Predicting post-traumatic stress disorder: The complex relationship between burnout, intentions to leave and emotional support among health care professionals

BACKGROUND

Health care professionals working in delivery rooms often encounter stressful situations. Understanding their challenges and the support they receive is essential for improving their well-being and consequently patient care.

PURPOSE

Examining the relationship between burnout, intentions to leave, post-traumatic stress disorder (PTSD) symptoms, and complex PTSD among health care professionals, and identifying their predictors.

METHODS

A mixed methods design, including a survey among 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences and PTSD, as well as 15 semi-structured interviews.

DISCUSSION

Most participants experienced multiple difficult events in the delivery room, reporting insufficient emotional support. Burnout and lack of emotional support were significant predictors of PTSD symptoms. Participants expressed a need for emotional support to cope with complex situations.

CONCLUSION

Burnout among midwives must be addressed through prevention and intervention programs. Emotional support is essential in mitigating PTSD symptoms among midwives and gynecologists, enhancing their resilience and well-being.

Longitudinal Analysis of Circulating Tumor DNA and Detection of Tumor Genomic Alterations Using Liquid Biopsy in Patients with Locally Advanced Esophagogastric Carcinoma

PURPOSE/OBJECTIVE(S)

For locally advanced esophageal (E), esophagogastric junction (EGJ), and gastric (G) carcinoma, the standard treatment is neoadjuvant chemoradiotherapy followed by surgery. The curative goal is to control the tumor locally, prevent regional recurrence, and prevent or delay metastatic progression. Up to one-third of patients will achieve complete pathologic response rate (pCR) under this treatment. Yet disease recurrence can occur in one-third of patients after definitive treatment. Our study provides real-world longitudinal data of liquid biopsy to analyze circulating tumor deoxyribonucleotide acid (ctDNA) for minimal residual disease (MRD) as an informative marker for early therapeutic response, detectable disease, and risk for recurrence. Furthermore, the liquid biopsy reveals variable tumor-specific sequence alterations.

MATERIALS/METHODS

A total of 8 patients with newly diagnosed locoregional esophagogastric cancers were evaluated with non-invasive plasma sample, collected at baseline, post-neoadjuvant chemoradiation, post-surgery, and serially as disease surveillance. Bespoke mPCR-NGS assay measured the ctDNA-based MRD levels and identified a comprehensive tumor-specific genomic profile. The primary outcome is assay recurrence compared to radiologic disease recurrence, defined as radiologic confirmed disease. Exploratory endpoints are used to examine the profile of tumor.

RESULTS

Baseline ctDNA levels were detected in 8 newly diagnosed patients. Longitudinal testing showed a decrease in ctDNA in 4 patients and residual disease in 2 patients after the start of neoadjuvant therapy. 1 patient demonstrated pCR in conjunction with ctDNA clearance.

CONCLUSION

Clearance of ctDNA may correlate to a favorable pCR and indicate a lower risk of relapse, guiding the strategy for adjuvant treatment. Personalized, tumor-informed sequence alterations of the 8 patients revealed a high frequency in TP53 alterations, which occurs early during development in esophagogastric cancer. This prospective study seeks to validate the application of ctDNA surveillance and tumor molecular alterations in a larger cohort after 5 years.

Aligning tumor mutational burden (TMB) quantification across diagnostic platforms: phase II of the Friends of Cancer Research TMB Harmonization Project

BACKGROUND

Tumor mutational burden (TMB) measurements aid in identifying patients who are likely to benefit from immunotherapy; however, there is empirical variability across panel assays and factors contributing to this variability have not been comprehensively investigated. Identifying sources of variability can help facilitate comparability across different panel assays, which may aid in broader adoption of panel assays and development of clinical applications.

MATERIALS AND METHODS

Twenty-nine tumor samples and 10 human-derived cell lines were processed and distributed to 16 laboratories; each used their own bioinformatics pipelines to calculate TMB and compare to whole exome results. Additionally, theoretical positive percent agreement (PPA) and negative percent agreement (NPA) of TMB were estimated. The impact of filtering pathogenic and germline variants on TMB estimates was assessed. Calibration curves specific to each panel assay were developed to facilitate translation of panel TMB values to whole exome sequencing (WES) TMB values.

