Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 906
Filter
Add filters

Year range
1.
Laryngo- Rhino- Otologie ; 101:S335, 2022.
Article in English | EMBASE | ID: covidwho-1967687

ABSTRACT

Background An olfactory disorder is often described as a characteristic initial symptom in patients with COVID-19 infection. The long-term olfactory disorders after a COVID-19 infection have not yet been described in detail. The aim of the study was to investigate the long-term effects of COVID-19 infections on smelling. Methods Patients with persistent, subjective smell &/ taste disorders were examined by means of questionnaires, endoscopic examinations, as well as side-separated olfactory testing using sniffin- sticks (TDI) and taste testing. After initial presentation and initiation of olfactory training, structured controls were performed for 72 patients six, 12 and 18 weeks after initial consultation. Results On average, the patient presented seven months after the onset of symptoms. 70 % of the patients were female and in average patients were 40 years old. Parosmia was reported by 64 % of the patients at this point. An at least unilateral functional anosmia was observed in 24 % and at least unilateral hyposmia in 71 % of the patients. A difference of ≥ 5 points in TDI between the respective sides could be identified in 35 %. During the first (six weeks), second (12 weeks) and third (18 weeks) control 32 %, 9 % and 14 % of the patients showed an improvement in smell of ≥ 5 points in the TDI test using sniffing sticks, respectively. Discussion Persistence of an olfactory disorder in the sense of hyp-/anosmia and parosmia can occur in young, female patients after COVID-19 infection. A side difference in smell can occur due to certain individual anatomy and the entry of the virus. A small proportion of patients with persistent olfactory disorders show regeneration.

2.
Laryngo- Rhino- Otologie ; 101:S193-S194, 2022.
Article in English | EMBASE | ID: covidwho-1967671

ABSTRACT

Introduction According to international publications the COVID-19 pandemic led to a delay in the medical treatment of different diseases. The purpose of our investigation was to evaluate the incidence and the stage of head and neck cancer in the period from 01/2020-12/2021. These data were compared to that before the pandemic in the time period from 01/2018-12/2019. Method Using our oncological documentation system, a monocentric analysis of the number of tumor diagnosis and tumor stages at initial diagnosis was carried out looking at the 2-year pandemic period from 2020-2021. The purpose of the investigation was to determine whether there was a pandemic-related delay in treatment of oncological patients in our clinic. Results The analysis showed no decrease in the number of new tumor cases in the pandemic years 2020-2021 compared to the years 2018-2019. Furthermore, no shift towards more advanced tumor stages during the COVID-19 pandemic could be determined. Conclusion Occasionally the COVID-19 pandemic led to delayed tumor diagnosis and treatment, which resulted in a worse outcome for many patients. This effect could be turned around by accurate appointment planning taking tumor suspected cases under consideration. Furthermore, special office hours particularly for tumor cases even in times of a lockdown including video consultations when appropriate and patient awareness campaigns led to a favorable patient care.

3.
Laryngo- Rhino- Otologie ; 101:S351-S352, 2022.
Article in English | EMBASE | ID: covidwho-1967657

ABSTRACT

Introduction Telemedicine can reduce poor health care access and improve the diagnosis and treatment of rare diseases. COVID-19 has also helped telemedicine to become more widely used in Germany. Since April 2020, the Facial Nerve Center Jena also offers virtual consultation hours. Material and Methods We analyzed in retrospect all initial encounters of patients with the Facial Nerve Center Jena between April 2020 and October 2021. 33 patients (20 f, 13 m) aged 9 to 69 years (median: 42) were treated. Results In 28 of 33 cases, a diagnosis of facial palsy was made at initial presentation (duration of paresis: 1 - 512 months, median: 11.5 months), 20 of which showed defect healing and synkinesis. In 4 cases, there was no evidence of facial palsy and further diagnostics were recommended. In one patient, a definite diagnosis could not be made due to technical problems with video transmission. Psychoeducation was given to 28 patients. 20 patients were counseled about a possible injection of botulinum toxin to reduce synkinesis. In 10 cases, we gave recommendation and instruction on corneal protection. Day-care treatment was indicated in 16 patients, and telemedicine biofeedback training was indicated in 8. Travel distances would have ranged from 40 to 1570 km (median: 360 km). Discussion Telemedicine is well suited for diagnosis and therapy of facial nerve palsies and subsequent defect healing, in part, because webcams are optimized to display faces. We see potential in video consultations to provide highly specialized care nationwide, to minimize travel distances, and to simplify second opinion consultations.

4.
Laryngo- Rhino- Otologie ; 101:S180, 2022.
Article in English | EMBASE | ID: covidwho-1967655

ABSTRACT

Introduction The use of biologics has been described as an effective therapy in phase 3 studies in severe CRSwNP. Relatively unexplored is the post-covid syndrome in CRSwNP patients. Method Case presentation. Results Presentation of a 75-year-old patient with CRSwNP, asthma, ASA intolerance and eosinophilic granulomatosis with polyangiitis. Drug therapy with daily 1-5 mg prednisolone oral and inhalation therapy with formoterol/ beclomethasone. In February 2021, the patient was diagnosed with SARS-CoV-2 infection. For four days, the patient was admitted to a hospital with pronounced physical weakness without respiratory insufficiency. Anosmia has long been known because of CRSwNP. After Covid-19 illness, the patient reported severe sleep impairment and a severe state of exhaustion compatible with a post-covid syndrome. In addition, the patient was impaired by a severe nasal obstruction. At presentation in the rhinological consultation 7 months after Covid-19 illness, severe nasal polyps (NP overall score 8) and anosmia were detected. Dupilumab therapy (anti IL-4/IL-13 antibody) was initiated for severe CRSwNP. In the course of 2 months, an improved quality of life with less nasal obstruction as well as a reduced NP overall score of 6 were shown. Furthermore, the sleep impairment and exhaustion of the patient did not improve. Conclusion Dupilumab therapy improves quality of life in patients with severe CRSwNP, which may be especially important in post-covid syndrome.

