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Objective: A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study analyzes data from the American Association of Neurological Surgeons membership identifying the impact of several demographic and educational characteristics influencing neurosurgical career choices centered on academia, private practice, or a combination in the United States., Methods: A list of all current neurosurgeons was obtained from the American Association of Neurological Surgeons membership, and information on physician characteristics was collected via internet searches and institutional databases. The practice type of all neurosurgeons considered in this study were categorized as follows: private practice, academic, or a combination of private practice and academic, termed privademic. These data were subsequently correlated to race, gender, current age, training at a top 40 National Institutes of Health-funded medical school or residency program, and current practice., Results: The median age of private practice and academic neurosurgeons was 58.18 and 53.61 years, respectively (P < 0.001). Age was significantly associated with practicing in an academic setting (odds ratio 0.96), with younger neurosurgeons pursuing careers in academia. Data indicated a positive and statistically significant contribution of female gender (P < 0.001) and training at a top-40 National Institutes of Health-funded institution to practicing in an academic setting (P < 0.01)., Conclusions: Neurosurgery as a field has grown significantly over the past century. The authors recommend that future efforts seek to diversify the neurosurgical workforce by considering practice setting, demographic characteristics, and educational background., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US)., Methods: This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests., Results: A total of 6,821 US inpatient hospital discharge records met inclusion/exclusion criteria. The estimated national prevalence of OGI during the 5-year period from 2009 to 2015 was 34,061 (95% confidence interval [CI] 31,445-36,677). The overall annual prevalence rate was 1.58 per 100,000 per year (CI 1.56-1.59). Overall, average annual prevalence rates were highest among patients 85 years or older (7.72, CI 6.95-8.49), on Medicare (3.92, CI 3.84-4.00), males (2.28, CI 2.25-2.30), African Americans (2.38, CI 2.32-2.44), and Native Americans (1.80, CI 1.62-2.00). OGI rates were lowest among Whites (1.21, CI 1.19-1.22), females (0.89, CI 0.87-0.91), those with private insurance (0.84, CI 0.82-0.86), and Asians (0.69, CI 0.64-0.74). Being in the lowest income quartile was a risk factor for OGI ( p < .05)., Conclusions: Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures.

Since the closure of Charity Hospital after Hurricane Katrina, New Orleans Student-Run Free Clinics have helped fill the resulting void in healthcare access for the underserved New Orleans population. To better understand the health insurance status and health outcomes of this patient population, 1036 patient records from seven New Orleans Student-Run Free Clinics were collected and analyzed between February 2017 and March 2020. Insurance status was significantly associated with gender, race, homelessness, and prior incarceration, but not with education. Substance use rehabilitation centers had low uninsured rates, while homeless shelters had higher uninsured rates. Patients on Non-Medicaid insurance were most likely to be prescribed a medication for diabetes (p = .01), hypertension (p = .21), and psychiatric conditions (p = .04), followed by those on Medicaid, and then those who were uninsured. This study demonstrates the benefits of health insurance and provides important data that can inform future health insurance enrollment efforts and health policy., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The US FDA uses evidence from clinical trials in its determination of safety and utility. However, these trials have often suffered from limited external validity and generalizability due to unrepresentative study populations with respect to clinical patient demographics. Section 907 of the FDA Safety and Innovation Act (FDASIA) of 2012 attempted to address this issue by mandating the reporting of certain study demographics in new device applications. However, no study has been performed on its effectiveness in the participant diversity of neurosurgical device trials., Methods: The FDA premarket approval (PMA) online database was queried for all original neurosurgical device submissions from January 1, 2006, to December 31, 2019. Endpoints of the study included racial and gender demographics of reported effectiveness trials, which were summated for each submission. Chi-square tests were performed on both endpoints for before and after years of FDASIA passage and implementation., Results: A total of 33 device approvals were analyzed, with 14 occurring before SIA implementation and 19 after. Most trials (96.97%) reported gender to the FDA, while 66.67% reported race and 63.64% reported ethnicity. Gender breakdown did not change significantly post-SIA (53.30% female, p = 0.884). Racial breakdown was significantly different from the 2010 US Census for all races (p < 0.001) both pre- and post-SIA. Only Native American race was significantly different in terms of representation post-SIA, increasing from 0% to 0.63% (p = 0.0187). There was no significant change in ethnicity., Conclusions: The FDASIA, as currently written, does not appear to have had a significant impact on the racial or gender diversity of neurosurgical device clinical trial populations. This may be due to the noncompulsory nature of its guidance, or a lack of more stringent regulation on the composition of clinical trials themselves.

