Efficacy of Sotrovimab (SOT), Molnupiravir (MOL), and Nirmatrelvir/Ritponavir (N/R) and Tolerability of Molnupiravir in Outpatients at High Risk for Severe COVID-19.

OBJECTIVE: The main goal of this study was to assess the potential clinical impact of an outpatient administration of available antivirals including SOT, N/R, and MOL to COVID-19 patients at high risk for disease progression. METHODS: We conducted a retrospective analysis on 2606 outpatient individuals with mild to moderate COVID-19 at risk for disease progression, hospitalization, or death. After receiving either SOT (420/2606), MOL (1788/2606), or N/R (398/2606), patients were followed-up with regarding primary (hospitalization rate) and secondary (treatment and side effects) outcomes by phone. RESULT: A total of 2606 patients were treated at the outpatient clinic (SOT: 420; N/R: 398; MOL: 1788). 3.2% of the SOT patients (1 ICU admission), 0.8% of the MOL patients (2 ICU admissions), and none of the N/R patients were hospitalized. 14.3% of the N/R patients reported strong to severe side effects, exceeding SOT (2.6%) and MOL (5%) patients. A reduction in COVID symptoms after the treatment was experienced by 43% of patients in both the SOT and MOL groups and by 67% of patients in the N/R group, respectively. Women had a higher chance of symptom improvement with MOL (OR 1.2, 95%CI 1.0-1.5). CONCLUSION: All antiviral treatment options effectively prevented hospitalization in high-risk COVID-19 patients and were well tolerated. Side effects were pronounced in patients with N/R.

Availability of Outpatient Child Psychiatric Care During COVID-19: A Simulated-Patient Study in Three U.S. Cities.

OBJECTIVE: In this study, the authors sought to ascertain the availability of outpatient child psychiatric appointments in three U.S. cities. METHODS: Using a simulated-patient methodology, investigators called 322 psychiatrists who were listed in a major insurer's database for three U.S. cities, and they attempted to make appointments for a child with three payment types: Blue Cross-Blue Shield, Medicaid, and self-pay. RESULTS: Initial appointments were available 11% of the time, and it was most difficult to obtain an appointment under Medicaid coverage. Nineteen percent of phone numbers were wrong, and 25% of psychiatrists were not accepting new patients. CONCLUSIONS: These results are concerning given the current mental health crisis among youths and suggest the need for more psychiatrists, higher reimbursement rates for psychiatric services, and continued efforts to increase access to care. This study also highlights the need for insurance companies to maintain accurate information in their databases.

Long COVID symptoms among outpatients with COVID-19: a descriptive study

Purpose: The purpose of this study is to describe long COVID-19 symptoms in patients receiving outpatient treatment.Materials and Methods: This prospective, observational, descriptive study was conducted in the COVID-19 clinic of a university hospital in February-May 2022. Patients who applied to the outpatient clinic and were diagnosed with COVID-19 were included in the study. Patients were follow up for prolonged COVID-19 symptoms for a 12 -week period. It was investigated whether there was a relationship between long COVID-19 symptoms frequency and gender, age and blood type.Results: At least one long COVID symptom was observed in 23% of 7139 patients included in the study. Myalgia was the most common symptom detected in 4.33% of all patients. Cough and loss of taste/smell were the most common symptoms in women, and dizziness in men. The frequency of 26 of 29 symptoms varied with age. While the symptoms most affected by the Body Mass Index were peripheral neuropathy and tinnitus, the least affected symptoms were loss of taste/smell, anxiety and depression.Conclusion: Long COVID symptoms were widely detected in COVID-19 outpatients. Age, gender and BMI may be factors affecting long COVID symptoms.

