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1.
Radiotherapy and Oncology ; 170:S620, 2022.
Article in English | EMBASE | ID: covidwho-1967489

ABSTRACT

The ESTRO vision statement for 2030 is “Radiation Oncology. Optimal Health for All, Together”. It is becoming increasingly clear that optimal health for all should include the health of caregivers, too. This is exemplified by the high level of burnout amongst radiation oncology professionals across the disciplines, as published recently by Franco et al. (1) Sadly, the COVID pandemic has had a negative impact on mental health of these professionals. (2) The young ESTRO committee (yESTRO) has aligned its activities to the ESTRO vision by setting up an ESTRO mentoring program in order to increase professional well-being for its young members. Mentorship benefits both mentor and the mentee. A review on mentorship in the medical field reported it to have an ‘important influence on personal development, career guidance, career choice, and research productivity, including publication and grant success’. (3) For mentors the benefits lie in enhancement of knowledge, leadership skills, educational skills and increased job satisfaction. With the yESTRO mentoring pilot program, yESTRO specifically aims to satisfy unmet needs for mentorship among young ESTRO members. Fifteen young members were selected as mentees based on their curriculum and personal motivation. The program had its official kickoff at ESTRO 2021 in Madrid with an onsite and an online speed dating session between mentors and mentees. Matches were made and mentor-mentee couples committed to meet at least every three months for the duration of one year. We will present the mid-term evaluation of the pilot at ESTRO 2022. The final evaluation takes place one year after the program started, after which it will be decided whether the program will continue. Yet the ambition of yESTRO is larger. This session will also provide practical advice for those considering to set up a mentoring program at their own institute. Or those seeking a mentor. In this ambition, we will be helped by the experiences shared by Daniel Portik, one of the mentees in the yESTRO mentoring program pilot.

2.
Radiotherapy and Oncology ; 170:S1645-S1646, 2022.
Article in English | EMBASE | ID: covidwho-1967486

ABSTRACT

Purpose or Objective Recruitment and retention of key NHS staff has been an ongoing challenge. The Reducing Pre-registration Attrition and Improving Retention (RePAIR) initiative was set up by Health Education England (HEE) in 2015 to explore effective interventions to improve retention across the student journey, from pre-enrolment to two years post qualification. Key objectives: · Map and identify areas of good practice, opportunities, and challenges of the RePAIR recommendations in England · Further embed partnership working across a range of stakeholders · Develop a shared online repository of good practice and understand the impact of COVID-19 on student education and training. Project delivered by Society of Radiographers (SoR), funded by HEE. Materials and Methods Sample: Radiotherapy approved Higher Education Institutions (HEI’s) n=10 and Radiotherapy Healthcare Providers (HCP’s) n=51 in England. A two stage project: · Multi-method survey of HEI’s, HCP’s and therapeutic radiography students on a placement expansion programme in England · Follow-up semi-structured interviews and Dual Moderator focus groups with key stakeholders Results A 100% HEI and 88% HCP survey response Key findings: • 80% of HEIs and 98% of HCPs were in favour of standardising clinical assessment documentation. • HEIs, HCPs and students felt simulation could replace up to 20% of clinical practice. • 70% of HEI’s and 51% of HCP’s surveyed had informal student support mechanisms however only 15% of HCP’s and 20% of HEI’s had extra support for year 2 • Physical and mental health and wrong career choice, were the most common reasons for attrition. • Recruitment initiatives were evident in all HEI’s and in 82% of HCP’s, however, only 27% of HCP’s were involved in retention initiatives. • Formal use of ‘culture of care’ tools was not standard practice. • All HEI’s had a transition to professional practice. 80% of HCP’s had a preceptorship programme with 20% collaborating with local HEI • Only 20% awareness of RePAIR from survey findings Conclusion Priority areas were identified and developed into workstreams: 1. Effective recruitment initiatives (e.g. outreach) 2. Effective retention initiatives, student support toolkit, return to practice 3. Strategies to increase student placement capacity (e.g. simulation and non-traditional placements) 4. Placement allocation and funding support 5. Standardised clinical assessment documentation 6. Preparation for practice (e.g preceptorship) This led to the development of an online toolkit – AHP Support Programme for Implementing Recruitment, Retention and Engagement (ASPIRRE), Standalone projects were identified, requiring separate research and development. • National project exploring requirements of implementing standardised clinical assessment. • Production of a professional body guidance document on simulation within pre-registration Therapeutic Radiography education and training programmes These projects address student and professional workforce growth, placement expansion and transformation requirements.