5.
Radiotherapy and Oncology ; 170:S906-S907, 2022.
Article in English | EMBASE | ID: covidwho-1967469

ABSTRACT

Purpose or Objective RTQA practice is known to have significant variation amongst institutions worldwide. It is critical to maintaining patient safety, treatment effectiveness and accuracy. However there is no standard practice, with often only target volume delineation reviewed alone and performed retrospectively. Previous studies have highlighted higher rates of changes made in more complex techniques and subsites. This study aims at evaluating our prospective structured peer review process in a proton beam therapy (PBT) centre. Materials and Methods We reviewed the RTQA cases of all patients treated at The Christie Proton Beam Centre since its opening in November 2018 until February 2021. The RTQA process is carried out weekly, is subsite specific and every case has their target volumes and plans reviewed in detail in the presence of consultants, fellows, physicists and dosimetrists. Since the COVID-19 pandemic, the peer review meetings are now virtual. Every peer review has a standardised RTQA form filled. We classified the peer reviews as having major/minor or no change. A major change was one where the target volumes (GTV and/or CTV) were too small or big;dose fractionation was incorrect to that of the prescription treated and any plan that was changed. A minor change was one where there were minor modifications to the target volumes, OARs or non-essential suggestions in relation to the plan that didn’t result in the plan being altered eg. addition of an OAR. Results There was a total of 1,209 peer reviews for 462 patients. 100% of cases had both volumes and plans peer reviewed prospectively. 591 were reviews of target volumes and 618 were plan reviews. In total there were 208 (17%) major changes, 194 (16%) minor and 807 (67%) with no changes. Of the major changes 137 (66%) were target volumes and 71 (34%) plans. Of the minor changes 174 (90%) were target volumes and 20 (10%) plans. There were more major and minor changes in the brain and head & neck subsites possibly due to their complexity. When diagnoses in the brain were categorised (Table 1) and reviewed against changes using a chi-squared test the resulting p-value = 0.027 suggests a significant relationship between type of diagnoses and likely need for change following peer review.(Table Presented) Conclusion Target volume delineation and radiotherapy plans particularly in brain, head & neck as well as other complex subsites require mandatory prospective review as highlighted above. We have shown this to be practically achievable and successful despite challenging times

6.
Gastroenterology ; 162(7):S-1222, 2022.
Article in English | EMBASE | ID: covidwho-1967424

ABSTRACT

Background: Data have shown an increase in alcohol use during the COVID-19 pandemic in North America. While the total number of emergency department (ED) visits decreased during the early pandemic, some studies show that the proportion of alcohol-associated visits increased during this time. There is otherwise a paucity of data on how potentially increased alcohol use during the pandemic has affected healthcare utilization and patient outcomes, especially in patients with liver disease. Methods: Clinical records from a tertiary hospital in Ontario, Canada were reviewed for all adult patients encounters in the ED, urgent care, or inpatient setting for alcohol-associated reasons between April 2019 and October 2019 (pre-pandemic cohort) and between April 2020 and October 2020 (pandemic cohort). Data collected included: age, sex, marital status, rurality and socioeconomic status (by postal code-linked national census data), medical history, alcohol consumption habits, use of medications for alcohol use disorder, alcohol-associated diagnosis (based on ICD-10 code), need for intensive care unit admission, consultations made, discharge disposition, and laboratory results. Bivariate chi-squared analysis was performed to compare data from the pre-pandemic and pandemic cohorts. Results: 528 records in the pre-pandemic cohort and 490 records in the pandemic cohort were ed and summarized (Tables 1 and 2). As compared with the pre-pandemic cohort, patients during the pandemic presenting with alcohol-associated diagnoses were older (43 years, IQR 31-57 vs. 38 years, IQR 24-55;p<.001), more likely to be male (66% vs. 55%;p=.001), have a prior history of habitual heavy alcohol use or alcohol use disorder (77% vs. 63%;p<.001), have a history of a psychiatric disorder (56% vs 46%;p=.003), and to have been previously prescribed medication for alcohol use disorder (18% vs. 5%;p<.001). In the pandemic cohort, there was a greater proportion of encounters for alcohol withdrawal (32% vs. 22%;p=.001), a lower proportion of encounters for alcohol intoxication (46% vs. 56%;p<.001), and a similar proportion of encounters for alcohol-associated liver disease (8% vs. 7%;p=.651) compared to the pre-pandemic cohort. Conclusion: Our data show differences in patient characteristics for patients presenting to hospital for alcohol-associated reasons during the COVID-19 pandemic. As compared with the year before the pandemic, patients were older, more often male, and more likely to have history of psychiatric disorders or heavy alcohol use. One concerning finding was a significant rise in alcohol withdrawal, which could potentially be due to increased consumption of alcohol during the pandemic. These data raise concern for an increase in prevalence of alcohol-associated liver disease in the future, highlighting the need for enhanced alcohol addiction services. (Table Presented)

