The importance of social networks in neurosurgery training in low/middle income countries

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Burden of the Beast

BackgroundThe advent of social media has significantly transformed various medical specialties, including neurosurgery. A systematic review of the literature was conducted to characterize the utilization of social media in neurosurgery and to evaluate the impact of social media usage in neurosurgery. Furthermore, the study aimed to determine the demographics of social media users in neurosurgery and delineate their purposes for engaging with social media platforms.MethodsA comprehensive literature search was conducted across the PubMed, EMBASE, Scopus, and Cochrane databases to identify studies investigating the role of social media in neurosurgery. Articles were screened for relevance, and selected studies were systematically reviewed and analyzed to assess the integration of social media within neurosurgical practices.Results105 studies were included. 2023 represented the year with the most published articles (28%). Most studies (52%) addressed general neurosurgery, followed by intracranial (24%) and spine surgery (24%). X (formerly Twitter) was the most frequently studied platform (46%), followed by YouTube (38%) and Facebook (30%). The primary purposes of social media use were patient education (36%), evaluation of the impact (22%), healthcare provider education (20%), collaboration (9%), research dissemination (8%), and career development (6%). 64% of studies targeted healthcare professionals, while 36% focused on patients. Sentiment towards social media use was positive in 50% of studies, negative in 19%, and neutral or exploratory in 31%.ConclusionThe literature highlights a notable increase in the use of social media in the neurosurgical field, particularly for education, impact analysis and research distribution. Platforms like X have become central for academic exchange and professional networking. Having a social media presence can be beneficial for neurosurgeons and can positively impact patient reviews, the department’s standing, and may even contribute to academic success. Furthermore, social media facilitates interdisciplinary collaboration and access to educational content.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00701-025-06695-1.

Background The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. ‘Neurosurgery cocktail’ (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery. Methods Facebook and Twitter metrics were extracted through each respective platform’s analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases. Results On Facebook, as of January 2021, the group had a total of 25.590 members (87.6% male), most commonly (29%) between 35 and 44 years of age with over 100 countries were represented. As of January 2021, they had amassed 6457 followers on Twitter. During the last 28 d between December 2020 and January 2021, the account published 65 tweets that garnered a total of 196,900 impressions. Twelve articles were identified in our literature review on the use of social media within the neurosurgical community. Conclusions NC is one of the most widely utilized neurosurgical social media resources available. Sharing knowledge has been broadened thanks to the recent social media evolution, and NC has become a leading player in disseminating neurosurgical knowledge.

Social media use in neurosurgery remains an understudied phenomenon. Our study aims to examine the global membership and engagement of the prominent Neurosurgery Cocktail Facebook group with over 25,000 neurosurgeons and trainees worldwide, specifically during the COVID-19 pandemic. Neurosurgery Cocktail's numbers of members, posts, comments, and reactions were collected from December 2019 to November 2020. Anonymized aggregate data of members' characteristics, including age, sex, and country of origin in November 2020, were also obtained. The most engaging posts in November 2020 were categorized into topics by a majority consensus of 3 reviewers. The average number of members steadily increased from 21,266 in December 2019 to 25,218 in November 2020. In November 2020, 18.8% of members were women, and 71.3% were between 25-44 years old. With members from 100 countries, 77.9% are from low- and middle-income countries, with the highest representation from India, Egypt, and Brazil. After the COVID-19 pandemic declaration, daily engagement peaked in April 2020 with a daily average of 41.63 posts, 336.4 comments, and 1914.6 reactions before returning to pre-pandemic levels. Among the 99 top posts in November 2020, the majority (56.5%) were classified as "interesting cases," with "education-related" as the second-most common topic (16.2%). Neurosurgery Cocktail has shown steady growth since its creation. The COVID-19 pandemic was correlated with a spike in activity without lasting impact. The group demonstrates social media's potential for knowledge exchange and promoting organic international collaborations.

