Engagement during post-acute care transition: Perceptions and experiences of family caregivers of older adults with dementia

Older adults with dementia experience hospitalizations and post-acute care transitions more than people without dementia and rely on family caregivers for support. Family caregivers of older adults with dementia, therefore, play a crucial role during care transitions, and caregiver engagement is acknowledged as a critical factor in promoting quality of care. Despite this, "engagement" has been exclusively defined from the perspective of clinical care providers in other settings, and little is known about the post-acute care experiences and perceptions of family caregivers. The purpose of this dissertation was to describe the meaning of engagement to family caregivers navigating post-acute care transition, to elucidate their perspectives on barriers and facilitators of engagement, and to explore their support needs.Following an interpretive descriptive approach and guided by Meleis's Middle Range transition theory, semi-structured interviews were conducted with a purposive sample of 15 family caregivers of older adults with dementia. Using an inductive coding process, similar codes were categorized by grouping codes that describe similar concepts related to the caregiver experiences and perceptions. The process helped to develop themes from the categories and a conceptual framework that described the meaning of engagement.Thematic findings revealed family caregivers' descriptions of the meaning of engagement during post-acute care transitions is linked to being there, having meaningful connection with professional care providers, and having communication with the person with dementia. Limited communication and not being able to be there were seen as barriers to engagement. Nine family caregivers' level of engagement was impacted by the COVID-19 pandemic new visitation policies. Facilitator to engagement were linked to having good communication with professional care providers and having past post-acute care transition experience. The support needs of family caregivers were also related to their relationship with healthcare providers and receiving support from family and friends. The study supports highlighting communication as an integral part of transition and makes an argument to expanding the Meleis's Middle Range transition theory. Findings of the study contribute to the dementia caregiving literature and make an appeal to healthcare providers and policymakers to include family caregivers as part of the care team. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Outcomes among patients admitted with cardiogenic shock during the first year of the covid-19 pandemic in the united states

BackgroundOutcomes of patients hospitalized for cardiogenic shock during the midst of the COVID-19 pandemic in the United States have yet to be well described. This study aimed to examine if the COVID-19 pandemic led to gender differences in in-hospital outcomes, length of stay, and total hospital charges.MethodsData was extracted from the National Inpatient Sample database for the calendar year 2020. Patients who were admitted with a principal diagnosis of cardiogenic shock (R57.0) were identified using relevant International Classification of Disease, and Clinical Modification codes. The key outcomes of mortality, use of mechanical ventilation, use of mechanical circulatory support, hemodialysis, vasopressors use, length of stay, and total hospital charges were then accessed.ResultsThere were 2,670 hospitalizations for a principal diagnosis of cardiogenic shock in 2020, of which 955 were females. After adjusting for age, race, hospital bed size, hospital location, hospital teaching status, insurance status, income level, and Elixhauser comorbidities;we found that females admitted with cardiogenic shock were more likely to require mechanical ventilation (aOR 1.54, 95% CI 1.02- 2.34), but had no difference in mortality, vasopressor use, mechanical circulatory support use, hemodialysis initiation, length of hospital stay and total hospital charges relative males.ConclusionOur study found that females admitted for cardiogenic shock during the first year of the pandemic had significantly higher rates of mechanical ventilation but no difference in other outcomes. Further studies are needed to investigate the effect of COVID-19 on the outcomes of female patients admitted for cardiogenic shock.Conflict of InterestNone

Nurses' experiences caring for patients with opioid use disorders

The purpose of this study was to examine nurses' experience of quality care for hospitalized patients with a history of opioid use disorder or self-injection of opioids and whether hospital, unit, or nurse characteristics impacted experiences of quality care. A secondary aim of the study was to understand how nurses' experiences of quality care for this population have been impacted by the COVID-19 pandemic. The Institute of Medicine's Six Domains of Health Care Quality were used to define quality care in this study. A national sample of 179 nurses completed an online survey regarding their experiences caring for patients with opioid use disorders. The majority of the participants were staff nurses who worked in emergency departments, critical care units, or mother baby units. Only 41.9% of the participants had received education regarding substance use disorders from their employers, and even less had participated in harm reduction education. Only 45% of the nurses had knowledge regarding harm reduction strategies for this population. The participants experienced a low number of restrictive safety measures and an average number of adverse events and effective care interventions when caring for patients with opioid use disorders. The nurses rated quality care and satisfaction as average. Correlation and linear regression analysis suggested trends in nurse, hospital and unit characteristics that are associated with nurses' experiences caring for this population;substance use disorder education, harm reduction education, and unit type were most often associated with nurses' experiences. Content analysis of open-ended questions regarding equity, patient-centeredness, timeliness and the impact of COVID-19 on experiences of quality care supported quantitative findings in the study and provided insight into the nurses' experiences. The findings in this study contribute to current evidence regarding the need for standardized hospital policies and practices aimed at improving quality care for patients with opioid use disorders. These policies and practices should incorporate harm reduction strategies that are patient-centered and evidence-based. Hospitals and nursing schools should provide education aimed at reducing stigma and improving care for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Preparing for the next pandemic by understanding the impact of COVID-19 mitigation measures on patients with eating Disorders: observations from an inpatient setting.