Impact of the Covid-19 Pandemic in the Treatment of Substance Use Disorder

This study aimed to characterize the impacts that the Covid-19 pandemic caused in patients undergoing treatment for substance use disorders, in the outpatient psychiatric service of a teaching hospital in the interior of the State of Sao Paulo. A documentary research was carried out on 123 medical records of patients who received care at the Psychiatry Outpatient Clinic in the years 2019, 2020 and 2021. Data analysis showed that the largest portion of patients who abandoned treatment did so before the beginning of the pandemic and that there was no significant increase in substance use by patients who remained under follow-up during the pandemic period. It was concluded that the scenario of the Covid-19 pandemic was not the main variable that interfered with substance consumption and treatment adherence and that possibly intrinsic and extrinsic determinants also affected consumption and adherence. More research will be needed to assess other factors that affect substance use and treatment adherence in the population studied.

The prevalence of vascular complications in SARS-CoV-2 infected outpatients.

BACKGROUND: The risk of thromboembolic events is increased for coronavirus disease (COVID)-19 inpatients. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected outpatients, only few data are available so far. METHODS: In our prospective single-center study, 461 SARS-CoV-2-infected outpatients were screened for the presence of deep vein thrombosis. RESULTS: Two outpatients had suffered a deep vein thrombosis. An association with previously known risk factors, such as preexisting thrombosis in the medical history or cardiovascular risk factors, could not be proven. CONCLUSION: General thromboprophylaxis in SARS-CoV-2-infected outpatients is still not recommended.

Using the basis-a profile as a predictor of sex offender treatment outcomes including assessed risk in an outpatient setting

This study aimed to understand the usefulness of the Basic Adlerian Scales for Interpersonal Success - Adult Form (BASIS-A) profile scores in the risk assessment of individuals convicted of a sexual criminal offense. Specifically, this study attempted to determine if a correlation existed between an individual's level of social interest and the difference in that individual's level of risk over time as measured by the STABLE-2007 and the Sex Offender Treatment Intervention and Progress Scale (SOTIPS) dynamic risk assessments. Due to the COVID-19 pandemic, the study was adapted to a hybrid of both in-person and virtual participation involving six total participants recruited from a private practice in suburban Illinois. Results of the partial correlation were not significant and deemed inconclusive due to low study participation. The impact of the pandemic on the study's outcome and the study's contribution to practice-oriented research as well as recommendations for future research regarding the BASIS-A, risk assessment, and practice-oriented research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Management of depression: A daily challenge in psychiatric emergencies

Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d'Orientation et d'Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (French) La depression est le trouble psychiatrique le plus frequent dans la population generale, et les consultations aux urgences pour depression seraient en hausse depuis plusieurs annees. Le Centre Psychiatrique d'Orientation et d'Accueil est un service d'urgences psychiatriques a vocation regionale situe a Paris qui recense environ 10 000 consultations par an. Parmi ces consultations, on retrouve pres de 40 % de diagnostics de troubles de l'humeur. La prise en charge du patient aux urgences repose sur une evaluation globale, qui ne doit pas se limiter a l'entretien psychiatrique. Le contexte d'arrivee, l'environnement et l'entourage du patient doivent etre pris en compte afin d'aboutir a une orientation optimale. Une attention particuliere doit etre portee aux premiers episodes (elimination d'un diagnostic differentiel, depistage d'un eventuel trouble bipolaire) et a l'evaluation du risque suicidaire. L'existence d'un facteur causal externe ou d'un trouble de personnalite comorbide ne doit pas faire banaliser la consultation et mener a un sous-diagnostic de depression caracterisee. Le traitement medicamenteux aux urgences est le plus souvent symptomatique (traitement anxiolytique par benzodiazepines ou neuroleptiques selon les situations), et l'orientation ambulatoire doit toujours etre privilegiee. Des adaptations therapeutiques peuvent alors etre envisagees. La decision d'une hospitalisation doit toujours etre argumentee, et le consentement aux soins rigoureusement evalue. La prise en compte et eventuellement l'accompagnement de l'entourage sont presque toujours necessaires. Tous ces elements doivent etre argumentes dans le dossier. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study.

Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.

Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy.