An adequate healthcare workforce characterizes high-quality health systems. Sustainable domestic neurosurgery training is critical to developing a local neurosurgical workforce in low- and middle-income countries (LMICs). This study evaluated how neurosurgical training is delivered in Ethiopia, provides a historical narrative of neurosurgery training in the nation, and proposes future educational opportunities. A mixed-methods design consisting of a semi-structured interview and a comprehensive survey was used to acquire data. The interview participants included neurosurgery program directors and faculty involved in resident education. The survey was sent to all current neurosurgery residents in Ethiopia. Ethiopian neurosurgical service began in 1970, and neurosurgical education started in 2006 with the establishment of the Addis Ababa University (AAU) residency program. The survey response rate was 86%, with 69 of 80 eligible neurosurgery residents responding. Most respondents were male (93%), aged 20-25 years (62%), and enrolled in the AAU program (61%). The oldest medical schools affiliated with tertiary hospitals were the top feeder institutions for neurosurgery training. Seventy-one percent of respondents worked for more than 60 hours/week, and 52% logged at least 100 cases annually. Survey responses demonstrated a critical need to establish subspecialty training and harmonize the national training curriculum. The history of Ethiopian neurosurgery training exemplifies how global neurosurgery efforts focused on capacity building can rapidly expand the local neurosurgical workforces of LMICs. Opportunities for neurosurgical education require initiatives promoting a subspecialized, diverse workforce that attains both the clinical and academic proficiency necessary for advancing neurosurgical care locally and globally.

Access to training in neurosurgery (Part 1): Global perspectives and contributing factors of barriers to access

