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Abstract Young children receiving outpatient cancer care are vulnerable to undermanaged pain. App‐based solutions that provide pain treatment advice to parents in real‐time and in all environments may improve access to quality pain care. We used a parent co‐design approach involving iterative rounds of user testing and software modification to develop a usable Pain Caregiver Resource (PainCaRe) real‐time pediatric cancer pain management app. Parents of children (2–11 years) with cancer completed three standardized modules using a PainCaRe prototype. App usability and acceptability were evaluated using the validated System Usability Scale and a thematic analysis of app testing sessions and interviews. Iterative testing sessions were conducted until data saturation. Interview themes were synthesized into action items that guided revisions to PainCaRe and additional testing rounds were conducted as necessary. Twenty‐two parents participated in three testing cycles. Overall, parents described PainCaRe as an acceptable and potentially clinically useful pain management tool. Mean system usability scores were in the acceptable scale range during each testing cycle. Usability issues identified and resolved included those related to software malfunction, complicated app navigation logic, lack of clarity on pain assessment questions, and the need for pain management advice specifically tailored to child developmental stage. Using co‐design methods, the PainCaRe cancer pain management app was successfully refined for its acceptability and utility to parents. Next steps will include a PainCaRe pilot study before evaluating the impact of the app on younger children's pain outcomes in a randomized controlled trial.

Background The role of rescue stenting (RS) in acute ischemic strokes due to intracranial atherosclerotic disease–related large vessel occlusion is an area of active investigation. This study evaluates the efficacy and safety of RS under these circumstances. Methods A systematic literature review, conforming to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, was conducted across PubMed, EMBASE, Cochrane, and OVID databases. Common and random effects analyses were conducted to compare outcomes including modified Rankin Scale score, 90‐day mortality, and symptomatic intracranial hemorrhage between patients receiving and those not receiving RS after failed endovascular thrombectomy within posterior circulation. Results Ten studies comprising 1202 patients (730 RS, 472 control) were analyzed. RS was associated with a statistically significant improvement in functional outcomes, evidenced by a higher proportion of patients achieving modified Rankin Scale score ≤2 at 90 days (32.74% versus 21.19% in controls; P

Introduction Intracranial atherosclerotic disease (ICAD) is associated with up to 32% of posterior circulation strokes.1 ICAD‐related strokes are at high risk for re‐occlusion following MT. Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. However, these rescue treatments are associated with their own risks.2,3 The SAMMPRIS trial reported that percutaneous transluminal angioplasty and stenting (PTAS) was associated with inferior outcomes compared to aggressive medical management alone but it is unclear whether these findings are generalizable to LVO strokes.4 Recent literature has reported clinical benefits associated with rescue stenting in the setting of ICAD‐related MT‐refractory strokes.5 However, most of the existing literature focuses on anterior circulation. This meta‐analysis aims to analyze the literature regarding the efficacy and safety of post‐thrombectomy PTAS in ICAD‐related posterior circulation strokes. Methods The search strategy was developed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.6 Using the common evidence medicine framework PICOS (Patient Population, Intervention, Control/Comparison, Outcome, and Study type), we specified our research question: “In patients with posterior circulation AIS who underwent endovascular thrombectomy but failed to recanalize or who had severe stenosis, is PTAS an effective and safe rescue treatment option?” An electronic search of PubMed, EMBASE, Cochrane and OVID databases was performed from date of database inception to March 2023. Data was collected and analyzed using “Meta” package in RStudio.7 Outcomes of interest included 90 day modified Rankin score (mRS) and 90‐day mortality. Results A total of 10 studies were collected, but only 7 double‐arm studies involving 965 participants were included in this analysis. Among these patients, 544 underwent rescue stenting, while 421 were control patients. In a common effects meta‐analysis, patients who underwent stenting were more likely to have an mRS ≤ 2 at 90 days (OR 1.73, 95% CI [1.25 – 2.37]; p < 0.001) and lower odds of mortality at 90 days (OR 0.31, 95% CI [0.23 – 0.42]; p < 0.001). Additionally, patients undergoing stenting were less likely to have symptomatic intracranial hemorrhage (sICH) (OR 0.34, 95% CI [0.17 ‐ 0.67]; p = 0.002). Furthermore, the stenting group showed significantly higher odds of achieving a modified treatment in cerebral ischemia score (mTICI) of 2b‐3 when compared to the control group (OR 11.32, 95% CI [6.54 ‐ 19.59]; p < 0.001). Conclusion PTAS appears to be an effective and safe treatment for ICAD after MT in the posterior circulation both improving likelihood of good outcomes and overall survival. Given the uncertainty of applying the results of the SAMMPRIS trial to LVOs, further research is needed to better assess the efficacy and safety of PTAS in this patient population.