Operative cancellations adversely affect patient health and impose resource strain on the healthcare system. Here, our objective was to describe neurosurgical cancellations at five Canadian academic institutions.

The Canadian Neurosurgery Research Collaborative performed a retrospective cohort study capturing neurosurgical procedure cancellation data at five Canadian academic centres, during the period between January 1, 2014 and December 31, 2018. Demographics, procedure type, reason for cancellation, admission status and case acuity were collected. Cancellation rates were compared on the basis of demographic data, procedural data and between centres.

Overall, 7,734 cancellations were captured across five sites. Mean age of the aggregate cohort was 57.1 ± 17.2 years. The overall procedure cancellation rate was 18.2%. The five-year neurosurgical operative cancellation rate differed between Centre 1 and 2 (Centre 1: 25.9%; Centre 2: 13.0%, p = 0.008). Female patients less frequently experienced procedural cancellation. Elective, outpatient and spine procedures were more often cancelled. Reasons for cancellation included surgeon-related factors (28.2%), cancellation for a higher acuity case (23.9%), patient condition (17.2%), other factors (17.0%), resource availability (7.0%), operating room running late (6.4%) and anaesthesia-related (0.3%). When clustered, the reason for cancellation was patient-related in 17.2%, staffing-related in 28.5% and operational or resource-related in 54.3% of cases.

Neurosurgical operative cancellations were common and most often related to operational or resource-related factors. Elective, outpatient and spine procedures were more often cancelled. These findings highlight areas for optimizing efficiency and targeted quality improvement initiatives.

COVID-19 has significantly impacted society for over 2.5 years, and Long COVID is concerning for its long-term impact on the healthcare system. Further, cognitive and emotional functioning in Long COVID has limited research, but 2 recent studies (Whiteside et al., 2022a, Whiteside et al., 2022b) examined cognitive and emotional functioning in Long COVID patients approximately 6 months post-diagnosis. The studies found limited cognitive deficits, but significant depression and anxiety, which in turn were the best predictors of low average cognitive scores. Further, the mean Personality Assessment Inventory (PAI) profile included highest mean elevations on somatic preoccupation (SOM) and depression (DEP) subscales. To further explore personality functioning in Long COVID, this study compared PAI profiles of Long COVID patients with a potentially similar group with post-concussion syndrome (PCS) which has been shown to have a strong psychological component.

Participants included 44 consecutive outpatients (Mean age = 47.89, SD = 13.05, 84% Female, 75% Caucasian) referred from a Long COVID clinic with cognitive complaints related to COVID, while the comparison group of PCS patients included 50 consecutive referrals (Mean age = 38.82, SD = 16.24, 52% Female, 90% Caucasian) related to cognitive complaints attributed to PCS. A series of t-tests between the 2 groups was conducted on the PAI validity, clinical, interpersonal, and treatment consideration scales. PAI clinical subscales were also compared. To control for multiple comparisons, p < .01 was utilized and effect sizes were compared.

The results demonstrated that both Long COVID (SOM M = 68.66, SD = 12.56; DEP M = 63.39, SD = 12.70) and PCS groups (SOM M = 65.28, SD = 12.06; DEP M = 70.32, SD = 16.15) displayed the highest mean elevations on PAI SOM and DEP scales but no statistically significant differences in mean scale elevations between Long COVID and PCS groups on SOM (t [92] = 1.33, p = .80) and DEP (t [92] = -2.11, p = .097). However, results demonstrated statistically significant differences on the paranoia subscale (PAR; t [92] = -3.27, p = .009), antisocial features subscale (ANT; t [92] = -2.22, p = .01), stress subscale (STR; t [90] = -3.51, p = .006) and suicidal ideation subscale (SUI; t [92] = -2.73, p = .000) of the PAI. Specifically, the mean scores for the PCS group were higher across the paranoia (M = 57.30), antisocial features (M= 52.24), stress (M = 58.44), and suicidal ideation subscales (M = 57.82) of the PAI than the Long COVID group. While these patterns of reporting differed between groups, mean scores for both groups were in the normal range.

Results support the similarities in emotional/personality functioning across Long COVID and PCS patients and the importance of evaluating psychological functioning in these samples as a standard part of neuropsychological evaluations. Further, the results suggest that psychological treatment strategies utilized with PCS patients may be helpful for Long COVID patients, but more research is needed.

