The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines.

BACKGROUND: Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs' characteristics and other factors mediate and moderate the interventions' effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. METHODS: We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. DISCUSSION: Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. TRIAL REGISTRATION: NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.

Health Literacy Among Adults With Multiple Chronic Health Conditions.

Low health literacy (HL) is associated with poorer health outcomes. We examined HL among adults with multiple chronic conditions (CCs), using 2016 Behavioral Risk Factor Surveillance System data. Health literacy was measured by 3 subjective questions about difficulty with the following tasks: (1) obtaining health information or advice; (2) understanding spoken health information; and (3) understanding written health information. We estimated the prevalence of low HL (difficulty with ≥1 HL tasks) and used multiple logistic regression analysis to examine associations between HL and number of CCs. The prevalence of low HL was 13.8% overall and increased with the number of CCs from 10.6% among those with no CC to 24.7% among those with 3 or more CCs, with the latter having more than twice the adjusted odds of low HL compared with the former (adjusted odds ratio = 2.65; 95% confidence interval, 2.36-2.97). Efforts to improve HL in this population are needed.

Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System.

INTRODUCTION: Our study aimed to examine the prevalence of chronic pain, its severity, its causes, and coping mechanisms that are used by North Carolina adults in rural, suburban, and urban areas. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System's first chronic pain module in 2018, representing 3,598 respondents. Self-reported chronic pain was defined as the affirmative response to the question, "Do you suffer from any type of chronic pain, that is, pain that occurs constantly or flares up often?" We computed prevalence of chronic pain and use of coping mechanisms by rural, suburban, or urban residential status. We used multiple logistic regression to assess the association between chronic pain and residential location, adjusting for demographic characteristics, employment, and health insurance. RESULTS: In 2018, an estimated 27.5% (95% confidence interval [CI], 25.6%-29.3%) of North Carolina adults experienced chronic pain. Prevalence of chronic pain in rural areas (30.9%) and suburban areas (30.8%) was significantly higher, compared with urban areas (19.6%). Compared with urban residents with chronic pain, those with chronic pain in suburban areas (adjusted odds ratio [AOR], 0.44; 95% CI, 0.26-0.76) and in rural areas (AOR, 0.39; 95% CI, 0.24-0.65) were less likely to use nonmedication therapies (eg, acupuncture, physical therapy, yoga) and were less likely to use 3 or more types of chronic pain treatment (suburban AOR, 0.47; 95% CI, 0.25-0.88; rural AOR, 0.53; 95% CI, 0.29-0.95). CONCLUSION: Our results indicate that persons living in rural and suburban areas may be more likely to have chronic pain and less likely to use nonmedication treatments than those in urban areas.

Developing Future Public Health Leaders Trained in Long-term Care Administration.

BACKGROUND: America's population is rapidly aging. Long-term care leaders have not been considered part of the public health workforce. The enumeration of long-term care into the public health workforce taxonomy has not occurred. This article examines the extent of graduate public health education oriented to long-term care and provides a case study of a successful curriculum at East Carolina University (ECU). METHOD: Web sites displaying the curriculum of 135 graduate programs/schools accredited by the Council on Education for Public Health (CEPH) were analyzed for graduate long-term care orientation. A case-study approach was used to describe the integration of long-term care into the Master of Public Health (MPH) Health Policy Administration & Leadership concentration at ECU. RESULTS: A review of 135 CEPH graduate MPH programs from January to July 2019 found that only 8 institutions offered graduate courses in long-term care administration. Of the 8, ECU Brody School of Medicine Department of Public Health was the only program directly linking coursework to licensure as a long-term care administrator. Program graduates total 30, which include 5 MPH students currently completing their Administrator in Training. At time of graduation, 17 students had obtained North Carolina licensure. CONCLUSIONS: Because of increases in population aging, this requires a public health workforce with skills and training in the care of older adults. Formal recognition of long-term care workers as an integral part of the public health workforce is needed. The Institute of Medicine called for this action more than a decade ago.