7.
Gastroenterology ; 162(7):S-1143, 2022.
Article in English | EMBASE | ID: covidwho-1967415

ABSTRACT

Background and aim Telehealth (TH) interventions may improve access to care, diseasespecific and general quality outcomes in chronic liver diseases (CLD). Given the current COVID-19 pandemic, TH interest has grown exponentially. We aimed to systematically evaluate outcomes of TH interventions in a variety of CLD. Methods We used key terms and searched PubMed/EMBASE from inception to 12/5/2020 for observational studies or clinical trials. Two authors independently screened s. We included any type of CLD, including post-transplant patients. Disagreements were solved by a third reviewer. We excluded s, case-reports, and reviews. We extracted the outcomes defined by the authors for each CLD (chronic hepatitis C or B, decompensated cirrhosis, hepatocellular carcinoma-HCC-, liver transplant referral and readmission/rejection after transplantation or weight loss in nonalcoholic fatty liver disease-NAFLD). No meta-analysis was planned due to the heterogeneity of the data. Results Of a total of 3567 studies screened, 29 met inclusion criteria (Table 1). Of these, 17 reported on HCV treatment outcomes [14 video telemedicine, 2 remote specialist consultation, and one texting based intervention]. All studies showed no statistically significant differences between sustained virological response (SVR) rates in telehealth intervention groups compared to control groups or historic general population. 4 retrospective studies examined decompensated cirrhosis/liver transplant referral, followup after transplant, and showed a reduction in time to transplant (138.8 days vs 249 day, P<0.01), mortality or readmission following transplant (28% vs 58%, P=0.004), and improved referral timing (0% immediate rejections of transplant referral vs 41%, P<0.001). Other important outcomes measured also demonstrated benefit in favor of telemedicine incorporation including autoimmune hepatitis remission (100% vs 77.3%, P=0.035). One study assessed chronic hepatitis B outcomes and had no difference in development of hepatocellular carcinoma, ALT fluctuation or cirrhosis over 2 years of follow-up. Finally, two studies assessed weight loss in nonalcoholic fatty liver disease: the prospective study showed no change in weight loss while the randomized clinical trial did. Conclusion TH interventions in patients with CLD shows consistent equivalent or improved clinical outcomes compared to traditional encounter. Similar SVR, decreased time to liver transplant referral and mortality outcomes were observed in the TH groups. In CHB, development of HCC, cirrhosis or biochemical remission was similar as well. In the NAFLD clinical trial, the TH group had 5%+ weight loss over 3 months compared to the control group. In the light of the ongoing COVID19 pandemic, TH in CLD should be the bridge to improve clinical outcomes when face-to-face encounters are not possible. (Table Presented) Abbreviations: DOC: Department of Corrections, TH: Telehealth, SVR: sustained virological response, SVR12: sustained virological response for 12 weeks, SVR24: sustained virological response for 24 weeks, GP: general practitioner, RCT: randomized controlled trial *Sterling et al, 2018 compared patients with private insurance in clinic vs indigent patients in clinic vs patients in the department of corrections using telemedicine. †Lepage et al, 2020 compared patients in outpatient clinic vs mixed delivery including clinic and telemedicine vs telemedicine only. ††These studies reported rates of SVR in their cohort and compared to historical rates of SVR in similar cohorts.

8.
Gastroenterology ; 162(7):S-1061, 2022.
Article in English | EMBASE | ID: covidwho-1967404

ABSTRACT

Background-During the COVID-19 pandemic all routine and surveillance gastroscopy was halted or delayed in the UK with considerable burden on recovery and risk of late diagnosis of significant pathology. We established an early diagnosis service using CytospongeR minimally invasive cell sampling device to help triage patients to timely gastroscopy and identify patients who could be managed without endoscopy. Methods-2 patient cohorts were identified: 1. Known Barrett's oesophagus on endoscopic surveillance 2. Patients with symptoms of gastrooesophageal reflux referred for routine gastroscopy. Exclusions were previous dysplasia of any grade on last gastroscopy, previous fundoplication, pregnancy and patient preference. Triage of patients on the waiting list was done initially from referrals to endoscopy and those on the Barrett's surveillance database, and then telephone clinic. 2 research nurses and 2 clinical nurse specialists were fully trained in delivering CytospongeR . All patients provided informed consent. All Cytology specimens were analysed by Cyted. Results were relayed to patients within 4 weeks of the procedure by consultant led nurse-run teleclinic or by letter for the Barrett's surveillance cohort. Clinical triage was according to the table below. TFF3+ was used as a marker for intestinal metaplasia, P53+ve and atypia for potential dysplastic change. Results-408 patients agreed to CytospongeR over 12 months November 2020-2021. 157 for Barrett's surveillance. 251 for Investigation of reflux. 28 failed to swallow (5% of Barrett's, 7.5% reflux). In the Barrett's Cohort 148 patients successfully swallowed, 139 for analysis 8 inadequate (5.4%) first samples. In the reflux cohort 232 successfully swallowed, 200 for analysis 32 inadequate first samples (13.8%) Discussion-Overall 205 (60.5%) of patients had low risk CytospongeR findings (no Barretts/short segment not requiring surveillance under BSG guidance) were managed symptomatically without initial gastroscopy, 114 (33.6%) had evidence of non dysplastic Barrett's and could be managed on a routine pathway. 20 (5.9%) had high risk findings suggesting dysplasia and had urgent gastroscopy. Conclusion-We report the largest single site series of CytospongeR in clinical practice in England and its pragmatic use in patients management and service recovery during the Pandemic. Notable benefits in the Barrett's cohort were timely identification of high numbers of potential dysplasia and also of those no longer requiring surveillance. Identification of new potential Barrett's for surveillance and the avoidance of unnecessary gastroscopy and early discharge were notable benefits in the Reflux cohort. Careful follow up and long-term outcomes of these patients will provide more data and safety netting for adoption of this new technique into routine clinical practice and help avoid unnecessary gastroscopy. (Table Presented)Table 1. CytospongeR findings and triage pathways in Barrett's oesophagus and gastrooesophageal reflux

