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Translational processes that facilitate effective interdisciplinary communication remain a ‘black box’. Here, we aimed to operationalize translational practices by combining conversation analysis and network science to analyze interdisciplinary research meetings. We applied conversation analysis to transcribed meetings, and identified chair, clarifying, skeptical, expert, connecting, and practical actions. For each meeting, we constructed a network (‘meetome’) with team members as nodes, and the number of consecutive speaking turns between members as links. We found that the relative occurrence of role-specific actions correlated with network measures. We discuss how awareness of interactional roles within meetings may help to implement a translational approach in interdisciplinary research teams.

Introduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level. Methods Secondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics. Results Data from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients’ sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants. Conclusions The identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit.

Objectives The aim was to investigate which factors influence the situational motivation of medical specialists and how situational and contextual motivation affect one another. Methods A qualitative design was used, and a constructivist approach was adopted with the Self-Determination Theory of motivation as a framework. Twenty-two medical specialists from three medical centers in the Netherlands were recruited through convenience, snowball and purposive sampling and observed for two days each. At the end of the second observation day, a semi-structured interview was conducted. Data were transcribed and coded in an open manner. Themes were finalized through discussion and consensus. Results Two-hundred and fifty hours of observation data together with the interview data identified that medical specialists experience six main themes influencing their situational motivation during a workday. Technical issues are influencing motivation negatively factors. Working with colleagues can be both a motivating factor and influence motivation negatively, e.g., filling in for each other through feelings of relatedness was motivating. Being in control of one's own planning through feelings of autonomy was motivating. Patient care, especially in combination with teaching, stimulated specialists' motivation. Conclusions The results indicate that factors influencing motivation negatively are mainly tasks and organizational processes that distract from patient care or that compromise the quality of care. When optimizing the work environment of medical specialists, autonomous motivation and continuing professional development are stimulated. These, in turn, can improve the quality of patient care and wellbeing of specialists.

OBJECTIVE Patients with skull base meningioma (SBM) often require complex surgery around critical neurovascular structures, placing them at high risk of poor health-related quality of life (HRQOL) and possibly neurocognitive dysfunction. As the survival of meningioma patients is near normal, long-term neurocognitive and HRQOL outcomes are important to evaluate, including evaluation of the impact of specific tumor location and treatment modalities on these outcomes. METHODS In this multicenter cross-sectional study including patients 5 years or more after their last tumor intervention, Short-Form Health Survey (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-BN20 questionnaires were used to assess generic and disease-specific HRQOL. Neurocognitive functioning was assessed with standardized neuropsychological assessment. SBM patient assessments were compared with those of 1) informal caregivers of SBM patients who served as controls and 2) convexity meningioma patients. In addition, the authors compared anterior/middle SBM patients with posterior SBM patients and anterior/middle and posterior SBM patients separately with controls. Multivariable and propensity score regression analyses were performed to correct for possible confounders. RESULTS Patients with SBM (n = 89) with a median follow-up of 9 years after the last intervention did not significantly differ from controls (n = 65) or convexity meningioma patients (n = 84) on generic HRQOL assessment. Statistically significantly but not clinically relevantly better disease-specific HRQOL was found for SBM patients compared with convexity meningioma patients. Anterior/middle SBM patients (n = 62) had significantly and clinically relevantly better HRQOL in SF-36 and EORTC QLQ-BN20 scores than posterior SBM patients (n = 27): physical role functioning (corrected difference 17.1, 95% CI 0.2–34.0), motor dysfunction (−10.1, 95% CI −17.5 to −2.7), communication deficit (−14.2, 95% CI −22.7 to −5.6), and weakness in both legs (−10.1, 95% CI −18.8 to −1.5). SBM patients whose primary treatment was radiotherapy had lower HRQOL scores compared with SBM patients who underwent surgery on two domains: bodily pain (−33.0, 95% CI −55.2 to −10.9) and vitality (−18.9. 95% CI −33.7 to −4.1). Tumor location and treatment modality did not result in significant differences in neurocognitive functioning, although 44% of SBM patients had deficits in at least one domain. CONCLUSIONS In the long term, SBM patients do not experience significantly more sequelae in HRQOL and neurocognitive functioning than do controls or patients with convexity meningioma. Patients with posterior SBM had poorer HRQOL than anterior/middle SBM patients, and primary treatment with radiotherapy was associated with worse HRQOL. Neurocognitive functioning was not affected by tumor location or treatment modality.

ObjectivesThe aim of this study was to identify mechanisms of autonomy-supportive consultation (ASC) that maternity care professionals use during decision-making in prenatal consultations.DesignThis study was a descriptive, qualitative analysis of professional–patient interactions in maternity care, using concepts and analytic procedures of conversation analysis.SettingThe prenatal consultations took place in hospitals and midwifery practices in the Netherlands. This study was part of a larger project. For the current study, we selected prenatal consultations concerning three topics in which patients make their own choices.ParticipantsThe first author invited the patient who was waiting in the waiting room. Participants were not selected a priori.Main outcome measuresThe main outcome measures were mechanisms of ASC.ResultsWe selected 20 consultations which were conducted by 20 different professionals. We found eight mechanisms in the professional–patient interaction which were categorised into three overarching themes. The first theme, ‘Lightheartedness’, comprises the interactional mechanisms ‘minimising language’ and ‘humour’. The theme ‘Orientation to agreement’ describes how professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding. The last theme, ‘Offering information and options’, describes the professional formally giving factual information almost completely without verbal interaction between the professional and the patient.ConclusionThe results of this study show that the model of ASC can be enriched by adding minimising language and humour to the mechanisms that can be used to fulfil the psychological need ‘relatedness’. Second, our results show that professionals use only few mechanisms to meet the patients’ psychological needs ‘competence’ and ‘autonomy’. They mainly use information giving to meet patients’ need competence. To meet patients’ need for autonomy, the professionals keep all options open. This suggests that professionals could pay more attention to other mechanisms to meet patients’ needs for ‘competence’ and ‘autonomy’.