RESULTS

Panel sizes >667 Kb are necessary to maintain adequate PPA and NPA for calling TMB high versus TMB low across the range of cut-offs used in practice. Failure to filter out pathogenic variants when estimating panel TMB resulted in overestimating TMB relative to WES for all assays. Filtering out potential germline variants at >0% population minor allele frequency resulted in the strongest correlation to WES TMB. Application of a calibration approach derived from The Cancer Genome Atlas data, tailored to each panel assay, reduced the spread of panel TMB values around the WES TMB as reflected in lower root mean squared error (RMSE) for 26/29 (90%) of the clinical samples.

CONCLUSIONS

Estimation of TMB varies across different panels, with panel size, gene content, and bioinformatics pipelines contributing to empirical variability. Statistical calibration can achieve more consistent results across panels and allows for comparison of TMB values across various panel assays. To promote reproducibility and comparability across assays, a software tool was developed and made publicly available.

Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic

INTRODUCTION

National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge.

METHODS

We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO).

FINDINGS

Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity.

CONCLUSION

National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.

Constraints on Dark Matter Properties from Observations of Milky Way Satellite Galaxies

We perform a comprehensive study of Milky Way (MW) satellite galaxies to constrain the fundamental properties of dark matter (DM). This analysis fully incorporates inhomogeneities in the spatial distribution and detectability of MW satellites and marginalizes over uncertainties in the mapping between galaxies and DM halos, the properties of the MW system, and the disruption of subhalos by the MW disk. Our results are consistent with the cold, collisionless DM paradigm and yield the strongest cosmological constraints to date on particle models of warm, interacting, and fuzzy dark matter. At 95% confidence, we report limits on (i) the mass of thermal relic warm DM, m_{WDM}>6.5  keV (free-streaming length, λ_{fs}≲10h^{-1}  kpc), (ii) the velocity-independent DM-proton scattering cross section, σ_{0}<8.8×10^{-29}  cm^{2} for a 100 MeV DM particle mass [DM-proton coupling, c_{p}≲(0.3  GeV)^{-2}], and (iii) the mass of fuzzy DM, m_{ϕ}>2.9×10^{-21}  eV (de Broglie wavelength, λ_{dB}≲0.5  kpc). These constraints are complementary to other observational and laboratory constraints on DM properties.

Effectiveness of an mHealth application to improve hypertension health literacy in India

AIM

The purpose of this research was to determine the effectiveness of a mobile health or mHealth application to improve hypertension health literacy among vulnerable populations in India. Additionally, we sought to estimate relationships between participant knowledge on hypertension and sociodemographic variables.

BACKGROUND

The World Health Organization advocates for the use of mobile technology to improve public health outcomes.

INTRODUCTION

The incidence of hypertension is on the rise in India, and effective and sustainable interventions are needed.

METHODS

A quantitative single arm pre-test post-test interventional and correlational design was used to test the hypertension mHealth application among participants in a limited resource setting. A paired t-test was performed to compare pre- and post-test results after participant use of the mHealth application. A regression model was used to estimate relationships between participant hypertension health literacy and sociodemographic variables.

RESULTS

A statistically significant improvement in test scores among participants after use of the mHealth app was found. Sociodemographic characteristics such as living in an urban environment, married, increased number of people living in household and alcohol use were determined to have a statistically significant effect on improvement of test score.

DISCUSSION

Results indicated the application was effective among participants with varied literacy and health literacy levels. These findings contribute to the potential widespread scalability of the app among populations with varied demographics.

CONCLUSION

This application provides an effective and valuable culturally tailored educational resource for nurses and other health providers to use to improve hypertension health literacy among vulnerable populations in India.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

This study contributes to nursing and health policy by answering a call from the World Health Organization to implement and research mHealth interventions to improve health outcomes, particularly in a low and middle income country where preventive health access is limited.

Examining professional values among nursing students during education: A comparative study

BACKGROUND

For nursing students, close monitoring of the appropriate development of their professional values is an important educational objective, since it may influence crucial areas such as safety and quality of care. Research aims: first, to find development of specific professional values of students at different educational stages characterized by variation in learning methods; second, to examine professional values of nursing students related to their sociodemographic characteristics.

