World Neurosurg
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Dr. Nathan Rifkinson (1912-2010) was an influential neurosurgeon who dedicated his entire career to the people of Puerto Rico. In 1948, he became the first formally trained neurosurgeon to practice in Puerto Rico. Driven by incredible tenacity and with the help of several other neurosurgery professors, he created a world-class neurosurgery residency training center. ⋯ In Puerto Rico, Dr. Rifkinson discovered a new niche that helped him grow to a unique iconic figure, advising physicians and government leaders on the Island. Together with all the other neurosurgery pillars and their extraordinary dedication, our professors have established an incredible legacy. Without the extreme goodness of our neurosurgery professors, neurosurgery in Puerto Rico would not be what it is now.
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Investigating neurosurgical interventions for traumatic brain injury (TBI) involves complex methodological and practical challenges. In the present report, we have provided an overview of the current state of neurosurgical TBI research and discussed the key challenges and possible solutions. ⋯ In settings in which traditional RCTs are difficult to conduct and substantial confounding by indication can be present, observational studies using an instrumental variable analysis and "pragmatic" RCTs are promising alternatives. Embedding TBI research into standard clinical practice should be more frequently considered but will require fundamental modifications to the current health care system. Finally, multimodality outcome assessment will be key to improving future surgical and nonsurgical TBI research.
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Extracranial-intracranial (EC-IC) bypass is a procedure in which a blood vessel outside the skull is connected to one inside the skull to improve cerebral blood flow. Certain aneurysms cannot be treated through standard clipping, and EC-IC bypass may be recommended in such cases. A vast body of literature exists on the use of EC-IC bypass as a treatment for cerebrovascular disorders. While beneficial to surgeons, these publications may not reach all the intended audience, which encourages the use of bibliometric analyses. Although a fraction of historically meaningful publications may not have been sufficiently valued through citation count, bibliometric analysis is the gold standard for assessing the impact of a publication. ⋯ We retrieved the top 50 most-cited articles on EC-IC bypass surgery and identified the landmark publications to provide a foundational understanding of the procedure as a treatment for complex disorders.
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Stepped wedge cluster randomized trials enable rigorous evaluations of health intervention programs in pragmatic settings. In the present study, we aimed to update neurosurgeon scientists on the design of stepped wedge randomized trials. ⋯ Stepped wedge designs can be attractive for study intervention programs aiming to improve the delivery of patient care, especially when examining a small number of heterogeneous clusters.
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Meta Analysis
Epidemiological Pattern of Traumatic Brain Injury in the COVID-19 Pandemic: A Systematic Review and Meta-analysis.
Although the incidence of traumatic brain injury (TBI) has decreased since the beginning of the coronavirus disease 2019 (COVID-19) pandemic and severe acute respiratory syndrome coronavirus 2 is still evolving, the number of TBI cases has still greatly increased in multiple countries. In the present systematic review and meta-analysis, we evaluated the epidemiological characteristics of patients with TBI before and during the COVID-19 pandemic. ⋯ Our results have indicated that during the COVID-19 pandemic, the TBI mortality rate had increased in low- to middle-income countries. The rate of assault as the cause of TBI had also increased during the pandemic.