3.
Gastroenterology ; 162(7):S-1250, 2022.
Article in English | EMBASE | ID: covidwho-1967437

ABSTRACT

Patients with cirrhosis have a relatively poor prognosis in intensive care (ICU) that could be affected by the9 pandemic. However, the impact of cirrhosis care compared to noncirrhotic patients is unclear pre and post-pandemic. Aim: Define impact of cirrhosis on mortality in ICU patients before & after COVID-19. Methods: ICU pts from a large tertiary hospital who were admitted for >24 hours were divided into pre-COVID (2019) and postpandemic (2020) eras. We excluded patients where cirrhosis diagnosis was unclear. Within the 2020 cohort, we further divided pts into COVID-positive or negative based on PCR. Pts with cirrhosis were matched 1:1 to non-cirrhotic pts with respect to age, ICU admission qSOFA & ICU length of stay in both cohorts. Reasons for ICU admission, infections, organ failures and discharge information were collected. We first compared only COVID negative cirrhosis vs other pts in the pre and post cohorts & then further compared these within the COVID positive pts. Logistic regression with death/hospice as the outcome was used with cirrhosis status, qSOFA, reason for ICU admission and organ failures as independent variables in the three matched cohorts (pre-COVID, post-COVID positive & post-COVID negative). Finally, to evaluate the relative impact of cirrhosis vs COVID-19, we combined the 2020 cohort and determined death/hospice determinants. Results: We included 200 age/LOS/qSOFA-matched pts with/without cirrhosis in pre-COVID cohort. Post-COVID similarly, 200 pts were included in the COVID negative group. 64 COVID+ pts (with/ without cirrhosis) were also included. More non-cirrhotic pts were admitted for procedural observation & stroke while altered mental status (AMS) were similar. Remaining organ failures were higher in cirrhosis in pre- and post-COVID settings (Table 1). In COVIDpositive pts, cirrhosis had lower infections, respiratory failure and intubation but trended towards higher death. Cirrhosis comparison pre vs post-COVID: Post-COVID cirrhosis pts had a higher MELDNa score (15.4±7.9 vs 22.3±10.2, p=0.004)and qSOFA (2.4 vs 1.7, p<0.001) compared to pre-COVID. Logistic regression for death/hospice (Table 2): Pre COVID was significant for cirrhosis, qSOFA , altered mental status & Pressors. Post-COVID in COVID-negative pts it was again significant for cirrhosis, Infection, renal failure & qSOFA. For only COVID positive patients, only renal failure was significant. In the entire 2020 cohort, COVID-19 positive status was not significant in death/hospice prediction, but cirrhosis remained significant. Conclusions: Cirrhosis remains a major cause of mortality in patients admitted to intensive care that continues regardless of COVID-19 pandemic-induced changes in the health system. Cirrhosis is predictive of death independent of COVID-19 despite controlling for demographics and organ failure severity. (Table Presented)

