Pediatric neurosurgery

Pediatric neurosurgery

Books

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Journals

Child’s Nervous System http://link.springer.com/journal/381

Journal of Pediatric Neurosciences http://www.pediatricneurosciences.com/

JOURNAL OF NEUROSURGERY:PEDIATRICS http://thejns.org

NEUROPEDIATRICS https://www.thieme-connect.com/products/ejournals/journal/10.1055/s-00000041

Pediatric neurosurgery journal

Regional comparison demonstrated a preference for the Journal of Neurosurgery and Child’s Nervous System, respectively, but four of the top five journals were common to both groups. Applying the verbal formulation of Bradford’s law to the North American citation database, a pattern of citation density was identified across the first three zones. Journals residing in the most highly cited first zone are presented as the core journals.

Bradford’s law can be applied to identify the core journals of neurosurgical subspecialties. While regional differences exist between the most highly cited and most frequently published in journals among North American and European pediatric neurosurgeons, there is commonality between the top five core journals in both groups 1).

Societies

International Bureau for Epilepsy

International League Against Epilepsy

Pediatric Neurosurgery Chapter of the Latinamerican Federation of Neurosurgical Societies (FLANC)

Resources

Hydrocephalus Association

About Kids Health Brain Tumours

Association for Spina Bifida and Hydrocephalus

Brain Tumour Research Assistance and Information Network

Hydrocephalus Foundation

Hydro Kids

International Bureau for Epilepsy

International League Against Epilepsy

The purpose of a study was to identify the national trends of exposure to pediatric procedures during neurosurgical residency and to subsequently evaluate how neurosurgery residents’ experiences correlate with the minimum requirements set forth by the American College of Graduate Medical Education (ACGME).

ACGME resident case logs from residents graduating between 2013 and 2017 were retrospectively reviewed. These reports were analyzed to determine trends in resident operative experience in pediatric procedures. The number of cases performed by residents was compared to the required minimums set by the ACGME within each pediatric surgical category. A linear regression analysis and t tests were utilized to analyze the change in cases performed over the study period.

A mean of 98.8 procedures were performed for each of the 877 residents graduating between 2013 and 2017. The total number of pediatric procedures declined at a rate of 1.7 cases/year (r2 = 0.77, p = 0.05). Spine and cerebrospinal fluid diversion procedures showed decreasing trends at rates of 1.9 (r2 = 0.70, p = 0.08) and 1.2 (r2 = 0.70, p = 0.08) cases/year, respectively. The number of trauma and brain tumor cases were shown to have increasing rates at 1.0 (r2 = 0.86, p = 0.02) and 0.3 (r2 = 0.69, p = 0.08) cases/year, respectively, with trauma cases showing significant increases. There was also a trend of increasing cases logged as the lead resident surgeon by 12.9 cases/year (r2 = 0.99, p < 0.001). The number of cases performed by the average graduating resident was also significantly higher than the minimums required by the ACGME; residents, on average, performed 3 times the required minimum number of pediatric cases.

Neurosurgical residents graduating from 2013 to 2017 reported significantly higher volumes of pediatric neurosurgery cases than the standards set for by the ACGME. During this time, there was also a significant trend of increasing cases logged as the lead resident surgeon, suggesting more involvement in the critical portions of pediatric cases. There was also a significant, but not clinically impactful, decrease in pediatric case volumes during this time. However, the overall data indicate that residents are continuing to gain valuable pediatric experience during residency training 2).

Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents

Research suggests that there may be a growing disparity between the supply of and demand for both pediatric specialists and neurosurgeons. Whether pediatric neurosurgeons are facing such a disparity is disputable, but interest in pediatric neurosurgery (PNS) has waxed and waned as evidenced by the number of applicants for PNS fellowships. The authors undertook a survey to analyze current neurosurgical residents’ perceptions of both benefits and deterrents to a pediatric neurosurgical career. METHODS: All residents and PNS fellows in the United States and Canada during the academic year 2008-2009 were invited to complete a Web-based survey that assessed 1) demographic and educational information about residents and their residency training, particularly as it related to training in PNS; 2) residents’ exposure to mentoring opportunities from pediatric neurosurgical faculty and their plans for the future; and 3) residents’ perceptions about how likely 40 various factors were to influence their decision about whether to pursue a PNS career. RESULTS: Four hundred ninety-six responses were obtained: 89% of the respondents were male, 63% were married, 75% were in at least their 3rd year of postgraduate training, 61% trained in a children’s hospital and 29% in a children’s “hospital within a hospital,” and 72% were in programs having one or more dedicated PNS faculty members. The residencies of 56% of respondents offered 6-11 months of PNS training and nearly three-quarters of respondents had completed 2 months of PNS training. During medical school, 92% had been exposed to neurosurgery and 45% to PNS during a clinical rotation, but only 7% identified a PNS mentor. Nearly half (43%) are considering a PNS career, and of these, 61% are definitely or probably considering post-residency fellowship. On the other hand, 68% would prefer an enfolded fellowship during residency. Perceived strengths of PNS included working with children, developing lasting relationships, wider variety of operations, fast healing and lack of comorbidities, and altruism. Perceived significant deterrents included shunts, lower reimbursement, cross-coverage issues, higher malpractice premiums and greater legal exposure, and working with parents and pediatric health professionals. The intrinsic nature of PNS was listed as the most significant deterrent (46%) followed by financial concerns (25%), additional training (12%), longer work hours (12%), and medicolegal issues (4%). The majority felt that fellowship training and PNS certification should be recommended for surgeons treating of all but traumatic brain injuries and Chiari I malformations and performing simple shunt-related procedures, although they felt that these credentials should be required only for treating complex craniosynostosis. CONCLUSIONS: The nature of PNS is the most significant barrier to attracting residents, although reimbursement, cross-coverage, and legal issues are also important to residents. The authors provide several recommendations that might enhance resident perceptions of PNS and attract trainees to the specialty 3).


