadership positions was proportionate to their membership across all societies. When gender and age were considered, women have achieved proportionate representation in each of the specialty societies' leadership positions. There was also proportionate representation of females as program directors, American Board of Otolaryngology directors, Residency Review Committee members, and journal editors/editorial board members. Finally, fewer female chairs or chiefs of departments/divisions were seen, but when age was taken into consideration, this difference was no longer significant. Women have achieved parity in

  14. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description.

    Science.gov (United States)

    McGirt, Matthew J; Speroff, Theodore; Dittus, Robert S; Harrell, Frank E; Asher, Anthony L

    2013-01-01

    Given the unsustainable costs of US health care, universal agreement exists among payers, regulatory agencies, and other health care stakeholders that reform must include substantial improvements in the quality, effectiveness, and value of health care delivery. The Institute of Medicine and the American Recovery and Reinvestment Act of 2009 have called for the establishment of prospective registries to capture patient-centered data from real-world practice as a high priority to guide evidence-based reform. As a result, the American Association of Neurological Surgeons launched the National Neurosurgery Quality and Outcomes Database (N(2)QOD) and began enrolling patients in March 2012 into its initial pilot project: a web-based lumbar spine module. As a nationwide, prospective longitudinal registry utilizing patient reported outcome instruments, the N(2)QOD lumbar spine surgery pilot aims to systematically measure and aggregate surgical safety and 1-year postoperative outcome data from approximately 30 neurosurgical practices across the US with the primary aim of demonstrating the feasibility and validity of standardized 1-year outcome measurement from everyday real-world practice. At the end of the pilot year, 1) risk-adjusted modeling will be developed for the safety, quality, and effectiveness of lumbar surgical care (morbidity, readmission, improvements in pain, disability, quality of life, and return to work); 2) data integrity and validation will be demonstrated via internal quality control analyses and auditing, and 3) the feasibility of obtaining a high level of follow-up (~80%) of nationwide 1-year outcome measurement will be established. N(2)QOD will use only prospective clinical data, will avoid the use of administrative data proxies, and will rely on neurosurgically relevant risk factors for risk adjustment. Once national benchmarks of quality and effectiveness are accurately established and validated utilizing practice-based data extractors in the pilot

  15. Gender differences in the acquisition of surgical skills

    DEFF Research Database (Denmark)

    Ali, Amir; Subhi, Yousif; Ringsted, Charlotte

    2015-01-01

    BACKGROUND: Females are less attracted than males to surgical specialties, which may be due to differences in the acquisition of skills. The aim of this study was to systematically review studies that investigate gender differences in the acquisition of surgical skills. METHODS: We performed...... a comprehensive database search using relevant search phrases and MeSH terms. We included studies that investigated the role of gender in the acquisition of surgical skills. RESULTS: Our search yielded 247 studies, 18 of which were found to be eligible and were therefore included. These studies included a total...... conditions). Male medical students tended to outperform females, while no gender differences were found among residents. Gaming experience and interest in surgery correlated with better acquisition of surgical skills, regardless of gender. Although initial levels of surgical abilities seemed lower among...

  16. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty.

    Science.gov (United States)

    Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D; Gilbert, Gwendolyn L

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

  17. Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

    Science.gov (United States)

    Seabury, Seth A; Helland, Eric; Jena, Anupam B

    2014-11-01

    The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to the restrictiveness of the cap ($250,000 versus $500,000). We found that, overall, noneconomic damages caps reduced average payments by $42,980 (15 percent), compared to having no cap at all. A more restrictive $250,000 cap reduced average payments by $59,331 (20 percent), and a less restrictive $500,000 cap had no significant effect, compared to no cap at all. The effect of the caps overall varied according to specialty, with the largest impact being on claims involving pediatricians and the smallest on claims involving surgical subspecialties and ophthalmologists.

  18. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA infection control policies differs by ward specialty.

    Directory of Open Access Journals (Sweden)

    Rosemarie Sadsad

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.

  19. Myelomeningocele (open spina bifida) - surgical management.

    Science.gov (United States)

    Akalan, N

    2011-01-01

    Myelomeningocele has been recognized since ancient times although written descriptions began not before the 17th century. Among all serious congenital malformations, myelomeningocele is unique that is has a steady and considerable prevalence while being compatible with life. It has a dismal prognosis when left untreated where virtually all die within the first year while aggressive treatment have a profound effect on survival and quality of life. Effective surgical treatment became possible parallel to the treatment of hydrocephalus in the late 1950s. Advent of the shunt systems undoubtedly changed the morbidity and mortality rates due to associated hydrocephalus. Aggressive and effective treatment improved survival rates but also those suffering physical and mental disabilities have increased as well. Ethical and socioeconomic concerns have led to proposal for selective treatment criteria which have raised arguments on medical and ethico-legal rounds. After the swing of the pendulum between early treatment in all affected children and selective treatment of those who fulfilled the criteria for good prognosis, early myelomeningocele repair is practiced widely unless the infant is critically ill.Incidence of myelomeningocele has been decreasing especially in the Western world, partly due to prenatal diagnosis and elective terminations, dietary folate supplementation. Still, it is the most common central nervous system malformation and one of the leading causes of paraplegia, worldwide. Unfortunately, gains in the management of myelomeningocele have been mainly on antenatal diagnosis and prevention while efforts on understanding its cause, mechanisms involved are still tentative. Concerning the surgical management, no revolutionary modification improving outcome has been introduced unlike other fields of neurosurgery.Medical management of a child with myelomeningocele requires a lifelong effort of several disciplines including urology, orthopedics physical and social

  20. The application of quality control circle in neurosurgery ICU nurses in raising compliance of the head of a bed

    Directory of Open Access Journals (Sweden)

    Na LI

    2014-11-01

    Full Text Available Objective: To explore the application of quality control circle in raising compliance of the head of a bed in neurosurgery ICU nurses. Methods: The quality control circle was made up of 4 ICU nurses, determine the subject in order to improve the neurosurgery ICU nurses in raising compliance of the head of a bed, according to the QCC activity steps to formulate plans, including grasp the current situation, goal setting, through analysis, circle members develop strategy and plan implementation and review, finally compared the situation before and after neurosurgery ICU nurses raised bed activities compliance. Results: After implementation of QCC, neurosurgery ICU nurses raised bed to 30 ~ 45 degrees. After activities, circle members in the team cooperation ability, cohesion, to accept new things ability, and innovative thinking ability and to raise the understanding of the relevant knowledge of the head of a bed has improved significantly. Conclusion: The application of quality management circle activity improves the neurosurgery ICU nurses effectively raise the compliance of the head of a bed, improve the comprehensive quality of the clinical nurses.

  1. Patient safety risks and patients treated by multiple specialties.

    NARCIS (Netherlands)

    Baines, R.; Bruijne, M. de; Langelaan, M.; Wagner, C.

    2013-01-01

    Objectives: To determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission. Methods: We performed structured retrospective patient record review study by trained nurses and physicians. We included 20 hospitals in the N

  2. Personality and Values as Predictors of Medical Specialty Choice

    Science.gov (United States)

    Taber, Brian J.; Hartung, Paul J.; Borges, Nicole J.

    2011-01-01

    Research rarely considers the combined influence of personality traits and values in predicting behavioral outcomes. We aimed to advance a germinal line of inquiry that addresses this gap by separately and simultaneously examining personality traits and physician work values to predict medical specialty choice. First-year medical students (125…

  3. Burnout Comparison among Residents in Different Medical Specialties

    Science.gov (United States)

    Martini, Shahm; Arfken, Cynthia L.; Churchill, Amy; Balon, Richard

    2004-01-01

    Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first…

  4. [Directions of ecology specialty construction and personnel training in China].

    Science.gov (United States)

    Zhang, Jia-En; Luo, Shi-Ming; Qin, Zhong; Ye, Yan-Qiong; Zhao, Ben-Liang

    2009-07-01

    This paper analyzed the present status of ecology specialty construction and personnel training in China. It was considered that there existed some problems to be solved, e. g., the contradiction between the rapid development of new subjects in ecology and the relative weakness in personnel qualified to teach, the unbalance between the extensive and intensive, and the deep and shallow teaching programs for the students in ecology, the conflict between the "soft" (theoretical) ecological education and the "hard" (technical) ecological construction, and the contradiction between the limited demands and the relative surplus supply of undergraduate students in ecology. Based on these analyses, a series of suggestions and countermeasures for the innovation of the teaching styles and training directions in ecological specialties were put forward, including 1) to formulate a development and construction plan of ecology specialty and to appropriately regulate the enrollment of undergraduate students, 2) to achieve the changes in current teaching styles from classroom to field and from "soft" theoretical teaching to "hard" technical training, 3) to develop and implement a variety of diversified teaching methods, such as participative, interactive, research-based, and innovative teaching for undergraduate students, 4) to enhance the undergraduate educational quality and teaching resource bank construction and to achieve teaching resource sharing, and 5) to establish "T-type" personnel training system in ecology. Some employment-oriented personnel training directions in ecology specialty were also presented.

  5. Specialty and Systems Engineering Supplement to IEEE 15288.1

    Science.gov (United States)

    2017-08-28

    15288.1 Tailoring Language ............................................................................ 2 3.2.1 Specialty Engineering Analysis and...believed necessary to maintain the level or rigor required by national security space acquisitions . 2. Context IEEE-15288.1: 2014, Standard for...be: 1. Normative (requirements rather than informative guidance), 2. Tailored appropriately for specific acquisition /contract considerations, and 3

  6. An Integrated Strategy for Teaching Biochemistry to Biotechnology Specialty Students

    Science.gov (United States)

    Ouyang, Liming; Ou, Ling; Zhang, Yuanxing

    2007-01-01

    The faculty of biochemistry established an integrated teaching strategy for biotechnology specialty students, by intermeshing the case-study method, web-assistant teaching, and improved lecture format with a brief content and multimedia courseware. Teaching practice showed that the integrated teaching strategy could retain the best features of…

  7. 76 FR 22733 - Cable Statutory License: Specialty Station List

    Science.gov (United States)

    2011-04-22

    ... Adobe Portable Document File (PDF) format that contains searchable, accessible text (not an image... affidavit. List of Specialty Stations: Call Letter and Cities of License CBAFT, Moncton, New Brunswick..., Canada CBOFT, Ottawa, Ontario, Canada CBUFT, Vancouver, British Columbia, Canada CBVT, Quebec...

  8. 76 FR 5213 - Cable Compulsory License: Specialty Station List

    Science.gov (United States)

    2011-01-28

    ... in 1989, see 54 FR 38461 (September 18, 1989), an owner or licensee of a broadcast station files a... television station classified as a specialty station at the base rate for ``permitted'' signals. See 49 FR... in order to maintain as current a list as possible. 55 FR 40021 (October 1, 1990). Its second...

  9. 76 FR 72982 - Cable Statutory License: Specialty Station List; Correction

    Science.gov (United States)

    2011-11-28

    ... the Federal Register on November 8, 2011 at 76 FR 69288: On page 69289, WNYA-CA, Albany, NY was... Copyright Office Cable Statutory License: Specialty Station List; Correction AGENCY: Copyright Office... use of the cable compulsory license. In response to the publication of an initial list of...

  10. 2016 Guide to Nursing Certification Boards by Specialty.

