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CNS Spotlight

CNS Launches Town Hall Xperience to Cover COVID-19 and Timely Neurosurgery Topics

By CNS Spotlight, COVID-19, HealthNo Comments

To address the need for neurosurgeons to rapidly share experiences and insights during COVID-19, the Congress of Neurological Surgeons (CNS) recently launched a complimentary Town Hall Xperience for CNS members.

The CNS Town Hall Xperience provides an informal and interactive format, where experts discuss their experiences and answer questions from members. Members can submit topics and questions in advance of the session, as well as during the session. Sessions are facilitated by preeminent faculty.

Multiple sessions each week ensure the latest timely COVID-19 and neurosurgery topics are covered and discussed. Summaries of the sessions will be available following the session, along with other helpful links and resources.

Topics will cover a variety of information helpful to practicing neurosurgeons and residents, including:

  • Managing a Neurosurgery Practice in the COVID-19 Crisis;
  • Fellowship Speed Dating: Subspecialties, Timelines and How to Make a Choice;
  • Subspecialty-specific topics; and
  • More.

Throughout the pandemic, publications, including Neurosurgery, are working to expedite breaking research, but there is a limit to the speed in which peer review can be accomplished.

Currently a CNS member? Learn more here.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

COVID-19 Perspectives, News and Insights in Neurosurgery

By CNS Spotlight, COVID-19, HealthNo Comments

Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), publishes top research on clinical and experimental neurosurgery covering the latest developments in science, technology, and medicine. As the COVID-19 pandemic evolves, Neurosurgery continues to publish the latest COVID-19 news and insights.

Recently, Neurosurgery published 15 articles covering a variety of COVID-19 related topics:

Explore the COVID-19 Information Hub and online education offerings for the latest research, knowledge, and expert insights in the weeks and months ahead. The Neurosurgery Perspectives section of the hub will be updated regularly as new COVID-19 content publishes.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

The COVID-19 Challenge from a Health System Perspective

By CNS Spotlight, COVID-19, Guest Post, HealthNo Comments

It’s hard to believe that just over a month ago, the first case of COVID-19 was reported in Michigan. We were all aware that it was coming, but really couldn’t imagine the profound impact this virus would have and the rapidity of the viral spread. Many reasons have been postulated for why Detroit in particular turned into one of the country’s most serious COVID-19 hotspots, including the fact that our international airport, Detroit Metropolitan Airport, is one of the 5 busiest hubs in the country. The resurgence of Michigan’s economy in the last few years also resulted in a dramatic rise in international industry business travel, including to China, Korea, Japan and Italy.

In anticipation of the surge in Michigan, Henry Ford Health System (HFHS) took many key steps at early points in the crisis. A month prior to the first detected COVID-19 case in the state, HFHS began holding daily infection prevention calls to start COVID-19 related education and training amongst the staff, and we activated our Incident Command structure where all physician and administrative teams across all business units were included. In an effort to keep staff and patients safe, business travel and HFHS events were cancelled prior to the state’s mandates.

At the onset of increased COVID-19 admissions in mid-March, HFHS stopped all elective surgeries, which helped create the immediate and much-needed capacity to accommodate any surge. We temporarily closed many ambulatory clinics and redeployed resources — including not only supplies but also over 550 physicians, nurses and staff — to the inpatient settings. In accordance with Accreditation Council for Graduate Medical Education (ACGME) guidelines, HFHS declared a Stage 3 Pandemic Crisis, transitioning most residents and fellows to patient care areas in the most immediate need of clinical support. In taking these steps, we were able to quickly create ICU and general inpatient capacity.

To expedite diagnosis at the HFHS’s five acute care hospitals, the laboratory services became Michigan’s first same-day results lab for COVID-19, having the ability to process 1,000 tests per day with 93% processed in 12 hours or less. We also chose to be very proactive in testing our employees to safeguard our patients and our community, and we were also very transparent in our reporting of employee COVID-19 positive results to highlight the need for testing, and the need for aggressive prevention measures, throughout our region and beyond.

Like hospitals throughout the world, we experienced some supply disruptions for personal protective equipment (PPE) as global demand far exceeded production capabilities. Maintaining the safety of our health care professionals on the front lines remains a critical focus for the System. Thus, our supply chain team aggressively responded to the global constraints for these items by actively sourcing PPE from alternative sources, like TD Industrial Coverings, Inc., and we received more than 250,000 PPE donations from area businesses, including Ford Motor Company and the DTE Energy Foundation. The HFHS also implemented conservation policies aligned with the Centers for Disease Control and Prevention (CDC) recommendations to ensure the frontline workers continued to have the protection they needed. To help address the high demand for PPE, the photomedicine and photobiology unit in our Department of Dermatology rapidly developed an innovative process to sterilize N95 respirators using a special form of ultraviolet C (UVC), so the respirators can be reused. Ultimately, we were able to secure adequate PPE supplies to mandate a universal mask policy for all staff, employees, patients and visitors to any Henry Ford facility, and N95 respirators were made available to all staff in contact with suspected COVID-19 patients and for those performing any procedure at risk for aerosolization of bodily fluids.

The Henry Ford Research Team also embarked upon dozens of studies either underway or under development to understand disease progression and outcomes, and to treat or prevent COVID-19. With assistance from Vice President Michael R. Pence and Food and Drug Administration Commissioner Stephen M. Hahn, MD, Henry Ford launched the country’s largest randomized controlled, double-blinded study to determine the effectiveness of hydroxychloroquine in preventing COVID-19 in health care workers and first responders. Another study is underway on the antibody assessment and treatment in preparation for a potential vaccine that focuses on collecting convalescent plasma and using it in a clinical trial format for newly infected patients. We are also testing anti-viral agents, agents that inhibit the cytokine storm, convalescent patient serum and other novel approaches to treatment.