9.
Gastroenterology ; 162(7):S-1006, 2022.
Article in English | EMBASE | ID: covidwho-1967393

ABSTRACT

Introduction: Pivotal anti-SARS-CoV-2 vaccines clinical trials did not include patients with immune-mediated conditions such as inflammatory bowel disease (IBD). We aimed to describe the implementation of anti-SARS-CoV-2 vaccines among IBD patients, patients' concerns before vaccination and side-effect profile of the anti-SARS-CoV-2 vaccines using real-world data. Methods: An anonymous web-based self-completed survey was distributed in 36 European countries between June and July 2021. The results of patients' characteristics, concerns, vaccination status and side-effect profile were analysed using descriptive statistics and logistic regression. Results: Among the 3272 IBD patients completing the survey (0.1% of the IBD European population), 79.6% had received at least one dose of anti-SARS-CoV- 2 vaccine, and 71.7% had completed the vaccination process. Most of the patients (70.6%) were vaccinated with the Pfizer-BioNTech (BNT162b2) vaccine. Patients over 60 years old had a significantly higher rate of vaccination (OR 2.98, 95% CI 2.20-4.03, p<0.001). Patients' main concerns before vaccination were the possibility of having worse vaccine-related adverse events due to their IBD (24.6%), having an IBD flare after vaccination (21.1%) and reduced vaccine efficacy due to IBD or associated immunosuppression (17.6%). After the first dose of the vaccine, 72.4% had local symptoms at the injection site and 51.4% had systemic symptoms (5 patients had non-specified thrombosis). Adverse events were less frequent after the second dose of the vaccine and in older patients. When comparing with previous studies from the general population, the IBD patients answering the survey did not seem to have increased side effects (table 1). Only a minority of the patients were hospitalized (0.3%), needed a consultation (3.6%) or had to change IBD therapy (13.4%) after anti- SARS-CoV-2 vaccination. Conclusion: Although IBD patients raised concerns about the safety and efficacy of anti-SARS-CoV-2 vaccines, the implementation of vaccination in those responding to our survey was high and the adverse events were comparable to the general population, with minimal impact on their IBD. (Table Presented)

10.
Gastroenterology ; 162(7):S-475, 2022.
Article in English | EMBASE | ID: covidwho-1967314

ABSTRACT

Introduction: COVID-19 pandemic has impacted the healthcare delivery systems worldwide. In the United States telemedicine was implemented widely to overcome this challenge The impact of telemedicine on patients' adherence to scheduled outpatient endoscopy as compared to the standard in-person consultation is unknown. Aim: 1/ To evaluate adherence to outpatient scheduled general endoscopic procedure in patients who had pre-procedure in-person consultation visit versus telehealth. 2/ To evaluate adequacy of bowel preparation among patients who had in-person visit versus telehealth among those who completed outpatient colonoscopy.? Method: We performed a chart review of patients on the outpatient endoscopy schedule from June to September 2021 in an inner-city tertiary hospital serving predominantly African American population. All patients had pre-endoscopy consultation done by faculty staff either by in-person or telehealth. A total of 416 patients scheduled for endoscopic procedures were included in this analysis. Of these, 153 patients (36.7%) had tele-health visit and 263 patients (63.2%) had in-person visit. We compared adherence to scheduled procedures and quality of colonoscopy performed as measured by the adequacy of bowel preparation. Results: There were no differences between in-person versus telehealth visits by age (P = 0.3), sex (P = 0.41) or covid 19 vaccination status (P = 0.91). However, blacks are more likely to use telehealth 41.6% versus 20.6% non-blacks (P < 0.001). There was no difference between pre-endoscopy telehealth vs in-person consultation in adherence to scheduled procedure and there was no difference in the adequacy of bowel preparation (Table 1). Furthermore, there was no difference among those who were vaccinated against COVID-19 vs non-vaccinated in attendance to scheduled procedures (Odds Ratio: 1.29;95%CI: 0.56 – 2.98) and in adequacy of bowel preparation (Odds Ratio: 1.63;95% CI: 0.48 - 5.57) Conclusion: There were no differences in the outcome among those with preendoscopy telehealth visit versus in-person visit. In a low socioeconomic community and minority population, utilization of telehealth services should be considered due to lower manpower cost and less economic and logistical burden to the patients. (Table Presented)

11.
Sleep Medicine ; 100:S297, 2022.
Article in English | EMBASE | ID: covidwho-1967131

ABSTRACT

Introduction: Since March 2020 BlueSleep has completed over 10,000 telemedicine consultations for diagnosis and treatment of sleep apnea exclusively by real-time telemedicine consultations using HIPAA-compliant video conferencing. Materials and Methods: This is a retrospective chart review of all virtual consultations performed between March 13, 2020 and December 31, 2021 at the BlueSleep center. This period coincided with the lockdown in New York City because of the COVID19 Pandemic. 10,171 telemedicine consultations were performed both for new and existing patients. No patients under the age of 18 were evaluated. The median patient age was 40 years old;2,412 males, 1,098 females. Diagnosis of sleep apnea was performed with disposable single-night or multi-night Home Sleep Tests (HST) with WatchaptOne (Itamar Medical) or Nightowl (Ectosense). Patients were given instructions for HSTs via asynchronous videos. HST data was transmitted to a portal for scoring and interpretation. Follow-up visit was by telemedicine, and treatment options including oral appliance therapy and CPAP were discussed. Surgical options were not available during the lockdown. If oral appliance therapy was chosen by the patient, a virtual visit with a dental professional was scheduled before sending a home impression kit. Home impressions were guided in real time with a dental professional. Dental impressions were submitted to the dental labs for fabrication of Mandibular Advancement Devices (MAD), and sent to the patient for a virtual home delivery by the dental professionals. A follow-up virtual visit was scheduled after the 4-week titration period, and depending on subjective results of decreased snoring and decreased daytime sleepiness, the patient was then instructed to repeat a HST for efficacy evaluation. If the patient chose CPAP, CPAP was shipped to the home, and a follow-up visit was scheduled for a virtual set-up visit, followed by compliance visits. All patients were scheduled for continuous telemedicine follow-up visits. Results: 10,171 visits were completed including first and follow-up visits. A total of 289 single-night and 2,275 multi-night HSTs were performed. 2,348 patients were diagnosed with OSA. 36% with mild OSA, 41% of patients with moderate OSA, and 23% with severe OSA. 1,163 had no OSA. 53% of patients were treated with OAT, 20% with CPAP. 271 patients were treated for primary snoring. 256 patients were treated for insomnia. 31 patients were diagnosed with Narcolepsy, and 636 patients were diagnosed with "other". Conclusions: A fully virtual model for diagnosis and treatment for obstructive sleep apnea and other sleep disorders is feasible and desirable. Telemedicine allows greater convenience (less time lost from work), and availability (greater geographic availability), and is a lower cost option. Acknowledgements: We wish to thank the entire BlueSleep staff that has helped make our service to patients available during the Covid 19 Pandemic.