    Science.gov (United States)

    Gavin, Cara

    2016-01-01

    Membership in a professional organization creates opportunities for individuals to grow in countless ways. Often, it allows us to develop new knowledge and form networks that change our lives. There are many advantages of becoming a member of a specialty organization. Each year, Dimensions of Critical Care Nursing is proud to provide an updated list of our professional nursing organizations.

  11. Using specialty advertising in a niche marketing plan.

    Science.gov (United States)

    Schwisow, C R

    1992-01-01

    While niche marketing is not a new strategy, an increasing number of competitors are pursuing the same niches, resulting in stiff competition within the health care industry, writes C. Ronald Schwisow. This means marketers need to be resourceful to maximize their communications efforts. One such approach is specialty advertising.

  12. Personality and Values as Predictors of Medical Specialty Choice

    Science.gov (United States)

    Taber, Brian J.; Hartung, Paul J.; Borges, Nicole J.

    2011-01-01

    Research rarely considers the combined influence of personality traits and values in predicting behavioral outcomes. We aimed to advance a germinal line of inquiry that addresses this gap by separately and simultaneously examining personality traits and physician work values to predict medical specialty choice. First-year medical students (125…

  13. IPM of specialty crops and community gardens in north Florida

    Science.gov (United States)

    Insect pests post serious challenges to specialty crops (vegetables, fruits and nut crops) and community gardens in North Florida. The major vegetable pests include silverleaf whitefly, Bemisia argentifolii; the green peach aphid, Myzus persicae; southeastern green stinkbug, Nezara viridula; brown s...

  14. Burnout Comparison among Residents in Different Medical Specialties

    Science.gov (United States)

    Martini, Shahm; Arfken, Cynthia L.; Churchill, Amy; Balon, Richard

    2004-01-01

    Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first…

  15. Assessing Student Interest and Familiarity with Professional Psychology Specialty Areas

    Science.gov (United States)

    Stark-Wroblewski, Kimberly; Wiggins, Tina L.; Ryan, Joseph J.

    2006-01-01

    The present study examined undergraduate psychology students' (N = 83) self-reported interest in and familiarity with five specialty areas in professional psychology: counseling psychology, clinical psychology, school psychology, forensic psychology, and criminal profiling. Results suggest that although students are quite interested in careers…

  16. Neurosurgery Nursing Management Analysis%神经外科护理管理分析

    Institute of Scientific and Technical Information of China (English)

    李咏梅

    2016-01-01

    目的:探讨有效的神经外科护理管理方法及应用效果。方法该院神经外科于2015年7月开始实施分级质量控制护理管理,选择实施前(2015年1-6月)期间神经外科收治的35例患者作为对照组,另选择实施后(2015年7-12月)期间神经外科收治的35例患者作为观察组,比较两组患者护理满意度;同时,实施前,实施后分别行护理质量评估,评估实施前后护理质量情况。结果实施后,神经外科临床护理质量指标(基础护理、重点环节护理、急救药品器材管理、病房护理、护理文件书写、压疮护理)评分均显著高于实施前,组间差异有统计学意义,P<0.05。观察组护理满意度(97.05%)显著高于对照组(70.58%),组间差异有统计学意义,P<0.05。结论神经外科护理管理应用分级质量控制管理,有助于提高临床护理质量和患者满意度,应推广使用该护理管理模式。%Objective objective to explore the effective method and application effect of neurosurgery nursing management. methods Our hospital neurosurgery began in July 2015 to carry out the implementation of grading nursing quality control management, choose before carrying out (from January 2015 to June) neurosurgery admitted during the period of 35 patients as control group, another choice after implementation (July to December 2015) neurosurgery admitted during the period of 35 patients as observation group, compared two groups of patients nursing satisfaction;Line at the same time, before the im-plementation, after implementation, respectively, nursing quality evaluation, evaluation before and after the implementation of nursing quality. Results after implementation of neurosurgery clinical nursing quality indicators (basic nursing care, e-mergency medicine equipment management, key link, ward nursing, nursing documents writing, pressure sores) scores were significantly higher than that of before

  17. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

    Science.gov (United States)

    Lecky, Fiona; Russell, Wanda; Fuller, Gordon; McClelland, Graham; Pennington, Elspeth; Goodacre, Steve; Han, Kyee; Curran, Andrew; Holliman, Damien; Freeman, Jennifer; Chapman, Nathan; Stevenson, Matt; Byers, Sonia; Mason, Suzanne; Potter, Hugh; Coats, Tim; Mackway-Jones, Kevin; Peters, Mary; Shewan, Jane; Strong, Mark

    2016-01-01

    Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70

  18. [Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps].

    Science.gov (United States)

    Zevallos, Leslie; Pastor, Reyna; Moscoso, Betsy

    2011-06-01

    To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

  19. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

    Directory of Open Access Journals (Sweden)

    Vaughan-Sarrazin Mary S

    2007-09-01

    Full Text Available Abstract Background The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served. Methods We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR (N = 10,478 and total knee replacement (TKR (N = 15,312 in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999–2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR, hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data. Results Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P Conclusion Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.

  20. A novel augmented reality system of image projection for image-guided neurosurgery.

    Science.gov (United States)

    Mahvash, Mehran; Besharati Tabrizi, Leila

    2013-05-01

    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  1. German Emergency Care in Neurosurgery and Military Neurology during World War II, 1939-1945.

    Science.gov (United States)

    Stahnisch, Frank W

    2016-01-01

    A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine

  2. The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

    Science.gov (United States)

    Wong, Kendrew; MacKenzie, Todd A.

    2015-01-01

    Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

  3. Supply versus demand: a review of application trends to Canadian surgical training programs.

    Science.gov (United States)

    Austin, Ryan E; Wanzel, Kyle R

    2015-04-01

    Despite increases in medical school enrolment, applications to surgical residency programs in Canada have been in decline over the past decade, with an increasing number of unmatched surgical residency positions. We examined the current status of surgical residency in Canada and analyzed application trends (2002–2013) for surgical training programs across Canada. Our findings suggest that most undergraduate medical schools across Canada are having difficulty fostering interest in surgical careers. We propose that a lack of adequate early exposure to the surgical specialties during undergraduate training is a critical factor. Moving forward, we must examine how the best-performing institutions and surgical programs have maintained interest in pursuing surgical careers and adapt our recruitment methods to both maintain and grow future interest. As Mary Engelbreit said, "If you don't like something, change it; if you can't change it, change the way you think about it."

  4. Anaesthesia and analgesia in Göttingen minipigs - examples of protocols used for neurosurgery and scanning procedures

    DEFF Research Database (Denmark)

    Alstrup, Aage Kristian Olsen

    Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections with bupr......Neurosurgery in Göttingen minipigs is often a welfare challenge, and therefore, the main goal of my talk will be to discuss how to improve animal welfare during brain surgery and the days following surgery. A combination of inhalation/infusion anaesthesia with opioids such as injections......, especially ensuring sufficient analgesia and water/food intake during the first hours and days. Compared to neurosurgery, scanning procedures are normally unproblematic from a welfare point of view. However, anaesthesia may influence the results of brain scans, particularly functional scans, such as positron...

  5. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration

    Science.gov (United States)

    MURAYAMA, Yuichi

    2016-01-01

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe’s growth strategy of Japanese economy. Innovative “Made in Japan” medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation. PMID:27298262

  6. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration.

    Science.gov (United States)

    Murayama, Yuichi

    2016-09-15

    Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe's growth strategy of Japanese economy. Innovative "Made in Japan" medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.

  7. [The processing of point clouds for brain deformation existing in image guided neurosurgery system].

    Science.gov (United States)

    Yao, Xufeng; Lin, Yixun; Song, Zhijian

    2008-08-01

    The finite element method (FEM) plays an important role in solving the brain deformation problem in the image guided neurosurgery system. The position of the brain cortex during the surgery provides the boundary condition for the FEM model. In this paper, the information of brain cortex is represented by the unstructured points and the boundary condition is achieved by the processing of unstructured points. The processing includes the mapping of texture, segmentation, simplification and denoising. The method of k-nearest clustering based on local surface properties is used to simplify and denoise the unstructured point clouds. The results of experiment prove the efficiency of point clouds processing.

  8. Automated location detection of injection site for preclinical stereotactic neurosurgery procedure

    Science.gov (United States)

    Abbaszadeh, Shiva; Wu, Hemmings C. H.

    2017-03-01

    Currently, during stereotactic neurosurgery procedures, the manual task of locating the proper area for needle insertion or implantation of electrode/cannula/optic fiber can be time consuming. The requirement of the task is to quickly and accurately find the location for insertion. In this study we investigate an automated method to locate the entry point of region of interest. This method leverages a digital image capture system, pattern recognition, and motorized stages. Template matching of known anatomical identifiable regions is used to find regions of interest (e.g. Bregma) in rodents. For our initial study, we tackle the problem of automatically detecting the entry point.

  9. 75 FR 32735 - Notice of the Specialty Crop Committee's Stakeholder Listening Session

    Science.gov (United States)

    2010-06-09

    ... the Le Rivage Hotel, 4800 Riverside Boulevard, Sacramento, California 95822. The public may file... programs affecting the specialty crop industry. The congressional legislation defines ``specialty crops... session. The listening session will elicit stakeholder input from industry and state representatives...

  10. 75 FR 34418 - Notice of the Specialty Crop Committee's Stakeholder Listening Session

    Science.gov (United States)

    2010-06-17

    ...; ] DEPARTMENT OF AGRICULTURE Office of the Secretary Notice of the Specialty Crop Committee's Stakeholder Listening Session AGENCY: Research, Education, and Economics, USDA. ACTION: Notice of stakeholder listening session. SUMMARY: The notice announces the Specialty Crop Committee's Stakeholder Listening Session....

  11. Curative effect and costs of surgical and gamma knife treatments on intractable epilepsy caused by temporal-hippocampal sclerosis.

    Science.gov (United States)

    Han, Z T; Chen, Q X

    2015-07-31

    This study aimed to investigate the curative effect and costs of surgical and gamma knife treatments on intractable epilepsy caused by temporal-hippocampal sclerosis. The subjects comprised patients who suffered from intractable epilepsy caused by temporal-hippocampal sclerosis and received treatment in the Department of Neurosurgery of our hospital between 2010 and 2011. After obtaining their consent, patients were evaluated and selected to receive surgical or gamma knife treatments. In the surgical group, the short-term curative rate was 92.60% and the average cost was US$ 1311.50 while in the gamma knife group, the short-term curative rate was 53.79%, and the average cost was US$ 2786.90. Both surgical and gamma knife treatments of intractable epilepsy caused by temporal-hippocampal sclerosis are safe and effective, but the short-term curative effect of surgical treatment is better than that of gamma knife, and its cost is lower.

  12. Perception of 1 st year medical students towards career choices and specialty of psychiatry

    OpenAIRE

    Suneet Kumar Upadhyaya; Chintan M Raval

    2015-01-01

    Background: Shortage of psychiatrists is a worldwide phenomenon. If the factors that attract or repel students towards a specialty can be identified, it may be possible to encourage them towards it. Choice of specialty as a career depends on the complex interplay of experiences before, during or after exposure to the specialty. Objectives: The aim was to understand perceptions of 1 st year medical students regarding career choices and the specialty of psychiatry through a cross-sectional ...