METHODS

The research consisted 261 students that were were divided into three groups based on educational level: novice, advanced, and senior students. Data were collected using the Revised Nurses' Professional Values Scale.

RESULTS

The research showed statistically significant differences were found between three groups with different levels of education and in domains of professional values such as caring, activism, and justice. However, no statistically significant differences between nursing student sociodemographic characteristics such as age, gender, status, and education and their professional values overall.

CONCLUSIONS

It can be concluded that nursing education has a significant effect on development of professional values, especially in the basic training phase, and there is a need to emphasize the application and practice of nursing values, particularly caring, activism, and justice, in theoretical courses.

The epidemiology of failure in total knee arthroplasty

Total knee arthroplasty (TKA) is a cost effective and extremely successful operation. As longevity increases, the demand for primary TKA will continue to rise. The success and survivorship of TKAs are dependent on the demographics of the patient, surgical technique and implant-related factors.

Currently the risk of failure of a TKA requiring revision surgery ten years post-operatively is 5%.

The most common indications for revision include aseptic loosening (29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses considerable clinical burdens on patients and financial burdens on healthcare systems.

We present a current concepts review on the epidemiology of failed TKAs using data from worldwide National Joint Registries.

Cite this article: Bone Joint J 2016;98-B(1 Suppl A):105–12.

Long term temporal and spatial changes in the distribution of polychlorinated biphenyls and polybrominated diphenyl ethers in Scottish soils

Long term changes in polychlorinated biphenyl (PCB) and polybrominated diphenyl ether (PBDE) concentrations in soil from four transects across Scotland were measured in three surveys conducted between 1990 and 2007-9. Overall PCB level declined during this period (22.5 to 4.55 ng/g, p<0.001) but PBDEs increased (0.68 to 2.55 ng/g, p<0.001), reflecting the ban on PCB use in the 1980s while PBDE use increased until about 2004 when the use of penta-mix congener ceased in Europe. The proportion of lighter PCB congeners (28+52) present declined (p<0.001) primarily between 1990 and 1999. However, the proportion of lighter PBDE congeners (47+99) in the soil samples increased (p<0.01) from 1990 to 1999 and declined (p<0.001) thereafter, probably reflecting the introduction of legislation banning penta-BDE products and the degradation of lighter congeners and their translocation. PCBs were slightly higher in two southernmost transects but PBDE concentrations were significantly higher (p<0.001) in the two southern transects than in the two northern transects. This may reflect proximity to areas of high population and industrial activity. It is concluded that temporal and spatial changes in the distribution of PCBs and PBDEs reflect geography, physical processes and legislation.

Producer-initiated field research leads to a new diagnostic test for footrot

The Cicerone Project was formed in 1998 to address problems faced by wool producers. In the New England area, the issue of suspected false positive diagnoses of virulent footrot, which can be a significant cause of economic loss to individual producers, was investigated. In New South Wales, footrot diagnosis is primarily a field diagnosis supported by the gelatin gel laboratory test. The principal causative agent of footrot is Dichelobacter nodosus. If the gelatin gel test finds strains of D. nodosus to be thermostable (gel stable), a finding of virulent footrot is likely and quarantine of the affected property follows. However, livestock producers and inspectors reported that there were a considerable number of cases where laboratory tests found strains to be stable but these strains did not cause virulent footrot in the field. Preliminary results using DNA markers associated with virulent footrot showed that one of these markers, intA, was absent in gel stable, field benign strains but present in all strains tested which caused field virulent footrot. A trial conducted at Uralla, New South Wales, demonstrated conclusively that there were strains of D. nodosus which were stable in the gelatin gel test but did not cause virulent footrot in the field. All of these strains were negative in the intA DNA test. These results were confirmed in a second field trial at Molong, New South Wales. These trials were instrumental in establishing that the gelatin gel test at times gave results inconsistent with the clinical expression of footrot, potentially leading to a false positive diagnosis of virulent footrot. Subsequent research led to confirmation of the intA test, which is now available as an additional tool for footrot diagnosis.