Background Little is known about long-term caregiver burden in meningioma patients. We assessed meningioma caregiver burden, its association with informal caregiver’s well-being and possible determinants. Methods In this multicenter cross-sectional study, informal caregivers completed the Caregiver Burden Scale (five domains and total score). Patients completed a disease-specific health-related quality of life (HRQoL) questionnaire focusing on symptoms (EORTC QLQ-BN20) and underwent neurocognitive assessment. Both groups completed a generic HRQoL questionnaire (SF-36) and the Hospital Anxiety, and Depression Scale. We assessed the association between caregiver burden and their HRQoL, anxiety and depression. Furthermore, we assessed determinants for the caregiver burden. Multivariable regression analysis was used to correct for confounders. Results One hundred and twenty-nine informal caregivers were included (median 10 years after patients’ treatment). Caregivers reported burden in ≥1 domain (34%) or total burden score (15%). A one-point increase in total caregiver burden score was associated with a clinically relevant decrease in caregiver’s HRQoL (SF-36) in 5/8 domains (score range: −10.4 to −14.7) and 2/2 component scores (−3.5 to −5.9), and with more anxiety (3.8) and depression (3.0). Patients’ lower HRQoL, increased symptom burden, and increased anxiety and depression were determinants for higher caregiver burden, but not patients’ or caregivers’ sociodemographic characteristics, patients’ neurocognitive functioning, or tumor- and treatment-related characteristics. Conclusions Ten years after initial treatment, up to 35% of informal caregivers reported a clinically relevant burden, which was linked with worse HRQoL, and more anxiety and depression in both patients and caregivers, emphasizing the strong interdependent relationship. Support for meningioma caregivers is therefore warranted.

BACKGROUND Many intracranial meningioma patients have an impaired health-related quality of life (HRQoL) and neurocognitive functioning up to 4 yr after intervention. OBJECTIVE To assess the long-term (≥5 yr) disease burden of meningioma patients. METHODS In this multicenter cross-sectional study, patients ≥5 yr after intervention (including active magnetic resonance imaging (MRI) surveillance) were included and assessed for HRQoL (Short-Form Health Survey 36), neurocognitive functioning (neuropsychological assessment), anxiety and depression (Hospital Anxiety and Depression Scale), and work productivity (Short Form-Health and Labour Questionnaire). Multivariable and propensity score regression analyses were used to compare patients and controls, and different treatment strategies corrected for possible confounders. Clinically relevant differences were reported. RESULTS At a median of 9 yr follow-up after intervention, meningioma patients (n = 190) reported more limitations due to physical (difference 12.5 points, P = .008) and emotional (13.3 points, P = .002) health problems compared with controls. Patients also had an increased risk to suffer from anxiety (odds ratio [OR]: 2.6, 95% CI: 1.2-5.7) and depression (OR: 3.7, 95% CI: 1.3-10.5). Neurocognitive deficits were found in 43% of patients. Although postoperative complications, radiotherapy, and reresection were associated with worse verbal memory, attention, and executive functioning when compared to patients resected once, the only clinically relevant association was between reresection and worse attention (–2.11, 95% CI: –3.52 to –0.07). Patients of working age less often had a paid job (48%) compared with the working-age Dutch population (72%) and reported more obstacles at work compared with controls. CONCLUSION In the long term, a large proportion of meningioma patients have impaired HRQoL, neurocognitive deficits, and high levels of anxiety or depression. Patients treated with 1 resection have the best neurocognitive functioning., Graphical Abstract Graphical Abstract

Introduction Meningioma patients often have subtle cognitive deficits that might be attributed to the tumor itself, to surgical treatment, or to the occurrence of seizures and their treatment. Magnetoencephalography (MEG) analysis of resting-state functional networks (RSNs) could help to understand the neurophysiological basis of cognitive impairment in these patients. We explored the correlation between RSN functional connectivity and topology of functional networks on the one hand, and cognition on the other hand in WHO grade I meningioma patients. Methods Twenty adult WHO grade I meningioma patients who had undergone tumor resection, as well as 20 healthy matched controls, were included. Neuropsychological assessment was done through a standardized test battery. MEG data were recorded, and projected to the anatomical space of the Automated Anatomical Labeling atlas. Functional connectivity (PLI), within the default mode network (DMN) and the bilateral frontoparietal networks were correlated to cognitive performance. Minimum spanning tree (MST) characteristics were correlated with cognitive functioning. Results Compared to healthy controls, meningioma patients had lower working memory capacity (p = 0.037). Within the patient group, lower working memory performance was associated with lower DMN connectivity and a lower maximum MST degree in the theta band (resp. p = 0.044 and p = 0.003). Conclusions This study shows that cognitive functioning is correlated with functional connectivity in the default mode network and hub-pathology in WHO grade I meningioma patients. Future longitudinal studies are needed to corroborate these findings and to further investigate the pathophysiology of cognitive deficits and possible changes in functional brain networks in meningioma patients. Electronic supplementary material The online version of this article (10.1007/s11060-018-2987-1) contains supplementary material, which is available to authorized users.

Introduction: Medical specialists face the challenge of maintaining their knowledge and skills and continuing professional development, that is, lifelong learning. Motivation may play an integral role in many of the challenges facing the physician workforce today including maintenance of a high performance. The aim of this study was to determine whether medical specialists show different motivational profiles and if these profiles predict differences in motivation for lifelong learning. Methods: An online questionnaire was sent to every medical specialist working in five hospitals in the Netherlands. The questionnaire included the validated Multidimensional Work Motivation Scale and the Jefferson Scale of Physician Lifelong Learning together with background questions like age, gender, and type of hospital. Respondents were grouped into different motivational profiles by using a two-step clustering approach. Results: Four motivational profiles were identified: (1) HAMC profile (for High Autonomous and Moderate Controlled motivation), (2) MAMC profile (for Moderate Autonomous and Moderate Controlled motivation), (3) MALC profile (for Moderate Autonomous and Low Controlled motivation), and (4) HALC profile (for High Autonomous and Low Controlled motivation). Most of the female specialists that work in an academic hospital and specialists with a surgical specialty were represented in the HALC profile. Discussion: Four motivational profiles were found among medical specialists, differing in gender, experience and type of specialization. The profiles are based on the combination of autonomous motivation (AM) and controlled motivation (CM) in the specialists. The profiles that have a high score on autonomous motivation have a positive association with lifelong learning.