  13. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification

    Science.gov (United States)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas

    2015-03-01

    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

  14. Information Security: A Scientometric Study of the Profile, Structure, and Dynamics of an Emerging Scholarly Specialty

    Science.gov (United States)

    Olijnyk, Nicholas Victor

    2014-01-01

    The central aim of the current research is to explore and describe the profile, dynamics, and structure of the information security specialty. This study's objectives are guided by four research questions: 1. What are the salient features of information security as a specialty? 2. How has the information security specialty emerged and evolved from…

  15. Assessment of Junior Doctors' Perceptions of Difficulty of Medical Specialty Training Programs

    Science.gov (United States)

    Rogers, Mary E.; Creed, Peter A.; Searle, Judy

    2012-01-01

    The demands placed on medical trainees by the different specialty training programs are important considerations when choosing a medical specialty. To understand these demands, 193 junior doctors completed a web-based survey, and: (a) ranked medical specialties according to perceived level of training difficulty (incorporating entry difficulty,…

  16. The impact of clerkships on students' specialty preferences: what do undergraduates learn for their profession?

    NARCIS (Netherlands)

    Maiorova, T.; Stevens, F.; Scherpbier, A.; Zee, J. van der

    2008-01-01

    OBJECTIVE: Clinical experiences and gender have been shown to influence medical students' specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice an

  17. Broad support evident for the emerging specialty of orofacial pain.

    Science.gov (United States)

    Talley, R L; Fricton, J R; Okeson, J P

    2000-01-01

    The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of

  18. Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery.

    Science.gov (United States)

    Masamune, K; Kobayashi, E; Masutani, Y; Suzuki, M; Dohi, T; Iseki, H; Takakura, K

    1995-01-01

    A variety of medical robots for stereotactic neurosurgery has been developed in recent years. Almost of all these robots use computed tomography (CT) to scan the brain of the patient before and during surgery. Currently, we are developing a needle insertion manipulator for magnetic resonance imaging (MRI)-guided neurosurgery. MRI techniques, including MRI angiography and functional MRI, are attractive for the development of interventional MRI therapies and operations. If a robot were available, these therapies would be minimally invasive, with more accurate guidance than is possible with current CT-guided systems. Actuation of a robot in an MRI environment is difficult because of the presence of strong magnetic fields. Therefore, the robot must be constructed of nonmagnetic materials. The system frame was manufactured using polyethylene terephthalate (PET) and was actuated using ultrasonic motors. Accuracy-evaluation procedures and phantom tests have been performed. The total accuracy of the system was approximately 3.0 mm. No artifacts caused by the manipulator were observed in the images.

  19. Development of computer-aided functions in clinical neurosurgery with PACS

    Science.gov (United States)

    Mukasa, Minoru; Aoki, Makoto; Satoh, Minoru; Kowada, Masayoshi; Kikuchi, K.

    1991-07-01

    The introduction of the "Picture Archiving and Communications System (known as PACS)," provides many benefits, including the application of C.A.D., (Computer Aided Diagnosis). Clinically, this allows for the measurement and design of an operation to be easily completed with the CRT monitors of PACS rather than with film, as has been customary in the past. Under the leadership of the Department of Neurosurgery, Akita University School of Medicine, and Southern Tohoku Research Institute for Neuroscience, Koriyama, new computer aided functions with EFPACS (Fuji Electric's PACS) have been developed for use in clinical neurosurgery. This image processing is composed of three parts as follows: (1) Automatic mapping of small lesions depicted on Magnetic Resonance (or MR) images on the brain atlas. (2) Superimposition of two angiographic films onto a single synthesized image. (3) Automatic mapping of the lesion's position (as shown on the. CT images) on the processing image referred to in the foregoing clause 2. The processing in the clause (1) provides a reference for anatomical estimation. The processing in the clause (2) is used for general analysis of the condition of a disease. The processing in the clause (3) is used to design the operation. This image processing is currently being used with good results.

  20. Straight trajectory planning for keyhole neurosurgery in sheep with automatic brain structures segmentation

    Science.gov (United States)

    Favaro, Alberto; Lad, Akash; Formenti, Davide; Zani, Davide Danilo; De Momi, Elena

    2017-03-01

    In a translational neuroscience/neurosurgery perspective, sheep are considered good candidates to study because of the similarity between their brain and the human one. Automatic planning systems for safe keyhole neurosurgery maximize the probe/catheter distance from vessels and risky structures. This work consists in the development of a trajectories planner for straight catheters placement intended to be used for investigating the drug diffusivity mechanisms in sheep brain. Automatic brain segmentation of gray matter, white matter and cerebrospinal fluid is achieved using an online available sheep atlas. Ventricles, midbrain and cerebellum segmentation have been also carried out. The veterinary surgeon is asked to select a target point within the white matter to be reached by the probe and to define an entry area on the brain cortex. To mitigate the risk of hemorrhage during the insertion process, which can prevent the success of the insertion procedure, the trajectory planner performs a curvature analysis of the brain cortex and wipes out from the poll of possible entry points the sulci, as part of brain cortex where superficial blood vessels are naturally located. A limited set of trajectories is then computed and presented to the surgeon, satisfying an optimality criteria based on a cost function which considers the distance from critical brain areas and the whole trajectory length. The planner proved to be effective in defining rectilinear trajectories accounting for the safety constraints determined by the brain morphology. It also demonstrated a short computational time and good capability in segmenting gyri and sulci surfaces.

  1. Quantifying cortical surface harmonic deformation with stereovision during open cranial neurosurgery

    Science.gov (United States)

    Ji, Songbai; Fan, Xiaoyao; Roberts, David W.; Paulsen, Keith D.

    2012-02-01

    Cortical surface harmonic motion during open cranial neurosurgery is well observed in image-guided neurosurgery. Recently, we quantified cortical surface deformation noninvasively with synchronized blood pressure pulsation (BPP) from a sequence of stereo image pairs using optical flow motion tracking. With three subjects, we found the average cortical surface displacement can reach more than 1 mm and in-plane principal strains of up to 7% relative to the first image pair. In addition, the temporal changes in deformation and strain were in concert with BPP and patient respiration [1]. However, because deformation was essentially computed relative to an arbitrary reference, comparing cortical surface deformation at different times was not possible. In this study, we extend the technique developed earlier by establishing a more reliable reference profile of the cortical surface for each sequence of stereo image acquisitions. Specifically, fast Fourier transform (FFT) was applied to the dynamic cortical surface deformation, and the fundamental frequencies corresponding to patient respiration and BPP were identified, which were used to determine the number of image acquisitions for use in averaging cortical surface images. This technique is important because it potentially allows in vivo characterization of soft tissue biomechanical properties using intraoperative stereovision and motion tracking.

  2. Josef Klingler's models of white matter tracts: influences on neuroanatomy, neurosurgery, and neuroimaging.

    Science.gov (United States)

    Agrawal, Abhishek; Kapfhammer, Josef P; Kress, Annetrudi; Wichers, Hermann; Deep, Aman; Feindel, William; Sonntag, Volker K H; Spetzler, Robert F; Preul, Mark C

    2011-08-01

    During the 1930s, white matter tracts began to assume relevance for neurosurgery, especially after Cajal's work. In many reviews of white matter neurobiology, the seminal contributions of Josef Klingler (1888-1963) and their neurological applications have been overlooked. In 1934 at the University of Basel under Eugen Ludwig, Klingler developed a new method of dissection based on a freezing technique for brain tissue that eloquently revealed the white matter tracts. Klingler worked with anatomists, surgeons, and other scientists, and his models and dissections of white matter tracts remain arguably the most elegant ever created. He stressed 3-dimensional anatomic relationships and laid the foundation for defining mesial temporal, limbic, insular, and thalamic fiber and functional relationships and contributed to the potential of stereotactic neurosurgery. Around 1947, Klingler was part of a Swiss-German group that independently performed the first stereotactic thalamotomies, basing their targeting and logic on Klingler's white matter studies, describing various applications of stereotaxy and showing Klingler's work integrated into a craniocerebral topographic system for targeting with external localization of eloquent brain structures and stimulation of deep thalamic nuclei. Klingler's work has received renewed interest because it is applicable for correlating the results of the fiber-mapping paradigms from diffusion tensor imaging to actual anatomic evidence. Although others have described white matter tracts, none have had as much practical impact on neuroscience as Klinger's work. More importantly, Josef Klingler was an encouraging mentor, influencing neurosurgeons, neuroscientists, and brain imaging for more than three quarters of a century.

  3. Otfrid Foerster, the great neurologist and neurosurgeon from Breslau (Wrocław): his influence on early neurosurgeons and legacy to present-day neurosurgery.

    Science.gov (United States)

    Piotrowska, Natalia; Winkler, Peter A

    2007-08-01

    As a result of the turbulences of World War II, Wrocław, Poland (formerly Breslau, Germany) lost its internationally acknowledged position in the field of neurosurgery, which it once had thanks to Otfrid Foerster. This innovative German doctor and scientist made a considerable contribution to the development of neurological and neurosurgical research worldwide. He also made Breslau a renowned center for scientific study, luring researchers from around the world. His achievements influenced many neurosurgeons during his lifetime, above all those from the US and England, including, for example, such well-known men as Fulton, Bucy, Bailey, and Penfield (who worked with Foerster in Breslau for quite a long time). Together Foerster and Penfield searched for the causes of epilepsy and the surgical methods to treat it. For young American neurosurgeons it was a very significant step in their careers to be able to train in Breslau under the guidance of Otfrid Foerster. In 1937 the British Association of Neurological Surgeons visited Breslau and awarded him with the honor of "Member Emeritus," which could be seen as the culmination of Foerster's career. In this paper the authors give an overview of Foerster's work and evaluate its significance. They also elucidate the difficult historical background during fascism in Germany using the sources of the Polish National Archives. Dr. Foerster's remaining traces in today's Wrocław are meticulously reported.

  4. Music and Medicine: The Tragic Case of Gershwin's Brain Tumor and the Challenges of Neurosurgery in the First Half of the 20th Century.

    Science.gov (United States)

    Bagatti, Davide

    2016-01-01

    Although neurosurgery has gone through moments of great renewal in recent decades, at the beginning of the 20th century it was still dealing with the unfathomable mysteries of the nervous system and its disorders. Historical insight improves understanding of the great personalities of the past and allows us to look at the efforts of pioneering surgeons with greater awareness. The literature was reviewed using online databases, textbooks, and retrieved articles. An overview of the case of Gershwin's brain tumor and its surgical resection is presented. This article presents the tragic case of Gershwin's brain tumor. Through his story, it is possible to get an idea of the difficulties with which the great neuroscientists and surgeons of the past approached the human nervous system and its pathologic manifestations. The first part of this article deals with the evolution of Gershwin's disease over the years and the subsequent brain surgery. In the second part, general considerations on the most striking symptoms experienced by the composer are reported, as well as a description of the different hypotheses on the nature of Gershwin's tumor. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The Korean Spinal Neurosurgery Society ; Are We Reimbursed Properly for Spinal Neurosurgical Practices under the Korean Resource Based Relative Value Scale Service?

