Publications
180 results found
Car TL, 2016, PRIORITIZING MEDICATION PROBLEMS IN CARE OF PEOPLE WITH CANCER AND SOLUTIONS FOR THESE: A PRIORITIZE STUDY, VALUE IN HEALTH, Vol: 19, Pages: A894-A894, ISSN: 1098-3015
Tudor Car L, Papachristou N, Bull A, et al., 2016, Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study, BMC Family Practice, Vol: 17, ISSN: 1471-2296
Background: Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care. Methods: We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the Average Expert Agreement.Results: The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts.Conclusions: The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their vie
Gentry S, L'Estrade Ehrstrom B, Gauthier A, et al., 2016, Serious gaming and gamification interventions for health professional education, Cochrane Database of Systematic Reviews, Vol: 6, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of Serious Gaming and Gamification interventions for delivering pre- and post-registration health professional education compared with traditional learning, other types of eLearning, or other Serious Gaming and Gamification interventions. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction.
Kononowicz AA, Woodham L, Georg C, et al., 2016, Virtual patient simulations for health professional education, Cochrane Database of Systematic Reviews, Vol: 5, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners’ knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.
Hervatis V, Kyaw BM, Semwal M, et al., 2016, Offline and computer-based eLearning interventions for medical students' education, Cochrane Database of Systematic Reviews, Vol: 4, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective of this review is to assess the effects of offline, computer-based eLearning compared with 'traditional' learning and other types of eLearning interventions for medical students' knowledge as well as changes in skills and attitude towards the intervention. Additionally, as secondary objectives, this review will assess the economic impact (cost-benefit, cost-utility or cost-effectiveness), unintended adverse effects, and medical students' satisfaction with using offline and computer-based educational interventions.
Paul P, Toon E, Hadadgar A, et al., 2016, Online- and local area network (LAN)-based eLearning interventions for medical doctors' education, Cochrane Database of Systematic Reviews, Vol: 2016, ISSN: 1465-1858
This is the protocol for a review and there is no abstract. The objectives are as follows: This review will evaluate the effectiveness of internet- and LAN-based eLearning for ongoing training of medical doctors, specifically looking at the impact of the learning on the learners' knowledge, skills, attitude, and satisfaction. This review will also assess any change in clinical practices or behaviours in response to these interventions, and the economic impact (cost and cost-effectiveness) of internet- and LAN-based educational interventions.
Saxena N, Kyaw BM, Vseteckova J, et al., 2016, Virtual reality environments for health professional education, Cochrane Database of Systematic Reviews, Vol: 2016, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows:To assess the effects of virtual reality environment (VRE)-based educational interventions for health professionals on knowledge, skills, and participants’ attitude towards and satisfaction with the interventions. Additionally, this review will assess the interventions' economic impact (cost and cost effectiveness), patient-related outcomes and unintended adverse effects of VRE-based educational interventions for post-registration healthcare providers.
Tudor Car L, Riboli-Sasco EF, Marcano Belisario JS, et al., 2015, Mobile learning for delivering health professional education (protocol), Cochrane Database of Systematic Reviews, Vol: 2015, ISSN: 1469-493X
This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on students’ knowledge, skills, professional attitudes and satisfaction.
Civljak M, Tudor Car L, Skara S, et al., 2015, The Gap between the Knowledge and Current Practices--A Case of Tobacco Control Programs in Croatia., Coll Antropol, Vol: 39, Pages: 803-808, ISSN: 0350-6134
Despite the availability of numerous evidence-based smoking prevention and cessation programs, many countries are still not implementing these research-proven programs. The primary aim of this paper is to summarize the extent to which evidence-based smoking control programs have been implemented in Croatia over the last two decades. Data from the systematic reviews of the Cochrane Tobacco Addiction Group, which are readily available worldwide, were used as criteria to evaluate whether effective, evidence-based programs have been implemented in Croatia. According to our findings, the most effective behavioral and pharmacological smoking cessation interventions have thus far been underutilized in Croatia. In addition, some interventions that have been continuously implemented in Croatia--such as using self-help materials, school-based programs and the celebration of World No Tobacco Day--have only small, short-term beneficial effects according to the Cochrane reviews. However, Croatia is a party to the World health Organization Framework Convention on Tobacco Control and therefore has effective national legislation on tobacco control. Croatia should develop and implement programs that integrate the existing high-quality empirical evidence on the effectiveness of various behavioral, pharmacological, and social interventions for smoking prevention and cessation. This programming should become a part of a continuous national strategy, and should be implemented throughout all of Croatia.