Diabetes Self-Care and Clinical Care Among Adults With Low Health Literacy.

OBJECTIVE: Low health literacy has been associated with unfavorable health outcomes. We examined diabetes self- and clinical care measures among adults with diabetes by 3 dimensions of health literacy. DESIGN/SETTING: Questions about health literacy were available for optional use in the 2016 Behavioral Risk Factor Surveillance System. We analyzed 2016 Behavioral Risk Factor Surveillance System data from 4 states and the District of Columbia that had included both the Health Literacy and Diabetes optional modules. PARTICIPANTS: Respondents who participated in the 2016 Behavioral Risk Factor Surveillance System in Alabama, Louisiana, Mississippi, Virginia, and Washington, District of Columbia, and completed both modules (n = 4397). MAIN OUTCOME MEASURES: Health literacy was measured by level of difficulty (easy, difficult) with 3 health literacy tasks: getting health advice or information, understanding health information delivered orally by health professionals, and understanding written health information. Diabetes care measures included physical activity, self-monitoring blood glucose, self-checking feet, hemoglobin A1c testing, professional foot examination, flu vaccination, professional eye examination, dental visits, and diabetes self-management education. RESULTS: Among those with self-reported diabetes, 5.9% found it difficult to get health advice or information, 10.7% found it difficult to understand information health professionals told them, and 12.0% found it difficult to understand written health information. Those who found it difficult to get health advice or information had 44% to 56% lower adjusted odds of A1c testing, professional foot examinations, and dental visits; those who found it difficult to understand written health information had lower odds of self-monitoring glucose and self-checking feet. Difficulty understanding both oral and written health information was associated with never having taken a diabetes self-management class. CONCLUSIONS: Our results suggest that problems with health literacy may be a barrier to good disease management among adults with diabetes and that health care providers should be attentive to the needs of patients with low health literacy, especially for diabetes-specific specialty care.

Educational Attainment and Characteristics of Leaders of Schools of Public Health and State Health Departments.

A perceived diversity exists in the educational training of leaders in state and academic public health that isn't observed in other heath disciplines. To assess this perception, the present study describes the training and experience of state health directors and deans of schools of public health. Data were collected in 2017 for deans of schools of public health (n = 56) and state health directors (n = 49) in the United States. Results indicated that 56 deans had at least one terminal degree, while 14 state health directors did not. Women comprised 23 of the dean and 24 state health director positions. Years in current position were 6.91 for deans and 3.51 for state health directors. Thirty-seven deans and 22 state health directors held graduate degrees in public health. As public health leaders advance towards retirement; it is imperative that the public health professionals obtain relevant training necessary to become tomorrow's public health leadership.

Self-reported Health Literacy Among North Carolina Adults and Associations with Health Status and Chronic Health Conditions.

BACKGROUND Low health literacy is a recognized contributor to health disparities. Significant proportions of the adult population, especially the underserved, have low health literacy. The purpose of this study was to examine health literacy and its associations with health status and chronic health conditions among North Carolina adults.METHODS The 2016 North Carolina Behavioral Risk Factor Surveillance System included health literacy questions that focused on accessing and understanding health information. Using these self-reported data, we estimated the prevalence of low health literacy and assessed its associations with general health status and chronic health conditions after adjusting for sociodemographic characteristics and health care access.RESULTS Overall, 4.8% of adults reported having difficulty getting health information or advice, 7.5% understanding oral information from health professionals, and 8.3% understanding written health information; 14.8% reported having difficulty with at least one of these tasks. The adjusted odds of low health literacy were moderately higher for those who had been diagnosed with the following conditions compared to those not diagnosed: heart attack, coronary heart disease, or stroke (AOR = 1.81, 95% CI=1.33, 2.47); COPD (AOR = 1.67, 95% CI = 1.19, 2.34); arthritis (AOR = 1.68, 95% CI = 1.32, 2.15); depression (AOR = 1.95, 95% CI=1.52, 2.50); and kidney disease (AOR = 1.62, 95% CI = 1.02, 2.60).LIMITATIONS All data were self-reported.CONCLUSIONS A notable segment of the North Carolina adult population has low health literacy, and those who do are particularly vulnerable to adverse health status. Targeted efforts are needed to identify strategies to improve health literacy and decrease health disparities.