    Science.gov (United States)

    Kwon, Woo-Keun; Kim, Joo Han; Moon, Hong Joo; Park, Youn-Kwan

    2017-01-01

    Objectives The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. Methods We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. Results During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. Conclusion More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement. PMID:28061492

  6. A current assessment of diversity characteristics and perceptions of their importance in the surgical workforce.

    Science.gov (United States)

    French, Judith C; O'Rourke, Colin; Walsh, R Matthew

    2014-11-01

    Diversity in the workforce is vital to successful businesses. Healthcare in general has suffered from a lack of cultural competence, which is the ability to successfully interact with individuals from diverse backgrounds. In order to eliminate discrimination and build a diverse workforce, physicians' perceptions and importance of diversity need to be measured. A 25-item, anonymous, online questionnaire was created, and a cross-sectional survey was performed. The instrument consisted of demographic and Likert-style questions which attempted to determine the participants' perceptions of the current level of diversity in their specialty and their perceived importance of particular diversity categories. Over 1,000 responses were received from US-based physicians across all specialties and levels of training. Statistically significant differences existed between surgical and nonsurgical specialties with regard to gender, prior work experience, and political identity. In the surgical workforce, there is significant perceived homogeneity regarding gender/sexual identity. Surgical respondents also deemed gender/sexual identity diversity to be less important than respondents from medical specialties. Surgeons and surgical trainees are less diverse than their medical colleagues, both by demographics and self-acknowledgement. The long-term impact and potential barriers to resolve these differences in diversity require further investigation.

  7. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    OpenAIRE

    Mekaj, Agon Y; Morina, Arsim A; Mekaj, Ymer H; Suzana Manxhuka-Kerliu; Miftari, Ermira I; Duci, Shkelzen B; Hamza, Astrit R.; Gashi, Musli M.; Mentor R Gjelaj; Kelmendi, Fatos M; Qamile Sh. Morina

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical...

  8. Spontaneous regression of a giant basilar artery aneurysm in a young adult after surgical injury:case report and literature review

    Institute of Scientific and Technical Information of China (English)

    ZHANG He; LI Ming-hua; WANG Chun; LI Yong-dong; XU Tao

    2007-01-01

    A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

  9. Can a one-day practical lesson in surgical skills encourage medical students to consider a surgical career?

    Science.gov (United States)

    Bauer, Florian; Rommel, Niklas; Koerdt, Steffen; Fichter, Andreas; Wolff, Klaus-Dietrich; Kesting, Marco R

    2016-05-01

    Interest in a surgical career is declining among medical students, and many more need to commit themselves to becoming surgeons to cope with this. We have therefore developed a one-day practical lesson in surgical skills to find out whether a short course such as this can make students more enthusiastic about surgery, and about subsequently pursuing a career in one of its subspecialties. Fifty-four randomly-selected medical students did a one-day practical course in the skills required for maxillofacial surgical specialties. The 4 subdivisions involved - traumatology, resection of a tumour (cancer surgery), plastic surgery (microsurgery), and cleft lip and palate surgery. All students took written tests and completed an evaluation form about their interest in a surgical career before and after training. There was a significant increase in test scores in almost all categories at the end of the course, and significantly more students were prepared to consider a surgical career or a career in maxillofacial surgery after the training. This study shows that a one-day training course in surgical skills can significantly improve medical students' surgical knowledge, and might encourage them to enter a surgical career. We recommend the integration of a short training course such as this into the medical school curriculum. Only time and further evaluation will tell whether this increased exposure to surgical techniques can be transformed into additional surgeons.

  10. [Medical specialty choice: what impact of teaching? Results of a survey of two medical schools].

    Science.gov (United States)

    Gaucher, Sonia; Thabut, Dominique

    2013-04-01

    Determinants of career choice are numerous. The impact of teaching has not yet been reported. The objectives were to assess determinants of career choice among DCEM 4 (sixth year) medical students at Paris Descartes University and Pierre-et-Marie-Curie University; and to determine the impact of teaching on career choice. Prospective study based on an online survey, after the 2011 National Grading Examination, among 865 DCEM 4 students. Collection of socio-demographic data, commonly reported determinants of medical specialty choice, and the impact of the teaching on this choice. Two hundred and seven (24%) students (67% female) answered the survey. During their medical studies, students changed their mind on their career choice an average of 3 times (range 0-10). Nearly 60% of them made their final choice during the fifth year. Choices varied significantly between the beginning and end of the studies (Pchoice, surgical careers were mainly chosen by male students (19.8% of males vs. 9.9% of females, P=0.04), whereas medical careers were chosen equally by males and females (37.7% vs. 35.5%, P=0.75). The main determinant was interest in the specialty (96% of students), followed by perceived quality of life (56% of students). Teaching was a determinant for 74% of students, of whom 88% were influenced by the teaching they received during their clinical training. In 42% of cases, the teacher did not belong to the university corpus. In 10% of cases, students were discouraged from their choice by a teacher (a university professor in 50%). Our results highlight the impact of both teaching and the teacher on medical students' career choice. If career choice is now compelled in France by the "careers law", teaching is more than ever an effective way of interesting students in specialties which might appear less attractive. At a time when the selection of candidates for hospital-university careers is mainly based on publications, this study calls for reflection on the

  11. 优质护理在神经外科中的应用%Application of Quality Care in Neurosurgery

    Institute of Scientific and Technical Information of China (English)

    曾惠莉

    2014-01-01

    Objective To investigate the quality care in neurosurgery application effect. Methods 100 patients were divided into two groups (each 50), control group with general care, observation group of high quality care. Care for some time, for the care effect and satisfaction of patients and their families to investigate, through the investigation contrast, draw two care effect differences. Results The results of the two groups of nursing and family satisfaction surveys, the implementation of quality care in all aspects of the observation group satisfaction has been greatly improved, reaching 98.00%, no case of medical malpractice, the patient's family is also the case for the patient more satisfied, compared to the difference was statistically significant. Conclusion In the spirit of the application of surgical care quality care with good results, it is worth widely used.%目的:探究优质护理在神经外科的应用效果。方法把100例患者分为两组(各50例),对照组采用一般护理,观察组采用优质护理。护理一段时间后,对于护理效果和患者及家属的满意度进行调查,通过调查对比,得出两组护理效果的差异。结果对两组的护理效果及家属满意度进行调查,实行优质护理的观察组患者各方面的满意度有了很大的提高,达到了98.00%,没有出现1例医疗纠纷,患者家属也对于患者情况更加满意,对比差异有统计学意义。结论在精神外科的护理中应用优质护理有良好的效果,值得广泛应用。

  12. Gender inflexion in the construction of a new medical specialty

    Directory of Open Access Journals (Sweden)

    Rachel Aisengart Menezes

    2008-01-01

    Full Text Available This article presents the constitution of a new medical specialty, Palliative Care, directed to patients "out of therapeutic possibilities". The concept emerged around 1960 in England and was implemented in Brazil a couple of years before 1990. It is characterized by an active attendance of the dying process. It postulates a "spiritual assistance" to the patient and his/her family members, including the emotional universe. Ethnographical observation and interviews with Brazilian professionals showed a majority of women among the health teams involved in this proposal. This article discusses and analyses the connection between the construction of the specialty and gender representation among these professionals that reflects popular social images about death, beliefs, emotions and the roles played by women and men in these subjects.

  13. [A historical view of the specialty of clinical microbiology].

    Science.gov (United States)

    Pérez, Evelio Perea; Álvarez, Rogelio Martín

    2010-10-01

    Clinical microbiology today is a well established specialty in Spain whose development has necessarily been linked to improvements in the diagnosis, treatment and prevention of infectious diseases. Over time, clinical, teaching, and research structures have been organized around these diseases. In addition, a scientific society for specialists in infectious diseases (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica) has been set up, which in turn, publishes the journal ENFERMEDADES INFECCIOSAS Y MICROBIOLOGÍA CLÍNICA, and organizes congresses, meetings, working groups and a quality control program, etc. Clinical microbiologists will continue to be needed to meet future challenges (identification of new pathogenic microorganisms, methodological changes, diagnostic quality and speed, nosocomial infections, the development of antimicrobial resistance, etc.), which constitute a well-defined area of knowledge specific to our specialty. Copyright © 2010 Elsevier España S.L. All rights reserved.

  14. The value of independent specialty designation for interventional cardiology.

    Science.gov (United States)

    Blankenship, James C; Powell, Wayne A; Gray, Dawn R; Duffy, Peter L

    2017-01-01

    Interventional cardiology has finally completed, after 26 years of advocacy, a professional hat trick: independent board certification, membership as a unique specialty in the American Medical Association House of Delegates (AMA HOD), and recognition by the Centers for Medicaid and Medicare Services (CMS) as a separate medical specialty. This article points out how these distinctions for interventional cardiology and its professional society, the Society for Cardiovascular Angiography and Interventions (SCAI), have led to clear and definite benefits for interventional cardiologists and their patients. We focus on the least understood of these three-recognition by CMS and its implications for reimbursement and quality assessment for interventional cardiologists. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  15. Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine

    Directory of Open Access Journals (Sweden)

    Russo Joan E

    2006-01-01

    Full Text Available Abstract Background Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. Methods We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1 relationship style and specialty choice factors; 2 specialty choice factors and specialty match, and 3 relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty. Results Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6. There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness. Conclusion Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.

  16. Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast.

    Science.gov (United States)

    Bonnet, Stéphane; Bertani, Antoine; Savoie, Pierre-Henri; Mathieu, Laurent; Boddaert, Guillaume; Gonzalez, Federico; Poichotte, Antoine; Durand, Xavier; Rongiéras, Frédéric; Balandraud, Paul; Pons, François; Rigal, Sylvain

    2015-10-01

    The aims of this study were as follows: first to quantify and review the types of surgical procedures performed by military surgeons assigned to a Forward Surgical Team (FST) providing medical support to the population (MSP) in the Ivory Coast (IC), and second to analyze how this MSP was achieved. Between 2002 and 2012, all of the local nationals operated on by the different FSTs deployed in the IC were included in the study. The surgical activity was analyzed and divided into surgical specialties, war wounds, nonwar emergency trauma, nontrauma emergencies, and elective surgery. Demographics, circumstances of health care management, wounded organs, and types of surgical procedures were described. Over this period, surgeons operated on 2,315 patients and performed 2,556 procedures. Elective surgery accounted for 78.7% of the surgical activity, nontrauma emergencies accounted for 12.7%, nonwar emergency trauma accounted for 8%, and war wounds accounted for 0.6%. The main surgical activities were visceral (43.8%) and orthopedic (including soft tissues) surgeries (38.5%). The FSTs contributed widely to MSP in the IC. This MSP required limited resources, standardization of the procedures and specific skills beyond the original surgical specialties of military surgeons to fulfill the needs of the local population. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  17. Implementing cognitive behavioral therapy in specialty medical settings

    OpenAIRE

    Magidson, Jessica F.; Weisberg, Risa B.

    2014-01-01

    This article is an introduction to the second issue of a two-part Special Series on integrating cognitive behavioral therapy (CBT) into medical settings. The first issue focused on integrating CBT into primary care, and this issue focuses on implementing CBT in other specialty medical settings, including cancer treatment, HIV care, and specialized pediatric medical clinics. Models for treatment delivery to improve ease of implementation are also discussed, including telehealth and home-delive...

  18. Lipid components and oxidative status of selected specialty oils

    Energy Technology Data Exchange (ETDEWEB)

    Madawala, S. R. P.; Kochhar, S. P.; Dutta, P. C.

