Objective To compare the type and frequency of healthcare visits in the year before suicide between decedents and controls. Patients and methods Cases (n=86) were Olmsted County, Minnesota residents whose death certificates listed “suicide” as the cause of death from January 1, 2000 through December 31, 2009. Each case had three age- and sex-matched controls (n=258). Demographic, diagnostic and healthcare usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and non-psychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months and 4 weeks before death. Results Cases and controls did not significantly differ in having had any healthcare exposure (p=.18). Suicide decedents, however, had significantly higher numbers of total visits in the 12 months, 6 months, and 4 weeks prior to death (all p<.001), were more likely to have carried psychiatric diagnoses in the previous year (OR 8.08; 95% CI 4.31 to 15.17, p<.001) and were more likely to have had outpatient and inpatient mental health visits (OR 1.24, 95% CI 1.05 to 1.47, p=.01, OR 6.76, 95% CI 1.39 to 32.96, p=.02, respectively). Only cases had had emergency department mental health visits; no control did. Conclusion Given that suicide decedents did not differ from controls in having had any healthcare exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared to controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of healthcare contacts were associated with elevated suicide risk.

Background Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project the QOL differences between older adult (age 65+) and younger adult (age 18-64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined. Methods This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27 and 52 included QOL (Linear Analogue Self Assessment [LASA], Functional Assessment of Cancer Therapy - General [FACT-G]) and mood (Profile of Mood States [POMS]). Kruskall-Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention. Results Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs 62.9, p=0.040), higher social well-being (FACT-G 91.1 vs 83.3, p=0.045), and fewer problems with anger (POMS Anger-Hostility 95.0 vs 86.4, p=0.028). Long-term benefits for older patients were seen in the Anger-Hostility scale at week 27 (92.2 vs 84.2, p=0.027) and week 52 (96.3 vs 85.9, p=0.005). Conclusions Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefitted differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.

Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.

No abstract