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1.
World Neurosurg ; 2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1550138

ABSTRACT

Given safety concerns during the COVID-19 pandemic, residency programs suspended away rotations in 2021 and the interview process transitioned to a virtual video format. In this study, we assessed the extent to which these changes affected match outcomes and if medical school ranking, international graduate status, or affiliation with a home neurosurgery program affected these outcomes. A cross-sectional analysis of neurosurgery match data from 2016-2021 was performed, and match outcomes were assessed based on matched program geography and program research ranking. Chi square tests were performed to identify significant differences between 2021 and 2016-2020 match results. A total of 1324 confirmed matched neurosurgery residents were identified from 2016-2021 (2016-2020: n=1113, 2021: n=211). There was no statistically significant difference in the rates of matching at a home program, within state, or within region between 2021 and 2016-2020 in the overall cohort. Proportions of international graduates and students without home programs among matched applicants were unchanged in 2021. In 2021, students from top 25 medical schools were less likely to match within their state or region (p<.05). Our findings may reflect an enhanced weighting given by programs to applicants from top medical schools in the absence of data from in-person rotations and interviews. These findings, coupled with the potential benefits of an increasingly virtual application process in improving equity and diversity among candidates from underrepresented communities, should be considered when determining permanent modifications to future residency application cycles.

2.
J Neurosurg ; : 1-10, 2021 Nov 26.
Article in English | MEDLINE | ID: covidwho-1538341

ABSTRACT

OBJECTIVE: The COVID-19 pandemic caused a significant disruption to residency recruitment, including a sudden, comprehensive transition to virtual interviews. The authors sought to characterize applicant experiences and perceptions concerning the change in the application, interview, and match process for neurological surgery residency during the 2020-2021 recruitment cycle. METHODS: A national survey of neurosurgical residency applicants from the 2020-2021 application cycle was performed. This survey was developed in cooperation with the Society of Neurological Surgeons (SNS) and the American Association of Neurological Surgeons Young Neurosurgeons Committee (YNC) and sent to all applicants (n = 280) who included academic video submissions to the SNS repository as part of their application package. These 280 applicants accounted for 69.6% of the total 402 neurosurgical applicants this year. RESULTS: Nearly half of the applicants responded to the survey (44.3%, 124 of 280). Applicants favored additional reform of the interview scheduling process, including a centralized scheduling method, a set of standardized release dates for interview invitations, and interview caps for applicants. Less than 8% of students desired a virtual-only platform in the future, though the majority of applicants supported incorporating virtual interviews as part of the process to contain applicant costs and combining them with traditional in-person interview opportunities. Program culture and fit, as well as clinical and research opportunities in subspecialty areas, were the most important factors applicants used to rank programs. However, subjective program "fit" was deemed challenging to assess during virtual-only interviews. CONCLUSIONS: Neurosurgery resident applicants identified standardized interview invitation release dates, centralized interview scheduling methods, caps on the number of interviews available to each candidate, and regulated opportunities for both virtual and in-person recruitment as measures that could significantly improve the applicant experience during and effectiveness of future neurosurgery residency application cycles. Applicants prioritized program culture and "fit" during recruitment, and a majority were open to incorporating virtual elements into future cycles to reduce costs while retaining in-person opportunities to gauge programs and their locations.

3.
J Neurointerv Surg ; 13(4): 304-307, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1013062

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT). METHODS: We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020). RESULTS: We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004). CONCLUSION: The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.


Subject(s)
African Americans/ethnology , COVID-19/ethnology , Healthcare Disparities/trends , Pandemics , Stroke/ethnology , Thrombectomy/trends , Aged , Aged, 80 and over , COVID-19/therapy , Female , Hospital Mortality/trends , Hospitalization/trends , Humans , Internationality , Male , Middle Aged , Prospective Studies , Registries , Risk Factors , Stroke/therapy , Thrombectomy/methods , Treatment Outcome
5.
J Neurointerv Surg ; 12(11): 1039-1044, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-742246

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. METHODS: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. RESULTS: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). CONCLUSION: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Stroke/therapy , Thrombectomy/statistics & numerical data , Aged , Aged, 80 and over , Anesthesia, General , COVID-19 , Endovascular Procedures , Female , Hospital Mortality , Humans , Independent Living , Linear Models , Male , Middle Aged , Prospective Studies , Reperfusion , Thrombectomy/methods , Treatment Outcome , Workflow
7.
J Neurointerv Surg ; 12(10): 927-931, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-710047

ABSTRACT

BACKGROUND: Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness. METHODS: A 37-question online survey was designed and distributed to physician members of three NI physician organizations. RESULTS: A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre-pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non-mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non-urgent elective cases, 68% of physicians reported dramatic reductions (>50%) in overall NI procedural volume compared with pre-pandemic. Increased door-to-puncture times were reported by 79%. COVID-19-positive infections occurred in 1% of physician respondents: an additional 8% quarantined for suspected infection. Sixty-six percent of respondents reported increased career stress, 56% increased personal life/family stress, and 35% increased career burnout. Stress was significantly increased in physicians with COVID-positive family members (P<0.05). CONCLUSIONS: This is the first study designed to understand the effects of the COVID-19 pandemic on NI physician practices, case volumes, compensation, personal/family stresses, and work-related burnout. Future studies examining these factors following the resumption of elective cases and relaxing of social distancing measures will be necessary to better understand these phenomena.


Subject(s)
Attitude of Health Personnel , Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Neurosurgery/statistics & numerical data , Pandemics/statistics & numerical data , Physician's Role , Pneumonia, Viral/epidemiology , COVID-19 , Humans , Male , Surveys and Questionnaires , United States
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