    2012-11-01

    Many vegetable oils are marketed as specialty oils because of their retained flavors, tastes and distinct characteristics. Specialty oil samples which were commercially produced and retailed were purchased from local superstores in Reading, UK, and Uppsala, Sweden and profiled for detailed lipid composition and oxidative status. These oil samples include: almond, hazelnut, walnut, macadamia nut, argan, avocado, grape seed, roasted sesame, rice bran, cold pressed, organic and cold pressed, warm pressed and refined rapeseed oils. The levels of PV were quite low (0.5-1.3mEq O{sub 2}/kg) but AV and Rancimat values at 100 degree centigrade (except for rapeseed oils) varied considerably at (0.5-15.5) and (4.2-37.0 h) respectively. Macadamia nut oil was found to be the most stable oil followed by argan oil, while walnut oil was the least stable. Among the specialty oils, macadamia nut oil had the lowest (4%) and walnut oil had the highest (71%) level of total PUFA. The organic cold pressed rapeseed oil had considerably lower PUFA (27%) compared with other rapeseed oils (28- 35%). In all the samples, {alpha}- and {gamma}- tocopherols were the major tocopherols; nut oils had generally lower levels. Total sterols ranged from 889 to 15,106 {mu}g/g oil. The major sterols were {beta}-sitosterol (61-85%) and campesterol (6-20%). Argan oil contained schottenol (35%) and spinasterol (32%). Compared with literature values, no marked differences were observed among the differently processed, organically grown or cold pressed rapeseed oils and other specialty oils in this study. (Author) 33 refs.

  19. Structure–property relationship of specialty elastomer–clay nanocomposites

    Indian Academy of Sciences (India)

    Anirban Ganguly; Madhuchhanda Maiti; Anil K Bhowmick

    2008-06-01

    The present work deals with the synthesis of specialty elastomer [fluoroelastomer and poly (styrene--ethylene-co-butylene--styrene (SEBS)]–clay nanocomposites and their structure–property relationship as elucidated from morphology studies by atomic force microscopy, transmission electron microscopy and X-ray diffraction and physico-mechanical properties. Due to polarity match, hydrophilic unmodified montmorillonite clay showed enhanced properties in resulting fluoroelastomer nanocomposites, while hydrophobic organo-clay showed best results in SEBS nanocomposites.

  20. Equity, public policy and outpatient specialty mental health services.

    Science.gov (United States)

    Savoca, E

    1993-01-01

    This study provides evidence on the role of the public sector in the allocation of ambulatory specialty mental health services across income groups in the adult population. Results suggest that in the early to mid-1980s, the tax and transfer system effectively lowered the price of services to the poor and the rich, thus causing the highest use by persons at the extreme ends of the income distribution. High utilization at the low end of the income scale can be largely attributed to publicly provided insurance. A comparison of demand prior to the Medicaid cuts brought on by the Omnibus Budget and Reconciliation Act (OBRA) of 1981 with post-OBRA estimates reveals the extreme sensitivity of demand to changes in coverage. Among upper income groups the results imply that the implicit price of specialty mental health care falls as income rises. This finding is consistent with the hypothesis that the government's exclusion of health benefits and expenditures from taxation effectively lowers the price of medical services to individuals in high marginal income tax brackets. It also suggests that recent proposals to limit the tax exclusion of employer-paid premiums may lead to a more equitable distribution of resources in the specialty mental health sector.

  1. Shale oil specialty markets: Screening survey for United States applications

    Energy Technology Data Exchange (ETDEWEB)

    1987-12-01

    EG and G requested J. E. Sinor Consultants Inc. to carry out an initial screening study on the possibilities for producing specialty chemicals from oil shale. Raw shale oil is not an acceptable feedstock to refineries and there are not enough user of heavy fuel oil in the western oil shale region to provide a dependable market. The only alternatives are to hydrotreat the oil, or else ship it long distances to a larger market area. Either of these alternatives results in a cost penalty of several dollars per barrel. Instead of attempting to enter the large-volume petroleum products market, it was hypothesized that a small shale oil facility might be able to produce specialty chemicals with a high enough average value to absorb the high costs of shipping small quantities to distant markets and still provide a higher netback to the plant site than sales to the conventional petroleum products market. This approach, rather than attempting to refine shale oil or to modify its characteristics to satisfy the specifications for petroleum feedstocks or products, focuses instead on those particular characteristics which distinguish shale oil from petroleum, and attempts to identify applications which would justify a premium value for those distinctive characteristics. Because byproducts or specialty chemicals production has been a prominent feature of oil shale industries which have flourished for periods of time in various countries, a brief review of those industries provides a starting point for this study. 9 figs., 32 tabs.

  2. Topical anaesthesia in children: reducing the need for specialty referral.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-01-31

    OBJECTIVE: The management of wounds in children is stressful, not only for the child, but also for parents and staff. In our Emergency Department (ED), we currently do not have a paediatric sedation policy, and thus children requiring suturing, not amenable to distraction and infiltrative anaesthesia, are referred to specialty teams for general anaesthesia. We proposed that the introduction of a topical anaesthetic gel (lidocaine, adrenaline, tetracaine - LAT) might help to reduce the number of referrals, by allowing the ED staff to perform the procedures, in combination with nonpharmacological approaches. METHODS: We carried out a retrospective review of ED records of all children aged 14 years or less attending with wounds, over an 8-month period, from 01 May 2007 to 31 January 2008. RESULTS: Two hundred and one (50.6%) patients presented before the introduction of LAT gel, whereas 196 (49.3%) patients presented afterwards. A total of 39 (19.4%) patients were referred for specialty review pre-LAT, whereas only 19 (9.7%) patients were referred in the LAT group. Of these, 31 (15.4%) pre-LAT and 15 (7.7%) LAT group required general anaesthesia. There is a significant difference between these two groups, using Fischer\\'s exact test, P=0.018. CONCLUSION: We have found that the introduction of topical anaesthetic gel in ED has significantly reduced the number of children with wounds referred to specialty teams for general anaesthesia. This has important implications for patient safety and hospital resources.

  3. [Surgical robotics, short state of the art and prospects].

    Science.gov (United States)

    Gravez, P

    2003-11-01

    State-of-the-art robotized systems developed for surgery are either remotely controlled manipulators that duplicate gestures made by the surgeon (endoscopic surgery applications), or automated robots that execute trajectories defined relatively to pre-operative medical imaging (neurosurgery and orthopaedic surgery). This generation of systems primarily applies existing robotics technologies (the remote handling systems and the so-called "industrial robots") to current surgical practices. It has contributed to validate the huge potential of surgical robotics, but it suffers from several drawbacks, mainly high costs, excessive dimensions and some lack of user-friendliness. Nevertheless, technological progress let us anticipate the appearance in the near future of miniaturised surgical robots able to assist the gesture of the surgeon and to enhance his perception of the operation at hand. Due to many in-the-body articulated links, these systems will have the capability to perform complex minimally invasive gestures without obstructing the operating theatre. They will also combine the facility of manual piloting with the accuracy and increased safety of computer control, guiding the gestures of the human without offending to his freedom of action. Lastly, they will allow the surgeon to feel the mechanical properties of the tissues he is operating through a genuine "remote palpation" function. Most probably, such technological evolutions will lead the way to redesigned surgical procedures taking place inside new operating rooms featuring a better integration of all equipments and favouring cooperative work from multidisciplinary and sometimes geographically distributed medical staff.

  4. Surgical fidelity: comparing the microscope and the endoscope.

    Science.gov (United States)

    Cote, Martin; Kalra, Ricky; Wilson, Taylor; Orlandi, Richard R; Couldwell, William T

    2013-12-01

    Both the microscope and the endoscope are widely used as visualization tools in neurosurgery; however, surgical dexterity when operating with each may differ. The aim of this study was to compare the surgical fidelity when using each of these visualization tools. Junior residents and expert surgeons performed standardized motor tasks under microscopic and endoscopic visualization. Demerits for inaccuracy and time needed to complete the tasks were used to compare the surgeons' performance with the microscope and the endoscope. The participants also performed a motor task under direct vision using different instruments to evaluate whether the shape of the instrument had any impact on the surgical fidelity. For the junior residents, the number of demerits accrued was lower with the microscope than with the endoscope, and the time needed to complete the tasks was also lower with the microscope. There was no difference in the number of demerits between the microscopic and the endoscopic experts, but the microscopic expert completed the task in a shorter time. There was no difference in demerits or performance time when comparing a short, straight instrument and a longer, bayoneted one. For junior residents, surgical fidelity is higher with the microscope than with the endoscope. This difference vanishes with experience, but a slower speed of execution is observed with endoscopic visualization, both in junior and expert surgeons.

  5. A neurologist in the origin of European and International neurosurgery: Clovis-Julien-Désiré Vincent (1879-1947).

    Science.gov (United States)

    Androutsos, G; Karamanou, M; Lymberi, M; Zambelis, T; Stamboulis, E

    2011-01-01

    Vincent Clovis began his carrier as a neurologist and finally became neurosurgeon at an advanced age. He is considered the founder of French neurosurgery, and after Harvey Williams Cushing, Europe's first neurosurgeon. He was mainly interested in pituitary tumors, in cerebral abscesses and in cerebral oedema.

  6. Publication performance and research output of Neurology and Neurosurgery training institutes in India: A 5-year analysis

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2015-01-01

    Conclusions: This evaluation of the publication performance and research output of neurology and neurosurgery training institutes would serve as a baseline data for future evaluations and comparisons. The absence of any publication and research output from several training institutes is a matter of concern.

  7. The Preferred Learning Styles of Neurosurgeons, Neurosurgery Residents, and Neurology Residents: Implications in the Neurosurgical Field.

    Science.gov (United States)

    Lai, Hung-Yi; Lee, Ching-Yi; Chiu, Angela; Lee, Shih-Tseng

    2014-01-01

    To delineate the learning style that best defines a successful practitioner in the field of neurosurgery by using a validated learning style inventory. The Kolb Learning Style Inventory, a validated assessment tool, was administered to all practicing neurosurgeons, neurosurgical residents, and neurology residents employed at Chang Gung Memorial Hospital, an institution that provides primary and tertiary clinical care in 3 locations, Linkou, Kaohsiung, and Chiayi. There were 81 participants who entered the study, and all completed the study. Neurosurgeons preferred the assimilating learning style (52%), followed by the diverging learning style (39%). Neurosurgery residents were slightly more evenly distributed across the learning styles; however, they still favored assimilating (32%) and diverging (41%). Neurology residents had the most clearly defined preferred learning style with assimilating (76%) obtaining the large majority and diverging (12%) being a distant second. The assimilating and diverging learning styles are the preferred learning styles among neurosurgeons, neurosurgery residents, and neurology residents. The assimilating learning style typically is the primary learning style for neurosurgeons and neurology residents. Neurosurgical residents start off with a diverging learning style and progress toward an assimilating learning style as they work toward becoming practicing neurosurgeons. The field of neurosurgery has limited opportunities for active experimentation, which may explain why individuals who prefer reflective observation are more likely to succeed in this field. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. A computer model of soft tissue interaction with a surgical aspirator.

    Science.gov (United States)

    Mora, Vincent; Jiang, Di; Brooks, Rupert; Delorme, Sébastien

    2009-01-01

    Surgical aspirators are one of the most frequently used neurosurgical tools. Effective training on a neurosurgery simulator requires a visually and haptically realistic rendering of surgical aspiration. However, there is little published data on mechanical interaction between soft biological tissues and surgical aspirators. In this study an experimental setup for measuring tissue response is described and results on calf brain and a range of phantom materials are presented. Local graphical and haptic models are proposed. They are simple enough for real-time application, and closely match the observed tissue response. Tissue resection (cutting) with suction is simulated using a volume sculpting approach. A simulation of suction is presented as a demonstration of the effectiveness of the approach.