4.
Gastroenterology ; 162(7):S-691, 2022.
Article in English | EMBASE | ID: covidwho-1967365

ABSTRACT

Introduction It is well established that persons with IBD have significantly higher rates of depression and anxiety than the general population, and that mental health symptoms exacerbate disease symptoms and impair quality of life. During the COVID pandemic, the general public has experienced escalating rates of anxiety and depression. Our aim was to determine the mental health impact of the COVID-19 pandemic on adults with IBD, focusing in this study on access to mental health resources. Methods All adults with current contact information in the population-based University of Manitoba IBD Research Registry (n=2833) were invited to participate in a survey via mail regarding their experiences with COVID-19 during autumn 2020, just prior to and during the second pandemic wave in Manitoba. The survey included background sociodemographic and disease information (e.g., symptom severity, medication use), COVID-related personal and health circumstances and coping. Results Response rate was 48.9% (n=1384). The mean age of respondents was 57.8 years, 59.3% were female and 46.9% had Crohn's disease. One in 5 (21.0%) of respondents had a prior diagnosis of a mental health condition. Overall, 11.6% felt they needed help from a mental health professional during the pandemic, with close to half (44.7%) of these individuals feeling they had inadequate access to a mental health professional. 10.0% accessed some type of resource;(of these, 52.5% used the internet, 24.5% used an app to help manage pandemic-related distress or anxiety). The most distressing aspects of the pandemic were concerns about family health (35.8%), concerns for getting infected with COVID-19 (27.2%), and having an IBD flare (9.0%). Trusted sources of information on the pandemic included television programs (64.2%), internet (46.1%), newspaper (27.8%), friends or family (21.7%), and social media (16.9%). Just over half (53.3%) spent 1-5 hours daily consuming information on COVID-19 from various sources, whereas 41.5% spent much less time (1-60 minutes/day). 51.4% tried to limit time spent watching the news or on the internet on the topic of COVID-19;of these, 9.6% found this quite or extremely difficult, and 22.1% had moderate difficulty limiting information consumption. Conclusion Mental health needs were prevalent for individuals with IBD during the first waves of the pandemic, with many of those who identified a need for professional help not feeling they had sufficient access to care. The most common mental health resource accessed was technology-based. A large proportion spent significant time focused on pandemic-related information. Further research is needed to examine changes over time during the pandemic and inter-relationships among mental health, care needs and IBD disease course.

5.
Gastroenterology ; 162(7):S-676, 2022.
Article in English | EMBASE | ID: covidwho-1967360

ABSTRACT

Background: Irritable bowel syndrome (IBS) is a stress-sensitive gut-brain disorder. The outbreak of Covid-19 has influenced the level of stress and anxiety at least for some people. Individuals with IBS often report poor self-rated health (SRH), which also reflects psychological and social aspects of life and an overall sense of well-being. This populationbased twin study evaluates whether the Covid pandemic has affected self-reports of abdominal symptoms of IBS and ratings of physical (p_SRH) and mental health (m_SRH) among individuals with IBS. Further, we calculate measures of twin similarity and correlations across traits to gain insights into the importance of genetic influences. Methods: In July 2021, we invited 17138 twins from the Norwegian Twin Register to complete a questionnaire asking how the pandemic affected their health and well-being, including depression, perceived stress, loneliness, anxiety, chronic somatic and pain-related diseases. Responses were received from 9032 twins, aged 19 – 86 of whom 831 reported a positive history of IBS (Table 1). Hierarchical regression models were used to estimate the impact of IBS on p_ SRH and m_SRH during the Covid pandemic, covariates in the stepwise modeling included age, sex, education, and other chronic physical and mental health conditions. Phenotypic, intraclass and cross-twin cross-trait correlations were computed for IBS and the health measures. Results: The majority of individuals with IBS reported no changes in abdominal pain or bowel disturbance during the pandemic. Nonetheless, they did report worse perceptions of health compared to those without IBS. Further findings revealed weak but significant associations between IBS and changes in perceived stress. Age was inversely related to ratings for p_SRH and m_SRH, with younger participants reporting that their mental and physical health worsened more than older participants. IBS retained significance as a predictor of worsening m_SRH after accounting for depression and perceived stress (model 5, Table 2) [OR = 1.22 (1.00;1.50), Table 2]. The intraclass correlations for worse p_SRH and m_SRH were greater among monozygotic (MZ) than dizygotic (DZ) twins, which is consistent with genetic variance explaining some of the differences in how the pandemic has affected perceptions of health. Cross-twin cross-trait correlations between IBS and worse p_SRH were 0.15 (0.11;0.18) for MZ twins and 0.08 (0.03;0.12) for DZ twins, suggesting that common genetic factors may underlie this relationship Conclusion: Abdominal symptoms of IBS did not change during the pandemic. However, IBS was predictive of worsening of mental SRH, not confounded by depression or perceived stress. These results underscore the role of psychosocial and emotional factors for mental health in IBS during the pandemic. (Table Presented) (Table Presented) (Table Presented) (Table Presented)

