Aims and MethodQuantifying the relationship between waiting time and clinic attendance in child and adolescent psychiatry would allow better estimation of the resources needed to eliminate waiting lists in specific initiatives. All cases on a waiting list were sent a questionnaire, return of the questionnaire being necessary for an appointment to be made. Those who did not return the questionnaire or did not attend were contacted and a reason obtained whenever possible. The data were analysed using Cox regression.ResultsMost who did not return their questionnaires had been waiting less than four weeks or longer than 30 weeks. Questionnaire return seemed a good estimate of intention to attend. Other factors improving questionnaire return were younger patient age, previous experience of the service, a clear common reason for referral, and a non-general practitioner referral source.Clinical ImplicationsWaiting lists in child and adolescent psychiatry may have a natural ‘endpoint’ at 30 weeks beyond which families give up, while waiting lists of less than one-month may be too short to lose transient problems. Failure to include this and other indicators of non-attendance may lead to overestimates of resources needed to remove queues for treatment. Questionnaires may be useful in identifying those intending to attend.

InterpretationPhysicians frequently do not discuss the implications of driving with brain tumour patients or are not properly documenting such advice (or both). Clear and concise reporting guidelines need to be drafted given the legal, medical, and ethical concerns surrounding this public health issue.

Medulloblastoma is one of the most common pediatric CNS malignancies and the most common primary tumor of the posterior fossa in children. Medulloblastoma can present with leptomeningeal seeding in up to 33% of patients at presentation. Primary leptomeningeal medulloblastoma without a discrete parenchymal mass has been reported 6 times in the literature to date, in both the pediatric and adult populations. This report aims to review the literature of these rare cases and present the first case of a primary leptomeningeal medulloblastoma with a desmoplastic/nodular subtype.

Background: Neurocognitive impairments from brain tumours may interfere with the ability to drive safely. In 9 of 13 Canadian provinces and territories, physicians have a legal obligation to report patients who may be medically unfit to drive. To complicate matters, brain tumour patients are managed by a multidisciplinary team; the physician most responsible to make the report of unfitness is often not apparent. The objective of the present study was to determine the attitudes and reporting practices of physicians caring for these patients. Methods: A 17-question survey distributed to physicians managing brain tumour patients elicited: (1) Respondent demographics; (2) Knowledge about legislative requirements; (3) Experience of reporting Barriers and attitudes to reporting. Fisher exact tests were performed to assess differences in responses between family physicians (fps) and specialists. Results: Of 467 physicians sent surveys, 194 responded (42%), among whom 81 (42%) were specialists and 113 (58%) were fps. Compared with the specialists, the fps were significantly less comfortable with reporting, less likely to consider reporting, less likely to have patients inquire about driving, and less likely to discuss driving implications. A lack of tools, concern for the patient–physician relationship, and a desire to preserve patient quality of life were the most commonly cited barriers in determining medical fitness of patients to drive. Conclusions: Legal requirements to report medically unfit drivers put physicians in the difficult position of balancing patient autonomy and public safety. More comprehensive and definitive guidelines would be helpful in assisting physicians with this public health issue.

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