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1. Global Perspectives on Task Shifting and Task Sharing in Neurosurgery

Author

Faith C. Robertson, Ignatius N. Esene, Angelos G. Kolias, Tariq Khan, Gail Rosseau, William B. Gormley, Kee B. Park, Marike L.D. Broekman, Jeffrey Rosenfeld, Naci Balak, Ahmed Ammar, Magnus Tisel, Michael Haglund, Timothy Smith, Ivar Mendez, Jannick Brennum, Stephen Honeybul, Akira Matsumara, Severien Muneza, Andres Rubiano, Patrick Kamalo, Graham Fieggen, Basant Misra, Gene Bolles, David Adelson, Robert Dempsey, Peter Hutchinson, Alexandrina Nikova, Osama Ghazala, Elubabor Buno, Shibashish Bhattacharjee, Takahiro Iizuka, Jafri Malin Abdullah, Bipin Chaurasia, Eghosa Morgan, Rodolfo E. Alcedo-Guardia, Lynne Lourdes N. Lucena, Kadir Oktay, Omar Ibrahim AbdAllah, Ahlem Saihi, Gacem Abdeldjalil, Mahi Asmaa, Claudio Yampolsky, Laura P. Saladino, Francisco Mannara, Sonal Sachdev, Benjamin Price, Vincent Joris, Nourou Dine Adeniran Bankole, Edgar M. Carrasco, Mirsad Hodzic, Marcos Wagner de Sousa Porto, Robson Amorim, Igor Lima Maldonado, Bizoza Yves, Gonzalo Suarez, Felipe Constanzo, Johanna Cecilia Valdeblanquez Atencio, Karen Alexa Ruiz Mora, Juan Manuel Rodriguez Gil, Kiriakos Paraskeva, Emrah Egemen, Trevcsor Ngamasata, Jeff Ntalaja, Antoine Beltchika, Glennie Ntsambi, Goertz Mirenge Dunia, Mahmoud M. Taha, Mohamed Arnaout, Ramez Kirollos, Mohamed Kassem, Omar Elwardany, Ahmed Negida, Birhanu Dolango, Mikael Aseged, Alemu Adise Mldie, Tsegazeab Laeke, Abenezer Aklilu, Esayas Adefris, Teemu Luoto, Rezai Jahromi Behnam, Emmanuel De Schlichting, Bougaci Nassim, Pierre Bourdillon, Martin N. Stienen, Stephan Lackermair, Franziska Anna Schmidt, Juergen Konczalla, Adrien Holzgreve, Andre Sagerer, Dieter M. Weinert, Paulette Kumi, Aaron Lawson McLean, James Loan, Julian Cahill, Simon Dockrell, Fardad T. Afshari, Paul May, Alkinoos Athanasiou, Steven Papadopoulos, Edroulfo-Georgios Espinoza, Athanasios Chatzisotiriou, Pavlos Vlachogiannis, Konstantina Karabatsou, Thanasis Paschalis, Christos Tsitsipanis, Gabriel Mauricio Longo Calderan, Ronny Leiva, Harsh Deora, Sreenivas Mukkamala, Dipesh Batra, Arvind Sukumaran, Kanishk Parmar, Anuj Bahl, Amit Agrawal, Nirankar Dev, Nikhil Thakur, Sanjay Behari, Chandrasekhar B.V.K. Yandrapati, Ritesh