L. Madison Michael

An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United States

OBJECT Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery is in its infancy. The authors calculate a number of publication productivity measures for almost all academic neurosurgeons and departments within the US. METHODS The h-index, g-index, m-quotient, and contemporary h-index (hc-index) were calculated for 1225 academic neurosurgeons in 99 (of 101) programs listed by the Accreditation Council for Graduate Medical Education in January 2013. Three currently available citation databases were used: Google Scholar, Scopus, and Web of Science. Bibliometric profiles were created for each surgeon. Comparisons based on academic rank (that is, chairperson, professor, associate, assistant, and instructor), sex, and subspecialties were performed. Departments were ranked based on the summation of individual faculty h-indices. Calculations were carried out from January to February 2013. RESULTS The median h-index, g-index, hc-index, and m-quotient were 11, 20, 8, and 0.62, respectively. All indices demonstrated a positive relationship with increasing academic rank (p < 0.001). The median h-index was 11 for males (n = 1144) and 8 for females (n = 81). The h-index, g-index and hc-index significantly varied by sex (p < 0.001). However, when corrected for academic rank, this difference was no longer significant. There was no difference in the m-quotient by sex. Neurosurgeons with subspecialties in functional/epilepsy, peripheral nerve, radiosurgery, neuro-oncology/skull base, and vascular have the highest median h-indices; general, pediatric, and spine neurosurgeons have the lowest median h-indices. By summing the manually calculated Scopus h-indices of all individuals within a department, the top 5 programs for publication productivity are University of California, San Francisco; Barrow Neurological Institute; Johns Hopkins University; University of Pittsburgh; and University of California, Los Angeles. CONCLUSIONS This study represents the most detailed publication analysis of academic neurosurgeons and their programs to date. The results for the metrics presented should be viewed as benchmarks for comparison purposes. It is our hope that organized neurosurgery will adopt and continue to refine bibliometric profiling of individuals and departments.

Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey

UNLABELLED OBJECT :The object of this study was to identify and quantify predictors of burnout and career satisfaction among US neurosurgeons. METHODS All US members (3247) of the American Association of Neurological Surgeons (AANS) were invited to participate in a survey between September and December 2012. Responses were evaluated through univariate analysis. Factors independently associated with burnout and career satisfaction were determined using multivariable logistic regression. Subgroup analysis of academic and nonacademic neurosurgeons was performed as well. RESULTS The survey response rate was 24% (783 members). The majority of respondents were male, 40-60 years old, in a stable relationship, with children, working in a group or university practice, and trained in a subspecialty. More than 80% of respondents reported being at least somewhat satisfied with their career, and 70% would choose a career in neurosurgery again; however, only 26% of neurosurgeons believed their professional lives would improve in the future, and 52% believed it would worsen. The overall burnout rate was 56.7%. Factors independently associated with both burnout and career satisfaction included achieving a balance between work and life outside the hospital (burnout OR 0.45, satisfaction OR 10.0) and anxiety over future earnings and/or health care reform (burnout OR 1.96, satisfaction OR 0.32). While the burnout rate for nonacademic neurosurgeons (62.9%) was higher than that for academic neurosurgeons (47.7%), academicians who had practiced for over 20 years were less likely to be satisfied with their careers. CONCLUSIONS The rates of burnout and career satisfaction were both high in this survey study of US neurosurgeons. The negative effects of burnout on the lives of surgeons, patients, and their families require further study and probably necessitate the development of interventional programs at local, regional, and even national levels.

Five-year institutional bibliometric profiles for 103 US neurosurgical residency programs

OBJECT Various bibliometric indices based on the citations accumulated by scholarly articles, including the h-index, g-index, e-index, and Googles i10-index, may be used to evaluate academic productivity in neurological surgery. The present article provides a comprehensive assessment of recent academic publishing output from 103 US neurosurgical residency programs and investigates intradepartmental publishing equality among faculty members. METHODS Each institution was considered a single entity, with the 5-year academic yield of every neurosurgical faculty member compiled to compute the following indices: ih(5), cumulative h, ig(5), ie(5), and i10(5) (based on publications and citations from 2009 through 2013). Intradepartmental comparison of productivity among faculty members yielded Gini coefficients for publications and citations. National and regional comparisons, institutional rankings, and intradepartmental publishing equality measures are presented. RESULTS The median numbers of departmental faculty, total publications and citations, ih(5), summed h, ig(5), ie(5), i10(5), and Gini coefficients for publications and citations were 13, 82, 716, 12, 144, 23, 16, 17, 0.57, and 0.71, respectively. The top 5 most academically productive neurosurgical programs based on ih(5)-index were University of California, San Francisco, University of California, Los Angeles, University of Pittsburgh, Brigham & Womens Hospital, and Johns Hopkins University. The Western US region was most academically productive and displayed greater intradepartmental publishing equality (median ih[5]-index = 18, median Ginipub = 0.56). In all regions, large departments with relative intradepartmental publishing equality tend to be the most academically productive. Multivariable logistic regression analysis identified the ih(5)-index as the only independent predictor of intradepartmental publishing equality (Ginipub ≤ 0.5 [OR 1.20, 95% CI 1.20-1.40, p = 0.03]). CONCLUSIONS The ih(5)-index is a novel, simple, and intuitive metric capable of accurately comparing the recent scholarly efforts of neurosurgical programs and accurately predicting intradepartmental publication equality. The ih(5)-index is relatively insensitive to factors such as isolated highly productive and/or no longer academically active senior faculty, which tend to distort other bibliometric indices and mask the accurate identification of currently productive academic environments. Institutional ranking by ih(5)-index may provide information of use to faculty and trainee applicants, research funding institutions, program leaders, and other stakeholders.