Mini: Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Relative value units (RVUs) form the backbone of health care service reimbursement calculation in the United States. However, it remains unclear how well RVUs align with objective measures of procedural complexity within neurosurgery., Methods: The 2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for neurosurgical procedures with >50 patients, using Current Procedural Terminology (CPT) codes. Length of stay (LOS), operative time, mortality, and readmission and reoperation rates were collected for each code and a univariate correlation analysis was performed, with significant predictors entered into a multivariate logistic regression model, which generated predicted work RVUs, which were compared with actual RVUs to identify undervalued and overvalued procedures., Results: Among 64 CPT codes, LOS, operative time, mortality, readmission, and reoperation were significant independent predictors of work RVUs and together explained 76% of RVU variance in a multivariate model (R 2  = 0.76). Using a difference of >1.5 standard deviations from the mean, procedures associated with greater than predicted RVU included surgery for intracranial carotid circulation aneurysms (CPTs 61697 and 61700; residual RVU = 12.94 and 15.07, respectively), and infratemporal preauricular approaches to middle cranial fossa (CPT 61590; residual RVU = 15.39). Conversely, laminectomy/foraminotomy for decompression of additional spinal cord, cauda equina, and/or nerve root segments (CPT 63048; residual RVU = -21.30), transtemporal craniotomy for cerebellopontine angle tumor resection (CPT 61526; residual RVU = -9.95), and brachial plexus neuroplasty (CPT 64713; residual RVU = -11.29) were associated with lower than predicted RVU., Conclusions: Work RVUs for neurosurgical procedures are largely predictive of objective measures of surgical complexity, with few notable exceptions., (Published by Elsevier Inc.)

Study Design: Prospective observational study., Objective: The objective of this study is to identify correlates of search ranking among academic pedigree, online ratings, and social media following., Summary of Background Data: Patients increasingly rely on online search in selecting healthcare providers. When choosing a spine surgeon, patients typically value surgical skill and experience as well as demeanor/bedside manner. It is unclear whether current search engine ranking algorithms reflect these preferences., Methods: A Google.com search for the top 25 spine surgeon websites by search ranking was conducted for each of the largest 25 American cities. Resulting websites were then perused for academic pedigree, experience, and practice characteristics. Surgeons' research output and impact were then quantified via number of publications and H-index. Online ratings and followers in various social media outlets were also noted. These variables were assessed as possible correlates of search ranking via linear regression and multivariate analyses of variance., Results: A total of 625 surgeons were included. Three categorical variables were identified as significant correlates of higher mean Google search ranking-orthopedics (vs. neurosurgery) as a surgical specialty (P = 0.023), board certification (P = 0.024), and graduation from a top 40 residency program (P = 0.046). Although the majority of the identified surgeons received an allopathic medical education, there was no significant difference in the mean rank of surgeons who had an MD versus DO medical degree (P = 0.530). Additionally, none of the continuous variables collected, including years in practice (P = 0.947), publications (P = 0.527), H-index (P = 0.278), social media following such as on Facebook (P = 0.105), or online ratings such as on Healthgrades (P = 0.080), were significant correlates of Google search ranking., Conclusions: Google search rankings do not always align with patient preferences, currently promoting orthopedic over neurosurgical specialists, graduation from top residency programs, and board certification, while largely ignoring academic pedigree, research, social media presence, and online ratings., Level of Evidence: 3.

