Austin Hospital

Self-report surveys were conducted in Australia between May 2020 and April 2024, allowing for an analysis of perceived psychological resilience in those with and without suicidal ideation (SI) during and after the COVID-19 pandemic. Linear mixed models were used to describe the factors associated with psychological resilience in these populations and in people experiencing transitions between SI states. Of the 1145 people who responded more than once to the survey, 879 (77%) always reported "never SI", 84 (7%) always reported SI, while 182 (16%) reported SI for only some of their surveys. People who moved between SI states reported significantly lower psychological resilience than those who reported "never SI", but significantly higher psychological resilience than those reporting SI in all their surveys. For participants always reporting SI, greater psychological resilience was significantly associated with greater hopefulness and quality of life, and less sleep than usual. In people who moved between SI states, greater psychological resilience was significantly associated with greater hopefulness, less psychological distress and lower likelihood of mental illness. Only participants with "never SI" reported better psychological resilience alongside consistent sleep and exercise quantities. These results have important implications for suicide prevention in Australia. However, bidirectional associations require further investigation.

BackgroundMobile stroke units (MSUs) accelerate prehospital acute stroke care and improve outcomes. Both onboard and telemedicine neurologist models of care are used but have not been directly compared.MethodsMSU-TELEMED was a randomized, open-label, blinded-endpoint trial comparing onboard neurologist care to a telemedicine care model for people presenting to an MSU with suspected stroke. MSU care was prospectively randomized by day to onboard versus telemedicine care. The primary outcome was a hierarchical composite outcome using a win-odds approach that prioritized: (1) safety, (2) scene-to-treatment-decision time, and (3) percentage of the total case time the neurologist spent in direct care (higher values denote better resource use). Every participant in each group was compared to those in the other, resulting in a “win/tie/loss” distribution for telemedicine compared to onboard.ResultsA total of 275 participants were assigned to telemedicine (n=135) or onboard (n=140) neurologist care groups. The primary outcome of win/tie/loss distribution favored the telemedicine model (76%/4%/20%) with an adjusted win odds of 3.5 (95% confidence interval [CI], 2.4–5.1). Safety events were similar (13% telemedicine vs. 12% onboard, risk ratio 0.9; 95% CI, 0.5–1.8). Median scene-to-treatment-decision time was 19 minutes in the telemedicine group and 13 minutes in the onboard group (adjusted difference in median time 4 minutes; 95% CI, 1.9–5.9). The median percentage of the neurologist’s time directly involved in patient care was 100% in the telemedicine group and 33% in the onboard group (adjusted difference in median percentage 63 percentage points; 95% CI, 53–74).ConclusionsCompared to an onboard model, an MSU telemedicine model of care was superior based on a composite hierarchical outcome of safety, scene-to-treatment-decision time, and percentage of the neurologist’s time spent in direct care. (Funded by the Sylvia and Charles Viertel Charitable Foundation and the Medical Research Future Fund “Golden Hour”; ClinicalTrials.gov number, NCT05991310.)

Out of hospital cardiac arrest (OHCA) is a significant public health problem associated with high mortality and high healthcare costs. The Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) randomised clinical trial showed that targeted mild hypercapnia did not lead to better neurologic outcomes at 6months compared to normocapnia after OHCA. We aimed to estimate the cost-effectiveness of mild hypercapnia compared to targeted normocapnia using data from the TAME trial. Pre-specified, prospective cost-effectiveness analysis alongside the TAME RCT from a healthcare perspective using a 6-month time horizon. The analysis included 1586 patients across 63 intensive care units (ICUs), in 17 countries. The primary measure of cost-effectiveness was the cost per quality-adjusted life year (QALY). Costs were estimated for each patient by multiplying resource use data by the relevant country-specific resource unit cost. QALYs were calculated using utility scores derived from the EQ-5D-5L administered at 6-month follow-up. There were no significant differences in costs or QALYs at 6months between groups. The incremental net monetary benefit was also not significant at a willingness-to-pay threshold of $50,000 per QALY, with the 95% CI including both negative and positive values. This analysis found that the cost-effectiveness of mild hypercapnia is highly uncertain when compared with normocapnia in adult patients following OHCA, with no significant differences in either costs or outcomes. Further research is required to determine the specific circumstances under which mild hypercapnia may provide value for money.

Abstract Background Obesity is a major risk factor for atherosclerotic cardiovascular disease (ASCVD), which promotes the formation and progression of coronary atherosclerosis. Given expected rise in obesity prevalence, effective anti-atherosclerotic strategies are essential for obese patients. Lowering LDL-C level is a guideline-recommended strategy to mitigate risk of ASCVD. However, whether obese patients favorably respond to lowering LDL-C levels has not yet been fully characterized. The OPTIMAL study was a randomized controlled trial which employed intravascular imaging to compare the efficacy of continuous glucose monitoring-guided and HbA1c-guided glycemic control on coronary atherosclerosis in statin-treated type 2 diabetic patients with CAD. The current study is a sub-analysis of the OPTIMAL study which evaluates coronary plaque progression in response to lowering LDL-C levels in obese and non-obese patients with type 2 diabetes mellitus (T2DM). Purpose To compare the effect of achieving LDL-C <1.8 mmol/L on coronary plaque progression in non-obese and obese subjects with T2DM. Methods This analysis included a total of 78 statin-treated type 2 diabetic patients with CAD. Serial IVUS imaging was conducted to measure percent atheroma volume (PAV) at non-culprit segments at both baseline and 48 weeks. Clinical characteristics and change in PAV were compared in obese (BMI≥25kg/m2, n=31) and non-obese patients (BMI<25kg/m2, n=47) according to achieved LDL-C level <1.8mmol/L at 48-weeks, respectively. Results LDL-C target attainment was similar in obese and non-obese individuals (41.9% vs. 57.4%, p=0.23). In non-obese patients, clinical characteristics and NIRS/IVUS parameters did not differ between those with and without achieved LDL-C <1.8mmol/L (Table 1). Achieving LDL-C level <1.8mmol/L was not necessarily associated with a significant change in PAV [-0.36% (-1.62, +0.90), p=0.57] (Figure 1). In obese patients, those achieving LDL-C <1.8 mmol/L were more likely to receive high-intensity statins (100% vs. 66%, p=0.03) and β-blockers (92% vs. 55%, p=0.04) with a lower frequency of metformin use (23% vs. 66%, p=0.03) (Table 2). On serial IVUS imaging analysis, following adjustment of clinical demographics and medication use, a greater regression of PAV was observed in association with achieving LDL-C <1.8 mmol/L [-1.06% (-1.93, -0.18), p=0.02] (Figure 2). Conclusions Plaque regression in response to achieving LDL-C <1.8 mmol/L differed by obesity, with significant benefit observed in obese T2DM patients. These findings highlight the need for aggressive LDL-C lowering in obese individuals to further reduce their cardiovascular risk.Table 1 and Figure 1 non-obese patients Table 2 and Figure 2 obese patients