6.
Gastroenterology ; 162(7):S-289, 2022.
Article in English | EMBASE | ID: covidwho-1967280

ABSTRACT

Introduction The COVID-19 pandemic has globally impacted public health and the world economy. This has related, in part, to challenges in accessing medical care including procedures, hospitalizations and/or surgeries that would have been otherwise warranted in their disease management. Access to care was affected during the pandemic as most providers were not seeing patients in person, but providing virtual care. Patients' perceptions of their access to care may cause significant stress and anxiety, in a population in which many already have existing mental health conditions. Methods Participants in the populationbased University of Manitoba IBD Research Registry (n=2833) were invited to participate in a survey regarding their experiences with COVID-19, during autumn 2020, just prior to and during the second pandemic wave in Manitoba. The survey included background sociodemographic and disease information (e.g., symptom severity, medication use), COVIDrelated personal and health circumstances and coping. Results There were 1384 respondents (48.9%), of which 46.9% had Crohn's disease, 40.8% had ulcerative colitis, 3.2% had ulcerative proctitis, 2.8% had IBD-U and 2.2% had an ileoanal pouch. The mean age of respondents was 57.8 years, 40.6% were male. Mean duration of disease was 24.8 years. 38.3% said the pandemic was affecting them extremely, or a lot, while 15.6% said not at all or a little. 65.5% and 62.1% of respondents felt they had good access to their non-IBD provider to discuss non-IBD health care issues, and IBD issues, respectively. Only 53% felt they had good access to their gastroenterologist to discuss their IBD. 45.3% of respondents had increased stress about accessing their physician or nurse, while 19.9% had increased stress about accessing their prescription IBD medications. 901 (65.1%) patients were on some form of IBD therapy;12.5% of IBD-medication users adjusted their IBD medications on their own, while 13.8% had a provider adjust their IBD therapy. Conclusion Our survey revealed that over half of respondents did not feel they had good access to their gastroenterologist, or had increased stress associated with accessing care or their IBD medications 9-10 months into the pandemic. Some adjusted their IBD therapies on their own. Perception regarding access to care is integral for patients with IBD, and further research is needed to understand if perceptions regarding limited access to care changed and whether or not care was in fact limited as the pandemic evolved.

