Sexual quality of life after gynaecological cancer: what young women want.

PURPOSE: Psychosexual distress is known to be a common complication of treatment for gynaecological cancer (GC), affecting the sexual quality of life (SQoL) for an increasing number of young gynaecological cancer survivors (YGCS). The SQoL in YGCS study aimed to identify strategies that are acceptable and helpful to YGCS in protecting and improving SQoL, using a salutogenic approach. METHODS: A qualitative study was undertaken with young women aged 18-45 and pre- or perimenopausal at diagnosis. Semi-structured interviews were conducted on Zoom and a thematic analysis of transcripts was completed in NVivo. RESULTS: Fifteen interviews with YGCS revealed three themes for strategy development: psychosexual education, psychosocial support, and healthcare policy and strategy to establish SQoL as standard care in gynaecologic oncology. CONCLUSION: The strategies put forward by YGCS showed the need for a holistic, patient-centric, and multidisciplinary approach to SQoL. A better understanding of the strategies acceptable to YGCS, including the importance of using a trauma-informed approach to communication and care, can help healthcare providers play a vital role in protecting and improving SQoL.

Online versus in-person gatekeeper suicide prevention training: comparison in a community sample.

BACKGROUND: Suicide prevention gatekeeper Training (GKT) is a frequently used suicide prevention intervention, however, there is still limited information about its long-term impact and effectiveness of online delivery. AIMS: The current study aimed to test the effectiveness of online GKT compared to in-person GKT in improving participant training outcomes. METHODS: A non-randomised comparison of pre-, post- and six-month follow-up data was conducted. In total 545 people participated in GKT, 317 in SafeTALK in-person sessions and 228 in online "Start" GKT by LivingWorks. Main outcome measures included: perceived knowledge; perceived preparedness; gatekeeper efficacy; and gatekeeper reluctance to intervene. RESULTS: Linear mixed model analysis demonstrated a significant effect for time for both modes of delivery for all four outcome measures. Post-hoc testing revealed that significant improvement in all outcomes were maintained above baseline at six-months following online and in-person training. CONCLUSIONS: Online training performed as good, or better than in-person GKT, on measured outcomes demonstrating utility and effectiveness of the modality for use in suicide prevention training practices. Findings additionally indicate that online training may reach participants that in-person programs do not. This study provides evidence that Online GKT has significant utility in addressing a crucial need for online alternatives to evidence-based suicide prevention training.

Sexual quality of life in young gynaecological cancer survivors: a qualitative study.

PURPOSE: The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a significant and often neglected issue in the treatment and survivorship period of young gynaecological cancer survivors (YGCS). This study sought to explore women's lived experiences to understand how to protect and improve SQoL. METHODS: A qualitative study with women aged 18-45 and pre- or perimenopausal at diagnosis (n = 15). A thematic analysis was performed in NVivo. Participants also completed a pre-interview questionnaire and The Female Sexual Distress Scale-Revised (FSDS-R). RESULTS: YGCS experienced high psychosexual distress. Notably, seven themes were identified: adjustment, confidence, fear, loss, shame, trauma, and communication. Gynaecological cancer (GC) treatment interfered with everyday life and had a long-term impact on mental, physical, and emotional health, with many reporting an altered sense of self, body image and sexual identity. Single women felt vulnerable in new relationships, while partnered women reported low sexual desire and guilt about sexual difficulties. Open communication, emotional intimacy, and an acceptance of the 'new normal' buffered the trauma of cancer and were vital to relationship satisfaction. Lastly, absent, or blunt patient-clinician communication contributed to psychosexual distress. CONCLUSION: GC interferes with sexual function, partner relationships, psychosexual wellbeing, and quality of life. A better understanding of the lived experiences of YGCS can help healthcare providers to adopt a holistic, patient-centric, and multidisciplinary approach to SQoL. YGCS want psychosexual communication and support, across all stages of treatment and care. Healthcare providers should initiate and normalise conversations on the impact of treatment on SQoL.

The implementation of interprofessional education: a scoping review.

INTRODUCTION: Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. METHODS: Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. RESULTS: Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. CONCLUSION: Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

Development and test-retest reliability assessment of a low-cost, 3D printed tool for assessing different aspects of hand dexterity.

