In Reply: Operationalizing Global Neurosurgery Research in Neurosurgical Journals

Abstract

To the Editor:We read with great interest the letters published on "Operationalizing Global Neurosurgery Research in Neurosurgical Journals" and related replies. [1][2][3] The growing interest in global surgery has had a significant impact on neurosurgery with the number of published papers and dedicated conference sessions/webinars increasing over time. 4,5 Advocates of global neurosurgery believe that we need to ensure the provision of adequate care to all patients with neurosurgical conditions no matter where they live and that this can be achieved through collaboration between countries with limited resources and high-income countries (HICs).However, why do we need a new "global" section in neurosurgical journals? The very basic knowledge of epidemiological and clinical data from a large part of our globe is limited. Less than 10% of neurosurgical publications are produced by low-income and lower middle-income countries, with 2 countries alone (India and Egypt) contributing 75% of these papers. 6 This leads to an inverse relationship between disease burden and number of publications. As an example, in traumatic brain injury, most of the papers originate from North America, Europe, Japan, Australia, and China, whereas trauma is an endemic disease in Africa, South East Asia, and Latin America. 7 When examining neurosurgical randomized controlled trials (RCTs), only 9% of the studies are led by low middle-income countries (LMICs). 8 Because RCTs usually form the basis of clinical guidelines, most if not all the published guidelines in neurosurgery are produced by HICs for HICs but are then supposed to be applied all over the world.As Galileo Galilei said "misura cio che e' misurabile e rendi misurabile cio' che non lo e" (measure what you can measure and make measurable what is not available).Neurosurgeons and scientists from HICs with expertise in data collection, RCTs, and guideline development need to work together with the large number of surgeons who work, often with limited resources, taking care of a large volume of patients to allow them to answer questions relevant to their practice and develop guidelines relevant to their settings. A good example of such collaborative work is the BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) project in Colombia, which aims to develop resourcestratified guidelines for managing traumatic brain injury. 9 The project is receiving methodological and funding support by the

In Reply: Operationalizing Global Neurosurgery Research in Neurosurgical Journals

“…We applaud the international effort stemming from Humanitas Clinical and Research Center-IRCCS, Italy; Humanitas University, Italy; The University of Cape Town, South Africa; Addenbrooke's Hospital, United Kingdom; The University of Cambridge, United Kingdom; The University of Bamenda, Cameroon; Universidad El Bosque, Colombia; and Valle-Salud IPS Clinical Network, Colombia and we thank Dr Servadei et al 1 for their letter in response to our article “Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals.” 2 In addition, we thank the authors 1 for reading and addressing content from related replies to our original article. 3,4…”

“…Recommendations of the Colombian Consensus Committee from the Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol (BOOTStraP) 8,9 are indeed effective and appropriate policy implementation measures to improve patient outcomes and quality of life; we agree with the authors. 1…”

“…Recommendations of the Colombian Consensus Committee from the Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol (BOOTStraP) 8,9 are indeed effective and appropriate policy implementation measures to improve patient outcomes and quality of life; we agree with the authors. 1 Similarly, since 2001, The University of Pennsylvania School of Medicine has partnered with the Government of Botswana Ministry of Health and the University of Botswana to build healthcare and increase research capacity, currently employing more than 120 fulltime staff in the country. This growing Botswana-UPenn partnership has allowed for interdisciplinary care, development of postgraduate training programs at the University of Botswana, and joint research programs addressing the health and welfare of the citizens of Botswana.…”

“…A recent meta-analysis 10 on the literature pertaining to the ethics of global surgery highights multiple ethical conflicts created by global surgical initiatives pertaining to the delivery of culturally competent patient care, the potential for nontransference of knowledge, and the development of sustainable and capacity-building partnerships. For example, as the authors 1 astutely point to in their reply, researchers from LMICs are frequently inappropriately credited in publication or furthermore insufficiently involved in planning of global surgery research partnerships, allowing for the potential for exploitation of LMICs by our pervasive publish or perish mentality. An additional meta-analysis of issues in global surgery 11 found that 20% of all publications did not include LMIC partners as coauthors; we thus agree with the authors 1 in their thoughtful reply—it is critical that we not only make a concerted effort to mitigate inequities in publishing and authorship but also posit similarly critical to build an environment in academic research that fosters literature on global surgical ethics from both HMIC and LMIC partners.…”

“…We express our sincere gratitude to Servadei et al 1 along with the World Federation of Neurosurgical Societies, The United Kingdom National Health Service, and the Young Neurosurgeons Committee for their generous contributions to the vehicle of global neurosurgery.…”