Objectives The aim was to obtain insight into the factors in the work environment that motivate or demotivate a medical specialist during his/her working day. Methods A qualitative ethnographic design was used, and a constructivist approach was adopted with the Self-Determination theory of motivation as a framework. Six medical specialists from VU University Medical Center in the Netherlands, recruited through convenience, snowball, and purposive sampling, were shadowed for one day each. Data were transcribed and open-coded. Themes were finalized through discussion and consensus. Results Sixty hours of observation data identified motivating and demotivating factors categorized into four themes that are important for specialists' motivation. Informational technology issues are demotivating factors. Working with colleagues can be both a motivating and demotivating factor, e.g., filling in for each other through feelings of relatedness was motivating. Being in control of one's planning through feelings of autonomy was motivating. Furthermore, patient care and teaching, especially in combination, stimulated specialists' motivation. Regarding the design of the study, we found that situational motivation is indeed observable. Conclusions The basic psychological needs autonomy, competence, and relatedness are important for specialists' motivation. Investing in a more motivating, open, transparent, and basic-needs- supportive work environment for medical specialists is necessary. Keywords: Continuing professional development, motivation, medical specialists, self-determination theory, qualitative research.

ObjectivesAlthough clinical learning is pivotal for nursing education, the learning process itself and the terminology to address this topic remain underexposed in the literature. This study aimed to examine how concepts equivalent to ‘learning in practice’ are used and operationalised and which learning activities are reported in the nursing education literature. The final aim was to propose terminology for future studies.DesignThe scoping framework proposed by Arksey and O’Malley was used to answer the research questions and address gaps in the literature. Two systematic searches were conducted in PubMed, EBSCO/ERIC and EBSCO/CINAHL between May and September 2018: first, to identify concepts equivalent to ‘learning in practice’ and, second, to find studies operationalising these concepts. Eligible articles were studies that examined the regular learning of undergraduate nursing students in the hospital setting. Conceptualisations, theoretical frameworks and operationalisations were mapped descriptively. Results relating to how students learn were synthesised using thematic analysis. Quality assessment was performed using the Critical Appraisal Skills Programme checklist.ResultsFrom 9360 abstracts, 17 articles were included. Five studies adopted a general, yet not explained, synonym for learning in practice, and the other approaches focused on the social, unplanned or active nature of learning. All studies used a qualitative approach. The small number of studies and medium study quality hampered a thorough comparison of concepts. The synthesis of results revealed five types of learning activities, acknowledged by an expert panel, in which autonomy, interactions and cognitive processing were central themes.ConclusionsBoth theoretical approaches and learning activities of the current body of research fit into experiential learning theories, which can be used to guide and improve future studies. Gaps in the literature include formal and informal components of learning, the relation between learning and learning outcomes and the interplay between behaviour and cognitive processing.

Traumatic brain injury (TBI)-related coagulopathy appears to be most prevalent in patients with tissue hypoperfusion, but evidence for this association is scarce. This study investigated the relationship between tissue perfusion and hemostatic derangements in TBI patients.Coagulation parameters were measured on emergency department admission in patients with TBI (head abbreviated injury scale ≥ 3). The level of hypoperfusion was simultaneously assessed by near-infrared spectroscopy (NIRS) at the forehead and arm, and by base excess and lactate. Coagulopathy was defined as an international normalized ratio1.2 and/or activated partial thromboplastin time40 s and/or thrombocytopenia (120 × 10(9)/L).TBI patients with coagulopathy (42%) had more signs of tissue hypoperfusion as indicated by increased lactate levels (2.1 [1.1-3.2] mmol/L versus 1.2 [1.0-1.7] mmol/L; P = 0.017) and a larger base deficit (-3.0 [-4.6 to -2.0] mmol/L versus -0.1 [-2.5 to 1.8] mmol/L; P 0.001). There was no difference in the cerebral or somatic tissue oxygenation index. However, there was a distinct trend toward a moderate inverse association between the cerebral tissue oxygenation index and D-dimer levels (r=-0.40; P = 0.051) as marker of fibrinolysis. The presence of coagulopathy was associated with an increased inhospital mortality rate (45.5% versus 6.7%; P = 0.002).This is the first study to investigate the relationship between hemostatic derangements and tissue oxygenation using NIRS in TBI patients. This study showed that TBI-related coagulopathy is more profound in patients with metabolic acidosis and increased lactate levels. Although there was no direct relationship between tissue oxygenation and coagulopathy, we observed an inverse relationship between NIRS tissue oxygenation levels and fibrinolysis.

Background Studies on the associations between preoperative cerebral edema, cognitive functioning, and health-related quality of life (HRQOL) in WHO grade I meningioma patients are virtually lacking. We studied the association between preoperative cerebral edema on postoperative cognitive functioning and HRQOL 6 months postoperatively in WHO grade I meningioma patients. Methods Twenty-one consecutive WHO grade I meningioma patients, who underwent surgery, were matched individually for age, gender, and educational level to healthy controls. Tumor and edema volume were assessed on preoperative T1- and T2-weighted MRI images, respectively. At least 5 months postoperatively, functional status, cognitive functioning, and HRQOL, using a cognitive test battery and the Short-Form Health Survey (SF-36), were determined. The correlation between preoperative tumor and cerebral edema volume with postoperative cognitive functioning and HRQOL was investigated using Kendall’s tau coefficients. Results Compared to healthy controls, patients had lower verbal memory capacity (p = .012), whereas HRQOL was similar to matched healthy controls. In all cognitive domains, postoperative functioning was much lower in patients with preoperative cerebral edema than in those without. There were significant correlations between preoperative cerebral edema and tumor volume and postoperative cognitive functioning. Preoperative cerebral edema and/or tumor volume were not associated with HRQOL. Conclusions Our results suggest that WHO grade I meningioma patients with larger volumes of preoperative cerebral edema are more at risk of experiencing limitations in longer-term cognitive functioning than patients with no or less edema preoperatively. This is an important knowledge for neurologists and neurosurgeons treating patients with a meningioma. More studies regarding the effect of peritumoral edema on cognitive functioning in meningioma patients are necessary. Electronic supplementary material The online version of this article (10.1007/s00701-019-03819-2) contains supplementary material, which is available to authorized users.

Polymethyl methacrylate (PMMA), an easily moldable and economical synthetic resin, has been used since the 1940s. In addition, PMMA has good mechanical properties and is one of the most biocompatible alloplastic materials currently available. The PMMA can serve as a spacer and as a delivery vehicle for antibiotics. Prior studies have indicated that no significant differences in infection rates exist between autologous and acrylic cranioplasty. Although inexpensive, the free-hand cranioplasty technique often yields unsatisfactory cosmetic results. In the present study, the application of a recently developed, economic modality for the perioperative application, and molding of PMMA to ensure a precise fit in 16 patients using computer-aided design, computer-aided manufacturing, and rapid prototyping was described.The mean defect size was 102.0 ± 26.4 cm. The mean volume of PMMA required to perform the cranioplasty procedure was 51 mL. The cost of PMMA was approximately 6 Euro (&OV0556;) per mL. The costs of fabricating the implants varied from 119.8 &OV0556; to 1632.0 &OV0556; with a mean of 326.4 &OV0556; ± 371.6. None of the implants required removal during the follow-up period.

