Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout.

Gout is the most common crystal arthropathy and is frequently diagnosed and managed by primary care physicians. Point-of-care ultrasound (POCUS) is a valuable tool to aid in the diagnosis of gout via the identification of the double contour sign, aggregates of crystals, tophi, and erosions. In addition, POCUS can aid in the management of gout by recognizing early signs of gout, monitoring the effectiveness of urate-lowering therapy, and guiding aspiration and corticosteroid injection.

Coming in: an examination of people with co-occurring substance use and serious mental illness exiting chronic homelessness.

Despite national efforts, the number of people who are chronically homeless in our cities remains high. People with serious mental illness and substance abuse problems continue to represent the majority of those experiencing long-term homelessness. Traditional shelters have difficulty engaging and addressing the needs of this group; however, there are an increasing number of alternative models, including the Safe Haven shelter program, developed to better meet their needs. In this article, the authors examine responses from 28 qualitative interviews conducted with 16 residents of a Safe Haven shelter serving chronically homeless people, at 3 and 9 months after entry. All had a severe mental illness and were actively substance abusing. The importance of a model that respects personhood, a place that feels like home, and challenges faced by residents as they "come in" are emphasized.

The BMC ACCESS project: the development of a medically enhanced safe haven shelter.

This paper describes the development and implementation of the Boston Medical Center (BMC) Advanced Clinical Capacity for Engagement, Safety, and Services Project. In October 2002, the BMC Division of Psychiatry became the first such entity to open a Safe Haven shelter for people who are chronically homeless, struggling with severe mental illness, and actively substance abusing. The low-demand Safe Haven model targets the most difficult to reach population and serves as a "portal of entry" to the mental health and addiction service systems. In this paper, the process by which this blended funded, multi-level collaboration, consisting of a medical center, state, city, local, and community-based consumer organizations, was created and is maintained, as well as the clinical model of care is described. Lessons learned from creating the Safe Haven Shelter and the development and implementation of the consumer-informed evaluation are discussed as well as implications for future work with this population.

Limited literacy and psychiatric disorders among users of an urban safety-net hospital's mental health outpatient clinic.

Little is known about the relationship between mental illness and literacy despite both being prevalent problems. We examine whether literacy varies by psychiatric diagnoses. Interviews and chart reviews (N = 100) were conducted in a behavioral health outpatient clinic. The relationships among sociodemographics, rapid estimate of adult literacy in medicine, measures of verbal and visual intellectual abilities, and psychiatric diagnoses were examined. The mean rapid estimate of adult literacy in medicine score was 55.9 which is equivalent to below an eighth grade literacy level. Psychotic disorder (p = 0.03) was associated with limited literacy, and substance abuse (p = 0.003) and PTSD (p = 0.07) were associated with higher literacy in bivariate analyses. These diagnoses were further examined in multivariate models. Limitations include the small sample size and the over-representation of people with high levels of education. Increasing our understanding of the relationships between health literacy and psychiatric disorders will help inform the development of appropriate psychiatric care and better outcomes.