Rasmussen K, Belisario JM, Wark PA, et al., 2014, Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction, JOURNAL OF GLOBAL HEALTH, Vol: 4, ISSN: 2047-2978
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- Citations: 37
George PP, Papachristou N, Belisario JM, et al., 2014, Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction, JOURNAL OF GLOBAL HEALTH, Vol: 4, ISSN: 2047-2978
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- Citations: 217
Marcano Belisario JS, Tudor Car L, Reeves TJA, et al., 2013, Search strategies to identify observation studies in MEDLINE and EMBASE [Methodology Protocol], Cochrane Database of Systematic Reviews
van-Velthoven MHMMT, Tudor Car L, Gentry S, et al., 2013, Telephone delivered interventions for preventing HIV infection in HIV-negative persons., Cochrane Database Syst Rev
BACKGROUND: This is one of the three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Although HIV infection can be prevented, still a large number of new infections occur. More effective HIV prevention interventions are needed to reduce the number of people newly infected with HIV. Phone calls can be used to potentially more effectively deliver HIV prevention interventions. They have the potential to save time, reduce costs and facilitate easier access. OBJECTIVES: To assess the effectiveness of voice landline and mobile telephone delivered HIV prevention interventions in HIV-negative persons. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, Web of Science, Cumulative Index to Nursing & Allied Health, the World Health Organization's Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International and the Centre for Agricultural Bioscience International Direct Global Health database, the System for Information on Grey Literature Europe, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections database, International AIDS Society conference database, AIDS Education Global Information System and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of delivering HIV prevention by phone calls to usual care in HIV-negative people regardless of their demographic characteristics and in all settings. DATA COLLECTION AND ANALYSIS: Two reviewers independently searched databases, screened citations, assessed study quality and extracted data. A third reviewer resolved any disagreement. Primary outcomes were knowledge about th
Gentry S, van-Velthoven MHMMT, Tudor Car L, et al., 2013, Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection., Cochrane Database Syst Rev, Vol: 2013
BACKGROUND: This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. OBJECTIVES: To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in beh
Tudor Car L, Gentry S, van-Velthoven MHMMT, et al., 2013, Telephone communication of HIV testing results for improving knowledge of HIV infection status., Cochrane Database Syst Rev
BACKGROUND: This is one of three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Both in developed and developing countries there is a large proportion of people who do not know they are infected with HIV. Knowledge of one's own HIV serostatus is necessary to access HIV support, care and treatment and to prevent acquisition or further transmission of HIV. Using telephones instead of face-to-face or other means of HIV test results delivery could lead to more people receiving their HIV test results. OBJECTIVES: To assess the effectiveness of telephone use for delivery of HIV test results and post-test counselling.To evaluate the effectiveness of delivering HIV test results by telephone, we were interested in whether they can increase the proportion of people who receive their HIV test results and the number of people knowing their HIV status. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health (CINAHL), WHOs The Global Health Library and Current Controlled Trials from 1980 to June 2011. We also searched grey literature sources such as Dissertation Abstracts International,CAB Direct Global Health, OpenSIGLE, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society and AEGIS Education Global Information System, and reference lists of relevant studies for this review. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-randomised controlled trials (qRCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) studies comparing the effectiveness of telephone HIV test results notification and post-test counselling to face-to-face or other ways of HIV test result delivery in people regardless of their demographic characteristics and in all settings. DATA COLLECTION AND ANALYSIS: T
Tudor Car L, Brusamento S, Elmoniry H, et al., 2013, The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review., PLoS One, Vol: 8
BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.