Bhoot, Pragnesh Bhatt, Uday Bhaumik, Manish Agrawal, Antony Thomas, Harish Chandrappa, Ankit Mathur, Petra Wahjoepramono, Selfy Oswari, Rafid Al-Mahfoudh, Abbas Alnaji, Nidal Abuhadrous, Bakr Abo Jarad, Ibrahim Nour, Or Cohen-Inbar, Roberto Colasanti, Alfredo Conti, Giovanni Raffa, Corrado Castrioto, Matteo M. Baccanelli, Santino Ottavio Tomasi, Matteo Zoli, Andrea Veroni, Andrea Di Cristofori, Luigi Giannachi, Laura Lippa, Donatella Sgubin, Morgan Broggi, Marcello Barbato, Francesco Restelli, Mario Ganau, Graziano Taddei, Hamzeh Albadawi, Mohammed Salameh, Madieyva Gulmira, Muffaq Lashhab, Walid El Gaddafi, Mohammad Altoumi, S.M. Manvinder, Davendran Kanesen, Mario Teo, Prabu Rau Sriram, Sarah Atiqah M. Zamri, Vayara Perumall Vinodh, Moussa Denou, Adyl Melhaoui, Oumaima Outani, Mahjouba Boutarbouch, Armin Gretschel, Pradhumna Yadav, Balgopal Karmacharya, Fatih Incekara, Hugo den Boogert, Buccket Argvoello Lopez, Hassane Ali Amadou, Danjuma Sale, Sanusi Bello, Poluyi Edward, Alvan-Emeka Ukachukwu, Evaristus Nwaribe, Ikechukwu Aniaku, Aliyu Baba Ndajiwo, Olabamidele Ayodele, Gyang Markus Bot, Sunday David Ndubuisu Achebe, Bakht Jamal, Muhammad Tariq, Ghulam Farooq, Danyal Zaman Khan, Ahtesham Khizar, Zahid Hussain, Anisa Nazir, Marco Gonzales-Portillo, Jhosep Silvestre Bautista, Roland A. Torres, Abigail Javier-Lizan, Isagani Jodl G. de los Santos, Jr., Nuno Morais, Lydia Dias, Carolina Noronha, Jovelo Monteiro Silva, Alexandra Seromenho-Santos, Kiril Lozanche, Ionut Negoi, Alexandru Tascu, Danil A. Kozyrev, Dr. Menelas Nkeshimana, Claire Karekezi, Marcel Didier Ndayishyigikiye, Faisal Alabbass, Faisal Farrash, Rawan Alhazmi, Jagos Golubovic, Milan Lepifá, Rosanda Ilifá, Aleksandar Stanimirovifá, Sergio Garcia-Garcia, Carlos A. Rodriguez Arias, Ruth Lau, Juan Delgado-Fernandez, Miguel A. Arraez, C. Fernandez Mateos, Ana M. Castano Leon, Saman Wadanamby, David Bervini, Hamisi K. Shabani, Kriengsak Limpastan, Khalil Ayadi, Altay Sencer, Ali Yalcinkaya, Elif Eren, Recep Basaran, Abdulkerim Gokoglu, Vyval Mykola, Felicita Tayong, Mario Zuccarello, Carolyn Quinsey, Michael C. Dewan, Paul H. Young, Edward Laws, Jack Rock, David B. Kurland, Carrie R. Muh, Eri Dario Delgado Aguilar, Kenneth Burns, Jacob Low, Conor Keogh, Chris Uff, Alfio Spina, and Fayez Alelyani