  9. Medical student debt and major life choices other than specialty

    Directory of Open Access Journals (Sweden)

    James Rohlfing

    2014-11-01

    Full Text Available Background: Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods: Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students. No incentives were offered for survey completion. Results: Responses were recorded from 102 US Allopathic medical schools (n=3,032, with 22 institutions (11 public, 11 private meeting inclusion criteria of 10% student body response proportion (n=1,846. Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions: Medical student debt and particularly debt

  10. The historical origin of the term "meningioma" and the rise of nationalistic neurosurgery.

    Science.gov (United States)

    Barthélemy, Ernest Joseph; Sarkiss, Christopher A; Lee, James; Shrivastava, Raj K

    2016-11-01

    The historical origin of the meningioma nomenclature unravels interesting social and political aspects about the development of neurosurgery in the late 19th century. The meningioma terminology itself was the subject of nationalistic pride and coincided with the advancement in the rise of medicine in Continental Europe as a professional social enterprise. Progress in naming and understanding these types of tumor was most evident in the nations that successively assumed global leadership in medicine and biomedical science throughout the 19th and 20th centuries, that is, France, Germany, and the United States. In this vignette, the authors delineate the uniqueness of the term "meningioma" as it developed within the historical framework of Continental European concepts of tumor genesis, disease states, and neurosurgery as an emerging discipline culminating in Cushing's Meningiomas text. During the intellectual apogee of the French Enlightenment, Antoine Louis published the first known scientific treatise on meningiomas. Like his father, Jean-Baptiste Louis, Antoine Louis was a renowned military surgeon whose accomplishments were honored with an admission to the Académie royale de chirurgie in 1749. His treatise, Sur les tumeurs fongueuses de la duremère, appeared in 1774. Following this era, growing economic depression affecting a frustrated bourgeoisie triggered a tumultuous revolutionary period that destroyed France's Ancien Régime and abolished its university and medical systems. The resulting anarchy was eventually quelled through legislation aiming to satisfy Napoleon's need for qualified military professionals, including physicians and surgeons. These laws laid the foundations for the subsequent flourishing of French medicine throughout the mid-19th century. Subsequent changes to the meningioma nomenclature were authored by intellectual giants of this postrevolutionary period, for example, by the Limogesborn pathologist Jean Cruveilhier known for the term

  11. Present status of surgical intervention for children with intractable seizures.

    Science.gov (United States)

    Depositario-Cabacar, Dewi T; Riviello, James J; Takeoka, Masanori

    2008-03-01

    We present a discussion of recent relevant publications in pediatric epilepsy surgery. In 1998, the Commission on Neurosurgery of the International League Against Epilepsy formed the Subcommission for Pediatric Epilepsy Surgery. Their proposed recommendations are included here. We also discuss updates on identification and selection of children with severe refractory epilepsy. Functional imaging has advanced in recent years as an important adjunct in identifying the epileptogenic zone during the preoperative evaluation. The newer imaging modalities are summarized. Routine positron emission tomography, positron emission tomography with special tracers, and single photon emission computed tomography have proven to be beneficial. Other newer investigative techniques await validation. A number of studies on postoperative outcomes over the past few years have demonstrated the benefits of early surgical treatment for selected children.

  12. Multiple sclerosis in Mexico: hospital cases at the National Institute of Neurology and Neurosurgery, Mexico City.

    Science.gov (United States)

    Corona, T; Rodrigues, J L; Otero, E; Stopp, L

    1996-05-01

    The frequency and clinical features of multiple sclerosis (MS) at the National Institute of Neurology and Neurosurgery in Mexico City for the period spanning 1984-1993 is presented. Hospital records of patients with clinically diagnosed MS were selected, the frequency and cumulative frequency of this diagnosis were determined and demographic information and clinical features were recorded. It was found that 70% of the patients were women, 25% were professionals, and 95% were of mixed race. The clinical features of our patients and their neuroimages were consistent with those of MS patients in other populations. Importantly, we found that the frequency of MS has almost doubled over the last 10 years. The reason for this phenomenon is discussed as resulting from better health screening, the availability of nuclear magnetic resonance imaging, and the cultural, demographic and dietary changes that have occurred due to the rapid urbanization of our country.

  13. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors.

    Science.gov (United States)

    Wang, Chao; Savkin, Andrey V; Clout, Ray; Nguyen, Hung T

    2015-09-01

    We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.

  14. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique.

    Science.gov (United States)

    Besharati Tabrizi, Leila; Mahvash, Mehran

    2015-07-01

    An augmented reality system has been developed for image-guided neurosurgery to project images with regions of interest onto the patient's head, skull, or brain surface in real time. The aim of this study was to evaluate system accuracy and to perform the first intraoperative application. Images of segmented brain tumors in different localizations and sizes were created in 10 cases and were projected to a head phantom using a video projector. Registration was performed using 5 fiducial markers. After each registration, the distance of the 5 fiducial markers from the visualized tumor borders was measured on the virtual image and on the phantom. The difference was considered a projection error. Moreover, the image projection technique was intraoperatively applied in 5 patients and was compared with a standard navigation system. Augmented reality visualization of the tumors succeeded in all cases. The mean time for registration was 3.8 minutes (range 2-7 minutes). The mean projection error was 0.8 ± 0.25 mm. There were no significant differences in accuracy according to the localization and size of the tumor. Clinical feasibility and reliability of the augmented reality system could be proved intraoperatively in 5 patients (projection error 1.2 ± 0.54 mm). The augmented reality system is accurate and reliable for the intraoperative projection of images to the head, skull, and brain surface. The ergonomic advantage of this technique improves the planning of neurosurgical procedures and enables the surgeon to use direct visualization for image-guided neurosurgery.

  15. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    Directory of Open Access Journals (Sweden)

    Afolabi Muyiwa Owojuyigbe

    2016-01-01

    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  16. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2011-01-01

    Full Text Available Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a "before-after" design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1-125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6% of 177 in the control group and 73 (41.7% of 175 among the intervention group (P = 0.195. The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08. The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control and 92% (intervention. Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant.

  17. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

    Science.gov (United States)

    Saramma, P. P.; Krishnakumar, K.; Dash, P. K.; Sarma, P. S.

    2011-01-01

    Background: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce. Aim: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures. Materials and Methods: An interventional study using a “before–after” design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival. Results: A total of 352 patients were on mechanical ventilator for a varying period of 1–125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention). Conclusion: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant. PMID:22346030

  18. Impact of insurance precertification on neurosurgery practice and health care delivery.

    Science.gov (United States)

    Menger, Richard P; Thakur, Jai Deep; Jain, Gary; Nanda, Anil

    2017-08-01

    OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. Information regarding attending, procedure, procedure type, insurance type, need for insurance approval, number of days for authorization, or insurance denial was obtained. Delay in authorization was defined as any wait period greater than 7 days. Some of the parameters were added retrospectively to enhance this study; hence, the total number of subjects may vary for different variables. RESULTS The most common procedure was back surgery with instrumentation (28%). Most of the patients had commercial insurance (57%) while Medicaid was the least common (1%). Across all neurosurgery procedures, insurance authorization, on average, was delayed 9 days with commercial insurance, 10.7 days with Tricare insurance, 8.5 days with Medicare insurance, 11.5 days with Medicaid, and 14.4 days with workers' compensation. Two percent of all patients were denied insurance preauthorization without any statistical trend or association. Of the 1985 patients, 1045 (52.6%) patients had instrumentation procedures. Independent of insurance type, instrumentation procedures were more likely to have delays in authorization (p = 0.001). Independent of procedure type, patients with Tricare (military) insurance were more likely to have a delay in approval for surgery (p = 0.02). Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and

  19. How many referrals to a pediatric orthopaedic hospital specialty clinic are primary care problems?

    Science.gov (United States)

    Hsu, Eric Y; Schwend, Richard M; Julia, Leamon

    2012-01-01

    American Academy of Pediatrics Surgery Advisory Panel guidelines recommending referral to pediatric orthopaedics, with scoliosis being the most frequent condition. For 38 (7.2%) cases, surgical treatment was required or recommended. Patient age, referral source, or type of insurance did not influence whether the condition was a primary care or a specialty care case. A total of 134 (25%) cases were referred without having an initial diagnosis made by the referring clinician. These patients were more likely to have been referred from a primary care practitioner than from a tertiary care practitioner whether the diagnosis eventually made was considered to be a primary care condition (P=0.03; relative risk, 1.9; 95% confidence interval, 96-3.86). Almost half of all new referrals to a tertiary pediatric orthopaedic clinic were for conditions considered to be manageable by primary care physicians should they chose to do so. This has implications for pediatric orthopaedic workforce availability, reimbursement under the Affordable Care Act, and pediatric musculoskeletal training needs for providers of primary care.

  20. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  1. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  2. Access to specialty mental health services among women in California.

    Science.gov (United States)

    Kimerling, Rachel; Baumrind, Nikki

    2005-06-01

    The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities. The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables. Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services. Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.

  3. Specialty-specific admission: a cost-effective intervention?

    LENUS (Irish Health Repository)

    Slattery, E

    2012-02-01

    INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to 17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions. CONCLUSION: Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.

  4. Referral patterns for endocrine surgical disease.

    Science.gov (United States)

    Cervera, Ixel; Boucai, Laura; Andreopoulou, Panagiota; Libutti, Steven K; Hughes, David T

    2014-06-01

    Referrals between physician specialties are common practice, and clear patterns develop. The increasing availability of high-volume endocrine surgery subspecialists with better outcomes may change these patterns. This study aimed to determine what factors influence endocrinologists' referral patterns for the surgical treatment of endocrine disease. A national, cross-sectional, voluntary survey of members of the American Association of Clinical Endocrinologists examined physician demographics, physician's opinions on referral to endocrine surgery, preferred surgeon specialty, knowledge about surgeon characteristics, and how these factors influenced which surgeons they referred patients, as well as what changes in these factors would alter their referral patterns. The survey response rate was 15% (73/500), and 97% were endocrinologists. On average, 0 to 5 patients/week were referred for surgery. Most respondents (91.8%) felt that endocrinologists should decide which surgeon to refer. General surgery was the preferred surgeon specialty (43.7%), and endocrine surgery was the preferred subspecialty (70.8%). The factors most often cited as very important in referral to a surgeon included surgeon outcome/complications (71%), familiarity with surgeon (65%), surgeon's communication with referring physician (61%), and surgeon volume (59%). The factors most often cited as likely to change physician referral patterns included patient satisfaction (62%), complication rates (57%), surgeon outcomes (54%), and surgeon volume (50%). The factors most often cited as unlikely to change referral patterns included new surgeon availability (70%) and hospital/surgeon advertising (58%). Referring physicians want experienced endocrine surgeons with high operative volumes and good outcomes whom they are familiar with. The promotion of referral to high-volume surgeons requires communication, good outcomes, and satisfied patients.

  5. Psychomotor skills of surgical trainees compared with those of different medical specialists.

    Science.gov (United States)

    Harris, C J; Herbert, M; Steele, R J

    1994-03-01

    Forty-eight trainees in surgery, psychiatry, anaesthetics and medicine underwent objective testing of manual dexterity (Mandex test), hand-eye coordination (Gibson spiral maze test) and visuospatial ability (embedded figures task). Surgical trainees performed significantly more quickly on the spiral maze test than psychiatrists (P = 0.03) but made more errors (P = 0.02). Combining male and female subjects across all groups, women were significantly more accurate than men. When men only were compared no psychomotor differences between specialty groups could be demonstrated. There were no differences in visuospatial ability by either sex or specialty. Self-selection on the basis of such skill is therefore unlikely.