COVID-19 was declared a pandemic in March 2020. The knowledge of COVID-19 pathophysiology soon provided a strong rationale for the early use of both anti-inflammatory and antithrombotic drugs; however, its evidence was slowly and partially incorporated into institutional guidelines. The unmet needs of COVID-19 outpatients were taken care of by networks of physicians and researchers. We analyse the characteristics, management and outcomes in COVID-19 outpatients who were taken care of by physicians within the IppocrateOrg Association. In this observational retrospective study, volunteering doctors provided data on 392 COVID-19 patients. The mean age of patients was 48.5 years (range: 0.5-97), and patients were taken care of in COVID-19 stage 0 (15.6%), stage 1 (50.0%), stage 2a (28.8%) and stage 2b (5.6%). Many patients were overweight (26%) or obese (11.5%), with chronic comorbidities (34.9%), mainly cardiovascular (23%) and metabolic (13.3%). The most frequently prescribed drugs included: vitamins and supplements (98.7%), aspirin (66.1%), antibiotics (62%), glucocorticoids (41.8%), hydroxychloroquine (29.6%), enoxaparin (28.6%), colchicine (8.9%), oxygen therapy (6.9%), and ivermectin (2.8%). Hospitalization occurred in 5.8% of cases, mainly in stage 2b (27.3%). A total of 390 patients (99.6%) recovered; one patient was lost at follow up, and one patient died after hospitalization. This is the first real-world study describing the behaviours of physicians caring for COVID-19 outpatients, and the outcomes of COVID-19 early treatment. The lethality in this cohort was 0.2%, while overall, and over the same period, the COVID-19 lethality in Italy was over 3%. The drug use described in this study appears effective and safe. The present evidence should be carefully considered by physicians and political decision makers.

A pilot study comparing in-person and remote outpatient substance use treatment services on quality-of-life outcomes.

Background: The widespread shift from in-person to Telehealth services during the Covid-19 pandemic irreversibly shifted the landscape of outpatient substance use treatment. This shift was necessitated by health, rather than data-driven, reasons. As we reflect on whether to continue providing Telehealth services moving forward, we require empirical support on the effectiveness of Telehealth services (compared to in-person services) in terms of patient outcomes, such as Quality of Life (QOL), to support this decision. Objective: To present data from a pilot project comparing changes in QOL across patients receiving outpatient in-person versus Telehealth substance use treatment in five clinics across New York State. Method: To retrospectively compare total self-reported QOL scores from admission to 3-months later utilizing the Quality-of-Life Enjoyment and Satisfaction scale during in-person (pre-pandemic, n = 298) and Telehealth (pandemic, n = 316) services with a mixed repeated measures ANOVA. Results: Self-reported QOL scores significantly improved across the first three months, regardless of treatment modality. Conclusion: Telehealth and in-person treatment appear comparable on QOL outcomes over the first 3 months of outpatient treatment. Both modalities are associated with improved QOL scores. Scientific significance: These preliminary findings provide evidence that Telehealth services are associated with positive patient outcomes and appear comparable to QOL outcomes among patients receiving in-person services. Future directions include further assessment of additional clinical outcomes and investigation into causal mechanisms.

ATENCIÓN HOSPITALARIA A INDÍGENAS MEXICANOS CONTAGIADOS INICIANDO LA PANDEMIA COVID-19

En este artículo se busca identificar los determinantes en el cambio del riesgo de hospitalización con y sin intubación respecto a la atención ambulatoria de acuerdo a condiciones de indigenismo con covid-19 al inicio de la pandemia. Con información de la Secretaría de Salud de México del 22 de mayo de 2020 se elaboran modelos logísticos multinomiales para ambos grupos de pacientes, ajustando por variables socioeconómicas, condiciones de salud y lugar de residencia.Alternate :Identify the determinants of the change in the risk of hospitalization with and without and with intubation with respect to outpatient care in indigenous and non-indigenous patients according to conditions of indigenism with covid-19 at the beginning of the pandemic. With information from the Ministry of Health of Mexico on May 20, 2020, multinomial logistic models are developed for both groups of patients, adjusting for socioeconomic variables, health conditions and place of residence that show common conditions such as pneumonia and others, as well as residence in large cities for indigenous people due to their migration.

