Birmingham Repertory Theatre

Introduction Hereditary angioedema (HAE) is a rare disorder characterized by unpredictable swelling attacks. Social determinants of health may impact patient care. Methods US patients from Inovalon’s closed claims database with ≥2 medical claims (D84.1 complement system or T783XXX angioedema) and ≥1 prescription for HAE medication between 1/1/2017–9/30/2021 were screened (first claim defined as index date). Patients with evidence of ACE inhibitor use after HAE diagnosis were excluded. Eligible patients had 12 months continuous enrollment in a health-plan pre- and 24 months post-index. Race/ethnicity, income, and rurality were analyzed to understand differences in healthcare resource utilization across the population. Results In multivariable models, Black and Hispanic/Latino patients had a greater risk of ≥1 emergency department (ED) visit than White patients (risk ratio [RR; 95% CI]: 1.29 [1.19–1.40] and 1.22 [1.10–1.36], respectively). Black patients also had a greater risk of hospitalization than White patients (RR [95% CI]: 1.69 [1.28–2.24]). Low-income (<$50K) patients had a higher risk of having ≥1 ED visit or hospitalization than patients with higher incomes (≥$50K; RR [95% CI]: 1.31 [1.21–1.41] and 1.31 [1.03–1.67], respectively). However, rural patients had a lower risk of hospitalization than urban/suburban patients (RR [95% CI]: 0.63 [0.40–0.99]) with a higher mean number of prophylaxis medication fills than urban/suburban patients (RR [95% CI]: 2.0 [1.10–3.66]; no differences by race/ethnicity or income). Conclusion Differences in healthcare resource utilization occur among patients with HAE associated with race/ethnicity, income, and rurality. Strategies to improve equity in care are needed.

LGBTQ+ individuals experience disproportionately high rates of mental health challenges, driven largely by exposure to stigma, discrimination, and minority stress. In response, there is growing interest in creative, community-based interventions that support wellbeing. This study evaluates “LGBTQteehee!”, a 10-week stand-up comedy programme designed to promote mental wellbeing and resilience among LGBTQ+ individuals. N = 6 participants took part in post-intervention qualitative data collection via focus group and semi-structured interviews. Data were analysed using Reflexive Thematic Analysis. Two overarching themes were identified: “Standing up Together: A Queer Ensemble” and “Comedy as Catharsis”, each comprising two subthemes. The first theme captured the importance of community, highlighting “Where Comedy Meets Community” and “Where Safety Takes Centre Stage”, emphasising the role of belonging, diversity, and psychological safety. The second theme reflected the transformative potential of comedy, with “Performing (Queer) Resilience” and “Taking the Mic and Owning the Moment” illustrating how participants reframed lived experience into empowering narratives and reported increased confidence and self-expression. Findings suggest that the benefits of the intervention extend beyond humour alone, instead reflecting the interplay between social connection and identity-affirming narrative expression. Participants described how having a space to talk openly about their mental health and receive support from others contributed to their perceptions of both individual and collective resilience. These findings suggest that community-based comedy interventions may offer accessible and identity-affirming spaces through which LGBTQ+ individuals can explore wellbeing, belonging, and resilience. Whilst further evaluation is required, the findings contribute to growing discussions regarding the role of arts-based approaches in supporting LGBTQ+ mental health and wellbeing.

Introduction Left ventricular assist devices (LVADs) are routinely considered by patients with heart failure to prolong life and improve quality of life (QOL); however, this has been accompanied by increasing demands on family caregivers (FCGs). To address gaps in formalized training around LVAD caregiving, we developed the ENABLE-LVAD program to optimize the experience of LVAD clinicians and FCGs of patients with LVADs. Methods We performed a pilot randomized trial (intervention vs. control) designed to test the feasibility, acceptability, and preliminary effectiveness of ENABLE-LVAD. The intervention consists of 1) 4-hour online LVAD coordinator training, who then conduct 2) 4 one-on-one virtual FCG coaching sessions focused on coping, self-care, symptom management, and decision making. The Feasibility of Intervention Measure (FIM, range 4-20, higher scores=higher feasibility) and Acceptability of Intervention Measure (AIM, range 4-20, higher scores=higher feasibility) were administered to LVAD coordinators and FCGs in the intervention arm at 24-weeks. The Hospital Anxiety and Depression Scale (higher scores=higher anxiety and depression), Perceived Stress Scale (higher scores=higher stress), and EQ Visual Analog Scale (EQ-VAS, higher scores=higher QOL) were collected from FCGs at baseline and 24-weeks. Statistical analyses were conducted using Fisher’s exact test for categorical variables and Mann-Whitney U tests for numerical values. Results From 6/2023-3/2024, we enrolled 4 LVAD nurse coordinators and 35 caregivers (intervention=18, control=17). Sixteen FCGs completed all 4 coaching sessions. LVAD coordinators reported high feasibility and acceptability of ENABLE-LVAD (FIM=17.5(1.9), AIM=17.8(1.7)). Similarly, FCGs reported high feasibility and acceptability of ENABLE-LVAD (FIM=16.4(2.7), AIM=16.3(2.4)). Positive trends in FCG-reported outcomes were shown in several domains for the intervention group, although we were not powered to test significance. Anxiety and depression decreased more in the intervention group (anxiety: 6.5->5.4 vs 6.5->6.8; depression: 4.8->4.7 vs 4.4->5.7). Stress decreased more in the intervention group (14.4->12.7 vs 16.0->15.9) and QOL increased more in the intervention group (69.2->74.3 vs 74.4->69.7). Conclusions ENABLE-LVAD was feasible and acceptable to both LVAD coordinators and FCGs and demonstrated a signal of potential effectiveness for anxiety, depression, stress and QOL. The findings highlight the potential of a structured intervention enhancing clinician and FCG experiences caring for patients with an LVAD. A larger hybrid implementation and effectiveness trial is needed to confirm these results.

BACKGROUND:For critically ill adults undergoing tracheal intubation, observational studies suggest that the use of etomidate to induce anesthesia may increase the risk of death. Whether the use of ketamine rather than etomidate decreases the risk of death is uncertain. METHODS:In a randomized trial conducted in 14 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults who were undergoing tracheal intubation to receive ketamine or etomidate for the induction of anesthesia. The primary outcome was in-hospital death from any cause by day 28. The secondary outcome was cardiovascular collapse during intubation, defined by the occurrence of a systolic blood pressure below 65 mm Hg, receipt of a new or increased dose of vasopressors, or cardiac arrest. RESULTS:A total of 2365 patients underwent randomization and were included in the trial population; 1176 were assigned to the ketamine group and 1189 to the etomidate group. In-hospital death by day 28 occurred in 330 of 1173 patients (28.1%) in the ketamine group and in 345 of 1186 patients (29.1%) in the etomidate group (risk difference adjusted for trial site, -0.8 percentage points; 95% confidence interval [CI], -4.5 to 2.9; P = 0.65). Cardiovascular collapse during intubation occurred in 260 of 1176 patients (22.1%) in the ketamine group and in 202 of 1189 patients (17.0%) in the etomidate group (risk difference, 5.1 percentage points; 95% CI, 1.9 to 8.3). Prespecified safety outcomes were similar in the two groups. CONCLUSIONS:Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidence of in-hospital death by day 28 than etomidate. (Funded by the Patient-Centered Outcomes Research Institute and others; RSI ClinicalTrials.gov number, NCT05277896.).