Pediatric acquired demyelinating syndromes (PADS) include a heterogeneous group of diagnoses, including acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorders (NMOSD), optic neuritis (ON) and transverse myelitis (TM). Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is often associated with demyelinating conditions, but may also present with encephalopathy without demyelinating lesions. Approximately 30% of patients diagnosed with MOGAD experience a relapse. Neurocognitive outcomes in PADS have reduced performance on tasks related to attention, processing speed, visual motor, and fine motor functioning. Psychosocial problems include anxiety, depression, and fatigue. Neurocognitive and psychosocial impacts of MOGAD events for the pediatric population are sparse. The current study sought to characterize neurocognitive sequelae from MOGAD (MAGAD+) compared to patients diagnosed withPADS without MOGAD (MOGAD-).

Twenty children and adolescents (6–18 years) diagnosed with PADS were recruited using a clinic convenience sample of patients. Study participants completed a neurocognitive battery and parents completed questionnaires of behavioral and emotional functioning. Demographic and medical variables were collected via retrospective chart review. Chi square and t-test analyses were used to compare MOGAD+ and MOGAD- groups. Performance on neuropsychological and behavioral questionnaires were compared to established sex and age norms to assess the degree to which group means deviate from normative expectations.

MOGAD+ and MOGAD- groups did not significantly differ based on demographic, neurocognitive, or parent reported social and behavioral functioning. Neurocognitive testing documented mean scores that were in the average range between groups. Notable variability in performance was observed within both MOGAD+ and MOGAD- groups. Bilateral fine motor deficits, visual motor, visual perception attention, and executive functioning deficits were notable for the combined PADS group, with 30-50% performing >1.5 SD below the mean. The number of white matter lesions or hospital duration were not significantly associated with performance on neurocognitive measures. However, older age of onset of PADS was significantly correlated with lower performance on visual motor integration and visual perception tasks (r(18) = -.50 p = .026; r(18) = -.53 p = .016). Findings also revealed associations of shorter hospitalization stays with higher behavioral symptoms on a parent measure of social/behavioral functioning (r(18) = -.47 p = .037).

Consistent with the PADS literature, relative to control norms, lower performance on tasks related to attention, executive functioning, visual motor, and fine motor skills, irrespective of MOGAD status, are observed in the current study. The variability of functioning and heterogeneity observed across PADS diagnoses warrants further study to better understand the impact of clinical course, treatment outcomes, and neuropsychological sequelae over time in this population. Higher behavioral distress with shorter hospital stays may indicate a potential opportunity for patient and family education preparing for return to home/community. The current study was limited by small sample size, variable time since hospitalization, and heterogeneous diagnoses within PADS that make it difficult to generalize findings. Future studies could prospectively follow patients over time to better understand the trajectory of recovery, identify predictors for relapse, and those at greatest risk of neurocognitive and behavioral deficits.

Insomnia affects 30-45% of the world population, is related to mortality (i.e., auto accidents and job-related accidents), and is related to mood and affect disorders such as anxiety and depression. Better understanding of insomnia via increased research will decrease the burden on insomnia. The neurocognitive model of sleep proposes that conditioned somatic and cognitive hyperarousal develop in response to repeated pairings of sleep-related stimuli with insomnia-related wakefulness. The purpose of this study was to examine the neurocognitive model of sleep using a novel laboratory paradigm, the Sleep Approach Avoidance Task (SAAT). It was hypothesized that individuals who report symptoms of insomnia will display a bias for negative sleep-related images from the SAAT, which is presumably a reflection of cognitive, behavioral and physiological processes associated with hyperarousal. It was also hypothesized that participants who report poor sleep would provide different subjective ratings for negative images (i.e., stronger valence and arousal) than individuals who reported better sleep.

An initial sample of 66 healthy college-aged participants completed the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI) the Dysfunctional Attitudes and Beliefs about Sleep (DBAS) scale and the Epworth Sleepiness Scale (ESS). Participants also completed the SAAT. The SAAT was developed to assess sleep-related bias in adults. The SAAT is a visual, joystick controlled reaction time task that measures implicit bias for positive and negative sleep-related images. At the end of the task the participants are also asked to rate each image along three dimensions included valence, arousal and dominance.