IntroductionLearning in the clinical setting is a major form of learning in undergraduate nursing education. In spite of this, how nursing students learn in clinical practice is still largely unknown. Moreover, there is no conceptual clarity on learning in practice in the current literature. This paper aims to set up a protocol for a scoping review of the literature in order to map different conceptualisations of learning in practice in undergraduate clinical nursing education in the hospital setting. The operationalisations of different concepts will be compared and the findings of the studies will be synthesised.Methods and analysisThis scoping review will be guided by the methodological framework proposed by Arksey and O’Malley and refined by Levac et al. and the Joanna Briggs Institute. The search strategy will be developed together with a medical information specialist and the search will be performed in electronic databases (PubMed, EBSCO/ERIC and EBSCO/CINAHL). In a first search, we will identify concepts that are used as an equivalent to learning in practice. Next, we will search for studies operationalising these concepts in undergraduate nursing education. Finally, we will check reference lists for additional publications. Abstracts and full-text studies will independently be screened by two researchers. All studies that have ‘learning in undergraduate clinical nursing practice’ as their main topic and that include a definition and operationalisation of an equivalent to learning in clinical practice, will be considered for inclusion. We will chart different conceptualisations and their theoretical underpinnings, as well as reported learning opportunities, informal and formal aspects of learning, social aspects of learning and gaps in the literature.Ethics and disseminationThis review will help design future studies on learning in clinical nursing practice using well-defined and agreed on terminology. The results will be disseminated through journal publications and conference presentations.

Technical developments and medical innovations have made healthcare increasingly more complex over the past few decades, putting ever so much more emphasis on teamwork. Optimal functioning of healthcare teams is important to ensure adequate and safe treatment of patients but also to create a working environment where promising innovations can be initiated and implemented effectively in order to improve patient care. This chapter will discuss human and organizational factors behind team collaboration that contribute to successful innovation.

Background A recent survey showed that potentially hazardous levels of certain attitudes have been associated with worse patient outcomes in orthopedic surgery, based on a questionnaire that was adopted from aviation. This questionnaire aims to evaluate the prevalence of potentially hazardous levels of machismo, impulsiveness, anxiety, antiauthority, resignation, and invulnerability in attitudes and was adopted for use among neurosurgeons. Methods All individual members of the European Association of Neurosurgical Societies (EANS) were invited to fill-out an online questionnaire. Questions were on a five-point Likert-scale ranging from strongly disagree to strongly agree with five questions per attitude and answers were collected together with neurosurgeon and practice characteristics. Participants could score five points for each question after which an overall score was calculated for each attitude. Like the orthopedic survey, a potentially hazardous level of any behavior was defined as a score >20. Results Resignation (n = 21; 7.7%) and anxiety (n = 10; 3.7%) had the highest prevalence of potentially hazardous levels among neurosurgeons. Few neurosurgeons showed potentially hazardous levels of antiauthority (n = 4; 1.5%), self-confidence (n = 2; 0.7%), or impulsive attitudes (n = 1; 0.4%). None of the participants showed potentially hazardous levels of machismo. Overall, 12.2% of neurosurgeons had a potentially hazardous score for at least one of the evaluated attitudes. Conclusion Findings of this study indicate a low prevalence of potentially hazardous levels of certain attitudes among neurosurgeons based on a questionnaire tailored to neurosurgery. However, the implications of this study are limited by various factors and warrant further evaluation and warrant further evaluation.

© The Author(s) (2018). Benign brain tumours may be hormone sensitive. To induce physical characteristics of the desired gender, transgender individuals often receive cross-sex hormone treatment, sometimes in higher doses than hypogonadal individuals. To date, long-term (side) effects of cross-sex hormone treatment are largely unknown. In the present retrospective chart study we aimed to compare the incidence of common benign brain tumours: meningiomas, pituitary adenomas (non-secretive and secretive), and vestibular schwannomas in transgender individuals receiving cross-sex hormone treatment, with those reported in general Dutch or European populations. This study was performed at the VU University Medical Centre in the Netherlands and consisted of 2555 transwomen (median age at start of cross-sex hormone treatment: 31 years, interquartile range 23-41) and 1373 transmen (median age 23 years, interquartile range 18-31) who were followed for 23 935 and 11 212 person-years, respectively. For each separate brain tumour, standardized incidence ratios with 95% confidence intervals were calculated. In transwomen (male sex assigned at birth, female gender identity), eight meningiomas, one non-secretive pituitary adenoma, nine prolactinomas, and two vestibular schwannomas occurred. The incidence of meningiomas was higher in transwomen than in a general European female population (standardized incidence ratio 4.1, 95% confidence interval 1.9-7.7) and male population (11.9, 5.5-22.7). Similar to meningiomas, prolactinomas occurred more often in transwomen compared to general Dutch females (4.3, 2.1-7.9) and males (26.5, 12.9-48.6). Noteworthy, most transwomen had received orchiectomy but still used the progestogenic anti-androgen cyproterone acetate at time of diagnosis. In transmen (female sex assigned at birth, male gender identity), two cases of somatotrophinomas were observed, which was higher than expected based on the reported incidence rate in a general European population (incidence rate females = incidence rate males; standardized incidence ratio 22.2, 3.7-73.4). Based on our results we conclude that cross-sex hormone treatment is associated with a higher risk of meningiomas and prolactinomas in transwomen, which may be linked to cyproterone acetate usage, and somatotrophinomas in transmen. Because these conditions are quite rare, performing regular screenings for such tumours (e.g. regular prolactin measurements for identifying prolactinomas) seems not necessary.

Sex hormones have been proposed as a possible risk factor for the development and growth of meningiomas. Hormonal therapy plays a fundamental role in the treatment of male-to-female transgenders and needs to be continued after sex reassignment surgery. Usually, this treatment leads to no adverse events; however, its impact on hormone-related tumours such as meningiomas has not yet been investigated thoroughly. We searched our cohort of 2810 male-to-female transgender persons, who have been treated between 1975 and 2010, for patients with meningiomas. Additionally, we conducted a literature search in PubMed and EMBASE. We found three patients who developed a meningioma in male-to-female transgenders in addition to five other who have been described in the literature. These findings support the role of female sex hormones in the development and growth of meningiomas. This might be an underrepresentation, because there is no standard protocol for screening for meningiomas in this population and meningiomas can remain asymptomatic for several years. We observed regression of multiple meningiomas in one of these three cases after discontinuation of hormonal treatment. The decision to stop or continue cross-sex hormone therapy in these particular patients should be carefully reconsidered individually.

