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1.
Psychiatr Danub ; 32(Suppl 1): 58-63, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890364

RESUMO

INTRODUCTION: The present retrospective study investigated clinical correlates of the revolving door (RD) phenomenon in a population of subjects affected by Bipolar Disorders (BDs). SUBJECTS AND METHODS: Medical records of subjects with BDs admitted to a psychiatric inpatient unit over a 5-year period of time were retrospectively reviewed and clinical data were extracted into an electronic dataset. "Revolving Door Subjects" (RDS) were defined as those who presented three or more "Revolving Door Hospitalizations" (RDH) during twelve months. Features of RDH were compared with non-RDH in order to identify characteristics associated with RD phenomenon and possible risk factors for readmission. To explore predictors of RDH, a stepwise backword logistic regression model was built, including the variables that were significantly associated with RDH in the bivariate analyses. RESULTS: In our sample of 176 subjects affected by BDs, 53 (19.9%) RDH were identified. In the RDH group, a higher prevalence of mixed episodes (p=0.029) and medical co-morbidities (p=0.004) was detected. Subjects with repeated hospitalizations were more often committed to psychiatric residential facilities at discharge (p=0.002). Treatment features related to RDH were represented by a higher prescription rate of atypical antipsychotics (p=0.030), benzodiazepines (p=0.001) and antidepressants (p=0.048). CONCLUSIONS: Findings from the present study suggest that the early identification and treatment of medical comorbidities and specific clinical features of BDs may help reducing the RD phenomenon in this population of subjects.


Assuntos
Antipsicóticos , Transtorno Bipolar , Transtornos Mentais , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Hospitalização , Humanos , Pacientes Internados , Estudos Retrospectivos
2.
Psychiatr Danub ; 32(Suppl 1): 194-199, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890389

RESUMO

G.B., 21-year-old patient of Albanian origin suffering from acute psychotic burning on schizotypal personality disorder induced by substance abuse, was admitted to the Psychiatric Service at Perugia' General Hospital, Italy. On admission, antipsychotic therapy was set up which had the role to reduced delusional and hallucinatory symptoms but the suspiciousness, the presence of magical thought and the closure towards surrounding world that characterize it, combined with the presence of intrusive images, consequently increased the anxiety experiences and negatively affects the establishment of a therapeutic relationship with the operators. During the hospitalization, daily support interviews were carried out: G.B. showed clear difficulty in expressing his own thought contents in presence of more than two operators emerged jointly with the tendency to project different emotional experiences based on the gender of the operator. Following these observations, with the aim to carrying out an intervention that could integrate a psychological approach to the pharmacological therapy in place, a specific personalized support setting was set up, consisting of a female and a male operator. This setting was structured coherently with the therapeutic goals to be achieved: creation of a therapeutic alliance, the integration of the patient's emotional experiences and containing the splitting through the transference analysis. By means of this setting, the patient has obtained a substantial improvement of the splitting framework allowing a better integration of his emotional experiences. At the end of the sessions, G.B. showed more confidence with the medical staff and showed himself to be more aware of his pathological and non-pathological mental states and consequently more adherent to taking drug therapy and to the continuation of post-discharge psychological therapy.


Assuntos
Transtorno da Personalidade Esquizotípica , Assistência ao Convalescente , Feminino , Humanos , Pacientes Internados , Itália , Masculino , Alta do Paciente , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/terapia , Adulto Jovem
4.
Medicine (Baltimore) ; 99(35): e21609, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871877

RESUMO

BACKGROUND: Cervical disc replacement (CDR) has been widely used as an effective treatment for cervical degenerative disc diseases in recent years. However, the cost of this procedure is very high and may bring a great economic burden to patients and the health care system. It is reported that outpatient procedures can reduce nearly 30% of the costs associated with hospitalization compared with inpatient procedures. However, the safety profile surrounding outpatient CDR remains poorly resolved. This study aims to evaluate the current evidence on the safety of outpatient CDR METHODS:: Four English databases were searched. The inclusion and exclusion criteria were developed according to the PICOS principle. The titles and abstracts of the records will be screened by 2 authors independently. Records that meet the eligibility criteria will be screened for a second time by reading the full text. An extraction form will be established for data extraction. Risk of bias assessment will be performed by 2 authors independently using Cochrane risk of bias tool or Newcastle-Ottawa scale. Data synthesis will be conducted using Stata software. Heterogeneity among studies will be assessed using I test. The funnel plot, Egger regression test, and Begg rank correlation test will be used to examine the publication bias. RESULTS: The results of this meta-analysis will be published in a peer-review journal. CONCLUSION: This will be the first meta-analysis that compares the safety of outpatient CDR with inpatient CDR. Our study will help surgeons fully understand the complications and safety profile surrounding outpatient CDR. OSF REGISTRATION NUMBER:: doi.org/10.17605/OSF.IO/3597Z.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Vértebras Cervicais/patologia , Degeneração do Disco Intervertebral/cirurgia , Substituição Total de Disco/métodos , Efeitos Psicossociais da Doença , Feminino , Humanos , Pacientes Internados , Masculino , Viés de Publicação , Segurança , Substituição Total de Disco/economia , Resultado do Tratamento
5.
Br J Radiol ; 93(1113): 20200407, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32735448

