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1.
BJPsych Open ; 8(S1):S161, 2022.
Article in English | ProQuest Central | ID: covidwho-1902542

ABSTRACT

AimsTo assess the monitoring of patients who present with first episode psychosis (FEP), who are commenced on antipsychotics, under the early intervention team (EIT), in accordance with NICE guidelines. Patients diagnosed with FEP are usually treated with atypical antipsychotic's hence have a higher chance of developing metabolic syndrome, thus screening for physical health is imperative.MethodsThis was a retrospective audit of patients with FEP, started on antipsychotics, under the EIT, between the 1st January 2020 to 31st December 2020. The date range allowed for a complete data set, as well as to assess the impact, if any, of COVID-19. A sample of 26 patients were identified by the EIT of which, once inclusion criteria was applied, 21 were audited.Compliance was calculated on investigations being completed at every stage, as defined in the standards. For example: blood pressure had to be measured at 12 weeks and 1 year to be compliant with the standard. Data collection and analyses was completed using the IT system ‘Rio’ and Microsoft Excel.ResultsThere was an overall compliance rate of 51%. The results showed no patients had their weight/BMI monitored as per guidelines. Waist circumference was not measured in any patients. 43% met the monitoring standards for pulse and blood pressure. On further analysis, by 1 year 90% of patients had their pulse and blood pressure checked. Blood lipids were correctly monitored in 48% of cases, nevertheless when the results were broken down, 86% of patients had been monitored within a year. Prolactin monitoring occurred correctly in 52% of patients. Blood tests including full blood count, urea and electrolytes and liver function tests adhered to guidance greater than other parameters at, 86%, 86% and 90%, respectively. 48% of patients had plasma glucose/HbA1c monitored. An ECG at 1 year was obtained in 67% of the patients.The compliance rate may have been lower than expected due to COVID-19 preventing in-person appointments, staff redeployment and disengagement from patients.ConclusionMonitoring after antipsychotic medication has been commenced requires improvement. Within one year, monitoring was generally met well. However, the monitoring did not always meet the specific time frames provided by NICE, thus current systems need reviewing. Recommendations included disseminating results throughout the EIT, adding waist circumference as an option on the physical health assessment form and create ‘blood sample sets’. Re-audit will allow us to assess the results of interventions and the impact COVID-19 had on monitoring.

4.
Int J Gen Med ; 14: 267-271, 2021.
Article in English | MEDLINE | ID: covidwho-1060965

ABSTRACT

We sought to examine the trend (April-July) in the treatment patterns among hospitalized COVID-19 patients using the Premier Healthcare Database (PHD). In the analysis, we identified 53,264 patients from 302 hospitalsthat continuously provided inpatient data from April 1, 2020 to July 31, 2020 to the PHD, a nationwide, population-based multihospital research database in the US. We used generalized estimating equations (GEE) models to assess changes in the proportion of therapies used during the study period. After adjusting for patient and provider factors, a decline in hydroxychloroquine and an increase in azithromycin and dexamethasone were observed among COVID-19 patients during the 4-month study period.

6.
Aging Dis ; 11(6): 1339-1344, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-955203

ABSTRACT

India has witnessed a high number of COVID-19 cases, but mortality has been quite low, and most cases have been asymptomatic or mild. In early April, we had hypothesized a low COVID-19 mortality in India, based on the concept of cross-immunity. The presence of cross-immunity is presumed to lead to a milder course of disease and allow the time necessary for the development of adaptive immunity by the body to eliminate the virus. Evidence supporting our hypothesis has started showing up. Multiple studies have shown the generation of different T cell subsets and B cells responding to epitopes of viral proteins, especially of the spike protein, as a part of adaptive immunity against SARS-CoV-2. Cross-reactive T-cells have been demonstrated in patients who have been previously exposed to endemic coronaviruses. The interplay of cross-immunity and herd immunity is apparent in the COVID-19 scenario in India from the presence of a large number of asymptomatic or mild cases, a low infection-fatality ratio and a generally flat curve of percentage positivity of cases with respect to total testing, both in periods of strict lock-down and step-wise unlocking. It seems that cross-immunity resulted in faster generation of herd immunity. Although the initial restrictive measures such as lockdown prevented the rapid spread of the outbreak, further extension of such measures and overly expensive ones such as enhanced testing in India will result in a huge burden on the health economics as well as the society. Hence, we propose a restructuring of the health services and approach to COVID-19. The restructured health services should move away from indiscriminate testing, isolation and quarantine, and instead, the emphasis should be on improving facilities for testing and management of only critical COVID cases and the replacement of complete lockdowns by the selective isolation and quarantine of susceptible persons such as the aged and those with co-morbidities. In the process of describing India-specific plans, we emphasize why the development of country-specific plans for tackling epidemics is important, instead of adopting a "one policy fits all" approach.

7.
Australas Psychiatry ; 28(5): 504-507, 2020 10.
Article in English | MEDLINE | ID: covidwho-760445

ABSTRACT

OBJECTIVES: During the COVID-19 pandemic, our mental health service experimented with working from home. The flexibility of this practice can enable improved efficiency, staff well-being and expanded operating hours in the longer term. This paper shares our experiences and makes recommendations for being a part of and leading distributed clinical teams. CONCLUSIONS: We saw a 3% increase in total appointment bookings and a 7% reduction in cancellations/non-attendance compared to the same period in 2019. Based on our experience and the literature, effective distributed teams have leaders that connect via video at least weekly; focus on transparency and output over micromanagement; prioritise staff relationships and err towards overcommunication.


Subject(s)
Coronavirus Infections/psychology , Mental Health Services/statistics & numerical data , Pneumonia, Viral/psychology , Telemedicine/statistics & numerical data , Workplace , Betacoronavirus , COVID-19 , Humans , Pandemics , Patient Acceptance of Health Care/statistics & numerical data , SARS-CoV-2
8.
Aging Dis ; 11(3): 480-488, 2020 May.
Article in English | MEDLINE | ID: covidwho-459276

ABSTRACT

The ongoing Corona virus (COVID-19) pandemic has witnessed global political responses of unimaginable proportions. Many nations have implemented lockdowns that involve mandating citizens not to leave their residences for non-essential work. The Indian government has taken appropriate and commendable steps to curtail the community spread of COVID-19. While this may be extremely beneficial, this perspective discusses the other reasons why COVID-19 may have a lesser impact on India. We analyze the current pattern of SARS-CoV-2 transmission, testing, and mortality in India with an emphasis on the importance of mortality as a marker of the clinical relevance of COVID-19 disease. We also analyze the environmental and biological factors which may lessen the impact of COVID-19 in India. The importance of cross-immunity, innate immune responses, ACE polymorphism, and viral genetic mutations are discussed.

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