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

Background: Rupture of the distal biceps tendon remains an uncommon injury that is ideally treated by operative repair. Single-incision anterior approach with suture anchor repair is one such method. The purpose of this study was to describe the outcomes in patients who underwent repair of the distal biceps tendon with single anterior incision and suture anchor repair. Methods: One hundred and nineteen patients (120 repairs) with distal biceps tendon repairs between January 1, 2002 and December 31, 2012 were identified and their charts retrospectively reviewed. Twenty-five of these patients participated in additional collection of outcome data including range of motion, strength, pain, satisfaction, and clinical outcome. Results: In the retrospective analysis, the population was 93% male. Average age was 47.3 yr; however, females had a significantly higher mean age (62.5). Most of the patients (69.8%) returned to full or partial work. The additional data collection cohort reported high satisfaction, little-to-no pain on visual analog scale (VAS) and average Disability of the Arm Shoulder and Hand (DASH) scores. Patients with workers’ compensation claims reported significantly higher pain and worse DASH scores. There was small but significant loss of pronation, and a small loss of grip strength that approached significance. Conclusions: Single anterior incision with suture anchor repair may be utilized for repair of ruptures of the distal biceps tendon with good clinical and functional outcomes and minimal loss of range of motion and strength. Females tend to be older at presentation than males with this condition. As in other studies, workers’ compensation claims were associated with poorer clinical outcomes. Level of Evidence: Therapeutic, level IV, case series study.

The Millennium Development Goals are a set of eight goals drafted by the United Nations in 2000 with the aim of improving the health and welfare of people worldwide. The goals provide specific targets to be met by 2015, using the 1990 basis as a standard. This review presents these goals as they relate to children, discussing progress and future aims. Although not all eight goals specifically address children, each has its own impact on global child health. Thus far, much progress has been made, but increased rates of improvement must be achieved in order to meet the goals by 2015 and improve the health of children worldwide.

With providers screening less than half of SDs at any point in the year before death, and less than 60% of SDs ever endorsing SI, including none at final appointments, the findings of this naturalistic study bring into question both current screening practices and screening effectiveness. Nonetheless, when SDs were screened, they were significantly more likely to endorse SI than were controls, not 1 of whom ever expressed SI. Taken together, these data suggest that patients expressing SI at any point are at elevated risk for eventual suicide.

For several years, medical schools in the United States have been urged to integrate public health and population science into their curricula. The first‐year Gross Anatomy course at Mayo Clinic serves as a teaching platform for many non‐technical skills that include professionalism, patient communication and near‐peer teaching that aim to meet core ACGME requirements. As part of the standard Gross Anatomy curriculum, students are assessed on a laboratory based learning activity referred to as a “bedside presentation,” where each small group is assigned a clinical condition and asked to present a hypothetical case as it relates to the anatomy and radiology on their cadaver. The objective of this study is to assess whether first‐year medical students’ knowledge of global health disparities and national population health improved after a longitudinal curriculum revision that combined public health concepts with the bedside presentation. Students first learned to examine a major cause of morbidity and/or mortality on a global/population level following which each team was asked to present a hypothetical patient (relating to their assigned cadaver) with an acute condition associated with the disease or behavior that they had researched earlier. Teams focused on associated anatomic and radiographic findings and used full‐body CT scans and corresponding anatomic parts to illustrate the effects of the disease. Pre‐course data indicate that students have a 50% understanding of population health trends. We anticipate that first‐year medical students will have an improved awareness of public health problems globally and in the United States after completing this activity in Gross Anatomy.