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Evolving concepts in intracranial pressure monitoring - from traditional monitoring to precision medicine.
Neurotherapeutics
January 2025
Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:
A wide range of acute brain injuries, including both traumatic and non-traumatic causes, can result in elevated intracranial pressure (ICP), which in turn can cause further secondary injury to the brain, initiating a vicious cascade of propagating injury. Elevated ICP is therefore a neurological injury that requires intensive monitoring and time-sensitive interventions. Patients at high risk for developing elevated ICP undergo placement of invasive ICP monitors including external ventricular drains, intraparenchymal ICP monitors, and lumbar drains.
View Article and Find Full Text PDFDevelopment and Validation of a Neurosurgical Phantom for Simulating External Ventricular Drain Placement.
J Med Syst
January 2025
Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements.
View Article and Find Full Text PDFSunset Sign Due to Intraventricular Tension Pneumocephalus: A Key Clue to Evaluating Delayed Emergence After General Anesthesia.
Cureus
November 2024
Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, USA.
Prompt emergence from general anesthesia is crucial after neurosurgical procedures, such as craniotomies, to facilitate timely neurological evaluation for identification of intraoperative complications. Delayed emergence can be caused by residual anesthetics, metabolic imbalances, and intracranial pathology, for which an eye examination can provide early diagnostic clues. The sunset sign (or setting sun sign), characterized by a downward deviation of the eyes, can be an early indicator of raised intracranial pressure (ICP) or midbrain compression, as is commonly observed in states of hydrocephalus or periaqueductal or tectal plate dysfunction.
View Article and Find Full Text PDFFear of violence and brain drain analysis among healthcare workers in Turkey.
BMC Health Serv Res
December 2024
Child Health and Diseases Department, Istanbul Education Research Hospital, Istanbul, Türkiye.
Background: This study investigates the relationship between healthcare professionals' intention to emigrate and their exposure to violence in Turkey, using a quantile regression model. Through this approach, it aims to reveal how healthcare professionals' attitudes toward brain drain vary across different levels of fear of violence, considering factors such as professional experience and income.
Methods: A cross-sectional study design was employed, utilizing a quantile regression model to analyze the variation in brain drain attitudes across different percentiles.
Retention strategies for medical doctors in low- and middle-income countries (LMICs): are they effective? A scoping review.
BMC Health Serv Res
December 2024
Centre of Leadership and Professional Development, Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
Background: High turnover among the medical professions is detrimental to the healthcare system and population well-being, particularly in low- and middle-income countries (LMICs) with limited financial and human resources. To prevent brain drain, effective strategies are vital to improve the retention of healthcare workers, especially doctors. However, little evidence has been synthesised regarding the effectiveness of these strategies, especially in LMICs.
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