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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. Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Author

Faith C. Robertson, Ignatius N. Esene, Angelos G. Kolias, Patrick Kamalo, Graham Fieggen, William B. Gormley, Marike L.D. Broekman, Kee B. Park, Jeffrey Rosenfeld, Naci Balak, Ahmed Ammar, Magnus Tisel, Michael Haglund, Timothy Smith, Ivar Mendez, Jannick Brennum, Stephen Honeybul, Akira Matsumara, Severien Muneza, Andres Rubiano, Gail Rosseau, Tariq Khan, Basant Misra, Gene Bolles, David Adelson, Robert Dempsey, Peter Hutchinson, Abenezer Aklilu, Abigail Javier-Lizan, Adil Belhachmi, Ahtesham Khizar, Alexandru Tascu, Ali Yalcinkaya, Aliyu Baba Ndajiwo, Alvan-Emeka Ukacjukwu, Amit Agrawal, Amit Thapa, Ana C.V. Silva, Armin Gretschel, Arvind Sukumaran, Atul Vats, Bakr Abo Jarad, Balgopal Karmacharya, Bipin Chaurasia, Boon Seng Liew, Carlos A. Rodriguez Arias, Claire Karekezi, Cohen-Inbar Or, Danjuma Sale, Davendran Kanesen, Djula Djilvesi, Evarsitus Nwaribe, M. Elhaj Mahmoud, Mian Awais, Sanjay Kumar, Amos O. Adeleye, Manish Agarwal, Menelas Nkeshimana, Sunday David Ndubuisi Achebe, Walid El Gaddafi, Ece Uysal, Eghosa Morgan, Elubabor Buno, Emmanuel Sunday, Esayas Adefris, Fayez Alelyani, Felipe Constanzo, Gabriel Longo, Ghulam Farooq, Goertz Mirenge Dunia, Gyang Markus Bot, Hamisi K. Shabani, Harch Deora, Hassan Almenshawy, Hazem Kuheil, Igor Lima Maldonado, Ionut Negoi, Irfan Yousaf, Jafri Malin Abdullah, Jagos Golubovic, Khalil Ayadi, Kriengsak Limpastan, Luxwell Jokonya, Mirsad Hodzic, Mohamed Kassem, Mohammed Al-Rawi, Muhammad Tariq, Mykola Vyval, Nidal Abuhadrous, Nikolaos Syrmos, Osaid Alser, Paul H. Young, Petra Wahjoepramono, Prabu Rau Sriram, Rafik Ouchetati, Recep Basaran, Ritesh Bhoot, Robson Amorim, Rosanda Ilić, Saman Wadanamby, Samuel M. Fetene, Sanjay Behari, Satish Babu, Trung Kien Duong, Tsegazeab Laeke, Ulrick S. Kanmounye, Vladimir Komar, Ipe Vazheeparambil George, Zahid Hussain, Lynne Lourdes N. Lucena, Hugues Brieux Ekouele Mbaki, Ken-Keller Kumwenda, Djvnaba Bah, Ibrahim E. Efe, Dickson Bandoh, Yunus Kuntawi Aji, and Thomas Dakurah

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

Background: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to nonspecialists, particularly in low- and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics. Results: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%). Conclusions: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce. Key words: Capacity, Global health, Global neurosurgery, LMIC, Task-sharing, Task-shifting, Workforce

Published
2020
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3. Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Author

Ali Yalcinkaya, Adil Belhachmi, Amos Olufemi Adeleye, Abigail Javier-Lizan, Rosanda Ilić, Fayez Alelyani, Alvan-Emeka Ukacjukwu, Jannick Brennum, Hugues Brieux Ekouele Mbaki, Rafik Ouchetati, Emmanuel Sunday, Recep Basaran, Jagos Golubovic, Jafri Malin Abdullah, Robson Luis Oliveira de Amorim, Peter J. Hutchinson, Abenezer Tirsit Aklilu, Walid El Gaddafi, Marike L. D. Broekman, Andres M. Rubiano, Yunus Kuntawi Aji, Ken-Keller Kumwenda, Carlos Arias, Magnus Tisel, Goertz Mirenge Dunia, Gail Rosseau, Mirsad Hodzic, Kriengsak Limpastan, Mian Awais, Claire Karekezi, Kee B. Park, B S Liew, Trung Kien Duong, Prabu Rau Sriram, Muhammad Tariq, Saman Wadanamby, Timothy R. Smith, Gabriel Longo, Sunday David Ndubuisi Achebe, Felipe Constanzo, Basant Misra, Ionut Negoi, Satish Babu, Thomas Dakurah, Ghulam Farooq, Stephen Honeybul, Menelas Nkeshimana, Luxwell Jokonya, Igor Lima Maldonado, David Adelson, Hassan Almenshawy, Tariq Khan, Arvind Sukumaran, Vladimir Komar, Hazem Kuheil, Robert J. Dempsey, Osaid Alser, Djula Djilvesi, Armin Gretschel, Danjuma Sale, Amit Agrawal, Sanjay Kumar, Hamisi K. Shabani, Amit Thapa, Nidal Abuhadrous, Michael M. Haglund, Mohamed Kassem, Ignatius N. Esene, Sanjay Behari, Bakr Abo Jarad, Dickson Bandoh, Ahmed Ammar, Severien Muneza, Djvnaba Bah, Ritesh Bhoot, Esayas Adefris, Samuel M. Fetene, Gene Bolles, Paul H. Young, Aliyu Baba Ndajiwo, Eghosa Morgan, Manish Agarwal, Harch Deora, Davendran Kanesen, Khalil Ayadi, Graham Fieggen, Lynne Lourdes N. Lucena, Ivar Mendez, Akira Matsumara, William B. Gormley, Evarsitus Nwaribe, Cohen-Inbar Or, Patrick Kamalo, Mykola Vyval, Faith C. Robertson, Zahid Hussain, Ece Uysal, Mohammed A. Alrawi, Nikolaos Syrmos, Balgopal Karmacharya, Angelos G. Kolias, Ipe Vazheeparambil George, Ana Cristina Veiga Silva, Tsegazeab Laeke, Naci Balak, Irfan Yousaf, Ibrahim E. Efe, Gyang Markus Bot, Atul Vats, M. Elhaj Mahmoud, Jeffrey V. Rosenfeld, Elubabor Buno, Alexandru Tascu, Ulrick Sidney Kanmounye, Ahtesham Khizar, Bipin Chaurasia, and Petra Wahjoepramono

