An implementation and effectiveness study evaluating Conflict Analysis in VA residential substance abuse services: Whole Health informed self-guided online care.

CONTEXT: Whole Health is an emerging healthcare framework that emphasizes wellbeing in place of illness. Conflict Analysis (CA), an online self-guided assessment, leverages innovative diagnostic and therapeutic resources that shares Whole Health objectives, including helping users explore their identity and develop a personalized health plan and helping users develop resources to optimize their health. OBJECTIVES: Paper presents CA implementation-effectiveness study in a Veteran Affairs inpatient substance recovery care. DESIGN: Patients were randomized to CA or mindfulness control. Patients completed Whole Health outcomes measures at baseline, completion (post), and three-week follow-up. Interventions took 2.5 h. Attending psychologist assessed CA protocols and completed outcome evaluation. Due to Coronavirus, recruitment and follow-up were curtailed. SETTING: Study took place in a rural northern New England Veteran Affairs inpatient substance recovery unit. OUTCOME MEASURES: Measures include The Personal Growth Initiative Scale, The Beck Cognitive Insight Scale, Perceived Stress Scale, The Patient Health Questionnaire, Perceived Psychological Wellbeing, and Perceived Therapeutic and Diagnostic Benefit. RESULTS: 12 patients were randomized, 11 completed post measures (CA=5; Mindfulness = 6), and 7 completed follow-up measures (CA=3; Mindfulness=4). CA offered significant Whole Health benefits when compared to control. Additionally, participant and clinician evaluations indicated that CA can be personally relevant, meaningful, and motivate therapeutic growth. Implications include extending CA research and expanding Whole Health related interventions. Although initial results suggest implementation feasibility and Whole Health benefit, more research is necessary to establish CA's utility within inpatient substance recovery care in particular and psychiatric rehabilitation in general.

Trends in COVID-19 cases and clinical management in Veterans Health Administration medical facilities: A national cohort study.

OBJECTIVE: We explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: This retrospective cohort study included patients diagnosed with COVID-19 in the United States Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used Cuzick's Trend Test to examine any differences in the distribution of our study variables across the six months. RESULTS: During our study period, we identified 43,267 patients with COVID-19. A total of 8,240 patients were hospitalized, and 13.1% (N = 1,081) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from 24.8% (N = 221/890) in March to 8.0% (N = 111/1,396) in August. Patients hospitalized in March compared to August were younger on average, mostly black, urban-dwelling, febrile and dyspneic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, there was a decline from March to August in receipt of mechanical ventilation (31.4% to 13.1%) and hydroxychloroquine (55.3% to <1.0%), while treatment with dexamethasone (3.7% to 52.4%) and remdesivir (1.1% to 38.9%) increased. CONCLUSION: Among hospitalized patients with COVID-19, we observed a trend towards decreased disease severity and mortality over time.

Longitudinal Examination of COVID-19 Public Health Measures on Mental Health for Rural Patients With Serious Mental Illness.

INTRODUCTION: There is emerging evidence to support that the COVID-19 pandemic and related public health measures may be associated with negative mental health sequelae. Rural populations in particular may fair worse because they share many unique characteristics that may put them at higher risk for adverse outcomes with the pandemic. Yet, rural populations may also be more resilient due to increased sense of community. Little is known about the impact of the pandemic on the mental health and well-being of a rural population pre- and post-pandemic, especially those with serious mental illness. MATERIAL AND METHODS: We conducted a longitudinal, mixed-methods study with assessments preceding the pandemic (between October 2019 and March 2020) and during the stay-at-home orders (between April 23, 2020, and May 4, 2020). Changes in hopelessness, suicidal ideation, connectedness, and treatment engagement were assessed using a repeated-measures ANOVA or Friedman test. RESULTS: Among 17 eligible participants, 11 people were interviewed. Overall, there were no notable changes in any symptom scale in the first 3-5 months before the pandemic or during the stay-at-home orders. The few patients who reported worse symptoms were significantly older (mean age: 71.7 years, SD: 4.0). Most patients denied disruptions to treatment, and some perceived telepsychiatry as beneficial. CONCLUSIONS: Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Longer-term outcomes are needed in rural patients with serious mental illness to better understand the impact of the pandemic on this population.