OBJECTIVE: The COVID-19 pandemic overwhelmed eating disorder (ED) services worldwide. Data suggests a worsening of psychopathology and an increased request for specialised treatments. Still, the studies are mostly based on experimental protocols with underpowered short-term opportunistic experimental designs. Thus, this study aims to assess the clinical and psychological differences between patients admitted to a specialised ED Unit before and after the COVID-19 breakout. METHODS: Consecutive patients admitted from June 2014 to February 2022 in a specialised EDs Unit were enrolled. A total sample of 498 individuals was enrolled in this retrospective study, collecting demographic and psychopathological data at admission. RESULTS: An increase in the admission of patients with anorexia nervosa has been reported, with lower age and higher levels of specific and general psychopathology, especially linked to body uneasiness. CONCLUSIONS: Results are put into the context of the preparation for the next pandemic that may require similar mitigation measures as COVID-19 to ensure the impact on existing and new patients. Covering an extended period with validated tools, our results might help psychiatric services to reassess their treatment pathways after the pandemic, helping clinicians to delineate future treatment interventions.KEYPOINTSAfter the COVID-19 breakdown, there was an increase in the admission of patients with anorexia nervosa to specialised services.More severe psychopathology was not accompanied by lower body mass index.Specialised eating disorders services should face sudden changes in patients' requests for treatment.Understanding the impact of the Covid-19 pandemic and the resulting mitigation measures taken can lead to better preparations for the next pandemic.

Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Variants on Inpatient Clinical Outcome.

BACKGROUND: Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. METHODS: Inpatients with COVID-19 at 5 hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole-genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. RESULTS: Severe disease or death within 28 days occurred for 977 (29%) of 3369 unvaccinated patients and 269 (22%) of 1230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvaccinated patients, the relative risk of severe disease or death for Delta variant compared with ancestral lineages was 1.30 (95% confidence interval [CI]: 1.11-1.49). Compared with Delta, the risk for Omicron patients was .72 (95% CI: .59-.88) and compared with ancestral lineages was .94 (.78-1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio: .40; 95% CI: .30-.54), but no significant outcome difference by variant. CONCLUSIONS: Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than with Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

Virtual family-centered rounds: a quality improvement initiative to adapt inpatient care during COVID-19 using a human-centred participatory design approach.

BACKGROUND: Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). METHODS: A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. RESULTS: Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD = 3.9) for a single patient round and transition time between patients averaged 2.9 min (SD = 2.6). CONCLUSION: Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.

Response to COVID-19 Pandemic: Managing Inpatient Pharmacy Services at King Abdulaziz Medical City - Jeddah.

Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

In-Patient Costs of Coronavirus Disease 2019 with Financial Regulations and Heath Economy

