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Whether the use of fludrocortisone affects outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). We conducted a retrospective analysis of 78 consecutive patients with a ruptured aSAH at a single academic center in the United States. The primary outcome was the score on the modified Rankin scale (mRS, range, 0 [no symptoms] to 6 [death]) at 90 days. The primary outcome was adjusted for age, hypertension, aSAH grade, and time from aSAH onset to aneurysm treatment. Secondary outcomes were neurologic and cardiopulmonary dysfunction events. Among 78 patients at a single center, the median age was 58 years [IQR, 49 to 64.5]; 64 % were female, and 41 (53 %) received fludrocortisone. The adjusted common odds ratio, aOR, of a proportional odds regression model of fludrocortisone use with mRS was 0.33 (95 % CI, 0.14-0.80; P = 0.02), with values <1.0 favoring fludrocortisone. Organ-specific dysfunction events were not statistically different: delayed cerebral ischemia (22 % vs. 39 %, P = 0.16); cardiac dysfunction (0 % vs. 11 %; P = 0.10); and pulmonary edema (15 % vs. 8 %; P = 0.59). The risk of disability or death at 90 days was lower with the use of fludrocortisone in aSAH patients. [ABSTRACT FROM AUTHOR]

There are only three fully trained neurosurgeons to care for Tanzania''s population of more than 41 million people. Madaktari was founded in 2006 to serve as a physician training partnership to establish more self-sufficient health care through education and training. Medical students play a valuable role in Madaktari as they are primarily responsible for collecting postneurosurgical outcome data on operations performed by Tanzanian physicians trained by our organization. In addition, medical students represent the future of global medicine. Thus, it is important to determine the extent that Madaktari has affected student interest in global health. Our purpose in this article is to explore one student''s experience working in global neurosurgery while working with Madaktari. In addition we attempted to determine the effect Madaktari may play on the future medical careers of eight medical student volunteers. To determine that effect we conducted a six-question online survey of medical student volunteers. We received responses from four of our eight medical student volunteers, all of whom stated they had a good or excellent experience volunteering with Madaktari and that their experience further increased their desire to incorporate global health into their careers. After working with Madaktari nearly half of the medical student volunteers have pursued or will be pursuing year-long funded global health research during their medical school careers. Madaktari is not only pioneering a path toward increased and more independent neurosurgical capabilities in Tanzania, but it is also helping foster increased interest and participation among U.S. medical students in global neurosurgery. [Copyright &y& Elsevier]

Objective: To elucidate the progress of neurosurgical practices in Tanzania, taking into account humanitarian, socioeconomic, and geographic influences. Method: Articles, records, and historical texts were consulted to establish a timeline and history of neurosurgery in Tanzania. Results: Reulen, a German neurosurgeon, was integral to the development of sustainable neurosurgical services in Tanzania. By training Tanzanians who returned to their country to practice, Reulen helped to establish a continuity of care and legacy on which future Tanzanian surgeons could build. Subsequently, as neurosurgical services were integrated into the Muhimbili Orthopedic Institute, surgeons found a hospital to call home and a place to focus their efforts. Neurosurgical services have now been offered to the Tanzanian people for >40 years, a direct consequence of international influences coupled with certain extraordinary Tanzanian physicians. Conclusions: Neurosurgery in Tanzania and Africa more generally has a long history; however, it was not until more recent efforts of certain local pioneers and educational advisors abroad that modernization occurred. The progress of the past 50 years is substantial and with continued efforts advances will continue to be made. [Copyright &y& Elsevier]

Background Neurosurgical educators strive to identify the best applicants, yet formal study of resident selection has proved difficult. We conducted a systematic review to answer the following question: What objective and subjective preresidency factors predict resident success? Methods PubMed, ProQuest, Embase, and the CINAHL databases were queried from 1952 to 2015 for literature reporting the impact of preresidency factors (PRFs) on outcomes of residency success (RS), among neurosurgery and all surgical subspecialties. Due to heterogeneity of specialties and outcomes, a qualitative summary and heat map of significant findings were constructed. Results From 1489 studies, 21 articles met inclusion criteria, which evaluated 1276 resident applicants across five surgical subspecialties. No neurosurgical studies met the inclusion criteria. Common objective PRFs included standardized testing (76%), medical school performance (48%), and Alpha Omega Alpha (43%). Common subjective PRFs included aggregate rank scores (57%), letters of recommendation (38%), research (33%), interviews (19%), and athletic or musical talent (19%). Outcomes of RS included faculty evaluations, in-training/board exams, chief resident status, and research productivity. Among objective factors, standardized test scores correlated well with in-training/board examinations but poorly correlated with faculty evaluations. Among subjective factors, aggregate rank scores, letters of recommendation, and athletic or musical talent demonstrated moderate correlation with faculty evaluations. Conclusion Standardized testing most strongly correlated with future examination performance but correlated poorly with faculty evaluations. Moderate predictors of faculty evaluations were aggregate rank scores, letters of recommendation, and athletic or musical talent. The ability to predict success of neurosurgical residents using an evidence-based approach is limited, and few factors have correlated with future resident performance. Given the importance of recruitment to the greater field of neurosurgery, these data provide support for a national, prospective effort to improve the study of neurosurgery resident selection. [ABSTRACT FROM AUTHOR]