METHODS: Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined.
RESULTS: During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19.
CONCLUSIONS: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.
METHOD: A generalized linear model (GLM) estimates the relationships between different travel mode indicators (e.g., length of motorway per inhabitants, number of motorcycles per inhabitant, percentage of daily trips on foot and by bicycle, percentage of daily trips by public transport) and the number of passenger transport fatalities. Because this city-level model is developed using data sets from different cities all over the world, the impacts of gross domestic product (GDP) are also included in the model.
CONCLUSIONS: Overall, the results imply that the percentage of daily trips by public transport, the percentage of daily trips on foot and by bicycle, and the GDP per inhabitant have negative relationships with the number of passenger transport fatalities, whereas motorway length and the number of motorcycles have positive relationships with the number of passenger transport fatalities.