9 research outputs found
Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study
Background: Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa.
Materials and methods: A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value \u3c0.05 was considered statistically significant.
Results: We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001).
Conclusion: There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability
Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study
Background: Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa.
Materials and methods: A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value \u3c0.05 was considered statistically significant.
Results: We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001).
Conclusion: There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability
Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.
Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group
CongrĂšs AFMED 2017 : Place de la diaspora dans lâĂ©volution de la chirurgie Ă Lubumbashi : cas de la Clinique MEDPARK: Place of the diaspora in the evolution of surgery in Lubumbashi: case of the MEDPARK hospital
Contexte et objectifs. La diaspora Congolaise reprĂ©sente aujourdâhui une alternative au dĂ©veloppement du secteur mĂ©dical en rĂ©publique DĂ©mocratique du Congo. Câest le cas de la clinique MedPark qui est un vĂ©ritable centre mĂ©dical de rĂ©fĂ©rence, crĂ©Ă© en Juillet 2016 Ă Lubumbashi dans la Province du Haut Katanga par le Professeur Muganza Adelin chirurgien GĂ©nĂ©ral et ViscĂ©ral oeuvrant Ă lâuniversitĂ© de Johannesburg, en collaboration avec dâautres chirurgiens de la diaspora et ceux oeuvrant au pays. Câest une clinique Ă vocation chirurgicale dans son ensemble et dispose dâun service dâurgences, de rĂ©animation et dâun plateau technique chirurgical performant.Nous allons prĂ©senter la pratique chirurgicale dans son ensemble sur 12 mois et montrer lâimpact de ce centre dans la formation continue Ă Lubumbashi en partenariat avec lâuniversitĂ© de Lubumbashi.MĂ©thodes. Il sâagit dâune Ă©tude rĂ©trospective portant sur 156 patients opĂ©rĂ©s Ă la Clinique MedPark, allant de Juillet 2016 au juillet 2017 et qui a consistĂ© en une Ă©valuation Ă©pidĂ©miologique et une analyse statistique de la sĂ©rie.RĂ©sultats. Sur cette pĂ©riode, 156 patients ont Ă©tĂ© opĂ©rĂ©s durant la pĂ©riode dâĂ©tude, lâĂąge moyen Ă©tant de 38 ans, un sex ratio de 2,6 H/1F.La rĂ©partition selon la discipline chirurgicale permet de retrouver la chirurgie viscĂ©rale et gĂ©nĂ©rale dans une proportion de 32% des cas, la neurochirurgie 28% des cas et lâurologie 17% des cas et la traumatologie et orthopĂ©die 13% des cas.LâĂ©volution post-opĂ©ratoire Ă©tait favorable dans 78% des cas.Nous avons enregistrĂ© 2,5% des cas dâinfections postopĂ©ratoires. La mortalitĂ© post-opĂ©ratoire Ă©tait de 6,4% des cas.Conclusions. Les mĂ©decins spĂ©cialistes de la diaspora Congolaise en collaboration avec des mĂ©decins spĂ©cialistes du pays et la FacultĂ© de mĂ©decine de Lubumbashi reprĂ©sentent une alternative au dĂ©veloppement de la chirurgie dans le Haut Katanga. Les rĂ©sultats de la sĂ©rie sont encourageants
Neurosurgery Education Around the World: Africa
In Africa, neurosurgery, as an independent specialty, started approximately 60 years ago introduced by European neurosurgeons in their respective colonized countries. After gaining independence from Europe, in many African countries local physicians and especially neurosurgeons were scarce or absent. In 1998, the neurosurgeon/inhabitant ratio was 1/230,000 in the world, whereas in Africa they averaged at 1/1,238,000. Since 86% of African neurosurgeons were concentrated in the North and South, SSA had a ratio of 1/6,368,000. In North and South Africa, neurosurgery had a faster pace in developing than in Sub-Saharan Africa (SSA) for many reasons, including socioeconomics. Since then, efforts to grow the neurosurgery workforce have been very successful. Their success stemmed from the hard work of local neurosurgeons coupled with international efforts, including the World Federation of Neurosurgical Societies (WFNS). This joint venture created cost-effective neurosurgical training centers in Africa with high retention rate of the trained workforce. By 2025, the African population is expected to reach 1.4 billion people with 1.1 billion in SSA. Such growth poses opportunities and challenges to the continued efforts to improve the availability of workforce, facilities, equipment, and supplies to provide neurosurgical care in Africa. In this chapter, the authors provide background, data, and proposed strategies for the above-summarized topics
Clinical characteristics of COVID-19 patients hospitalized at Clinique Ngaliema, a public hospital in Kinshasa, in the Democratic Republic of Congo: A retrospective cohort study.