Brusamento S, Ghanotakis E, Tudor Car L, et al., 2012, Male involvement for increasing the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) programmes., Cochrane Database Syst Rev, Vol: 10
BACKGROUND: Despite efforts to increase the uptake of prevention of mother to child transmission of HIV (PMTCT) services, coverage is still lower than desired in developing countries. A lack of male partner involvement in PMTCT services is a major barrier for women to access these services. OBJECTIVES: To evaluate the impact of interventions which aim to enhance male involvement to increase women's uptake of PMTCT interventions in developing countries. SEARCH METHODS: We searched the following databases from the year 2000 to November 2011: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, the WHO Global Health Library, ClinicalTrials.gov, Current Controlled Trials, AEGIS, CROI, IAS, IAC web sites. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies assessing interventions to increase male involvement for improvement of uptake PMTCT services in low- and middle-income countries.. DATA COLLECTION AND ANALYSIS: Two reviewers independently searched, screened, assessed study quality and extracted data. A third reviewer resolved any disagreement. MAIN RESULTS: Only one study met the inclusion criteria, an RCT conducted in Tanzania between May 2003 and October 2004. Women in the intervention group (n=760) received a letter for their male partners, which invited them to return together to receive Couple Voluntary Counselling and Testing (CVCT) for HIV. Women in the control group (n=761) received individual HIV VCT during their first ANC visit and then usual care. The percentages of women who received HIV VCT and collected their results were 48%, 45% and 39% in the intervention group and 93%, 78% and 71% in the control group (p <0,001). Only 33% of women in the intervention group returned with their male partners and only 47% of them went through the whole CVCT process. The
Tudor Car L, Van Velthoven MHMMT, Brusamento S, et al., 2012, Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review., PLoS One, Vol: 7
BACKGROUND: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. METHODS: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. RESULTS: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). CONCLUSION: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring co
van Velthoven MHMMT, Tudor Car L, Car J, et al., 2012, Telephone consultation for improving health of people living with or at risk of HIV: a systematic review., PLoS One, Vol: 7
BACKGROUND: Low cost, effective interventions are needed to deal with the major global burden of HIV/AIDS. Telephone consultation offers the potential to improve health of people living with HIV/AIDS cost-effectively and to reduce the burden on affected people and health systems. The aim of this systematic review was to assess the effectiveness of telephone consultation for HIV/AIDS care. METHODS: We undertook a comprehensive search of peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed the quality of randomized controlled trials which compared telephone interventions with control groups for HIV/AIDS care. Telephone interventions were voice calls with landlines or mobile phones. We present a narrative overview of the results as the obtained trials were highly heterogeneous in design and therefore the data could not be pooled for statistical analysis. RESULTS: The search yielded 3321 citations. Of these, nine studies involving 1162 participants met the inclusion criteria. The telephone was used for giving HIV test results (one trial) and for delivering behavioural interventions aimed at improving mental health (four trials), reducing sexual transmission risk (one trial), improving medication adherence (two trials) and smoking cessation (one trial). Limited effectiveness of the intervention was found in the trial giving HIV test results, in one trial supporting medication adherence and in one trial for smoking cessation by telephone. CONCLUSIONS: We found some evidence of the benefits of interventions delivered by telephone for the health of people living with HIV or at risk of HIV. However, only limited conclusions can be drawn as we only found nine studies for five different interventions and they mainly took place in the United States. Nevertheless, given the high penetration of low-cost mobile phones in countries with high HIV endemicity, more evidence is needed on how telephone consultation can aid in the d
Tudor Car L, van-Velthoven MH, Brusamento S, et al., 2011, Integrating prevention of mother-to-child HIV transmission (PMTCT) programmes with other health services for preventing HIV infection and improving HIV outcomes in developing countries., Cochrane Database Syst Rev
BACKGROUND: Every year nearly 400,000 children are infected with HIV through mother-to-child transmission (MTCT), which is responsible for more than 90% of HIV infections in children. In high-income countries, the MTCT rate is less than 1% through perinatal prevention of mother-to-child HIV transmission (PMTCT) interventions. In low- and middle-income countries, PMTCT programme coverage remains low and consequently transmission rate high. The World Health Organisation recommends integration of PMTCT programmes with other healthcare services to increase access and improve uptake of these interventions. OBJECTIVES: To assess the effect of integration of perinatal PMTCT measures with other health care services on coverage and service uptake compared to stand-alone PMTCT programmes and healthcare services or partially integrated PMTCT interventions. SEARCH STRATEGY: We searched the following databases, for the time period of January 1990 to August 2010: MEDLINE, EMBASE, the WHO Global Health Library, CAB abstracts, CINAHL, POPLINE, PsycINFO, Sociological Abstracts, ERIC, AEGIS, Google Scholar, New York Academy of Medicine Grey Literature, Open SIGLE, British Library Catalogue, ProQuest Dissertation & Theses Database and U.S. National Library of Medicine Gateway system. We also searched the Cochrane Database of Systematic Reviews (the Cochrane Library 2010, Issue 7), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2010, Issue 7), Database of Abstracts of Reviews on Effects (the Cochrane Library 2010, Issue 7). We also searched for ongoing trials in the WHO International Clinical Trials Registry and Controlled clinical trials (January 1990 to July 2010). We performed ISI Web of Knowledge Cited Reference Search and scanned the reference lists of the included articles for additional relevant studies. We contacted authors to locate additional eligible studies. To maximise sensitivity we did not employ any methodological filters. SELECTION CRITERI
