Analysis of surgical and MRI factors associated with cerebellar mutism.

The surgical risk factors and neuro-imaging characteristics associated with cerebellar mutism (CM) remain unclear and require further investigation. Therefore, we aimed to examine surgical and MRI findings associated with CM in children following posterior fossa tumor resection. Using our data registry, we retrospectively collected data from pediatric patients who acquired CM and were matched based on age and pathology type with individuals who did not acquire CM after posterior fossa surgery. The strength of association between surgical and MRI variables and CM were examined using odds ratios (ORs) and corresponding 95% confidence intervals (CIs). A total of 22 patients (11 with and 11 without CM) were included. Medulloblastoma was the most common pathology among CM patients (91%); the remaining 9% were diagnosed with a pilocytic astrocytoma. Tumor attachment to the floor of the fourth ventricle (OR 6; 95% CI 0.7-276), calcification/hemosiderin deposition (OR 7; 95% CI 0.9-315.5), and post-operative peri-ventricular ischemia on MRI (OR 5; 95% CI 0.5-236.5) were found to have the highest measures of association with CM. Our results may suggest that tumor attachment to the floor of the fourth ventricle, pathological calcification, and post-operative ischemia have a relatively higher prevalence in patients with CM. Collectively, our work calls for a larger multi-institutional cohort study of CM patients to encourage further investigation of the determinants and management of CM in order to potentially minimize its development and predict onset.

Preferences in Learning Styles and Modes of Information Delivery in Patients Receiving First-Day Education for Radiation Therapy.

PURPOSE: The primary objective of this study was to determine levels of patient satisfaction with current first-day teaching practices at a large, academic Canadian Radiation Therapy Department. A secondary objective was to investigate patient preferences in learning styles and modes of information delivery. METHODS: A literature review was conducted on learning styles, modes of information delivery, and patient education in radiation therapy. Based on this review, a quantitative survey was designed to evaluate patient preferences. Inclusion and exclusion criteria were generated to select participants. The study population included 21 patients with prostate cancer and 24 patients with breast cancer. The surveys were distributed for a 2-week period. The Sign Test and Kruskal-Wallis Test were used to analyze the data. RESULTS: The results revealed that patients significantly disagreed with the use of group sessions and strongly agreed with sit-down, one-on-one sessions and the use of supporting print material. Patients agreed with the use of a combination of teaching methods. Male participants more frequently strongly agreed with the use of videos to support educational practices. Significant results were found on preference for visual and kinesthetic learning. Overall, participants agreed that teaching sessions reduced anxiety. CONCLUSIONS: Radiation therapists are encouraged to continue with current teaching practices since patients reported high levels of satisfaction. The results of this study indicate that a combination of teaching methods including visual aids and videos for male patients may be of benefit. Therefore, to further strengthen teaching sessions, the use of a multimedia tool can be investigated in the future.

Effects of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentrations and Physical Performance in Athletes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: There is currently no systematic review examining the effects of vitamin D supplementation among athletes. A rigorous systematic review and meta-analysis is important to provide a balanced view of current knowledge on the effect of vitamin D on serum 25-hydroxyvitamin D [25(OH)D] concentrations and physical performance. OBJECTIVES: This systematic review of randomized controlled trials (RCTs) evaluated the effects of oral vitamin D supplementation on serum 25(OH)D concentrations and physical performance in athletes. METHODS: Multiple electronic databases were searched, and study eligibility, methodological quality assessment, and data extraction were completed independently and in duplicate. Studies were stratified by baseline vitamin D sufficiency, season, and latitude. A cut-off of 30 ng/ml (75 nmol/l) of 25(OH)D was used for sufficiency. Absolute mean differences (AMDs) between vitamin D and placebo using random effects analysis, and heterogeneity using Q statistic and I 2 index, were calculated. AMD with 95% confidence interval (CI), p value, and I 2 are reported. RESULTS: In total, 13 RCTs (2005-2016) with 532 athletes (vitamin D 311, placebo 221) were eligible. A total of 433 athletes (vitamin D 244, placebo 189) had complete outcome data. Among athletes with baseline values suggesting insufficiency, vitamin D supplementation led to significant increases from 3000 IU (AMD 15.2 ng/ml; 95% CI 10.7-19.7, p < 0.0001, I 2 = 0%) and 5000 IU (AMD 27.8 ng/ml; 95% CI 16.9-38.8, p < 0.0001, I 2 = 78%) per day at >45° latitudes. Both doses led to sufficiency concentrations during winter months. Among athletes with baseline vitamin D suggesting sufficiency, serum 25(OH)D sufficiency was maintained from different doses at both latitudes. Of 13 included trials, only seven measured different physical performances and none demonstrated a significant effect of vitamin D supplementation during 12 weeks of follow-up. CONCLUSION: Despite achieving sufficiency in vitamin D concentrations from ≥3000 IU supplementation, physical performance did not significantly improve. Between-study heterogeneity was large, and well-designed RCTs examining the effect of vitamin D supplementation on serum 25(OH)D concentrations, physical performance, and injuries in different sports, latitudes, ethnicities, and vitamin D status are needed.