Engaging Long-Term Care Workers in Research: Recruitment Approaches and Participant Characteristics From a Randomized Controlled Trial to Improve COVID-19 Vaccine Confidence.

OBJECTIVE: To describe and compare the recruitment methods employed in a randomized controlled trial targeting long-term care workers, and resulting participant baseline characteristics. DESIGN: We used a multifaceted recruitment process to enroll long-term care workers in our 3-arm randomized controlled trial comparing 2 interventions to enhanced usual practice, for improving COVID-19 vaccine confidence and other outcomes. SETTING AND PARTICIPANTS: Adult long-term care workers living in the United States employed within the last 2 years were invited to join the study. Participants also had to meet specific screening criteria related to their degree of worry about the vaccine and/or their vaccination status. METHODS: We used a participatory approach to engage our long-term care stakeholders in codesigning and executing a combination of recruitment methods, including targeted e-recruitment, paid e-recruitment, and in-person recruitment. Participants were screened, consented, and enrolled online. We implemented a participant verification process to ensure the integrity of our study data, and used a tailored participant management platform to manage enrollment. RESULTS: We enrolled 1930 long-term care workers between May 2022 and January 2023. We met our enrollment target, despite each recruitment method having limitations. Total variable costs of approximately $102,700 were incurred and differed on a per-enrolled participant basis across methods: $25.73 for targeted e-recruitment, $57.12 for paid e-recruitment, and $64.92 for in-person methods. Our sample differed from the national population in age, gender, race/ethnicity, education, and role in long-term care. Differences were also observed between online and in-person recruitment methods. CONCLUSIONS AND IMPLICATIONS: Our results support the feasibility of enrolling a large number of long-term care workers in a randomized controlled trial to increase COVID-19 vaccine confidence. Findings build upon the evidence base for engaging this important population in research, a critical step to improving long-term care resident health and well-being. Results from our trial are anticipated in 2024.

Rescue of embryonic lethality in Mdm4-null mice by loss of Trp53 suggests a nonoverlapping pathway with MDM2 to regulate p53.

The p53 protein can inhibit cell cycling or induce apoptosis, and is thus a critical regulator of tumorigenesis. This protein is negatively regulated by a physical interaction with MDM2, an E3 ubiquitin ligase. This interaction is critical for cell viability; loss of Mdm2 causes cell death in vitro and in vivo in a p53-dependent manner. The recently discovered MDM2-related protein MDM4 (also known as MDMX) has some of the same properties as MDM2. MDM4 binds and inhibits p53 transcriptional activity in vitro. Unlike MDM2, however, MDM4 does not cause nuclear export or degradation of p53 (refs. 9,10). To study MDM4 function in vivo, we deleted Mdm4 in mice. Mdm4-null mice died at 7.5-8.5 dpc, owing to loss of cell proliferation and not induction of apoptosis. To assess the importance of p53 in the death of Mdm4-/- embryos, we crossed in the Trp53-null allele. The loss of Trp53 completely rescued the Mdm4-/- embryonic lethality. Thus, MDM2 and MDM4 are nonoverlapping critical regulators of p53 in vivo. These data define a new pathway of p53 regulation and raise the possibility that increased MDM4 levels and the resulting inactivation of p53 contribute to the development of human tumors.

The saphenous nerve in foot and ankle surgery: its variable anatomy and relevance.