Subjects
Surgery, RD1-811, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018–January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. Results: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). Conclusions: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs. Key words: Global health, Global neurosurgery, LMIC, Neurotrauma, Task sharing, Task shifting, Workforce

Published
2020
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2. Beyond Socrates’ Dia-logos : The Locations Of Mind

Author

Luigi Giannachi and Luigi Giannachi

Abstract

If we could talk with the great fathers of philosophy about some of today's world issues, what resources could we infer and what lessons could we reflect? These are the surreal dialogues between thinkers and myths of ancient Greece (such as Plato, Heraclitus or Medusa) and philosophers enlightened by those ancient places of the mind (such as Bruno, F. Nietzsche). The Dia-Logos outlines the actions and modalities of the human mind meeting historical characters who live in modernity times. The structure of the texts deliberately exploits the patterns of the narrative genre. There is the discovery of a fictitious Socrates'manuscript, who has never left personal writings, by a penfriend. This event starts the surreal voyages that will lead to dialogues. PUBLISHER: TEKTIME

Published
2017

3. Lumbar Synovial Cysts: Microsurgical Treatment and Outcome in 40 Cases: Review and Critical Analysis of the Literature

Author

Vincenzo Amato, Claudio Irace, Claudio Corona, and Luigi Giannachi

Subjects
Surgical resection, Retrospective review, medicine.medical_specialty, business.industry, Spinal instability, medicine.disease, Microsurgical treatment, Surgery, Ganglion cyst, Lumbar, Concomitant, medicine, Synovial cyst, business
Abstract

Lumbar Synovial Cysts: Microsurgical Treatment and Outcome in 40 Cases: Review and Critical Analysis of the Literature Intraspinal synovial cysts (SCs) are uncommon benign growths that occur adjacent to the spinal facet joints. Surgical resection is the treatment of choice for symptomatic patients, but, much debate continues regarding the indication of concomitant fusion to prevent delayed instability. In this study, we report a retrospective review of 40 patients treated for lumbar SCs with microsurgical technique, and analyse the related literature in order to better understand and manage this pathology.

Published
2014

4. Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients

Author

Claudio Irace, Claudio Corona, Vincenzo Amato, and Luigi Giannachi

Subjects
medicine.medical_specialty, Sacrum, Lumbosacral spine, medicine.medical_treatment, Bone Screws, Computed tomography, Screw thread, Fixation (surgical), Postoperative Complications, Fracture Fixation, Medicine, Humans, Pedicle screw, Retrospective Studies, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, General Medicine, Surgery, Treatment Outcome, Spinal fusion, Fluoroscopy, Equipment Failure, Implant, Tomography, business, Nuclear medicine, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative fluoroscopy. The results are compared with published data.MethodsCases involving 102 consecutive patients (424 inserted screws) were reviewed. Surgery was performed in all cases by the same surgeon's team, using the same implant, and all results were assessed by means of a specific CT protocol. The screw position was assessed by the authors and an independent observer. Screw position was classified as correct when the screw was completely surrounded by the pedicle cortex, as “cortical encroachment” (questionable violation) if the pedicle cortex could not be visualized, and as “frank penetration” when the screw was outside the pedicular boundaries. Frank penetration was further subdivided as minor (when the edge of the screw thread was up to 2.0 mm outside the pedicle cortex), moderate (2.1–4 mm), and severe (> 4 mm). The incidence of intra- and postoperative complications not related to screw position as well as hardware failures were also registered, with a minimum follow-up duration of 8 months.ResultsThe rate of frank pedicle screw misplacement was 5%. The rate of minimal or questionable pedicle wall violation was 2.8%. Among the frank misplacements, 6 were classified as minor, 12 as moderate, and 3 as severe penetration. Two patients (2%) had radicular pain and neurological deficits (inferomedial and inferolateral minor misplacement at L-4 and L-5, respectively), and 5 patients (4.9%) complained only of radicular pain. At the follow-up examination all patients had completely recovered their neurological function and radicular pain was resolved in all cases. The complications not related to screw malposition were 2 pedicle fractures (2% of patients), 1 nerve root injury (1%), and 1 dural laceration (1%). Five patients (4.8%) had postoperative anemia and required transfusions. Superficial or deep wound infection was noted in 3 patients (2.9%). Late hardware failure occurred in 2 patients (2%). One patient developed adjacent segmental instability and required additional surgery to extend the fusion.ConclusionsOur rates of screw misplacement and complications compare favorably with the lowest rates of the series in which conventional technique was used and are close to the rates reported for image-guided methods. The risk of malpositioning may be reduced with careful preoperative surgical planning, accurate knowledge of the spinal anatomy, surgical experience, and correct indication for conventional surgery. The conventional technique still remains a practical, safe, and effective surgical method for lumbosacral fixation.

Published
2010

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