ObjectivesTo describe the clinical characteristics of patients infected with SARS-CoV-2 at Clinique Ngaliema, a public hospital, in Kinshasa, in the Democratic Republic of Congo (DRC).MethodsThis retrospective study analyzed medical records including socio-demographics, past medical history, clinical manifestation, comorbidities, laboratory data, treatment and disease outcome of 160 hospitalized COVID-19 patients, with confirmed result of SARS-CoV-2 viral infection.ResultsThe median age of patients was 54 years (IQR: 38-64), and there was no significant gender difference (51% of male). The most common comorbidities were hypertension (55 [34%]), diabetes (31 [19%]) and obesity (13 [8%]). Fever (93 [58%]), cough (92 [57%]), fatigue (87 [54%]), shortness of breath (72 [45%]) and myalgia (33 [21%]) were the most common symptoms, upon admission. Patients were categorized into mild (92 [57%]), moderate (19 [12%]) and severe (49 [31%]). Severe patients were older and were more likely to have comorbidities, compared to mild ones. The majority of patients (92% [147 of 160]) patients received hydroxychloroquine or chloroquine phosphate. Regression model revealed that older age, lower SpO2, higher heart rate and elevated AST at admission were all risk factors associated with in-hospital death. The prevalence of COVID-19 and malaria co-infection was 0.63% and 70 (44%) of all patients received antimalarial treatment before hospitalization.ConclusionOur findings indicated that the epidemiological and clinical feature of COVID-19 patients in Kinshasa are broadly similar to previous reports from other settings. Older age, lower SpO2, tachycardia, and elevated AST could help to identify patients at higher risk of death at an early stage of the illness. Plasmodium spp co-infection was not common in hospitalized COVID-19 patients
Surgical Navigation Stimulator by Reality Mixed for Teaching and Practice in percutaneous spine procedures
Introduction: Spine Have, a mixed reality navigation simulator, has been developed to enhance the training of resident doctors in orthopedics, neurosurgery, and related fields like anesthesiology. This tool allows residents to practice intricate lumbar procedures virtually, including facet infiltration and transpedicular screw placement, thereby improving their learning curve and reducing patient risks. This simulator serves as both a teaching aid and a pre-surgical planning tool, potentially lowering operating time and fluoroscopy use.
Materials and Methods: The SpineNav simulator integrates 3D models from real patient CT scans with polyurethane and silicone mannequins, employing mixed reality to enhance lumbar spine procedure training. It provides realistic anatomical models for procedural practice, including facet infiltration and transpedicular screw placement. System validation involved comparing performance metrics like procedure time and accuracy between this new system and traditional fluoroscopy methods.
Results: The study validated the efficacy of the SpineNav Mixed Reality Simulator by comparing it with traditional fluoroscopy methods. Seven orthopedic and anesthesiology residents participated, performing three types of lumbar procedures: facet infiltration, transpedicular screw placement, and locating Kambin's triangle. The mixed reality system significantly reduced procedure time (p < 0.05) compared to traditional methods. Specifically, the mean procedure times for the SpineNav system were 15 minutes for facet infiltration, 25 minutes for transpedicular screw placement, and 20 minutes for locating Kambin's triangle. Accuracy metrics showed no significant difference in error rates (distance to target points) between the two methods, indicating comparable precision. Participants reported higher satisfaction with the SpineNav simulator, highlighting its ease of use, realism, and utility in enhancing spatial orientation and procedural understanding.
Conclusions: The SpineNav Mixed Reality Simulator marks a significant advancement in surgical education for spine procedures. By integrating 3D models, additive manufacturing, and mixed reality technology, it provides an effective training tool for orthopedics and neurosurgery residents. The study found that the simulator significantly reduced procedure times while maintaining accuracy comparable to traditional methods. Participants reported high satisfaction, noting its ease of use and realistic feedback. Overall, the SpineNav simulator shortens the learning curve and enhances training efficiency, offering a valuable resource for improving surgical skills and patient safety
Impact de la mise en place dâun rĂ©seau des soins pour la traumatologie grave dans la ville de Kinshasa, RD Congo : Ă©tude quasi-expĂ©rimentale
Contexte et objectif: Une part non nĂ©gligeable de dĂ©cĂšs posttraumatiques semble Ă©vitable par une meilleure prise en charge. Lâobjectif de la prĂ©sente Ă©tude Ă©tait dâĂ©valuer lâimpact de la mise en place dâun rĂ©seau des soins sur la mortalitĂ© des patients traumatisĂ©s graves dans la ville de Kinshasa.
