Benchmarking palliative care practices in neurooncology: a german perspective.

PURPOSE: To benchmark palliative care practices in neurooncology centers across Germany, evaluating the variability in palliative care integration, timing, and involvement in tumor board discussions. This study aims to identify gaps in care and contribute to the discourse on optimal palliative care strategies. METHODS: A survey targeting both German Cancer Society-certified and non-certified university neurooncology centers was conducted to explore palliative care frameworks and practices for neurooncological patients. The survey included questions on palliative care department availability, involvement in tumor boards, timing of palliative care integration, and use of standardized screening tools for assessing palliative burden and psycho-oncological distress. RESULTS: Of 57 centers contacted, 46 responded (81% response rate). Results indicate a dedicated palliative care department in 76.1% of centers, with palliative specialists participating in tumor board discussions at 34.8% of centers. Variability was noted in the initiation of palliative care, with early integration at the diagnosis stage in only 30.4% of centers. The survey highlighted a significant lack of standardized spiritual care assessments and minimal use of advanced care planning. Discrepancies were observed in the documentation and treatment of palliative care symptoms and social complaints, underscoring the need for comprehensive care approaches. CONCLUSION: The study highlights a diverse landscape of palliative care provision within German neurooncology centers, underscoring the need for more standardized practices and early integration of palliative care. It suggests the necessity for standardized protocols and guidelines to enhance palliative care's quality and uniformity, ultimately improving patient-centered care in neurooncology.

Alien hand syndrome in ruptured aneurysms: case report and review of the literature.

Alien hand syndrome is a rare condition associated with lesions of the corpus callosum and of the supplementary motor area, which can be caused by ruptured cerebral aneurysms. We present a novel case of a patient with a subarachnoid haemorrhage from an aneurysm of the anterior communicating artery who developed alien hand syndrome and intermanual conflict. In addition, we performed a systematic literature search and evaluated data on clinical presentation, treatment and radiological findings from relevant papers. To date, 17 cases of alien hand syndrome in aneurysmatic subarachnoid haemorrhage have been reported. Aneurysms of the anterior communicating artery were the most common origin of subarachnoid haemorrhage (10/17), followed by pericallosal artery aneurysms (7/10). The prognosis appears to be favourable; however, damage to the supplementary motor area during treatment should be avoided to keep symptoms minimal.

Survey on Training Satisfaction among German Neurosurgical Trainees.

BACKGROUND: There has been a fivefold increase of neurosurgeons over the last three decades in Germany, despite a lesser increase in operations. Currently, there are approximately 1,000 neurosurgical residents employed at training hospitals. Little is known about the overall training experience and career opportunities for these trainees. METHODS: In our role as resident representatives, we implemented a mailing list for interested German neurosurgical trainees. Thereafter, we created a survey including 25 items to assess the trainees' satisfaction with their training and their perceived career prospects, which we then distributed through the mailing list. The survey was open from April 1 until May 31 2021. RESULTS: Ninety trainees were enrolled in the mailing list and we received 81 completed responses to our survey. Overall, 47% of the trainees were very dissatisfied or dissatisfied with their training. Sixty-two percent of the trainees reported a lack of surgical training. Fifty-eight percent of trainees found it difficult to attend courses or classes and only 16% had consistent mentoring. There was an expressed desire for a more structured training program and mentoring projects. In addition, 88% of trainees were willing to relocate for fellowships outside their current hospitals. CONCLUSIONS: Half of the responders were dissatisfied with their neurosurgical training. There are various aspects that require improvement, such as the training curriculum, structured mentoring, and reduction of the amount of administrative work. We propose the implementation of a modernized structured curriculum, which addresses the mentioned aspects, in order to improve neurosurgical training and, consecutively, patient care.

The German version of the neurofibromatosis 2 impact on quality of life questionnaire correlates with severity of depression and physician-reported disease severity.

