Impact of Prehospital Pain Management on Emergency Department Management of Injured Children.

OBJECTIVE: Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS: This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS: We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS: We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.

Parental perception of a picture-based chronic asthma care management tool in an urban pediatric emergency department.

BACKGROUND: National asthma guidelines recommend use of an asthma action plan (AAP) as part of chronic asthma care. Unfortunately, AAPs have not been tailored for use in acute care settings, where many patients at risk for poor chronic asthma care are seen, including those who are non-English-speaking or have low literacy levels. We previously developed a picture-based medication plan (PBMP), a unique type of AAP for use in an ambulatory setting and designed to increase patient use and understanding. However, little is known about how parents seeking emergency department (ED) asthma care would perceive the PBMP. OBJECTIVE: To assess parental attitudes toward an asthma PBMP in the largest pediatric ED in Los Angeles County. METHODS: We surveyed a consecutive sample of English- or Spanish-speaking parents of children 2-17 years seeking ED asthma care. Parents used a 5-point Likert scale for various statements regarding their perceptions of the PBMP. Responses were analyzed by sociodemographics, asthma control, and health literacy using Chi-squared and t-tests. RESULTS: 90 parents provided feedback on the PBMP. The majority of parents endorsed the PBMP. Endorsement was 20%-30% higher among Spanish-speaking parents and those who did not complete high-school compared to English-speaking parents and parents with a high school education or higher (p < 0.05 for both comparisons). CONCLUSION: Spanish-speaking parents and parents with less than a high-school education overwhelmingly endorsed the PBMP. It may be useful to consider incorporating the PBMP as part of patient-centered chronic asthma care strategies for populations seen in ED settings.

Genome-wide association study of bipolar I disorder in the Han Chinese population.

We report the first genome-wide association study in 1000 bipolar I patients and 1000 controls, with a replication of the top hits in another 409 cases and 1000 controls in the Han Chinese population. Four regions with most strongly associated single-nucleotide polymorphisms (SNPs) were detected, of which three were not found in previous GWA studies in the Caucasian populations. Among them, SNPs close to specificity protein 8 (SP8) and ST8 α-N-acetyl- neuraminide α-2,8-sialyltransferase (ST8SIA2) are associated with Bipolar I, with P-values of 4.87 × 10(-7) (rs2709736) and 6.05 × 10(-6) (rs8040009), respectively. We have also identified SNPs in potassium channel tetramerization domain containing 12 gene (KCTD12) (rs2073831, P=9.74 × 10(-6)) and in CACNB2 (Calcium channel, voltage-dependent, ß-2 subunit) gene (rs11013860, P=5.15 × 10(-5)), One SNP nearby the rs1938526 SNP of ANK3 gene and another SNP nearby the SNP rs11720452 in chromosome 3 reported in previous GWA studies also showed suggestive association in this study (P=6.55 × 10(-5) and P=1.48 × 10(-5), respectively). This may suggest that there are common and population-specific susceptibility genes for bipolar I disorder.

Prospective comparison of Fibroscan, King's score and liver biopsy for the assessment of cirrhosis in chronic hepatitis C infection.

Historically, liver biopsy (LB) was the sole method to evaluate the severity of hepatic fibrosis in patients with chronic hepatitis C infection. However, LB is expensive and associated with a risk of severe complications. Therefore, noninvasive tests have been developed to assess the severity of liver fibrosis. The accuracy of Fibroscan (FS) and King's score (KS) was evaluated individually and in combination using liver histology as the reference standard. One hundred and eighty-seven patients were identified who had undergone a biopsy with a diagnosis of chronic hepatitis C virus (HCV) mono-infection (HCV RNA-positive by RT-PCR), attending King's College Hospital (n = 88) or the Royal Free Hospital (n = 99) (London) between May 2006 and December 2007. Liver fibrosis was scored using the Ishak method; significant fibrosis was defined as Ishak fibrosis stage F3-F6, and cirrhosis defined as Ishak fibrosis F5-F6. The diagnostic accuracy of each test was assessed by area under receiver operator characteristic curves (AUROC). Median age was 49 years (43-54) and 115 (61%) were male. The AUROC for FS, KS and FS + KS for the diagnosis of Ishak F3-F6 were 0.83, 0.82 and 0.85, respectively and for the diagnosis of cirrhosis (>or=F5) were 0.96, 0.89 and 0.93, respectively. The negative predictive values for the diagnosis of cirrhosis using the optimal cut-off results for fibrsocan (10.05 kPa), KS (24.3) and the two combined (26.1) were 98%, 91% and 94%, respectively. The noninvasive markers and, particularly, FS were effective tests for the prediction of cirrhosis in chronic hepatitis C. Both KS and FS also had clinical utility for the prediction of Ishak fibrosis stages F3-F6.