  6. Finding discriminative and interpretable patterns in sequences of surgical activities.

    Science.gov (United States)

    Forestier, Germain; Petitjean, François; Senin, Pavel; Riffaud, Laurent; Henaux, Pierre-Louis; Jannin, Pierre

    2017-09-21

    Surgery is one of the riskiest and most important medical acts that is performed today. Understanding the ways in which surgeries are similar or different from each other is of major interest to understand and analyze surgical behaviors. This article addresses the issue of identifying discriminative patterns of surgical practice from recordings of surgeries. These recordings are sequences of low-level surgical activities representing the actions performed by surgeons during surgeries. To discover patterns that are specific to a group of surgeries, we use the vector space model (VSM) which is originally an algebraic model for representing text documents. We split long sequences of surgical activities into subsequences of consecutive activities. We then compute the relative frequencies of these subsequences using the tf*idf framework and we use the Cosine similarity to classify the sequences. This process makes it possible to discover which patterns discriminate one set of surgeries recordings from another set. Experiments were performed on 40 neurosurgeries of anterior cervical discectomy (ACD). The results demonstrate that our method accurately identifies patterns that can discriminate between (1) locations where the surgery took place, (2) levels of expertise of surgeons (i.e., expert vs. intermediate) and even (3) individual surgeons who performed the intervention. We also show how the tf*idf weight vector can be used to both visualize the most interesting patterns and to highlight the parts of a given surgery that are the most interesting. Identifying patterns that discriminate groups of surgeon is a very important step in improving the understanding of surgical processes. The proposed method finds discriminative and interpretable patterns in sequences of surgical activities. Our approach provides intuitive results, as it identifies automatically the set of patterns explaining the differences between the groups. Copyright © 2017 Elsevier B.V. All rights

  7. Predictors of final specialty choice by internal medicine residents.

    Science.gov (United States)

    Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E

    2006-10-01

    Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. To identify factors that predict the clinical practice of residents following their training. Prospective cohort study. Two hundred and four categorical residents from 2 university-based residency programs. Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P personal attributes during the selection process.

  8. Implementing cognitive behavioral therapy in specialty medical settings.

    Science.gov (United States)

    Magidson, Jessica F; Weisberg, Risa B

    2014-11-01

    This article is an introduction to the second issue of a two-part Special Series on integrating cognitive behavioral therapy (CBT) into medical settings. The first issue focused on integrating CBT into primary care, and this issue focuses on implementing CBT in other specialty medical settings, including cancer treatment, HIV care, and specialized pediatric medical clinics. Models for treatment delivery to improve ease of implementation are also discussed, including telehealth and home-delivered treatment. The six articles in this series provide examples of how to transport CBT techniques that are largely designed for implementation in outpatient mental health settings to specialized medical settings, and discuss unique considerations and recommendations for implementation.

  9. [Research of genetics teaching in biological teacher-training specialty].

    Science.gov (United States)

    Zhang, Yu

    2008-02-01

    Genetics is an essential subject of life science, at the same time, it is a required course in the major of biology. Some colleges such as: agriculture, forest, animals, medicine, teacher-training and general college all offer genetics, because of the difference in specialized character and aim of training, genetics has the distinction in the system of knowledge and laying particular emphasis on content. The author seeks how to make genetics well in teaching content, method and so on in biological teacher-training specialty, and puts views.

  10. Problems attendance in physical education students of technical specialties

    Directory of Open Access Journals (Sweden)

    Vladymyr Petrenko

    2014-12-01

    Full Text Available Purpose: to examine the relevant aspects of motivation attendance in physical education students of technical specialties and make adjustments to the process of improving the quality of teaching. Material and Methods: during the study used the following methods: general scientific – analysis, comparison, generalization; sociological, questionnaire, interview; Mathematics and statistics. The study involved students of ICT Zhytomyr State Technological University, only 238 people. Results: the tendency changes of success in physical education and physical training of students of ICT. Conclusions: pedagogical experiment confirmed the positive impact of physical education classes in which students choose their maintenance is carried out on a competitive basis in accordance with personal interests and needs.

  11. «Interventional Neuroradiology: a neuroscience sub-specialty?».

    Science.gov (United States)

    Rodesch, Georges; Picard, Luc; Berenstein, Alex; Biondi, Alessandra; Bracard, Serge; Choi, In Sup; Feng, Ling; Hyogo, Toshio; Lefeuvre, David; Leonardi, Marco; Mayer, Thomas; Miyashi, Shigeru; Muto, Mario; Piske, Ronie; Pongpech, Sirintara; Reul, Jurgen; Soderman, Michael; Chuh, Dae Sul; Tampieri, Donatella; Taylor, Allan; Terbrugge, Karel; Valavanis, Anton; van den Berg, René

    2013-09-01

    Interventional Neuroradiology (INR) is not bound by the classical limits of a specialty, and is not restricted by standard formats of teaching and education. Open and naturally linked towards neurosciences, INR has become a unique source of novel ideas for research, development and progress allowing new and improved approaches to challenging pathologies resulting in better anatomo-clinical results. Opening INR to Neurosciences is the best way to keep it alive and growing. Anchored in Neuroradiology, at the crossroad of neurosciences, INR will further participate to progress and innovation as it has often been in the past.

  12. Residents' views about family medicine specialty education in Turkey

    Directory of Open Access Journals (Sweden)

    Uzuner Arzu

    2010-04-01

    Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e

  13. Specialty location decisions in the reformed NHS: a case study.

    Science.gov (United States)

    Hindle, T; Roberts, E; Worthington, D

    1998-08-01

    A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of 'small' specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.

  14. A cross-sectional survey of clinicians performing periodontal surgical crown lengthening.

    Science.gov (United States)

    Wyatt, Gillian; Grey, Nick; Deery, Chris

    2004-09-01

    The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

  15. Exodus of male physicians from primary care drives shift to specialty practice.

    Science.gov (United States)

    Tu, Ha T; O'Malley, Ann S

    2007-06-01

    An exodus of male physicians from primary care is driving a marked shift in the U.S. physician workforce toward medical-specialty practice, according to a national study by the Center for Studying Health System Change (HSC). Two factors have helped mask the severity of the shift--a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians. Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population. At the same time, primary care physicians' incomes have lost ground to both inflation and medical and surgical specialists' incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics. If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care--trends that could aggravate a predicted shortage of primary care physicians.

  16. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

    Science.gov (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A

    2011-04-01

    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  17. 单次肌松药全身麻醉下进行神经外科手术的可行性%The feasibility of neurosurgery under general anesthesia with a single dose of muscle relaxant

    Institute of Scientific and Technical Information of China (English)

    李玉兰; 刘映龙; 徐成明; 吕兴华; 万占海

    2012-01-01

    Objective To evaluate the feasibility of neurosurgery under general anesthesia with single dose of muscle re -laxant. Methods 60 patients with ASA I - II scheduled for neurosurgery were randomly divided into Atracurium (group A) and Succinylcholine (group S), each group had 30 cases. After anesthesia induction and intubation with a single use of Atracuri -um or Succinylcholine, anesthesia was maintained with Propofol and Remifentanil at BIS level. The duration of neuromus -cular blocking, the anesthetics consumption, the presence of unwanted patient movement, the airway pressure, the extuba -tion delay and the rate of residual neuromuscular blockade of two groups were recorded. The surgical conditions were scaled by surgeons after operation. Results No patients' movement was observed during operation, there were 2 patients of control group had cough. The recovery time of muscle tone in group A was longer than group S (P 0.05). Conclusion The feasibility of neurosurgery under general anesthesia with a single dose of muscle relaxant is affirmed, but airway stimulation is not allowed in this condition.%目的 探究单次肌松药全身麻醉下进行神经外科手术的可行性.方法 选取我院ASA Ⅰ~Ⅱ级全身麻醉下进行神经外科手术患者60例,随机分为阿曲库铵组(A组)和琥珀酰胆碱组(S组),每组各30例.麻醉诱导后停用肌松药,全程仅用得普利麻、瑞芬太尼静脉泵注维持电脑双频指数(BIS)麻醉.观察两组麻醉药用量、肌松恢复时间、术中体动次数、气道压、拔管时间、残余肌松发生率、拔管时间及外科麻醉评分.结果 两组患者均无术中体动,S组2例发生呛咳;A组肌松恢复时间较S组长(P0.05).结论单次肌松药全身麻醉下进行神经外科手术是基本可行的,但在这种麻醉状态下不宜进行气管内操作.

  18. Intangible Cultural Heritage and Geographical Indication of Specialty Resources: A Case Study of Shiyan City

    Institute of Scientific and Technical Information of China (English)

    Zai; HU; Wanzhen; XIONG; Zhiguo; SUN; Shuting; WANG; Limin; HUANG

    2013-01-01

    The protection of intangible cultural heritage and geographical indications of the specialty in Shiyan City was analyzed,and then related suggestions were proposed,for example,to collect and organize the intangible cultural heritage related to traditional specialty;to enhance the application of those intangible cultural heritage projects related to traditional industry and agriculture;to establish some demonstration bases for the productive protection of intangible cultural heritages;to strengthen the application of geographical indications of traditional specialty;to build national quality standards for various specialty with geographical indications;to integrate and cultivate the famous specialty brands with geographical indication;to implement the double protection of the geographical indications and intangible cultural heritages;to improve the poverty alleviation through developing the specialty industry with geographical indications.

  19. Oral health in Brazil - Part II: Dental Specialty Centers (CEOs

    Directory of Open Access Journals (Sweden)

    Vinícius Pedrazzi

    2008-08-01

    Full Text Available The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers, which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System. Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

  20. Exploring personal interests of physicians in hospitals and specialty clinics.

    Science.gov (United States)

    Koelewijn, Wout T; Ehrenhard, Michel L; Groen, Aard J; van Harten, Wim H

    2014-01-01

    Physicians' interests substantially influence intra-organizational dynamics in hospitals, though little is known about the actual content and structure of these interests. The objective of this study was to both identify and build a structured model of physicians' interests. Based on literature and 27 semi-structured interviews with physicians, a questionnaire containing 10 interests was developed. Next, 1475 physicians in the Netherlands filled out an online survey. Analyses of the data revealed a distinction between the primary interest of 'helping patients as well as possible' and nine secondary interests. Factor analysis identified the main secondary interest dimensions as work-related, setting-related, and life-related. Value attached to interests differs between specialties and types of hospitals. The influence of hospital type on the value attached to interests is stronger than the influence of specialty group on the value attached to interests. Insight in the relative importance of different interests may help policy-makers make decisions that foster shared interests. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. A survey of sub-specialty preferences of radiography students of the University of Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    E T Namah

    2013-01-01

    Full Text Available Background: Technological advances and computing have expanded both the scope and capacity of diagnostic medical imaging (the radiography profession. This has created many diverse imaging modalities which in turn, have culminated in different sub-specialties in the profession. Objective: The aims of the study were to determine the level of awareness of imaging sub-specialties, preferred sub specialties and reasons for preferences of sub-specialties in senior level radiography students of the University of Lagos. Methods: The study was a prospective cross-sectional survey. Consents were obtained before the students were recruited for the study. Data Collection and Analysis: A questionnaire semi-structured in line with objectives of the study was used in data collection. A computer software Epi Info version 3.3 was used to analyze data while results were expressed as percentages of responses and were presented in tables and pie charts. Results : Greater than 90% showed awareness of sub-specialties in the radiography profession whereas 35% preferred ultrasonography to other sub-specialties. The least preferred sub-specialty was conventional radiography (4.3%. Remuneration (73.3% and less physical exertion (73.3% were major attractors to preferred sub-specialties whereas concerns over radiation hazard were major detractors (58.3%. Conclusion : Awareness of sub-specialties in the radiography profession was high amongst students studied. Furthermore, ultrasonography was the most preferred sub-specialty among the respondents. Remuneration was the main attractor to sub-specialties whereas fears over effects of ionizing radiation were the major detractors to some sub-specialties.