12.
Journal of the American College of Surgeons ; 233(5):e236-e237, 2021.
Article in English | EMBASE | ID: covidwho-1966795

ABSTRACT

INTRODUCTION: Ultrasound examination is an essential component in the preoperative evaluation of patients needing creation of an arteriovenous access. This test is not usually incorporate as part of the initial outpatient visit. Point of care ultrasound examination as part of the initial physician visit decrease cost, generate a surgical planning, as a one-time stop before scheduling. We the experience of incorporation POCUS examination of the upper extremities, in the initial consultation visit of patients needing creation of an arteriovenous access. METHODS: A retrospective review of a prospectively maintain database of dialysis access patients;from which data was collected from patients which have point of care ultrasound as planning imaging during their initial visit, and then underwent a surgical access creation. Data was extracted from periprocedural and clinical follow-up records. RESULTS: Nineteen patients underwent point of care ultrasound examination at vascular surgery visit and underwent creation of an arteriovenous access. The mean age of patients 50.5 years (24-70 years). Twelve patients were male (63%), and seven patients were female (37%). An arteriovenous fistula was successfully created on 18 patients (95%). Thirteen patients are using their access for hemodialysis (68%). CONCLUSION: This preliminary study demonstrates that performance of POCUS examination by operating surgeon in office, is a suitable technique which allows for a successful rate for arteriovenous access creation, allowing savings in healthcare costs of the patient, allowing the visit as a one-stop evaluation and surgical planning. This study was performed during the COVID-19 pandemic.

13.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S108, 2022.
Article in English | EMBASE | ID: covidwho-1966678

ABSTRACT

Background: Within the general hospital setting, Consultation-Liaison (C-L) Psychiatry services are critical for managing patients with behaviors that frequently result in behavioral emergencies, including agitation, verbal aggression, physical aggression, and demanding behavior (Pestka et al., 2012). To most effectively manage these difficult patient behaviors, early consultation to C-L Psychiatry may prevent behavior from escalating to the level of a behavioral emergency. Yet, data is limited regarding the effectiveness of C-L Psychiatry in impacting the occurrence and reoccurrence of behavioral emergencies. Method: Data on all behavioral emergencies that occurred at the University of Virginia Medical Center from January 2020 to December 2020 were collected. Variables collected include patient demographic information, frequency of behavioral emergency, type of behavioral emergency, factors contributing to behavioral emergency, and whether the C-L Psychiatry service had been consulted. Patients who received a C-L Psychiatry consult prior to a behavioral emergency will be compared on the above variables to patients who did not receive this consult to identify differences between the two groups. Results: Preliminary data indicates that UVA Medical Center had an average of 61.2 (range 38-82) behavioral emergencies per month between January 2020 and December 2020. These fell into five categories consistent with previous pilot data: physical aggression, leaving the unit, verbal aggression, agitation, and non-compliance (Yost & Smith, 2020). Factors contributing to behavioral emergencies were identified as delirium, dementia, personality disorder, substance withdrawal, frustration, and TBI. Data will be further analyzed to determine how frequently patients who exhibit behavioral emergencies had received C-L Psychiatry services prior to the behavioral emergency or had not received this service during their hospitalization. Additional analyses will be conducted to determine differences between these two groups on type of behavioral emergency and factors contributing to behavioral emergency. Discussion: This data will inform how patients with challenging behavior are identified early in their hospitalization and how C-L Psychiatry can proactively intervene to decrease behavioral emergencies. Further, this project suggests a need to create process for identifying patients at risk for behavioral emergencies. Future directions will be discussed. Conclusions/Implications: The findings from this quality improvement project have important clinical implications concerning how C-L Psychiatry manages patients with challenging behavior and how frontline staff identify and utilize C-L Psychiatry. References: 1. Pestka EL, Hatteberg DA, Larson LA, Zwygart AM, Cox DL, Borgen EE Jr. Enhancing safety in behavioral emergency situations. Medsurg Nurs. 2012;21(6):335-41. 2. Yost, JS & Smith, JB. A taxonomy of behavioral emergencies in the general hospital: A comparison of behavioral emergencies pre-covid-19 and during the covid-19 outbreak. Brief oral presentation delivered at the 2020 Annual Meeting of the Academy of Consultation-Liaison Psychiatry.