BACKGROUND: Several studies have raised doubt regarding the role of the saphenous nerve (SN) in the foot, and some authors omit the SN from ankle blocks. Our aim was to assess the SN anatomy with reference to foot and ankle surgery. METHODS: In 29 cadaveric feet the SN was traced to its termination. At the ankle, the distances from the SN to the tibialis anterior tendon (TAT) and the long saphenous vein (LSV) were recorded. RESULTS: In 24 specimens, a SN was present at the ankle, and in 19 specimens extended to the foot. The mean distances from the nerve to the TAT and LSV were 15 mm and 4mm respectively. The nerve reached the first metatarsal (MT) in 28% of specimens. CONCLUSION: Although the SN anatomy is less extensive than previously described, it often reaches the first MT and therefore should routinely be included in ankle blocks for forefoot surgery.

Susceptibilities of Helicoverpa zea (Lepidoptera: Noctuidae) Populations From the Mississippi Delta to a Diamide Insecticide.

The corn earworm, Helicoverpa zea (Boddie), is a major pest of row crops in the Southern United States. Control of this insect is dependent on preventative insecticidal transgenic crops and synthetic insecticide applications when damaging populations are encountered in the field. Recently, the use of chemicals from the diamide class of insecticides, particularly chlorantraniliprole, has been used to control unacceptable populations. Due to the increased importance of this active ingredient for control of corn earworms, populations of this insect from the Mississippi Delta have been monitored for susceptibilities annually since 2016. Overall, 58 populations of H. zea were examined for their susceptibility to chlorantraniliprole through diet-incorporated bioassays from 2016 to 2021. Based on probit analysis, there was only a 4-fold difference between the highest and lowest LC50 estimates for all populations tested. Through weights of 2nd and 3rd instar larvae, there appears to be a substantial fitness cost associated with surviving caterpillars that fed on various concentrations of chlorantraniliprole in bioassays, which is not captured through the yes or no response of typical survival analysis. Overall, there was not a detectable trend of reduced susceptibility to chlorantraniliprole over the course of the six-year study.

Preference of Formosan subterranean termites for blue-stained southern yellow pine sapwood.

Little research has been conducted to investigate interactions between the invasive Formosan subterranean termite, Coptotermes formosanus Shiraki, and pine bark beetles native to the southeastern United States. Facilitative interactions between these organisms could alter stand dynamics and impact wood utilization strategies. American Wood Protection Association Standard E1-09 choice tests were carried out to determine the feeding preference of Formosan subterranean termites for blue-stained versus unstained southern yellow pine sapwood. Three separate colonies of Formosan subterranean termites consumed on average twice as much air-dried blue-stained southern yellow pine sapwood over unstained air-dried controls. Additionally, Formosan subterranean termites consumed over five-times more kiln-dried blue-stained sapwood than unstained kiln-dried control wafers. The implications of these results are particularly relevant to pine forest ecology, nutrient cycling, and the utilization of blue-stained southern pine building products in the southeastern United States, where Formosan subterranean termites have become established.

Feeding Behavior and Fruiting Form Damage by Bollworm (Lepidoptera: Noctuidae) in Bt Cotton.

Bt technologies have played a major role in the control of bollworm, Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae), in cotton. Variation in expression levels among varieties and plant parts, along with selection pressure on bollworm populations, has led to the development of resistance to some Bt proteins. Trials were conducted to evaluate how cotton varieties expressing different Bt proteins affect bollworm larval behavior and their damage in flowering cotton. Differences in larval recovery were observed among cotton varieties at 3 d with 3-gene Bt cotton having the lowest recovery and non-Bt cotton having the greatest recovery. Loss of bloom tags and abscission of small bolls at the site of infestation affected bollworm larval recovery among varieties. Day after infestation was the main factor that affected bollworm movement across all varieties. Number of total damaged fruiting forms by an individual bollworm larva was different among all varieties. Overall, flower bud (square) and fruit (boll) damage by an individual larva was lower on 3-gene cotton than 2-gene cotton and non-Bt cotton. An individual larva damaged fewer squares on 2-gene cotton than non-Bt cotton, but boll damage from bollworm was similar among 2-gene cotton and non-Bt cotton. The level of square and boll damage in 2-gene cotton has increased compared to previous research further supporting the occurrence of bollworm resistance to Cry proteins. The 3-gene cotton containing the Vip3A gene experienced low levels of damage and survival. These results will be important for improving management recommendations of bollworm in Bt cotton technologies.