BACKGROUND: Hand dexterity assessments related to fine motor movements are routinely administered in clinical settings to ascertain an individual's hand function. However, to perform a detailed assessment multiple devices are needed which can be time-consuming and costly to administer. PURPOSE: We designed and assessed the test-retest reliability of a 3D printed dexterity device in a cohort of healthy young adults and community-dwelling older adults. This study examines the reliability of the device, association between perceived fine motor gripping and manipulation dexterity components, and dominant hand outperformance during both tasks. STUDY DESIGN: Test-retest study of a clinical measurement tool. METHODS: A convenience sample of thirty-six healthy community-dwelling older and young adults was included in our study. The device was used to collect data at two testing sessions to establish test-retest reliability. Fine motor manipulation dexterity was assessed by lifting notched pegs over a vertical barrier and inserting them into randomly oriented holes sequentially. Fine motor gripping dexterity was assessed by taking these notched pegs out of the holes, lifting them over the barrier and dropping them into a large container. RESULTS: Intraclass correlation coefficient (ICC)2,1 showed good to excellent test-retest reliability on the dominant and nondominant hands when using the device. Only modest association was found within-hand for the gripping versus manipulation dexterity tests. The between-hand motor gripping dexterity test demonstrated a strong association; however, between-hand the motor manipulation dexterity test was only moderately associated. CONCLUSION: The device was reliable, discriminated between the motor gripping and motor manipulating dexterity tasks, and was sensitive to handedness during the motor manipulating dexterity task. It shows promise as a hand dexterity assessment device which may provide efficiency and cost advantages. It is freely available via http://www.rehabtools.org/dexterity.html.

Effectiveness of suicide prevention gatekeeper training: 12-month follow-up of SafeTALK training to community members.

OBJECTIVE: Long-term assessments of gatekeeper training (GKT) with multiple follow-ups are rare. Therefore, the aim of the current analysis is to examine 12-month follow-up outcomes of SafeTALK training in addition to the earlier analysis of pre-, post-, and 6-month follow-up. METHOD: Two hundred and sixty two community volunteers participated in half-day (4-h) gatekeeper training sessions. Before, after, and 6- and 12-month follow-up surveys were used to assess participants' knowledge, efficacy, and reluctance to intervene. Linear mixed effects regression was used in statistical analysis. RESULTS: Fifty six participants (21.4%) completed the 12-month follow-up, representing an attrition rate of 78.6% from pre-test. Linear mixed model analysis revealed a significant, consistent effect for time for knowledge, efficacy, and reluctance. Post-hoc testing revealed significant differences between scores at pre-test and 12-month follow-up for GK knowledge and efficacy; however, no significant difference was seen between these time points for reluctance to intervene. No significant change was measured between the 6 and 12 months for any outcomes. GK knowledge and efficacy remained significantly above pre-test scores. CONCLUSION: The evaluation of the GKT demonstrated the long-term effectiveness of community-based suicide prevention training programs to improve and maintain GK knowledge and efficacy.

Factors of sexual quality of life in gynaecological cancers: a systematic literature review.

BACKGROUND: The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a well-established survivorship issue for gynaecological cancer survivors (GCS), yet little is known on how to intervene. PURPOSE: The aim of this systematic review was to identify the factors explaining the variability in SQoL for GCS. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the software Covidence. Electronic databases Scopus, Web of Science, PUBMED and CINAHL were searched for original research on GCS published between 2002 and 2018. We performed a two-stage screening process against selection criteria and quality assessment of individual studies. The Salutogenic Theory and the PRECEDE-PROCEED model were used as theoretical frameworks to identify and categorise factors. RESULTS: The initial search yielded 3,505 articles resulting in a total of 46 studies used to examine the association between factors of SQoL and gynaecological cancers. Our findings suggested that SQoL varies across subgroups based on age, menopausal status, relationship status, and treatment modality. Protective factors included clinicians' knowledge and confidence, preventive medical approach, risk and needs assessment, patient-clinician communication, relationship quality, psychosocial support, symptom management, accessibility of psychosexual care, and self-efficacy in the rediscovery of sexuality. CONCLUSION: Despite the high incidence and long-term impact of sexual health issues on quality of life, supportive care needs are not being met. A better understanding of the evidence base around the factors of SQoL can help health professionals take steps to protect and improve SQoL in GCS.