14.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S103-S104, 2022.
Article in English | EMBASE | ID: covidwho-1966677

ABSTRACT

Background: Despite training in consultation-liaison (CL) psychiatry representing a core requirement for general residency training in psychiatry, there is significant variation in the structure, timing, length, setting, and educational components for residents in programs throughout the country. The last official survey of CL training in residency was conducted by the Academy of Consultation-Liaison Psychiatry (ACLP) in 2010 with responses from 92 residency programs across the country (Heinrich 2013). Based on the results of that survey, recommendations were issued by the ACLP in 2014 concerning best practices for residency training in CL psychiatry (Heinrich 2014). Methods: Members of the ACLP Residency Education Subcommittee designed an updated survey based on the survey tool used in 2013. In addition to questions about the structure of residency training, we also asked questions about CL fellowships and their relationship to the CL experience of residents attending structures on CL services, learners from other health professions, educational content, and modifications made during the COVID-19 pandemic. Following exemption by the Partners Institutional Review Board, we distributed the survey in anonymous and confidential format through RedCap to 273 adult psychiatry residency program directors using the American Medical Association’s FREIDATM database. Program directors were instructed that they could complete the survey themselves or forward to relevant faculty. Results: We will discuss the results of the survey including the response rate;distribution of programs in terms of geography, size and focus;length, timing, structure and setting of CL rotation;presence and role of fellows and other learners;model of attending staffing;educational and didactic components;and modifications made in the setting of COVID-19. Discussion: Based on the findings, we anticipate a discussion of trends in residency CL education over the past decade. Specifically, we anticipate focus on earlier CL training, novel training patterns, CL rotations spread across multiple years, increasing focus on outpatient CL experiences, and increased learners and other staff on services. The topic is of immediate relevance to training in CL psychiatry and thus to developing careers in CL psychiatry, a meeting theme. Conclusion: We expect these findings will provide important information for issuing an updated set of guidelines for CL training in residency for the next decade. References: 1. Heinrich TW, Schwartz AC, Zimbrean PC, Lolak S, Wright MT, Brooks KB, Ernst CL, Gitlin DF. “Recommendations for training psychiatry residents in psychosomatic medicine.” Psychosomatics 2014;55:438-449. 2. Heinrich TW, Schwartz AC, Zimbrean PC, Wright MT;Academy of Psychosomatic Medicine's Residency Education Subcommittee. The state of the service: a survey of psychiatry resident education in psychosomatic medicine. Psychosomatics. 2013 Nov-Dec;54(6):560-6. doi: 10.1016/j.psym.2013.07.005.

15.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S54, 2022.
Article in English | EMBASE | ID: covidwho-1966668

ABSTRACT

Background: To date, scarce structured guidelines for the assessment of service quality improvement interventions and service quality standards for Consultation Liaison Psychiatry Services (CLP) have been described (1-4). Our aim is to measure the impact of introducing an electronic triage referral system (ETR) and a proactive CLP model (PCL) during the COVID-19 pandemic by establishing key performance indicators (KPI). Methods: Observational exploratory study conducted at the Hospital Clínico Red Salud-UCChristus, a teaching hospital in Santiago, Chile, ∼400 beds. ETR was introduced in May 2020, and PCLP from May to August 2020. Data was collected from CLP discharged records, from January 2019 to September 2021. Study approved by our Ethical Review Board. Results: We observed a constant increase in the number of referrals and assessments from 2019 to 2021. Most frequent referrals in 2019-2021 were made by the Internal Medicine team and the most common diagnosis was delirium. Two main KPIs were assessed: • Time of Response (ToR): After the introduction of ETR, there was an increase in the % of patients seen within 24 hours of referral between 2019, 2020 & 2021 (51.4%, 69.9% and 71.3% respectively). A similar trend was observed in ToR within 48 hours. Of those considered urgent by referrers, 87% were seen within 24 hours of referral in both 2020 and 2021, with an overall achievement of 100% within 48 hours. • “Staffing workload index” (SWI): After ETR & PCL were introduced, we observed an increase in staffing available working hours at the hospital in 2020 and 2021 (40% increase), which was sustained after PCL was terminated. We were able to estimate a rate between staff hours and average referrals per week (SWI), to measure the staff turn towards clinical activities as needed by referrals. The overall SWI was 1.32 in 2019, 1.57 in 2020 (1.05 during 3-month COVID-19 peak of cases) and 1.09 in 2021. Moreover, SWI had a -0.17 correlation with % of ToR Discussion: The ETR and PCL initiatives had an impact in our service, as observed in our KPIs ToR and SWI. Our CLP service has been able to adapt to service demands, by increasing staffing available working hours when needed and reducing time of response. Conclusions: ToR may be a useful and easy to collect KPI to routinely monitor service efficiency. Still remains a challenge for our service to introduce qualitative parameters of service user satisfaction in a 360º fashion to integrate patients, family, referrers and CLP staff. Trials to assess the efficacy of introducing complex interventions such as ETR, PCL and KPI surveillance are needed. References: 1. Trigwell, P., & Kustow, J. (2016). A multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP). BJPsych bulletin, 40(4), 192–194. https://doi.org/10.1192/pb.bp.115.051458 2. Wood, R., & Wand, A. P. (2014). The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. Journal of psychosomatic research, 76(3), 175–192.https://doi.org/10.1016/j.jpsychores.2014.01.002 3. Brightey-Gibbons F, Patterson E, Rhodes E, Ryley A, Hodge S, Eds. Quality Standards for Liaison Psychiatry Services (Fifth ed.). London: Royal College of Psychiatrists;2017. 4. Kovacs, Z., Asztalos, M., Grøntved, S., & Nielsen, R. E. (2021). Quality assessment of a consultation-liaison psychiatry service. BMC psychiatry, 21(1), 281. https://doi.org/10.1186/s12888-021-03281-4

16.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S45, 2022.
Article in English | EMBASE | ID: covidwho-1966664

