World Neurosurg
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Strong performance in neurosurgical sub-internships is a vital component of a successful residency application and requires adequate familiarity with clinical knowledge and technical skills that may not be covered in standard medical school curricula. Accordingly, a need exists for immersive and comprehensive sub-internship preparation programs that respect time and resource limitations, are optimized based on longitudinal student feedback, provide opportunities for mentorship, and foster enthusiasm for neurosurgery. Therefore, residents at a single institution designed and implemented a comprehensive curriculum for a 1-day sub-internship academy. ⋯ Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and provided opportunities for mentorship. The participants indicated the academy positively impacted their sub-internship performance, and areas for improvement to guide future iterations of the academy were identified.
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Aneurysmal subarachnoid hemorrhage (aSAH) is a common neurosurgical disorder with high morbidity and poor prognosis, and the associated delayed cerebral ischemia (DCI) is a key factor contributing to poor prognosis. Despite extensive research on the risk factors associated with DCI development, the evidence remains conflicting. Therefore, this meta-analysis of case-control studies aimed to investigate the risk factors for DCI occurrence during hospitalization in patients with aSAH. ⋯ Patients with aSAH who have a Hunt-Hess scale score ≥4, a modified Fisher scale score ≥3, a WFNS scale score ≥4, intraventricular hemorrhage, pre-existing hypertension, cerebral vasospasm, a high white blood cell count on admission, intracranial infection, and female sex are at high risk of DCI and hence should be carefully monitored in the intensive care unit.
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Caregiver health literacy (HL) in patients' transition from hospital to home care is an important factor for good results. ⋯ Key findings showed that caregivers with higher HL were typically younger, male, better educated, and more likely to be healthcare professionals. These caregivers managed patients with lower dependence on daily activities, while those with lower HL, mainly females, cared for patients with higher dependence. The study highlights the need for targeted interventions and public policies to enhance HL among caregivers, particularly to improve outcomes for patients with complex needs.
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Dorsal root ganglion (DRG) stimulator leads were designed to be placed percutaneously, yet open surgical placement via laminectomy is an option. We present the largest series to date of surgically-placed DRG stimulators and the first series where open surgical implantation was the chosen technique and not a salvage procedure. ⋯ Open DRG lead placement via laminotomy/laminectomy is reported as a salvage procedure but may have comparable safety and efficacy profile to percutaneous implantation when utilized as the primary implantation method. Before establishing open DRG as an alternative permanent implantation method, more studies are needed to determine whether such benefits as less migration outweigh the risks of a more invasive implantation procedure.
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This study aimed to identify surgical, patient-specific, and radiographic risk factors for proximal junctional failure (PJF), a complex complication following adult spinal deformity (ASD) surgery. ⋯ In ASD patients, the presence of concurrent osteoporosis or paravertebral muscle wasting significantly increases the risk of developing PJF. The use of bicortical screws, UIV screw angle exceeding 1°, and positioning the UIV in the lower thoracic or lumbar region also further elevate this risk. Lower preoperative SS, higher preoperative PI-LL, higher preoperative pelvic tilt, higher preoperative SVA, higher postoperative LL, and a greater change in LL characterize patients with PJF.