Background: The utilization of locum tenens physicians in the United States has risen significantly as a stopgap for clinical practice needs, particularly in rural and other underserved areas. The difficulty in hiring new physicians to remote hospitals has resulted in the dependence of these institutions on locum tenens coverage. Here, we assess the quality and cost of neurosurgical care between locum and non-locum neurosurgeons in the United States, the first study in our knowledge to do so., Methods: A 5% random sample of the Medicare claims limited data set was queried for 2005-2011 for neurosurgical cases using International Classification of Diseases, Clinical Modification, 9th edition (ICD-9-CM) procedure codes for common cranial and spine procedures. Cases were divided into locum and non-locum groups using ICD modifier Q6. The association between locum care and 30-day surgical complications, disposition, and cost of care was evaluated., Results: A total of 112,397 patients met inclusion criteria, with locum tenens practitioners involved in 164 (0.15%) cases. Locum and non-locum cohorts were statistically and clinically similar at baseline, with respect to comorbidity and case type. Mortality (0.00% vs. 0.19%; P=0.739), discharge disposition (P=0.739), surgical complication rates, and length of stay (8.74 ± 12.24 vs. 10.54 ± 15.51 days; P = 0.117) did not appear to differ significantly between the 2 groups. Hospitalization costs were also similar (158,780.20 ± 223,735.50 vs. 168,104.40 ± 308,074.90 USD; P = 0.698), as were amounts paid by patients (39,197.70 ± 14,144.75 vs. 39,234.36 ± 15,467.63 USD, P = 0.976)., Conclusions: Among Medicare beneficiaries, there exists no difference in short-term complication rates, lengths of hospitalization, or costs between locum and non-locum neurosurgeons., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Central cord syndrome (CCS) is the most common incomplete spinal cord injury (SCI), resulting in various degrees of neurologic compromise below the level of the affected cervical cord. The management of CCS is controversial regarding not only whether to surgically intervene, but also when surgery should occur. In this study, we conduct the largest multi-center study to date examining differences in inpatient outcomes, general discharge disposition, length of stay, and cost associated with early versus late surgical intervention for CCS., Patients and Methods: The National Inpatient Sample (NIS) was queried for years 2012-2015 for patients who underwent surgery with a primary diagnosis of CCS. The median interval between admission and intervention was noted. Patients operated upon prior to this timepoint were placed in the early surgery group, and others into the later surgery group. The groups were then compared, while using 1:1 propensity score matching to control for baseline presentation, with respect to mortality, discharge disposition, length of stay, and total charges., Results: A total of 422 patients met inclusion and exclusion criteria. The median time from admission to intervention was 2 days. Patients with higher initial severity of injury were more likely to undergo early surgery. Upon controlling for severity of initial presentation, earlier intervention did not appear to affect mortality or post-operative length of stay. However, patients operated upon earlier had more favorable discharge destinations (p = 0.025) and a lower associated cost of care ($198,050.70 vs. $243,048.10, p = 0.009)., Conclusion: Earlier surgical intervention for CCS may result in better patient disposition and less total charges., Level of Evidence: III., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI)., Methods: All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes., Results: Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively)., Conclusion: Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population., (Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Postoperative nausea and vomiting (PONV) occurs commonly in surgical patients despite widespread prophylactic antiemetic use. Rescue options are currently limited. 5HT3 antagonists are most frequently used for prophylaxis, but if they fail, additional doses are not effective as rescue medication. Intravenous (IV) amisulpride, a well-studied D2/D3 antagonist, has been shown in trials to prevent PONV. This study was designed to determine if amisulpride could be used to treat established PONV in patients at low-to-moderate risk of PONV who had not received any prior prophylaxis., Methods: Men and women aged over 18 years were permitted to enroll if they were to undergo general inhalational anesthesia, expected to last at least 1 hour, for an outpatient or inpatient surgical procedure. Patients who then suffered PONV were randomized equally to 1 of 3 single-dose IV regimens: placebo or 5 or 10 mg amisulpride. The primary end point was complete response, defined as no emesis in the period 30 minutes to 24 hours after study drug treatment and no use of rescue medication in the entire 24-hour period., Results: One thousand nine hundred eighty-eight patients were enrolled preoperatively, of whom 560 were randomized to a treatment arm. Complete response occurred in 39 of 181 patients (21.5%) in the placebo group compared to 60 of 191 patients (31.4%; P = .016) and 59 of 188 patients (31.4%; P = .016) in the amisulpride 5 and 10 mg groups, respectively. The adverse event profile of amisulpride at either dose was similar to placebo., Conclusions: IV amisulpride at 5 and 10 mg was safe and efficacious in the treatment of established PONV in surgical patients undergoing general anesthesia with no prior PONV prophylaxis.