Current use of Social Media in Neurosurgery in Spain

Surgeons practicing in high-income countries (HIC) like the United States, which spends an estimated 765 billion dollars per year on unnecessary healthcare costs, are generally not accustomed to resource limitations.1 However, the coronavirus disease 2019 (COVID-19) pandemic has strained the usually robust healthcare system in HIC. Lack of adequate testing, small reserves of ventilators and global supply chain disruptions, among other causes, have led to shortages affecting care for critically ill patients – most notably human resources, ventilators, and personal protective equipment (PPE).2 This has transformed hospitals in HIC to a "resource variable environment" with uncertainty of the supplies, intensive care unit (ICU) beds, and staff available at any given time. Although this challenging environment is novel for many providers in HIC, these constraints are commonplace for providers in low- and middle-income countries (LMIC). Only 12% of the world's specialist surgical and anesthesia workforce practice in the world's poorest regions in Africa and Southeast Asia, where a third of the world's population lives and the majority of the world's surgical burden lies.3,4 LMIC also face a severe shortage of ICU capacity, for example, Uganda has only 0.1 ICU beds per 100,000 population, compared with 20 beds per 100,000 in the United States.5,6 Approximately 1 in every 4 hospitals in LMIC do not have access to oxygen, rendering them unable to provide timely, basic care for many patients.3 At most hospitals in LMIC, PPE shortages are the norm and essential care is provided by family members at the bedside.3,7 To overcome these and other daily challenges, LMIC providers must often improvise, adapt, and innovate. Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies. However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic. In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks. HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique.8–11 In many LMIC, healthcare supply chains are vulnerable at baseline, and providers are regularly faced with shortages of supplies and PPE. Items that are considered disposable in HIC, such as endotracheal (ET) tubes and electrocautery tips and pads, are often reused after high level disinfection. Equipment shortages in LMIC have led to the expanded use of regional anesthesia with intravenous (IV) sedation, and most surgeries are performed open rather than via laparoscopy. Operating room supplies are opened only as-needed and evaluated after each case; only the most essential available instruments for every case are opened, and key instruments are prioritized for sterilization throughout the day. Similar strategies towards the pragmatic use of operating room resources could be considered in HIC and may even decrease perioperative costs.12 Public private partnerships and innovative local production strategies have emerged in LMIC in response to widespread oxygen shortages.13,14 Such strategies may be considered in HIC should there be an oxygen shortage during the COVID-19 pandemic. Additionally, surgical gowns, head covers, and surgical drapes in LMIC are cloth, requiring washing and reuse, whereas such supplies are disposable in the majority of hospitals in HIC, particularly in the US. The use of disposable surgical textiles is largely driven by reimbursements to hospitals based on volume of purchases, and there is a lack of evidence to suggest that the use of disposables have an overall cost or safety benefit.15 Transitioning to increased use of reusable products where possible would make HIC hospitals less vulnerable to supply chain disruptions and would additionally have a substantial sustainability benefit. Amid the COVID-19 pandemic, the number of patients requiring mechanical ventilation in the US could range between 1.4 and 31 patients per available ventilator, which would necessitate thoughtful resource allocation should HIC face a ventilator shortage.16 Even outside the setting of pandemics, LMIC face a constant shortage of ventilators and ICU care, even in national referral hospitals.17 As a result, many young patients die from reversible etiologies, such as surgical disease, postsurgical complications, infectious diseases, trauma, and peripartum maternal or neonatal complications.18 Providers in these settings routinely make difficult ethical and practical decisions about the allocation of ICU care, often informed by the local context and cultural factors. This extends through the entirety of the perioperative journey, from who can be offered surgery, to operative approaches and postoperative care. Scoring systems appropriate for the LMIC context have been developed, and take into account some of these factors.19,20 Other mitigation strategies include the development of high-dependency units, which have increased capacity for monitoring and oxygen delivery, and training programs for the limited numbers of ward nurses emphasizing early recognition and intervention for critically ill patients.21 Should ventilator shortages become apparent, a planning exercise for this type of scenario in HIC may be worthwhile given the current reality of ventilator shortages to potential need. A large volume of critically-ill patients combined with potentially high rates of healthcare worker infections and exposures has led to staffing shortages in both HIC and LMIC during COVID-19. LMIC already face severe staffing shortages due to a variety of factors, including low numbers of graduates, poor salaries and working conditions, and high attrition rates.22 Addressing such shortages has required a number of innovations, some of which could potentially be adapted for use in HIC. A program to engage family members in multiple aspects of patient care has been used successfully by Narayana Health in India. Family members were trained to perform tasks such as monitoring fluid balance, taking and recording vital signs, and assisting with incentive spirometry, which not only cut costs and addressed staffing shortages, but reduced postoperative complication rates.23 Due to social distancing guidelines and visitor restrictions in hospitals this may be most effectively utilized for post-hospitalization care and rehabilitation programs as support staff and rehab centers are also part of the overwhelmed healthcare community. In LMIC, both physician and nonphysician general practitioners are commonly called upon to perform essential surgery.24 Such task sharing, where healthcare workers are reorganized and required to work in alternative roles to meet changes in workforce demands, is a common solution to staffing shortages in LMIC. During the COVID-19 pandemic, this practice been a necessary adaptation in HIC as the imminent need for many specialties declined, whereas intensivists and generalists have been in high demand. In our own HIC institutions we have seen the re-allocation of surgical critical care physicians and surgeons into roles assisting in the medical intensive care units and medical floors helping care for both COVID and non-COVID medical patients. This crisis has brought attention to the need to address the shortage of more broadly trained personnel and generalist physicians, which is largely attributed to the high costs of medical school and procedure-based reimbursement strategies, resulting in higher salaries for specialist physicians.25 Going forward, the expansion of policies to incentivize young doctors to enter general practice, such as tuition reimbursement and a transition to value-based payment strategies in both HIC and LMIC may be necessary. The widespread, immediate implications of the acute shortages during the COVID-19 pandemic have highlighted the need for systems strengthening in both HIC and LMIC and have forced us to re-examine our approach to healthcare delivery. Telemedicine is being optimized globally more than ever before to prevent surges through forward triage, minimize healthcare worker exposures and address workforce shortages.26 The widespread implementation of telehealth interventions can be leveraged long after the pandemic ends to overcome challenges of distance and patient access in both HIC and LMIC. This will need to be done thoughtfully to ensure that alternatives are developed when necessary for vulnerable populations that may have challenges in technology use. Disruption in the global supply chain for healthcare supplies has underscored the importance of building redundancies into the system, and has led to the opening up of new local supply chains by linking local stakeholders.27 Shortages of PPE and other essential equipment have also highlighted the need for a transparent, centrally controlled strategic reserve of medical supplies. Hospitals have had to rapidly scale up ICU capacity, which has underlined the value of redundant capacities and flexibility within the healthcare system. These lessons have highlighted the need for long-term investment to build flexible, resilient health systems and are sure to help providers in both HIC and LMIC care for more patients safely and effectively both during this pandemic and long after it ends. Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic. The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing. Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner. However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation. For surgeons working in HIC, there is much to learn from counterparts in LMIC. Healthcare systems in many LMIC, particularly in Africa, have more experience responding to infectious disease pandemics, especially in contact tracing and community mobilization. The extensive network of community health workers in LMIC is an essential component of grass roots public health infrastructure that HIC may be able to emulate.28 Triage systems, finite resources, and limited personnel in LMIC require constant thoughtfulness regarding testing, treatment, and disposition. More importantly, working in a resource-variable environment requires fostering a set of soft skills that LMIC practitioners utilize on a daily basis. These include adaptability, resourcefulness, frugality of supplies, humility, and leadership among others. These lessons highlight the importance of fostering bilateral partnerships and increasing relevance of global health competencies to surgical training. Examples such as task sharing illustrate that HIC can adapt and can respond to these challenges with resilience.29 This requires vigilant monitoring of the situation and constant improvisation in the face of unpredictable challenges. These and other nontechnical skills are always essential to ensure safe and high quality surgical care but become especially pertinent during this trying time. The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks. There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19.30 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC. This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity – regardless of geography. New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action.31 The overall lack of collective and individual health equity around the globe dramatically weakens our global heath security and without addressing this disparity, the even the best attempts by HIC to ensure safeguard domestic health will always be undermined.32 The grave reality is in both LMIC and now in HIC, population needs vastly outpace our resources, and it is the patients who are affected unless we too improvise, adapt, and innovate. Global surgery collaborations with reciprocity between partners, with trainees and faculty working together, enhance our capacity to share our collective expertise and navigate this pandemic resiliently.

