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Academic neurosurgery in the UK: present and future directions
Authors and affiliations
Mueez Waqar1,2 - HYPERLINK "mailto:mueez.waqar@manchester.ac.uk" mueez.waqar@manchester.ac.uk
Benjamin M Davies3 - HYPERLINK "mailto:bd375@cam.ac.uk" bd375@cam.ac.uk
Rasheed Zakaria5,6 - HYPERLINK "mailto:rzakaria@nhs.net" rzakaria@nhs.net
Damiano G Barone3,5 - HYPERLINK "mailto:baronedg@gmail.com" dgb36@cam.ac.uk
Angelos G Kolias3,4 - HYPERLINK "mailto:angeloskolias@gmail.com" angeloskolias@gmail.com
Kenny K Yu1,2 - kenny.yu@manchester.ac.uk
Jonathan R Ellenbogen7 jellenbogen@nhs.net
Paul M Brennan8,9 - HYPERLINK "https://outlook.manchester.ac.uk/owa/redir.aspx?C=LbCPJFxKouHF3WAwSqa0nqUWhmC53erspUayJ4H_MH4uKvN1d5rVCA..&URL=mailto%3apaul.brennan%40ed.ac.uk" \t "_blank" paul.brennan@ed.ac.uk
Mark RN Kotter3,4,10 - HYPERLINK "mailto:mrk25@cam.ac.uk" mrk25@cam.ac.uk
William P Gray9,11,12 - HYPERLINK "mailto:GrayWP@cardiff.ac.uk" GrayWP@cardiff.ac.uk
Andrew T King1,2 - HYPERLINK "mailto:andrew.king@manchester.ac.uk" andrew.king@manchester.ac.uk
Carole Turner3,4,9,13 - HYPERLINK "mailto:clt29@medschl.cam.ac.uk" clt29@medschl.cam.ac.uk
Neil Kitchen14,15 - HYPERLINK "https://outlook.manchester.ac.uk/owa/redir.aspx?C=K-C7KDF40ArySkgzxN9qV9U-HeNk86_jrNIXxW1QLXz0sJ89ARvWCA..&URL=mailto%3aneilkitchen%40nhs.net" \t "_blank" neilkitchen@nhs.net
Paul May5,16 - HYPERLINK "mailto:paul.may@thewaltoncentre.nhs.uk" paul.may@thewaltoncentre.nhs.uk
Michael D Jenkinson5,9,17 - HYPERLINK "mailto:michael.jenkinson@liv.ac.uk" michael.jenkinson@liv.ac.uk
Peter J Hutchinson3,4,18 - HYPERLINK "mailto:pjah2@cam.ac.uk" pjah2@cam.ac.uk
1Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
2Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
3Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
4Surgery Theme, Cambridge Clinical Trials Unit, Cambridge, UK
10WTMRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University ofCambridge, Cambridge, UK
5Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
6Institute of Integrative Biology; 17Institute of Translational Medicine; The University of Liverpool, Liverpool, UK
7Department of Neurosurgery, Alder Hey Childrens NHS Foundation Trust, Liverpool, UK
8Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh and Western General Hospital, Edinburgh, UK
11Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
12Department of Neurosurgery, University Hospital Wales, Heath Park, Cardiff, UK
14Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
9Member of Academic Committee; 13Research Manager; 15President Elect; 16President; 18Chair of Academic Committee; Society of British Neurological Surgeons (SBNS), UK
Disclosures
MW and BMD are supported by National Institute for Health Research (NIHR) Academic Clinical Fellowships
KKY is supported by an NIHR Academic Clinical Lectureship
DGB is supported by a Wellcome Trust Fellowship
AGK is supported by a Clinical Lectureship, School of Clinical Medicine, University of Cambridge
MRK is supported by a NIHR Clinician Scientist Award (CS-2015-15-023)
WPG is supported by and directs the HCRW B.R.A.I.N. Biomedical Research Unit
PJH is supported by a NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre and the NIHR Research Group on Global Neurotrauma
Short title
Academic neurosurgery in the UK
Funding and ethics
This work was not funded and did not require ethical approval.
Article type
Editorial
Correspondence
Please address correspondence to
Peter J Hutchinson
Professor of Neurosurgery NIHR Research Professor Box 167 Academic Division of Neurosurgery Addenbrooke's Hospital Cambridge CB2 0QQ UK
HYPERLINK "mailto:pjah2@cam.ac.uk" pjah2@cam.ac.uk
Academic phone contact - Max Pitches: +44 1223 336946
Contributions
MW: assimilated manuscript sections; authored the introduction, international standing and conclusion subsections; contributed to Table 3, 5 and 6; prepared the final draft.
BMD: aided in assimilation of the manuscript subsections and preparation of final draft; authored the academic consultants and professors subsection; contributed to Table 3.
RZ: authored the funding subsection; contributed to Table 3 and 4; aided in review of manuscript drafts.
DGB: authored the training subsection; contributed to Table 1 and 2; aided in review of manuscript drafts.
AGK: authored the academic neurosurgical bodies in the UK subsection; contributed to Table 3; aided in review of manuscript drafts.
KKY: contributed to training section and Table 3; aided in review of manuscript drafts.
JRE: contributed to training subsection; aided in review of manuscript drafts.
PMB: contributed to the training section; aided in review of manuscript drafts.
MRNK: contributed to training section and Table 3; aided in review of manuscript drafts.
WPG: contributed to all manuscript subsections and Table 2, 4 and 5; aided in review of manuscript drafts.
ATK: contributed to academic consultants and professors subsection; aided in review of manuscript drafts.
CT: contributed to Table 4 and 5; aided in review of manuscript drafts.
NK: contributed to international standing subsection; aided in review of manuscript drafts.
PM: contributed to introduction and conclusion; reviewed manuscript drafts.
MDJ: devised review idea; aided in author recruitment; assigned article subsections; contributed to all sections; reviewed manuscript drafts.
PJH: devised review idea; aided in author recruitment; assigned article subsections; contributed to all sections; reviewed manuscript drafts.
Acknowledgements
The authors would like to thank the NIHR Trainees Coordinating Centre and Joint Committee on Surgical Training (JCST) for providing data pertaining to academic neurosurgery as outlined in various sections of the manuscript
Main message
The UK is a top 5 contributor to global neurosurgical research output.
There are structured and unstructured academic neurosurgical training routes.
Funding is a bottleneck for neurosurgeons pursuing academia.
Academic neurosurgical bodies in the UK foster subspecialty research.
Key references
Jamjoom AA, Wiggins AN, Loan JJ, Emelifeoneu J, Fouyas IP, Brennan PM. Academic Productivity of Neurosurgeons Working in the United Kingdom: Insights from the H-Index and Its Variants. World Neurosurg 2016;86:287-93.
Wilkes FA, Akram H, Hyam JA, Kitchen ND, Hariz MI, Zrinzo L. Publication productivity of neurosurgeons in Great Britain and Ireland. J Neurosurg 2015;122(4):948-54.
Chari A, Jamjoom AA, Edlmann E, Ahmed AI, Coulter IC, Ma R, et al. The British Neurosurgical Trainee Research Collaborative: Five years on. Acta Neurochir (Wien) 2018;160(1):23-8.
The Royal College of Surgeons of England. Surgical Trials Initiative. 2018. HYPERLINK "https://www.rcseng.ac.uk/standards-and-research/research/surgical-trials-initiative/" https://www.rcseng.ac.uk/standards-and-research/research/surgical-trials-initiative/ (accessed October 4th 2018).
Hauptman JS, Chow DS, Martin NA, Itagaki MW. Research productivity in neurosurgery: trends in globalization, scientific focus, and funding. J Neurosurg 2011;115(6):1262-72.
Abstract
Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice, with the overall aim of improving treatment and outcome for patients. In this article, we provide an overview of the current and future directions of British academic neurosurgery. Training pathways are considered together with personal accounts of experiences of structured integrated clinical academic training (ICAT) and unstructured academic training. Life as an academic consultant is also described. Funding is explored, for the specialty as a whole and at the individual level. UK academic neurosurgical organisations are highlighted. Finally, the UKs international standing is considered.
Keywords
Academia; neurosurgery; academic neurosurgery; research; integrated clinical academic training; ICAT
Background and history
Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice. Academic neurosurgery is practiced by academic neurosurgeons, who can be of at least three types: translational basic scientists undertaking predominantly translational science research; clinical academics undertaking predominantly clinical research; and research active clinicians whose time is divided in favour of clinical commitments to regular research efforts. The ultimate aim of academic neurosurgery is to improve patient outcome and lead to a better understanding of disease processes to guide novel therapies.