Background: Although antiemetics are commonly used to prevent postoperative nausea or vomiting, the failure rate is appreciable and there is currently no generally accepted standard for rescue treatment of postoperative nausea or vomiting after failed prophylaxis. This prospective, randomized, double-blind, parallel-group, placebo-controlled, multicenter study was designed to test the hypothesis that intravenous amisulpride, a dopamine D2/D3-antagonist, is superior to placebo at treating established postoperative nausea or vomiting after failed prophylaxis., Methods: A total of 2,285 adult patients undergoing surgery under general inhalational anesthesia and receiving standard antiemetic prophylaxis were enrolled at 23 sites in Canada, France, Germany, and the United States. Of these, 702 patients experienced postoperative nausea or vomiting in the 24-h period after surgery and were randomized to receive a single dose of 5 or 10 mg intravenous amisulpride or matching placebo. The primary endpoint was complete response, defined as no emesis or rescue antiemetic use for 24 h after study drug administration, excluding emesis in the first 30 min. Secondary endpoints included incidence of emesis and rescue medication use, nausea burden, time to treatment failure, and length of stay in postanesthesia care unit and hospital., Results: Complete response occurred in significantly more patients receiving 10 mg amisulpride (96 of 230, 41.7%) than placebo (67 of 235, 28.5%), a 13.2% difference (95% CI, 4.6 to 21.8; odds ratio, 1.80; P = 0.006). A 5-mg dose of amisulpride did not show a significant benefit (80 of 237, 33.8%); the difference from placebo was 5.2% (95% CI, 3.1 to 13.6; odds ratio, 1.24; P = 0.109). The total number of adverse events recorded and proportion of patients with at least one adverse event were comparable between the placebo and amisulpride groups. No clinically relevant toxicities were observed., Conclusions: A single 10-mg dose of intravenous amisulpride was safe and more effective than placebo at treating established postoperative nausea or vomiting in patients failing postoperative nausea or vomiting prophylaxis.

Introduction and Hypothesis: Urinary incontinence is common amongst Chinese immigrants. These women are a rapidly growing population in the USA who require unique assessment tools due to language barriers. Presently, there are no Chinese language surveys to assess knowledge of urinary incontinence. Our goal was to translate and validate a urinary incontinence knowledge survey from English into Chinese., Methods: The English language Urinary Incontinence Quiz (UIQ) developed and validated by Branch et al. for the Educational Demonstration of Urinary Continence Assessment and Treatment for the Elderly program assesses general knowledge of urinary incontinence as a disease entity. We translated it into Chinese using the forward translation/back translation technique. The Chinese and English versions were then administered to bilingual volunteers in a nonrandomized order during a single encounter. Their responses were analyzed using Cohen's kappa coefficient to establish the validity of the translated knowledge survey., Results: Minimal reconciliation was needed in construction of the Chinese survey. Minor English grammatical corrections were made to the back-translated English survey. One question testing two knowledge concepts was separated into two questions to allow clear testing of both concepts individually. Twenty-one bilingual participants performed the validity testing. Over 50% (8 out of 15) of the questions showed nearly perfect agreement with a kappa coefficient >0.80, 5 out of the 15 questions showed substantial agreement with kappa coefficients between 0.61 and 0.8 and two questions showed moderate agreement with kappa coefficients between 0.4 and 0.6., Conclusions: We validated a translation of the UIQ for assessment of urinary incontinence knowledge in Chinese-speaking immigrants to the USA.

Based on findings of a recent survey, accountable care organizations should keep eight points in mind as they seek to establish interoperability among their provider constituents: Create a shared governance structure to make IT decisions. Conduct a readiness assessment and gap analysis. Reconfigure the technology infrastructure and processes to support new value-based care delivery protocols. Consider targeting programs around high-risk groups. Develop real-time data-sharing systems. Ensure privacy and security policies and procedures are in place. Assess and address workforce issues expeditiously. Participate in broader interoperability efforts.