Introduction: Coronavirus Disease 2019 (COVID-19) is an emerging disease that infects patients, who have critical and complex health problems, that need to be treated in hospitals. The financial regulations and heath economy to management efficiency in hospitals is an important indicator for hospital administrators to make decisions for efficient health service provision. Then, the purposes were to: analyze the cost of in-patient with COVID-19 per day and per admission, and compare COVID-19 severity with the cost of in-patient. Methods: This retrospective study using secondary data from the standard data set HOSxP data system program 43 folders of 18, between 2021 and 2022 was conducted. The total hospital costs was analyzed from the 4191 samples of in-patients with COVID-19 on the 18 community hospital in Sakon Nakhon Province, Thailand. Results:The majority of samples were females 52.6%, age group between 30 - 39 of 26.0 %, the insurance type was Social Security Scheme 60.9% (average sleeping days 11 days), lived in Sakon Nakhon province, Thailand 77.7%, no medical conditions 97.7 %, the severity of disease was asymptomatic and mild symptoms 80.5%. In addition, the cost of an in-patient COVID- 19 ward was 104.1 USD per day. The cost of complication diseases resulted from 1,063.3 USD - 1,681.1 USD per admission, moderate symptoms and pneumonia were 1,681.1 USD per admission, and mild symptoms were 1,063.3 USD per admission, which was higher than the standard cost (p<0.015). Furthermore, the cost of mild symptoms was 1,063.3 USD per admission was higher than the estimated cost (p<0.05), and the cost of moderate symptoms with pneumonia was 1,681.1 USD per admission, higher than the estimated cost ( p<0.001). Conclusions: As a consequence, the various levels of clinical severity and the cost of an in-patient with COVID-19 is higher than the standard cost and estimated cost. However, there is still no suitable fiscal legislation.

A case of Kretschmer's sensitive delusion related to COVID-19 pandemic

Presents a case report of a 45-year-old woman with a brief psychotic disorder, in which pathogeny was an effect of the pandemic, modulating a classic syndrome described more than one century ago by Ernst Kretschmer. During the mandatory screening before hospital admission, the patient tested positive for SARS-CoV-2. Basic tests were performed, including blood alcohol concentration, urinary drug screening, and brain computerized tomography - all normal. Regarding her premorbid personality, she had cluster C personality traits. The discharge diagnosis was a Brief psychotic disorder. Other differential diagnoses were considered such as schizophreniform disorder, psychotic depression, bipolar disorder, late-onset schizophrenia, but the rapid onset of the picture, the brief resolution, the absence of dominant affective symptomatology, and the absence of negative symptomatology led to assume that it was more likely a brief reactive psychosis. antipsychotic medication was suspended gradually and she didn't present any recurrence of symptoms. In this case report, the author reviews a classic nosological entity, commonly forgotten, revived by a very current and particular social situation (the COVID-19 pandemic), whose social conditionings can affect mental health. The author emphasizes the importance of a thorough anamnesis with a complete evaluation of the premorbid character, which allowed an early intervention and subsequent better prognosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Features of the COVID-19 in lung tissue damage admitted to hospital

The COVID-19 pandemic continues to spread despite all the efforts of the medical community. The aim of the study - to identify the features of a new coronavirus infection (COVID-19) with lung tissue damage in men and women receiving inpatient treatment. Material and methods. The method of continuous sampling selected 225 patients admitted to inpatient treatment. The patients were divided in 2 groups: the 1st group - men (n=85), the 2nd group - women (n=140). Statistical processing was carried out using the IBM SPSS Statistics 22.0 program. Results. In a comprehensive study of the features of lung tissue damage by the new coronavirus infection SARS-CoV-2 in men and women was found that women received inpatient treatment more often, after ineffective outpatient treatment, the general serious condition at admission was more typical for women who had a positive result of a PCR-test for the detection of SARS-CoV-2 (p=0.038). In the presence of general clinical manifestations complaints of loss of sense of smell were more often presented by women (p=0.020). According to laboratory studies in the indicators of general clinical and biochemical blood tests, on average men often have higher levels of creatinine (p<0.001), women more often have elevated levels of ESR (p=0.003), erythrocytes (p<0.001), CRP (p=0.042) and decreased hemoglobin (p=0.029). Conclusion. In the first wave of the Wuhan pandemic of the SARS-CoV-2 virus strain women prevailed among patients admitted to inpatient treatment with lung tissue damage after ineffective outpatient treatment (p=0.038). There was a commonality in age and clinical manifestations, of the complaints in women, only loss of sense of smell was more common (p=0.020). The erythrocytosis detected in women, increased ESR and CRP, lower hemoglobin and creatinine levels are not specific for COVID-19. There were no statistically significant differences in the terms of hospitalization and the fatal outcome of the disease between men and women.Copyright © Eco-Vector, 2022.

COVID-19 and Clostridioides difficile Coinfection Outcomes among Hospitalized Patients in the United States: An Insight from National Inpatient Database.