A simple, noninvasive test for the diagnosis of liver fibrosis in patients with hepatitis C recurrence after liver transplantation.

Recurrent hepatitis C is a common cause of graft loss in patients undergoing liver transplantation, and serial protocol liver biopsies have been used to identify patients at risk of graft loss from rapid fibrosis progression. The aim of this study was to derive a simple noninvasive index to predict fibrosis in patients with recurrent hepatitis C post-transplant. A retrospective study was performed assessing serial liver biopsies for post-transplant chronic hepatitis C infection. One hundred eighty-five patients were included in the analysis; median age 53 years (interquartile range 48-59) and 140 (76%) were male. Liver histology showed 53 (29%) had Ishak fibrosis stages F0/F1, 31 (17%) had F2, 29 (16%) had F3, 19 (10%) had F4 and 53 (29%) had F5/F6. The London Transplant Centres' (LTC) score was derived combining aspartate aminotransferase (AST IU/L), time from liver transplant (TFLT months), international normalized ratio and platelets. Diagnostic accuracy of the LTC score was assessed using area under receiver-operating characteristic (ROC) curves. The area under the ROC curve for moderate fibrosis (F >or= 2) was 0.78 (95% CI, 0.70-0.86; P < 0.0001), for advanced fibrosis (F4-6) was 0.80 (95% CI, 0.72-0.87; P < 0.0001) and for cirrhosis was 0.80 (95% CI, 0.72-0.88; P < 0.0001). An optimal cut-off value of 6.3 distinguished patients with no or mild fibrosis (F

Self-motivated learning with gamification improves infant CPR performance, a randomised controlled trial.

Background: Effective paediatric basic life support improves survival and outcomes. Current cardiopulmonary resuscitation (CPR) training involves 4-yearly courses plus annual updates. Skills degrade by 3-6 months. No method has been described to motivate frequent and persistent CPR practice. To achieve this, we explored the use of competition and a leaderboard, as a gamification technique, on a CPR training feedback device, to increase CPR usage and performance. Objective: To assess whether self-motivated CPR training with integrated CPR feedback improves quality of infant CPR over time, in comparison to no refresher CPR training. Design: Randomised controlled trial (RCT) to assess the effect of self-motivated manikin-based learning on infant CPR skills over time. Setting: A UK tertiary children's hospital. Participants: 171 healthcare professionals randomly assigned to self-motivated CPR training (n=90) or no refresher CPR training (n=81) and followed for 26 weeks. Intervention: The intervention comprised 24 h a day access to a CPR training feedback device and anonymous leaderboard. The CPR training feedback device calculated a compression score based on rate, depth, hand position and release and a ventilation score derived from rate and volume. Main outcome measure: The outcome measure was Infant CPR technical skill performance score as defined by the mean of the cardiac compressions and ventilations scores, provided by the CPR training feedback device software. The primary analysis considered change in score from baseline to 6 months. Results: Overall, the control group showed little change in their scores (median 0, IQR -7.00-5.00) from baseline to 6 months, while the intervention group had a slight median increase of 0.50, IQR 0.00-33.50. The two groups were highly significantly different in their changes (p<0.001). Conclusions: A significant effect on CPR performance was demonstrated by access to self-motivated refresher CPR training, a competitive leaderboard and a CPR training feedback device.