Inadequate placental development results in a number of untoward pregnancy outcomes, including pre-eclampsia, placental abruption and infarction, and fetal growth restriction and stillbirth. Although it was once assumed that these pregnancy-related complications caused only upfront maternal and fetal morbidity and mortality, poor placental development and function is now a well-recognized female-specific risk factor for future vascular morbidity and mortality. The epidemiological, genetic, and physiological research linking placental development and cardiovascular disease is growing, and this knowledge will undoubtedly not only translate into improved pregnancy outcomes for at-risk women, but also help to identify which women who had a complicated pregnancy could benefit from long-term follow-up and risk modification for cardiovascular disease. This article reviews the literature and provides suggestions for future follow-up of this vulnerable population of women., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Published data from the Middle East and North Africa (MENA) region indicate suboptimal quality of cancer care, while the World Health Organization predicts an increase in cancer cases in developing countries. Major advances in breast cancer management mandate the development of guidelines to improve the quality and efficacy of oncology practice in the MENA region. A Breast Cancer Regional Guidelines Committee was organized and activated, comprising experts from various regional cancer institutions. The multidisciplinary team included 12 medical oncologists, 3 radiation oncologists, 2 radiologists, 2 surgeons, and 1 pathologist. The committee members agreed on adapting the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Breast Cancer for use in the MENA region to achieve common practice standards for treating patients. The members suggested several modifications to the guidelines, especially those related to risk factor profiles. United States-based NCCN experts reviewed these recommendations before final approval. The MENA-NCCN Breast Cancer Guidelines modification process was the first initiative in the development of common practice guidelines in the region. This project may serve as a foundation for the development of evidence-based practice standards, and improve collaborative projects and initiatives.

Background: We present a model of a community-academic partnership formed to replicate a unique salon-based health education and promotion program among African-American and Latino communities in Philadelphia., Objectives: The purpose of this article is to describe the partnership principles established and lessons learned in replicating the salon-based program that sought to develop a cadre of community-academic partners and build community-based organizations' (CBOs) capacity to implement and evaluate the program., Methods: As the lead organization, the Arthur Ashe Institute for Urban Health (AAIUH), formed a partnership with two CBOs, three universities, and 17 salons. Guiding principles were established to manage the large collaborative and ensure success., Lessons Learned: By embracing a common mission and principles of understanding, co-learning, building capacity and sharing responsibility and recognition, this partnership was able to achieve positive outcomes. Challenges faced were related to replication, CBO infrastructure, data management capacity, and other process issues., Conclusions: Despite challenges, we created and sustained an enduring partnership and brought positive change to the community. Lessons learned highlight issues to examine before furthering this work such as fostering trust and building meaningful relationships.

A series of 4-(5-bromo-1,3-dioxo-1,3-dihydro-2H-isoindol-2-yl)-butyryl N-(substituted phenyl) amides (3a-I) were synthesized and evaluated for their anticonvulsant activity in MES test according to the protocols of Antiepileptic Drug Development (ADD) programme of National Institutes of Health (NIH, Bethesda, USA).The most active compounds of the series were 3a, 3c, 3d, 3f, 3g, 3i and 3k at the dose of 30 mg/kg (i.p.) 0.5 h and 4 h after administration. In neurotoxic screen (NT), 3d, 3i and 3k were less toxic when compared with the other compounds.

Beginning in January 1989, consecutive female admissions to the ARTC MMTP Clinics in NYC were interviewed about their medical, drug, sexual and social experiences during 6 distinct historical years. Bloods were drawn and each sample tested for HIV via ELISA and Western Blot analysis. The data for 256 females was analyzed. The sample was predominantly Black (56%) and Hispanic (36%). Fifty-four percent (140) were between the ages of 31 and 40; 35% (91) were between the ages of 18 and 30; and 10% (27) were 41 or older. The majority, 179 (69%), had less than a high school education, while 79 (31%) had a high school education or greater. The seropositivity for this sample of females was 60.4%. Aside from the common types of illnesses often seen in gay men infected with the HIV virus (i.e., pneumonia, night sweats, sore throat and swollen glands) our sample of females presented with symptoms such as abnormal discharges from the vagina, infections or abscesses of the veins, kidney or bladder infections, bleeding from the bowels and hepatitis infections. The most commonly reported risk factors among our sample of HIV positive females were sharing injecting materials (38%); injecting drugs in the veins (37.2%); dividing an injection (24.3%); and blood transfusions (10.9%). Of our HIV positive females, 42 of 97 (43.3%) reported having sex with a man they shared needles with only one time so that having sex with a man who is potentially infected with the HIV virus only once may be enough for a female to seroconvert. One limitation of this data is that there is no knowledge of when the HIV positive women seroconverted. Some of the behaviors reported could be due to exposure to AIDS education, and not to the knowledge to their HIV serostatus.