The development of modern neurosurgery in the UK has been underpinned by academic enquiry. For example, in Glasgow, William Macewen introduced Listers aseptic techniques to revolutionise the treatment of brain abscesses. ADDIN EN.CITE Canale199632013201320117Canale, D. J.Department of Neurosurgery, University of Tennessee, Memphis, USA.William Macewen and the treatment of brain abscesses: revisited after one hundred yearsJ NeurosurgJ Neurosurg133-42841Brain Abscess/*history/surgeryHistory, 19th CenturyHistory, 20th CenturyHumansNeurosurgery/*historyScotland1996Jan0022-3085 (Print)
0022-3085 (Linking)8613822http://www.ncbi.nlm.nih.gov/pubmed/861382210.3171/jns.1996.84.1.01331 In London, Victor Horsley carried out experiments in brain localisation, acting as the Professor Superintendent of the Brown Institution, the University of Londons animal experimental base. ADDIN EN.CITE Powell201732033203320317Powell, M. P.National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom. Electronic address: mickpowell@aol.com.The History of Neurosurgery at the National Hospital, Queen Square, London, with Some Personal Recollections from 1948 Onwards: The Early YearsWorld NeurosurgWorld Neurosurg634-646103HistoryHospitalLondonNationalNeurosurgeryNeurosurgical pioneersQueen Square2017Jul1878-8769 (Electronic)
1878-8750 (Linking)28232150http://www.ncbi.nlm.nih.gov/pubmed/2823215010.1016/j.wneu.2017.02.0212 In Oxford, the relocated Hugh Cairns published extensively on the need for helmets for motorcyclists and the repair of cranial defects with acrylic or titanium. ADDIN EN.CITE Aziz199532043204320417Aziz, T. Z.Adams, C. B.Department of Neurosurgery, Radcliffe Infirmary, Oxford, England.Neurosurgery at the Radcliffe Infirmary, Oxford: a historyNeurosurgeryNeurosurgery505-10373EnglandHistory, 18th CenturyHistory, 19th CenturyHistory, 20th CenturyHospitals, University/*historyHumansNeurosurgery/*history1995Sep0148-396X (Print)
0148-396X (Linking)7501117http://www.ncbi.nlm.nih.gov/pubmed/75011173
Today, research forms an integral part of neurosurgical training and practice. ADDIN EN.CITE ADDIN EN.CITE.DATA 4, 5 The aim of this article is to present an overview of the current and future directions of British academic neurosurgery.
Training
Clinical and academic training requires dedicated time and commitment. Table 1 shows a comparison between clinical and academic pathways. There are two main routes for neurosurgical trainees with an interest in academia, which are not mutually exclusive:
Structured academic training: this is via the Integrated Clinical Academic Training (ICAT) scheme. It includes defined short-term posts with allocated clinical and academic time. Structured academic neurosurgical training is being offered in an increasing number of regions.
Postgraduate academic training in England proceeds serially through the academic foundation programme (AFP), academic clinical fellowship (ACF), higher degree (PhD/MD), and academic clinical lectureship (ACL). Each of these stages represents a potential bottleneck in pursuit of academic practice. Entry is competitive, based on a formal application and interview. Furthermore, at the ACF/ACL stages, unless already appointed on a clinical training post, applicants must also apply to the national selection centre and be deemed eligible at national clinical interviews. There are currently only 27 neurosurgical trainees appointed to an ACF/ACL post. This compares to 264 neurosurgical trainees appointed to conventional clinical training posts (unpublished data from the Joint Committee on Surgical Training, JCST).
In Wales, academic trainees are appointed to the Wales Clinical Academic Trainee (WCAT) Program. It currently differs from the English programme in that academic training is also run-through, subject to satisfactory academic performance, and clinical salaries are maintained during their higher degree (usually a PhD). National Selection or WCAT Trainees can also be appointed to the Wellcome Trust funded GW4 Clinical Academic Training programme across Cardiff, Bristol, Bath and Exeter Universities. Table 2 shows the geographical distribution of ACF/ACL trainees based in England and Wales.
In Scotland, academic training differs in that graduates must firstly gain a national training number through conventional specialty application systems. They can then apply for run-through pre-doctoral academic schemes (e.g. Edinburgh Clinical Academic Track (ECAT) Lectureship, Scottish Clinical Research Excellence Development Scheme (SCREDS) Lectureship).
Beyond these stages, senior academic trainees and those that have completed training can apply for personal award schemes such as the NIHR Clinician Scientist scheme. This offers up to 5 years funding towards a programme of research.
Unstructured academic training: this includes ad-hoc academic experience obtained through research projects leading to MDs or PhDs, without necessarily having the same opportunity for dedicated time away from clinical work or access to structured mentorship programmes.
Case studies to highlight these are presented in Table 3. Importantly, trainees engaging in academia must meet the same clinical competencies as other trainees to gain their Certification of Completion of Training (CCT). A higher degree is a key component of academia and on average, 30 trainees per year take time out of their training programme to pursue a higher degree (unpublished data from the JCST). Neurosurgery is amongst the specialties that includes academia in its curriculum and trainees can therefore count up to 12 months of out of programme research (OOPR) towards their training. Trainees undertaking a higher degree in the mid to end stages of their clinical training can also continue to participate on the registrar on-call rota. This provides a financial supplement and opportunity to maintain clinical skills, but may reduce academic time.
In future, the number of structured academic posts is likely to increase and run-through academic training may also eventually be offered in England.
Academic consultants and professors
Academic interests continue for many neurosurgeons following completion of training. In general, neurosurgeon translational basic scientists and clinical academics hold university positions with honorary consultant contracts, whilst research active clinical neurosurgeons are primarily employed by the NHS in purely clinical roles and may or may not hold honorary university contracts. The craft nature of the neurosurgical discipline also means that, regardless of academic category, academic neurosurgeons must dedicate a substantial amount of their time to clinical practice.
The Society of British Neurological Surgeons (SBNS) holds a database of consultant members with registered research interests. There are currently 13 practicing Professors of Neurosurgery in the UK, including 4 honorary professors. Of the remaining consultants in the database, job plans are as follows: standalone full-time NHS appointment (9, 24%); full-time NHS appointment with honorary university affiliation (20, 54%); and full-time university academic appointment with honorary consultant contract (8, 22%). Most academic consultants hold post-graduate research degrees, namely MDs (26%) or PhDs (44%). By reviewing their output from the last 5 years listed on MEDLINE, almost half (45%) have laboratory science interests, although research output is predominantly clinical.
Neurosurgeon translational basic scientists and clinical academics have to deliver both patient care and research. This requires funding from both internal and external streams, usually only available on a competitive basis. Academic output is also monitored in terms of the Research Excellence Framework (REF), which is not required for NHS clinically active neurosurgeons.
Funding
Given the small size of the specialty, neurosurgery has been successful in securing income from major funders (see table 4 for data on NIHR Personal Awards Programmes). However, research funding remains a bottleneck for neurosurgeons pursuing academia. This bottleneck is also faced by those on NIHR sponsored ACF and ACL programmes, which come with financial support to cover conference attendance but not research costs or bench fees.
Funders with an interest in neurosurgical themes are advertised on the SBNS website, though this is by no means exhaustive. Most available funding streams are for PhD studentships. In terms of national research councils, the MRC (UK) offers support to surgical trainees in clinical posts in the form of Clinical Research Training Fellowships whilst the Wellcome Trust offers PhD Fellowships for Clinicians via their specific university centres. In cases where the project relates to specific disciplines such as neuro-oncology, charities such as Cancer Research UK and Epilepsy Research UK offer fellowships. The RCS England offers one year surgical research fellowships including salary (30 awarded in 2016-17). A number of PhD studentships are also funded in collaboration with industry, for example in projects investigating a specific device or product.
Postdoctoral fellows face similarly tough hurdles to fund ongoing research. The options include applying for personal grants as part of Clinician Scientist Fellowships (NIHR or MRC affiliated) or funding as principal or co-principal investigators on project grants or studies. Pump priming grants are available from the Surgical Royal Colleges for the purposes of supporting small projects. For trainees wishing to secure University academic positions, Clinician Scientist fellowships are almost a requisite, as is a track record of significant grant income and evidence of developing an independent research programme of work.
In future, as academic neurosurgery grows in the UK, one potential solution to increasing funded programmes is jointly funded posts by a research body or council and a charity, as are increasingly being offered in other specialties.
Academic neurosurgical bodies in the UK
The Academic Committee of the Society of British Neurological Surgeons (SBNS-AC) has overall strategic responsibility of academic neurosurgical matters in the UK. The committee consists of academic neurosurgeons, representatives from the various neurosurgical subspecialty interest groups, trainees and SBNS council. Since 2010, a dedicated research manager has been employed to coordinate the development of neurosurgical research and trials in the UK. Additionally, the academic committee is responsible for organising an annual two-day meeting focussing on neurosurgical research, known as British Neurosurgical Research Group meeting. The meeting is hosted by various neurosurgical units in the UK and provides a forum for discussion of pilot research findings and pitching of new research ideas.
The various neurosurgical subspecialty interest groups (cerebrospinal fluid, functional, oncology, paediatrics, trauma, vascular, skull base, spine) are actively engaged in research either by initiating or supporting multi-centre research activities as well as investigating basic mechanisms underlying the relevant disease states. The scope of the subspecialty interest groups extends beyond academia, for example, the British Neurovascular Group has setup a UK and Ireland subarachnoid haemorrhage database with almost 90,000 cases registered to date.
The trainee-led British Neurosurgical Trainee Research Collaborative (BNTRC) was formed in 2012, with support from the academic committee of the SBNS. The BNTRC has successfully facilitated a number of multi-centre studies and been instrumental in the setup of two ongoing randomised controlled trials, RESCUE-ASDH and Dex-CSDH (see Table 6). The model used by the BNTRC includes peer review of national study proposals by relevant members of the SBNS-AC, as well as internal committee review. Two examples of completed BNTRC initiatives include the national external ventricular drain study and the national chronic subdural haematoma study, both of which have published results. ADDIN EN.CITE ADDIN EN.CITE.DATA 6, 7 Recently, the BNTRC has also collaborated with the UKs Neurology and Neurosurgery Interest Group (NANSIG), a network of medical students and junior doctors, to successfully complete a national prospective observational study on cauda equina syndrome (Evaluation of National Treatment and Investigation of Cauda Equina Syndrome, ENTICE). The BNTRC committee recently published a paper outlining the progress made in the first 5 years and vision for the future including the potential for global collaboration. ADDIN EN.CITE ADDIN EN.CITE.DATA 8
The future direction of these organisations will probably be towards international collaboration as done so by other surgical specialties. For example, GlobalSurg was setup by general surgeons and now boasts a member-base of over 5000 surgeons worldwide. The organisation has successfully completed observational studies on an international level. ADDIN EN.CITE GlobalSurg201832403240324017GlobalSurg, CollaborativeSurgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort studyLancet Infect DisLancet Infect Dis2018/02/182018Feb 131474-4457 (Electronic)
1473-3099 (Linking)29452941https://www.ncbi.nlm.nih.gov/pubmed/2945294110.1016/S1473-3099(18)30101-49 Within neurosurgery, the NIHR Global Health Research Group on Neurotrauma has been setup and aims to foster collaborative traumatic brain injury research with developing countries and fund UK-based posts and international PhD students. There is also an argument for developing a group of neurosurgeon translational scientists to foster progress in basic science research in neurosurgery, as translational medicine first requires something to translate into clinical practice.
