Patrick J. McDonald

Industry Financial Relationships in Neurosurgery in 2015: Analysis of the Sunshine Act Open Payments Database

OBJECTIVEnThe 2013 Physician Payments Sunshine Act mandates that all U.S. drug and device manufacturers disclose payments to physicians. All payments are made available annually in the Open Payments Database (OPD). Our aim was to determine prevalence, magnitude, and nature of these payments to physicians performing neurologic surgery in 2015 and to discuss the role that financial conflicts of interest play in neurosurgery.nnnMETHODSnAll records of industry financial relationships with physicians identified by the neurological surgery taxonomy code in 2015 were accessed via the OPD. Data were analyzed in terms of type and amounts of payments, companies making payments, and comparison with previous studies.nnnRESULTSnIn 2015, 83,690 payments (totaling

Transitioning in hydrocephalus: Current practices in Canadian Paediatric Neurosurgery centres

99,048,607) were made to 7613 physicians by 330 companies. Of these, 0.01% were >

Conflict of interest policies and disclosure requirements in neurosurgical journals

1 million, and 73.2% were <

Non-surgical transient cerebellar mutism—case report and systematic review

100. The mean payment (

Googling concussion care in the USA: a critical appraisal of online concussion healthcare providers

13,010) was substantially greater than the median (

Head Transplants: Ghoulish Takes on New Definition

114). Royalties and licensing accounted for the largest monetary value of payments (74.2%) but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%) but accounted for only 2.5% of total reported monetary value. Neurologic surgery had the second highest average total payment per physician of any specialty.nnnCONCLUSIONSnThe neurological surgery specialty receives substantial annual payments from industry in the United States. The overall value is driven by a small number of payments of high monetary value. The OPD provides a unique opportunity for increased transparency in industry-physician relationships facilitating disclosure of financial conflicts of interest.

P.120 Conflict of interest in neurosurgery: an analysis of disclosure policies in neurosurgical journals

IntroductionnAdvances in perinatal care in the developed world have resulted in more children living into adulthood with complex chronic health conditions. Transition is a process to improve and maximize the functional status of adolescents via the provision of adequate and appropriate health services in adulthood. This process is frequently disjointed, fragmented and inconsistent and inadequate transition increases morbidity, hospital admissions and urgent interventions. Ten thousand children are diagnosed with hydrocephalus annually in North America. Most survive to adulthood yet there are few transitioning programs and little research data on successful programs for this population.nnnMethodsnAn email survey of paediatric neurosurgical centres in Canada was carried out to establish current transition practices and attitudes for adolescents with hydrocephalus. Data were analyzed descriptively.nnnResultsnEleven out of 12 centres responded. The age of transition ranged from 16 to 18 years. Four centres have access to a dedicated Adult Hydrocephalus Clinic. Referral practices vary between centres and we highlight inconsistencies in care to this cohort of patients in Canada. There is little satisfaction among neurosurgeons with current transition arrangements in Canada. Several suggestions were made on how to improve this process.nnnConclusionnWe recommend research into the needs of patients with hydrocephalus in order to formalize appropriate standards for transitioning patients with a view to developing national guidelines to standardize the transition process. This will require input from patients, families and the wider medical and allied health professional groups.

P.119 Industry relationships with neurological surgery in the 2015 Open Payments Database

OBJECTIVEAn increasing amount of funding in neurosurgery research comes from industry, which may create a conflict of interest (COI) and the potential to bias results. The reporting and handling of COIs have become difficult, particularly as explicit policies themselves and definitions thereof continue to vary between medical journals. In this study, the authors sought to evaluate the prevalence and comprehensiveness of COI policies among leading neurosurgical journals.METHODSThe authors conducted a cross-sectional study of publicly available online disclosure policies in the 20 highest-ranking neurosurgical journals, as determined by Google Scholar Metrics, in July 2016.RESULTSOverall, 89.5% of the highest-impact neurosurgical journals included COI policy statements. Ten (53%) journals requested declaration of nonfinancial conflicts, while 2 journals specifically set a time period for COIs. Sixteen journals required declaration from the corresponding author, 13 from all authors, 6 from reviewers, and 5 from editors. Four journals were included in the International Committee of Medical Journal Editors (ICMJE) list of publications that follow the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (currently known as Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals). Five journal policies included COI declaration verification, management, or enforcement. The neurosurgery journals with more comprehensive COI policies were significantly more likely to have higher h5-indices (p = 0.003) and higher impact factors (p = 0.01).CONCLUSIONSIn 2016, the majority of, but not all, high-impact neurosurgical journals had publically available COI disclosure policies. Policy inclusiveness and comprehensiveness varied substantially across neurosurgical journals, but COI comprehensiveness was associated with other established markers of individual journals favorability and influence, such as impact factor and h5-index.

Multi-disciplinary management of paediatricpediatric sports-related concussion: early experience of the pan am concussion program

IntroductionTransient cerebellar mutism has been well recognized in literature as a complication of posterior fossa tumor resection. It is marked by profound impairment of fluency, articulation, and modulation of speech, irritability and autistic features and typically resolves within days to months. Underlying pathophysiology is debated, but currently unknown.MethodsWe present a case of a child with similar clinical findings after cerebellitis, demonstration of diffuse cerebellar signal changes, swelling, and protruding tonsils at the level of foramen magnum.DiscussionTo support the hypothesis that this clinical syndrome may occur in a non-surgical context, we present a review of literature of non-surgical transient cerebellar mutism.

AT-22ALISERTIB MONOTHERAPY IN THE TREATMENT OF RELAPSED ATYPICAL TERATOID RHABDOID TUMOR (ATRT)

Aim: To examine the online personnel and practice profiles of concussion healthcare providers in the USA. Methods: We conducted independent, blinded, Google Internet searches for concussion healthcare providers using the terms ‘concussion clinic’ and ‘concussion program’ and each American state and completed a critical appraisal of healthcare personnel and services at these websites. Results: A total of 184 concussion healthcare providers were identified. Despite offering care to traumatic brain injury (TBI) patients, access to professionals with expertise in TBI including neuropsychologists (40.8%), neurologists (33.7%) and neurosurgeons (21.7%) was variable across sites. Conclusion: Concussion healthcare in the USA is presently delivered by a range of healthcare professionals with varying levels of training in TBI offering a variety of services.