Lack of pharmacokinetic interaction between buspirone and haloperidol in patients with schizophrenia.

The pharmacokinetic interaction between buspirone and haloperidol was evaluated in schizophrenic patients in two different groups. In both groups, haloperidol doses (10-40 mg/day) remained constant for 6 weeks before the addition of buspirone 10 mg three times daily. Serial blood samples were obtained from the 11 patients in group I at baseline (before addition of buspirone) and after administration for 24 hours. The pharmacokinetic parameters of haloperidol were determined alone and with coadministration of buspirone. In group II, buspirone 10 mg three times daily was added to treatment with haloperidol in 27 patients. Blood samples were obtained before addition of buspirone and at weeks 2 and 6 of treatment with buspirone. Samples were obtained 10 to 12 hours after administration of the evening dose and before the morning dose. Haloperidol and its metabolite, reduced haloperidol (RH), were assayed by means of high-performance liquid chromatography with electrochemical detection. Significant changes in the pharmacokinetic parameters of haloperidol were not found in group I; a mean increase in the half-life (t1/2) of haloperidol from 21.5 to 28.1 hours was observed, but this finding was not statistically significant. Under steady-state conditions, plasma levels of haloperidol in the patients in group II did not change significantly from baseline to week 6. Plasma concentrations of RH remained unaltered in both groups. The results indicate that coadministration of buspirone does not markedly affect the pharmacokinetics or plasma concentrations of haloperidol.

The willingness of families caring for victims of stroke to pay for in-home respite care--results of a pilot study in Taiwan.

This contingent survey was designed to investigate the willingness of family caregivers of stroke victims to pay for in-home respite care. Between September 1996 and December 1996, a designated family member from each family of 174 vascular accident patients hospitalized in the Taipei Metropolitan Area, including two medical centers, received the first interview during preparation and planning for discharge of the patient from the hospital, and follow up interview in their own homes at the end of the second month after the patient was discharged from the hospital. A willingness to pay for in-home respite care was measured as the percentage of monthly family income which would be sacrificed to receive the respite care. Logistic regressions were used to perform multivariate analysis. The willingness to pay for respite care ranged from US$ 363 to 2182, and 42.5% of the family caregivers interviewed indicated a willingness to pay at least 50% of monthly family income for respite care. Family income was strongly associated with the amount of money that family caregivers were willing to pay for respite care. After results were adjusted for the effect of variance in income level, the degree of dependence of patients on the caregiver was significantly associated with the percentage of monthly family income for respite care. The more severe the physical dysfunction of patient, the higher the willingness to pay for in-home respite care utilization. Initially, respite care could be provided to families caring for patients with severe dysfunction, and then the scope enlarged to include caregivers taking care of patients with mild dysfunction.

The effectiveness of systematic stroke care.

A coordinated, multidisciplinary approach had been applied to enhance the effectiveness of stroke care with varying enthusiasm; however, the effectiveness of this kind of stroke treatment model was noted in many studies. This study was designed to measure the effectiveness of systematic stroke management on the physical-functional outcome in terms of Activities of Daily Living (ADLs) scores. The higher the ADLs score, the higher the degree of physical disability, i.e., the higher the degree of dependence. Eighty-six stroke patients from the Department of Neurology in a medical center, and 88 stroke patients from the Department of Medicine in a local hospital were followed from the admission day to the discharged date. The effectiveness of stroke care in each hospital was measured by the comparisons between ADLs scores at discharge and ADLs scores at admission. Two-sample tests show that demographic characteristics, length of stay, average time elapsed since the occurrent stroke, number of families in caregiving, and ADLs scores at admission and at discharge did not differ much between these two groups. The improved ADLs scores for stroke patients treated in the Department of Neurology of the medical center were changed from the 14.1 +/- 4.9 at admission to 12.1 +/- 5.2 at discharge, and the changes of ADLs scores for patients treated in the Department of Medicine of the regional hospital was from 12.8 +/- 5.1 to 12.3 +/- 5.5 according to the degree of improvement. The significant finding was that the degree of improvement of ADLs scores for CVA patients from the medical center was significant (Wilcoxon Matched-Pairs Signed-Ranks Test, Z = -2.8, p < 0.01). Moreover, the degree of improvement of ADLs scores strongly differed between these two groups (Repeated measures of two-way ANOVA, F = 6.0, p < 0.05). The information presented here informs us that degree of physical-functional status of stroke patients should be improved because of the systematic stroke management.