International standing
The UK is amongst the top 5 producers of neurosurgical publications globally. It has similar standing when considering the mean journal impact factor of publications. ADDIN EN.CITE Hauptman201132213221322117Hauptman, J. S.Chow, D. S.Martin, N. A.Itagaki, M. W.Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7039, USA. jhauptman@mednet.ucla.eduResearch productivity in neurosurgery: trends in globalization, scientific focus, and fundingJ NeurosurgJ Neurosurg1262-7211562011/10/04*BibliometricsBiomedical Research/statistics & numerical data/*trendsHumansInternationalityMEDLINE/statistics & numerical dataNeurosurgery/statistics & numerical data/*trendsPublishing/statistics & numerical data/*trendsResearch Support as Topic/statistics & numerical data/*trendsRetrospective StudiesUnited States2011Dec1933-0693 (Electronic)
0022-3085 (Linking)21962030https://www.ncbi.nlm.nih.gov/pubmed/2196203010.3171/2011.8.JNS1185710 This is particularly impressive considering that the UK has a much lower neurosurgeon to population ratio (0.55 per 100,000 population, based on the number of full SBNS members) compared to the other top 5 producers such as the United States (1.613 per 100,000 population) and Japan (5.895 per 100,000 population). ADDIN EN.CITE WFNS32453245324512WFNSGlobal Neurosurgical Workforce Map: 2016 World Neurosurgery Workforce201826th Mayhttps://www.wfns.org/menu/61/global-neurosurgical-workforce-map26/05/201811 The sparsity of neurosurgical training and consultant posts probably helps to sustain the national academic output through healthy competition. Nevertheless, there is still marked discrepancy between neurosurgical units in UK and USA when considering the mean H-index, which is almost half in the UK what it is in the USA. ADDIN EN.CITE ADDIN EN.CITE.DATA 5, 12
The UK is also a top 5 contributor to neurosurgical RCTs. ADDIN EN.CITE Hauptman201132213221322117Hauptman, J. S.Chow, D. S.Martin, N. A.Itagaki, M. W.Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7039, USA. jhauptman@mednet.ucla.eduResearch productivity in neurosurgery: trends in globalization, scientific focus, and fundingJ NeurosurgJ Neurosurg1262-7211562011/10/04*BibliometricsBiomedical Research/statistics & numerical data/*trendsHumansInternationalityMEDLINE/statistics & numerical dataNeurosurgery/statistics & numerical data/*trendsPublishing/statistics & numerical data/*trendsResearch Support as Topic/statistics & numerical data/*trendsRetrospective StudiesUnited States2011Dec1933-0693 (Electronic)
0022-3085 (Linking)21962030https://www.ncbi.nlm.nih.gov/pubmed/2196203010.3171/2011.8.JNS1185710 There have been a number of international multi-centre trials with a UK based neurosurgical principal (Table 5). ADDIN EN.CITE ADDIN EN.CITE.DATA 13-19 Most recently, the RESCUEicp trial published its results of decompressive craniectomy versus medical management of raised intracranial pressure in the setting of trauma, that is refractory to two tiers of medical therapy. ADDIN EN.CITE ADDIN EN.CITE.DATA 14 Other active trials with a UK-based neurosurgical PI are shown in Table 6. The number of active trials is likely to increase in future, aided by projects such as The Royal College of Surgeons Surgical Trials Initiative. ADDIN EN.CITE The Royal College of Surgeons of England201833863386338612The Royal College of Surgeons of England,Surgical Trials Initiative2018October 4th2018https://www.rcseng.ac.uk/standards-and-research/research/surgical-trials-initiative/20184th October20 Specialty leads (PJAH for neurosurgery) are appointed under this initiative to foster trial development within their specialty through 7 regional surgical trials centres.
In the context of Europe, research in the UK may be negatively affected by the results of the EU referendum (Brexit). This is in at least three ways: reputation there may be a reluctance from Europe to include UK sites in multi-centre studies; pharma relocation companies may base their workings offshore and preferentially back and fund European PIs; employment there are already reports of recruitment difficulties in relation to UK based positions, and researchers may choose to base their operations elsewhere. ADDIN EN.CITE O'Dowd201732253225322517O'Dowd, A.London.Brexit is shifting drug industry's focus away from UK, MPs hearBMJBMJj56683592017/12/082017Dec 61756-1833 (Electronic)
0959-535X (Linking)29212655https://www.ncbi.nlm.nih.gov/pubmed/2921265510.1136/bmj.j566821
Conclusion
Academic neurosurgery has a rich history in the UK, which remains a top 5 contributor to global research output based on publication count and the number of active randomised trials. There are an increasing number of opportunities for trainees and consultants to be involved with academia. Structured academic training with allocated research time has a number of benefits compared to ad-hoc research and may well become the norm with time. At every level, academic engagement provides the opportunity to directly improve patients care, mental stimulation, the potential for collaboration and continued professional development. There are several challenges ahead for academic neurosurgery in the UK including how to increase access to funding, maintaining momentum and taking steps towards global collaboration.
Acknowledgements
The authors would like to thank the NIHR for providing data on funding. The authors would like to thank the JCST for providing data on academic and clinical neurosurgical trainee numbers.
References
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18. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 2013;382(9890):397-408.
19. Kirkpatrick PJ, Turner CL, Smith C, Hutchinson PJ, Murray GD, Collaborators S. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. Lancet Neurol 2014;13(7):666-75.
20. The Royal College of Surgeons of England. Surgical Trials Initiative. 2018. HYPERLINK "https://www.rcseng.ac.uk/standards-and-research/research/surgical-trials-initiative/" https://www.rcseng.ac.uk/standards-and-research/research/surgical-trials-initiative/ (accessed October 4th 2018).
21. O'Dowd A. Brexit is shifting drug industry's focus away from UK, MPs hear. BMJ 2017;359:j5668.
22. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009;374(9695):1067-73.
Clinical training Integrated Clinical Academic Training Academic Training Medical SchoolMB/PhD programmesUndergraduate degree
(e.g. Bsc)Foundation ProgrammeAcademic Foundation Programme (AFP): up to 4 months of research over a 2-year periodPre-doctoral research activity
(e.g. MSc)Specialty Training (SHO)Academic Clinical Fellowship
(ACF): up to 9 months of research over a 3-year period
Wales Clinical Academic Training (WCAT) posts
Run through Academic Training ST1-ST8 including PhDDoctoral training
(e.g. PhD)Specialty Training (Registrar)Academic Clinical Lectureship (ACL): up to 2-years of research over a 4-year period
Wales Clinical Academic Training (WCAT) posts
Run through Academic Training ST1-ST8 including PhD and subsequent Clinical LectureshipPost-doctoral TrainingConsultant Clinician Scientist (senior trainees also eligible for this award)
Principal investigator Table 1. Clinical, integrated and academic training pathways in the UK.
Table 2. Geographical distribution of currently appointed Academic Clinical Fellows (ACFs) and Academic Clinical Lecturers (ACLs) in Neurosurgery in England and Wales. Source: NIHR Trainees Coordinating Centre and local data from WPG.
Health Education England RegionACFACLEast of England21North Central and East London10North West22North West London11South London01South West10Thames Valley11West Midlands01WalesCardiff21Grand Total108
Table 3. Experience of academic neurosurgery: a series of accounts by trainees and consultants.
Academic Foundation Programme (AFP)
Mueez Waqar
Salford Royal Hospital, ManchesterThe AFP is a 2-year appointment with dedicated academic time. The nature of the academic time varies by deanery and can be in blocks or days per week. In my deanery, I was given one 4-month academic block in foundation year 2, without any on call commitments. I was very well supported from the start and had complete flexibility to pursue any research area I wanted. As I had an interest in neurosurgery, I chose to pursue a pituitary based project at my base hospital.
I thought that the research I did during my academic block this was a step up from research I had done as a student as I was expected to refine a research question and develop study methodology. Data collection and analysis was again more independent, but my supervisor was always at hand to help where needed. My study was eventually presented and published. At the end of the year, all of the AFPs presented their projects at a regional event, which I thought was a nice touch.
I really enjoyed my AFP and it sparked an interest in an academic career. However, to do well in the programme, you have to overcome reduced clinical exposure at such an early stage, which is easily achieved through locum shifts and clinic/theatre visits. NIHR
Academic Clinical Fellowship (ACF)
Benjamin M Davies
Cambridge University Hospitals NHS Foundation Trust, CambridgeThe ACF is a 3-year appointment, which comes with an allocation of 25% protected academic time. On-call commitments continue but you are removed from routine day-to-day practice. How and when the academic allocation is taken will vary on a centre and individual basis. I was awarded the ACF at ST1 and have chosen to take my academic time at the end of my appointment. The attraction of this arrangement for me was to balance sufficient clinical progression to support my entry onto the junior registrar rota, whilst offering the opportunity of running into a PhD or alike. Alternative options were an allocation each year or each week, but this will need to align with the practicalities of the department also.
