Background: Equestrian athletes (horse riders) are at high risk for head injury, including concussions. Materials & methods: Adults riders were recruited via social media posting to complete a branching survey collecting data on demographics, riding experience, helmet use, injury history and concussion symptom knowledge. Results are reported as frequencies and percentages, with associations tested using chi-square with significance level p < 0.05. Results: Of the 2598 subjects, about 75% reported always wearing a helmet. Of those who did not, the most common reasons were that helmets are unnecessary (57.4%) or do not fit well (48.6%). Many indicated improper storage conditions and/or did not follow manufacturer’s replacement recommendations. Most (75.4%) reported a high level of comfort with recognizing concussion signs, with half experiencing a prior head injury. Conclusion: This information suggests opportunities for intervention to improve helmet use through increased fit, while the responses indicate a need for further education on proper helmet use.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) survivors are at high risk for poor quality of life (QoL). Standard outpatient neurologic assessment may not capture some affective and cognitive factors important for long-term QoL, and reintegration into normal social roles. The purpose of this study is to determine the utility of the Quality of Life in Neurological Disorders (Neuro-QoL) measures for assessment of such factors in nursing practice. Methods: Standard demographic and clinical characteristics were collected on patients >1 year post-aSAH, along with self-report information on seven Neuro-QoL measures (Ability to Participate in Social Roles and Activities [ABL]; Satisfaction with Social Roles and Activities [SATIS]; Cognitive Function [COG]; Depression [DEP]; Anxiety [ANX]; Lower Extremity Function - Mobility [LE] & Upper Extremity Function - Fine Motor [UE]). Scores are T-scores with mean 50(±10). Associations were determined using Spearman correlations or paired t-tests as appropriate. Results: Participants (N=35) were 48.6(±12.5) years, 4.7(±3.6) years post aSAH, 80% female, 65.7% African American, and mean Hunt Hess Grade 2.3(±0.8). Age, race, and gender were not associated with Neuro-QoL outcomes. Our average sample T-scores were: ABL=45.3; SATIS=47.6; COG=44.3; DEP=49.3; ANX=51.3; LE=46.5; UE=46.7. COG was associated with ABL and SATIS ( p <0.02). ANX was associated with ABL ( p =0.02). UE and LE were associated with ABL (r=0.5, p =0.001; r=0.8, p <0.0001, respectively) and SATIS (r=0.5, p =0.005; r=0.8, p <0.0001). Conclusions: The Neuro-QoL measures provide an effective tool for nursing assessment of QoL in post-aSAH. Although physical disability impairs social integration, we also found that cognitive and anxiety symptoms uniquely influenced the ability to integrate into social roles and may reduce overall QoL.

Psychotherapy and pharmacotherapy are the most common treatments utilized in patients diagnosed with depressive disorders. Their efficacy in remitting symptoms and restoring patients to baseline functioning has been established throughout the literature; however, questions still remain on whether pharmacotherapy is necessary in all patients and if used, when initiation is most beneficial. Current guidelines recommend initiating only psychotherapy in patients with mild depression and advancing to pharmacotherapy as appropriate. Evidence-based literature has shown pharmacotherapy to have a significant and independent treatment effect in depressive disorders compared with psychotherapy. Combination treatment with both modalities has also shown to be beneficial for remitting depressive symptoms in this patient population. Therefore, treatment should be individualized for each specific patient based on severity of disease, history of depression and response to treatment, cost of treatment, and patient preference.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries high disability rates. Depression and anxiety are also common for survivors, but little work has been done to investigate the role of social determinants of health (SDOH) on such outcomes. The purpose of this abstract is to examine the impact of SDOH on physical disability, depression, and anxiety at 1-month post-aSAH, in order to better identify factors that are amenable to intervention to improve quality of life for these patients. Methods: A retrospective chart review was conducted of aSAH patients (selected by ICD-9/10 code) seen at a high-volume neurology and neurosurgery clinic from 2002-2018. Standard patient demographic and clinical characteristics were collected. The outcomes of physical disability, depression, and anxiety were also collected at 1-month post-aSAH. The studied SDOH characteristics were: race, gender, marital status, employment, smoking, drug/alcohol use, and household income level category (defined as low or middle income per US Census Bureau standards). Results: These patients (N=970) were 52.9 (±14.5) years old, 59.5% Caucasian, and 67.4% female. In addition to stroke severity measures (i.e., Hunt/Hess Grade, Fisher, GCS at time of admission), physical disability at 1-month was also associated with female gender, drug abuse, and low household income ( p ≤0.05). Depression at 1-month was not associated with stroke severity measures but was associated with these same SDOH factors and also with unemployment prior to aSAH ( p <0.0001). Anxiety was not associated with drug abuse or income in this group. Race, marital status, and smoking history were not found to be associated with these 1-month outcomes. Conclusions: This work demonstrates that measures of SDOH should be included in addition to clinical variables in a comprehensive predictive model of outcomes post-aSAH.

Ch ro nic ins om nia -Ni gh tly zo lpi de m us e -Co nc er n fo r ta pe rin g wi th dr aw als THE CASEA 49-year-old man with chronic insomnia was referred to the pharmacist authors (LF and DP) to initiate and manage the tapering of nightly zolpidem use. Per chart review, the patient had complaints of insomnia for more than 30 years. His care had been transferred to a Nebraska clinic 5 years earlier, with a medication list that included zolpidem controlled release (CR) 12.5 mg nightly. Since then, multiple interventions to achieve cessation had been tried, including counseling on sleep hygiene, adjunct antidepressant use, and abrupt discontinuation. Each of these methods was unsuccessful. So, his family physician (SS) reached out to the pharmacist authors (LF and DP).