neurosurgical

Pregnant neurosurgical resident

Pregnant neurosurgical resident

It is possible for a neurosurgical resident to be pregnant, as there are no specific restrictions on pregnant individuals becoming or remaining neurosurgical residents. However, pregnant residents may need to make accommodations for their pregnancy, such as modifying their work schedule or duties, in order to ensure the safety of both the resident and the patient. It is important for the resident to discuss their pregnancy with their program director and to stay in close communication with their obstetrician throughout their pregnancy.

Establishment of a diverse neurosurgical workforce includes increasing the recruitment of women in neurosurgery. The impact of pregnancy on the training and career trajectory of female neurosurgeons poses a barrier to recruitment and retention of women in neurosurgery 1).

A Women in Neurosurgery survey evaluated female neurosurgeons’ perception and experience regarding childbearing of female neurosurgeons and identified several recommendations regarding family leave policies. Additionally, pregnancy may carry higher risk in surgical fields, yet little guidance exists to aid both the pregnant resident and her training program in optimizing the safety of the training environment with specific considerations to risks inherent in neurosurgical training. A review of current literature aims to address best practices that can be adopted by pregnant neurosurgery residents and their training programs to improve the well-being of these residents while considering the impact on their education and the educational environment for their colleagues 2)

see The Pregnant Resident By Olabisi Sanusi, MD -March 9, 2021

see Motherhood and Neurosurgery: How to Make it Work

see Surgeons navigating their pregnancies see a bleak picture getting a bit brighter

see Advice to a pregnant surgical resident

1)

Gupta M, Reichl A, Diaz-Aguilar LD, Duddleston PJ, Ullman JS, Muraszko KM, Timmons SD, Germano IM, Abosch A, Sweet JA, Pannullo SC, Benzil DL, Ben-Haim S. Pregnancy and parental leave among neurosurgeons and neurosurgical trainees. J Neurosurg. 2020 May 29;134(3):1325-1333. doi: 10.3171/2020.2.JNS193345. PMID: 32470929.
2)

Tomei KL, Hodges TR, Ragsdale E, Katz T, Greenfield M, Sweet JA. Best practices for the pregnant neurosurgical resident: balancing safety and education. J Neurosurg. 2022 Nov 8:1-8. doi: 10.3171/2022.9.JNS221727. Epub ahead of print. PMID: 36683192.

WFNS Neurosurgical Anatomy Webinar (12th – 13th May 2020)

WFNS Neurosurgical Anatomy Webinar (12th – 13th May 2020)

Dear Colleagues,

On behalf of the World Federation of Neurological Surgeons “Neuroanatomy Committee” we are pleased to launch its “1st online, dynamic educational course” to promote sound clinical judgement, enhance the neurosurgical skills of young neurosurgeons and trainees around the globe, encourage them to rise to their challenges and respond to their enquiries.

The course will encompass special presentations by distinguished faculty, case discussions and short video sessions reflecting the importance and relevance of anatomical knowledge to neurosurgical interventions.

Sincerely,

Imad N. Kanaan & Vladimír Beneš

Chairmen of WFNS Neuroanatomy

Neurosurgical Training in Europe

Neurosurgical Training in Europe

Many proposals and guidelines have been published and recommended for neurosurgical training in Europe 1) 2) 3) 4)

Theoretical and practical aspects of neurosurgical training are highly variable throughout European countries, despite some efforts within the last decades to harmonize this.

Some countries are rated significantly above (and others significantly below) the current European average for several analyzed parameters 5).

Although there is a comparable duration of 4 to 6 years of neurosurgical residency across Europe, the content thereof varies widely.

The reason for these diverse training conditions could be explained by (1) the number of sovereign countries in Europe, (2) the unique historical educational concept in each of the European countries, and (3) the different socioeconomical setting of these countries. Another cause can be found in the cultural autonomy of each country and hence the ability of each country’s specific neurosurgical society to implement recommendations of the EANS for resident training only to a varying degree. There rarely is any specific or mandatory neurosurgical curriculum for any teaching hospital 6).