BACKGROUND: Neurofibromatosis type 2 (NF2) is a rare genetic disease that causes a wide range of disabilities leading to compromised quality of life (QOL). There is clear need for a validated disease-specific tool to assess quality of life among German-speaking patients with neurofibromatosis type 2 (NF2). The NFTI-QOL questionnaire has produced useful results in English-speaking cohorts. The aim of this study was to produce and validate a German version of the NFTI-QOL (NFTI-QOL-D) and to correlate QOL scores with a depression score (PHQ-9) and clinical disease severity. METHODS: The original English-language NFTI-QOL was translated into German and then back-translated in order to preserve the questionnaire's original concepts and intentions. A link to an online survey encompassing the NFTI-QOL-D and the PHQ-9 depression questionnaire was then sent to 97 patients with NF2 by email. The respondents' scores were compared to clinician-reported disease severity scores. RESULTS: 77 patients completed the online survey in full. Internal reliability among NFTI-QOL-D responses was strong (Cronbach's alpha: 0.74). Both PHQ-9 and clinician disease severity scores correlated with NFTI-QOL-D scores (Pearson's rho 0.63 and 0.62, respectively). CONCLUSIONS: The NFTI-QOL-D is a reliable and useful tool to assess patient-reported QOL in German-speaking patients with NF2. The correlation of QOL with both psychological and physical disease parameters underlines the importance of individualized interdisciplinary patient care for NF2 patients, with attention paid to mental well-being as well as to somatic disease manifestations.

Women in leadership positions in European neurosurgery - Have we broken the glass ceiling?

Introduction: The proportion of male neurosurgeons has historically been higher than of women, although at least equal numbers of women have been entering European medical schools. The Diversity Committee (DC) of the European Association of Neurosurgical Societies (EANS) was founded recently to address this phenomenon. Research question: In this cross-sectional study, we aimed to characterize the status quo of female leadership by assessing the proportion of women heading European neurosurgical departments. Material and methods: European neurosurgical departments were retrieved from the EANS repository. The gender of all department chairs was determined via departmental websites or by personal contact. The proportion of females was stratified by region and by type of hospital (university versus non-university). Results: A total of 41 (4.3%) female department chairs were identified in 961 neurosurgery departments in 41 European countries. Two thirds (68.3%) of European countries do not have a female neurosurgery chair. The highest proportion of female chairs was found in Northern Europe (11.1%), owing to four female chairs in a relatively small number of departments (n = 36). The proportions were considerably smaller in Western Europe (n = 17/312 (5.5%)), Southern Europe (n = 14/353 (4.0%)) and Central and Eastern Europe (n = 6/260 (2.3%)) (p = 0.06). The distribution of female chairs in university (n = 19 (46.3%)) versus non-university departments (n = 22 (53.7%)) was even. Discussion and Conclusion: There is a significant gender imbalance with 4% of all European neurosurgery departments headed by women. The DC intends to develop strategies to support equal chances and normalize the presence of female leaders in European neurosurgery.

Gender disparity in German neurosurgery.

OBJECTIVE: Despite the rising number of women in higher education and leadership positions, the proportional rise of female neurosurgeons still lags behind these fields. This study evaluates the gender distribution in German neurosurgical departments across all career levels, and is aimed at heightening the awareness of gender disparity and the need for improving gender equality and its related opportunities. METHODS: Data on gender distribution across all professional levels in German neurosurgical departments were obtained from departmental websites as well as by email and telephone request. Results were additionally analyzed in reference to hospital ownership type of the neurosurgical departments. RESULTS: A total of 140 German neurosurgical departments employing 2324 neurosurgeons were evaluated. The analysis revealed a clear preponderance of men in leadership positions. Only 9 (6.3%) of 143 department heads were women, and there were only 1 (2.4%), 17 (14.5%), and 4 (12.5%) women among 42 vice-directors, 117 chief senior physicians, and 32 managing senior physicians, respectively. Senior physicians not holding a leadership position were female in 23.1%, whereas board-certified neurosurgeons not holding a senior physician position and residents were female in 33.6% and 35.0%, respectively. Of note, the highest proportion of female department heads (15.6%) was found in private hospitals. CONCLUSIONS: The number of women in leadership positions in German neurosurgical departments is dramatically low, and with increasing leadership status gender disparity increases. Mentorship, recruitment, the perception of benefits offered by diversity and programs facilitating gender equality, job sharing, parental leave policies, and onsite childcare programs are needed to turn German neurosurgical departments into modern medical departments reflecting the gender profile of the general patient population.