LogDoctor: an open and decentralized worker-centered solution for occupational management in healthcare

Occupational stress among health workers is a pervasive issue that affects individual well-being, patient care quality, and healthcare systems' sustainability. Current time-tracking solutions are mostly employer-driven, neglecting the unique requirements of health workers. In turn, we propose an open and decentralized worker-centered solution that leverages machine intelligence for occupational health and safety monitoring. Its robust technological stack, including blockchain technology and machine learning, ensures compliance with legal frameworks for data protection and working time regulations, while a decentralized autonomous organization bolsters distributed governance. To tackle implementation challenges, we employ a scalable, interoperable, and modular architecture while engaging diverse stakeholders through open beta testing and pilot programs. By bridging an unaddressed technological gap in healthcare, this approach offers a unique opportunity to incentivize user adoption and align stakeholders' interests. We aim to empower health workers to take control of their time, valorize their work, and safeguard their health while enhancing the care of their patients

Posterior quadrant disconnection for refractory epilepsy: how I do it

Background: Posterior quadrant disconnection (PQD) is intended to interrupt the propagation of intractable unilateral temporo-parieto-occipital epilepsy. Method: An enhanced operative video presents the illustrative case of a total PQD indicated for a 15-year-old boy with Sturge-Weber syndrome suffering from seizure recurrence after a partial PQD. We describe the surgical procedure with emphasis on relevant anatomy and multimodal intraoperative guidance in three steps: (i) parieto-occipital disconnection, (ii) posterior callosotomy, and (iii) temporal disconnection/resection. Pearls and pitfalls of surgical management are discussed. Conclusion: PQD is a less invasive surgical option to typical hemispherotomy and hemispherectomy for selected indications of posterior multilobar epilepsy.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

External hydrocephalus associated with dural sigmoid sinus arteriovenous fistula: a case report

External hydrocephalus (EH) is a recognised sub-type of hydrocephalus associated with macrocephaly in infancy. EH is characterised by the enlargement of subarachnoid spaces (so-called subarachnomegaly) with a normal ventricular system on brain imaging. EH is traditionally considered benign and self-limiting, yet its pathophysiology remains puzzling. Mounting evidence for an association between EH and hydrovenous disorders reshapes our understanding of this condition and its management. To our knowledge, we report the first association between EH and dural arteriovenous fistula (dAVF) in a 17-months-old boy. As dAVF may be a life-threatening condition, early diagnosis and optimal treatment are critical. This case epitomises the intricacies of EH’s aetiology and associated conditions requiring careful management. Therefore, we recommend considering MR angiography in EH’s workup and long-term follow-up. Our experience supports the ongoing reconsideration of EH’s presumed benignity.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Complete Corpus Callosotomy for Refractory Epilepsy in Children

Corpus callosotomy is an interhemispheric disconnection by callosal commissural fiber ablation. Its rationale is the disruption of ictal spread to prevent seizure generalization. The objective pursued is alleviation of intractable, debilitating, and injurious manifestations of generalized epilepsy.1 Eight decades of experience support this procedure's safety and effectiveness for appropriately selected patients with drug-resistant epilepsy not amenable to optimal resection; particularly, favorable outcomes for tonic or atonic seizures with drop attacks have been reported.2,3 Children may benefit more than adults from callosotomy for improved daily function, psychosocial adjustment, and family satisfaction.4 A meta-analysis found a better seizure reduction from total than partial callosotomy (88.2% vs. 58.6% of worthwhile reduction) comprising drop-attacks (77.8% vs. 45.4%) with an increased but transient (i.e. resolution within 6 weeks) risk of significant disconnection syndromes (12.5% vs. none).5 Here, we present the illustrative case of a 4-year-old boy with Lennox-Gastaut syndrome who underwent open single-stage complete callosotomy. Video 1 shows the microscope-assisted interhemispheric approach aided by stereotactic navigation. We showcase critical steps such as dissection of cingulate gyri and anterior and then posterior callosotomy while highlighting crucial anatomic landmarks. This procedure may be accessible for epilepsy surgeons worldwide in resource-constrained environments6 while serving as a basis for promising high-technology development (e.g. endoscopic, radiosurgical, laser interstitial thermal therapy, or magnetic resonance−guided focused ultrasound callosotomies). In this video article, we aim to provide a streamlined and stepwise approach to this rare but important epilepsy surgery.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Single-stage resection of bottom-of-a-sulcus dysplasia involving eloquent cortex using navigated transcranial magnetic stimulation and intraoperative modalities