Purpose: The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients. Materials and methods: In this multi-cohorts non-randomized phase II and observational study, non-benign meningioma patients were treated according to their WHO grade and Simpson's grade. Patients with atypical meningioma (WHO grade II) and Simpson's grade 1-3 [Arm 1] entered the non-randomized phase II study designed to show a 3-year PFS > 70% (primary endpoint). All other patients entered the 3 observational cohorts: WHO grade II Simpson grade 4-5 [Arm 2] and Grade III Simpson grade 1-3 or 4-5 [Arm 3&4] in which few patients were expected. Results: Between 02/2008 and 06/2013, 78 patients were enrolled into the study. This report focuses on the 56 (median age, 54 years) eligible patients with WHO grade II Simpson's grade 1-3 meningioma who received RT (60 Gy). At a median follow up of 5.1 years, the estimated 3-year PFS is 88.7%, hence significantly greater than 70%. Eight (14.3%) treatment failures were observed. The 3-year overall survival was 98.2%. The rate of late signs and symptoms grade 3 or more was 14.3%. Conclusions: These data show that 3-year PFS for WHO grade II meningioma patients undergoing a complete resection (Simpson I-III) is superior to 70% when treated with high-dose (60 Gy) RT. (C) 2018 Elsevier B.V. All rights reserved.

miR-200a has been implicated in the pathogenesis of meningiomas, one of the most common central nervous system tumors in humans. To identify how miR-200a contributes to meningioma pathogenesis at the molecular level, we used a comparative protein profiling approach using Gel-nanoLC-MS/MS and identified approximately 130 dysregulated proteins in miR-200a-overexpressing meningioma cells. Following the bioinformatic analysis to identify potential genes targeted by miR-200a, we focused on the non-muscle heavy chain IIb (NMHCIIb), and showed that miR-200a directly targeted NMHCIIb. Considering the key roles of NMHCIIb in cell division and cell migration, we aimed to identify whether miR-200a regulated these processes through NMHCIIb. We found that NMHCIIb overexpression partially rescued miR-200a-mediated inhibition of cell migration, as well as cell growth in vitro and in vivo. Moreover, siRNA-mediated silencing of NMHCIIb expression resulted in a similar migration phenotype in these cells and inhibited meningioma tumor growth in mice. Taken together, these results suggest that NMHCIIb might serve as a novel therapeutic target in meningiomas.

Objective Treatment of meningiomas in neurofibromatosis type II (NF2) patients is challenging because the natural history of these tumors is unclear. More insight in tumor growth and factors predicting growth may contribute to a better clinical management. In this study, growth characteristics of supratentorial NF-related meningiomas were examined and the association between tumor growth rate and location was evaluated. Methods In all NF2 patients followed up at the VU University Medical Center, who underwent a minimum of 3 consecutive scans, tumor volumes were assessed by using 3D volumetric measurement (Brainlab, Feldkirchen, Germany). Growth patterns were visually analyzed. To assess the association between tumor growth rate and tumor location, the meningiomas were divided in 3 groups on the basis of their location: skull base, convexity, and “other.” Univariable and multivariable logistic regression models were built. Results Twenty-one patients (13 females) with a mean (standard deviation) follow-up period of 5.55 (2.48) years and a total of 210 meningiomas were included in the analyses. Tumors followed different growth patterns and did not increase in size simultaneously within 1 patient. Skull base meningiomas had a significantly higher absolute growth rate compared with convexity (β = 0.91, 95% confidence interval [CI] 0.08–1.73) and “other” (β = 1.07, 95% CI 0.27–1.86) and a significantly higher relative growth rate on both linear and geometric growth rate compared with “other” (β = 90.73, 95% CI 5.50–175.95 and β = 18.63, 95% CI 2.94–34.31, respectively) on multivariable logistic regression. Conclusion Within a single patient, NF2-related meningiomas follow different growth patterns. Skull base meningiomas grow faster compared with other locations. Yearly magnetic resonance imaging scans and timely treatment of skull base meningiomas should be considered.

Background The clinical relevance of Health-Related Quality of Life (HRQoL) in meningioma patients has been increasingly acknowledged in recent years. Various questionnaires have been used. However, almost none of these questionnaires has been particularly developed for and/or validated in this patient group. Therefore, the aim of this study was to assess the relevance and comprehensiveness of existing HRQoL questionnaires used in meningioma research and to assess the agreement between patients and health care professionals (HCPs) on the most relevant and important HRQoL issues. Methods A systematic literature search, following the PRISMA statement, was conducted to identify all HRQoL questionnaires used in meningioma research. Semi-structured interviews were organized with patients and HCPs to (1) assess the relevance of all issues covered by the questionnaires (score 0–3: not relevant–highly relevant), (2) assess the ten most important issues, and (3) identify new relevant HRQoL issues. Results Fourteen different questionnaires were found in the literature, comprising 140 unique issues. Interviews were conducted with 20 patients (median age 57, 71% female) and 10 HCPs (4 neurosurgeons, 2 neurologists, 2 radiotherapists, 1 rehabilitation specialist, 1 neuropsychologist; median experience 13 years). Meningioma patients rated 17–80% of the issues in each of the questionnaires as relevant, HCPs 90–100%. Patients and HCPs agreed on the relevance of only 49 issues (35%, Cohen’s kappa: 0.027). Both patients and HCPs considered lack of energy the most important issue. Patients and HCPs suggested five additional relevant issues not covered by current HRQoL questionnaires. Conclusions Existing HRQoL questionnaires currently used in meningioma patients do not fully cover all relevant issues to these patients. Agreement between patients and HCPs on the relevance of issues was poor. Both findings support the need to develop and validate a meningioma-specific HRQoL questionnaire. Electronic supplementary material The online version of this article (10.1007/s00701-017-3332-8) contains supplementary material, which is available to authorized users.

