COVID-19 and mental health treatment in primary care: Impacts of a global pandemic on a psychopharmacological collaborative care management program.

OBJECTIVE: The COVID-19 pandemic has had a profound impact on individuals with mental health (MH) disorders and on the delivery of MH services. Studies examining treatment models which did not require substantial changes to the delivery of services during pandemic restrictions, such as collaborative care management (CoCM) programs are minimal. Therefore, a longitudinal retrospective cohort analysis was conducted to examine the impacts of the COVID-19 pandemic on a psychopharmacological CoCM program. METHOD: Data was collected on all U.S. Veterans enrolled in a CoCM program at a large VA during the first 10 months of the COVID-19 pandemic and compared to a one-year prior date matched control group. Treatment in the program pre-COVID vs. treatment during the pandemic was compared in relation to baseline symptomatology, improvements in MH symptoms, and program adherence. RESULTS: 462 Veterans were referred during the control dates, compared to 351 during the pandemic. Veterans enrolled during the first four months of each study arm, done to allow for a minimum of 6 months of follow up data, had no differences in baseline symptoms of depression or anxiety. Veterans receiving care during the pandemic had higher rates of program completion than pre-pandemic controls. COVID-era Veterans had higher rates of depression response than controls, and no differences were observed in depression remission, anxiety response, or anxiety remission. CONCLUSIONS: Psychopharmacological CoCM treatment models can successfully manage depression and anxiety with no observed decrease in the effectiveness of this intervention even during periods of unprecedented disruptions to the delivery of MH services.

Anxiety and Depressive Symptoms in Patients with COPD: Modifiable Explanatory Factors.

Anxiety and depressive symptoms affect up to 80% of people with chronic obstructive pulmonary disease (COPD). To reduce this symptom burden, clinicians should target modifiable explanatory factors while accounting for nonmodifiable explanatory factors of these symptoms. The purpose of this secondary data analysis was to examine which modifiable factors explain anxiety and depressive symptoms in COPD. This secondary data analysis of 1,760 COPD patients used multiple regression to explain anxiety and depressive symptoms from sets of modifiable patient characteristics and demographic controls. Clinically significant symptoms of anxiety or depression presented in 29.6% (n = 526) of participants, and 20.6% (n = 363) had both. Significant modifiable explanatory factors of both disorder symptoms were perceived functional status, functional capacity, psychosocial impact, symptom self-management, and significant symptoms for the other. Somatic symptom burden and dyspnea explained anxiety and depressive symptoms, respectively. Addressing these modifiable factors may reduce anxiety and depressive symptoms in patients with COPD.

Measurement-based care in integrated health care: A randomized clinical trial.

Introduction: Many suggest that the next step for integrated care is widespread implementation of measurement-based care (MBC). Although the measures most associated with MBC are standardized, no randomized clinical trial has demonstrated their use to improve psychotherapeutic outcomes with embedded behavioral health providers in integrated care. Two evidence-based MBC systems have been studied in a variety of behavioral health environments, but neither system has been investigated in integrated health care. Addressing this gap in the literature, the present study evaluated the use of MBC, specifically the Partners for Change Outcome Management System, in three integrated care sites. Method: Using a randomized design within routine care, treatment as usual (TAU; n = 133) was compared using the Outcome Rating Scale (ORS) and Patient Health Questionnaire-9 (PHQ-9) with a feedback condition (n = 147) in which behavioral health providers had access to patient-generated outcome (ORS only) and alliance information at each session. Results: Patients in the feedback condition demonstrated significantly more improvement than those in the TAU condition posttreatment on the ORS. Patients in the feedback condition also achieved significantly more clinically significant change as measured by both the ORS and PHQ-9. Feedback condition patients also attended significantly more sessions and dropped out significantly less that TAU patients. Discussion: Although our findings need to be replicated, this study offers evidence that the improved outcomes and reduced dropouts associated with MBC in traditional behavioral health centers also occur in integrated care settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Utilizing an Artificial Neural Network to Predict Self-Management in Patients With Chronic Obstructive Pulmonary Disease: An Exploratory Analysis.

PURPOSE: The main objective of this study was to utilize an artificial neural network in an exploratory fashion to predict self-management behaviors based on reported symptoms in a sample of stable patients with chronic obstructive pulmonary disease (COPD). DESIGN AND METHODS: Patient symptom data were collected over 21 consecutive days. Symptoms included distress due to cough, chest tightness, distress due to mucus, dyspnea with activity, dyspnea at rest, and fatigue. Self-management abilities were measured and recorded periodically throughout the study period and were the dependent variable for these analyses. Self-management ability scores were broken into three equal tertiles to signify low, medium, and high self-management abilities. Data were entered into a simple artificial neural network using a three-layer model. Accuracy of the neural network model was calculated in a series of three models that respectively used 7, 14, and 21 days of symptom data as input (independent variables). Symptom data were used to determine if the model could accurately classify participants into their respective self-management ability tertiles (low, medium, or high scores). Through analysis of synaptic weights, or the strength or amplitude of a connection between variables and parts of the neural network, the most important variables in classifying self-management abilities could be illuminated and served as another outcome in this study. FINDINGS: The artificial neural network was able to predict self-management ability with 93.8% accuracy if 21 days of symptom data were included. The neural network performed best when predicting the low and high self-management abilities but struggled in predicting those with medium scores. By analyzing the synaptic weights, the most important variables determining self-management abilities were gender, followed by chest tightness, age, cough, breathlessness during activity, fatigue, breathlessness at rest, and phlegm. CONCLUSIONS: The results of this study suggest that self-management abilities could potentially be predicted through understanding and reporting of patient's symptoms and use of an artificial neural network. Future research is clearly needed to expand on these findings. CLINICAL RELEVANCE: Symptom presentation in chronically ill patients directly impacts self-management behaviors. Patients with COPD experience a number of symptoms that have the potential to impact their ability to manage their chronic disease, and artificial neural networks may help clinicians identify patients at risk for poor self-management abilities.