Background: Focal cortical dysplasia (FCD) is a common etiology of refractory epilepsy, particularly in children. Surgical management is potentially curative, but poses the challenge of distinguishing the border between ictogenic regions of dysplasia and functionally critical brain tissue. Bottom-of-a-sulcus dysplasia (BOSD) amplifies this challenge, due to difficulties in physiologic mapping of the deep tissue. Methods: We report a one-stage resection of a dysplasia-associated seizure focus abutting and involving the hand and face primary motor cortex. In doing so, we describe our surgical planning integrating neuronavigated transcranial magnetic stimulation (nTMS) for functional motor mapping, combined with intraoperative ultrasonography, intracranial electroencephalography, and magnetic resonance imaging (MRI). A 5-year-old girl with intractable focal epilepsy was referred to our comprehensive epilepsy program. Despite attentive pharmacotherapy, she experienced status epilepticus and up to 70 seizures per day, accompanied by multiple side effects from her antiseizure medication. A right frontal BOSD in close proximity to the hand motor area of the precentral gyrus was identified on MRI. Postoperatively, she is seizure-free for over 1 year with no hand deficit. Conclusion: Although technically complex, single-stage resection taking advantage of comprehensive surgical planning with optimized fusion of functional mapping and intraoperative modalities merits consideration given the invasiveness of a two-stage approach for limited added value. Integrated pre-surgical nTMS allowed for mapping of eloquent cortex without invasive electrocortical stimulation.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Traumatic brain injury (TBI) is a major public health burden, causing death and disability worldwide. Intracranial hypertension and brain hypoxia are the main mechanisms of secondary brain injury. As such, management strategies guided by intracranial pressure (ICP) and brain oxygen (PbtO2) monitoring could improve the prognosis of these patients. Our objective was to summarize the current evidence regarding the impact of PbtO2-guided therapy on the outcome of patients with TBI. We performed a systematic search of PubMed, Scopus, and the Cochrane library databases, following the protocol registered in PROSPERO. Only studies comparing PbtO2/ICP–guided therapy with ICP-guided therapy were selected. Primary outcome was neurological outcome at 3 and 6 months assessed by using the Glasgow Outcome Scale; secondary outcomes included hospital and long-term mortality, burden of intracranial hypertension, and brain tissue hypoxia. Out of 6254 retrieved studies, 15 studies (n = 37,245 patients, of who 2184 received PbtO2-guided therapy) were included in the final analysis. When compared with ICP-guided therapy, the use of combined PbO2/ICP–guided therapy was associated with a higher probability of favorable neurological outcome (odds ratio 2.21 [95% confidence interval 1.72–2.84]) and of hospital survival (odds ratio 1.15 [95% confidence interval 1.04–1.28]). The heterogeneity (I2) of the studies in each analysis was below 40%. However, the quality of evidence was overall low to moderate. In this meta-analysis, PbtO2-guided therapy was associated with reduced mortality and more favorable neurological outcome in patients with TBI. The low-quality evidence underlines the need for the results from ongoing phase III randomized trials.SCOPUS: re.jinfo:eu-repo/semantics/publishe

COVID-19 Impact on Neurosurgical Practice: Lockdown Attitude and Experience of a European Academic Center

info:eu-repo/semantics/publishe

Applicative accuracy at entry and target points for robot-assisted depth electrodes implantation for drug-resistant epilepsy. Monocentric retrospective analysis of 1090 consecutive trajectories