Tudor L, Sikirić P, Tudor KI, et al., 2008, [Amusia and aphasia of Bolero's creator--influence of the right hemisphere on music]., Acta Med Croatica, Vol: 62, Pages: 309-316, ISSN: 1330-0164
OBJECTIVES: The experience with cortical localization (BA 44, 45, 22) of language (Broca, Wernicke and others) in the left hemisphere has been repeatedly tested over the last 150 years and is now generally accepted. A single case report with autopsy findings (Leborgne, Tan tan), has enabled to localize the seat of spoken language in the left third frontal convolution. As music and language have a lot in common and even share the same hearing system, it is logical to try to localize the cognitive centers for music too. METHODS: The disabling neurological disease illness of Maurice Ravel (1875-1937), a French impressionist composer, is not the right example to localize music center as that of Broca's language center, but it demonstrates the role of the right hemisphere in music production. In the last five years of his life, Ravel suffered from an unknown disease that affected the left hemisphere causing aphasia, apraxia, alexia, agraphia and amusia. It was the reason why Ravel could not compose during the last years of his life. In contrast to Ravel, Shebalin and Britten continued writing music works of their own although aphasic after having sustained two strokes to the left hemisphere. While lacking clinical cases with selective ablative brain lesions, research into the music localization can be done using modern imaging technologies such as fMRI and PET. RESULTS: Exercising music (professionally) develops analytical process in the left hemisphere whereas other individuals process music in their right hemisphere. There is right ear (left hemisphere) predominance in musicians and vice versa in musical amateurs. Music lateralization towards the right hemisphere is seen in women and in inattentive listeners. It can be subject to cultural influence, so the Japanese process their traditional popular music in the left hemisphere, whereas Westerners process the same music in the right hemisphere. Music and language are processed separately; they are localized in homologou
Tudor KI, Tudor M, Buca A, et al., 2008, [Electrosurgery, the cornerstone of current achievements of brain tumor surgery--on the occasion of 80th anniversary]., Acta Med Croatica, Vol: 62, Pages: 33-40, ISSN: 1330-0164
Neurosurgical pioneers had so many obstacles that prevented safe work and favorable outcome of the patients operated on. The mortality rate was high and discouraging. The operations were fast and rude whereafter the patients were dying or suffered prolonged hemorrhagic shock. The three cornerstones of neurosurgery, i. e. cerebral localization, asepsis and narcosis, had not yet been discovered and the only diagnostic tools available were recently discovered x-rays, ventriculography and angiography. However, the greatest challenge for the neurosurgeon was that even if luckily localized through a craniotomy, how to remove the brain tumor while avoiding uncontrollable bleeding. Therefore, an array of techniques and tricks were developed such as bone wax, Cushing silver clips, packing of the wound, etc. but all of them were insufficient in case of intracerebral hemostasis. Electrosurgery revolutionized this unacceptable situation thoroughly. It was introduced in neurosurgery 80 years ago (on October 1, 1926) by great Cushing, whereupon its usage has spread rapidly worldwide. The mortality rate was lowered to 13%! The coagulator was constructed by Harvard's physicist Bovie, after whom is named. Owing to the new technique, the control of bleeding in neurosurgery has become much safer, craniotomies are larger than before and the operation time is esentially longer. Since the perfection of bipolar coagulation (by Greenwood and Malis brothers), and after the introduction of the operating microscope (Donaghy, Krayenbühl, Yasargil) in 1970, this half of a century-long monopolar era was over, and the new time of microneurosurgery has begun. It enables better, easier and more precise hemostasis of the magnified brain blood vessels (microscope).
Tudor M, Tudor L, Tudor KI, et al., 2008, [Unusual open craniocerebral injury caused by sickle's tip]., Acta Med Croatica, Vol: 62, Pages: 85-88, ISSN: 1330-0164
A nine years old girl suffered an unusual penetrating injury to the head caused by a sickle's tip sticked into the skull bones during a lavender harvest on island of Hvar. GCS score was 15. A sickle's blade and its handle were clearly seen coming out of the frontal bone, hanging free, while its tip was firmly sitting in the skull bones! After a neuroradiological diagnostical work up (skull x rays and CT scans) that confirmed intracranial penetration she was operated as an emergency. An osteoclastic craniotomy was done, a and a sickle thereafter easily extracted. Lacerated and contused brain and the penetrating canal were debrided and dura defect covered with a patch. Broad spectrum antibiotics were administered after antitetanic prophylaxis. Postoperative course was uneventful especially regarding infection. One year after the accident she goes normaly to school.