  2. Research on Platform Construction of Manufacturing Practice for Industrial Design Specialty in Colleges

    OpenAIRE

    Xiaowei Jiang; Yumei Song

    2015-01-01

    In view of that manufacturing practice is indispensable practical link of industrial design specialty, the author analyzes the current situation of manufacturing practice in industrial design specialty and the existing problem in manufacturing practice system, discussing the necessity of research on manufacturing practice for industrial design specialty. Among them establishing the manufacturing practice factory of industrial design on campus, which lets the student enter and learn various pr...

  3. Perceived effects of specialty nurse certification: a review of the literature.

    Science.gov (United States)

    Wade, Charlene H

    2009-01-01

    Recent evidence suggests that specialty nurse education and certification may improve the quality of patient care. Specialty nurse certification also may improve nurses' job satisfaction and sense of empowerment, as well as positively affect collaboration with other health care team members. Despite the evidence that there are intrinsic rewards for specialty certification, the lack of extrinsic value to nurses makes it unlikely that greater numbers of nurses will be attracted to certification unless health care administrators increase opportunities for recognition and greater compensation.

  4. How to start and operate a National Emergency Medicine specialty organisation

    Directory of Open Access Journals (Sweden)

    Elizabeth L. DeVos

    2014-12-01

    Full Text Available As a service for the International Federation for Emergency Medicine, a task force of the Specialty Implementation Committee wrote this manuscript of guidelines for developing a National Emergency Medicine (EM specialty organisation. This manuscript offers structural and procedural considerations for creating or developing an EM specialty organisation in a country or region that currently does not have one. It was written in response to requests for aid in developing a country’s specialty of EM. International EM leaders with experience in the development of national organisations have reviewed these guidelines.

  5. DETERMINANTS OF SPECIALTY CHOICE OF RESIDENT DOCTORS; CASE STUDY--AMONG RESIDENT DOCTORS IN NIGERIA

    National Research Council Canada - National Science Library

    Osuoji, Roland I; Adebanji, Atinuke; Abdulsalam, Moruf A; Oludara, Mobolaji A; Abolarinwa, Abimbola A

    2015-01-01

    This study examined medical specialty selection by Nigerian resident doctors using a marketing research approach to determine the selection criteria and the role of perceptions, expected remuneration...

  6. [Complaint analysis derived from surgical practice].

    Science.gov (United States)

    Fajardo-Dolci, Germán; Rodríguez-Suárez, Francisco Javier; Campos-Castolo, Esther Mahuina; Carrillo-Jaimes, Arturo; Zavala-Suárez, Etelvina; Aguirre-Gas, Héctor Gerardo

    2009-01-01

    This study reports on the analysis of medical complaints presented to the National Commission on Medical Arbitration (Comisión Nacional de Arbitraje Médico, CONAMED) between June 1996 and December 2007 to determine its magnitude and to identify the causes of safety problems in medical care. Out of 182,407 complaints presented to CONAMED, 87% were resolved by the Office of Orientation and Management. The remaining 18,443 complaints were presented to the Council Directorate. Of those cases, 48% were resolved by an agreement between the complainants and the physicians, 31% were not resolved by this method, and 3% were irresolute complaints. The highest frequency of complaints was registered in the Federal District (Distrito Federal) and the State of México (Estado de México), mainly corresponding to social security institutions and private hospitals. Among the nine most frequently involved specialties, six were surgical specialties. Malpractice was identified in 25% of all cases. The principal demands of those making complaints were the refunding of expenses in patient medical care (51%) and indemnification (40%) and, in those, the average amount of payments was 4.6 times greater. Due to the incidence of medical complaints, it was reasonable to investigate the causes and to take preventive and corrective actions required for its decrease. It was proposed to the Mexican Academy of Surgery that this organization should use their educational leadership and assume the vanguard in the dissemination and promotion of the WHO plan "Safe Surgery Saves Lives" and the implementation in Mexico of the "Surgical Safety Checklist."

  7. The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up.

    Science.gov (United States)

    Sutiono, Agung Budi; Faried, Ahmad; McAllister, Susan; Ganefianty, Amelia; Sarjono, Kalih; Arifin, Muhammad Zafrullah; Derrett, Sarah

    2017-03-02

    Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  9. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  10. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  11. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin

    2016-07-01

    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  12. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  13. Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees.

    Science.gov (United States)

    Zammar, Samer G; El Tecle, Najib E; El Ahmadieh, Tarek Y; Adelson, P David; Veznedaroglu, Erol; Surdell, Daniel L; Harrop, James S; Benes, Vladimir; Rezai, Ali R; Resnick, Daniel K; Bendok, Bernard R

    2015-08-01

    To assess microsurgical and diagnostic cerebral angiography modules and their corresponding objective assessment scales as educational tools for European neurosurgical residents at the European Association of Neurosurgical Societies Resident Vascular Neurosurgery course, which was held in Prague, Czech Republic, on September 2013. Microsurgical skills and cerebral angiography are fundamental skills in vascular neurosurgery. There is a need to develop a simulation-based curriculum focusing on these skills for neurosurgical trainees worldwide. The course consisted of 2 modules: microanastomosis and diagnostic cerebral angiography. In addition to an initial screening survey, each module was divided into 3 components: 1) a before didactic cognitive knowledge and technical skills testing, 2) a didactic lecture, and 3) an after didactic cognitive knowledge and technical skills testing. We compared the trainees' cognitive and technical scores from the before and after testing phases. Wilcoxon sum rank test was used to test statistical significance. The knowledge test median scores increased from 63% and 68% to 80% and 88% (P neurosurgery curriculum is feasible and may enhance resident knowledge and technical proficiency. Copyright © 2015. Published by Elsevier Inc.

  14. North Carolina surgical workforce trends.

    Science.gov (United States)

    Poley, Stephanie T; Kasper, Elizabeth W; Walker, Elizabeth K; Lyons, Jessica C; Newkirk, Vann R; Thompson, Kristie

    2011-01-01

    Between 1997 and 2008, the number of general surgeons in North Carolina increased and shifted demographically, geographically, and by specialty. However, surgeon numbers--overall and by specialty--do not appear to have increased as quickly or to have shifted in the same ways as North Carolina's general population.

  15. Monitorización neurofisiológica intraoperatoria: métodos en neurocirugía Intraoperative neurophysiological monitoring: methods in neurosurgery

    Directory of Open Access Journals (Sweden)

    J. Urriza

    2009-01-01

    Full Text Available La monitorización neurofisiológica intraoperatoria (MIO utiliza las distintas técnicas neurofisiológicas en el quirófano para monitorizar la función nerviosa durante la cirugía, evitando posibles lesiones neurológicas, con lo que disminuye la morbilidad y mejora el manejo quirúrgico, permitiendo cirugías más agresivas y mejorando las estrategias quirúrgicas. Existen dos tipos de técnicas en la monitorización neurofisiológica, las de mapeo -que identifican las estructuras en riesgo- y las de monitorización propiamente dichas -que proveen un feed-back continuo de la función- así como sus complicaciones, que aunque infrecuentes, existen. Se exponen las técnicas quirúrgicas que se pueden utilizar en la monitorización así como una posible guia orientativa sobre su uso según la zona quirúrgica y las estructuras en riesgo. La MIO constituye uno de los avances más importantes que ha tenido lugar en la neurocirugía moderna.IONM uses different neurophysiological techniques during surgery time, thus avoiding possible lesions to the neurological structures, making surgery safer and better. We describe two types of IONM: mapping techniques and monitoring techniques, as well as their advantages, disadvantages and complications. We look into the more useful techniques in this field, as well as providing orientation about its use according to the surgical areas and the neurological structures under risk. In conclusion, we affirm that IONM is one of the most important advances in modern neurosurgery.

  16. Minimally invasive neurosurgery with interventional magnetic resonance. Its present and future

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo [Jikei Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    We have used X-ray fluoroscopy, ultrasonography, and computed tomography in treatment. However, these methods do not provide precise image. Since magnetic resonance (MR) provides high-resolution images, it is more suitable in treatment. Recently open-type MR has been introduced for clinical diagnosis and treatment. Interventional MR provides a real-time images, high-resolutional images, and thermal distribution. Open MR can be used for minimally invasive neurosurgery. Interventional MR (I-MR) can be used in treatment and is extremely useful for minimally invasive surgery of the brain and spinal cord. We have used an open-type permanent MR scanner (Airis, Hitachi), for minimally invasive neurosurgery. Stereotactic brain tumor biopsy, aspiration of intracerebral hematoma, and percutaneous laser disc hernia ablation under MR guidance has been performed in our department. I-MR provided precise, and less-invasive treatment. Stereotactic biopsy was done in 12 patients with brain tumors. Precise, accurate biopsy is possible with MR fluoroscopic guidance. Hematomas were also aspirated safely and precisely by monitoring real-time image. Percutaneous laser disc hernia ablation (PLDA) was done in 201 patients with lumbar disc herniation (127 at L4/5 and 48 at L5/S1). Patients ranged in age from 17 to 72 years. A MR-compatible 18-gauge 15-cm-long titanium needle was clearly visualized and safety and accurately inserted into the disc herniation from multiple directions. Laser ablation was done (mean, 1,000 J). Signs and symptoms improved immediately after ablation. The overall success rate was 90.5% (MacNab's criteria). Two patients (1.0%) had discitis after PLDA. I-MR and fluoroscopy provide near-real-time images for treatment of brain tumors and hematoma. Precise treatment can be performed with the Patil MR-compatible stereotactic system. PLDA was performed safety and accurately with I-MR. The results were satisfactory. I-MR-PLDA is a safe, precise, and minimally

  17. [Readability of surgical informed consent in Spain].

    Science.gov (United States)

    San Norberto, Enrique María; Gómez-Alonso, Daniel; Trigueros, José M; Quiroga, Jorge; Gualis, Javier; Vaquero, Carlos

    2014-03-01

    To assess the readability of informed consent documents (IC) of the different national surgical societies. During January 2012 we collected 504 IC protocols of different specialties. To calculate readability parameters the following criteria were assessed: number of words, syllables and phrases, syllables/word and word/phrase averages, Word correlation index, Flesch-Szigriszt index, Huerta Fernández index, Inflesz scale degree and the Gunning-Fog index. The mean Flesch-Szigriszt index was 50.65 ± 6,72, so readability is considered normal. There are significant differences between specialties such as Urology (43.00 ± 4.17) and Angiology and Vascular Surgery (63.00 ± 3.26, P<.001). No IC would be appropriate for adult readability according to the Fernández-Huerta index (total mean 55.77 ± 6.57); the IC of Angiolo