Cargando…
The Current State of Rural Neurosurgical Practice: An International Perspective
INTRODUCTION: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812136/ https://www.ncbi.nlm.nih.gov/pubmed/29456356 http://dx.doi.org/10.4103/jnrp.jnrp_273_17 |
_version_ | 1783299986629328896 |
---|---|
author | Upadhyayula, Pavan S. Yue, John K. Yang, Jason Birk, Harjus S. Ciacci, Joseph D. |
author_facet | Upadhyayula, Pavan S. Yue, John K. Yang, Jason Birk, Harjus S. Ciacci, Joseph D. |
author_sort | Upadhyayula, Pavan S. |
collection | PubMed |
description | INTRODUCTION: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. METHODS: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. RESULTS: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. CONCLUSIONS: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery. |
format | Online Article Text |
id | pubmed-5812136 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-58121362018-02-16 The Current State of Rural Neurosurgical Practice: An International Perspective Upadhyayula, Pavan S. Yue, John K. Yang, Jason Birk, Harjus S. Ciacci, Joseph D. J Neurosci Rural Pract Review Article INTRODUCTION: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. METHODS: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. RESULTS: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. CONCLUSIONS: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5812136/ /pubmed/29456356 http://dx.doi.org/10.4103/jnrp.jnrp_273_17 Text en Copyright: © 2018 Journal of Neurosciences in Rural Practice http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Review Article Upadhyayula, Pavan S. Yue, John K. Yang, Jason Birk, Harjus S. Ciacci, Joseph D. The Current State of Rural Neurosurgical Practice: An International Perspective |
title | The Current State of Rural Neurosurgical Practice: An International Perspective |
title_full | The Current State of Rural Neurosurgical Practice: An International Perspective |
title_fullStr | The Current State of Rural Neurosurgical Practice: An International Perspective |
title_full_unstemmed | The Current State of Rural Neurosurgical Practice: An International Perspective |
title_short | The Current State of Rural Neurosurgical Practice: An International Perspective |
title_sort | current state of rural neurosurgical practice: an international perspective |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812136/ https://www.ncbi.nlm.nih.gov/pubmed/29456356 http://dx.doi.org/10.4103/jnrp.jnrp_273_17 |
work_keys_str_mv | AT upadhyayulapavans thecurrentstateofruralneurosurgicalpracticeaninternationalperspective AT yuejohnk thecurrentstateofruralneurosurgicalpracticeaninternationalperspective AT yangjason thecurrentstateofruralneurosurgicalpracticeaninternationalperspective AT birkharjuss thecurrentstateofruralneurosurgicalpracticeaninternationalperspective AT ciaccijosephd thecurrentstateofruralneurosurgicalpracticeaninternationalperspective AT upadhyayulapavans currentstateofruralneurosurgicalpracticeaninternationalperspective AT yuejohnk currentstateofruralneurosurgicalpracticeaninternationalperspective AT yangjason currentstateofruralneurosurgicalpracticeaninternationalperspective AT birkharjuss currentstateofruralneurosurgicalpracticeaninternationalperspective AT ciaccijosephd currentstateofruralneurosurgicalpracticeaninternationalperspective |