Bibliometric Analysis of 6 Major European Neurosurgical Publications from 2011-2020 (part 3): a Comparative Metrics Review.

Background: We previously conducted bibliometric analysis of 6 North American neurosurgical journals. Objective: To perform a bibliometric analysis of 6 European neurosurgical journals to build on our previous studies. Methods: We searched Web of Science for articles published in Acta Neurochirurgica, British Journal of Neurosurgery, Child's Nervous System, Journal of Neurological Surgery Part A: Central European Neurosurgery, Journal of Neurosurgical Sciences, and Neurosurgical Review between 2011 and 2020. We analyzed bibliometric parameters related to total annual document distribution, author metrics, journal metrics, country and continental distribution, institution, keywords, and journal impact. Results: European countries provided the greatest contributions. Acta Neurochirurgica followed by Child's Nervous System published the greatest number of articles and had the highest h-index and number of citations. From 2018 to 2020, total documents increased 79.6%, original articles increased 86.5%, review articles increased 103.6%, citations increased 79.6%, number of publishing authors increased 72.1%, number of authors in multi-author documents increased 72.4%, and author's keywords and keywords plus increased 72.4% and 27.0%, respectively. The collaboration index decreased 5.3% from 4.49 to 4.25. Annual published documents and citations were lower for European journals versus North American journals. Conclusion: Several parameters of the European journals increased by 2020. One interesting finding is that growth for the 6 journals dramatically increased in the 2 years prior to the COVID-19 pandemic. While neurosurgeon free time during lockdowns may account for much of the increase in 2020, the trend began before this. Our analysis did not identify a cause for the pre-COVID increases.

Social media in neurosurgery during COVID-19: an evaluation of the role of Neurosurgery Cocktail platform.

BACKGROUND: Social media use in neurosurgery remains an understudied phenomenon. Our study aims to examine the global membership and engagement of the prominent Neurosurgery Cocktail Facebook group with over 25,000 neurosurgeons and trainees worldwide, specifically during the COVID-19 pandemic. METHODS: Neurosurgery Cocktail's numbers of members, posts, comments, and reactions were collected from December 2019 to November 2020. Anonymized aggregate data of members' characteristics, including age, sex, and country of origin in November 2020, were also obtained. The most engaging posts in November 2020 were categorized into topics by a majority consensus of 3 reviewers. RESULTS: The average number of members steadily increased from 21,266 in December 2019 to 25,218 in November 2020. In November 2020, 18.8% of members were women, and 71.3% were between 25-44 years old. With members from 100 countries, 77.9% are from low-and middle-income countries, with the highest representation from India, Egypt, and Brazil. After the COVID-19 pandemic declaration, daily engagement peaked in April 2020 with a daily average of 41.63 posts, 336.4 comments, and 1,914.6 reactions before returning to prepandemic levels. Among the 99 top posts in November 2020, the majority (56.5%) were classified as "interesting cases", with "education-related" as the second-most common topic (16.2%). CONCLUSIONS: Neurosurgery Cocktail has shown steady growth since its creation. The COVID-19 pandemic was correlated with a spike in activity without lasting impact. The group demonstrates social media's potential for knowledge exchange and promoting organic international collaborations.

Challenges and prospects of neurosurgical teleconsultations in a developing country: a reality check.

