Information Sharing in Neurosurgery Topics Among Pediatric Patients and Loved Ones Within the Reddit Community.

Introduction With crowd-sourced knowledge, patients arrive at their healthcare visits ready to play an active role. This exploratory study seeks to understand common concerns among patients and loved ones on Reddit, an anonymous internet forum. Ultimately, recognizing common concerns can aid providers in directing their conversations with patients. Methods Reddit posts in the "hot" tab of each subreddit were retroactively screened from September 1, 2022. Posts written within a five-year period were included. Posts by pediatric patients, loved ones, and pregnant patients experiencing the condition or whose fetus was diagnosed were included. Posts omitting the poster's age or individuals, outside of loved ones, who self-identified as over the age of 17 were excluded. Results A total of 12 subreddits and 286 posts were identified, with 37% of posts written by patients and 63% of posts written by a loved one. R/scoliosis patients (n=29) and r/epilepsy loved ones (n=28) sought the most health advice. The subreddit r/hydrocephalus comprised the most post-operative treatment symptom questions. The r/cerebralpalsy subreddit sought the most advice related to daily activities. Discussion Patients within r/scoliosis, r/hydrocephalus, and r/epilepsy are asking health-related questions. Hydrocephalus patients utilize anonymous internet responses to prepare for upcoming healthcare visits. Individuals in r/cerebralpalsy are utilizing Reddit as a method of communication; understanding how these patients interact with social media can guide software development tailored for online interactions. The anonymity of Reddit prevents us from understanding the diversity of posters. Conclusion Reddit is an avenue to disseminate correct information to pediatric patients and loved ones. Healthcare providers can use the information gathered to tailor their discussions better.

United States insurance coverage of immediate lymphatic reconstruction.

INTRODUCTION: Immediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance providers in the United States and compared it to our institutional experience with obtaining coverage for ILR. METHODS: The study analyzed the publicly available ILR coverage statements for American insurers with the largest market share and enrollment per state to assess coverage status. Institutional ILR coverage was retrospectively analyzed using deidentified claims data and categorizing denials based on payer reason codes. RESULTS: Of the 63 insurance companies queried, 42.9% did not have any publicly available policies regarding ILR coverage. Of the companies with a public policy, 75.0% deny coverage for ILR. In our institutional experience, $170,071.80 was charged for ILR and $166 118.99 (97.7%) was denied by insurance. CONCLUSIONS: Over half of America's major insurance providers currently deny coverage for ILR, which is consistent with our institutional experience. Randomized trials to evaluate the efficacy of ILR are underway and focus should be shifted towards sharing high level evidence to increase insurance coverage for BCRL prevention.

Showing Some Spine on Reddit: Neurosurgical Spinal Cord Conditions in Adults.

BACKGROUND: A crowdsourcing resource used by patients with spinal disease has yet to be thoroughly investigated: the Internet. One such platform is Reddit, a virtual, anonymous meeting place. Analyzing how patients use spinal condition "subreddits" may enable a greater understanding of the questions that patients do not ask their doctors. METHODS: Up to 50 posts in each subreddit's "hot" tab were retroactively screened from June 1, 2022. Posts written by those who had the condition or those interested in knowing more were included. Redditors self-identifying as younger than 18 years were excluded. Posts were subcategorized into questions related to social advice, health advice, providing health education or suggesting equipment, detailing their personal experience, or researchers recruiting patients for research. RESULTS: Eight subreddits with 398 posts were identified related to spinal conditions, including scoliosis, herniated disks, spondylolisthesis, kyphosis, spina bifida, and degenerative disk disease, and 2 subreddits for spinal cord injury. Most patients sought out health advice (59.8%), specifically related to questions regarding their treatments (33.6%), followed by social advice (14.1%) relating to activities in their daily lives. Six posts from the spinal cord injury subreddits discussed the inability to achieve or maintain an erection. DISCUSSION: Patients with spinal conditions congregate on Reddit. Analysis of subreddits allows for a more robust fund of knowledge, granting providers an opportunity to address the main health concerns of patients and caregivers.

Your Brain on Reddit: Exploring Neurosurgical Concerns on a Popular Social Media Site.

OBJECTIVE: Social media has irreversibly impacted global interpersonal connectivity. This study aims to understand how information discussed in condition-specific communities, called "subreddits," on the major social media platform Reddit, can improve education by medical providers. METHODS: The top 50 Reddit posts in each subreddit's "hot" tab were retroactively screened from June 1, 2022. Posts written by those 18 and older who had the condition or were engaging in a better understanding of the condition were included in the analysis. In addition, posts were placed in 1 of 6 categories based on the redditors' primary questions: social advice, health advice, providing health education or suggesting equipment, personal experience/progress, researchers recruiting patients for research, or others. RESULTS: We identified 605 posts within 15 subreddits related to cranial neurosurgical topics including epilepsy, traumatic brain injury, stroke, brain tumors/cancer, seizures, hydrocephalus, cerebrospinal fluid leaks, Chiari malformations, aneurysms, pineal cysts, ataxia, and moyamoya. Asking for health advice was the most common form of information seeking across subreddits (53.6%), specifically treatment-related questions (41.0%). Redditors from r/epilepsy and r/seizures constituted 84.6% of nonsurgical treatment questions relating to antiepileptic dosing or side effects. CONCLUSIONS: Cranial neurosurgical disease can overwhelm patients, leaving them with unaddressed questions. Reddit provides anonymity and camaraderie within condition-specific communities not found at the doctor's office. The ease of access to an Internet community may encourage redditors to seek health information online.

A retrospective data analysis on the induction medications used in trauma rapid sequence intubations and their effects on outcomes.

PURPOSE: Rapid sequence intubation (RSI) in trauma patients is common; however, the induction agents used have been debated. We determined which induction medications were used most frequently for adult trauma RSIs and their associations with hemodynamics and outcomes. We hypothesized that etomidate is the most commonly used induction agent and has similar outcomes to other induction agents. METHODS: This retrospective review at two U.S. level I trauma centers evaluated adult trauma patients undergoing RSI within 24 h of admission, between 01/01/2016 and 12/31/2017. We compared patient characteristics and outcomes by induction agent. Comparisons on the primary outcome of in-hospital mortality and secondary outcomes of peri-intubation hypotension, hospital and ICU length of stay (LOS), ventilator days, and complications used logistic regression or negative binomial regression. Regression models adjusted for hospital site, age, patient severity measures, and intubation location. RESULTS: Among 1303 trauma patients undergoing RSI within 24 h of admission, 948 (73%) were intubated in the emergency department (ED) and 325 (25%) in the operating room (OR). The most common induction agents were etomidate (68%), propofol (17%), and ketamine (11%). In-hospital mortality was highest in the etomidate group (25.5%), followed by ketamine (17%), and propofol (1.8%). CONCLUSION: Etomidate was most commonly used in ED intubations; propofol was most used in the OR. Compared to propofol, patients induced with etomidate had higher mortality and complication rates. Findings should be interpreted with caution given limited generalizability and residual confounding by indication.