In Cambridge, I am now part of Dr Mark Kotters research group, leading his clinical research programme on Cervical Myelopathy. I arrived in Cambridge without any special research topic of interest but found the combination of prevalence and significant unmet need in myelopathy an attractive and worthwhile focus. Over the last 3 years we have established the first international charity for myelopathy, commenced patient research priority and core outcome initiatives, identified delays in diagnosis, including potential influences such as deficiencies in medical training, clinical examination, clinical assessments and the qualitative reporting of MRI imaging. We are developing a new pocket assessment for myelopathy and building towards the first regenerative medicine trial for myelopathy (RECEDE-Myelopathy), for which I am a trainee PI.
An ACF appointment is clearly not the only route into academic neurosurgery, but it is certainly a very useful opportunity. The programme has afforded me not just protected research time, but through the accompanying programmes provided by the University and NIHR, great academic training and opportunities to network. I have found that balancing clinical training with academia and a personal life is difficult, and no doubt that problem will remain. However, I have always enjoyed the research foil to clinical practice and I see it as something which can challenge me throughout my career.NIHR
Academic Clinical Lectureship (ACL)
Kenny Yu
Salford Royal Hospital, ManchesterThe ACL scheme is typically a 4-year appointment with 50% research time. It is usually awarded to trainees within the final 2 years of their training and is seen as a bridging scheme to assist those who have completed a higher research degree to complete further post-doctoral research to strengthen their application for an intermediate fellowship or clinician scientist fellowship at the end of training. Research time can be taken up to a maximum of 2 years, though the full research time does not have to be taken. The scheme technically ends at the point of CCT - the date of which can be negotiated with each trainees host deanery.
I entered the ACL scheme at ST7 level in Manchester. My experience in Manchester has been that my training and research needs have been well supported. In my first year, I was able to take my full 50% protected time (6 months) for a research fellowship at The Hospital for Sick Children and St. Michaels Hospital in Toronto, Canada, where I was able to gain post-doctoral research experience. In my second year, I was able to leverage this experience to successfully apply for a grant which I will now use to generate pilot data.
My typical week is currently split into 2.5-3 days of clinical activity, which are typically elective theatre sessions for two days and a clinic session, MDT or theatre list for the remainder. On call commitments are halved. My research days are spent at the university where I am part of a wider Neuro-inflammation/Neuro-oncology group where I set up experiments, attend lab meetings and catch up with papers and other administrative duties.
My experience of the ACL scheme in Manchester has been extremely positive, but the success of the scheme is largely down to the level of support provided by the host clinical department.NIHR
Clinician Scientist Award
Mark RN Kotter
Cambridge University Hospitals NHS Foundation Trust, CambridgeThe NIHR Clinician Scientist Award is awarded for a period up to 5 years to postdoctoral senior trainees or consultants. I am supported by this award in my capacity as a consultant neurosurgeon with a sub-specialist interest in complex spine surgery.
In every given week, there will be sessions scheduled for theatre, outpatient appointments, and other clinical activities. I also participate in the complex spine on-call rota.The remainder of the week is free for research. Ourfocus is regenerative medicine, stem cells, and spinal cord injury.As the lead for academic spine, I am tasked with building a translational research program for spinal pathologies in Cambridge.I am particularly interested in cervical myelopathy CSM, the most common form of spinal cord dysfunction of adulthood.Supported by the NIHR, we are currently preparing RECEDE(REgeneration in CErvical DEgenerative)Myelopathy, the first regenerativemedicinetrial in CSM.
I lead a basic science research lab that investigates mechanisms of regeneration of the Central Nervous System, and which provides the basis of our clinical research. The need for better (human) models led us to develop a technology that has simplified the generation of human cells using a novel approach termed "direct cell reprogramming". This provides a scalable platform for studying neurological diseases and has opened exciting opportunities for collaboration.
I enjoy the independence and the great variety of my work. Three points are fundamental: 1) patients always come first; 2) find synergies between the different aspects of your work to keep focussed, and 3) bring together the right people, support them and build strong teams.Traditional PhD via non ICAT route
Rasheed Zakaria
Walton Centre NHS Foundation Trust, LiverpoolTrainees can undertake higher degrees at any point in their training. Usually, the choice is between a funded project that is ready to go and arguably, the longer route - obtaining a PhD fellowship grant based on an idea. I pursued the 2nd of these options with a project developed with local support around investigating local invasion and outcomes in brain metastases.
As a trainee in Liverpool, I initially received funding from my trust through research capacity funding in order to cover my salary for 12 months and allow me to gather pilot data for a bigger research proposal. I continued doing locum on calls to supplement my income and maintain clinical skills during this period. I received further support from the Royal College of Surgeons of England to help with salary and consumable costs via their one year Research Fellowship Programme and finally was able to compete for and win a national MRC (UK) Clinical Research Training Fellowship to fully fund the completion of my PhD, including fees and other on-costs.
My experience was less conventional and only possible with excellent support and enthusiasm from my clinical and research mentors. Overall this patchwork of funding was slightly stressful at times because I was constantly looking for the next award but it meant that I had the experience of having to write multiple applications and focus my research goals and experimental plan very tightly. Finally, working on brain metastases has been very fruitful as it is something of a neglected area despite being common and important. As a result, I have been able to develop strong international collaborations in this field and this has stood me in good stead for post-doctoral projects which I am now developing.
Table 4. Funding from NIHR Personal Award Programmes for surgical specialties and neurology (2006-present). This table shows the total amount awarded to various specialties including neurosurgery. This is the sum of NIHR Professorships, NIHR Clinician Scientist Awards, NIHR Fellowships and NIHR Clinical Trials Fellowships. Note that subset data for vascular surgery was not available. Source: NIHR Trainees Coordinating Centre.
SpecialtyTotal from NIHR Personal Award Programmes () General surgery7,741,095Neurology7,576,545Ophthalmology5,360,189Neurosurgery4,786,852Paediatric surgery2,149,461Otolaryngology1,909,177Trauma and orthopaedics1,196,700Plastic surgery1,062,376Urology642,202Cardiothoracic surgery341,995Oral Maxillofacial Surgery304,239
Table 5. Completed phase III trials with a UK-based neurosurgical PI. ADDIN EN.CITE ADDIN EN.CITE.DATA 13-19, 22
SubspecialtyName Inclusion criteria (simplified)Randomised groupsPrimary outcome and resultTraumaSurgical Trial in Traumatic intraCerebral Haemorrhage
( S T I T C H ) A d u l t s ( e"1 4 y e a r s )
T r a u m a t i c i n t r a c e r e b r a l h a e m a t o m a m e a s u r i n g e"1 0 m l
N o s u b d u r a l o r e x t r a d u r a l h a e m a t o m a r e q u i r i n g s u r g e r y
I c t u s d"4 8 h o u r s
C l i n i c a l e q u i p o i s e o f s u r g i c a l v s . n o n - s u r g i c a l m a n a g e m e n t (
N o s e v e r e p h y s i c a l / m e n t a l c o m o r b i d i t y E a r l y s u r g e r y d"1 2 h
I n i t i a l c o n s e r v a t i v e m a n a g e m e n t E x t e n d e d G l a s g o w O u t c o m e S c a l e a t 6 m o n t h s
R e c r u i t m e n t s t o p p e d e a r l y b u t s u r g e r y g r o u p h a d f a v o u r a b l e o u t c o m e U s e o f d r a i n s v e r s u s n o d r a i n s a f t e r b u r r - h o l e e v a c u a t i o n o f c h r o n i c s u b d u r a l h a e m a t o m a A g e e"1 8 y e a r s
S y m p t o m a t i c c h r o n i c s u b d u r a l h a e m a t o m a ( b i l a t e r a l s u b d u r a l s t r e a t e d a s s i n g l e c a s e r e c e i v i n g s a m e t r e a t m e n t o n b o t h s i d e s )
N o i p s i l a t e r a l s h u n t i n p a s t 6 m o n t h s
S u i t a b l e f o r b u r r - h o l e e v a c u a t i o n
I n t r a - o p e r a t i v e l y , d r a i n i n s e r t i o n d e e m e d s a f e D r a i n : s o ft silicone subdural drain, subdural space filled with saline during closure, drain kept in dependent position for 48h