RESUMO

OBJECTIVES: To present a single-centre experience on CT pulmonary angiography (CTPA) for the assessment of hospitalised COVID-19 patients with moderate-to-high risk of pulmonary thromboembolism (PTE). METHODS: We analysed consecutive COVID-19 patients (RT-PCR confirmed) undergoing CTPA in March 2020 for PTE clinical suspicion. Clinical data were retrieved. Two experienced radiologists reviewed CTPAs to assess pulmonary parenchyma and vascular findings. RESULTS: Among 34 patients who underwent CTPA, 26 had PTE (76%, 20 males, median age 61 years, interquartile range 54-70), 20/26 (77%) with comorbidities (mainly hypertension, 44%), and 8 (31%) subsequently dying. Eight PTE patients were under thromboprophylaxis with low-molecular-weight heparin, four PTE patients had lower-limbs deep vein thrombosis at ultrasound examination (performed in 33/34 patients). Bilateral PTE characterised 19/26 cases, with main branches involved in 10/26 cases. Twelve patients had a parenchymal involvement >75%, the predominant pneumonia pattern being consolidation in 10/26 patients, ground glass opacities in 9/26, crazy paving in 5/26, and both ground glass opacities and consolidation in 2/26. CONCLUSION: COVID-19 patients are prone to PTE. ADVANCES IN KNOWLEDGE: PTE, potentially attributable to an underlying thrombophilic status, may be more frequent than expected in COVID-19 patients. Extension of prophylaxis and adaptation of diagnostic criteria should be considered.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Embolia Pulmonar/epidemiologia , Idoso , Comorbidade , Angiografia por Tomografia Computadorizada/métodos , Feminino , Hospitalização , Humanos , Itália/epidemiologia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Risco
6.
Bull Tokyo Dent Coll ; 61(3): 195-200, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32801260

RESUMO

We report a case of suspected reinfection with the mumps virus in an elderly patient which resulted in temporary closure of an inpatient ward. A 65-year-old man with colorectal cancer was admitted to the digestive surgery ward at our hospital to undergo a stoma closure operation. He was subsequently referred to our department with right swelling in the preauricular region on postoperative day 4. The swelling subsided within a few days, and the patient was discharged. A serum titer test revealed a high level of antibodies to the mumps virus, however. Therefore, staff who had come into close contact with the patient were examined and the decision taken to stop admitting new patients to the ward. When symptoms are detected in a patient has already had mumps, it is important to consider the possibility of reinfection. Furthermore, it is necessary for medical workers to undergo a serum antibody test to the mumps virus and receive a further vaccination if antibody levels are too low to confer immunity.


Assuntos
Vírus da Caxumba/imunologia , Caxumba , Idoso , Anticorpos Antivirais , Humanos , Pacientes Internados , Masculino
10.
J Nurs Adm ; 50(9): 474-480, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826517

RESUMO

OBJECTIVE: The aim of this study was to connect patients' perceptions of nurses' daily care actions with patients' overall ratings of their hospital experience and hospitals' human caring culture. BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey measuring patients' hospital experience. Current literature lacks the connections between patients' perceptions of nurses' daily care actions and their overall hospital experience measured by the HCAHPS survey. METHODS: This is a correlational study based on the HCAHPS surveys from patients discharged from a hospital in the United States. Correlations were conducted between patients' perceptions of nurses' daily care actions and overall hospital experience. RESULTS: A total of 3,258 (16.6%) patients returned the HCAHPS survey between January and May 2019. Significant relationships were found among patients' perceptions of nurses' daily care actions, hospitals' caring culture, and overall experience. CONCLUSION: Nurses' daily care actions significantly contribute to favorable patients' overall hospital ratings on HCAHPS.


Assuntos
Pacientes Internados , Cuidados de Enfermagem/estatística & dados numéricos , Cultura Organizacional , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estados Unidos
11.
J Hosp Med ; 152020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32816669

RESUMO

Viral testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly early in the COVID-19 pandemic, was limited by supply of reagents. We pooled nasopharyngeal samples from patients at low risk of SARS-CoV-2 infection in groups of 3 for testing. Three weeks of testing using this strategy resulted in 530 patient tests in 179 cartridges; 4 positive test groups required the use of 11 additional cartridges with an overall positive rate of 0.8% in a low-risk population. This strategy resulted in the use of 340 fewer cartridges than if each test were performed on one patient sample. Pooled testing of low-risk populations allows for continued testing even when supplies are relatively scarce.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Testes Genéticos/métodos , Pacientes Internados , Pandemias , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
12.
Wiad Lek ; 73(7): 1533-1538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32759451