Cauda equina syndrome and dural ectasia: rare manifestations in chronic ankylosing spondylitis.

Cauda equina syndrome (CES) is a rare manifestation in patients with long-standing ankylosing spondylitis (AS). We report a 57-year-old male patient with a 30-year history of AS who developed CES in the past 4 years. The CT and MRI examinations showed unique appearances of dural ectasia, multiple dorsal dural diverticula, erosion of the vertebral posterior elements, tethering of the conus medullaris to the dorsal aspect of the spinal canal and adhesion of the nerve roots of the cauda equina to the wall of the dural sac. A large dural defect was found at surgery. De-adhesion of the tethered conus medullaris was performed but without significant clinical improvement. The possible aetiologies of CES and dural ectasia in patients with chronic AS are discussed and the literature is reviewed.

Cost comparisons between family-based care and nursing home care for dementia.

A prospective study was carried out in Taiwan to measure the family cost of caregiving at home for 289 patients newly diagnosed with dementia (106 with senile-type dementia, 171 with vascular-type dementia). Their families were first interviewed in the outpatient department and then followed for 1 month after the dementia diagnosis was made. Simultaneously, the costs for providing nursing home care to patients with dementia were calculated using accounting data reported from six nursing homes. Comparisons were made between the amount and type of cost encountered by families and by nursing homes to determine whether family-based care was cheaper and more appropriate than nursing home care for dementia patients with different functional levels. The results showed that higher costs were encountered for caregiving at home when the patients had severe dependence. This tendency was more evident for patients with senile dementia than for patients with vascular-type dementia. The cost of labour was an important expense for families caring for patients at home (at least 85% of family costs). Our findings suggest that, when family labour cost is considered, nursing home care is less expensive than family-based care for long-term care, especially for dementia patients with severe or moderate dependence. Nursing home care is also a better choice when patients have great need for multiple health services.

Estimation of costs due to hospitalization for first-ever stroke patients in northern Taiwan.

BACKGROUND: The need for healthcare services and the related costs for stroke patients may rise steadily in the future. Even with the predictable and substantial burden of stroke, little effort has been devoted to measuring the population-based direct medical and nonmedical costs in Taiwan. METHODS: Data from the study "Epidemiological Study of Stroke, Diabetes, and Cardiovascular Disease," which included 8,705 people older than 35 years of age, and the study "Costs of Stroke," which included 660 first-ever stroke patients, were used for the cost calculations. The cost of hospital care for stroke patients was obtained in two steps. First, the incidence of stroke and readmissions within one year were tallied; the sum was then multiplied by the average length of stay. Second, the total medical and nonmedical costs were divided by the sum obtained from step 1. The resulting quotient obtained was the cost of hospital care for stroke patients per day. RESULTS: There were 6,691 incidents of stroke and stroke-related readmissions in 1995 (4,041 men and 2,650 women). The total person-days of hospital stay were 233,569 days (144,264 for men and 89,305 days for women). The average medical and nonmedical costs of hospital care per person-day was US $251.4 (NT $6,788 at an exchange rate of US $1 = NT $27). Cost for men (US $287, NT $7,749) was more than for women (US $208, NT $5,616). The total direct costs of hospital care were US $58,710,000 (NT $1,585,000,000) in 1995. CONCLUSIONS: An average of US $1,682,000 (NT $45,410,000) in hospital care costs for stroke could have been saved in 1995 if the person-day stay had been decreased by only one day.

Willingness of families caring for victims of dementia to pay for nursing home care: results of a pilot study in Taiwan.