BACKGROUND: The surgical Simpson grade, introduced in 1957, is the standard measure for meningioma resection and prediction of recurrences. We used an magnetic resonance (MR)-based grading system for the radiologic extent of resection, and assessed agreement of the extent of resection between the surgical Simpson grade and the MR-based scale.METHODS: Patients were prospectively included during a 2-year period. Immediately after surgery, the surgeon determined the Simpson grade. MR imaging was performed within 72 hours and at 3 months after surgery. Scans were assessed by a neuroradiologist, blinded to the surgeon's grading. Intraclass correlation coefficient (ICC) and absolute agreement were used to evaluate agreement between both scales.RESULTS: Thirty-five patients (41 tumors) were included. Absolute agreement was 76%, with an ICC of 0.613. At 3 months postoperatively, the ICC and absolute agreement were 0.682 and 78%. In 20% of cases, the extent of resection was less favorable on the early postoperative MR imaging than the surgeon's Simpson grade.CONCLUSIONS: Agreement for extent of meningioma resection between both scales was good in terms of the ICC. When the surgical Simpson grade is unclear, MR imaging at 3 months after surgery may be used as a baseline for further follow-up. In a substantial portion of cases, the extent of resection was less favorable on the early postoperative MR imaging than the surgeon's Simpson grade. The predictive value of the radiologic extent of resection for the risk of long-term recurrences is a subject for further research.

Background: Due to increasing life expectancy, the number of older patients harboring a meningioma is expected to increase. We determined whether preoperative variables and postoperative clinical outcome differ between younger and older adults.Methods: Medical records of meningioma patients were retrospectively analyzed. Preoperative variables were age, gender, neurological symptoms, Karnofsky Performance Status (KPS), American Society of Anesthesiologists Physical Status (ASA)-classification and tumor characteristics. Clinical outcome was assessed using complication rates, length of hospital stay and destination after discharge. After 6-12 and 12-18-month KPS, neurological symptoms and Glasgow Outcome Scale (GOS) scores were assessed for older (age ≥ 65 years) and younger adults (18-65 years) using Mann-Whitney U, T test, Pearson's Chi square or Fisher's exact.Results: 89 patients were included (23 ≥ 65 years). Before surgery, older patients scored higher on ASA classification (p = 0.003) and lower on KPS (p = 0.017). There was no significant difference postoperatively in mortality, complications and duration of hospital stay. Less older patients were discharged directly to home compared to younger adults (52 vs 80%, respectively; p = 0.004). In surviving patients, less older subjects had a good recovery (GOS 4-5) at 6-12 months' follow-up compared to younger subjects (64 vs 93%, respectively; p = 0.035). At 12-18 months, there was no significant difference in good recovery between both age groups (82 vs 92%).Conclusion: In this cohort, outcome was worse for patients ≥ 65 years old in terms of discharge destination and good recovery at 6-12 months. At 12-18 months follow-up, older subjects performed not significantly different from younger ones. Careful patient selection seems essential to reach good results in meningioma surgery for patients ≥ 65 years old.

BACKGROUND: Previous studies reported that meningioma patients have impaired health-related quality of life (HRQoL) and cognitive function up to 5 years after intervention. We aimed to assess the long-term disease burden of meningioma patients. METHODS: In this multicenter cross-sectional study, intracranial meningioma patients at a median of 9.9 years after anti-tumor therapy were included. HRQoL was measured with the SF-36 and EORTC QLQ-BN20, anxiety and depression with the Hospital Anxiety and Depression Scale (11/21 points is indicative for probable anxiety or depression), and objective cognitive functioning on six domains (z-score< -1.5 is defined as a clinically relevant deficit). Generalized linear models were used to compare meningioma patients with healthy controls, corrected for age, sex, educational level and comorbidities, and one-sample t-tests to compare meningioma patients with data of newly diagnosed glioblastoma. Patient recruitment and data collection is still in progress. RESULTS: 164 meningioma patients were included (mean age:63.9 years, WHO grade I:91.7%, surgery:89.2%, radiotherapy:14.6%). Compared with 110 controls, meningioma patients had worse HRQoL scores on 4/10 SF-36 scales/component scores: role limitations due to physical problems and emotional problems, social functioning, and the mental component score (range mean difference: 4.4–13.8, all p0.05), and better on all other items/scales. More patients suffered from probable anxiety (14.3%) and depression (7.5%) than controls (anxiety: 3.7%, p=0.015; depression: 7.5%, p=0.011). Clinically relevant cognitive deficits were found in executive function (10.9%), verbal memory (19.4%), working memory (13.4%), attention (10.3%), information processing (25.0%) and psychomotor speed (14.4%). CONCLUSION: Almost 10 years after the last anti-tumor treatment, meningioma disease burden is still significant. A considerable number of patients have impaired HRQoL, suffer from cognitive deficits and report high levels of anxiety and depression.

Objective To estimate the incidence of central nervous system (CNS) tumors in Suriname. Methods A retrospective chart review was performed at the Academic Hospital Paramaribo and the State Health Insurance foundation. Patients receiving a diagnosis of CNS tumor in the period 2000–2010 were included in the study if a computed tomography scan or magnetic resonance imaging study was available. Demographic data and patient characteristics and disease variables were retrieved. Results The study comprised 251 patients who met the inclusion criteria. The incidence of treated CNS tumors was 5 per 100,000 per year. There was a peak incidence in the 41–50 age group and a male-to-female ratio of 1:1.46. Of CNS tumors, 21% were gliomas, 26.7% were meningiomas, 4.7% were schwannomas, and 12.0% were pituitary adenomas. Suriname has a low glioma incidence compared with globally (40%–60% of CNS tumors globally). The incidence of pituitary adenoma was higher than expected. There are indications for a higher glioma and meningioma incidence in Javanese and a higher metastases incidence in Creoles. Conclusions The annual incidence of treated CNS tumors of 5 per 100,000 inhabitants in Suriname was in accordance with the expectation of an incidence of 3–6 per 100,000. Suriname is considered a country with a low cancer incidence. The differences found among various subgroups were too small to make definitive statements. • Peer Review Article

While surgical and radiotherapeutic improvements increased life expectancy of meningioma patients, little is known about these patients' health-related quality of life (HRQoL). Therefore, the objectives of this systematic review were to assess HRQoL in meningioma patients, the methodological quality of the used questionnaires (COSMIN criteria), and the reporting level of patient-reported outcomes (PROs) in the included studies (International Society of Quality of Life Research criteria). Nineteen articles met our inclusion criteria. HRQoL was measured with 13 different questionnaires, 3 validated in meningioma patients. According to our predefined cutoff, HRQoL data were reported sufficiently in 5 out of 19 studies. Both findings hamper interpretation of the PRO results. In general, meningioma patients reported clinically worse HRQoL than healthy controls. Although meningioma patients had better HRQoL than glioma patients, this difference was not clinically relevant. Radiotherapy seemed to improve some domains of HRQoL in the short term, while HRQoL decreased to pre-radiotherapy levels in the long term. Tumor resection increased HRQoL, but long-term follow-up showed persistent reduced HRQoL compared with healthy controls. These results suggest an impaired HRQoL in meningioma patients, even years after anti-tumor treatment. Results of this systematic review warrant high quality prospective studies, better instruments to assess HRQoL, and improved level of reporting for this group of patients.