No drain: subdural space filled with saline during closureRate of surgically treated symptomatic recurrence within 6 months
Rate significantly lower in drain groupRandomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) Adolescents and adults (10-65 years)
Survivable traumatic brain injury with abnormal CT brain
No previous cr a n i e c t o m y
I n t r a c r a n i a l p r e s s u r e e"2 5 m m H g f o r 1 - 1 2 h o u r s r e f r a c t o r y t o s t a g e 1 a n d 2 m e a s u r e s
N o b l e e d i n g d i a t h e s i s M e d i c a l t r e a t m e n t a n d h e m i - o r b i f r o n t a l c r a n i e c t o m y w i t h i n 4 - 6 h o u r s
M e d i c a l t r e a t m e n t + / - b a r b i t u r a t e s E x t e n d e d G l a s g o w O u t c o m e S c a l e a t 6 m o n t h s : s u r g e r y g r o u p h a d l o w e r m o r t a l i t y b u t h i g h e r r a t e o f s e v e r e d i s a b i l i t y i n c l u d i n g v e g e t a t i v e s t a t e V a s c u l a r B R i t i s h A n e u r y s m N i m o d i p i n e T r i a l
( B R A N T ) A d u l t s ( e"1 8 y e a r s , n o n - p r e g n a n t )
A n e u r y s m a l s u b a r a c h n o i d h a e m o r r h a g e
P r e s e n t a t i o n d"9 2 h o u r s o f I c t u s
N o m a j o r r e n a l , h e p a t i c , p u l m o n a r y o r c a r d i a c d i s e a s e ( i n c l u d i n g m y o c a r d i a l i n f a r c t i o n d"6 m o n t h s )
N o s u b a r a c h n o i d h a e m o r r h a g e i n p a s t w e e k p r o d u c i n g c o m a 2 1 - d a y c o u r s e o f e n t e r a l 6 0 m g n i m o d i p i n e 4 - h o u r l y
2 1 - d a y c o u r s e o f p l a c e b o R a t e o f c e r e b r a l i n f a r c t i o n a t 3 m o n t h s : s i g n i f i c a n t l y l o w e r i n n i m o d i p i n e g r o u p I n t e r n a t i o n a l S u b r a c h n o i d A n e u r y s m T r i a l
( I S A T ) A n e u r y s m a l s u b a r a c h n o i d h a e m o r r h a g e
I c t u s d"2 8 d a y s
C l i n i c a l s t a t e j u s t i f i e d t r e a t m e n t
A n e u r y s m a m e n a b l e t o e i t h e r e n d o v a s c u l a r o r o p e n s u r g i cal treatment and equipoise in which to useEndovascular treatment (coiling)
Open surgery (mostly clipping)Modified Rankin Score at 12 months: endovascular group had lower rates of mortality and dependenceSurgical Trial in
Intracerebral Haemorrhage
(STICH) Spontaneous supratentorial intracerebral haematoma e"2 c m , n o t e x t e n d i n g t o b r a i n s t e m
G C S e"5
I c t u s d"7 2 h o u r s
C l i n i c a l u n c e r t a i n t y a b o u t s u r g i c a l v s . n o n - s u r g i c a l m a n a g e m e n t
N o s e v e r e p h y s i c a l / m e n t a l c o m o r b i d i t y E a r l y s u r g e r y d"2 4 h
I n i t i a l c o n s e r v a t i v e m a n a g e m e n t G l a s g o w O u t c o m e S c o r e a t 6 m o n t h s : n o s i g n i f i c a n t d i f f e r e n c e S u r g i c a l T r i a l i n
I n t r a c e r e b r a l H a e m o r r h a g e I I
( S T I C H I I ) S p o n t a n e o u s s u p r a t e n t o r i a l l o b a r i n t r a c e r e b r a l h a e m a t o m a , d"1 c m f r o m c o r t i c a l s u r f a c e , m e a s u r i n g 1 0 - 1 0 0 m l
N o t i n v o l v i n g b a s a l g a n g l i a , t h a l a m u s o r b r a i n s t e m
N o i n t r a v e n t r i c u l a r h a e m o r r h a g e
I c t u s d"4 8 h o u r s
G C S m o t o r s c o r e e"5 a n d e y e s c o r e e"2
N o s e v e r e p h y s i c a l / m e n t a l c o m o r b i d i t y E a r l y s u r g e r y d"1 2 h
I n i t i a l c o n s e r v a t i v e m a n a g e m e n t E x t e n d e d G l a s g o w O u t c o m e S c a l e a t 6 m o n t h s : n o s i g n i f i c a n t d i f f e r e n c e S i m v a s T a t i n i n A n e u r y s m a l S u b A r a c h n o i d H a e m o r r h a g e
( S T A S H ) ( A d u l t s ( 1 8 - 6 5 y e a r s , n o n - p r e g n a n t )
A n e u r y s m a l s u b a r a c h n o i d h a e m o r r h a g e w i t h r e a s o n a b l e p r o s p e c t o f s u r v i v a l
P r e s e n t a t i o n d"9 6 h o u r s f r o m i c t u s
F u l l y i n d e p e n d e n t b a s e l i n e a n d n o r e n a l / h e p a t i c i m p a i r m e n t o r d r u g m i s u s e
N o t t a king statin, anticoagulant or contraindicated medication 21-day course of Simvastatin 40mg
21-day course of Placebo Modified Rankin Scale at 6 months: no significant difference
Table 6. Ongoing phase III clinical trials with a UK-based neurosurgical PI. *PI is an interventional vascular neuoradiologist, but given its relevance, the trial was included in this list.
SubspecialtyName Inclusion criteria (simplified)Randomised groupsPrimary outcomeTraumaRandomised Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute Subdural Haematoma
(RESCUE-ASDH)
Adults (>16 years)
Acute traumatic subdural haematoma
Treatment with surgeryBone flap put back
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l a=p2 ytQ* A d u l t s ( e"1 6 y e a r s )
C h r o n i c s u b d u r a l h a e m a t o m a c a u s i n g s y m p t o m s
N o c o n t r a i n d i c a t i o n s t o u s e o f s t e r o i d s 2 - w e e k c o u r s e o f p l a c e b o
2 - w e e k t a p e r e d c o u r s e o f d e x a m e t h a s o n e M o d i f i e d R a n k i n s c a l e a t 6 m o n t h s O n c o l o g y R a d i a t i o n v e r s u s O b s e r v a t i o n f o l l o w i n g s u r g i c a l r e s e c t i o n o f A t y p i c a l M e n i n g i o m a
( R O A M ) A d u l t s ( e"1 6 y e a r s )
W H O g r a d e I I m e n i n g i o m a s i n a l l l o c a t i o n s e x c e p t o p t i c n e r v e s h e a t h
S i m p s o n g r a d e 1 - 3 r e s e c t i o n
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P o s t o p e r a t i v e r a d i o t h e r a p y R a d i o l o g i c a l p r o g r e s s i o n - f r e e s u r v i v a l a t 0 . 5 , 1 a n d 5 - y e a r s p o s t - s u r g e r y P a e d i a t r i c s a n d h y d r o c e p h a l u s B r i t i s h A n t i b i o t i c a n d S i l v e r I m p r e g n a t e d C a t h e t e r s f o r v e n t r i c u l o p e r i t o n e a l S h u n t s
( B A S I C S ) A d u l t s a n d c h i l d r e n
H y d r o c e p h a l u s o f a n y a e t i o l o g y
P r i m a r y t r e a t m e n t w i t h a v e n t r i c u l o p e r i t o n e a l s h u n t ( V P S )
C l e a r C S F s a m p l e a t t h e t i m e o f s h u n t i n s e r t i o n N o n - i m p r e g n a t e d V P S
S i l v e r l i n e ( S i l v e r i m p r e g n a t e d ) V P S
B a c t i s e a l ( a n t i b i o t i c i m p r e g n a t e d ) V P S E a r l y s h u n t i n f e c t i o n r a t e ( w i t h i n 6 m o n t h s ) S p i n e N E r v e R o o t b l o c k V E r s u s S u r g e r y
( N E R V E S ) A d u l t s ( 1 6 - 6 5 y e a r s )
S c i a t i c a s e c o n d a r y t o l u m b a r d i s c h e r n i a t i o n f o r 6 w e e k s t o 1 2 m o n t h s
N o s e r i o u s n e u r o l o g i c a l d e f i c i t
F a i l e d c o n s e r v a t i v e t r e a t m e n t f o r 6 w e e k s E p i d u r a l s t e r o i d i n j e c t i o n
M i s c r o d i s c e c t o m y O s w e s t r y D i s a b i l i t y Q u e s t i o n n a i r e a t 3 m o n t h s F O R a m i n o t o m y V e r s u s A n t e r i o r D i s c e c t o m y
( F O R V A D ) A d u l t s ( e"1 8 y e a r s )
U n i l a t e r a l o r b i l a t e r a l c e r v i c a l b r a c h i a l g i a s e c o n d a r y t o n e r v e r o o t c o m p r e s s i o n f o r a t l e a s t 6 w e e k s
S i n g l e o r 2 - l e v e l n e r v e e n t r a p m e n t
P o s t e r o l a t e r a l d i s c a n d / o r f o r a m i n a l n a r r o w i n g
F a i l e d c o n s e r v a t i v e m a n a g e m e n t P o s t e r i o r C e r v i c a l F o r a m i n o t o m y ( P C F )
A n t e r i o r C e r v i c a l D i s c e c t o m y ( A C D ) N e c k D i s a b i l i t y I n d e x a t 1 2 m o n t h s V a s c u l a r T r e a t m e n t O f P o o r - g r a d e S u b A r a c h n o i d h a e m o r r h a g e T r i a l 2
( T O P S A T 2 ) * A d u l t s ( 1 8 - 8 0 y e a r s )
W F N S g r a d e I V o r V a n e u r y s m a l s u b a r a c h n o i d h a e m o r r h a g e
D o e s n o t m e e t c r i t e r i a f o r b r a i n s t e m d e a t h
C o n v e n t i o n a l s a c c u l a r a n e u r y s m T r e a t m e n t o f a n e u r y s m w i t h i n 2 4 h o u r s o f i c t u s
T r e a t m e n t o f a n e u r y s m a f t e r n e u r o l o g i c a l i m p r o v e m e n t t o W F N S g r a d e 1 - 3 M o d i f i e d R a n k i n S c o r e a t 1 2 m o n t h s S u b C u t a n e o u s I n t e r L e u k i n - 1 r e c e p t o r a n t a g o n i s t i n S u b A r a c h n o i d H a e m o r r h a g e
( S C I L S A H ) A d u l t s ( e"1 8 y e a r s , n o n - p r e g n a n t )
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h4 0J+ j h4 h4 0J+ Uh % 0J+ mH nH uj h4 0J+ Uh4 h4 0J+ 2 1F:p/ . A!"#$% R ( . A!n"n#$n% R D y K _ b l a n k y K 4 h t t p s : / / o u t l o o k . m a n c h e s t e r . a c . u k / o w a / r e d i r . a s p x ? C = K - C 7 K D F 4 0 A r y S k g z x N 9 q V 9 U - H e N k 8 6 _ j r N I X x W 1 Q L X z 0 s J 8 9 A R v W C A . . & U R L = m a i l t o % 3 a n e i l k i t c h e n % 4 0 n h s . n e t yX; H,]ą'c 3 D y K y K h t t p s : / / w w w . r c s e n g . a c . u k / s t a n d a r d s - a n d - r e s e a r c h / r e s e a r c h / s u r g i c a l - t r i a l s - i n i t i a t i v e / yX; H,]ą'c j D Jamjoom201632063206320617Jamjoom, A. A.Wiggins, A. N.Loan, J. J.Emelifeoneu, J.Fouyas, I. P.Brennan, P. M.Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom. Electronic address: aabjamjoom@gmail.com.
Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom.
Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.Academic Productivity of Neurosurgeons Working in the United Kingdom: Insights from the H-Index and Its VariantsWorld NeurosurgWorld Neurosurg287-9386Algorithms*BibliometricsCohort StudiesEfficiencyFemaleHumansInternetMale*NeurosurgeonsNeurosurgery/*statistics & numerical dataPublishing/*statistics & numerical dataSearch EngineUnited KingdomBibliometricsNeurosurgeryh-index2016Feb1878-8769 (Electronic)
1878-8750 (Linking)26410200http://www.ncbi.nlm.nih.gov/pubmed/2641020010.1016/j.wneu.2015.09.041Wilkes201532073207320717Wilkes, F. A.Akram, H.Hyam, J. A.Kitchen, N. D.Hariz, M. I.Zrinzo, L.Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, University College London;Publication productivity of neurosurgeons in Great Britain and IrelandJ NeurosurgJ Neurosurg948-541224AdultAgedBibliometricsBiomedical Research/statistics & numerical dataEfficiencyFemaleHumansIrelandMaleMiddle AgedNeurosurgery/*statistics & numerical dataPeriodicals as Topic/*statistics & numerical dataPublicationsSex FactorsSpecializationSurgeons/*statistics & numerical dataUnited KingdomNHNN = National Hospital for Neurology and NeurosurgeryNIH = National Institutes of HealthSBNS = Society of British Neurological Surgeonsh-indexm-quotientneurosurgerysex2015Apr1933-0693 (Electronic)
0022-3085 (Linking)25614943http://www.ncbi.nlm.nih.gov/pubmed/2561494310.3171/2014.11.JNS14856 F D Jamjoom201832383238323817Jamjoom, A. A. B.Joannides, A. J.Poon, M. T.Chari, A.Zaben, M.Abdulla, M. A. H.Roach, J.Glancz, L. J.Solth, A.Duddy, J.Brennan, P. M.Bayston, R.Bulters, D. O.Mallucci, C. L.Jenkinson, M. D.Gray, W. P.Kandasamy, J.Hutchinson, P. J.Kolias, A. G.Ahmed, A. I.British Neurosurgical Trainee Research, CollaborativeDepartment of Clinical Neuroscience, Western General Hospital, Edinburgh, UK.
Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
Department of Neurosurgery, Royal London Hospital, London, UK.
Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
Wessex Neurological Centre, University Hospitals Southampton, Southampton, UK.
Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK.
Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
Division of Rheumatology, Orthopaedics and Dermatology, The University of Nottingham, Nottingham, UK.
Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK.
Department of Neurosurgery, The Walton Centre, Liverpool, UK.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.Prospective, multicentre study of external ventricular drainage-related infections in the UK and IrelandJ Neurol Neurosurg PsychiatryJ Neurol Neurosurg Psychiatry120-1268922017/10/272018Feb1468-330X (Electronic)
0022-3050 (Linking)29070645https://www.ncbi.nlm.nih.gov/pubmed/29070645PMC580033610.1136/jnnp-2017-316415Brennan201732393239323917Brennan, P. M.Kolias, A. G.Joannides, A. J.Shapey, J.Marcus, H. J.Gregson, B. A.Grover, P. J.Hutchinson, P. J.Coulter, I. C.British Neurosurgical Trainee Research, CollaborativeDepartment of Clinical Neurosciences, Western General Hospital, Edinburgh.
Division of Neurosurgery, Addenbrooke's Hospital and University of Cambridge, Cambridge.
Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London.
Department of Neurosurgery, Charing Cross Hospital, London.
Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne.
Department of Neurosurgery, Royal London Hospital, London; and.
Department of Neurosurgery, James Cook Hospital, Middleborough, United Kingdom;The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United KingdomJ NeurosurgJ Neurosurg732-73912742016/11/12BHC = bur-hole craniostomyBNTRC = British Neurosurgical Trainee Research CollaborativeCSDH = chronic subdural hematomaGCS = Glasgow Coma ScaleINR = international normalized ratioNSU = neurosurgical unitORION = Outcome Registry Intervention and Operation NetworkRCT = randomized controlled trialSBNS = Society of British Neurological SurgeonsTDC = twist-drill craniostomyUK = United Kingdomchronic subdural hematomamRS = modified Rankin Scaleneurosurgeryoutcomesvascular disorders2017Oct1933-0693 (Electronic)
0022-3085 (Linking)27834599https://www.ncbi.nlm.nih.gov/pubmed/2783459910.3171/2016.8.JNS16134
D Chari201832373237323717Chari, A.Jamjoom, A. A.Edlmann, E.Ahmed, A. I.Coulter, I. C.Ma, R.May, P.Brennan, P. M.Hutchinson, P. J. A.Kolias, A. G.British Neurosurgical Trainee Research, CollaborativeDepartment of Neurosurgery, Royal London Hospital, London, UK.
Division of Neurosurgery, Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK.
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK.
Department of Neurosurgery, Wessex Neurological Centre and University of Southampton, Southampton, UK.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK.
Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
Department of Neurosurgery, The Walton Centre, Liverpool, UK.
Surgery Theme, Cambridge Clinical Trials Unit, Cambridge Biomedical Campus, Cambridge, UK.
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK. angeloskolias@gmail.com.
Surgery Theme, Cambridge Clinical Trials Unit, Cambridge Biomedical Campus, Cambridge, UK. angeloskolias@gmail.com.The British Neurosurgical Trainee Research Collaborative: Five years onActa Neurochir (Wien)Acta Neurochir (Wien)23-2816012017/11/05Clinical trialsCollaborativeResearchResidentTrainee2018Jan0942-0940 (Electronic)
0001-6268 (Linking)29101466https://www.ncbi.nlm.nih.gov/pubmed/29101466PMC573520210.1007/s00701-017-3351-50 D Khan201432223222322217Khan, N. R.Thompson, C. J.Taylor, D. R.Venable, G. T.Wham, R. M.Michael, L. M., 2ndKlimo, P., Jr.Department of Neurosurgery.An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United StatesJ NeurosurgJ Neurosurg746-5512032013/12/24Academic Medical Centers/statistics & numerical dataAdult*BibliometricsDatabases, Factual/statistics & numerical dataEfficiencyFemaleHumansInternship and Residency/*statistics & numerical dataMaleNeurosurgery/*education/*statistics & numerical dataPhysicians/*statistics & numerical dataPublications/statistics & numerical dataSurgery Department, Hospital/*statistics & numerical dataUnited States2014Mar1933-0693 (Electronic)
0022-3085 (Linking)24359012https://www.ncbi.nlm.nih.gov/pubmed/2435901210.3171/2013.11.JNS131708Wilkes201532073207320717Wilkes, F. A.Akram, H.Hyam, J. A.Kitchen, N. D.Hariz, M. I.Zrinzo, L.Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, University College London;Publication productivity of neurosurgeons in Great Britain and IrelandJ NeurosurgJ Neurosurg948-541224AdultAgedBibliometricsBiomedical Research/statistics & numerical dataEfficiencyFemaleHumansIrelandMaleMiddle AgedNeurosurgery/*statistics & numerical dataPeriodicals as Topic/*statistics & numerical dataPublicationsSex FactorsSpecializationSurgeons/*statistics & numerical dataUnited KingdomNHNN = National Hospital for Neurology and NeurosurgeryNIH = National Institutes of HealthSBNS = Society of British Neurological Surgeonsh-indexm-quotientneurosurgerysex2015Apr1933-0693 (Electronic)
0022-3085 (Linking)25614943http://www.ncbi.nlm.nih.gov/pubmed/2561494310.3171/2014.11.JNS14856 tD D Gregson201533773377337717Gregson, B. A.Rowan, E. N.Francis, R.McNamee, P.Boyers, D.Mitchell, P.McColl, E.Chambers, I. R.Unterberg, A.Mendelow, A. D.Stitch investigatorsNeurosurgical Trials Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK.
South Tees Hospitals Foundation Trust, James Cook University Hospital, Middlesbrough, UK.