A citation analysis of the influence on research of Skinner's verbal behavior

The influence of Skinner's Verbal Behavior on the generation of verbal behavior research was examined in a citation analysis that counted the citations of the book from January 1957 to August 1983 and described the fields in which the citations occurred. In a subsequent content analysis, citations were classified as directly influenced by the book if they selected at least one of Skinner's classes of verbal behavior for empirical examination. Directly influenced citations were sorted as descriptive, applied, or basic. The total number of citations of the book (836), the increasing annual number of citations, and the range of fields in which the book has been cited are evidence of its broad influence. However, empirical investigations employing at least one of Skinner's classes of verbal behavior are only a small proportion (31/836) of the citations. Of this small proportion an even smaller number constitutes experimental analyses (19/836). The small proportion of empirical studies suggests that Verbal Behavior is primarily cited for reasons other than as source material for research hypotheses in the study of verbal behavior. Some speculations are offered to account for the book's limited influence on research.

Toxicity in sponges and holothurians: a geographic pattern

Toxicity in sponges and holothurians is inversely related to latitude and may reach 100 percent for holothurians in high-diversity coral reefs. Evidence from approximately 700 experiments and from underwater observations suggests that predation by fish has resulted in natural selection for noxious and toxic chemical compounds in species within these taxa.

Informative rate and reproducibility of the investigational GeneSearch ProCaM assay in a multicenter laboratory setting

e22038

Background: PSA tests have low specificity, which frequently results in unnecessary biopsy and typically limits screening to patients with PSA values >4.0 ng/mL. The investigational ProCaM assay detects CpG island methylation within the promoter regions of three markers (GSTP1, RARß2, and APC) that are indicative of the presence of prostate cancer. The objective of this research study was to assess assay testing reproducibility and lot-to-lot variability. Methods: Assay reproducibility: 8 operators from 4 external clinical laboratories tested a panel comprised of a negative panel member (NM2C5 cells) for the internal control (ß-Actin), a high positive and low positive panel members (LNCaP cells) for all 3 markers and ß-Actin. Variability of assay results based on marker cycle threshold (Ct) values was determined. Lot variability: 3 unique lots of the ProCaM Test Kit were evaluated on DNA extracted from 169 post-DRE urine samples to show reproducibility across kit lots. Urine samples were collected from consenting subjects that were scheduled for prostate biopsy and tested by 3 operators at the same facility. Results: Assay reproducibility: The informative rate was 98% (766 valid results of 782 total tests). The overall intersite %CV and SD values for Cts were = 9.2% and 1.49%, respectively. The percent agreement with qualitative (positive/negative) outcome for High, Low, and Negative panel members was = 98% for GSTP1, RARß2, APC, and ß-Actin. Lot variability: Of the 169 biopsy results a histology positivity rate of 39% (66/169) was shown. Urine sample results for these samples showed that the areas under the curve for the 3 unique ProCaM Test Kit lots were equivalent (0.72, 0.74, 0.75, p > 0.263). Using the result categories of negative and positive with identical cutoffs for GSTP1, RARß2, APC for samples with >5 ssDNA copies 98% concordance was observed for all 3 lots evaluated. Conclusions: The investigational assay produces a qualitative result without the requirement for normalization or sample dilution and requires only one reaction per patient sample. Current results demonstrate that the assay has a high informative test rate and that results are reproducible across sites, operators runs, and kit lots.

[Table: see text]

'Restricting choices and limiting independence': social and economic impact of multiple sclerosis upon households by level of disability

OBJECTIVE

To examine the relationship between the social and economic impact of multiple sclerosis (MS) and levels of MS-related disability upon households in the following domains: household composition, housing modification, employment, standard of living, children, intimate and close relationships, and social life.

METHODS

A national sample of people with MS (pwMS) (n = 920), consisting of members of the MS Society and those accessing the MS Society website, completed a cross-sectional survey to generate quantitative and qualitative data.

RESULTS

Over three-quarters of the sample reported that MS had impacted on at least some areas of daily life. The reported impact increased significantly in a linear fashion in each domain with increasing disability, as measured by an activities of daily living index, although there was a discernible 'levelling off' in terms of impact in some domains among those at the higher levels of disability and dependency. Analysis of the qualitative data suggests that this impact can be conceptualized as a gradual process of 'restricting choices' and 'limiting independence' for both pwMS and their households.

DISCUSSION

MS restricts social and economic opportunities for pwMS and those who they live with. These findings extend the literature to households to illustrate the impact of MS not only on pwMS but also on their partners, children and other family members.