The incidence of Clostridioides difficile infection (CDI) has been increasing compared to pre-COVID-19 pandemic levels. The COVID-19 infection and CDI relationship can be affected by gut dysbiosis and poor antibiotic stewardship. As the COVID-19 pandemic transitions into an endemic stage, it has become increasingly important to further characterize how concurrent infection with both conditions can impact patient outcomes. We performed a retrospective cohort study utilizing the 2020 NIS Healthcare Cost Utilization Project (HCUP) database with a total of 1,659,040 patients, with 10,710 (0.6%) of those patients with concurrent CDI. We found that patients with concurrent COVID-19 and CDI had worse outcomes compared to patients without CDI including higher in-hospital mortality (23% vs. 13.4%, aOR: 1.3, 95% CI: 1.12-1.5, p = 0.01), rates of in-hospital complications such as ileus (2.7% vs. 0.8%, p < 0.001), septic shock (21.0% vs. 7.2%, aOR: 2.3, 95% CI: 2.1-2.6, p < 0.001), length of stay (15.1 days vs. 8 days, p < 0.001) and overall cost of hospitalization (USD 196,012 vs. USD 91,162, p < 0.001). Patients with concurrent COVID-19 and CDI had increased morbidity and mortality, and added significant preventable burden on the healthcare system. Optimizing hand hygiene and antibiotic stewardship during in-hospital admissions can help to reduce worse outcomes in this population, and more efforts should be directly made to reduce CDI in hospitalized patients with COVID-19 infection.

A Comprehensive Examination of Pediatric Behavioral Health Service Demand and Utilization in a Large, Academic Health System from 2019 to 2021.

Studies of the effects of COVID-19 on youth suggest a worsening in mental health globally. We performed a retrospective analysis of data from January 2019-November 2021 for all outpatient referrals, as well as outpatient, inpatient, and emergency department (ED) encounters for behavioral health (BH) reasons in children aged < 18 in a large academic health system in the United States. Mean weekly rates of outpatient psychiatry referrals, outpatient psychiatry visits, ED visits, and inpatient admissions for BH reasons were compared between pre-pandemic and pandemic periods. The average weekly rate of ambulatory referrals (8.0 ± 0.33 to 9.4 ± 0.31) and completed appointments (194.2 ± 0.72 to 213.1 ± 0.71) significantly increased during the pandemic, driven largely by teenagers. The weekly average of ED pediatric encounters for BH did not increase during the pandemic, although the percentage of all pediatric ED encounters that were for BH did increase from 2.6 to 4.1% (p < 0.001). Length of stay for pediatric BH ED patients increased from 1.59 ± 0.09 days pre-pandemic to 1.91 ± 0.11 days post-pandemic (p < 0.0001). Inpatient admissions for BH reasons overall decreased during the pandemic, due to a decrease in inpatient psychiatric bed capacity. However, the weekly percentage of inpatient hospitalizations for BH reasons that occurred on medical units increased during the pandemic (15.2% ± 2.8-24.6% ± 4.1% (p = 0.0006)). Taken together, our data suggest the COVID-19 pandemic had varying degrees of impact, depending on the setting of care.

Converting an Inpatient Nursing Unit to a Pandemic-Response Unit: Lessons Learned.

The University of California, San Francisco (UCSF) Hospital Epidemiology and Infection Prevention and the Department of Nursing used lessons-learned during COVID-19 as a foundation to create a framework to be used as a guide for converting an inpatient unit to a pandemic-response unit. This article provides details of this framework and other lessons learned that can be applied to other pandemic pathogens.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions.

Background: Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods: It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results: The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions: Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Impact of the COVID-19 pandemic on the hospitalization trends in a third level Child Neuropsychiatry Unit