7.
Sleep Medicine ; 100:S219, 2022.
Article in English | EMBASE | ID: covidwho-1967129

ABSTRACT

Introduction: Sleep problems can actively contribute to the onset, maintenance and worsening of mental disorders. Beyond insomnia, several other sleep pathologies may be associated with adverse mental health outcomes, and having multiple sleep disorders may be an aggravating factor. This study aimed to delineate the current landscape of sleep difficulties and symptoms of sleep disorders linked to poor mental health, investigate associations between the age at onset of sleep problems and subsequent mental health, and assess the perceived impacts of sleep problems. Materials and Methods: A representative sample of 1,200 Canadians (16 to 88 years old, 53% females) completed an online survey on sleep and mental health between 21 and 24 September 2021 (i.e. after the acute phase of the COVID-19 pandemic in Canada). The survey included questions inspired form the Sleep Disorders Questionnaire, Sleep Disorders Symptom Checklist-25, Pittsburgh Sleep Quality Index, STOP-Bang, and Insomnia Severity Index. The sample was stratified in two groups based on self-reported current mental disorder diagnosis: mental disorder diagnoses [219 (18.2%)] vs no diagnosis [960 (80.0%)]. Total scores on the General Anxiety Disorder-7 and Patient Health Questionnaire were used to determine anxiety and depression symptoms severity. Results: Of those with mental disorder diagnoses, 80.4% (176/219) endorsed symptoms of at least one sleep disorder, a proportion significantly higher compared to the 42.7% observed in the rest of the sample (p<.001, V=.29). The mental disorder diagnoses group included higher proportions of respondents endorsing symptoms of insomnia disorder, sleep apnea, bruxism, restless legs syndrome, nightmare disorder, hypersomnia and somnambulism. After adjusting for age, sex, income level and total sleep time, having a mental disorder diagnosis was associated with: insomnia (OR=3.52, p<.001), obstructive sleep apnea (OR=1.95, p=.006) and bruxism (OR=2.77, p<.001). Half of those with mental disorders diagnoses endorsed symptoms of multiple sleep disorders, a proportion significantly higher than what was observed in the rest of the sample (p<.001, V=.35). Endorsing symptoms of insomnia, sleep apnea, bruxism, restless legs syndrome, and hypersomnia were associated with more severe anxiety and depression symptoms after adjusting for age, sex, income level, total sleep time, and mental disorders diagnoses (B>.98, p<.012). Younger age at onset of sleep problems was a significant independent predictor for current self-reported diagnosis of mental disorders (OR=.96, p<.001). Compared to the rest of the sample, the mental disorder group reported significantly worse impacts of sleep problems on mental health, family relationships, physical health, cognitive functioning, productivity level, and global daily functioning. Conclusions: These results reinforce the transdiagnostic nature and cumulative impacts of the various profiles of sleep problems associated with mental health issues. These findings also suggest that the relationship between sleep and mental health is not solely driven by short sleep duration or insomnia. There is a need to enhance awareness about the diverse profiles of sleep issues linked to poor mental health and the relevance of early intervention, notably during youth. Should future longitudinal studies based on objective measures confirm these observations, this may inform further development of transdiagnostic sleep interventions for people with mental disorders.

8.
Sleep Medicine ; 100:S185, 2022.
Article in English | EMBASE | ID: covidwho-1967127

ABSTRACT

Introduction:Mental health conditions such as anxiety represent a growing health concern for students in institutions of higher education. Postsecondary students are a vulnerable population that is increasingly recognized to be at risk for both mental health problems and significant sleep problems. While it has been hypothesized that poor sleep quality may be a risk factor for developing anxiety, little is known about the frequency and severity of sleep problems and their association with anxiety within the postsecondary student population. The aim of this systematic review was to synthesize the best evidence on the association between sleep quality and anxiety in postsecondary students. Materials and Methods: An experienced librarian developed systematic search strategies in four databases: MEDLINE, Embase, APA PsycInfo (through Ovid Technologies Inc.) and CINAHL, Cumulative Index to Nursing and Allied Health Literature (through EBSCOhost). Databases were searched from inception to September 2020. Random pairs of independent reviewers screened titles and s for eligibility and critically appraised all eligible studies. We assessed the quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for cohort studies, and the Hoy tool for cross-sectional studies. One author extracted and synthesized the results from all of the low and moderate risk of bias studies. We synthesized our results by study design and population. Results: Once duplicates were removed, a total of 3203 unique citations were screened. Fifty-one articles were eligible and critically appraised. Studies with low and moderate risk of bias were included in our final synthesis of which 24 were cross-sectional studies and four were cohort studies. With the exception of one study, all cross-sectional studies reported a statistically significant association between poor sleep quality and anxiety. All four of the cohort studies found that students who reported poor sleep quality were more likely to develop future anxiety and students with anxiety were more likely to develop future poor sleep quality. Conclusions: Poor sleep quality is associated with anxiety in postsecondary students. Due to the cross-sectional nature of most studies, we cannot determine the direction of this association. Future studies should focus on developing high-quality prospective cohort or longitudinal studies to help understand the impact and direction that this association has in postsecondary populations. This research has the potential to inform the development and design of mental health policies and programs that are created by postsecondary institutions to address the increasing rates of student mental health issues. Acknowledgements: Canadian Institutes of Health Research (CIHR) Operating Grant: Knowledge synthesis: COVID-19 in Mental Health & Substance Use;University of Ontario Institute of Technology;Institute of Disability and Rehabilitation Research.