Dieback and recovery in poplar and attack by the hornet clearwing moth, Sesia apiformis (Clerck) (Lepidoptera: Sesiidae)

A survey of 801 poplar trees in central east England in 1999 demonstrated a correlation between crown dieback and infestation by hornet clearwing moth (Sesia apiformis), induced by a period of drought in 1995-1996. To determine whether trees colonised by S. apiformis would subsequently deteriorate and die or whether they could recover despite infestation and damage to the stem, all trees in the original survey were re-assessed in 2001, 2003 and 2005. The repeat surveys showed that trees with 70% or less crown dieback in 1999 replaced their canopy and generally improved by 2005, irrespective of the numbers of S. apiformis in the stem, whereas trees that had 75% or more crown dieback in 1999 either died or declined further. The presence of S. apiformis did not prevent tree recovery, and there was little evidence that infestation slowed the rate of recovery. Populations of S. apiformis, measured in terms of the numbers of adult emergence holes visible in the base of the trees, decreased between 2001 and 2005 at the same time as the amount of dieback visible in the canopy of the poplars markedly decreased. However, the fall in numbers of emergence holes at this time reflected a decline in larval establishment 2-3 years earlier, and indicated that the moth population had responded to a more rapid restoration in the internal state of the trees, which was not reflected immediately by the gradual replacement of dead branches and reduction in dieback symptoms.

Imaging and therapy for Epstein-Barr virus-associated gastric cancer

4644

Background: Epstein-Barr virus (EBV) has been identified in a wide variety of malignancies, including gastric carcinomas. The virus encodes kinases that phosphorylate nucleoside analogs such as 2’-deoxy-2’-fluoro-5-iodo-1-beta-D- arabinofuranosyluracil (FIAU). We hypothesized that it might be possible to use the viral enzyme to specifically concentrate [125I]FIAU or [131I] FIAU in tumor cells harboring virus and thus deliver imaging and therapeutic radiation. Bortezomib is a potent stimulator of viral kinase expression in EBV tumor cell lines. Methods: We imaged lytic induction in vivo and evaluated the effect of [131I] FIAU on human cancer xenografts in SCID mice. These include a tumor line engineered to constitutively express the EBV thymide kinase (EBVTK), and a control engineered with a sham vector (SHAM), as well one EBV-associated human gastric tumor (KT tumor). Mice were treated with buffer, bortezomib (2μg/g), or radiolabeled FIAU or radiolabeled FIAU and bortezomib in combination. For imaging, mice, [125I]-FIAU and SPECT/CT were used. For therapy, 131I-FIAU was used and tumor dimensions were monitored with calipers. Results: SPECT/CT imaging with [125I]-FIAU of tumor-bearing SCID mice showed selective concentration of radiotracer in tumor tissue in EBVTK (3/3) and in EBV-associated KT tumors (3/3) when animals were pretreated with bortezomib. Treatment with buffer had no effect on 3 EBVTK tumors and 3 SHAM tumors all of which increased in volume. Treatment with 1.6 mCi of [131I]-FIAU alone led to tumor response in 3/3 mice with EBVTK tumors and 0/3 mice with SHAM tumors. Treatment with [131I]-FIAU alone had no effect on EBV KT tumor xenografts (0/3) and all tumors increased in volume. Treatment with bortezomib induced modest responses in all KT tumors. However, treatment with bortezomib and [131I]-FIAU led to marked tumor regression (>80%) in EBV-associated KT tumors (3/3). Conclusions: Treatment with bortezomib leads to selective concentration of radiolabeled FIAU in the EBV-associated tumor xenografts. In combination with [131I]-FIAU it leads to tumor regression.

No significant financial relationships to disclose.