ABSTRACT

Background: Dysgeusia is a distortion of taste sensation. Etiologies can include medications and Covid-19, among others. Dysgeusia may lead to appetite loss which is nonspecific and can have multiple causes, including major depressive disorder (MDD) (Coulter, 1988). Although post-marketing data revealed no association between nifedipine and dysgeusia (Ackerman, 1997), case reports of dysgeusia from nifedipine exist (Ackerman, 1997). We present a case of nifedipine-induced dysgeusia mistaken for depression. Case Report: A 42-year-old man with hypertension and diabetes was admitted to the hospital following right thalamocapsular and intraventricular hemorrhages. Hypertension was managed with metoprolol, lisinopril, nifedipine, and chlorthalidone. Levetiracetam was started for seizure prophylaxis. Medications included pantoprazole, simethicone, transdermal lidocaine, insulin, metformin, docusate, senna, and subcutaneous heparin. Psychiatric consultation was requested out of concern that appetite loss indicated depression. The day before psychiatric evaluation, mirtazapine 15 mg at bedtime for mood and appetite was started. Nifedipine 90 mg daily had been started 9 days prior to his first complaint of decreased appetite. The patient reported feeling disconnected from his family and “sad" for ∼10 years, complaining that family members “talk behind his back.” He was otherwise without paranoia. He denied insomnia, anhedonia, hopelessness, poor concentration, suicidal ideation, homicidal ideation, guilt, mania, or hallucinations. He reported poor appetite due to epigastric discomfort and bad taste to foods. Covid-19 testing was not yet widely available. No other signs or symptoms suggestive of Covid-19 were present. Although alert and fully oriented, concentration was impaired with sometimes tangential thought processes. Affect was full without depression. A diagnosis of adjustment disorder was made. The psychiatry team suspected nifedipine-induced dysgeusia and advised discontinuing nifedipine. Appetite improved two days later. Discussion: This case highlights the importance of considering alternative causes of nonspecific symptoms of depression, including decreased appetite, that may have non-psychiatric causes. Dysgeusia is widely recognized as a symptom of Covid-19. Other causes, including medications may be underrecognized and amenable to intervention. Conclusion: It would be helpful to consider medication side-effects as potential causes for taste distortion alongside psychiatric diagnoses, and COVID-19. References: 1. Coulter DM: Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of post marketing surveillance BMJ 1988;296: 1086–8. 2. Ackerman BH, Kasbekar N: Disturbances of taste and smell induced by drugs. Pharmacotherapy 1997;17(3):482-96.

17.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S43-S44, 2022.
Article in English | EMBASE | ID: covidwho-1966663

ABSTRACT

Background: Catatonia, a motor dysregulation syndrome with behavioral components, has undergone many conceptual changes since its inception as a syndrome by Kahlbaum in 1874. Prevalence of catatonia in consultation-liaison services is approximately 5.5 percent in patients aged 65 and older.1 Stuporous catatonia is most common, but catatonia may present in excited or malignant subtypes. Together, the subtypes have over 40 documented signs and symptoms, making catatonia difficult to diagnose and appropriately treat.2 Catatonia involves hyperactivation of the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex. GABA, NMDA, and dopamine have been implicated. GABA-A agonism by benzodiazepines improve catatonia by normalizing OFC activity.3 Case: A 66-year-old male with schizophrenia was admitted to a medical unit for failure to thrive after not eating for three days. He had not taken his medications for 2 weeks including chlorpromazine, quetiapine, oxcarbazepine, and clonazepam. Upon psychiatric consult, the patient exhibited staring, grimacing, echopraxia, and negativism. He was diagnosed with stuporous catatonia. 30 minutes after lorazepam challenge (2 milligram intravenous lorazepam), the patient was moving, conversing, and eating. After second dose of lorazepam, the patient became difficult to redirect, displaying stereotypy, verbigeration, and hitting. Additional doses of lorazepam were unsuccessful in breaking excited catatonia. History revealed previous catatonic episodes, including nine months prior when the patient was admitted to a gero-psychiatric unit. He initially presented in stuporous state, normalized with lorazepam, then transitioned to excited state. He received 16 milligrams of lorazepam in 24 hours without successful termination of excited catatonia. Lorazepam in combination with carbamazepine, clozapine, or valproic acid was unsuccessful. Catatonia was successfully treated with 10 sessions of electroconvulsive therapy (ECT) with lorazepam, clozapine, and valproic acid. Maintenance ECT was not continued because of the COVID pandemic, and the patient was admitted to a state facility after regression. Discussion: Catatonia is often encountered on consultation-liaison services in general hospital settings. We observed conversion of stuporous catatonia to excited catatonia after administration of lorazepam. This treatment-resistant catatonia ultimately required ECT. No reported cases of stuporous catatonia transitioning to excited catatonia were found on thorough literature review. Recognition of this conversion may be difficult and may require development of a catatonia scale that clearly identifies the presenting subtype. This is a challenge;clinical signs are not mutually exclusive among subtypes. This patient’s clinical course may provide insight into the identification of treatment-resistant catatonia, and accurate identification is necessary to allow for timely escalation of treatment. References: 1. Solmi M, et al. Prevalence of catatonia and its moderators in clinical samples: Results from a meta-analysis and meta-regression analysis. Schizophrenia Bulletin. 2017;44(5):1133–50. 2. Fink M, Taylor MA. The catatonia syndrome. Archives of General Psychiatry. 009;66(11):1173. 3. Ellul P, Choucha W. Neurobiological approach of Catatonia and Treatment Perspectives. Frontiers in Psychiatry. 2015;6.

