Brain tumour patients' use of social media for disease management: Current practices and implications for the future.

OBJECTIVE: The role of social media in disease management is evolving. We aimed to define current use of social media for patients with primary brain tumours. METHODS: This was a single-centre cross-sectional prospective study; a questionnaire was administered on electronic tablets to patients in the Outpatient Department of Royal Melbourne Hospital. RESULTS: Of the 201 participants, 55.7 % were female and 61.2 % were aged 30-59 years. The Internet was used by 84.5 % of participants, 70.6 % of those used social media. This included social networking sites (33.1 %), wikis (28.1 %) and blogs (14.0 %) to access information, for communication or for interaction related to their brain tumour. Participants indicated preferences for privacy and flexibility and valued when health professionals contributed. Subjective social functioning and activities of daily living benefits were reported from use, however no difference in Health Related Quality of Life was found between social media users and non-users. CONCLUSIONS: This study is the first to examine social media use in disease management for brain tumour patients and defines its use and potential for targeted online interventions. PRACTICE IMPLICATIONS: Through identifying concerns regarding current social media sites and determining preferences of patients we have created recommendations to direct design of online content for patients.

Challenges in the Australasian neurosurgery training program: who should be trained and where should they train?

OBJECTIVE: Neurosurgical training poses particular challenges in Australia and New Zealand, given the large landmass, small population, and widely separated, often small, neurosurgical units. Such factors have necessitated a move away from autonomous, single-institution-based training to the selection of trainees by a centralized binational process. The success of this system is based on rigorous standardized evaluation of candidates' academic achievements, anatomical knowledge, references, and interview performance. Similarly, the accreditation of hospitals to train successful candidates has been standardized. The authors review the evolution of trainee selection and the accreditation of training posts in Australia and New Zealand. METHODS: The records of the Neurosurgical Society of Australasia Surgical Education and Training Board were reviewed for documents pertaining to the selection of neurosurgical trainees and the accreditation of training posts. Application records and referee scores from 2014 to the present were reviewed to encompass process changes, in particular the change from written referee reports to standardized interviews of referees. Surgical logbook case numbers for 23 trainees completing training in 2016, 2017, and 2018 were collated and presented in an aggregated, de-identified form as a measure of adherence to accreditation standards. Written evaluations of the training experience were also sought from two trainees reflecting on the selection process, the quality of training posts, and training limitations. RESULTS: While a time-consuming process, the method of obtaining referee reports by interview has resulted in a wider spread of scores, more able to separate high- and low-scoring applicants than other components of the selection process. Review of the training post accreditation records for the last 2 years showed that adherence to standards has resulted in loss of accreditation for one unit and shortened periods of review for units with more minor deficiencies. Two applications for accreditation have been denied. Examination of caseload data showed that trainees more than fulfill minimum requirements in accredited training posts, confirming the robust nature of this aspect of unit accreditation. CONCLUSIONS: A key factor determining the success of neurosurgical training in Australia and New Zealand has been a willingness to evolve selection and other processes to overcome challenges as they become apparent. According to available analyses, the revised referee process and strict accreditation standards appear effective. The benefits and challenges of the current training system are discussed in the context of a paucity of international literature.

Successful resolution of the ophthalmic manifestations of a falcotentorial meningioma through Cerebrospinal fluid diversion.

We report the case of a falcotentorial meningioma presenting only with binocular, horizontal diplopia in an otherwise healthy sixty-two-year old male. Review of the established literature highlights a lack of consensus regarding management of this extremely rare pineal region tumor. Complete surgical resection ultimately remains the ideal therapeutic option but surgical excision continues to bear serious risk of neurologic and ophthalmic morbidity, including hemianopia and cortical visual impairment. We advocate that a multidisciplinary approach focusing on patient values is critical in treatment of these uncommon lesions. Cerebrospinal fluid diversion in this patient achieved successful resolution of symptoms secondary to intracranial hypertension whilst facilitating close surveillance.

Acute cervical cord syrinx after aneurysmal subarachnoid haemorrhage.

We report the acute formation of a cervical cord syrinx after aneurysmal subarachnoid haemorrhage, followed by spontaneous resolution. To our knowledge, not previously described in the literature, this case provides further insights into the pathophysiology of syrinx formation, and is discussed with reference to prevailing theories.

A systematic review of types and efficacy of online interventions for cancer patients.

OBJECTIVE: This review examines the evidence-based literature surrounding the use of online resources for adult cancer patients. The focus is online resources that connect patients with their healthcare clinician and with supportive and educational resources, their efficacy and the outcome measures used to assess them. METHODS: The following databases were systematically searched for relevant literature: MEDLINE, PsychINFO, Cochrane Central Register of Controlled Trials, CINAHL, Inspec and Computers and Applied Science. Included were studies conducted in an outpatient setting, and reporting a measurable, clinically relevant outcome. Fourteen studies satisfied the inclusion criteria. RESULTS: The efficacy of online interventions was varied, with some demonstrating positive effects on quality of life and related measures, and two demonstrating poorer outcomes for intervention participants. The majority of interventions reported mixed results. Included interventions were too heterogeneous for meta-analysis. CONCLUSIONS: The overall benefit of online interventions for cancer patients is unclear. Although there is a plethora of interventions reported without analysis, current interventions demonstrate mixed efficacy of limited duration when rigorously evaluated. PRACTICE IMPLICATIONS: The efficacy of on-line interventions for cancer patients is unclear. All on-line interventions should be developed using the available evidence-base and rigorously evaluated to expand our understanding of this area.

Leukoaraiosis and early neurological recovery after intravenous thrombolysis.

BACKGROUND: Early neurological recovery after intravenous thrombolysis (IVT) is associated with favorable outcome after acute ischemic stroke. Leukoaraiosis, a marker of chronic ischemia, is a possible negative predictive factor of early recovery. However, its negative attenuating effects remain inadequately studied, leading to uncertainty in the prediction of outcomes after IVT. We aim to determine the influence of leukoaraiosis on early neurologic recovery. METHODS: We included consecutive acute ischemic stroke patients who received IVT between 2007 and 2011. The following data were included: demographics, vascular risk factors, stroke type, National Institutes of Health Stroke Scale (NIHSS) at onset, and at 24 hours after IVT. Baseline computed tomography (CT) brain scans were analyzed. Two blinded assessors rated the CT scans using the van Swieten scale for leukoaraiosis. Median regression was used to assess the relationship between leukoaraiosis and neurologic recovery. RESULTS: We included 158 patients. The median (interquartile range [IQR]) age was 77 (68-84) and 71 (45%) were female. The median (IQR) NIHSS was 13 (7-18.75) at baseline and 7.5 (2-16) at 24 hours. After taking into account variables independently associated with leukoaraiosis, median regression analysis failed to demonstrate the association between the presence of leukoaraiosis and early neurologic recovery (NIHSS relative one) after IVT, for either of the 3 prespecified dichotomization-based definitions of leukoaraiosis. CONCLUSIONS: In our sample, there was no evidence of the association between the degree of leukoaraiosis and early neurological recovery after IVT.