Determining newly licensed nurses' satisfaction of a clinical advancement program

Nurse retention is a concerning issue in healthcare organizations. Newly licensed nurses leave their jobs at a higher rate than experienced nurses. The impact of COVID-19 has resulted in increased numbers of nurses leaving the acute care, inpatient setting due to early retirement or transition to outpatient ambulatory settings. Clinical advancement programs are a recommended strategy that is strongly associated with nurse retention. The purpose of this scholarly practice project was to describe the development, implementation, and evaluation of a clinical advancement program for newly licensed nurses in a 171-bed community teaching hospital located in the Northeast United States. The objective of the project was to evaluate participant satisfaction with a clinical advancement program. The Career Achievement and Recognition of Excellence Survey was used to measure the newly licensed nurses' perceived satisfaction with the clinical advancement program. The conclusions of the project indicated that the participants agreed with the clinical advancement program in theory but found it too challenging to participate in the program outside of the residency program. The survey results also identified opportunities for improvement including embedding the program into the residency program with the goal of improving retention rates of newly licensed nurses at the project site. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Evaluation of the psychiatric diagnosis of children and adolescents before and during the COVID-19 pandemic: A sample from a university hospital

Objective: The aim of this study is to determine the sociodemographic characteristics and psychiatric diagnoses of children and adolescents who refered to the psychiatry outpatient clinic during the COVID-19 pandemic. Method: This study enrolled the patients who were presented to the Child and Adolescent Psychiatry outpatient clinic between September 2019 and March 2020 and between September 2020 and March 2021. The patients were scanned retrospectively with the Nucleus outpatient clinic system. The data were analyzed with SSPS 21.0. Age, gender and psychiatric diagnosis of patients Results: were examined. This study enrolled 1157 patients with 10.8 mean age and 61.5% male participants. 53% (n = 622) of patients was diagnosed before pandemia and 46.2% (n = 535) of patients was diagnosed during pandemia. Before pandemia: patients were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 40%, Anxiety Disorder (AD) 16.1%, Autism Spectrum Disorder (ASD) 5.1%. During pandemia: patients were diagnosed with ADHD 27.3%, AD 19.3%, ASD 5.6%. During the pandemia the number of female patients increased (p = 0.017), mean age of patients decreased (p = 0.035), the diagnosed ADHD rates decreased (p < 0.001) and the diagnosed AD (p = 0.024), Major Depressive Disorder (MDD) (p=0.001) rates increased. Conclusion: In our study the diagnosis of AD and MDD during pandemia increased and the diagnosis of ADHD decreased. Because of the online education during pandemia, number of ADHD patients decreased and increasing in diagnosis of AD and MDD might caused by phsycial and social limitations. In this period it is important to follow and treat the patients that already have psychiatric disorder like ADHD. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Turkish) Amac: Cin'de baslayan ve tum dunyayi etkileyen COVID-19 salgini global bir saglik krizine donusmustur. Bu calismanin amaci, COVID-19 pandemisi sirasinda psikiyatri poliklinigine basvuran cocuk ve ergenlerin sosyodemografik ozelliklerini ve psikiyatrik tanilarini belirlemektir. Yontem: AFSU cocuk psikiyatri poliklinigine Eylul 2019-Mart 2020 ve Eylul 2020-Mart 2021 tarihleri arasinda basvuran hastalar calismaya dahil edilmistir. Hastalar retrospektif olarak Nucleus poliklinik sistemi ile taranmistir. Veriler SSPS 21.0 ile analiz edilmistir. Vakalarin yas, cinsiyet ve psikiyatrik tanilari incelenmistir. Bulgular: Calismaya 1157 hasta dahil edilmistir. Hastalarin yas ortalamasi 10,8 yil ve %61,5'i erkek cinsiyetteydi. Hastalarin %53,8'i (n = 622) pandemi oncesinde, %46,2'si (n = 535) pandemi sonrasinda basvuru yapmistir. Pandemi sonrasi donemde, pandemi oncesi doneme gore basvurular kiz cinsiyet yonunde artmistir (p = 0,017) ve basvuranlarin yas ortalamasi azalmistir (p = 0,035). Pandemi oncesinde basvuranlarin %40,0'i Dikkat Eksikligi ve Hiperaktivite Bozuklugu (DEHB), %16,1'i Anksiyete Bozuklugu (AB), %5,1'i Otizm Spektrum Bozuklugu (OSB) ana tanisi alirken, pandemi sonrasi basvuranlarin %27,3'u DEHB, %19,3'u AB, %5,6'si OSB ana tanisi almistir. Pandemi sonrasinda pandemi oncesine gore DEHB tanisi alma sikligi azalmistir (p < 0,001), AB (p = 0,024) ve Major Depresif Bozukluk (MDB) (p = 0,001) tanilarinda artis gorulmustur. Sonuc: Calismamizda pandemi sonrasi AB ve MDB tanilarinin artis gosterdigi, DEHB tanisinin ise azaldigi gorulmustur. Pandemi sirasinda uzaktan egitim surecine gecilmesi, DEHB belirtileri nedeniyle yapilan basvurulari azaltirken ortaya cikan fiziksel ve sosyal kisitliliklar AB ve MDB tanilarini arttirmis olabilir. Bu donemde DEHB gibi mevcut psikiyatrik bozuklugu olan hastalarin takiplerinin ve tedavilerinin aksatilmamasi uzun donemde gidisat icin onem arz etmektedir. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Ways to Optimize Medical Services for Covid-19 Patients