Social Media in Neurosurgery: Using ResearchGate

Towards a collaborative-integrative model of education and training in neurosurgery in low and middle-income countries

Social Media in Neurosurgery: A Systematic Review

e18542 Background: The use of ehealth digital interventions (DI) can have a great potential to improve adjustment of cancer patients and caregivers. However, limited information is available about use of ehealth with Spanish and Portuguese speaking cancer patients from US, Spain, and Latin America. This study sought to explore the use of ehealth or DI by mental health providers (MHP) with Spanish and Portuguese speaking cancer patients and to determine the impact of the national income levels (World Bank Classification) on the use of this technology. Methods: An online survey was conducted from March to July 2021, publicized through social media and an organization Listserv. MHP (psychologists, psychiatrists) who treated Latino or Hispanic cancer patients in Latin America, Spain and the US, were invited to participate. The survey obtained demographic and professional information, The survey included questions about the use of eight DI (mobile apps, internet videos, websites, virtual conferences, virtual support groups, text messages, social networks, and emails) during the pandemic. For the purposes of this analysis, we excluded telehealth. Results: Among the 114 MHP (97% psychology related) from 18 countries, 25% were from high income countries (HIC; US, Spain, Puerto Rico, Chile, and Uruguay), and 75% were from middle income countries (MIC; other Latin American countries predominantly Mexico, Argentina, Peru). They were all Hispanic/Latino and 82% females. The majority, 77% of MHP, reported using at least 1 of the 8 DIs with cancer patients, average of two DIs (M = 2.3, SD = 1.9). Half of the MHP use internet-based videos with patients, 44% websites, 37% mobile apps, 29% virtual conferences, 19% virtual support groups, 19% text messages, 18% social networks, and 11% emails. Apps were recommended to improve emotional well-being (55%), anxiety/stress (53%), sleep disturbance (37%), depression (20%), fatigue (17%), pain (16%), loneliness/social support (13%), communication problems (12%), and other physical symptoms (8%). Comparing the country's income level across the use of the 8 DIs, only the use of mobile apps (62% HIC vs. 28% MIC) and email support (24% HIC vs. 6% MIC) were found significant. Conclusions: Previous research (with predominantly North American and European samples) has found that DIs can help cancer patients with side effects, improving self-management and wellbeing. DIs were largely used by MHP to mitigate emotional and physical symptoms and to improve the QoL of Latino cancer patients and only MHP from MIC (compared to HIC) differed in their use of mobile apps and email support. These findings support the potential for DI to improve care, and symptom management in Latino cancer patients from Latin America, the US, and Spain.