In order to examine the value family caregivers attach to the benefits associated with nursing home services, this contingent survey was designed to investigate the willingness of family caregivers of dementia victims to pay for nursing home care. A total of 136 members of families of dementia patients from the department of neurology and psychiatry of four medical centers in Taiwan were interviewed by phone. These family members provided in-home care for dementia victims and had expressed the need for nursing home placement. These family caregivers were asked to explicitly state the maximum amount of family income per month they are able to give up to receive nursing home services. The willingness to pay (WTP) for nursing home care ranged from US$185 to $2,407 per month, and 37.5 percent of the family caregivers interviewed indicated a willingness to pay at least 50 percent of the monthly family income for nursing home placement. The amount of monthly family income was strongly associated with the WTP for nursing home care in dollars. Age and education of the caregiver, and accessibility of nursing home care were significantly associated with WTP in both cost range and percentage of monthly family income. Interviewees who were older than 65 years (odds ratio is 3.52), and educated equal to or above senior high school (odds ratio is 5.57) were inclined to pay at least 50 percent of monthly family income for nursing home placement. As other variables were adjusted, respondents older than 65 years were willing to pay US$208.4 per month more than those younger than 65 years for nursing home placement; and the educated equal to or above senior high school were inclined to pay US$171.9 per month more than those with less than a senior high school education. The easier it was to find nursing home agencies near the residence, the more willing the family was to pay at least 50 percent of their monthly family income for nursing home services; with an odds ratio of 16.51. The families with the higher accessibility to nursing home agencies were willing to pay US$174.3 per month more than caregivers with lower accessibility. Family caregivers, who were older than 65 years, educated above the senior high school level, with a higher family income, and easier accessibility to nursing home services, were likely to attach higher economic values to nursing home placement.

Analysis of costs borne by families of patients hospitalized for stroke.

BACKGROUND: Studies focusing on the economic impact of cancer on families have emphasized that costs of chronic disease are substantial for patients and their families. However, little effort has been devoted to measuring the costs of care for families of patients hospitalized with stroke. METHODS: A total of 215 stroke patients and their families from four teaching hospitals in the Taipei metropolitan area were monitored from the date of the patient's admission to hospital until the date of discharge. The value of labor contributed by families was estimated by assigning the current monetary market rate of providing health aide to the time families spent caring for patients in hospital. Lost earnings of patients and families, expenditure for medical care, and expenses for food, clothes, adult diapers, transportation and other miscellaneous items were determined and summed to arrive at the total family cost of providing care. RESULTS: The average cost of care for one family per inpatient day was NT$4,358.20. A total of 98.6% of the families incurred labor costs, which accounted for about half of family costs for providing care. Hospital bills accounted for almost 19% of total family costs. The income loss for families and patients accounted for about 25% of total family costs. Expenses for food, clothes, transportation, diapers and other illness-related miscellaneous items accounted for about 12% of total family costs. Multiple regression analyses demonstrated that the number of family members involved in giving care and the length of stay are important predictors for the total cost of care. Average total family costs per day increased by 24.3% when an additional family member was involved in providing care. Total family costs increased 2.5% for each hospital day. CONCLUSIONS: If direct and indirect nonmedical costs are not included in the total cost calculation for providing hospital care to stroke patients, the economic impact of care on families is likely to be underestimated.

Factors determining the attitudes of family caregivers of dementia patients toward nursing home placement in Taiwan: comparisons between urban and semiurban areas.

This study sought to determine the factors that influence the attitudes of family caregivers of dementia patients toward nursing home placement. A telephone survey of primary caregivers was conducted in two metropolitan areas of Taiwan. Caregivers of dementia patients were recruited from the neurology and psychiatry outpatient departments of two medical centers in Taipei (a highly urbanized area, n=144) and two medical centers in Kaohsiung (an area of mixed farm and nonfarm sectors, n=134). Family caregivers were asked if they would place patients in a nursing home if their dementia progressed. The mental status of dementia patients was the most significant variable affecting caregivers attitudes toward nursing home placement. Family manpower available for caregiving at home was especially emphasized as a determining factor affecting the decision to use nursing home care by primary caregivers in highly urbanized areas.