The timing of detection and hospitalization of patients with COVID-19 is an indicator of the quality and consistency of medical services, coordination and integration of the activities of various levels, specialties of the health care system and play an important role from a clinical and epidemiological point of view. In the Samarkand region Republic of Uzbekistan, 219 238 people were tested in 2020, of which 1,1% had SARS-COV-2 RNA. A positive result was observed in 1,4% of cases when taking samples at home from townspeople and in 1,07% when taking samples directly in laboratories for COVID-19, i.e. community sampling of patients did not adversely affect quality analysis. In patients treated in a hospital, COVID-19 proceeded from mild to moderate in 71,0% of cases and without pneumonia - in 33,0%. Consequently, it is necessary to rethink the organizational aspects of patient care, with an emphasis on the provision of outpatient care. © 2022. Specialusis Ugdymas. All Rights Reserved.

Early 3-day course of remdesivir in vaccinated outpatients with SARS-CoV-2 infection. A success story.

A number of treatment options have been evaluated in order to prevent the severe progression of COVID-19 pneumonia eventually in patients with increased risk due to comorbidities. Remdesivir for a 3-day outpatient course has been associated with a significant lower risk of hospitalization or death. A matched-pair retrospective study was conducted in Department of Infectious Diseases of University General Hospital of Alexandroupolis in order to evaluate the role of remdesivir and vaccination in preventing severe clinical outcome. Nonhospitalized vaccinated patients with a 3-day course of remdesivir had a 75% lower possibility of hospitalization and 95% of respiratory failure. Nobody was intubated or died and the duration of hospital stay was limited (4 day s vs. 10 days). Vaccination and a 3-day course of remdesivir in high risk nonhospitalized patients prevented significantly severe clinical progress of COVID-19 pneumonia.