Introduction: The COVID-19 outbreak and related confinement measures have disturbed the psychological well-being of young children and adolescents, especially in at-risk groups. Aim of the study was to evaluate the trend and severity of children' and adolescents' neuropsychiatric diseases in the context of a prolonged state of confinement measures. Materials and Methods: Data were retrospectively collected from all subjects aged between 4 and 16 years +/- 6 months, admitted to the Child Neuropsychiatry ward of the Gaslini Children Hospital between 01/01/20 and 30/05/21. Demographic and clinical characteristics were noted for each subject. Subjects were then divided in admitted before or after COVID outbreak, considered as the 9th Match 2020. Data of psychiatric patients about subjects' functioning (Children Global Assessment Scale, C-GAS) and disease severity (Global Impression- Severity, CGI-S) were collected. Results: Of 561 inpatients, 105 were admitted before the COVID-19 outbreak and 456 after, with an absolute increment of 30% for psychiatric diseases compared to neurological ones (33/105, 31.43% before vs. 187/456, 41.0% after;p = .013). For psychiatric diseases, there was an increase in the hospitalization duration (3.91 +/- 4.07 vs. 13.02 +/- 4.25;p = .04), an increase of subjects with previous neuropsychiatric disorders (27.7%, 9/33 vs. 47.7%, 89/187;p = .034), a decrease of CGAS scores (56,24 +/- 13,87 vs. 51,63 +/- 17,797;p = .050) and an increase disease severity worsening (CGI-S 3.76 +/- 1.12 vs. 4. 48 +/- 1.36;p = .006). In the female gender and in the ethnic minorities' subgroup, number of hospitalizations have statistically increased, with CGI-S and CGAS scores more impaired after the COVID-19 outbreak. On multivariate analysis, being female, having a previous psychiatric diagnosis, and belonging to an ethnic minority appeared to influence patients' overall impairment index (p < .005). Conclusions: The COVID-19 outbreak and the measures adopted to contain the virus spread had an impact on the severity of the course of psychiatric admissions, with greater influence on subjects who were already psychologically vulnerable, female, and who belonged to ethnic minorities. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) Introduzione: Lo scoppio della pandemia da COVID-19 e le relative misure di confinamento hanno minato il benessere psicologico della popolazione in eta evolutiva, soprattutto nelle categorie a rischio. Scopo dello studio e stato quello di valutare andamento e gravita dei soggetti accolti per patologia neuropsichiatrica nel contesto di uno stato prolungato di prosecuzione di misure di contenimento del contagio. Materiali e metodi: Sono state retrospettivamente raccolti i dati di tutti i soggetti di eta compresa fra 4 e 16 anni +/- 6 mesi ricoverati presso la UO di Neuropsichiatria Infantile dell'Ospedale Gaslini tra lo 01/01/20 e il 30/05/21. Per ciascun caso sono state annotate le caratteristiche demografiche e cliniche. I soggetti sono stati divisi tra ricoverati prima e dopo l'inizio della pandemia, considerato come data il 9 marzo 2020. Per i casi psichiatrici sono state applicate scale di funzionamento Children Global Assessment Scale (C-GAS) e di gravita Global Imression-Severity (CGI-S). Risultati: Di 561 accessi, 105 sono avvenuti preCOVID e 456 postCOVID, con un incremento assoluto del 30% degli accessi per patologia psichiatrica rispetto a quella neurologica (33/105, 31,4% preCOVID vs 187/456, 41,0% postCOVID;p = ,013). Per la patologia psichiatrica, si e assistito ad un aumento dei giorni di ospedalizzazione (3,91 +/- 4,07 vs 13,02 +/- 4,25;p = ,04), un aumento dei soggetti con precedente diagnosi neuropsichiatrica (27,7%, 9/33 vs 47,7%, 89/187;p = ,034), una diminuzione dei punteggi CGAS (56,24 +/- 13,87 vs 51,63 +/- 17,797;p = ,050) ed un aumento della gravita di patologia (CGI-S 3,76 +/- 1,12 vs 4,48 +/- 1,36;p = ,006). Nel sottogruppo di soggetti di genere femminile e delle minoranze etniche, i ricoveri per patologia psichiatrica sono risultati significativamente aumentati con punteggi CGI-S e CGAS maggiormente compromessi dopo lo scoppio del COVID-19. All'analisi multivariata, il sesso femminile, una pregressa diagnosi psichiatrica e l'appartenenza a minoranze etniche appaiono avere un effetto sull'indice di compromissione globale dei pazienti (p < ,005). Conclusioni: La pandemia da COVID-19 e le misure adottate per contenere il contagio hanno impattato la gravita del decorso dei ricoveri neuropsichiatrici, con maggiore effetto su soggetti gia fragili, di genere femminile ed appartenenti a minoranze etniche. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Effectiveness of narrative intervention on psychopathological dimensions and clinical evolution of psychiatric residential patients during the COVID-19 pandemic