Tudor M, Tudor L, Tudor KI, et al., 2007, Walter Edward Dandy, MD (1886-1946), a pioneer and leading figure in neurosurgery, NEUROLOGIA CROATICA, Vol: 56, Pages: 25-34, ISSN: 0353-8842
Tudor M, Tudor L, Tudor KI, 2006, Harvey William Cushing (1869-1939), the founder of modern neurosurgery, NEUROLOGIA CROATICA, Vol: 55, Pages: 15-26, ISSN: 0353-8842
Tudor M, Tudor L, Tudor KI, 2005, Wartime craniobasal injuries in Southern Croatia, Acta Clinica Croatica, Vol: 44, Pages: 125-129, ISSN: 0353-9466
During the war in Croatia (1991-1995), 26 patients with craniobasal (facio-orbital) injuries were treated in southern Croatia. Numerous complications that accompany these lesions give them specific neurosurgical importance. Patient records were retrospectively analyzed in order to assess outcome in this group of patients. Cerebrospinal fluid fistula was observed in one third of the patients. Cerebrospinal fluid fistula based infection occurred in over 50% of cases. Endocranially located retained foreign bodies were seen in 10 patients. A higher rate of reoperation (mostly for cerebrospinal fluid fistula) was recorded in this group of patients as compared with other sites of head injuries. Favorable outcome was recorded in 18 and unfavorable outcome in 8 patients, whereas 3 patients died. This survey of patient records showed it to be of utmost importance to follow the well defined neurosurgical policy according to which the primary wound repair (especially of the torn basal dura mater) should be a definitive one. Cerebrospinal fluid fistula, retained foreign bodies, low Glasgow Coma Scale on admission, and reoperation exert an unfavorable effect on patient outcome.
Tudor M, Tudor L, Tudor KI, 2005, Complications of missile craniocerebral injuries during the Croatian Homeland War, MILITARY MEDICINE, Vol: 170, Pages: 422-426, ISSN: 0026-4075
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Tudor M, Tudor KI, Tudor L, 2005, Babinski, the father of French neurosurgery, NEUROLOGIA CROATICA, Vol: 54, Pages: 27-36, ISSN: 0353-8842
Tudor M, Tudor L, Tudor KI, 2005, [Hans Berger (1873-1941)--the history of electroencephalography]., Acta Med Croatica, Vol: 59, Pages: 307-313, ISSN: 1330-0164
The discovery of electroencephalography (EEG) in 1929 by the German psychiatrist Hans Berger was a historical breakthrough providing a new neurologic and psychiatric diagnostic tool at the time, especially considering the lack of all those now available in daily practice (EP, CT, MRI, DSA, etc.) whithout which the making of neurologic diagnosis and planning neurosurgical operative procedures would now be unconceivable. There are no recent reports on the topic in the Croatian medical literature. The methods used in the study included search through previous reports, bibliographic notes, Internet sources, and analysis of continuous scientific attempts made through centuries to discover the real nature and meaning of electrical activity. Galvani's accidental discovery of "biological electricity" led to Volta's discovery of the battery (voltaic pile). Using it, Rolando was the first to stimulate cerebral surface. Thus, enabling Fritsch and Hitzig and Ferrier to develop the idea of cerebral localization (Jackson, Gowers, Gotch and Horsley). It was understandable that brain electrical stimulation produces contralateral motor response, but it was unknown whether there was a spontaneous (intrinsic) brain electrical current that could be recorded. Caton was the first to report on the "current in the brain gray substances onto open brain. Based on Caton's discovery and of those of Beck, Danilevsky, Prawdicz-Neminsky and others, Berger made the first EEG (electrocorticogram) recording on July 6, 1924, during a neurosurgical operation on a 17-year-old boy, performed by the neurosurgeon Nikolai Guleke. He reported on the topic in 1929, using the terms alpha and beta waves. The "spike and waves" (Spitzenwellen) were described shortly thereafter by the American group of EEG pioneers (H. and P. Davies, F. and E. Gibbs, Lenox and Jasper), although Berger had also observed them but considered them artifacts. The discovery of electroencephalography was a miles
Tudor M, Carija R, Ledenko V, et al., 2005, The intradural thoracic disc herniation combined with spinal meningioma. Case report and review of literature, NEUROLOGIA CROATICA, Vol: 54, Pages: 89-96, ISSN: 0353-8842
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