There was a positive correlation between the SAAT and the ISI [r(61) = .30, p = .01], indicating that symptoms of insomnia are related to negative approach-related bias for sleep-related images. No other correlations were observed between the SAAT and self-report sleep measures. With regard to rating of images, higher dominance ratings for negative images were correlated with the SAAT [r(62) = .24, p = .03], which indicates that the approach bias for negative images is associated with “being in control.” Multiple linear regression was used to test if ISI scores and dominance ratings for negative images significantly predicted SAAT bias scores. The overall regression was statistically significant [r2 = .13, F(2, 58) = 4.15, p = .02]. ISI scores significantly predicted SAAT scores (ß = .27, p = .04), whereas dominance ratings for negative images did not significantly predict SAAT scores (ß = .20, p = .11). Exploratory correlational analyses were also completed for ratings of images and other sleep self-report measures. Valence ratings for positive sleep-related images were positively correlated with the ESS [r(64) = .36, p = .01], whereas valence ratings for negative sleep-related images were negatively correlated with the ESS [r(64) = -.24, p = .03].

Hypotheses were partially supported with the ISI being the only self-report measure associated with negative bias for sleep-related images. While ratings of dominance are associated with bias for negative sleep-related images, these ratings do not provide unique variance. These findings indicate a cognitive processing bias for sleep-related stimuli among young adult poor sleepers. Limitations, implications for assessment and intervention are discussed.

The internet allows easy access for the sales of psychoactive agents that are not regulated by the FDA. Some of those agents are used to help manage anxiety, depression and sleep, such as tianeptine, etizolam, and phenibut. These medications have the potential for abuse and potentially leading to altered mental status when intoxicated or withdrawing. This presents a challenge to clinicians who may not be aware of availability of such substances. Available literature has discussed the use of above substances individually, but how do you treat if there is use of more than one substance with different mechanisms of actions? Here we present a case of an adult male who has used all three agents simultaneously, leading to a hospital admission.

A 32-year-old male presented to the emergency department (ED) for altered mental status (AMS). He has a documented history of anxiety but was never treated with prescription medications. No history of substance use was documented. He was self-medicating with concurrent use of tianeptine (atypical antidepressant with mu agonist properties,) phenibut (GABA mimetic) and etizolam (a benzodiazepine-like agent). During his stay, he was agitated and delirious with reports of visual hallucinations. Neuroimaging and lab studies were within normal limits, EEG showed no seizure activity. Over the course of his hospital stay, he was started on Depakote for agitation, a Valium taper for suspected benzodiazepine withdrawal and prevention of seizures, Seroquel for delirium, and baclofen for suspected GABAergic withdrawal symptoms. The patient’s AMS improved and he was discharged on hospital day 10.

This case illustrates the difficulty managing poly-substance use/abuse and stresses the importance for physicians to screen for psychoactive agents purchased over the internet or over the counter to improve treatment outcomes. Continued discussions with patients regarding risks/benefits of use of such substances would be beneficial and help increase awareness.

Children treated for brain tumors often experience social and emotional difficulties, including challenges with emotion regulation; our goal was to investigate the attention-related component processes of emotion regulation, using a novel eye-tracking measure, and to evaluate its relations with emotional functioning and white matter (WM) organization.

Fifty-four children participated in this study; 36 children treated for posterior fossa tumors, and 18 typically developing children. Participants completed two versions of an emotion regulation eye-tracking task, designed to differentiate between implicit (i.e., automatic) and explicit (i.e., voluntary) subprocesses. The Emotional Control scale from the Behavior Rating Inventory of Executive Function was used to evaluate emotional control in daily life, and WM organization was assessed with diffusion tensor imaging.

We found that emotional faces captured attention across all groups (F(1,51) = 32.18, p < .001, η2p = .39). However, unlike typically developing children, patients were unable to override the attentional capture of emotional faces when instructed to (emotional face-by-group interaction: F(2,51) = 5.58, p = .006, η2p = .18). Across all children, our eye-tracking measure of emotion regulation was modestly associated with the parent-report emotional control score (r = .29, p = .045), and in patients it was associated with WM microstructure in the body and splenium of the corpus callosum (all t > 3.03, all p < .05).

Our findings suggest that an attention-related component process of emotion regulation is disrupted in children treated for brain tumors, and that it may relate to their emotional difficulties and WM organization. This work provides a foundation for future theoretical and mechanistic investigations of emotional difficulties in brain tumor survivors.

In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.

An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.

We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.

Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.

This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.