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The most common PC information needs were as follows for patients, disease course/prognosis (n = 10), general disease information (n = 9), decision-making (n = 7) and symptoms (n = 6); for caregivers, services and resources (n = 15), disease course/prognosis (n = 14), general disease information (n = 13) and skills (n = 10). There was substantial variability in information needs, both between patients and caregivers and among members of the same group.

ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.

ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.

Cardiopulmonary resuscitation is one of the most important end-of-life care decisions. However, the experience of bereaved families during code status discussions is not well documented.

The aims of this study were to describe the degree of emotional distress of bereaved families when discussing code status, identify their perceived areas for improvement and determine associated factors.

This study is part of a nationwide post-bereavement survey, the Japan Hospice and Palliative care Evaluation 3 (J-HOPE3) study. Questionnaires were sent to the relatives of cancer patients who had died in palliative care units in Japan in 2014.

From an analysis of 338 questionnaires, 37% of families reported high emotional distress during code status discussions and 32% reported a need for improvement. Multiple logistic regression analyses revealed the following were associated with high-level distress the family had hoped for the miraculous and spontaneous recovery of the patient (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.31-4.43, P = 0.0049), the family felt they could not voice their opinion about Cardiopulmonary resuscitation (OR 2.07, CI 1.12-3.81, P = 0.02), or the physician failed to adapt the explanation to the family's preparation level (OR 0.36, CI 0.18-0.68, P = 0.0015). Factors identified for improvement were holding discussions in a relaxing atmosphere conducive to questioning (OR 0.36, CI 0.16-0.80, P = 0.012), and ensuring the physician adapted the explanation to the family's preparation level (OR 0.47, CI 0.23-0.96, P = 0.037).

We recommend the development of educational programs for code status discussions to improve the experience of bereaved family members.

We recommend the development of educational programs for code status discussions to improve the experience of bereaved family members.

American Heart Association/American Stroke Association guidelines recommend endovascular stroke therapy (EST) with recombinant tissue plasminogen activator (rt-PA) for eligible patients in acute ischemic stroke (AIS). Using the National Inpatient Sample database, we evaluated trends in treatment with rt-PA and EST for AIS and their outcomes.

This is a cross-sectional observational study of patients with AIS admitted in US hospitals from 2012 to 2016. Patients were grouped into those who received rt-PA alone, EST alone, and rtPA+EST. Survey statistical procedures were performed. selleck kinase inhibitor Multivariable regression analysis with pairwise comparisons of each treatment group with no treatment group was performed for discharge outcomes.

The study included 2,290,520 patients with AIS with the mean age of 70.46 years. Treatment rates increased from 2012 to 2016 for rt-PA by 7% per year (5.86%-7.67%, odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.05-1.08) and EST by 38% per year (0.55%-1.75%, OR= 1.38, 95% CI 1.31-1.45) but not rt-PA+EST (0.54%-0.57%, OR= 1.04, 95% CI 0.99-1.08). The mean length of stay reduced from 2012 to 2016 for rt-PA (6.07-4.91 days, P < 0.0001) and rt-PA+EST (9.19-7.10 days, P=0.0067) but not for EST (9.61-8.51 days, P= 0.5074). The odds of patients discharged home increased by 8%, 9%, and 15% among patients who received rt-PA alone, EST alone, and rt-PA+EST, respectively, compared with no treatment group.

The utilization of rt-PA alone and EST alone increased but that of rt-PA+EST remained unchanged from 2012 to 2016 in the National Inpatient Sample.

The utilization of rt-PA alone and EST alone increased but that of rt-PA+EST remained unchanged from 2012 to 2016 in the National Inpatient Sample.

Global use of telemedicine has increased rapidly during the coronavirus disease 2019 (COVID-19) pandemic to bridge the gap in existing health care services. Intercontinental trends in neurosurgeons' perception and practices of telemedicine have been sparingly reported.

We conducted an online anonymized and validated survey using a structured questionnaire to gain insight into neurosurgeons' experience with telemedicine across various continents and rated its usefulness on a 5-point Likert scale.

We received 286 responses across 5 continents. There was a trend to support a major paradigm shift favoring teleconsultations during the COVID-19 pandemic in respondents from North America (P= 0.06). Signed prescriptions were e-mailed along with video-based teleconsultations preferentially in Europe and North America. In comparison, audio- or text-based teleconsultations along with unsigned prescriptions were prevalent in Asia and Africa (P= 0.0005). Acceptability and perceived usefulness for telemedicine during the pandemic were similar across the globe, regardless of neurosurgeons' experience (mean satisfaction score 3.72 ± 1.09; P= 0.62). A majority of neurosurgeons from Asia and South America complained of difficulties during teleconsultations owing to lack of appropriate infrastructure, internet connectivity/prescription-related issues, and potential risk of litigation (P= 0.0005). Approximately 46% of neurosurgeons, predominantly from Europe and North America, thought that telemedicine could play a vital role in clinical practice even after the COVID-19 pandemic subsides (mean satisfaction score 3.26 ± 1.16; P= 0.007).

Telemedicine in neurosurgery is a viable alternative to physical outpatient services during the COVID-19 pandemic and could potentially play a vital role after the pandemic.

Telemedicine in neurosurgery is a viable alternative to physical outpatient services during the COVID-19 pandemic and could potentially play a vital role after the pandemic.