The US residency programs overall tend to be more structured when compared to the corresponding curricula in Europe, although exceptions may apply. This is evident especially via the well-organized monthly and/or yearly rotations, which advance the resident during the consecutive PGYs 7).

Country-specific composite scores for satisfaction with quality of theoretical and practical training, as well as working hours per week, were obtained from an electronic survey distributed among European neurosurgical residents between June 2014 and March 2015. These were related to anonymous country-specific results of the EBE-NS between 2009 and 2016, using uni- and multivariate linear regression analysis.

A total of n = 1025 written and n = 63 oral examination results were included. There was a significant linear relationship between the country-specific EBE-NS result in the written part and the country-specific composite score for satisfaction with quality of theoretical training [adjusted regression coefficient (RC) -3.80, 95 % confidence interval (CI) -5.43-7 -2.17, p < 0.001], but not with practical training or working time. For the oral part, there was a linear relationship between the country-specific EBE-NS result and the country-specific composite score for satisfaction with quality of practical training (RC 9.47, 95 % CI 1.47-17.47, p = 0.021), however neither with satisfaction with quality of theoretical training nor with working time.

With every one-step improvement on the country-specific satisfaction score for theoretical training, the score in the EBE-NS Part 1 increased by 3.8 %. With every one-step improvement on the country-specific satisfaction score for practical training, the score in the EBE-NS Part 2 increased by 9.47 %. Improving training conditions is likely to have a direct positive influence on the knowledge level of trainees, as measured by the EBE-NS. The effect of the actual working time on the theoretical and practical knowledge of neurosurgical trainees appears to be insignificant 8).

The European Training Courses in Neurosurgery

The EANS Training Committee and the Executive Director are responsible for arranging the European Training Courses in Neurosurgery.

What it is: 4 annual 4-day courses covering the key topics of: Vascular Neurosurgery

Tumour

Head Injury/Functional

Spine/Peripheral Nerves

History: Founded in the 1970s by Professors Brihaye, Pia and Vigoroux, the courses aim to serve the needs of neurosurgical trainees in the latter half of their training in neurosurgery.

The excellence of the courses and their scientific and social value is acknowledged throughout the neurosurgical community, and the current committee would like to acknowledge the tremendous part played by the founders, past chairmen of the Training Committee and previous Executive Administrator, Stephanie Garfield-Birkbeck, in bringing this about.

Fellowships

AOSpine Fellowships

AOSpine has compiled a comprehensive list of available fellowships. Please visit https://aospine.aofoundation.org/Structure/education/spine-centers/Pages/spine-centers.aspx for more information.

The Brain Prize

The Brain Prize of €1 million is awarded annually.

The Prize recognizes highly original and influential advances in research on the nervous system. If several researchers have contributed significantly to this achievement, more than one individual may receive the Prize. Nominees can be of any nationality but the research for which they are nominated must have been conducted in Europe or in collaboration with researchers in Europe. More information available on www.thebrainprize.org.

Fellowships in Portugal

The Portuguese Society of Neurosurgery is offering a number of clinical fellowships in accredited training programmes, lasting from six months to two years.

Further information is available from the SPNC secretariado@spnc.pt or www.spnc.pt

AANS Fellowships

The AANS also offer a range of fellowships.

Pain and Spine Fellowship

Scott & White Neuroscience Institute

The comprehensive Pain & Spine Fellowship at Scott & White is designed to provide educational experience in spinal and pain pathology to a graduate of a Neurosurgery training program or senior neurosurgery resident. Clinical and research experiences will be included. Both US and International candidates will be considered.

Contact: Vasilios A. Zerris, MD, MPH

Cervical Spine Research Society – European Section Research Grant

The Cervical Spine Research Society is a multidisciplinary organization that provides a forum for the exchange of ideas and promotes clinical and basic science research of the cervical spine. The organization values collegial interaction and strong scientific principles.

To faciliate research in the field of cervical spine the Cervical Spine Research Society – European Section (CSRS-ES) has the opportunity to offer € 25.000,- annually to research projects.

European Board Examination in Neurological Surgery

see European Board Examination in Neurological Surgery.