Monitoring of brain function and metabolism during surgery may be of benefit for patient outcome. Microdialysis is the only sampling technique to date that allows continuous monitoring of drug or metabolite concentrations in the extracellular fluid of multiple tissues in the brain. This qualitative systematic review aimed to determine whether microdialysis is a valid tool for detecting changes in tissue composition as would be expected upon changes in (induced) tissue metabolic composition during brain surgery. A systematic review was conducted by performing a MEDLINE search using the terms “Intraoperative Period” (Medical Subject Heading [MeSH]) OR “Surgery” [Subheading] OR “Monitoring, Intraoperative” [MeSH] AND “Microdialysis” [MeSH] AND “Brain” [MeSH]. Two reviewers independently assessed the methodological quality of the studies. For each study the grades of recommendation were determined. The search strategy yielded 46 publications in Medline. Data extraction was performed on 16 studies. The methodological quality of studies was low, with overall scores of 4 or 5. A quantitative analysis could not be performed because of lack of sufficient data. A qualitative analysis was positive with regard to the detection of different states of tissue composition by microdialysis. However, the levels of recommendation on the outcome statements were low, resulting in a grade D level of recommendation on all statements. The available evidence for the validity of cerebral microdialysis as a diagnostic tool during brain surgery is of low scientific quality. In order to develop cerebral microdialysis as a valid instrument for monitoring of brain metabolism during surgery, standardised clinical prospective studies in homogeneous patient populations are required.

Purpose Because unprofessional behavior of physicians is associated with unprofessional behavior in medical school, identifying unprofessional behavior in medical school is critical. Research has noted the difficulty in assessing professional behavior. Instead of identifying isolated behaviors, it could be more helpful to recognize behavioral patterns to evaluate students’ professional behavior. The authors aimed to identify patterns in the unprofessional behaviors of medical students and to construct descriptions based on these patterns.Method Content analysis of research articles yielded a template of unprofessional behaviors for coding student evaluation forms indicating unsatisfactory professional behavior, collected from 2012 to 2014 at the VUmc School of Medical Sciences, Amsterdam, the Netherlands. Latent class analysis was used to identify classes of students with a high chance of displaying comparable unprofessional behaviors. Teachers’ feedback of prototype students was summarized to generate profile descriptions.Results A template of 109 behaviors was used to code 232 evaluation forms of 194 students (3.9% students/year). Latent class analysis identified three hypothetical classes of students: Class 1 (43%) was labeled as “Poor reliability,” class 2 (20%) was labeled as “Poor reliability and poor insight,” and class 3 (37%) was labeled as “Poor reliability, poor insight, and poor adaptability.”Conclusions These profiles of unprofessional behavior might help to improve the evaluation of unprofessional behavior in medical school. Further research should provide evidence for confidently accepting or rejecting the profiles as an instrument to identify which students are expected to benefit from remediation trajectories.

Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a ‘narrow’ or a ‘broad’ definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at using an intersectionality-based approach to define diversity-related learning objectives and to evaluate how biomedical and sociocultural aspects of diversity were integrated into a medical curriculum in the Netherlands. We took a three-phase mixed methods approach. In phase one and two, we defined essential learning objectives based on qualitative interviews with school stakeholders and diversity literature. In phase three, we screened the written curriculum for diversity content (culture, sex/gender and class) and related the results to learning objectives defined in phase two. We identified learning objectives in three areas of education (medical knowledge and skills, patient–physician communication, and reflexivity). Most diversity content pertained to biomedical knowledge and skills. Limited attention was paid to sociocultural issues as determinants of health and healthcare use. Intersections of culture, sex/gender and class remained mostly unaddressed. The curriculum’s diversity-responsiveness could be improved by an operationalization of diversity that goes beyond biomedical traits of assumed homogeneous social groups. Future efforts to take an intersectionality-based approach to curriculum evaluations should include categories of difference other than culture, sex/gender and class as separate, equally important patient identities or groups.

To investigate whether the development of coagulopathy at different stages after isolated traumatic brain injury (TBI) is associated with distinct cranial computed tomography characteristics.Retrospective cohort study in 226 patients with moderate-to-severe isolated TBI who were categorized as subjects without coagulopathy or with acute temporary, acute sustained or delayed coagulopathy.Coagulopathy was defined as an activated partial thromboplastin time40 seconds and/or prothrombin time (PT)1.2 and/or platelet count120*10(9)l(-1). Cranial CT scans were assigned to the six-point Traumatic Coma Data Bank (TCDB) CT-classification.Coagulopathy occurred in 44% of patients in the first 24-hours post-trauma. Patients with acute, sustained coagulopathy showed a prolonged PT (1.64 ± 0.89) when compared to patients without (1.03 ± 0.07), acute temporary (1.27 ± 0.22) or delayed coagulopathy (1.08 ± 0.06; p0.05). Patients with acute temporary or delayed coagulopathy had the worst TCDB CT classification scores, while mortality rates were the highest in patients with sustained or delayed coagulopathy.Not only the mere presence of coagulopathy, but also the course of haemostatic alterations following neurotrauma may hold predictive value for patient outcome, irrespective of the severity level of cerebral injury.

Objective The purpose of this study was to review the epidemiology and the clinical, radiological, pathological, and follow-up data of all surgically treated pediatric meningiomas during the last 35 years in The Netherlands. Methods Patients were identified in the Pathological and Anatomical Nationwide Computerized Archive database, the nationwide network and registry of histopathology and cytopathology in The Netherlands. Pediatric patients of 18 years or younger at first operation in 1974–2009 with the diagnosis meningioma were included. Clinical records, follow-up data, radiological findings, operative reports, and pathological examinations were reviewed. Results In total, 72 patients (39 boys) were identified. The incidence of operated meningiomas in the Dutch pediatric population is 1:1,767,715 children per year. Median age at diagnosis was 13 years (range 0–18 years). Raised intracranial pressure and seizures were the most frequent signs at presentation. Thirteen (18 %) patients had neurofibromatosis type 2 (NF2). Fifty-three (74 %) patients had a meningioma World Health Organization grade I. Total resection was achieved in 35 of 64 patients. Fifteen patients received radiotherapy postoperatively. Mean follow-up was 4.8 years (range 0–27.8 years). Three patients died as a direct result of their meningioma within 3 years. Four patients with NF2 died as a result of multiple tumors. Nineteen patients had disease progression, requiring additional treatment. Conclusion Meningiomas are extremely rare in the pediatric population; 25 % of all described meningiomas show biological aggressive behavior in terms of disease progression, requiring additional treatment. The 5-year survival is 83.9 %, suggesting that the biological behavior of pediatric menigiomas is more aggressive than that of its adult counterparts.

