A survey of neurosurgical management and prognostication of traumatic brain injury following the RESCUEicp trial.

PURPOSE: Decompressive craniectomy remains controversial because of uncertainty regarding its benefit to patients; this study aimed to explore current practice following the RESCUEicp Trial, an important study in the evolving literature on decompressive craniectomies. MATERIALS AND METHODS: Neurosurgeons in New Zealand, Australia, USA and Nepal were sent a survey consisting of two case scenarios and several multi-choice questions exploring their utilisation of decompressive craniectomy following the RESCUEicp Trial. RESULTS: One in ten neurosurgeons (n = 6, 10.3%) were no longer performing decompressive craniectomies for TBI following the RESCUEicp Trial and two fifths (n = 23, 39.7%) were less enthusiastic. Most neurosurgeons would not operate in the face of severe disability (n = 46, 79.3%) or vegetative state/death (n = 57, 98.3%). Neurosurgeons tended give more optimistic prognoses than the CRASH prognostic model. Those who suggested more pessimistic prognoses and those who use decision support tools were less likely to advise decompressive surgery. CONCLUSIONS: RESCUEicp has had a notable impact on neurosurgeons and their management of TBI. Although there remains no clear clinical consensus on the contraindications for decompressive craniectomy, most neurosurgeons would not operate if severe disability or vegetative state (the rates of which are increased by such surgery) seemed likely. Whilst unreliable, prognostic estimates still have an impact on clinical decision making and neurosurgical management. Wider use of decision support tools should be considered.

Concurrent Pituicytoma, Meningioma, and Cavernomas After Cranial Irradiation for Childhood Acute Lymphoblastic Leukemia.

BACKGROUND: The majority of patients with acute lymphoblastic leukaemia develop disease relapse in the central nervous system in the absence of central nervous system-directed prophylactic therapy. In the past, prophylactic cranial irradiation was commonly used in the form of whole-brain radiotherapy in patients with acute lymphoblastic leukemia to prevent the development of intracranial diseases. However, in addition to the inherent risk of toxicity, this type of therapy has several delayed side effects including the development of secondary intracranial tumors. CASE DESCRIPTION: We report a rare case of a patient with concurrent pituicytoma, meningioma, and cavernomas 44 years after prophylactic cranial irradiation for childhood acute lymphoblastic leukemia. The patient presented with visual disturbance, headache, and features of hypopituitarism. Endoscopic transsphenoidal resection of the pituicytoma and meningioma was performed. Subsequent regrowth of the residual meningioma necessitated further surgery and adjuvant treatment with radiotherapy. CONCLUSIONS: This case report highlights the unusual case of a patient with 3 concurrent intracranial lesions of distinct pathologies after prophylactic cranial irradiation therapy for childhood acute lymphoblastic leukemia.

A media content analysis of New Zealand's district health board Population-Based Funding Formula.

AIM: The Population-Based Funding Formula (PBFF) has a significant impact on health funding distribution between New Zealand's 20 district health boards (DHBs) yet is subject to little independent oversight or public scrutiny. There has been widespread dissatisfaction among DHBs with the allocation process; however, there are limited formal avenues available for DHBs and the public to discuss the PBFF. As such, the news media has become a key platform for voicing concerns. This study aims to gain a better understanding of how the PBFF is portrayed in the news media and of perceptions of funding allocations across the country. METHOD: We conducted thematic analyses of 487 newspaper articles about the PBFF, published over 13 years from 2003-2016. We then identified trends in the data. RESULTS: Typically presented in a negative light, the PBFF was commonly framed against a background of financial struggle and resultant impacts on health services and staff. The effect of factors driving DHB allocations and the PBFF process itself were also key themes. There were significant regional and temporal variations in reporting volume, with most articles focusing on South Island DHBs and occurring during the introduction of the PBFF and at the time of the most recent review. CONCLUSIONS: The findings suggest general discontent with the PBFF model across the DHB sector and a sense that the PBFF has failed to address various challenges facing DHBs. The geographic imbalance in reporting volume suggests that frustration with the PBFF is particularly keenly felt in the South Island. Although the PBFF is a lightning rod for frustrations over limited health funding, the findings point to the need to improve transparency and dialogue around the formula and to monitor of the impact of PBFF allocations throughout the country.

Patient-targeted Googling and social media: a cross-sectional study of senior medical students.

BACKGROUND: Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling (PTG), which involves a healthcare professional using a social networking site (SNS) or publicly available search engine to find patient information online. The study's aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. METHOD: The authors surveyed final year medical students at the Otago Medical School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students' attitudes towards PTG, and reasons why they might engage in PTG. RESULTS: Fifty-four students completed the survey (response rate = 65.1%), which showed that PTG was uncommon (n = 9, 16.7%). Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue (n = 29, 53.7%). SNS usage was high (n = 51, 94.4%); participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. CONCLUSIONS: The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information.