Department of Neurosurgery, University of Heidelberg, D-69120 Heidelberg, Germany.Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of Early Surgery compared with Initial Conservative TreatmentHealth Technol AssessHealth Technol Assess1-13819702015/09/09Acute DiseaseAdolescentAdultAgedAged, 80 and overCerebral Hemorrhage, Traumatic/mortality/surgery/*therapyFemaleHematoma/mortality/surgery/*therapyHumansMaleMiddle AgedPatient SelectionSample SizeTime-to-TreatmentTreatment OutcomeYoung Adult2015Sep2046-4924 (Electronic)
1366-5278 (Linking)26346805https://www.ncbi.nlm.nih.gov/pubmed/26346805PMC478088710.3310/hta19700Hutchinson201632263226322617Hutchinson, P. J.Kolias, A. G.Timofeev, I. S.Corteen, E. A.Czosnyka, M.Timothy, J.Anderson, I.Bulters, D. O.Belli, A.Eynon, C. A.Wadley, J.Mendelow, A. D.Mitchell, P. M.Wilson, M. H.Critchley, G.Sahuquillo, J.Unterberg, A.Servadei, F.Teasdale, G. M.Pickard, J. D.Menon, D. K.Murray, G. D.Kirkpatrick, P. J.R. ESCUEicp Trial CollaboratorsFrom the Division of Neurosurgery, Department of Clinical Neurosciences (P.J.H., A.G.K., I.S.T., E.A.C., M.C., J.D.P., P.J.K.), and the Division of Anaesthesia (D.K.M.), Addenbrooke's Hospital and University of Cambridge, Cambridge, the Department of Neurosurgery, Leeds General Infirmary, Leeds (J.T., I.A.), the Department of Neurosurgery (D.O.B.) and Neurosciences Intensive Care Unit (C.A.E.), Wessex Neurological Centre, University Hospital Southampton, Southampton, the NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham (A.B.), the Department of Neurosurgery, St. Bartholomew's and Royal London Hospital (J.W.), and the Department of Neurosurgery, St. Mary's Hospital (M.H.W.), London, the Institute of Neuroscience, Neurosurgical Trials Group, Newcastle University (A.D.M.), and the Department of Neurosurgery, Royal Victoria Infirmary (P.M.M.), Newcastle upon Tyne, Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals, Haywards Heath (G.C.), the Institute of Health and Wellbeing, University of Glasgow, Glasgow (G.M.T.), and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, University of Edinburgh, Edinburgh (G.D.M.) - all in the United Kingdom; the Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (J.S.); the Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany (A.U.); and the Neurosurgery-Neurotraumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Arcispedale S. Maria Nuova-IRCCS Reggio Emilia, University of Parma, Parma, Italy (F.S.).Trial of Decompressive Craniectomy for Traumatic Intracranial HypertensionN Engl J MedN Engl J Med1119-30375122016/09/08AdolescentAdultAgedBrain Injuries/*complications/therapyChildCombined Modality Therapy*Decompressive Craniectomy/adverse effectsDisabled PersonsFemaleGlasgow Coma ScaleHumansIntracranial Hypertension/drug therapy/etiology/mortality/*surgeryMaleMiddle AgedPersistent Vegetative State/epidemiology/etiologyTreatment OutcomeYoung Adult2016Sep 221533-4406 (Electronic)
0028-4793 (Linking)27602507https://www.ncbi.nlm.nih.gov/pubmed/2760250710.1056/NEJMoa1605215Pickard198933793379337917Pickard, J. D.Murray, G. D.Illingworth, R.Shaw, M. D.Teasdale, G. M.Foy, P. M.Humphrey, P. R.Lang, D. A.Nelson, R.Richards, P.et al.,Wessex Neurological Centre, Southampton General Hospital.Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trialBMJBMJ636-4229866741989/03/11Administration, OralAdultAgedBlood Pressure/drug effectsCerebral Infarction/mortality/*prevention & controlClinical Trials as TopicDouble-Blind MethodFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNimodipine/administration & dosage/adverse effects/*therapeutic usePrognosisRandom AllocationRecurrenceSubarachnoid Hemorrhage/*drug therapy/mortalityTime Factors1989Mar 110959-8138 (Print)
0959-8138 (Linking)2496789https://www.ncbi.nlm.nih.gov/pubmed/2496789PMC1835889Molyneux200533803380338017Molyneux, A. J.Kerr, R. S.Yu, L. M.Clarke, M.Sneade, M.Yarnold, J. A.Sandercock, P.International Subarachnoid Aneurysm Trial Collaborative, GroupNeurovascular Research Unit, Nuffield Department of Surgery, University of Oxford and Oxford Radcliffe Hospitals NHS Trust, Radcliffe Infirmary, Oxford, UK. nvru@nds.ox.ac.ukInternational subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusionLancetLancet809-1736694882005/09/06Activities of Daily LivingAdultAgedAneurysm, Ruptured/mortality/surgery/*therapy*Embolization, Therapeutic/adverse effectsFollow-Up StudiesHumansIntracranial Aneurysm/mortality/surgery/*therapyMiddle Aged*Neurosurgical Procedures/adverse effectsQuality of LifeRecurrenceSubarachnoid Hemorrhage/surgery/therapySurvival RateTreatment Outcome2005Sep 3-91474-547X (Electronic)
0140-6736 (Linking)16139655https://www.ncbi.nlm.nih.gov/pubmed/1613965510.1016/S0140-6736(05)67214-5Mendelow200533813381338117Mendelow, A. D.Gregson, B. A.Fernandes, H. M.Murray, G. D.Teasdale, G. M.Hope, D. T.Karimi, A.Shaw, M. D.Barer, D. H.Stich investigatorsDepartment of Neurosurgery, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK. a.d.mendelow@ncl.ac.ukEarly surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trialLancetLancet387-9736594572005/02/01AgedCerebral Hemorrhage/surgery/*therapyFemaleGlasgow Coma ScaleHematoma/pathology/surgery/*therapyHumansMaleMiddle AgedPrognosisTreatment Outcome2005Jan 29-Feb 41474-547X (Electronic)
0140-6736 (Linking)15680453https://www.ncbi.nlm.nih.gov/pubmed/1568045310.1016/S0140-6736(05)17826-XMendelow201333823382338217Mendelow, A. D.Gregson, B. A.Rowan, E. N.Murray, G. D.Gholkar, A.Mitchell, P. M.Stich Ii InvestigatorsNewcastle University, Neurosurgical Trials Unit, Newcastle upon Tyne, UK.
Newcastle University, Neurosurgical Trials Unit, Newcastle upon Tyne, UK. Electronic address: barbara.gregson@ncl.ac.uk.
Edinburgh University, Centre for Population Health Sciences, Medical School, Edinburgh, UK.
Royal Victoria Infirmary, Newcastle upon Tyne, UK.Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trialLancetLancet397-40838298902013/06/04Acute DiseaseAdolescentAdultAgedAged, 80 and overCerebral Hemorrhage/mortality/surgery/*therapyCraniotomy/statistics & numerical dataDisabled Persons/statistics & numerical dataFemaleGlasgow Coma ScaleHematoma/mortality/surgery/*therapyHumansMaleMiddle AgedTime-to-TreatmentTreatment OutcomeYoung Adult2013Aug 31474-547X (Electronic)
0140-6736 (Linking)23726393https://www.ncbi.nlm.nih.gov/pubmed/23726393PMC390660910.1016/S0140-6736(13)60986-1Kirkpatrick201433833383338317Kirkpatrick, P. J.Turner, C. L.Smith, C.Hutchinson, P. J.Murray, G. D.Stash CollaboratorsAcademic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Academic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: clt29@medschl.cam.ac.uk.
Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK.Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trialLancet NeurolLancet Neurol666-751372014/05/20AdultAgedFemaleFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic useInternationalityMaleMiddle AgedSimvastatin/*therapeutic useSubarachnoid Hemorrhage/*diagnosis/*drug therapyTreatment OutcomeYoung Adult2014Jul1474-4465 (Electronic)
1474-4422 (Linking)24837690https://www.ncbi.nlm.nih.gov/pubmed/2483769010.1016/S1474-4422(14)70084-5 D Hutchinson201632263226322617Hutchinson, P. J.Kolias, A. G.Timofeev, I. S.Corteen, E. A.Czosnyka, M.Timothy, J.Anderson, I.Bulters, D. O.Belli, A.Eynon, C. A.Wadley, J.Mendelow, A. D.Mitchell, P. M.Wilson, M. H.Critchley, G.Sahuquillo, J.Unterberg, A.Servadei, F.Teasdale, G. M.Pickard, J. D.Menon, D. K.Murray, G. D.Kirkpatrick, P. J.R. ESCUEicp Trial CollaboratorsFrom the Division of Neurosurgery, Department of Clinical Neurosciences (P.J.H., A.G.K., I.S.T., E.A.C., M.C., J.D.P., P.J.K.), and the Division of Anaesthesia (D.K.M.), Addenbrooke's Hospital and University of Cambridge, Cambridge, the Department of Neurosurgery, Leeds General Infirmary, Leeds (J.T., I.A.), the Department of Neurosurgery (D.O.B.) and Neurosciences Intensive Care Unit (C.A.E.), Wessex Neurological Centre, University Hospital Southampton, Southampton, the NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham (A.B.), the Department of Neurosurgery, St. Bartholomew's and Royal London Hospital (J.W.), and the Department of Neurosurgery, St. Mary's Hospital (M.H.W.), London, the Institute of Neuroscience, Neurosurgical Trials Group, Newcastle University (A.D.M.), and the Department of Neurosurgery, Royal Victoria Infirmary (P.M.M.), Newcastle upon Tyne, Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals, Haywards Heath (G.C.), the Institute of Health and Wellbeing, University of Glasgow, Glasgow (G.M.T.), and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, University of Edinburgh, Edinburgh (G.D.M.) - all in the United Kingdom; the Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (J.S.); the Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany (A.U.); and the Neurosurgery-Neurotraumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Arcispedale S. Maria Nuova-IRCCS Reggio Emilia, University of Parma, Parma, Italy (F.S.).Trial of Decompressive Craniectomy for Traumatic Intracranial HypertensionN Engl J MedN Engl J Med1119-30375122016/09/08AdolescentAdultAgedBrain Injuries/*complications/therapyChildCombined Modality Therapy*Decompressive Craniectomy/adverse effectsDisabled PersonsFemaleGlasgow Coma ScaleHumansIntracranial Hypertension/drug therapy/etiology/mortality/*surgeryMaleMiddle AgedPersistent Vegetative State/epidemiology/etiologyTreatment OutcomeYoung Adult2016Sep 221533-4406 (Electronic)
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t 0 6, 5 5p yt.= T (L D Gregson201533773377337717Gregson, B. A.Rowan, E. N.Francis, R.McNamee, P.Boyers, D.Mitchell, P.McColl, E.Chambers, I. R.Unterberg, A.Mendelow, A. D.Stitch investigatorsNeurosurgical Trials Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK.
