Development of a robotic training curriculum for visceral and gastrointestinal surgical trainees: an international Delphi study.

Aneurysmal subarachnoid hemorrhage (aSAH) results from the rupture of an intracranial aneurysm and accounts for approximately 10% of all new strokes worldwide []. Because this type of stroke often affects relatively young people with an average age of around 55 years, many of those affected are in their most productive years in terms of work and social life [, ]. The case-fatality rate in Europe after aSAH is 37% (95% CI: 32–42%) []. Most patients who survive the first month experience consequences in one or more cognitive domain(s), including executive function, language, and memory [–]. In addition, emotional consequences such as depression, anxiety, and posttraumatic stress disorder occur in up to half of survivors [, , ]. These cognitive and emotional consequences strongly affect quality of life and limit participation in daily activities, such as returning to work and social activities [, , ]. Because cognitive and emotional consequences are often less visible than motor consequences, they may remain unrecognized. It is therefore crucial that these consequences are timely identified and appropriately addressed. Cognitive or emotional screening refers to the use of brief, validated instruments specifically designed to identify potential problems in cognitive or emotional functioning. Examples of cognitive and emotional screening instruments are the Montreal Cognitive Assessment (MoCA) [] and the Hospital Anxiety and Depression Scale (HADS) [], respectively. There is considerable variation in outcomes after aSAH between countries []. This may relate to differences in diagnostic and referring practices, in-hospital treatment strategies, and the screening and management of cognitive and emotional consequences after discharge. Knowing these variations is important to identify potential gaps in care. Therefore, we examined variations across Europe in national guidelines and clinical practice regarding the screening of cognitive and emotional consequences after aSAH in patients directly discharged home from the hospital. The study consisted of two parts: (1) a review of national (a)SAH guidelines and (2) an online survey of clinical practice among neurosurgeons.