Strategies to Prevent Elderly Suicide: A Delphi consensus study

Objectives In the next decades, many countries will become ‘ageing societies’. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. Methods A New Zealand (NZ) ‘expert panel’ has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults’ suicide prevention. Results A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for ‘A suicide prevention strategy for the elderly…’ to enhance the national all-ages suicide prevention strategy. Conclusion The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.

The public health approach to suicide prevention in Ireland

This article provides an overview of the public health approach to suicide in Ireland. The authors provide detail on the current suicide prevention strategy in Ireland, Connecting for Life, which is a whole-of-government, systemic, multicomponent national strategy. As the strategy enters its final extended phase of implementation over the period 2020–2024, the public health elements of Connecting for Life are presented, including the population level and more targeted approaches. The findings of an interim review of the strategy are discussed, in addition to the local and national implementation structures which are in place to assist implementation and monitoring of the strategy.

Planning Cervical Deformity Surgery Including DJK Prevention Strategies

Distal junctional kyphosis (DJK) is a major concern following cervical deformity (CD) correction, leading to failed realignment and revision surgery. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. First we focus on characterization of the baseline deformity. Secondly, we assess our patients clinically. Thirdly, we simulate the correction with the use of novel in-construct measurements. The fourth step is to develop a DJK prevention strategy tailored to the individual. The last step is to perform surgery and check correction during the operation.

Abstract 1122‐000155: Vertebral Artery Origin Treatment by Endovascular Techniques Registry (VOTER): Safety in the First 20 Cases

Introduction : Background: Stenosis of the vertebral artery origin (VAOS), while under‐diagnosed, is common and may cause up to 25% of posterior circulation infarction. Stenting is widely employed as a secondary prevention strategy, but prospective clinical studies of safety and efficacy are limited. Objective: To report periprocedural and 30‐day outcomes after stenting of the vertebral origin in the first 20 patients of the Vertebral Artery Origin Treatment by Endovascular Techniques Registry (VOTER). Methods : VOTER is a prospective, multicenter, cohort study of patients with symptomatic vertebral artery stenosis > = 50%. Demographic, clinical, and procedural data is collected via a RedCap constructed, cloud‐based, data entry portal. In addition, there is clinical follow‐up data collected at 30 days and 1 year. Lesion stenosis[OGS1] percentage along with representative images are collected pre‐stent, post‐stent, and at 1 year for validation by an independent core laboratory. The primary outcome is stroke and death at 30 days. The secondary outcome is restenosis > = 50% at 1 year follow‐up. Results : A total of 10 sites have been activated to enroll in the study. Of these, 3 sites have enrolled a total of 20 subjects. The median age was 64 (range 47–87) years; 14 (70%) were male, and 16 (80%) were white. 19 patients (95%) were hypertensive, with 5 patients (25%) having a history of ischemic heart disease. The median Modified Rankin score (mRS) at admission was 1 (range 0–3). Presenting symptoms included dizziness/vertigo (43%), visual field defects (14.3%), hemiparesis (14.3%), dysarthria (19.0%), diplopia (4.8%), ataxia (4.8%), and dysphasia (4.8%). All patients were treated with dual antiplatelet therapy. All stents utilized were drug eluting. The median pre‐stent stenosis was 80% (range 60–99%) with a median of 15% (range 0–33%) post‐stent residual. There were no periprocedural strokes, death, or technical complications. One month follow up was available in 15 patients (75%), with 2 reporting new neurological symptoms: 1 with blurred vision and 1 with dizziness and facial numbness. No new imaging confirmed infarctions occurred. Symptomatic improvement was noted in 40% of subjects although there was no change in the median 30 day mRS. Conclusions : VOTER is the first large prospective registry of vertebral origin stenting in North America. These early results from the first 20 subjects are consistent with procedural safety and the importance of continued study of stenting as a secondary prevention strategy for posterior circulation infarction in the setting of VAOS.