9.
Sleep Medicine ; 100:S178, 2022.
Article in English | EMBASE | ID: covidwho-1967125

ABSTRACT

Introduction: Students pursuing postsecondary education are a population at significant risk for both sleep problems and poor mental health outcomes such as depression and anxiety. Interventions such as sleep hygiene education and cognitive behavioural therapy (CBT) are commonly used treatments for sleep problems and have been effective in improving sleep and mental health in the university student population. Digitally-delivered CBT has also been shown to be effective in improving sleep in youth, however it has not been evaluated in the postsecondary student population. Materials and Methods: We conducted a systematic review of the quantitative and qualitative evidence on the effectiveness and user experiences of digital sleep interventions to improve sleep and mental health outcomes in postsecondary students. We searched MEDLINE, CINAHL, Embase, and APA PsycInfo for studies published from 2000 to 2021. We included randomized controlled trials (RCTs), cohort studies, case-control studies, qualitative studies, and mixed methods studies. Pairs of reviewers independently screened and critically appraised studies, and extracted data. We aimed to use a sequential approach at the review level to synthesize and integrate data across qualitative and quantitative research studies. Results: We screened 5361 citations and 58 full text articles. Eight relevant RCTs and one cohort study were critically appraised. Three interventions were assessed including CBT, digital sleep hygiene education, and relaxation music. Most studies were assessed as high risk of bias. Given the methodological limitations of the included studies, we are unable to conclude on the effectiveness of digital sleep interventions for postsecondary students. We did not identify any qualitative studies. Conclusions: Methodological limitations preclude firm conclusions. Further research is needed to assess the effectiveness of digital alternatives for delivering sleep interventions to improve sleep and mental health outcomes in postsecondary students. Qualitative studies exploring the views and preferences of students and providers are required to inform the development of novel interventions that are acceptable in this population. Acknowledgements: Canadian Institutes of Health Science (CIHR) Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health & Substance Use

10.
Sleep Medicine ; 100:S114-S115, 2022.
Article in English | EMBASE | ID: covidwho-1967123

ABSTRACT

Insomnia is a serious public health concern and has been linked to impaired work productivity. Studies show a link between poor sleep and aspects of occupational functioning such as absenteeism, reduced productivity and low work satisfaction. One in every three workers in the UK are affected by sleep problems costing the economy around £36 billion/year due to loss of productivity in the workplace. This results in around 200,000 working days lost every year, and it is estimated that the cost to industry will rise steadily to £44 billion by 2030 if nothing is done about it. Few studies have evaluated the effectiveness of CBT-I in workplaces, and have found improvements in severity of insomnia and quality of sleep, and slight improvements in productivity and presenteeism, but not in absenteeism. While most interventions for insomnia are focused on the treatment of those above clinical thresholds, there is crucial need for early intervention/prevention of insomnia. This has been further exacerbated during the Covid-19 pandemic due to isolation, financial insecurities, loss of loved ones and fear of infection, causing extensive sleep problems as well as stress, anxiety and depressive symptoms. This study will examine the efficacy of a new hybrid dCBT-I for mild to severe insomnia and symptoms of depression and anxiety delivered to employees in the workplace. This trial tests the efficacy of implementing a hybrid dCBT-I + emotion regulation (ER) in the workplace in a mixed methods evaluation with a two-arm randomised waitlist control (WLC) design. The dCBT-I+ER intervention is 8-weeks long and delivered via self-guided online platform and four videoconferencing therapy sessions. Primary outcomes are the Insomnia Severity Index, the Patient Health Questionnaire and the Generalised Anxiety Disorder. Secondary outcomes are job productivity, job satisfaction, well-being, quality of life, self-reported (sleep diary data) and objective (actigraphy) sleep parameters. We recruited 163 workers with sleep and emotion regulation problems ranging from subclinical to clinical levels not engaged in treatment at the time of the trial. Due to the study design, analyses for the primary hypotheses will be done when the last enrolled participant provides post-intervention follow-up (1-month) outcome measures. We hypothesise that participants randomly allocated to dCBT-I+ER will demonstrate significantly greater improvements on the primary outcomes compared to WLCs post-intervention. They will also demonstrate significantly greater improvements on objective (actigraphy) and self-reported (sleep diary) sleep parameters. Exploratory analyses will also indicate the impact of the dCBT-I+ER on work productivity, job satisfaction, wellbeing, and quality of life. Evaluation of an early intervention for workers with mild to severe symptoms of insomnia and emotion regulation difficulties will contribute to the understanding of benefits of early interventions in the workplace, and its impact on mental health and productivity. The mixed methods evaluation will provide insight into the application of intervention and help us understand people’s experiences of the intervention and what helped or hindered its use. This pilot study forms the basis of what could become a larger nationwide service delivery programme of mental health interventions for insomnia in the workplace.