Central nervous system tumors account for the highest mortality among pediatric malignancies.

1)

Venable GT, Shepherd BA, Roberts ML, Taylor DR, Khan NR, Klimo P Jr. An application of Bradford’s law: identification of the core journals of pediatric neurosurgery and a regional comparison of citation density. Childs Nerv Syst.2014 Aug 7. [Epub ahead of print] PubMed PMID: 25098356.
2)

White MD, Zollman J, McDowell MM, Agarwal N, Abel TJ, Hamilton DK. Neurosurgical Resident Exposure to Pediatric Neurosurgery: An Analysis of Resident Case Logs. Pediatr Neurosurg. 2019 May 21:1-7. doi: 10.1159/000500299. [Epub ahead of print] PubMed PMID: 31112956.
3)

Dias MS, Sussman JS, Durham S, Iantosca MR. Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents. J Neurosurg Pediatr. 2013 Nov;12(5):422-33. doi: 10.3171/2013.7.PEDS12597. Epub 2013 Aug 30. PubMed PMID: 23992238.

Consolidated Health Economic Evaluation Reporting Standards in Neurosurgery

Consolidated Health Economic Evaluation Reporting Standards

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.


The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgeryketogenic dietvagus nerve stimulation) therapies, a review of Wijnen et al., examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes “standard optimal care” 1).


The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe traumatic brain injury. To improve future treatment decision-making, resource allocation and research initiatives, a study of van Dijck et al., from The Netherlands reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology.

systematic review was performed using the following databases: PubMedMEDLINEEmbaseWeb of ScienceCochrane libraryCENTRALEmcarePsycINFOAcademic Search Premier and Google ScholarArticles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement.

Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% – 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported.

Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality 2).

References

1)

Wijnen BFM, van Mastrigt GAPG, Evers SMAA, Gershuni O, Lambrechts DAJE, Majoie MHJM, Postulart D, Aldenkamp BAP, de Kinderen RJA. A systematic review of economic evaluations of treatments for patients with epilepsy. Epilepsia. 2017 May;58(5):706-726. doi: 10.1111/epi.13655. Epub 2017 Jan 18. Review. PubMed PMID: 28098939.
2)

van Dijck JTJM, Dijkman MD, Ophuis RH, de Ruiter GCW, Peul WC, Polinder S. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS One. 2019 May 9;14(5):e0216743. doi: 10.1371/journal.pone.0216743. eCollection 2019. PubMed PMID: 31071199.

Hubris syndrome in neurosurgery

Hubris syndrome

Hubris syndrome (HS) is an acquired psychiatric disorder that affects people who exercise power in any of its forms. It has been reported in many fields, from politics to finance. The physician-patient relationship is also one of power. A lack of humbleness and empathy in this situation can lead to qualities such as self-confidence and self-assurance becoming pride, arrogance and high-handedness, which characterise a doctor suffering from HS.

The diagnostic criteria for HS initially reported in political leaders with government responsibilities are analysed and transferred to the medical field of neurosurgery. Two forms of medical HS are described and ten diagnostic criteria are proposed that are valid for any physician-patient relationship.

HS is an acquired psychiatric disorder that is triggered by power and enhanced by success, and can easily be observed on a daily basis in physicians working in settings that are very close to us. Early identification of these medical behaviours is necessary to be able to mitigate their consequences 1).

1)

Gonzalez-Garcia J. [Hubris syndrome in neurosurgery]. Rev Neurol. 2019 Apr 16;68(8):346-353. doi: 10.33588/rn.6808.2018355. Review. Spanish. PubMed PMID: 30963532.
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