European Association of Neurosurgical Societies

see European Association of Neurosurgical Societies.

Working Time directive

The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training.

A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time).

A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work <40, 40-50, 51-60, 61-70, 71-80, or >80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p < 0.001). Less than every fifth European resident spends >50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002).

The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work even more hours/week if their clinical education were to improve; probably due to subjective impression of insufficient training 9).

Books

Training in Neurosurgery in the Countries of the EU: A Guide to Organize a Training Programme

Editors: Reulen, H.-J. (Ed.)

Agreed standards and guidelines are the heart and soul of improving the differing training systems and to harmonize neurosurgical training in the European countries. Such standards and guidelines have been laid down in the European Training Charter of the European Union of Medical Specialists and recently novellated. This book, written by experienced neurosurgeons, offers all those concerned with neurosurgical training – trainers and trainees – practical advice to implement the above mentioned standards and recommendations. It has been written as a manual: “How to do it”. It describes the tasks of a chairman (programme director), the tasks of the teaching staff, the organisation of a training curriculum, a rotation plan or a morbidity and mortality conference, the periodic progress evaluation, the course of an external audit and many more important topics. It contains a lot of practical tips, check lists and useful examples. Well educated young colleagues offer “safe neurosurgery” to our patients.

Table of contents (15 chapters) Introduction Antunes, J. Lobo Pages 1-2

UEMS charter on training of medical specialists in the EU — the new neurosurgical training charter Steers, J. (et al.) Pages 3-11

Neurosurgical training programme director position and responsibilities Neil-Dwyer, G. (et al.) Pages 13-16

Teaching staff Antunes, J. Lobo Pages 17-19

The ideal neurosurgical training curriculum Long, D. M. Pages 21-31

Internal regulations and general guidelines of a neurosurgical department and training programme Reulen, H.-J. (et al.) Pages 33-38

Principles of teaching in a structured training programme, the rotations, and the surgical training plan Steiger, H.-J. Pages 39-50

A structured neurosurgical training plan and the neurosurgical logbook in the UK Lindsay, K. W. Pages 51-57

The European Neurosurgical Log-Book (UEMS/EANS) Reulen, H.-J. Pages 59-66

Morbidity & mortality conferences — How can we do it? Brennum, J. (et al.) Pages 67-71

Problem-based learning in residency training and the tutorial process for training and education in neurosurgery Winkler, P. A. (et al.) Pages 73-76

Research rotation in a trainee’s curriculum Reulen, H.-J. (et al.) Pages 97-101

The accreditation of a training programme Reulen, H.-J. Pages 103-106

The European Examination — its present status and potential development Haase, J. Pages 107-114

Neurosurgical subspecialization: pros and cons Schackert, G. (et al.) Pages 115-119

PASSION Resident project

PASSION Resident project

Neurosurgical Training in Germany

Neurosurgical Training in Germany

Neurology

Kleineberg et al. found substantial variation among European countries in the duration of residency training programmes, and especially in the choice of obligatory rotations to external medical disciplines. Despite a presumably similar spectrum of patients, neurology residency training programmes across Europe are not harmonised. The structure of the programme should be determined by its relevance for neurologists today and in the future 10).

1)

Martin M, Burn SC. Neurosurgical residency in the United States: a trainee’s experience. Acta Neurochir (Wien) 2005;147(11):1211–1212. discussion 1212.
2)

Neil-Dwyer G, Lang DA, Trojanowski T. European Union of Medical Specialists. Neurosurgical training programme director position and responsibilities. Acta Neurochir Suppl. 2004;90:13–16.
3)

Steers J, Reulen HJ, Lindsay KW. European Union of Medical Specialists, Joint Residency Advisory and Accreditation Committee . UEMS charter on training of medical specialists in the EU—the new neurosurgical training charter. Acta Neurochir Suppl. 2004;90:3–11.
4)

Trojanowski T. Report of the JRAAC on the situation of the accreditation training programmes in Europe. Acta Neurochir (Wien) 2008;150(8):851–853.
5) , 8)

Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K. Residency program trainee-satisfaction correlate with results of the European board examination in neurosurgery. Acta Neurochir (Wien). 2016 Oct;158(10):1823-30. doi: 10.1007/s00701-016-2917-y. Epub 2016 Aug 12. PubMed PMID: 27517689.
6)

Burkhardt JK, Zinn PO, Bozinov O, Colen RR, Bertalanffy H, Kasper EM. Neurosurgical education in Europe and the United States of America. Neurosurg Rev. 2010 Oct;33(4):409-17. doi: 10.1007/s10143-010-0257-6. Epub 2010 Apr 29. PubMed PMID: 20429023; PubMed Central PMCID: PMC3683626.
7)

American Board of Neurological Surgery (ABNS) ABNS Board Certification. 2009 http://www.abns.org/content/primary_certification_process.asp.
9)

Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K. Working time of neurosurgical residents in Europe-results of a multinational survey. Acta Neurochir (Wien). 2016 Jan;158(1):17-25. doi: 10.1007/s00701-015-2633-z. Epub 2015 Nov 14. PubMed PMID: 26566781.
10)

Kleineberg NN, van der Meulen M, Franke C, Klingelhoefer L, Sauerbier A, Di Liberto G, Carvalho V, Berendse HW, Deuschl G; RRFS national representatives’ network. Differences in neurology residency training programmes across Europe – a survey among EAN-RRFS national representatives. Eur J Neurol. 2020 Apr 5. doi: 10.1111/ene.14242. [Epub ahead of print] PubMed PMID: 32248603.

Today: Neurosurgical Approaches to the Cranial Compartments

Neurosurgical Approaches to the Cranial Compartments

This course is aimed at ST3-ST8 level trainees and subspecialty (skull base and cerebrovascular) fellows. Teaching of the approaches are tailored to the specific needs and experience of the individual trainee. This workshop is co-organised by the east and west of Scotland training programs. The program includes complex surgical procedures which cannot be performed by trainees without prior cadaveric exposure.

It covers the whole armamentarium of intracranial approaches and provides fundamental insight to very complex procedures. The focus is on enabling trainees to safely approach superficial and deep seated vascular and benign intracranial lesions arising from or being in proximity to the cranial vault or skull base. Trainees will gain a heightened appreciation of the critical structures encountered through these approaches.

Suitability

ST3-ST8 and subspecialty (skull base and cerebrovascular) fellows. Teaching of the approaches will be tailored to the specific needs and experience of the individual trainee.

Relevant Grades: ST3, ST4, ST5, ST6, ST7, ST8, SpR, SAS

Course Format

Introductory Lectures followed by hands on Cadaveric workshops. Commonly performed techniques such as pterional, bifrontal, middle fossa and retrosigmoid craniotomies will be covered as well as more complex approaches to the third ventricle, pineal region, antero-lateral brainstem and C1/C2 complex. State of the art Pentero Zeiss microscopes, Integra Mayfield clamps, Codman microinstruments, and Anspach high speed drills will be readily available in all stations (two participants per station – one faculty member per station)

Course Objectives

Familiarize trainees with the surgical anatomy pertinent to common as well as complex neurosurgical procedures, which will be comprehensively taught. Identify anatomical avenues for the safe exposure of both superficial and deeper intracranial structures. Expose trainees to microsurgical principles (appropriate application of the operating microscope, high speed drill, and microdissection).

Learning Outcomes

Upon completion of the course, participants should be able to:

  • Enable trainees to safely approach superficial and deep seated vascular and benign intracranial lesions arising from or being in proximity to the cranial vault or skull base.
  • Trainees will have a heightened appreciation of the critical structures encountered through these approaches.

Medical Management of Neurosurgical Patients

Medical Management of Neurosurgical Patients

by Rene Daniel and Catriona M Harrop

List Price: $74.95

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Emerging as a new sub-specialization within the hospitalist community, the neurosurgery hospitalist provides preoperative risk stratification, advises on managing pre- and postoperative complications, and helps doctors make decisions about when to involve specialists other than neurosurgeons. This collaborative approach to the neurosurgery patient has been shown to offer effective care since hospitalists can be better attuned than specialists to multiple medical problems that most patients have.