Objective: Evaluation of the practical effectiveness of a Narrative Medicine (MN)-based intervention on adaptive capacity and relapse prevention in patients with severe mental illness (SMIs) residing in a protected community during the Pandemic due to Covid 19. Method: During the second lockdown, in a residential community with 20 subjects all suffering from SIMs, a group of 6 patients was included in an experimental protocol designed on the principles of MN and compared in parallel with a control group of the same number of patients. The clinical evolution was measured with standardized assessment tools (GAF;CGI;BPRS;MMSE;EuroQoL) together with a nonstandardized qualitative methodology. The total duration of the study was 16 weeks. Results: At the end of the study there was a significant improvement in the score of CGI, GAF, BPRS and in particular, about the latter, in the dimensions of: feelings of guilt, suspiciousness, hostility, affective flattening. On a qualitative level, there was a parallel improvement in the ability to express and recognize emotions with favorable effects on relationships. At the same time, a greater satisfaction of the operators was appreciated. There were no relapses and no need for hospitalization or changes in ongoing therapy. Conclusions: Our experience has shown that during the stressful event of the pandemic, rather than foreseeable relapses, the MN approach has led to an improvement of the clinical picture not only in the patients of the study, but also, albeit to a lesser extent, in the other guests of the community. At the same time, increased satisfaction of the operators was appreciated. The integration between EBM-based clinical practice and MN appears to be a promising field of research for further studies on patients with SMIs in residential care regarding appropriateness of interventions, quality of treatments, cost-effectiveness and optimization of resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) Oggetto: Valutazione dell'efficacia pratica di un intervento basato sulla Medicina Narrativa (MN) su capacita di adattamento e prevenzione delle ricadute in Pazienti affetti da Malattia Mentale Severa (SMIs) residenti in una comunita protetta durante la Pandemia dovuta a Covid 19 Metodo: Durante il secondo lockdown, in una comunita residenziale con 20 soggetti tutti affetti da SIMs, un gruppo di 6 pazienti e stato inserito in un protocollo sperimentale progettato sui principi della MN e confrontato parallelamente a un gruppo di controllo di altrettanti pazienti. L'evoluzione clinica e stata misurata con strumenti di valutazione standardizzati (GAF;CGI;BPRS;MMSE;EuroQoL) congiuntamente a una metodologia qualitativa non standardizzata. La durata complessiva dello studio e stata di 16 settimane. Risultati: A conclusione dello studio si e osservato un significativo miglioramento del punteggio di CGI;GAF;BPRS e in particolare, circa quest'ultima, nelle dimensioni di: sentimenti di colpa, sospettosita, ostilita, appiattimento affettivo. Sul piano qualitativo si riscontrava un miglioramento parallelo della capacita di esprimere e riconoscere le emozioni con ricadute favorevoli sulle relazioni. Congiuntamente si e apprezzata una maggiore soddisfazione degli operatori. Non si sono verificate ricadute e non sono stati necessari ricoveri o variazioni delle terapie in corso. Conclusioni: Dalla nostra esperienza e risultato che durante l'evento stressante della pandemia, piuttosto che prevedibili riacutizzazioni, attraverso l'approccio basato sulla MN si e ottenuto un miglioramento del quadro clinico non solo nei pazienti dello studio, ma di riflesso, seppure in minor misura, anche negli altri ospiti della comunita. Contestualmente si e apprezzata una maggiore soddisfazione degli operatori. L'integrazione tra pratica clinica basata sulla EBM a MN appare un promettente campo di ricerca per ulteriori studi su Pazienti con SMIs in assistenza residenziale riguardo appropriatezza degli interventi, qualita dei trattamenti, economicita e ottimizzazione delle risorse. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Psychiatric ward admissions during the COVID-19 pandemic in Canton of Ticino (Swiss Confederation) and the province of Como (Italy): a comparison between two different systems of care and outbreak response strategies

The aim of the study was to estimate the effect of the COVID-19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country's number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate's reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic;p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems. r. © the Author(s), 2023 Licensee PAGEPress, Italy.

Case study on psychological first aid on Italian COVID-Hospital

Coronavirus disease had an enormous impact on public health by affecting millions of people who have either fallen ill or died as a result of this disease. The pandemic resulted in several short- and long-term psychological effects, while restrictive measures adopted resulted in challenges in terms of support and counselling meetings, demonstrating the need to move to a digital health care system. In this context, the Psychological First Aid Service at Sant'Andrea, a service for COVID-19 patients and their loved ones, was set up in the Lazio region (Italy). The service provides two free telephone interviews, and if necessary, people are directed to other free support services in the region. In this article, we report a case study of two brothers who contacted the service during the second pandemic wave in Italy. The case has been discussed according to the recent literature, taking the practical and operational aspects of psychological first aid into account. (PsycInfo Database Record (c) 2023 APA, all rights reserved)