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A virtual, telehealth-based inpatient psychiatric unit was implemented in a multicampus health care system to care for patients involuntarily admitted under emergency hold laws who tested positive for COVID-19. Through a multidisciplinary approach, these patients received proper general medical and psychiatric treatments. This column describes the development and operationalization of the unit in terms of team structure, patient referral and admission, patient and staff safety, general medical and psychiatric treatments, and discharge planning. The results of this virtual approach to caring for patients with both COVID-19 and acute mental illness illustrate the potential of a multidimensional approach for improving care efficiency during public health emergencies.
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COVID-19 , Trastornos Mentales , Humanos , Internamiento Obligatorio del Enfermo Mental , Pacientes Internos , Pandemias/prevención & control , Trastornos Mentales/terapia , Atención a la SaludRESUMEN
Constrictive pericarditis (CP) results in pericardial non-compliance and diastolic dysfunction. Definitive treatment is pericardiectomy, but data on CP after orthotopic heart transplantation (OHT) are limited. Accordingly, a retrospective review of 8 cases of surgically proven CP after OHT undergoing pericardiectomy was conducted. In this series, all patients were male. The median time to symptomatic CP after OHT was 1.7 years (range: 0.8-18.1 years). The echocardiographic assessment was diagnostic for CP in 3 cases (38%). Cross-sectional imaging was performed in 6 cases, revealing ≥ mild pericardial thickening in all. A total of 6 patients (75%) underwent cardiac catheterization, which revealed CP in 5 (83%). Post-pericardiectomy 30-day mortality was 13% (1 patient). The median survival after pericardiectomy was 2.3 years (range: 18 days-14.6 years) and 5-year survival was 29%. Overall, CP after OHT represents a subset of patients with CP with high morbidity and mortality, and multimodality assessment is essential for its diagnosis. Despite a relatively low surgical mortality, long-term survival is poor.
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Predicción , Trasplante de Corazón/efectos adversos , Pericardiectomía/métodos , Pericarditis Constrictiva/diagnóstico , Complicaciones Posoperatorias/epidemiología , Adulto , Ecocardiografía Doppler , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Pericarditis Constrictiva/etiología , Pericarditis Constrictiva/cirugía , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Adulto JovenRESUMEN
Background. Pica is a condition that is commonly missed in childhood. This condition occurs worldwide and is considered normal in children from ages 18- to- 36 months. It is also commonly seen in pregnant women due to associated nutritional deficiencies. Acuphagia is a subtype of pica which has been briefly described in the literature. Its classification has been speculated to belong on a spectrum of obsessive-compulsive disorders (OCD). This case involves Mr. C, a 16-year-old male with a history of depression, anxiety, and ten previous intentional foreign body ingestions involving sharp objects such as needles, forks, and thumbtacks. He states that he recently ate a nail and denies any current obsessions. He was admitted from a local involuntary receiving facility due to decreased bowel movements in the last week. Learning points and recommendations for practitioners are described.
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BACKGROUND: Shared decision-making (SDM) involves patients and clinicians choosing treatment jointly. SDM in mental health is hampered by lack of well-developed supporting tools. We describe an evidence-based patient decision aid (PDA) to facilitate SDM for treatment-resistant depression (TRD) following US National Quality Forum standards which are based upon the International Patient Decision Aid Standards (IPDAS). METHODS: A web-based PDA was developed by a multidisciplinary steering committee of clinicians, patient advocates, patients and a decision scientist. Development included creating content consistent with decision-making domains that are impacted by patient preference in TRD. Development was guided by literature review, group conference calls/discussions, patient and clinician interviews (N = 8), high and lower literacy focus groups (N = 11) and pilot study (N = 5). The PDA presents risk-benefit information on domains (e.g., effectiveness, mode of administration, side effects, cost) and includes values clarification exercises. Pilot study patients were administered the Decisional Conflict Scale (DCS) and Decision Self-Efficacy Scale (DSES) prior to and following PDA interaction and clinician SDM. RESULTS: During the pilot, prior to PDA interaction, mean (standard deviation) DCS score was 42.2 (14.4) and DSES score was 86.0 (14.6) out of 100. Following PDA interaction and SDM, DCS decreased (improved) to 28.1 (SD 4.1) and DSES increased to 95.5 (6.7). All patients endorsed that the PDA helped them to: recognize pros and cons of options; understand how treatments were administered, possible side-effects, and likelihood of benefit; recognize what was important relative to the decision; organize thoughts and prepare for a discussion with their clinician. CONCLUSIONS: This PDA may support SDM in TRD. A future trial to determine impact of the present SMD on decision-making quality is warranted. It also highlights gaps in comparative effectiveness trials that could guide equitable shared decision-making.
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Técnicas de Apoyo para la Decisión , Trastorno Depresivo Resistente al Tratamiento , Toma de Decisiones , Trastorno Depresivo Resistente al Tratamiento/tratamiento farmacológico , Humanos , Participación del Paciente , Prioridad del Paciente , Proyectos PilotoRESUMEN
Past research with unaffected relatives of individuals with schizophrenia has suggested a new qualitative endophenotype for schizophrenia that involves a unique change in visual processing response to red light. The current study provides the first report of this "red light effect" in individuals with schizophrenia (N=15), compared with nonpsychiatric controls (N=16), using a location backward masking by pattern paradigm with red and green background conditions. Analyses revealed a statistically significant group difference in the overall change in accuracy to a red background. Controls tended to show an increase in accuracy with the red (compared with green) background, although the medium effect size was not statistically significant in the small sample. In contrast, participants with schizophrenia showed a statistically significant decrease in accuracy with the red background. Results support recent reports which have suggested that a unique change in visual processing in response to red light may represent a new endophenotype for schizophrenia. This effect is unique from most existing endophenotypes in that it represents a distinct qualitative performance pattern rather than simply poorer performance relative to a comparison group.