OBJECTIVE: The adoption of telemedicine became a necessity during the COVID-19 pandemic because patients found commuting to be difficult owing to travel restrictions. Initially, audio-based teleconsultations were provided. Later, on the basis of the feedback of patients and caregivers, the authors started to provide video-based teleconsultations via WhatsApp. The authors subsequently surveyed the patients and caregivers to determine their satisfaction levels with telemedicine services. METHODS: An anonymized telephone survey of patients who had participated in teleconsultation was conducted with a structured questionnaire. The responses were analyzed and their correlations with the perceived benefits and limitations of audio and video teleconsultation were determined. RESULTS: Three hundred respondents were included in the first round of surveys, of whom 250 (83.3%) consented to video teleconsultation. Among the respondents who participated in both audio and video teleconsultations (n = 250), paired analysis showed that video teleconsultation was perceived as better in terms of providing easier access to healthcare services (p < 0.001), saving time (p < 0.001), and satisfaction with the way patient needs were conveyed to healthcare providers (p = 0.023), as well as in terms of adequacy of addressing healthcare needs (p < 0.001) and consequently providing a higher rate of overall satisfaction (p < 0.001). For both audio and video teleconsultation, overall patient satisfaction was significantly related to only previous exposure to WhatsApp. However, for video consultation, longer call duration (p = 0.023) was an important independent factor. Video teleconsultation was preferable to face-to-face consultation irrespective of educational status, but higher education was associated with preference for video teleconsultation. CONCLUSIONS: Both audio and video teleconsultation are viable cost-effective surrogates for in-person physical neurosurgical consultation. Although audio teleconsultation is more user-friendly and is not restricted by educational status, video teleconsultation trumps the former owing to a more efficient and satisfactory doctor-to-patient interface.

Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes.

OBJECTIVE: The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase. METHODS: This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B). RESULTS: The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups. CONCLUSIONS: The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.

Scientometric Analysis of Top 100 Most Cited Articles on Imaging in COVID-19: The Pandemic of Publications.

The coronavirus disease 2019 (COVID-19) pandemic in 2020 was paralleled by an equally overwhelming publication of scientific literature. This scientometric analysis was performed to evaluate the 100 most cited articles on COVID-19 imaging to highlight research trends and identify common characteristics of the most cited works. A search of the Web of Science database was performed using the keywords "COVID CT," "COVID Radiograph," and "COVID Imaging" on June 29, 2021. The 100 top cited articles found were arranged in descending order on the basis of citation counts and citations per year and relevant data were recorded. Our search revealed a total of 4,862 articles on COVID-19 imaging published in the years 2020 to 2021. The journal with maximum number of publications ( n = 22), citation count ( n = 8,788), and impact was Radiology . Citations for the top 100 articles ranged from 70 to 1,742 with the most cited article authored by A.I. Tao and published in Radiology . Two authors tied at first spot, having maximum impact, with both having 5 publications and a total of 3,638 citations among them. China was the leading country with both the maximum number of publications ( n = 49) and total citations ( n = 13,892), the United States coming second in both. This study evaluates publication and citation trends in literature and shows that the countries most affected by the pandemic early on have contributed to the majority of the literature. Furthermore, it will help radiologists to refer to the most popular and important article texts on which to base their unbiased and confident diagnoses.

Bibliometric Analysis of Major Neurosurgical Publications 2011-2020, Part 2: Journal, Author, Yearly Publication Trends, and Citation Related Metrics.

Background: Scientometrics, a subfield of bibliometrics, examines scientific publications by using bibliometric methods. The aim of a scientometric study is to study the various citation-based metrics of scientific articles, such as parameters pertaining to authors (including institutions and country of origin), articles, journals, and other citation related metrics. Objective: In this second part of our scientometric analysis of the 6 major neurosurgical journals from 2011-2020, we study journal and author trends, yearly publication trends, and citation related metrics in Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, Operative Neurosurgery, and World Neurosurgery. Methods: We analyzed parameters, including article and journal metrics (total articles published per journal per year, breakdown of the Bradford's law distribution of journals, and Lotka's law, journal impact factors), author metrics (country of origin, collaborations), citation totals, and keyword counts. Results and Discussion: The highest number of published articles from all journals occurred in 2011, the lowest in 2016. World Neurosurgery published the most. The author collaboration index has declined since 2016 with a notable drop in 2020 when the COVID-19 pandemic began. Impact factors remained stable, except for Operative Neurosurgery, which experienced a steep decline in 2020, and World Neurosurgery, which experienced a mild decline in 2020. Canadian authors were the most likely to participate in multi-country collaborations. Conclusion: The most articles were published in Journal of Neurosurgery, followed by Neurosurgery, Spine, and World Neurosurgery.

Cognitive deficits and memory impairments after COVID-19 (Covishield) vaccination.