RESUMO

OBJECTIVE: The aim: The aim of the study is to define the legal framework of forensic psychiatric examination commissioned by the court in relation to the competence of medical practitioners and the position of the subject as a patient in the process of forensic psychiatric examination in order to determine the correlation of special legal regulation with criminal and civil procedure regulation and to make proposals for the enhancement of the legal regulation. PATIENTS AND METHODS: Materials and methods: This study is based on the analysis of international law, medical civil procedure and criminal procedure legislation, juridical practice, medical law legal doctrine. The following methods were used in this research: the method of interpretation of legal norms, analysis of legal acts, and the induction-deduction method, upon which the conclusions were drawn and recommendations were provided. CONCLUSION: Conclusion: The current regulatory framework does not provide for the procedure by which the subject's medical treatment is conducted during forensic psychiatric examination, nor does it determine the criteria for the admissibility of treatment of the persons concerned and the extent of treatment. During the examination, the medical practitioner who is in the expert's procedural position in relation to the subject under examination in the particular examination should not carry out the treatment of the subject.


Assuntos
Pacientes Internados , Pacientes Ambulatoriais , Criminosos , Humanos , Direito Internacional
14.
PLoS One ; 15(8): e0237628, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790773

RESUMO

This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 dialysis patients), but are applicable elsewhere. A discrete-event simulation was used to model a worst case spread of COVID-19, to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans. If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed. Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and inpatients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity. Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Modelos Teóricos , Pneumonia Viral/epidemiologia , Diálise Renal , Ambulâncias , Infecções por Coronavirus/virologia , Inglaterra/epidemiologia , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/virologia , Carga de Trabalho
15.
Int J Biol Sci ; 16(13): 2265-2270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760195

RESUMO

The 2019 novel coronavirus disease (COVID-19) epidemic in China has presented substantial challenges to traditional forms of mental health service delivery. This review summarizes the expert consensus on the mental health treatment and services for severe psychiatric disorders during the COVID-19 outbreak developed by the Chinese Society of Psychiatry and other academic associations. The Expert Recommendations on Managing Patients with Mental Disorders during a Serious Infectious Disease Outbreak (COVID-19) outline the appropriate measures for psychiatric hospitals or psychiatric units in general hospitals, including the delivery of outpatient, inpatient, and community mental health services. The Expert Recommendations on Internet and Telehealth in Psychiatry during Major Public Health Crises (COVID-19) describe the assessment and treatment issues of internet-based mental health services during the COVID-19 outbreak. The expert consensus recommendations provide guidance for mental health professionals in managing psychiatric services during the COVID-19 outbreak in China. The experiences from China in addressing the challenges in the management of major psychiatric disorders may be useful and relevant to other countries who are combating the COVID-19 pandemic.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Betacoronavirus , China/epidemiologia , Consenso , Humanos , Pacientes Internados , Internet , Serviços de Saúde Mental/organização & administração , Pacientes Ambulatoriais , Pandemias , Telemedicina
16.
mBio ; 11(4)2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769090

RESUMO

Coronavirus disease 2019 (COVID-19) is the greatest pandemic of our generation, with 16 million people affected and 650,000 deaths worldwide so far. One of the risk factors associated with COVID-19 is secondary bacterial pneumonia. In recent studies on COVID-19 patients, secondary bacterial infections were significantly associated with worse outcomes and death despite antimicrobial therapies. In the past, the intensive use of antibiotics during the severe acute respiratory syndrome coronavirus (SARS-CoV) pandemic led to increases in the prevalence of multidrug-resistant bacteria. The rising number of antibiotic-resistant bacteria and our decreasing capacity to eradicate them not only render us more vulnerable to bacterial infections but also weaken us during viral pandemics. The COVID-19 pandemic reminds us of the great health challenges we are facing, especially regarding antibiotic-resistant bacteria.


Assuntos
Infecções Bacterianas , Infecções por Coronavirus/epidemiologia , Coronavirus , Pandemias , Pneumonia Viral , Adulto , Bactérias , Betacoronavirus , China , Humanos , Pacientes Internados , Estudos Retrospectivos , Fatores de Risco
17.
J Int AIDS Soc ; 23(7): e25573, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32657527

RESUMO

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US. METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US. RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%. CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.


Assuntos
Infecções por Coronavirus/complicações , Infecções por HIV/complicações , Pacientes Internados , Pacientes Ambulatoriais , Pneumonia Viral/complicações , Telemedicina , Adulto , Idoso , Assistência Ambulatorial/normas , Betacoronavirus , Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Rhode Island/epidemiologia , Fatores de Risco , Estados Unidos
18.
J Affect Disord ; 274: 1062-1067, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32663933

RESUMO

BACKGROUND: The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. METHODS: We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTERED RECOMMENDATIONS: Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. LIMITATIONS: Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. CONCLUSIONS: Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pacientes Internados/psicologia , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Pneumonia Viral/complicações , Encaminhamento e Consulta , Idoso , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Psiquiatria
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