Clinical pastoral education as professional training: some entrance, curriculum and assessment implications.

Clinical Pastoral Education is professional training for pastoral care. This paper compares CPE against the professional training model. While limiting the discussion to Christian pastoral care, the professional education model suggests a clarification of the trainee's theological and other entry requirements for a basic unit, a more thoughtful provision of information during CPE training, a careful attention to group membership and an appropriate integration with the theological curriculum. It also suggests more specific competency standards and more reliable, valid and objective assessment methods.

Hypofractionated adjuvant surgical cavity radiotherapy following resection of limited brain metastasis.

BACKGROUND: Following surgical resection of oligometastatic disease to the brain there is a high rate of local relapse which is reduced by the addition of focal radiation therapy, often delivered as single fraction stereotactic radiosurgery (SRS) to the surgical cavity. This study audited the outcomes of an alternative approach using hypofractionated radiation therapy (HFRT) to the surgical resection cavity. METHODS AND MATERIALS: Seventy-nine patients who received surgical resection and focal radiation therapy to the surgical cavity using HFRT with intensity modulated radiation therapy with or without stereotactic radiotherapy were identified. Doses were delivered in five fractions every second day for 10 days. Follow-up involved MRI surveillance with three-monthly MRI scans post resection. The major endpoints were local control at the surgical cavity site, and presence of radiation necrosis at the treated site. RESULTS: Seventy-nine patients were included for the analysis with a median follow-up of 10.8 months. Of the cohort, 56% experienced intracranial progression, with all patients progressing distant to the resection cavity, and 7% progressing locally in addition. The one-year local control rate was 89.8%. The median progression-free survival was 10.0 months and median overall survival was 14.3 months. There was one CTCAE grade 3 toxicity of symptomatic radiation necrosis with no grade 4-5 toxicities seen. CONCLUSIONS: The rate of local relapse following HFRT to the surgical cavity is low with minimal risk of radiation necrosis. HFRT can be considered as an alternative to SRS for focal radiotherapy after brain metastasis resection.

Health Literacy and Health Behaviors Among Adults With Prediabetes, 2016 Behavioral Risk Factor Surveillance System.

OBJECTIVES: Evidence is needed for designing interventions to address health literacy-related issues among adults with prediabetes to reduce their risk of developing type 2 diabetes. This study assessed health literacy and behaviors among US adults with prediabetes and the mediating role of health literacy on health behaviors. METHODS: We used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) (N = 54 344 adults). The BRFSS health literacy module included 3 questions on levels of difficulty in obtaining information, understanding health care providers, and comprehending written information. We defined low health literacy as a response of "somewhat difficult" or "very difficult" to at least 1 of these 3 questions. Respondents self-reported their prediabetes status. We included 3 health behavior indicators available in the BRFSS survey-current smoking, physical inactivity, and inadequate sleep, all measured as binary outcomes (yes/no). We used a path analysis to examine pathways among prediabetes, health literacy, and health behaviors. RESULTS: About 1 in 5 (19.0%) adults with prediabetes had low health literacy. The rates of physical inactivity (31.0% vs 24.6%, P < .001) and inadequate sleep (38.8% vs 33.5%, P < .001) among adults with prediabetes were significantly higher than among adults without prediabetes. The path analysis showed a significant direct effect of prediabetes and health literacy on health behaviors. The indirect effect of prediabetes through health literacy on health behaviors was also significant. CONCLUSION: BRFSS data from 2016 showed that rates of low health literacy and unhealthy behaviors were higher among adults with prediabetes than among adults without prediabetes. Interventions are needed to assist adults with prediabetes in comprehending, communicating about, and managing health issues to reduce the risk of type 2 diabetes.