MĂ©thodes: CâĂ©tait une Ă©tude multicentrique quasi-expĂ©rimentale avant/aprĂšs portant sur les patients adultes hospitalisĂ©s en rĂ©animation ousoins intensifs pour traumatisme grave, entre le 1er janvier 2009 et le 31 dĂ©cembre 2014. Lâintervention a consistĂ© Ă la mise en place dâun rĂ©seau de soins entre les deux groupes. La mortalitĂ© hospitaliĂšre ajustĂ©e sur lâĂąge, le sexe et le score RTS Ă©taient le critĂšre de jugement principal.
RĂ©sultats: Au total, 4 hĂŽpitaux ont participĂ© et ont inclus 195 patients consĂ©cutifs dans le groupe prĂ©-interventionnel contre 9 hĂŽpitaux et 210 patients dans le groupe post-interventionnel. Entre les deux groupes, le taux dâadmission directe sâest amĂ©liorĂ© (48,6 % vs 75,9 %) ainsi que le temps dâarrivĂ©e Ă lâhĂŽpital (6,5 h vs 4,2 h). Il a Ă©tĂ© relevĂ© une diminution des volumes de perfusion associĂ©e Ă une augmentation des taux dâutilisation des catĂ©cholamines (2% vs 6,6 %), de la transfusion sanguine (15,8 % vs 25,7 %) et de lâacide tranexamique (zĂ©ro % vs 77,6 %). Le taux dâintubationen cas de GCS < 9 (13,2 % vs 37 %), dâadministration de mannitol en prĂ©sence dâune mydriase (58 % vs 72,4 %) et de rĂ©alisation du scanner cĂ©rĂ©bral chez les patients ayant un GCS â€14 (10,6 % vs 54,6%) ont augmentĂ© Ă©galement. En revanche, le pourcentage de patients ayant bĂ©nĂ©ficiĂ© dâun drainage thoracique (0,5 % vs 1,4 %) et la frĂ©quence dâactes de chirurgie (43 % vs 50 %) nâont pas significativement variĂ©. La mortalitĂ©, quant Ă elle, est significativement passĂ©e de 73,3 % Ă 54,7 %.
Conclusion: Une amélioration des pratiques et une baisse de la mortalité ont été observées aprÚs la mise en place du réseau de soins.
English title: Impact of the establishment of a severe trauma care network in the City of Kinshasa, Democratic Republic of the Congo: a quasi-experimental study
Context and objective: Better management is mandatory for avoidable post-traumatic deaths. This study aimed to assess the impact of the implementation of a trauma network on the mortality of severe trauma patients in Kinshasa, DR Congo.
Methods: The multicentric quasic-experimental before/after survey included adult patients admitted in intensive care unit for trauma in Kinshasa between January 2009 and December 2014. The relevance of the implementation of a trauma network was assessed. In-hospital mortality adjusted for age, gender and RTS score was the primary endpoint.
Results: A total of 195 consecutive patients was concerned from 4 hospitals in the pre-intervention group vs 210 patients from 9 hospitals in the postintervention group. In the two groups, the direct admission rate improved (48.6 % vs 75.9 %) as well as the time of arrival at the hospital (4.2 h vs 6.5 h). There was a decrease in infusion volumes associated with an increase utilization rate of catecholamines 2 % vs. 6.6 %), blood transfusion (15.8 % vs. 25.7 %) and acid tranexamic (0 % vs 77.6 %). The rate of intubation in the event of GCS < 9 (13.2 % vs 37 %), administration of mannitol in the presence of mydriasis (58 % vs 72.4 %) and realization of the brain scan in patients with a GCS â€14 (10.6 % vs 4.6 %) also increased. However, the percentage of patients who received chest drainage (0.5 % vs 1.4 %) and the frequency of surgery (43 % vs 50 %) did not vary significantly. Mortality, meanwhile, fell from 73.3 % to 54.7 %.
Conclusion: An improvement in practices and a reduction in mortality were observed after the implementation of the trauma network