Stony Brook School of Medicine, Stony Brook, New York, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
Bowdoin College, Brunswick, Maine, USA.
World Neurosurg. 2020 Nov;143:e88-e105. doi: 10.1016/j.wneu.2020.06.237. Epub 2020 Jul 13.
Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains.
PubMed, CINAHL, and Embase were searched for GNS literature published from 1999 to 2019. Then, health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change. This items chart was subsequently used to categorize the GNS literature into health system domains.
A total 63 articles were determined to focus on a health system domain. Of these articles, 6 focused on multiple domains, yielding an adjusted total of 70 articles. Overall, the most represented health system domain was service delivery (21 articles), followed by workforce (19), infrastructure (15), financing (12) and information management (3). A total of 30 low- and middle-income countries (LMICs) were represented across all articles. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the articles.
This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system-focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.
近年来，全球神经外科学（GNS）的研究成果呈指数级增长。随着研究工作的增加，我们首先必须分析当前的 GNS 文献如何适应基于系统的政策的宏观框架。本研究的目的是根据卫生系统领域确定和分类 GNS 研究。
从 1999 年至 2019 年，在 PubMed、CINAHL 和 Embase 上搜索 GNS 文献。然后，根据全球外科学和社会变革计划中提供的公开文件定义和分项卫生系统领域。随后，使用该项目图表将 GNS 文献分类到卫生系统领域。
确定了 63 篇文章重点关注卫生系统领域。其中 6 篇文章关注多个领域，调整后共有 70 篇文章。总体而言，代表性最强的卫生系统领域是服务提供（21 篇），其次是劳动力（19 篇）、基础设施（15 篇）、融资（12 篇）和信息管理（3 篇）。所有文章共涉及 30 个中低收入国家（LMICs）。此外，第一作者隶属于高收入国家机构的文章占 71.4%。
本综述强调了在 GNS 背景下加强信息管理研究的迫切需要。此外，以卫生系统为重点的 GNS 文献仅占所有 LMICs（30/143）的 20%。应该注意到作者的趋势，因为如果作者的目标与 LMICs 的神经外科医生之间存在脱节，可能会出现许多道德（和实际）问题。
