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OBJECTIVE: The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation. METHODS: Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of "opioid" and "pain" and "spinal cord stimulator." Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. RESULTS: Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use. DISCUSSION: SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.

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OBJECTIVE: Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field. METHODS: The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows. RESULTS: The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden. CONCLUSIONS: The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.

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OBJECTIVE: To conduct a systematic review of the available literature for primary research articles identifying potential gene mutations, polymorphisms and other molecular regulatory mechanisms related to trigeminal neuralgia in order to identify the genetic and molecular models of primary trigeminal neuralgia currently being investigated. METHODS: PubMed and Web of Science were systematically searched to identify primary research articles discussing genetic predictors of trigeminal neuralgia and neuropathic pain that were published prior to July 2020. This review was conducted according to PRISMA guidelines. RESULTS: Out of the 333 articles originally identified, a total of 14 papers were selected for study inclusion. These articles included 5 human studies, 6 mouse studies and 3 rat studies. Four articles investigated sodium channels, 1 investigated a sodium channel and nerve growth factor receptor, 2 investigated potassium channels, 1 investigated calcium channels, 1 investigated the downstream regulatory element antagonist modulator protein, 1 investigated the dynorphin-kappa opioid receptor system, 1 investigated TRPA1, 1 investigated the Nrg1/ErbB3/ErbB2 signaling complex, 1 investigated a serotonin transporter and 1 investigated potassium channels, sodium channels, calcium channels, chloride channels, TRP channels and gap junctions. CONCLUSION: Researchers have identified multiple genetic and molecular targets involved with potential pathophysiologies that have a relationship to the creation of trigeminal neuralgia. At this time, there does not seem to be clear causal frontrunner, demonstrating the possibility that genetic predisposition to trigeminal neuralgia may involve multiple genes and/or downstream products, such as ion channels.

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The epicenter of the COVID-19 crisis since March 17, 2020-the New York metropolitan area-is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It has been challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information has seldom been disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19-relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professions, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.

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OBJECTIVE: The primary objective was to evaluate prescribing of potentially inappropriate medications (PIMs) as defined by the Beers criteria in outpatient clinics with and without mandatory pharmacy medication reviews. DESIGN: Retrospective electronic medical chart review at a single academic Veterans Affairs (VA) medical center. SETTING: Home-based primary care (HBPC) and geriatric primary care. PATIENTS: Patients were included if they were 65 years of age or older at the time of enrollment and newly enrolled with an initial visit to HBPC or geriatric primary care between January 2015 and September 2015. Charts were included if patients received at least one follow-up visit with their primary care provider within 13 months of the initial visit. An additional inclusion criterion for HBPC patients was the documentation of at least one follow-up medication review by a clinical pharmacist within 13 months of the initial mandatory chart review. A total of 30 patients were included in both groups. INTERVENTIONS: Mandatory pharmacy medication reviews compared with usual care (no formal pharmacy review). MAIN OUTCOME MEASURE: Mean change in PIMs prescribed in both groups. RESULTS: The mean number of PIMs at initial and final visits was 0.4 unit per patient in HBPC. In geriatric primary care, the mean number of PIMs at the initial visit was 0.4 unit per patient, which increased at the final visit to 0.6 unit per patient. CONCLUSION: No change in PIMs was observed in the HBPC group, while an increase was observed in geriatric primary care.

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Aware of parental reports of academic variability, we investigated month-to-month fluctuations in cognitive abilities and EEG status by repeated measures testing in six children with benign epilepsy with central-temporal spikes (BECTS). All showed greater than normal test-retest variability. Daytime EEG abnormalities were also variable. Short-term fluctuations in cognitive function appear common in children with BECTS, potentially impacting academic performance.

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La hidrocefalia de presión normal (HPN) afecta a una gran proporción de la población anciana. En Colombia, secalcula que 10.000 personas podrían estar afectadas. Los síntomas de alteración en la marcha y caídas, urgencia eincontinencia urinaria y alteración cognoscitiva y demencia enfatizan la sospecha de HPN pero no son suficientespara el diagnóstico ya que muchas enfermedades en los ancianos tienen estos mismos síntomas. Además de lademostración del ensanchamiento de los ventrículos por TAC de cráneo o RM, es necesario realizar pruebas específicaspara la HPN. Los centros de remisión casi siempre usan métodos especializados tales como la medición deflujo de LCR o el drenaje lumbar externo de LCR para realizar el diagnóstico; sin embargo en otras institucioneslos médicos pueden identificar los pacientes con HPN y recomendarles el tratamiento evaluando la respuestaclínica a través de la punción lumbar evacuatoria. El tratamiento de la HPN con derivación ofrece como resultadouna mejoría notoria de los síntomas, incluyendo la demencia. Por lo tanto, la HPN es un desorden que debe serconsiderado para muchos pacientes ancianos de acuerdo a su historia, sintomatología, hallazgos neurologicos yhallazgos imagenológicos en la TAC o en la RM.

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BACKGROUND: The effect of healthcare professional-led education for patients with osteoporosis or those at high risk for the disease on adherence with treatment recommendations was investigated. METHODS: Eight databases were searched using multiple key words, and combinations of key words, to find the highest level of evidence available. Four randomized controlled trials, 2 quasi-experimental trials, and 3 descriptive longitudinal comparative studies were identified and assessed. FINDINGS: Eight of the 9 studies showed improved adherence with treatment recommendations for patients with osteoporosis or those at high risk for the disease after the healthcare professional-led educational intervention. A professional nurse may be in the best position to lead this type of education, with 6 of the 9 studies using nurses as educators.

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