International audienceBackground: The implantation of SEEG electrodes with robotic assistance has become a standard procedure for invasive intracranial recordings in drug-resistant epilepsy. As compared with laser registration, the use of bony fiducials enables to reach a superior accuracy but requires the placement of 5 to 6 bony markers prior to imaging. Defining bony landmarks on Leskell G-frame is an option whose theoretical registration accuracy (rms value provided by the software) seems satisfactory. However data regarding the applicative accuracy on that method on a great number of procedures in real word conditions has been largely unknown until now. The objective of the present study was to assess the applicative accuracy obtained through this registration method.Methods: Monocentric retrospective analysis of the concordance between the planned and actual trajectories in 73 consecutive patients undergoing intracranial recordings for intractable epilepsy between Oct 2018 and Feb 2023. For each lead, the coordinates of the entry point and target point of the planned trajectory and those of the actual trajectory defined on the postoperative CT were automatically extracted via a dedicated MatLab® script. The Euclidian distance of error in mm at the entry point and target point were computed, as well as the angular deviation in degree between the trajectories. The statistical analysis (uni, multivariate, mixed model) was conducted with R software® (Version 2022.12.0+353)Results: A total of 1090 trajectories (73 patients) were evaluated. The mean Euclidian distance of error at the entry point was 0.86 mm (+/-0.58). At the target point, it was 2.15 mm (+/- 0.72). The mean angle of deviation in degree was 1.23. For orthogonal trajectories, the mean error was 0.55 and 0.43 mm in y and z respectively. The orthogonality of the trajectory was significantly associated with a smaller error at the entry point and target point (p 0.05). The length of the trajectory was significantly correlated to the magnitude of error at the target (p < 0.001; r=0.37). This was found to be ascribable to a certain degree of flexibility of the electrode not to the registration method.Conclusions: These applicative accuracy data show that this registration method does not differ significantly from the one based on additional bony markers. It has the advantage of a homogeneous distribution of the markers around the whole volume of the skull. In addition, it does not require the placement of bony fiducials, which saves time. The mean error at the entry remains infra-millimetric and is consistent with the results of similar studies. The order of magnitude of the difference is not clinically relevant and derives mainly from methodological differences in the metrics for quantifying accuracy

Brain Tissue Oxygenation-Guided Therapy and Outcome in Traumatic Brain Injury: A Single-Center Matched Cohort Study

Brain tissue oxygenation (PbtO2)-guided therapy can improve the neurological outcome of traumatic brain injury (TBI) patients. With several Phase-III ongoing studies, most of the existing evidence is based on before-after cohort studies and a phase-II randomized trial. The aim of this study was to assess the effectiveness of PbtO2-guided therapy in a single-center cohort. We performed a retrospective analysis of consecutive severe TBI patients admitted to our center who received either intracranial pressure (ICP) guided therapy (from January 2012 to February 2016) or ICP/PbtO2-guided therapy (February 2017 to December 2019). A genetic matching was performed based on covariates including demographics, comorbidities, and severity scores on admission. Intracranial hypertension (IH) was defined as ICP &gt; 20 mmHg for at least 5 min. Brain hypoxia (BH) was defined as PbtO2 &lt; 20 mmHg for at least 10 min. IH and BH were targeted by specific interventions. Mann&ndash;Whitney U and Fisher&rsquo;s exact tests were used to assess differences between groups. A total of 35 patients were matched in both groups: significant differences in the occurrence of IH (ICP 85.7% vs. ICP/PbtO2 45.7%, p &lt; 0.01), ICU length of stay [6 (3&ndash;13) vs. 16 (9&ndash;25) days, p &lt; 0.01] and Glasgow Coma Scale at ICU discharge [10 (5&ndash;14) vs. 13 (11&ndash;15), p = 0.036] were found. No significant differences in ICU mortality and Glasgow Outcome Scales at 3 months were observed. This study suggests that the role of ICP/PbtO2-guided therapy should await further confirmation in well-conducted large phase III studies

Fibrin-coated collagen fleece versus absorbable dural sealant for sellar closure after transsphenoidal pituitary surgery: a comparative study

Various surgical methods to prevent postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal surgery have been reported. However, comparative studies are scarce. We aimed to compare the efficacy of a fibrin-coated collagen fleece (TachoSil) versus a dural sealant (DuraSeal) to prevent postoperative CSF leakage. We perform a retrospective study comparing two methods of sellar closure during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma resection: TachoSil patching versus DuraSeal packing. Data concerning diagnosis, reconstruction technique, and surgical outcomes were analyzed. The primary endpoint was postoperative CSF leak rate. We reviewed 198 consecutive patients who underwent 219 EETS for pituitary adenoma from February 2007 and July 2018. Intraoperative CSF leak occurred in 47 cases (21.5%). A total of 33 postoperative CSF leaks were observed (15.1%). A reduction of postoperative CSF leaks in the TachoSil application group compared to the conventional technique using Duraseal was observed (7.7% and 18.2%, respectively; p = 0.062; Pearson exact test) although non-statistically significant. Two patients required lumbar drainage, and no revision repair was necessary to treat postoperative CSF rhinorrhea in Tachosil group. Fibrin-coated collagen fleece patching may be a valuable method to prevent postoperative cerebrospinal fluid (CSF) leaks during EETS for pituitary adenoma resection.SCOPUS: ar.jinfo:eu-repo/semantics/publishe