Job burnout: An examination of outpatient clinics

The purpose of this study was to examine job burnout of medical providers in outpatient clinics. Job burnout is a psychological syndrome resulting from job interpersonal stressors;it is measured using three dimensions: (1) emotional exhaustion-feelings of being emotionally overextended and exhausted by one's work, (2) depersonalization-a unfeeling and impersonal response toward patients, and (3) personal accomplishment-feelings of competence and achievement in one's work (Maslach & Jackson, 2020). Using a convenience sample, healthcare providers in Southern Nevada were asked to participate. The study was approved by the University of Nevada, Las Vegas, Internal Review Board (IRB). After an initial Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)) was administered virtually (due to COVID-19), healthcare providers were presented with a job burnout educational in-service regarding how to identify and define job burnout, a summary of research and findings regarding employee stress, information of when to seek help, and a discussion of how job burnout affects patient care. After a 60-day period, the MBI-HSS (MP) was re-administered, voluntarily, to the same employees. This project's aim was to improve job burnout subscale scores in a 60-day period using a job burnout educational intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of COVID-19 pandemic on outpatient depression treatment and NHIF expenditure

The COVID-19 pandemic expansion in Bulgaria imposed a significant burden on population status and disease diagnostics, control, and treatment. The goal of our study is to analyze the impact of the COVID-19 pandemic on utilization of antidepressants in the outpatient treatment of depression and public spending on their reimbursement. The study is a cross-sectional, retrospective, observational, macroeconomic analysis of National Health Insurance Fund (NHIF) expenditures of antidepressants, reference price per defined daily dose (DDD), and utilization. The results reveal that the costs and reference value per DDD decreased or remained almost the same during 2019– 2020. The utilization increased slightly for six international nonproprietary names (INNs) and decreased for four of them. Statistical analysis confirms that there are no significant differences. The highest utilization rate found is for escitalopram (both 2019 and 2020), followed by paroxetine and venlafaxine. The COVID-19 pandemic and social isolation lead to worsening of mental health and require health system reorganization to ensure the treatment of patients with chronic diseases. The measures implemented in Bulgaria at the beginning of the pandemic led to a stable level of medicine utilization and outpatient treatment of depression as well as a similar rate of NHIF expenditure compared with those from the previous year. FUNDING There is no funding to report. © 2022. Zornitsa Mitkova et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Telemental health uptake in an outpatient clinic for veterans during the COVID-19 pandemic and assessment of patient and provider attitudes

This study aimed to (a) describe the process of rapid uptake of telemental health in an outpatient mental health clinic for veterans and their family members during the coronavirus disease 2019 (COVID-19) pandemic and (b) present patient and provider attitudes about telemental health. Virtual visit (video and phone) trends for this clinic are described over the 8 weeks pre- and post-COVID-19 closure. As part of a quality improvement initiative over a subsequent 2-week period, 147 patient visits (127 unique individuals), and 24 mental health providers who were part of a multidisciplinary team were eligible to complete an anonymous self-report satisfaction survey immediately after a telehealth session. Prior to the COVID-19 closure, the clinic averaged 112.75 completed visits per week, with virtual visits accounting for less than 5% of all appointments. In the second month after closure, the clinic averaged 153.75 completed visits per week (36.36% increase in volume), with virtual visits accounting for 100% of visits (42% phone, 58% video). The proportion of video compared to telephone visits increased pre to postclosure. The no-show rate significantly decreased pre to postclosure (10.87% vs. 15.01%, resp., chi2 = 17.81, p < .001). Patient and provider satisfaction with telemental health were high. Prospectively, most patients (83.56%) expressed preference for televisits-only or televisits combined with in-person visits. Patients and providers were satisfied with telemental health. Convenience was an oft-cited advantage by both patients and providers. Telemental health may represent a cost-effective solution to mental health care access during and beyond COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement Rapid and wide-spread uptake of telemental health in an outpatient clinic serving veterans and military service members was feasible and deemed satisfactory to patients and providers. Telemental health was associated with lower no-show rates. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Improving therapeutic communication in mental health nursing: A quality improvement project