The cancer burden is expected to reach 20 million new cases annually in low and middle-income countries (LMICs) by 2025. Few estimates suggest that thyroid cancer could become the third most common cancer diagnosed in women by 2019. Health care services need to gear up to provide close clinical follow-up care for patients especially in LMICs where there is already a shortage of healthcare personnel. We conducted this study to assess the effect of remote monitoring using tele-follow up on compliance, satisfaction and economic benefit. Participants were recruited to traditional hospital follow-up (consultation, clinical examination, and investigations as per hospital policy) or tele-follow up based on social media. Outcomes included information needs, participants’ compliance, and satisfaction, post-op complications, clinical investigations ordered. A total of 64 patients with thyroid cancer were recruited- 24 in hospital follow up group and 40 in the remote monitoring group. There were no significant differences between groups regarding satisfaction with information received. Responses were significantly more positive in the social media group, with a higher percentage reporting “very satisfied”. Wound evaluation through tele-follow up was on par with OPD follow up. If all of these 40 patients would have come to our OPD follow-up, they would have travelled on an average of 930 kms per patient. This study shows that social media is a practical tool in follow-up of cancer patients in LMICs where traditional telemedicine tools are restricted and conventional follow-up is economically challenging to patients. It also ensures compliance which is a major issue with conventional follow-up due to poor infrastructure.

Social media allows for easy access and sharing of information in real-time. Since the beginning of the coronavirus disease (COVID-19) pandemic, social media has been used as a tool for public health officials to spread valuable information. However, many Internet users have also used it to spread misinformation, commonly referred to as “fake news.” The spread of misinformation can lead to detrimental effects on the infrastructure of healthcare and society. The purpose of this scoping review was to identify the sources and impact of COVID-19 misinformation on social media and examine potential strategies for limiting the spread of misinformation. A systemized search of PubMed, Embase, and Web of Science electronic databases using search terms relevant to the COVID-19 pandemic, social media, misinformation, or disinformation was conducted. Identified titles and abstracts were screened to select original reports and cross-checked for duplications. Using both inclusion and exclusion criteria, results from the initial literature search were screened by independent reviewers. After quality assessment and screening for relevance, 20 articles were included in the final review. The following three themes emerged: (1) sources of misinformation, (2) impact of misinformation, and (3) strategies to limit misinformation about COVID-19 on social media. Misinformation was commonly shared on social media platforms such as Twitter, YouTube, Facebook, messaging applications, and personal websites. The utilization of social media for the dissemination of evidence-based information was shown to be beneficial in combating misinformation. The evidence suggests that both individual websites and social media networks play a role in the spread of COVID-19 misinformation. This practice may potentially exacerbate the severity of the pandemic, create mistrust in public health experts, and impact physical and mental health. Efforts to limit and prevent misinformation require interdisciplinary, multilevel approaches involving government and public health agencies, social media corporations, and social influencers.