Ultrasonically guided needle aspiration biopsy in the diagnosis of advanced superior vena cava syndrome.

From July 1990, 11 cases with advanced superior vena cava (SVC) syndrome were undergone ultrasonically guided needle aspiration or biopsy. Ten cases were diagnosed by thin-needle aspiration cytology. Two cases with cytologic proven lymphoma and one case without cytologic diagnosis were undergone needle biopsy, and two of them were proven to be lymphoma. The diagnostic rate of aspiration cytology was 91.0% (10/11) and of aspiration biopsy was 66.6% (2/3). The diagnostic rate of combination of aspiration cytology and biopsy was 100%. For reducing the incidence of pneumothorax, we strongly recommend this two-stage procedure that needle biopsy was performed only when cytologic diagnosis was not conclusive. Only one case developed pneumothorax in performing needle biopsy. In conclusion, ultrasonically guided needle aspiration biopsy is a safe, convenient, and high-yield diagnostic procedure for selected cases of advanced SVC syndrome.

Etiologic diagnosis of pulmonary infection by ultrasonically guided percutaneous lung aspiration.

Ultrasonically (US) guided percutaneous lung aspiration was performed for patients clinically diagnosed as having pneumonia (n = 18) or lung abscess (n = 16) and thus taking antibiotics. The procedure was done because of either unsatisfactory clinical or roentgenographic responses, critical underlying disease or poor general condition in the patients. Most cases with pneumonia showed hypoechoic lesion with irregular margin and typical consolidated change, while some cases showed central necrosis. Microorganisms were identified by stains in 9 cases. The overall sensitivity of needle aspiration and culture was 72.2% (13/18). Five cases failed to grow microorganism in culture, mostly due to delayed resolved pneumonia. In cases with lung abscess, the typical ultrasonographic finding was hypoechoic lesion with irregular margin associated with central necrosis or air-fluid level. The overall sensitivity for needle aspiration and culture was 81.2% (13/16). Only one case of pneumothorax was seen, which was recovered with chest intubation and oxygen inhalation. Our result showed that US-guided percutaneous lung aspiration is a technique with high diagnostic yield and low complication rate for cases with pneumonia or lung abscess.

Consistency between preference and use of long-term care among caregivers of stroke survivors.

Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n1 = 324) or a preference for home care (n2 = 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.

Family caregivers' priorities for home care: a need assessment study.

BACKGROUND: Many studies have demonstrated that patients prioritize some attributes of health care over others. However, little effort has been devoted to measure which service attributes are most important to consumers, regardless of their satisfaction, in the field of home care. Moreover, home care requires family members to participate as caregivers. Thus, evaluating the needs of family caregivers who also provide home care should provide an opportunity to envision an effective home care system. METHODS: This study was designed to measure family caregivers' need for auxiliary home care services by examining their priorities for attributes of home care services. The respondents were asked to select 5 attributes, which were most important for them, from 19 choices of home care services, and then to rank 5 attributes in decreasing order of importance to determine their priorities, coded from 1 (the first priority) to 5 (the last important priority). The degree of satisfaction from a single attribute, whether or not the desired attribute was in fact provided, personal data of family caregivers, and types of patient's insurance were also included in this study. RESULTS: The interviewees were inclined to assign high priority to the ease of contacting home care nurses by telephone (73.6%) and the timeliness of obtaining needed services in an emergency (63.6%); they were less likely to attach high priority to provision of spiritual support (6.3%), respect given by home care nurses (5.4%), and acceptance of suggestions (4.5%). Whether a single attribute was selected as a top five priority was significantly associated with family caregiver's education level, degree of satisfaction with the attribute and whether the desired attribute was actually received. CONCLUSIONS: The interviewees had different priorities for attributes of home care, and they assigned high importance to the attributes less satisfied and received; examples are the timeliness of obtaining needed services in an emergency, and the ease of contacting home care nurses by telephone.