Occupational Hazards and Health and Safety Risks for Latino Tree Trimmers in the Pine Forest Industry.

A pilot project was conducted to evaluate the working conditions and work-related body pain among Latino immigrant tree trimmers (n = 57) in the commercial pine forest service industry. Participants were interviewed about personal and work characteristics, job-related occupational hazards, and body pain. A structured questionnaire and a body pain diagram were used as measures for evaluating associations between personal and work characteristics and body pain. The most common health complaints were physical exhaustion (80.7 percent) and headache (33.9 percent). The reported percent of work-related body pain was 54.4 percent. Statistically significant associations were identified between experiencing body pain in knees, working more than two years, and working more than six hours per day (p < .05) as a tree trimmer. Thorough clinical evaluations are needed to confirm these findings. Future research including a larger sample size and more in-depth evaluations are needed to better evaluate worker tasks, musculoskeletal risk factors, and safety climate issues among this highly vulnerable occupational group.

Applicability of the dual isotopes δ15N and δ18O to identify nitrate in groundwater beneath irrigated cropland.

Identification of the nitrate sources that adversely impact groundwater quality is a necessary first step in the control of this major worldwide pollutant. The impact of nitrate leachate from urea-ammonium nitrate (UAN) (50% urea-N, 25% ammonium-N, 25% nitrate-N) fertilizer, whose use has increased dramatically in the last three decades largely because it can be applied through sprinkler irrigation systems to corn in all growth stages, is investigated. The dual isotopes δ15NNO3 and δ18ONO3 were measured in groundwater samples from 39 irrigation wells in two intensively sprinkler-irrigated, corn-growing areas of Nebraska with nitrate-contaminated (N > 10 mg/L) groundwater and documented UAN use to ascertain whether nitrified ammonia and nitrate fertilizers can be distinguished in the High Plains aquifer. The areas, which are highly vulnerable to nitrate leaching and differ only in the composition and thickness of their unsaturated zones, are uniquely suited to provide scientific evidence of the feasibility of identifying nitrate fertilizer leachate in groundwater and thereby add significantly to the small body of existing and inconclusive data. The dual isotope method (DIM) results indicate that the nitrate contamination in 38 wells is mostly nitrified ammonium fertilizer. Most importantly, nitrate fertilizer from UAN was not identified isotopically in groundwater beneath almost all fields with documented heavy UAN use. This could be a potentially valuable finding for fertilizer management or it could convey limitations on the appropriateness of the DIM for nitrate fertilizer source identification in groundwater. Slightly enriched δ15NNO3 values in a few wells coincide with the practice of wintering cattle on corn stubble, which reportedly occurred more frequently in one focus area. The absence of natural soil-N leachates and denitrification in groundwater enabled an apparently reliable identification of manure leachates in both areas.

Survival of patients following neurosurgical treatment of colorectal adenocarcinoma metastasis in the Northern Sydney-Central Coast area.

Cerebral metastases from gastrointestinal primaries constitute about 3-5% of surgically resected brain secondaries. There has been a paucity of regional and worldwide data concerning the survival and clinical course of patients undergoing neurosurgical treatment of cerebral metastases from colorectal origin. The clinical course and survival of 32 patients undergoing neurosurgical intervention for colorectal carcinoma metastases between 1999 and 2007 was examined. The 21 male and 11 female patients examined had a median age of 61.8 years at diagnosis of colorectal cancer; median interval between colorectal cancer diagnosis and cerebral metastatic disease was 27.6 months; and 88% of patients underwent microsurgical resection. Median survival from neurosurgical intervention was 7.5 months. Perioperative mortality was 3%. Age, gender and infratentorial location of lesions had no significant impact on survival. Patients undergoing whole brain radiotherapy (WBRT) had a significantly longer survival than those not undertaking this treatment (median survival 10.6 vs. 5.2 months, p = 0.018). A randomised, controlled trial of the utility of WBRT following surgical resection in this tumour subtype seems appropriate.