Medical Management of Neurosurgical Patients is a first of its kind textbook providing a standardized source of information for neurosurgery hospitalists in order to establish a common ground and improve their knowledge and training. The work will focus on the management of CNS infections, management of bleeding in the context of CNS surgery (a potentially catastrophic complication), management of sodium and blood glucose levels including steroid-induced hyperglycemia, perioperative pain control, and management of pressure injuries and rehabilitation in the context of CNS injury.

Webinar- Utilizing the exoscope in neurosurgical oncology

Utilizing the exoscope in neurosurgical oncology

Explained by Dr. Nader Sanai

see Video here

The following time-stamps will guide you to certain key points & examples during this webinar:

At 1:30: “Moving from a pure optical platform to a digital platform is something that we are going to see increasingly in our operating rooms”

At 3:10: “As a tumor surgeon, we have multiple information chains, we have the structural MRI, functional MRI, tractography, MR spectroscopy, MAG imaging, fluorescence-guided surgery, intraoperative navigation and all of these things have to be integrated in our brains and extrapolated through our actions with the tumor. I think what this platform (ZEISS KINEVO 900) is enabling us to do, is give us the ability to integrate a lot of this in real-time so that we do not have to do this ourselves and we do not have to be swiveling our heads to look at this scan or that scan as we are operating.”

At 6:01: “Now, the PointLock concept is really one where you want to specifically focus on a particular target in three-dimensional space. But you want to be able to pivot around it without having to find it again. We all do that in the OR and while it may take only few seconds, those are precious seconds where you lose your chain of thoughts. [..] Achieving this at a functional level… and by that I mean the ability where the robot does it for you and you do not have to adjust at all in terms of fine tuning the focus or fine tuning the special referencing [..] I have used it in the OR, really without any training on it and it is something very intuitive.”

At 7:17: “Many of us use MRI spectroscopy (for example) to identify hotspots where we will perform biopsy. For example, in a low grade tumor we want to decrease the chance of missing a focus of transformation. By bookmarking those sites on the microscope, we can make sure that we can go directly to that spot without worrying about aligning the navigation and all of the other anatomical information around it.”

At 9:06: “In brain tumor operations there are many dimensions of the tumor that we need to work along and we often operate – move the microscope – operate. This platform enables you to continuously operate as you are moving. And, if you are using it as an exoscope function (particularly), you, yourself don’t have to move at all. Effectively, the microscope moves and you stay still. [..] it is an important distinction when you are doing a multi-hour operation and you are able to stay in a position of comfort and stability [..] instead of moving around your torso to accommodate the dimension.”

At 11:03: “The next generation of microscope will be something that is not so much part of you but is working in parallel with you. [..] For example, in a far-lateral type approach for lower cranial schwannoma, there are issues in positioning and the angle of view. But here we can operate in a relatively neutral position using 3D 4K visualization.“

At 13:13: Case explanation for Retrosigmoid Crainiotomy for Petrous Face Meningioma using the combination of exoscopic visualization and robotics.

At 13:54: “This is at the point where one can transition to the exoscope. Because the angles of approach that you want as you are trying to pull this tumor away from the brain tumor margins, really can be quite extreme. You can see in the inset where the angle of the microscope head is relative to my head. If I had to stretch to get to that angle I’m going to be relatively uncomfortable and less stable ergonomically with my hands and torso.”

At 15:12: “I would also add that the learning curve for this is not very steep. It is a relatively simple device to adopt into your workflow because many of us have already gotten used to using the foot pedal for basic robotic movements of the microscope head. What this does is: add these additional dimensions of moving in an angle and pivoting around a point. So, it is really like a real-time surveillance image happening as you operate.

At 16.31: “The digital integration of real-time functional imaging, real-time tractography, real-time stimulation mapping data into the cortex will basically make it seamless.”

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation

by Vasilios Zerris (Author)

List Price: $99.99

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The American Board of Neurological Surgery oral examination has undergone periodic review and revision over the years, with a new format instituted in spring 2017. This review book is specifically geared to the new format. The ABNS oral examination process is relevant, rigorous, and of value to the neurosurgical specialty and the public, ensuring neurosurgeons meet the highest standards of practice.