Non-allergic rhinitis: a case report and review

Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency. Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR.

The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: an updated systematic review and meta-analysis

OBJECTIVE Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS In August 2015 a systematic literature search was performed using clinicaltrials.gov , the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.

Highly Cited Works in Skull Base Neurosurgery

OBJECTIVE Citation analysis can be used to evaluate an articles impact on its discipline. This study characterizes the most-cited articles related to skull base surgery. METHODS The 100 most-cited skull base neurosurgery articles in all journals were examined. A separate listing of the top 100 most-cited articles in dedicated skull base journals was also examined. The following information was recorded for each article: number of authors, country of origin, citation-count adjusted for number of years in print, topic, and level of evidence. RESULTS The 100 overall most-cited articles appeared in 25 journals. The top 100 most-cited articles in dedicated skull base journals appeared in 3 journals. Publication dates ranged from 1965-2006 for the overall list and 1993-2010 for the dedicated skull base list. Citations ranged from 11-59 (mean, 19) for the dedicated skull base list and 115-487 for the overall list (mean, 175). The average time-adjusted citation count was 8.4 for the overall list and 2 for the dedicated skull base journal list. CONCLUSIONS An original article in a nondedicated skull base journal related to the subspecialty of skull base with a citation count of 150 or more and time-adjusted citation count of 10 can be considered a high-impact publication. An original article in a dedicated skull base periodical having a total citation count of 20 or more and an average citation count of 2 per year or more can be considered a high impact publication.

Resection of an anterior spinal cord AVM through a far-lateral approach.

A small arteriovenous malformation near the craniocervical junction with contributions from the anterior spinal artery was discovered in a young developmentally-delayed woman after she presented with altered mental status and evidence of subarachnoid hemorrhage. The malformation could not be completely treated with endovascular therapy, so it was resected through a far-lateral approach. This stereoscopic video demonstrates how to gain the exposure needed to address a lesion in this area. The video can be found here: http://youtu.be/ByjPGm_eXLc .

Spina Bifida Occulta as a Relative Contraindication for Percutaneous Retrograde Lead Insertion for Sacral Nerve Root Stimulation

Percutaneous retrograde lead insertion for sacral nerve root stimulation is a newly described technique being applied to a variety of pain disorders. The success of the procedure rests in a defined epidural space such that there is unimpeded progression of the lead into the desired location. It is hypothesized that any condition that results in anatomic compromise of the epidural space would prevent the success of the procedure.

Five-Year Institutional Bibliometric Profiles for 119 North American Neurosurgical Residency Programs: An Update

BACKGROUND We recently performed a comprehensive bibliometric analysis of 103 U.S. neurosurgical departments and found the ih(5)-index as meaningful and reproducible using public data. The present report expands this analysis by adding 14 Canadian and 2 additional U.S. programs. METHODS Departments were included if listed in the American Association of Neurological Surgeons Residency Directory. Each institution was considered a single entity, and original research articles with authors who were neurosurgeon faculty were counted only once per institution, although a single article may have been credited toward multiple institutions, if applicable. The following bibliometric indices were calculated and used to rank departments: ih(5), ig(5), ie(5), and i10(5). In addition, intradepartmental comparison of productivity among faculty members was analyzed by computing Gini coefficients for publications and citations. RESULTS The top 5 most academically productive North American neurosurgical programs based on ih(5)-index were found to be the University of Toronto, University of California at San Francisco, University of California at Los Angeles, University of Pittsburgh, and Brigham and Womens Hospital. The top 5 Canadian programs were the University of Toronto, University of Calgary, McGill University, University of Sherbrooke, and University of British Columbia. The median ih(5)-index for U.S. and Canadian programs was 12 and 10.5, respectively. CONCLUSIONS This is the most accurate comprehensive analysis to date of contemporary bibliometrics among North American neurosurgery departments. Using the ih(5)-index for institutional ranking allows for informative comparison of recent scholarly efforts.

Outcomes Research in Neurosurgery: Do Administrative Databases Hold the Answers?

f one keeps abreast of thecurrent neurosurgical literature, it is apparent that a fascination with databases has developed. I With the introduction of the Affordable Care Act in 2010, the quest for quality and outcome measures has taken center stage. To that end, we have seen a dramatic increase in the use of large databases to assess various outcomes and predictors of such outcomes in patients with neurosurgical ailments. Since 2012, Dr. Nanda, one of the coauthors in the current paper, has published a number of papers using the same administrative database—the National Inpatient Sample (NIS)—on various neurosurgical diseases and injuries: C2 fractures, benign intracranial tumors, shunting for hydrocephalus, spinal and cranialmeningiomas, spinal cord tumors, deep brain stimulation for Parkinson disease, acoustic neuromas, and posttraumatic cerebrospinal fluid leaks (1, 2, 4, 9, 11, 20, 21, 23, 24). The work by Missios et al. in a paper recently published in WORLD NEUROSURGERY is another such article looking at intracranial gliomas.