Subjects
medicine.medical_specialty, Referral, Global health, lcsh:Surgery, Psychological intervention, Global neurosurgery, Certification, MOH, Ministry of Health, lcsh:RC346-429, Maintenance of Certification, LMIC, Patient safety, LMIC, Low- and middle-income country, TS/S, Task-shifting and task-sharing, medicine, lcsh:Neurology. Diseases of the nervous system, Task-sharing, Capacity, Descriptive statistics, business.industry, lcsh:RD1-811, Task-shifting, Family medicine, DRC, Democratic Republic of the Congo, Workforce, Original Article, Surgery, Neurology (clinical), business
Abstract

Background: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to nonspecialists, particularly in low- and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics. Results: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%). Conclusions: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce. Key words: Capacity, Global health, Global neurosurgery, LMIC, Task-sharing, Task-shifting, Workforce

Published
2020

4. Synchronous intravascular large B-cell lymphoma within meningioma

Author

Zhao-Dong Xu, John Woulfe, Richard Moulton, Bruce F. Burns, Salmin Muftah, and Walid El Gaddafi

Subjects
medicine.medical_specialty, Intravascular large B-cell lymphoma, Pathology, Hematology, Cerebral Convexity, business.industry, Aggressive lymphoma, General Medicine, medicine.disease, Pathology and Forensic Medicine, Lymphoma, Meningioma, Internal medicine, medicine, Histopathology, Neurology (clinical), Fever of unknown origin, business
Abstract

Intravascular large B-cell lymphoma is a rare and aggressive lymphoma with a dismal prognosis. Synchronous intravascular large B-cell lymphoma within meningioma has not previously been documented. We report a case of a 73-year-old woman of Asian descent who presented with fever of unknown origin with generalized weakness. CT scan and MRI of the head revealed a dural-based mass lesion consistent with meningioma in the left frontal cerebral convexity. Surgery was performed to remove the tumor and histopathology showed a meningioma within which was a synchronous intravascular large B-cell lymphoma. The hematology and oncology services were consulted and palliative treatment was initiated due to the patient's poor Eastern Cooperative Oncology Group performance status. The patient died within 30 days post-surgery. To the best of our knowledge, this case represents the first report of synchronous intravascular large B-cell lymphoma within a meningioma.

Published
2011

5. Synchronous intravascular large B-cell lymphoma within meningioma

Author

Salmin, Muftah, Zhaodong, Xu, Walid, El Gaddafi, Richard, Moulton, Bruce, Burns, and John, Woulfe

Subjects
Neoplasms, Multiple Primary, Brain Neoplasms, Meningeal Neoplasms, Humans, Female, Lymphoma, Large B-Cell, Diffuse, Meningioma, Vascular Neoplasms, Aged
Abstract

Intravascular large B-cell lymphoma is a rare and aggressive lymphoma with a dismal prognosis. Synchronous intravascular large B-cell lymphoma within meningioma has not previously been documented. We report a case of a 73-year-old woman of Asian descent who presented with fever of unknown origin with generalized weakness. CT scan and MRI of the head revealed a dural-based mass lesion consistent with meningioma in the left frontal cerebral convexity. Surgery was performed to remove the tumor and histopathology showed a meningioma within which was a synchronous intravascular large B-cell lymphoma. The hematology and oncology services were consulted and palliative treatment was initiated due to the patient's poor Eastern Cooperative Oncology Group performance status. The patient died within 30 days post-surgery. To the best of our knowledge, this case represents the first report of synchronous intravascular large B-cell lymphoma within a meningioma.

Published
2011

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