Neurosurgical Review: For Daily Clinical Use and Oral Board Preparation by Vasilios A. Zerris and distinguished contributors is a multimodal and a visually rich prep tool for the ABNS exam. The resource provides a unique approach to studying and melding online didactic materials with audio-enhanced charts. Readers can use the material as a completely online exam prep course with audio or use the print version as a quick reference guide.

Key Features

Charts and schematics provide an excellent learning tool and study prep The high yield and easy to memorize format helps readers “visualize” knowledge Audio files enhance the ability to create a mental framework, thereby increasing comprehension and retention of content Cases presented at the end of each chapter focus primarily on core material tested in the general neurosurgery ABNS exam session taken by all candidates irrespective of their declared subspecialty This is an essential textbook for neurosurgical residents, fellows, and practitioners prepping for the ABNS boards. It also serves as a user-friendly refresher of fundamental knowledge all neurosurgeons need to know.

This book includes complimentary access to a digital copy on https://medone.thiem

The Clinical Practice of Neurological and Neurosurgical Nursing

The Clinical Practice of Neurological and Neurosurgical Nursing

$119.99

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Base your care of neurological patients on evidence-based best practices, with the completely updated, fully illustrated The Clinical Practice of Neurological and Neurosurgical Nursing , 8th Edition.

This is the most current and comprehensive neuroscience nursing text, written to support you in the everyday high-level assessments, information processing and decision making required of the neurological nurse. A must-have for offering accurate, efficient care of adult/geriatric neuroscience patients, this is ideal for both beginning and advanced neuro nurses and nursing students. NEW chapter on hydrocephalus NEW chapter on neurological care in the community NEW and revised content throughout the text that reflects current best practices Case studies that offer real-life scenarios to reinforce concepts Treatment Summaries, Clinical Vignettes and Clinical Pearls that provide vital clinical tips Sections covering a broad range of neuroscience care considerations: Ethical perspectives and end-of-life care – Preparing and caring for patients after acute care, brain death and organ donation Assessment and evaluation of neuroscience patients – Overview of neuroanatomy and neurophysiology, diagnostics for patients with neurological disorders, comprehensive neurological examination, neurological assessment Common management challenges – Intracranial hypertension, hydrocephalus, management of patients with altered level of consciousness, evaluation/treatment of delirium, common neuroendocrine syndromes, neurosurgical procedures, rehabilitation Nursing management of patients with injury to the neurological system; cranial nerve disorders and peripheral nerve injuries; neoplasms of the neurological system; cerebrovascular disease; pain, seizures, and CNS infections; movement disorders; neurodegenerative and neuromuscular diseases Ideal for nurses working in intensive care units, emergency departments, neuroscience specialty units and medical-surgical units that admit neuroscience patients Nursing management guidance that is infused with pathophysiology content, providing a rationale for care and for identifying patient outcomes Guide for establishing and updating a neuroscience patient database Excellent study aid for preparing for the certified neuroscience registered nurse (CNRN) exam and stroke certification (SCRN) Thorough overview of neurology team communications – Best practices for coordination, continuity, and patient safety

Your book purchase includes a complimentary download of the enhanced eBook for iOS™, Android™, PC, and Mac. Take advantage of these practical features that will improve your eBook experience:

The ability to download the eBook on multiple devices at one time—providing a seamless reading experience online or offline Easily convert to audiobook, powering your content with natural language text-to-speech Powerful search tools and smart navigation cross-links that allow you to search within this book, or across your entire library of VitalSource eBooks

About the Clinical Editors

Joanne V. Hickey, PhD, RN, ACNP, FAAN, FCCM, is Patricia L. Starck/PARTNERS Professor of Nursing, Department of Research at the Cizik School of Nursing, University of Texas Health Science Center at Houston at the University of Texas Health School of Nursing in Houston, Texas.

Andrea L. Strayer, MS, NP, CNRN, is Inpatient Neurosurgery Nurse Practitioner at the University of Wisconsin Hospital in Madison, Wisconsin.