South Tees Hospitals Foundation Trust, James Cook University Hospital, Middlesbrough, UK.
Department of Neurosurgery, University of Heidelberg, D-69120 Heidelberg, Germany.Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of Early Surgery compared with Initial Conservative TreatmentHealth Technol AssessHealth Technol Assess1-13819702015/09/09Acute DiseaseAdolescentAdultAgedAged, 80 and overCerebral Hemorrhage, Traumatic/mortality/surgery/*therapyFemaleHematoma/mortality/surgery/*therapyHumansMaleMiddle AgedPatient SelectionSample SizeTime-to-TreatmentTreatment OutcomeYoung Adult2015Sep2046-4924 (Electronic)
1366-5278 (Linking)26346805https://www.ncbi.nlm.nih.gov/pubmed/26346805PMC478088710.3310/hta19700Hutchinson201632263226322617Hutchinson, P. J.Kolias, A. G.Timofeev, I. S.Corteen, E. A.Czosnyka, M.Timothy, J.Anderson, I.Bulters, D. O.Belli, A.Eynon, C. A.Wadley, J.Mendelow, A. D.Mitchell, P. M.Wilson, M. H.Critchley, G.Sahuquillo, J.Unterberg, A.Servadei, F.Teasdale, G. M.Pickard, J. D.Menon, D. K.Murray, G. D.Kirkpatrick, P. J.R. ESCUEicp Trial CollaboratorsFrom the Division of Neurosurgery, Department of Clinical Neurosciences (P.J.H., A.G.K., I.S.T., E.A.C., M.C., J.D.P., P.J.K.), and the Division of Anaesthesia (D.K.M.), Addenbrooke's Hospital and University of Cambridge, Cambridge, the Department of Neurosurgery, Leeds General Infirmary, Leeds (J.T., I.A.), the Department of Neurosurgery (D.O.B.) and Neurosciences Intensive Care Unit (C.A.E.), Wessex Neurological Centre, University Hospital Southampton, Southampton, the NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham (A.B.), the Department of Neurosurgery, St. Bartholomew's and Royal London Hospital (J.W.), and the Department of Neurosurgery, St. Mary's Hospital (M.H.W.), London, the Institute of Neuroscience, Neurosurgical Trials Group, Newcastle University (A.D.M.), and the Department of Neurosurgery, Royal Victoria Infirmary (P.M.M.), Newcastle upon Tyne, Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals, Haywards Heath (G.C.), the Institute of Health and Wellbeing, University of Glasgow, Glasgow (G.M.T.), and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, University of Edinburgh, Edinburgh (G.D.M.) - all in the United Kingdom; the Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (J.S.); the Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany (A.U.); and the Neurosurgery-Neurotraumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Arcispedale S. Maria Nuova-IRCCS Reggio Emilia, University of Parma, Parma, Italy (F.S.).Trial of Decompressive Craniectomy for Traumatic Intracranial HypertensionN Engl J MedN Engl J Med1119-30375122016/09/08AdolescentAdultAgedBrain Injuries/*complications/therapyChildCombined Modality Therapy*Decompressive Craniectomy/adverse effectsDisabled PersonsFemaleGlasgow Coma ScaleHumansIntracranial Hypertension/drug therapy/etiology/mortality/*surgeryMaleMiddle AgedPersistent Vegetative State/epidemiology/etiologyTreatment OutcomeYoung Adult2016Sep 221533-4406 (Electronic)
0028-4793 (Linking)27602507https://www.ncbi.nlm.nih.gov/pubmed/2760250710.1056/NEJMoa1605215Pickard198933793379337917Pickard, J. D.Murray, G. D.Illingworth, R.Shaw, M. D.Teasdale, G. M.Foy, P. M.Humphrey, P. R.Lang, D. A.Nelson, R.Richards, P.et al.,Wessex Neurological Centre, Southampton General Hospital.Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trialBMJBMJ636-4229866741989/03/11Administration, OralAdultAgedBlood Pressure/drug effectsCerebral Infarction/mortality/*prevention & controlClinical Trials as TopicDouble-Blind MethodFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNimodipine/administration & dosage/adverse effects/*therapeutic usePrognosisRandom AllocationRecurrenceSubarachnoid Hemorrhage/*drug therapy/mortalityTime Factors1989Mar 110959-8138 (Print)
0959-8138 (Linking)2496789https://www.ncbi.nlm.nih.gov/pubmed/2496789PMC1835889Molyneux200533803380338017Molyneux, A. J.Kerr, R. S.Yu, L. M.Clarke, M.Sneade, M.Yarnold, J. A.Sandercock, P.International Subarachnoid Aneurysm Trial Collaborative, GroupNeurovascular Research Unit, Nuffield Department of Surgery, University of Oxford and Oxford Radcliffe Hospitals NHS Trust, Radcliffe Infirmary, Oxford, UK. nvru@nds.ox.ac.ukInternational subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusionLancetLancet809-1736694882005/09/06Activities of Daily LivingAdultAgedAneurysm, Ruptured/mortality/surgery/*therapy*Embolization, Therapeutic/adverse effectsFollow-Up StudiesHumansIntracranial Aneurysm/mortality/surgery/*therapyMiddle Aged*Neurosurgical Procedures/adverse effectsQuality of LifeRecurrenceSubarachnoid Hemorrhage/surgery/therapySurvival RateTreatment Outcome2005Sep 3-91474-547X (Electronic)
0140-6736 (Linking)16139655https://www.ncbi.nlm.nih.gov/pubmed/1613965510.1016/S0140-6736(05)67214-5Mendelow200533813381338117Mendelow, A. D.Gregson, B. A.Fernandes, H. M.Murray, G. D.Teasdale, G. M.Hope, D. T.Karimi, A.Shaw, M. D.Barer, D. H.Stich investigatorsDepartment of Neurosurgery, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK. a.d.mendelow@ncl.ac.ukEarly surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trialLancetLancet387-9736594572005/02/01AgedCerebral Hemorrhage/surgery/*therapyFemaleGlasgow Coma ScaleHematoma/pathology/surgery/*therapyHumansMaleMiddle AgedPrognosisTreatment Outcome2005Jan 29-Feb 41474-547X (Electronic)
0140-6736 (Linking)15680453https://www.ncbi.nlm.nih.gov/pubmed/1568045310.1016/S0140-6736(05)17826-XMendelow201333823382338217Mendelow, A. D.Gregson, B. A.Rowan, E. N.Murray, G. D.Gholkar, A.Mitchell, P. M.Stich Ii InvestigatorsNewcastle University, Neurosurgical Trials Unit, Newcastle upon Tyne, UK.
Newcastle University, Neurosurgical Trials Unit, Newcastle upon Tyne, UK. Electronic address: barbara.gregson@ncl.ac.uk.
Edinburgh University, Centre for Population Health Sciences, Medical School, Edinburgh, UK.
Royal Victoria Infirmary, Newcastle upon Tyne, UK.Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trialLancetLancet397-40838298902013/06/04Acute DiseaseAdolescentAdultAgedAged, 80 and overCerebral Hemorrhage/mortality/surgery/*therapyCraniotomy/statistics & numerical dataDisabled Persons/statistics & numerical dataFemaleGlasgow Coma ScaleHematoma/mortality/surgery/*therapyHumansMaleMiddle AgedTime-to-TreatmentTreatment OutcomeYoung Adult2013Aug 31474-547X (Electronic)
0140-6736 (Linking)23726393https://www.ncbi.nlm.nih.gov/pubmed/23726393PMC390660910.1016/S0140-6736(13)60986-1Kirkpatrick201433833383338317Kirkpatrick, P. J.Turner, C. L.Smith, C.Hutchinson, P. J.Murray, G. D.Stash CollaboratorsAcademic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Academic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: clt29@medschl.cam.ac.uk.
Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK.Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trialLancet NeurolLancet Neurol666-751372014/05/20AdultAgedFemaleFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic useInternationalityMaleMiddle AgedSimvastatin/*therapeutic useSubarachnoid Hemorrhage/*diagnosis/*drug therapyTreatment OutcomeYoung Adult2014Jul1474-4465 (Electronic)
1474-4422 (Linking)24837690https://www.ncbi.nlm.nih.gov/pubmed/2483769010.1016/S1474-4422(14)70084-5Santarius200933843384338417Santarius, T.Kirkpatrick, P. J.Ganesan, D.Chia, H. L.Jalloh, I.Smielewski, P.Richards, H. K.Marcus, H.Parker, R. A.Price, S. J.Kirollos, R. W.Pickard, J. D.Hutchinson, P. J.Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trialLancetLancet1067-7337496952009/09/29AdultAgedAged, 80 and over*Craniotomy*DrainageFemaleHematoma, Subdural, Chronic/complications/diagnosis/mortality/*surgeryHumansMaleMiddle AgedSurvival RateTreatment Outcome2009Sep 261474-547X (Electronic)
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