Global Perspectives on Task Shifting and Task Sharing in Neurosurgery.

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

Pattern of neurological diseases at the Jimma University Medical Center neurology clinic, Jimma, Ethiopia, 2015–17: a survey of newly enrolled patients

Background: The burden of neurological diseases is higher in low-income and middle-income countries than in high-income countries. However, there is a paucity of literature on neurological diseases in sub-Saharan Africa, including Ethiopia. This study aims to describe the pattern of neurological diseases in newly enrolled patients at the neurology clinic of Jimma University Medical Center, Ethiopia. Methods: I collected data from records for newly enrolled neurological patients at Jimma University Medical Center neurology clinic between June 30, 2015, and June 30, 2017. I used a sampling technique to calculate the required sample size and I used SPSS version 24.0 for analysis. Findings: I accessed data from 2347 medical patients, 639 (27·2%) of whom were diagnosed with a neurological disorder, and data from 226 of these were included in final analysis. Most patients were male (143 [63·3%]). Mean age was 38·17 years (SD 17·75, range 15–80 years); 131 patients (57·9%) were aged between 15 and 40 years. The most common reasons for attending were: convulsion (96, 42·5%); hemiparesis (62, 27·4%); and pain, paraesthesia, and tingling sensation (24, 10·6%). Most patients (92, 40·7%) reported that they had had symptoms for more than 1 month; however, 43 (19%) presented within 24 h of symptom onset and 17 (7·5%) within 3 h. The most common conditions in the study group were epilepsy (95 patients, 42%), cerebrovascular disease (67, 29·6%), peripheral neuropathy (26, 11·5%), and Parkinson's disease (10, 4·4%). ICD-10 classification episodic and paroxysmal disorders were observed in 165 patients (72·9%); polyneuropathies and other disorders of the peripheral nervous system, and extrapyramidal and movement disorders were noted in 36 patients (15·9%). Interpretation: The causes of neurological morbidity in this low-resource setting are highly disabling but easily preventable and treatable. Hypertension was the most common comorbidity, especially in patients with stroke and peripheral neuropathy, so patients should be advised on lifestyle modification and be managed appropriately. Importantly, health-care policy makers should focus on planning for disease prevention and better management of common neurological disorders. Funding: None