Effects of a Digital Self-care Intervention in Adults with COPD: A Pilot Study.

Self-care improves quality of life, and reduces exacerbations and mortality risk in people with chronic obstructive pulmonary disease (COPD). The purpose of this report is to describe the development and testing of the feasibility and acceptability of a digital, educational self-care intervention designed to improve self-care ability, adherence, knowledge, somatic symptoms, anxiety, and depressive symptoms.This pilot study was a quasi-experimental, repeated measures design. Self-care behaviors were identified, and educational modules were developed and built into a web-based platform. Twenty participants were enrolled to determine feasibility, acceptability, and preliminary efficacy.The intervention was deemed acceptable and feasible as evidenced by > 95% completion rates and high degree of participation. Overall, the intervention was well received and is feasible for future home-based interventions in those with COPD. Results included significant improvements in adherence and knowledge, and significant associations between self-care ability, adherence, and depressive symptoms.

Radiologic Technologists' Job Satisfaction: A Look at Work Environment, Communication, and Leadership.

PURPOSE: To explore radiologic technologist job satisfaction pertaining to work environment, communication, and leadership. METHODS: Investigators designed and distributed a 12-item survey to 117 registered technologists (R.T.s). Data were statistically analyzed using descriptive statistics, independent t tests, and a univariate analysis of variance. RESULTS: Fifty-nine R.T.s responded to the survey. No significant differences in total satisfaction scores were found between technologists who have an associate degree and those who have a bachelor's degree. A univariate analysis of variance yielded a significant difference in satisfaction scores between technologists with different levels of experience. R.T.s with fewer than 20 years of experience were less satisfied than technologists with 20 or more years of experience. DISCUSSION: Results suggest R.T.s want effective leadership and appreciate continuing education opportunities and supportive peers. R.T.s valued being recognized for good work and were less satisfied with changes in administration because of moving to a system-wide approach. R.T. satisfaction influenced by length of time in the profession demonstrated a pattern of overall greater satisfaction among those in the field 20 or more years. An exception to this group's overall greater satisfaction is their low scoring of satisfaction with recent changes involved in becoming a hospital system. CONCLUSION: R.T.s value competent leadership, teamwork, peer support, and effective communication.

Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care.

BACKGROUND: Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed. PURPOSE: The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families. METHODS/SEARCH STRATEGY: A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis. FINDINGS/RESULTS: The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking. IMPLICATIONS FOR PRACTICE: Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations. IMPLICATIONS FOR RESEARCH: Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.

The Baptist Health Nurse Retention Questionnaire: A Methodological Study, Part 1.

OBJECTIVE: The purposes of this study were to develop and test the Baptist Health Nurse Retention Questionnaire (BHNRQ) and examine the importance of nurse retention factors. BACKGROUND: Multiple factors, including increasing patient acuity levels, have led to concerns regarding nurse retention. An understanding of current factors related to retention is limited. METHODS: To establish the psychometric properties of the BHNRQ, data were collected from 279 bedside nurses at a 391-bed, Magnet® redesignated community hospital. A principal component analysis was conducted to determine the subscale structure of the BHNRQ. Additional analyses were conducted related to content validity and test-retest reliability. RESULTS: The results of the principal components analysis revealed 3 subscales: nursing practice, management, and staffing. Analyses demonstrate that the BHNRQ is a reliable and valid instrument for measuring nurse retention factors. CONCLUSION: The BHNRQ was found to be a clinically useful instrument for measuring important factors related to nurse retention.

Exploring the Lived Experience of Women Immediately Following Mastectomy: A Phenomenological Study.

BACKGROUND: In 2014, it is estimated that 232,670 new cases of breast cancer occurred in the United States. Unilateral or bilateral mastectomy is a frequently chosen option for treating this disease. OBJECTIVE: The purpose of this study was to explore, through an in-depth interview process, the lived experience of women immediately following mastectomy when they see their scars for the first time. METHODS: Purposeful sampling was used until saturation was reached. In-depth interviews were conducted with 10 women related to their mastectomy experience. The data were analyzed using a phenomenological approach. RESULTS: The following 8 themes emerged from the data; lasting impact, personal impact, relational impact, gratitude, support system, coping strategies, timing, and discomfort. CONCLUSIONS: The results of the study provide evidence that women face ongoing challenges following seeing their mastectomy scars for the first time that is not adequately addressed by healthcare professionals. IMPLICATIONS FOR PRACTICE: Nurses and other healthcare professionals need to gain a better understanding of the difficulties perceived by women following seeing the scars from mastectomy and implement strategies to assist in successful adaptation to the experience.

Neonatal Abstinence Syndrome: The Experience of Infant Massage.

Babies born to women who have used opioids during pregnancy frequently develop withdrawal symptoms following birth. Although a consistently used protocol is not available to treat these infants, interventions commonly used include a pharmacological regimen and supportive care such as swaddling, frequent feedings, decreased sensory stimulation, and protection from skin breakdown (Murphy-Oikonen, Montelpare, Bertoldo, Southon, & Persichino, 2012). A qualitative study was designed to better understand how infant massage might impact these babies' behavior and the mothers' relationship with their babies. Themes derived from the data include empowerment, enjoyment and bonding, and calm and comfort. The themes suggest that infant massage helps alleviate withdrawal symptoms in infants while fostering a connection between mother and child.