Vaccination is an essential public health strategy to control the 2019 Coronavirus (COVID-19) pandemic. While the benefits of the COVID-19 vaccines far outweigh the risks, side effects continue to be reported in the literature. We report a 65-year-old man who developed cognitive deficits and memory impairments following his first dose of Oxford AstraZeneca vaccine (Covishield). The onset of acute cognitive deficits and memory impairments could be another complication to COVID-19 vaccination that physicians and neurologists need to be warned to. Monitoring the safety of COVID-19 vaccines and describing side effects associated with them is essential to improve safety profiles and enhance public trust.

Lessons learned during covid-19 pandemic, a worldwide survey: evolution of global neurosurgical practice.

BACKGROUND: During the COVID-19 pandemic, a multitude of surveys have analyzed the impact virus spreading on the everyday medical practice, including neurosurgery. However, none have examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to be able to deal with their patients in such a difficult time. METHODS: From April 2021 to May 2021 a modified Delphi method was used to construct, pilot, and refine the questionnaire focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed among 1000 neurosurgeons; the responses were then collected and critically analyzed. RESULTS: Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they have changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported to have suffered from COVID-19. 56.2% of the respondents reported having felt depressed in the last 1 year. 40.9% of respondents reported having faced financial difficulties. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge while 31.6% spent the extra time in research activities. CONLCUSIONS: Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in tendency to complete stoppage of physical clinic services and drop in the use of PPE kits were evident. Respondents' age had an impact on how the clinical services and operative practices have evolved. Financial concerns overshadow mental health.

Effect of External Ventricular Drain Tunnel Length on Cerebrospinal Fluid Infection Rates-A Bayesian Network Meta-Analysis.

BACKGROUND: External ventricular drain (EVD)-associated cerebrospinal fluid infection (EACI) remains a major complication associated with EVD. Length of EVD tunnel, an overlooked but modifiable factor, can be associated with increased risk of EACI. The aim of this study is to find the tunnel length associated with least chances of EACI by performing a network meta-analysis. METHODS: A comprehensive search of different databases was performed to retrieve studies that studied the rates of EACI with different EVD tunnel lengths and a Bayesian network meta-analysis was performed. RESULTS: Six studies met the inclusion criteria and were included in the network meta-analysis. With 0 cm tunnel length as reference, the odds ratio (OR) for developing EACI was minimum for tunnel length 5-10 cm (OR, 0.027). It was followed by tunnel length of 5 cm (OR, 0.060) and 10 cm (OR, 0.075). The surface under the cumulative ranking curve plot showed that the probability of the tunnel length 5-10 cm (ranked first), 5 cm (ranked second), and 10 cm (ranked third) for being the best EVD tunnel length was found to be 86%, 64%, and 61%, respectively. CONCLUSIONS: The length for which an EVD is tunneled may have an impact on the rate of EACI. Our network meta-analyses showed that the tunnel length of 5-10 cm was associated with the lowest rates of EACI, with 86% probability of being the best EVD tunnel length. The probability of a patient with 5-10 cm EVD length developing EACI was 2.7% compared with zero tunnel length.

Scientometric analysis of medical publications during COVID-19 pandemic: the twenty-twenty research boom.

INTRODUCTION: There was significant surge in the academic publications after the onset of COVID-19 outbreak. The aim of this study was to scientometrically analyze all the medical publications on COVID-19 in 2020 as well as the top 100 cited articles. EVIDENCE ACQUISITION: We performed a search of the "Web of Science" database using the keywords "COVID," and "corona" on December 20, 2020. EVIDENCE SYNTHESIS: Our search retrieved a total of 45,420 articles on the topic COVID-19 in the year 2020. Corresponding authors from 143 countries contributed to these articles. The highest number of articles were contributed by corresponding authors from the USA (N.=10299), whereas 50 articles in the top 100 cited articles had corresponding authors from China. Among the top 100 cited, the majority were published from Huazhong University of Science and Technology in China (N.=37). New England Journal of Medicine had the maximum impact (h-index of 57), closely followed by Lancet (h-index=55). CONCLUSIONS: Scientific publications amount on COVID-19 disease grew at an astonishing pace during 2020. We caution the readers that this rapidity of publication could have missed out on the rigorous review process and the scientific basis of the methods followed.