As the number of new COVID-19 cases decrease in Michigan and we extubate more patients from ventilators than we intubate, we’re beginning to perform time-sensitive ambulatory surgeries and procedures that were postponed due to the pandemic. We are starting with cases that can reasonably be accomplished on an outpatient basis using existing and available staff so as not to overburden the current inpatient needs for the hospitals. In our first week of restarting these ambulatory procedures, 80% of patients called were willing to be scheduled, while 20% preferred to wait given ongoing fear in the community of exposure. We have designated COVID-19-free operating rooms and teams, specifically assigned to these time sensitive non-COVID-19 cases to help reassure patients and families. Of 8,000 cases postponed since the start of the pandemic in mid-March, we hope to reschedule and perform 2,000 prioritized cases by mid-May in a staged way, taking great care to guard against another surge. All along we have been performing emergency cases with immediate threat to “life and limb,” but as we look to expand our inpatient surgical readiness in the weeks ahead, we plan to prioritize cancer, cardiovascular, neurosurgical and transplant cases given the risks of further delays to those patient populations.

The COVID-19 pandemic has challenged us to navigate through unprecedented circumstances, but it’s a challenge I strongly believe we will overcome together, and emerge even stronger as a profession, and as a community.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Henry Ford Medical Group
Detroit, Mich.

We believe we’re through the peak of the surge, but we’re not ready to declare victory yet.

Steven N. Kalkanis, MD, FAANS

The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm

By CNS Spotlight, COVID-19, Faces of Neurosurgery, HealthNo Comments

The COVID-19 pandemic is disrupting neurosurgical care at medical centers throughout the United States. Institutional and governmental recommendations are not specific to neurosurgery. Protocols are urgently needed to help neurosurgeons triage cases based on acuity, and also to minimize the risk of infection for both patients and peri-operative medical staff. In many academic tertiary care hospitals, there is limited personal protective equipment and staffing shortages.

Given that there is insufficient data to create formal guidelines, physicians from the University of California San Francisco (UCSF) Department of Neurological Surgery and Department of Anesthesia have presented their institutional neurosurgical treatment algorithm during the California COVID-19 shelter in place order. The UCSF protocols are based on outbreak “surge levels,” and using these levels to guide operating room utilization based on the acuity of neurosurgical cases. The protocols and checklists from UCSF, which are published online in Neurosurgery — the official journal of the Congress of Neurological Surgeons (CNS) —  offer some guidance to neurosurgeons in other centers.

Click here to read “Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm.”

The CNS also offers a related webinar presentation, “UCSF’s Experience with COVID-19 in the Midst of the California Shelter-in-place Order.”  Click here to view the webinar.

John F. Burke MD, PhD
Resident, Neurological Surgery
University of California San Francisco
San Francisco, California

 

 

Praveen V. Mummaneni, MD
Professor, Neurological Surgery
University of California San Francisco
San Francisco, California

CNS Publishes New Concussion Guidelines

By CNS Spotlight, Concussion, Cross Post, GuidelinesNo Comments

Published online in Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), in August, the “Concussion Guidelines Step 2: Evidence for Subtype Classification,” provides support for re-thinking the way we diagnose concussion.

Angela K. Lumba-Brown, MD, co-director of the Stanford Brain Performance Center, Assistant Professor of Emergency Medicine at Stanford University, and co-author of the guideline, states that because concussion symptoms may vary greatly from person to person, early subtyping can direct strategies for recovery.

The study represents the work of a multidisciplinary team of experts across the country, unified to define five common concussion subtypes:

1. Headache/Migraine
2. Vestibular
3. Cognitive
4. Oculomotor
5. Anxiety/Mood

Notably, two concussion-associated conditions — sleep disturbance and cervical strain — often occur in relation to subtypes, but do not stand alone as concussion diagnostic criteria.

Through a rigorous review of the scientific literature and meta-analysis, the expert workgroup identified differences in the prevalence of each subtype shortly following head injury. Studying the first few days following a concussion is critical because the majority of scientific literature to-date examines concussion signs and symptoms spanning the first week to a month following injury, during which large variability in recovery patterns occur.

  • This study provides support for the presence of all five subtypes as early as three days following injury — directing an urgent change in the way concussion is currently diagnosed. For example:
    Anxiety and mood symptoms, often thought to manifest much later in the concussion course, are present in a large portion of patients early on.
  • Both children and adults exhibit vestibular impairments immediately following a concussion, representing an opportunity for early intervention with vestibular therapies.

This work demonstrates that a comprehensive, initial concussion assessment should incorporate evaluations of all five subtypes and two associated conditions. This work was supported by the Brain Trauma Evidence-Based Consortium, a U.S. Department of Defense-funded project in collaboration with the Brain Performance Center at Stanford University and the Brain Trauma Foundation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Congress of Neurological Surgeons Releases New Pediatric Guidelines

By CNS Spotlight, Cross Post, Pediatrics, Quality ImprovementNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. We wanted to bring attention to a Congress of Neurological Surgeons (CNS) evidence-based guideline on pediatric myelomeningocele that recently appeared in Neurosurgery, the official journal of the CNS, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In August, Neurosurgery published the “Congress of Neurological Surgeons (CNS) Systematic Review and Evidence Based Guidelines for Pediatric Myelomeningocele,” which includes 6 chapters that systematically review the literature and include evidence-based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord.

According to the CNS press release, “it is the Guideline Task Force’s aim that these systematic reviews and subsequent evidence-based recommendations will lead to improvement in the quality of life for infants and children with myelomeningocele.”

To read the full Neurosurgery article, click here. The complete guideline can also be found on the CNS website, here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Catherine A. Mazzola, MD

David F. Bauer, MD