Over 46 million adults in the United States (U.S.) live with a mental illness. Locally in Nevada, the psychiatrist to patient ratio is approximately 700:1, and patients are seen primarily in the inpatient setting, if seen at all, due to the wait average of 85 hours in the hospital emergency rooms for access into mental health hospitals or specialty units of a general hospital. Moreover, costs for mental health mood disorders alone are estimated at over seven million dollars annually. The Institute of Medicine (IOM) opined the need for change in healthcare to redesign practice and clinical communication with patients in all healthcare settings;however, more is still needed in mental health. Therapeutic communication is essential to meet the patient's physical and psychological needs while establishing the nurse-patient trusting relationship. Clinical outcomes in mental health settings remain poor, with non-therapeutic communication resulting in poor patient outcomes. A leading cause of inadequate treatment includes non-therapeutic communication during pre- and post-discharge treatment. It is not well described in the literature what role nurses play, nationally or locally, in ensuring the safe transition of mental health patients from an emergency room to a specialty unit. Mental health nurses are expected to complete clinical assessments on admitted clients, including effective therapeutic interpersonal communication techniques and psychosocial intervention skills to provide safety, trust, collaboration with rapport, respect, genuineness with the caring emphasis, and empathy. Nurses may be able to decrease adverse events within mental health settings, in part, by practicing therapeutic communication;unfortunately, evidence shows that nurses are often unprepared in mental health to incorporate therapeutic communication and relationship building among their patients. Expected knowledge of, and competence in therapeutic communication would seem to be a logical requirement for mental health nurses;however, Nevada's current practice does not require demonstrated knowledge and competency in therapeutic communication between mental health nurses and patients in hospital settings. Competency development may guide nurses to develop critical thinking skills to practice and support psychiatric patients to achieve optimal outcomes. The lack of required knowledge and competency related to therapeutic communication is the underlying impetus for this Doctor of Nursing Practice (DNP) project. The purpose of this DNP project was to develop, implement, and evaluate an educational module for mental health nurses and staff to improve knowledge and competency in therapeutic communication with their patients. The TeamSTEPPS Program was adapted to develop a mental health-specific educational module focused on therapeutic communication to accomplish this purpose. The educational module was implemented online due to Covid-19 Pandemic, and this intervention was evaluated using four previously validated TeamSTEPPS instruments. Fifty-two participants were included in this project. Results indicated a statistically significant change in knowledge and competency pre- compared to the post-intervention with the educational module. Based on the results of this project, one may conclude that implementing additional mental health education for nurses may improve their knowledge and competency related to therapeutic communications with their patients, as was demonstrated in this project. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Buffering effect of in-patient psychiatric care on the link between fear of covid-19 and mental health consequences.

BACKGROUND& AIMES: Psychiatric admissions during the covid-19 pandemic were limited, overlooking their possible benefit. This study focused on assessing the effect of the fear of covid on the mental health and well-being of inpatients as opposed to outpatients. METHODS: During the first lockdown, forty-four inpatients and day care patients (inpatient group) and 74 outpatients (outpatient group) were recruited after an informed consent procedure. Fear of the infection was assessed using the Fear of COVID-19 (FCV-19S); severity of mental health symptomatology was evaluated with the outcome questionnaire-45 (OQ-45); wellbeing was assessed with the Psychological well-being scale (PWB). OUTCOMES: There was no difference between the inpatient group and outpatient group in their fear of COVID-19 levels.FCV-19 predicted changes in the outpatient OQ total score (B â€‹= â€‹2.21, p â€‹< 0.001), OQ interpersonal relation subscale (B â€‹= â€‹0.34, p â€‹= 0.01), PWB total score (B â€‹= â€‹-0.05, p â€‹< 0.001), PWB environmental mastery subscale (B â€‹= â€‹-0.07, p â€‹< 0.001) and PWB positive relation subscale (B â€‹= â€‹-0.05, p â€‹< 0.001), but not in the inpatient group. CONCLUSIONS: Mental health and wellbeing of the outpatient group, which had less therapeutic contact than the inpatient group, correlated with the fear of covid, supporting the hypothesis that intensive psychiatric therapy had a protective effect on the mental health consequences of "fear of covid".