Hybrid Workshops During the COVID-19 Pandemic-Dawn of a New Era in Neurosurgical Learning Platforms.

BACKGROUND: During the COVID-19 pandemic, disruption of surgical hands-on training has hampered the skills acquisition by budding neurosurgeons. Online and virtual classrooms have not been able to substitute the hands-on experience and learning via direct interaction with senior colleagues. To overcome these challenges, we organized a hybrid workshop where simulation-based learning modules, and direct and virtual interaction with surgeons during live surgeries or didactic lectures were utilized to help delegates in understanding the nuances of neurosurgery. METHODS: A 3-day hybrid workshop was held in March 2021, which was attended by 133 delegates. A structured questionnaire was utilized to record their feedback. RESULTS: An overwhelming majority of the respondents (94.1%, n = 64) found hybrid conferences to be better than an online conference. Most of the respondents (88.3%, n = 60) rated the utility of direct face-to-face interaction to be more satisfying as compared with online interaction with faculty during a webinar. Again, many the respondents (86.8%, n = 59) believed that similar hybrid events will be the new normal given the current situation of COVID-19 pandemic. A large majority (88.2%, n = 60) of the respondents reported that they will prefer a hybrid event over an online conference. CONCLUSIONS: In this era of the COVID-19 pandemic, "hybrid" microneurosurgery workshops offer unique opportunities to enhance surgical skills acquisition by hands-on simulation-based learning and observing live surgical demonstrations, apart from 2-way interactions with experts under one roof. This may be a stepping stone for what lies ahead in the future of neurosurgical training.

Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India.

OBJECTIVE: We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center. METHODS: This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on March 25, 2020 to November 30, 2020 with that of same period in the previous year, 2019. RESULTS: There were 687 neurosurgery admissions during the study period compared with 2550 admissions in 2019. The total number of surgeries performed in neurosurgery also showed a similar trend, with only 654 surgeries in 2020 compared with 3165 surgeries in 2019. During COVID-19 times, 474 patients were operated on including both trauma and nontrauma cases. Of the 50 patients with suspected/indeterminate COVID-19 who were operated on, 5 turned out to be positive for COVID-19. Significant differences were seen in the mortality (P < 0.01) and morbidity (P < 0.01) among patients with trauma on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (P < 0.001) and morbidity (P < 0.001) in patients who did not have trauma. CONCLUSIONS: The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.

Turning a New Chapter in Neurosurgery Outpatient Services: Telemedicine A "Savior" in this Pandemic.

BACKGROUND: Teleconsultation services in India, especially in neurosurgery, are relatively new. Despite its large-scale adoption during the COVID-19 pandemic, comprehensive analyses of patients' perspectives and hurdles are lacking. MATERIALS AND METHODS: We conducted an anonymized telephonic survey of consecutive neurosurgical patients who availed telemedicine services at our institute, using a validated, structured questionnaire. To prevent bias, interviewers were not involved in the study design/analyses. Patients' perception of usefulness and performance of teleconsultation was graded on a 5-point Likert scale. RESULTS: Of the 330 patients who availed teleconsultation services, 231 (70%) completed the survey. Even though 91% of the respondents had access to a smartphone, only 10% received a video-based teleconsult. As per respondents, the challenges included poor network (7%), suboptimal communication/discussion (5.6%), lack of physical examination (6%), and misinterpretation of prescription by pharmacists/patients (6%). The majority of the respondents (58%) either agreed/strongly agreed that teleconsultation helped them tide over the medical exigency during the lockdown; however, the clinical diagnosis did not influence this response (P = 0.21). The vast majority of the respondents felt that teleconsultation is beneficial (97%), as it minimizes their exposure to COVID-19. One-third of the patients preferred this service over physical visits and 60% agreed to its continuation till resumption of routine care. Access to video-teleconsultation was the chief suggestion in 39 of 74 suggestions received. CONCLUSIONS: Telemedicine in neurosurgery offers favorable patient satisfaction during this pandemic and may be a satisfactory alternative to physical outpatient services in the future. Video-based teleconsults should be the preferred modality of communication for neurosurgery patients.