Examining relations between neuropsychological and clinical epilepsy-specific factors with psychopathology and adaptive skills outcomes in youth with intractable epilepsy.

Pediatric epilepsy is a prevalent childhood neurological disorder. Youth with a diagnosis of medically uncontrollable or intractable epilepsy are at increased risk for poor neurocognitive and psychosocial functioning. To date, there is a paucity of clinical research examining and/or characterizing the relations of neuropsychological, clinical, and epilepsy-specific medical factors in clinical outcomes among youth with diagnosed intractable epilepsy. One hundred and twenty-six patients (6-20 years) with diagnosed intractable epilepsy and who were evaluated as part of a presurgical work-up and medical standard of care participated in a neuropsychological evaluation, including parent completion of the Behavior Assessment System for Children - Second Edition Parent Report Scale (BASC-2 PRS). Medical chart review was conducted to obtain demographic and epilepsy-specific information. Results indicated that an increase in the BASC-2 PRS Adaptive Symptoms Index T-Scores was associated with a decrease in the BASC-2 PRS Internalizing, Externalizing, and Behavioral Symptoms Index score. Additionally, the Wechsler (Wechsler Intelligence Scale for Children - Fourth Edition [WISC-IV], Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V], Wechsler Adult Intelligence Scale - Fourth Edition [WAIS-IV]) Similarities z-score was associated with the BASC-2 PRS Externalizing Symptoms Index T-Score. No demographic or clinical medical factors remained in any of the three final models. Findings highlight the importance of verbal reasoning and adaptive functioning as protective factors in clinical outcomes among youth with diagnosed intractable epilepsy and may provide future direction for targeted interventions.

Exploring the influence of service dogs on participation in daily occupations by veterans with PTSD: A pilot study.

INTRODUCTION: Post traumatic stress disorder (PTSD) resulting from military service can seriously impact quality of life. There is support for the use of service dogs amongst people with PTSD in managing symptoms by reducing anxiety and depression. To date, few studies have investigated this phenomenon comprehensively, particularly in relation to enhancing participation in daily occupations. METHODS: We explored the experience of a group of ex-serving members of the Australian military with PTSD, who had partnered with a service dog. We sought to understand the influence of the service dog on PTSD symptom management and participation in meaningful daily occupations. Seven participants who had been paired with a service dog were recruited from a Veterans' support organisation. Two semi-structured focus group sessions were conducted, audio-recorded and transcribed verbatim. The transcripts from the focus group sessions and researcher field notes were analysed independently by two researchers using an inductive approach to generate codes and themes. RESULTS: The themes that emerged from the data were: isolation, safety, lifeline, reconnection and challenges. Veterans in this study reported that partnering with a service dog helped them to feel safe, helped them to manage the symptoms and impact of PTSD, resulting in improved sleep quality, emotional regulation, reduced anxiety, enhanced anger management, and a reduction in the misuse of alcohol and prescription medication and suicidal ideation. These changes led to improved relationships and increased participation in meaningful daily occupations. Ongoing financial support for veterans who have partnered with a service dog needs to be more closely examined. CONCLUSION: These findings are important and highlight that a larger and more comprehensive, research project examining the impact of service dogs on the quality of life.

Open-source 3D printed sensors for hand strength assessment: Validation of low-cost load cell and fabric sensor-based systems.

BACKGROUND/AIM: Pinch and grip strength assessment is commonly performed in occupational therapy practice. However, the typically utilised methods are limited to pinch or grip dynamometers and do not readily translate to handling everyday objects. With the advent of consumer-grade 3D printing and low-cost sensor systems, the possibilities for creating customised assessment devices are expanding. As a first step in determining the validity of low-cost sensor systems, their data must be compared to a gold standard. Consequently, this study examined the criterion validity of two such systems for measuring pinch strength, specifically a small load cell and pressure-sensing fabric, with a mechanical pinch gauge. METHODS: A total of 33 participants performed strength tests using a mechanical pinch grip device, which had a plastic 3D printed cover with a pressure-sensing fabric overlaid on it to allow for simultaneous criterion validation, and a small load cell with a plastic 3D printed casing designed for comfortable pinch grip assessment. RESULTS: The simultaneously assessed fabric sensor and mechanical pinch grip device showed excellent absolute (ICC2,k  = 0.94) and relative (Pearson's R = 0.90) agreement. Both devices showed similar excellent relative (R > 0.75) agreement with the load cell despite non-simultaneous assessment. These findings indicate that 3D printed sensors incorporating a load cell and a pressure-sensing fabric can be used to replicate a pinch grip assessment performed with a mechanical pinch gauge. CONCLUSIONS: This study lays the foundation for these sensor systems to be modified for use as assessment tools during the performance of functional tasks using everyday objects. Additionally, because both systems generate real-time force data they could be used for biofeedback as part of rehabilitation and strengthening programs. To aid uptake and future research using these systems, the 3D print models, step-by-step hardware design and software programs used are provided in an open-source format at www.rehabtools.org/otsensors.html.

Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes.

OBJECTIVE: The cerebroplacental ratio (CPR) is a semi-quantitative marker for fetal brain-sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin-twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years. METHODS: One-hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI-2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI-2. RESULTS: Ninety-nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post-laser CPR <1.0 was a risk factor for lower BDI-2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs ß = -0.23, p = 0.01]; this relationship remained significant after controlling for pre-surgical CPR and Quintero stage (adjusted ß = -0.25, p = 0.01). CONCLUSIONS: In this population, an abnormal CPR was associated with poorer 2-year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd.

Predictors of 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome.

OBJECTIVE: The purpose of this study was to determine risk factors for poor cognitive performance among children who are treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome. STUDY DESIGN: This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed with the Battelle Developmental Inventory 2nd Edition (BDI-2). Multilevel regression models evaluated risk factors for poor cognitive performance at shared (pregnancy) and individual (child) levels. In addition to development, blindness, deafness, and cerebral palsy were assessed based on physical examination. A priori power analysis determined that a sample of ≥100 children was required for adequate statistical power (0.80). RESULTS: One hundred children (57 families) were evaluated. Total BDI-2 score was within normal range (mean, 101.3 ± [SD]12.2); 1 child had a BDI-2 score of <70. Individual child-level risk factors for lower BDI-2 included male sex (ß = -0.37; P < .01), lower head circumference (ß = 0.28; P < .01), and higher diastolic blood pressure (ß = -0.29; P < .01). At the pregnancy level, lower maternal education (ß = 0.60; P < .001), higher Quintero stage (ß = -0.36; P < .01), and lower gestational age at birth (ß = 0.30; P < .01) were associated with worse cognitive outcomes. Donor/recipient status, gestational age at surgery, fetal growth restriction, and co-twin fetal death were not risk factors. The rate of neurodevelopmental impairment (blindness, deafness, cerebral palsy, and/or a BDI-2 score <70) was 4%. CONCLUSION: Overall cognitive performance quotients were in the normal range, with risk factors for poor outcomes seen at the pregnancy and child levels. Clinical and socioeconomic characteristics can identify at-risk children who need additional interventions.

Reducing anxiety in the pediatric emergency department: a comparative trial.

BACKGROUND: Anxiety among patients in a pediatric emergency department (PED) can be significant, but often goes unaddressed. OBJECTIVE: Our aim was to determine whether exposure to Child Life (CL) or hospital clowning (HC) can reduce anxiety in children presenting to a PED. METHODS: Patients were randomized to CL, HC, or control and assessed upon entry to examination room (T1), before physician arrival (T2), and during physician examination (T3), using the modified Yale Preoperative Anxiety Scale (m-YPAS). CL and HC interventions occurred for 5 to 10 min before physician entry. Effects were analyzed using mixed analysis of variance. RESULTS: m-YPAS scores ranged from 23 to 59, with a higher score indicating increased anxiety. Mixed analysis of variance on the study sample (n = 113) showed a significant interaction between groups (CL, HC, control) and time (p = 0.02). Additional analyses indicated effect of group only at T2 (CL: mean = 23.8; 95% confidence interval [CI] 23.2-24.5; HC: mean 25.2; 95% CI 24.2-26.2; control: mean = 26.1; 95% CI 24.2-27.9; p = .02). Subanalysis of patients with T1 m-YPAS score ≥ 28 (n = 56) showed a significant interaction between group and time (p = 0.01). Additional analysis showed effect of group only at T2 (CL: mean 24.4; 95% CI 23.3-25.6; HC: mean 27.0; 95% CI 25.2-28.7; control: mean 29.2; 95% CI 25.6-32.7; p = 0.003). CONCLUSIONS: CL services can reduce state anxiety for patients presenting to a PED with heightened anxiety at baseline. This reduction occurred immediately after CL intervention, but was not observed in patients exposed to HC or during physician examination.

Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period.

The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child's clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.

What Factors Influence Clinicians' Use of Technology in Neurorehabilitation? A Multisite Qualitative Study.

OBJECTIVE: Technology is being increasingly used for physical assessment and interventions in health care settings. However, clinical adoption is relatively slow, and the factors affecting use remain underexplored. This study aimed to investigate factors influencing technology use by clinicians working in neurorehabilitation. METHODS: In this qualitative study, 9 physical therapists and 9 occupational therapists (N = 18) were recruited from urban and regional locations in Australia and in Singapore. Three 60-minute focus groups were conducted via video conferencing. Each group comprised 3 physical therapists and 3 occupational therapists working across different neurorehabilitation settings. Participants were asked to discuss which technologies they used in their workplace for physical assessment and treatment and barriers, motivators, and future desires for technology use. Transcripts were analyzed independently using an inductive approach to generate codes and themes. RESULTS: Our results comprised 3 themes and 7 categories. These were encompassed by a single overarching theme, namely "Technology use is influenced by the benefits and challenges of the technology itself, users, and organizational context." Themes showed that technology should promote effective interventions, is preferred if easy to use, and should be dependable. Furthermore, clinical reasoning is important, and users have varying levels of receptivity and confidence in technology use. Also, organizational resources are required, along with supportive cultures and processes, to facilitate technology use. CONCLUSIONS: The themes identified multiple and interlinking factors influencing clinicians' use of technology in neurorehabilitation settings. Clinicians often consider context-specific benefits and challenges when deciding whether to use technology. Although our study found that clinicians generally perceived technology as having a beneficial role in improving health outcomes, there were several challenges raised. Therefore, the characteristics of the technology itself, individual users, and organizational context should be considered. IMPACT: These findings will guide successful technology implementation and future developments.

The purpose, content and development phases of a graduate entry ePortfolio in occupational therapy.

BACKGROUND: There is a trend in higher education towards the use of digital or electronic portfolios (ePortfolios) to collect evidence that demonstrates learning and skill development. There are very few papers that examine the key features and what to include in an occupational therapy ePortfolio. OBJECTIVE: This study presents an approach to developing a graduate entry ePortfolio to prepare occupational therapy students for transition to work. METHODS: An e-Delphi approach was used to gather the opinions of eight categories of experts. Three rounds of questionnaires were used to explore the purpose, terminology, content, structure, and development phases of a graduate entry ePortfolio. RESULTS: Key stakeholders indicated that the purpose of a professional portfolio is to create a professional profile, record experiences, skills and behaviours, and promote recording of lifelong learning and achievements. Delphi expert panel members emphasised the importance of personal choice in selecting evidence recorded in each collection, which must be guided by ethical decision-making. CONCLUSIONS: The findings of the study are important to students who wish to build an ePortfolio to organise and display evidence of competence prior to graduation in readiness to enter the workforce. The recommendations also will be of value to occupational therapy educators in curriculum development.

Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome.

OBJECTIVE: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery. MATERIALS AND METHODS: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated. NDI was a composite outcome of: Battelle Developmental Inventory 2nd edition (BDI-2) score <70, cerebral palsy, blindness, and/or deafness. Multilevel logistic regression with robust standard errors was used to evaluate associations between cerebral lesions and NDI. RESULTS: Fifty-six children were 'high-risk survivors' and had neonatal cerebral imaging. Ten twins (18%) had at least one cerebral lesion, including grade 1-2 intraventricular hemorrhage (8), cystic periventricular leukomalacia (2), ventriculomegaly (1), and bilateral subependymal cyst (1). The risk of NDI in the 'high-risk survivors' was 7% (4/56) compared with 0% (0/43) in the remaining group. Among 'high-risk survivors', cerebral lesions were a significant risk factor for NDI (OR = 19.28, p < .001). CONCLUSIONS: Among 'high-risk survivors' of TTTS treated with laser surgery, cerebral lesions identified on neonatal imaging were associated with NDI at 2-years.