The utility of an investigational real-time RT-PCR assay system for the detection of micrometastases in sentinel lymph nodes of breast cancer confirmed by 0.2 mm histological interval analysis

10560

Background: Comparison between real-time RT-PCR and histological analysis for the detection of lymph node metastasis in breast cancer patients is difficult because of the necessary use of different tissue for the two tests. In order to minimize this challenge this study used histology sections taken every 0.2 mm and all tissue between the sections was analyzed by real-time RT-PCR. Methods: 129 Lymph nodes (LNs) were obtained by Sentinel LN biopsy and/or axillary dissection from 80 breast cancer patients. All LNs were cut in half. One half of each LN was used for the routine intra-operative diagnosis. The other half was used for the 0.2mm histological interval analysis. All 10μm sections cut for histology at 0.2 mm intervals were analyzed using frozen section H&E under a light microscope. All remaining tissue between the sections used for histological analysis was assayed by real-time RT-PCR using the genetic markers mammaglobin and cytokeratin-19 (investigational GeneSearch Breast Lymph Node Assay, Veridex, LLC, Warren, NJ, USA). Cutoffs were pre- set for the real-time RT-PCR to detect only metastasis greater than 0.2 mm. Results: Compared to the histological diagnosis using 0.2 mm interval frozen sections, the real-time RT-PCR results were as follows; sensitivity of 100.0% (34/34), specificity of 93.7% (89/95) and overall accuracy of 95.3% (123/129). Conclusions: These data suggest by utilizing the 0.2 mm histological interval analysis, sampling discrepancies are minimized and a high level of sensitivity and overall accuracy is seen for the real-time RT-PCR assay. Assay specificity calculations may be less than 100% due to interpretation challenges in frozen section histology, especially in the cases of smaller metastases and/or lobular cancer, causing a small percentage of clinically relevant metastasis to be missed.

[Table: see text]

Improved diagnosis of virulent ovine footrot using the intA gene

Footrot is a mixed bacterial infection of the hooves of sheep. The gram-negative anaerobic bacterium Dichelobacter nodosus is the principal causative agent, with different strains causing diseases of different severity, ranging from benign to virulent. In Australia, in the state of New South Wales (NSW), only virulent footrot is subject to regulatory action, including quarantine. However, it is often difficult to distinguish benign footrot from virulent footrot in the initial stages of infection, or under adverse climatic conditions. The gelatin gel test, which measures the thermostability of secreted bacterial proteases, is the laboratory test most widely used in Australia to aid in the differential diagnosis of footrot. The proteases of virulent strains are, in general, more thermostable than the proteases of benign strains. However, there are some false positives in the gelatin gel test, which may lead to unnecessary quarantine procedures. We used Southern blot analysis on 595 isolates of D. nodosus from 124 farms on which sheep had benign or virulent footrot to test for the presence of the intA gene. We found that for D. nodosus strains which are stable in the gelatin gel test, there is a high correlation between the presence of the intA gene and the ability of the strain to cause virulent footrot. We also developed a PCR-based assay for the rapid detection of intA, which can be used to test DNA extracted from colonies grown on plates, or DNA extracted from cotton swabs of culture plates.

Risk of ventriculoperitoneal shunt infections due to gastrostomy feeding tube insertion in pediatric patients with brain tumors

OBJECTIVE

To determine the risk of ventriculoperitoneal (VP) shunt infections after percutaneous retrograde gastrostomy feeding tube (GT) placement in children with brain tumors.

PATIENTS AND METHODS

All children (age 0-18 years) with primary brain tumors diagnosed and treated at the Hospital for Sick Children, Toronto, Canada, were subjected to a retrospective analysis. Two groups were identified: the study group included children with a VP shunt and a GT; the control group included children with VP shunts only. Each study patient was matched with 2 controls to compare the rate of infections (cohort comparative study).

RESULTS

There were 1,167 children diagnosed and treated with primary brain tumors during the study period (1988-2003); 174 (15%) had a VP shunt and 23 (2%) children had both, a VP shunt and a GT. In the study group (n=17), GTs were inserted at a median time of 80 days (range 6-204 days) after VP shunts. VP shunt infection rate was 23.5% (4/17) compared to 8.8% (3/34) in the control group (OR 3.18; 95% CI 0.622-16.54, p=0.16). Three (75%) of the infection episodes in the study group presented with an ascending VP shunt infection directly related to the GT insertion or manipulation in the first 6 weeks. These GTs were inserted at 13, 47 and 49 days after VP shunt insertion.

CONCLUSION

Placement of percutaneous retrograde GTs, in the acute phase, in children with brain tumors and VP shunts may increase the risk of ascending meningitis especially if there are early GT-related complications.