Trends in Neurosurgical Teleconsultation Services Across the Globe During COVID-19 Pandemic.

BACKGROUND: Global use of telemedicine has increased rapidly during the coronavirus disease 2019 (COVID-19) pandemic to bridge the gap in existing health care services. Intercontinental trends in neurosurgeons' perception and practices of telemedicine have been sparingly reported. METHODS: We conducted an online anonymized and validated survey using a structured questionnaire to gain insight into neurosurgeons' experience with telemedicine across various continents and rated its usefulness on a 5-point Likert scale. RESULTS: We received 286 responses across 5 continents. There was a trend to support a major paradigm shift favoring teleconsultations during the COVID-19 pandemic in respondents from North America (P = 0.06). Signed prescriptions were e-mailed along with video-based teleconsultations preferentially in Europe and North America. In comparison, audio- or text-based teleconsultations along with unsigned prescriptions were prevalent in Asia and Africa (P = 0.0005). Acceptability and perceived usefulness for telemedicine during the pandemic were similar across the globe, regardless of neurosurgeons' experience (mean satisfaction score 3.72 ± 1.09; P = 0.62). A majority of neurosurgeons from Asia and South America complained of difficulties during teleconsultations owing to lack of appropriate infrastructure, internet connectivity/prescription-related issues, and potential risk of litigation (P = 0.0005). Approximately 46% of neurosurgeons, predominantly from Europe and North America, thought that telemedicine could play a vital role in clinical practice even after the COVID-19 pandemic subsides (mean satisfaction score 3.26 ± 1.16; P = 0.007). CONCLUSIONS: Telemedicine in neurosurgery is a viable alternative to physical outpatient services during the COVID-19 pandemic and could potentially play a vital role after the pandemic.

Adapting Neurosurgery Practice During the COVID-19 Pandemic in the Indian Subcontinent.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has changed the practice of neurosurgery. Significant resources have been dedicated to the disease. The pandemic in the Indian subcontinent, compared with the rest of the world, is relatively delayed. The neurosurgical practice cannot remain unaffected by hugely disruptive measures such as a lockdown. The inevitable increase in COVID infections with the gradual relaxation of lockdown continues to pose a risk for health care providers. Therefore, it is imperative to evaluate whether the pandemic has had a discernible effect on health care providers, especially in terms of practice modifications in private establishments and publicly funded hospitals, the emotional impact on the surgeon, and the influence of social media on the psyche of the surgeon. METHODS: An online questionnaire-based survey was prepared, with questions related to the COVID-specific themes of precautions taken in outpatient services and operating theaters, the influence of social media, the economic loss incurred, and the perceptible impact of telemedicine and webinars. The links to the survey were mailed to neurosurgeons in private and public practice countrywide. The responses were anonymized to ensure free and unbiased answers to the survey questions. RESULTS: A total of 176 responses were received from across the Indian subcontinent. The median age of respondents was 39 years (range, 32-70 years) and the postresidency experience was 7 years (range, 0-34 years). Respondents were an equitable mix of public and private practitioners. Of respondents, 46% were practicing restricted outpatient services, more in public institutions (P = 0.22) which also had a higher incidence of tele-outpatient services (26% vs. 17%). Wearing surgical masks, N95 masks, and gloves were the most commonly practiced precautionary measures in outpatient services (>60%). Although private practitioners were continuing elective cases (40%), public institutes were more cautious, with only emergency patients being operated on (29%). The greatest fear among all practitioners was passing the infection to their family (75%). Social media were helpful for brainstorming queries and updating practice modifications, but some surgeons admitted to receiving threats on social media platforms (37.5%). Depression and economic losses were palpable for approximately 30% neurosurgeons. CONCLUSIONS: The survey highlights the perception of neurosurgeons toward the pandemic and the difference in public-private practice. Suspension of elective procedures, severe curtailment of regular outpatient appointments, drastic modifications of the normal outpatient department/operating room practices, and apprehensions related to inadequacy of safety provided by personal protective equipment use and financial losses of private establishments were some of the visible themes in our survey results. Although telemedicine has not been as widely adopted as expected, online education has been favorably received.