Contains fulltext : 107714.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch on prehospital run time and outcome in severe TBI. METHODS: Prehospital run times of 497 patients with severe TBI who were solely treated by a paramedic EMS (n=125) or an EMS/P-HEMS combination (n=372) were retrospectively analyzed. Other study parameters included the injury severity score (ISS), Glasgow Coma Scale (GCS), prehospital endotracheal intubation and predicted and observed outcome rates. RESULTS: Patients who received P-HEMS care were younger and had higher ISS values than solely EMS-treated patients (10%; P=0.04). The overall prehospital run time was 74+/-54min, with similar out-of-hospital times for EMS and P-HEMS treated patients. Prehospital endotracheal intubation was more frequently performed in the P-HEMS group (88%) than in the EMS group (35%; P

Only a small percentage of World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients have a favorable outcome. The influence of clinical parameters on outcome was assessed. Retrospective evaluation of consecutive patients admitted from 2000-2007 with grade V subarachnoid hemorrhage at two institutions by evaluating, over time, the motor value of the Glasgow Coma Scale, effects of external ventricular drainage and rebleeding on outcome. Six-month outcome was assessed with the extended Glasgow Outcome Scale; favorable outcome was defined as good recovery or moderately disabled. Of 126 patients, 28 had absent brainstem reflexes, without improvement after external ventricular drainage. Rebleeding occurred in 26 patients, resulting in treatment withdrawal in 14. Only one patient had a favorable outcome after rebleeding. Of the 84 remaining patients, 61 improved at day 2 after subarachnoid hemorrhage to Glasgow Coma Scale motor value ≥4; 24 of these (39%) had a favorable outcome. All 23 patients with a Glasgow Coma Scale motor value ≤3 had an unfavorable outcome or died. Patients younger than 65 yrs of age had a better outcome (p < .03). Hydrocephalus was present in 71 of 84 patients. Favorable outcome was similar for patients with a positive external ventricular drainage response (8 of 28) as compared to no response to external ventricular drainage (12 of 43). The high rebleeding rate and subsequent poor outcome in World Federation of Neurologic Surgeons grade V patients warrants early treatment to secure the ruptured aneurysm. Favorable outcome was seen in 39% of patients with a Glasgow Coma Scale motor value ≥4 at day 2. In this study, patients with Glasgow Coma Scale motor value ≤3 at day 2 all had a very poor prognosis

BACKGROUND: Various studies in oncological/neurological patients highlight that informal caregivers suffer from a significant disease burden. We aimed to assess the meningioma caregiver burden, and its effects on caregivers health-related quality of life (HRQoL), and levels of anxiety and depression. METHODS: In a multicentre cross-sectional study informal caregivers of intracranial meningioma patients at a median of 10 years after their last anti-tumour therapy were included. Informal caregivers were family members or close friends and completed the caregiver disease burden scale, SF-36 (HRQoL) and the Hospital Anxiety and Depression Scale. Caregiver burden was assessed as an independent determinant for caregivers HRQoL, and levels of anxiety and depression with multivariable analysis correcting for relevant confounders. Participant recruitment is still in progress. RESULTS: 110 informal caregivers were included (mean age: 64.5, female: 37.2%). Informal caregivers reported any caregiver burden in 35.2% of cases, and clinically relevant burden in 15.7%. More specifically, 20.4% of caregivers suffered from stress, 11.2% from social isolation, 13.0% from feelings of disappointment, 21.0% from emotional problems, and 12.0% from environmental factors complicating the care for the patient. The total caregiver burden score was significantly associated with decreased HRQoL on 6/8 scales and 2/2 component scores: physical function (=-6.53, p=0.071), role limitation due to physical problems (=-13.62, p=0.041), bodily pain (=-13.11, p=0.014), social function (=-11.87, p=0.001), mental health (=-14.32, p

Introduction Continuous EEG (cEEG) is of great interest in view of the reported high prevalence of non-convulsive seizures on intensive care units (ICUs). Here, we describe our experiences applying a seizure warning system using cEEG monitoring. Methods Fifty comatose ICU patients were included prospectively and monitored. Twenty-eight patients had post-anoxic encephalopathy (PAE) and 22 had focal brain lesions. A measure of neuronal interactions, synchronization likelihood, was calculated online over 10s EEG epochs and instances when the synchronization likelihood exceeded a threshold where marked as seizures. Results Five patients developed seizures. Our method detected seizures in three patients, in the other patients seizures were missed because of they were non-convulsive and had a focal character. The average false positive rate was 0.676/h. Discussion This is our first attempt to implement online seizure detection in the ICU. Despite problems with artifacts and that we missed focally oriented seizures, we succeeded in monitoring patients online. Given the relatively high occurrence of seizures, online seizure detection with cEEG merits further development for use in ICUs.

BACKGROUND: Meningioma patients suffer from short- and long-term neurological sequelae and impaired health-related quality of life (HRQoL). However, it is unknown how these impairments affect patients’ work productivity and healthcare consumption on the long-term. MATERIAL AND METHODS: In a multicentre cross-sectional study intracranial meningioma patients of working age (18–67 years) at a median of 10.0 years after anti-tumour therapy were included. Patients completed a validated questionnaire on work productivity (SF-HLQ), and a study-specific questionnaire on healthcare consumption. One-sample t-test was used to compare meningioma patients with normative data of the Dutch population. Generalised linear models were used to compare meningioma patients with a control population, corrected for: age, sex, educational level and comorbidity. Patient recruitment and data collection is still in progress. RESULTS: 106 meningioma patients were included (mean age: 57.7 years, WHO grade I: 93.5%, surgery: 94.2%, radiotherapy: 17.5%). Meningioma patients had a paid job in 48.1% of cases, compared with 71.8% of the Dutch population of working age (p