18.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S20-S21, 2022.
Article in English | EMBASE | ID: covidwho-1966660

ABSTRACT

Introduction: Anorexia Nervosa (AN) is an eating disorder defined by an abnormally low body weight due to purging behaviors/food intake restrictions and distorted self-image. Coronavirus disease 2019 (COVID-19) has changed our environment due to social distancing, lockdown, and reduced access to regular mental health services. Reports indicate a negative impact of COVID-19 on mental health1, including patients with AN2. Our Consultation-Liaison service noticed an increase in new-onset AN cases and a worsening of established AN cases attributed to the environment created by COVID-19. Methods: PubMed literature review with keywords “COVID-19” and “AN.” Review of seven AN cases seen during the pandemic. Case series: Seven cases (COVID-19 negative) of worsening AN were seen by our Consultation-Liaison service between August 2020 and January 2021. Six cases were newly diagnosed, five cases presented severe dehydration, electrolyte imbalance, or bradycardia requiring inpatient stabilization, and five cases needed transfer to inpatient eating disorder units. The lack of structured activities and increased social media use leading to distorted self-image were found to be a trigger. Discussion: The impact of the Pandemic in AN can vary. The lack of structure, increased social media use, and reduced access to mental health services may increase AN incidence and worsening of symptoms3. However, a study reported a positive response to AN treatment during confinement4, possibly due to family dynamics5. It is important to note that patients with AN are a vulnerable population that requires greater support and monitoring to prevent worsening symptoms and long-term consequences. These observations suggest the need for further research to understand the impact of the pandemic on AN symptoms onset and severity. References: 1. Phillipou, A., et al. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. The International journal of eating disorders, 53(7), 1158–1165. https://doi.org/10.1002/eat.23317 2. Termorshuizen, J. D., et al. (2020). Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ∼1,000 individuals in the United States and the Netherlands. The International journal of eating disorders, 53(11), 1780–1790. https://doi.org/10.1002/eat.23353 3. Branley-Bell, D., et al. (2020). Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. Journal of eating disorders, 8, 44. https://doi.org/10.1186/s40337-020-00319-y 4. Fernández-Aranda, F., et al. (2020). COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study. European eating disorders review: the journal of the Eating Disorders Association, 28(6), 871–883. https://doi.org/10.1002/erv.2784 5. Yaffa, S., et al. (2021). Treatment of eating disorders in adolescents during the COVID-19 pandemic: a case series. Journal of eating disorders, 9(1), 17. https://doi.org/10.1186/s40337-021-00374-z

19.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S7, 2022.
Article in English | EMBASE | ID: covidwho-1966658

ABSTRACT

Background: The University of Colorado (UCH) Consultation-Liaison Psychiatry (CLP) service and Psychiatric Consultation for the Medically Complex clinic (PCMC) are developing a brain health outreach program for those hospitalized with COVID. Patients with COVID have increased risk of cognitive and psychiatric sequelae due to intrinsic viral properties, hyperinflammatory state, and increased disposition to ICU level care (Inoue, 2019;Cothran, 2020). Development of a post COVID brain health program has become paramount and UCH is not alone in creation of new clinic protocols to meet the needs of this population (Rovere Querini, 2020;O'Brien, 2020). Hospitals around the globe are developing new screeners to identify patients at higher risk of neuropsychiatric sequelae and refer them to appropriate resources. Methods: The program makes use of two arms: The first assesses those discharged from the hospital using a screener developed by the UCH post-COVID hospitalization program. The second screens patients currently admitted to the hospital with COVID using psychiatric and neurocognitive screeners. Both allow patients to be referred to PCMC for evaluation and treatment. Evaluation includes psychiatric interview and additional screeners including: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and PTSD Checklist for DSM-5 (PCL-5). Additional neuropsychiatric evaluation via Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and cognitive rehabilitation referral, are available. Clinic treatment includes pharmaceuticals, individual therapy referral, or referral to the PCMC COVID Survivorship Support Group. Results: To date, 100 patients have been screened in arm 1 (outpatient outreach) and arm 2 (inpatient outreach). In arm 2, about 54% of the population identifies as female, 46% as male, 61% identified as white, and 86% spoke English. Of those in arm 2 that agreed to full participation, 26% agreed to future check-ins and 6% were seen in the clinic. There was a difference in those who did and didn't fully participate based on ethnicity, language, and insurance status;though not of statistical significance. HADs scores demonstrated different trends based on these same demographic factors, though also not statistically significant. Discussion: By using this two-armed approach, the service has been able to more effectively outreach patients and refer them to appropriate care. Though data is not complete, referral needs seem to differ based on demographic data. Conclusions: As data continues to be collected, the clinic model is expanding to outreach high risk patients for neuropsychiatric sequelae. This will strengthen our existing system, with risk of reoccurrence of similar events, and inform a new standard of care for COVID survivors. 1. Cothran, T. P., Tam, J. W.;et.al. (2020). A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun, 88, 957-958. 2. Inoue, S., Nishida, O, et.al. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246. 3. O'Brien, H., Hurley, K., et.al. (2020). An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci, 1-8. 4. Rovere Querini, P., Ciceri, F., et.al. (2020). Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed, 91(9-s), 22-28.

20.
Annals of Oncology ; 33:S412, 2022.
Article in English | EMBASE | ID: covidwho-1966329

ABSTRACT

In the elderly, it is necessary to take into account the changes in physical, mental, and social functions related to aging. In general, after assessing the general condition of the elderly, necessary life support should be provided, and long-term follow-up should be conducted. When introducing cancer drug therapy, there are times when standard treatment is deemed difficult to implement. The actual practice is to assess the general condition of the patient, determine the risk for each patient, and adjust the intensity of treatment as necessary. In addition to side effect management, support for maintaining nutritional status, physical activity, and social activity, as well as decision-making support, are considered important. Specifically, a multidisciplinary approach should be taken, and the use of home medical care, home nursing care, and nursing care insurance should be devised. In addition, the cancer consultation service should be used, and social support systems for medical expenses should be widely publicized. Cancer drug therapy is now available on an outpatient clinic, and oral drugs, molecular targeted drugs, and immune checkpoint inhibitors can be selected, making it essential to understand and respond to the situation appropriately at home. Online medical care is attracting attention due to the impact of Covid-19 infection, and information sharing between oncologists and visiting physicians, as well as in multidisciplinary collaboration, is necessary. For this purpose, not only telephone support but also various ICT devices are expected to be utilized. With the reform of the all-generation security system underway in Japan, there is a need to develop a system that can make effective use of limited medical resources.

SELECTION OF CITATIONS
SEARCH DETAIL