11.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S85, 2022.
Article in English | EMBASE | ID: covidwho-1966675

ABSTRACT

Background: There is a relative paucity of data on the telehealth experience of health care providers. The present study helps to address this gap by examining the telehealth experiences of mental health providers. Methods: An IRB-approved anonymous survey (31 questions) was circulated in the state of Maryland at the Kennedy Krieger Institute, the Division of Child Psychiatry at Johns Hopkins University and at the University of Maryland, several community mental health practices, and professional organizations. Mental health professionals (physicians, psychologists, licensed social workers, nursing providers), and trainees (medical residents, post-doctoral fellows, and social work trainees) were eligible to participate in the survey. The survey focused on three key domains: patient care, work-life balance, and personal life. 175 providers participated in this survey Results: 75% of the respondents were female. 30% of respondents had been in practice for more than 20 years. 10% were trainees. The majority of respondents reported an overall positive impact of telehealth on their clinical practice. The comfort level with telehealth was high across the board. The impact on work-life balance and personal lives of practitioners was mixed with the highest negative impact (90%)reported by early-career practitioners. The majority of respondents reported a negative impact on education of trainees. Discussion: Several mental health disciplines were represented in the survey. Providers were comfortable with using technology and found benefits for patient care. Managing individual work schedules and maintaining the therapeutic relationship with patients seemed to be the areas of concern, especially for early-career providers. This may be due to relatively less control over their schedules and the presence of other competing responsibilities. Conclusion: The COVID-19 pandemic accelerated the establishment of telehealth services. The overall impact seems to be positive especially in the mental health field. In our attempt to understand the impact of this transition on the mental health providers, we found that there are specific trends for the degree of impact based on the duration of practice and field of practice of the providers. This information may help inform future clinical practices and policies, as telehealth will likely continue to be an integral part of medical care beyond the COVID-19 pandemic. References: 1. -19 and tele Health, education and research adaptations Wijesooriya NR, Mishra V, Brand PLP, Rubin BK. COVID-19 and telehealth, education, and research adaptations. Paediatr Respir Rev. 2020;35:38-42. doi:10.1016/j.prrv.2020.06.009 2. Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, Wozniak J, Schwamm LH. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019 Jan;25(1):40-44. PMID: 30667610.

12.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S65, 2022.
Article in English | EMBASE | ID: covidwho-1966673

ABSTRACT

Background/Significance: Severe depression, psychosis, and catatonia are prevalent conditions on inpatient medical-surgical services and frequently drive psychiatric consultation. These syndromes are more common in patients with SMI, who are often socioeconomically disadvantaged. ECT can be a rate limiting and urgently indicated therapy in the treatment of these conditions. Transfer to inpatient psychiatry for the purposes of providing ECT can be difficult due to medical-surgical instability. ECT is at baseline a scarce resource in many institutions. Access to ECT for patients outside the inpatient psychiatric service is limited and requires the cooperation of multiple services. Barriers to the provision of ECT on the medical-surgical floors include navigation of a typically full ECT schedule, anesthesia availability, the portability of ECT equipment, and, more recently, restrictions imposed by the COVID-19 pandemic, which necessitates further precautions for procedures requiring anesthesia. We describe a quality improvement intervention designed to assess the needs for and delivery of urgent / emergent ECT referrals in the general hospital. Methods: We convened a group of stakeholders including representatives from medicine, surgery, anesthesia, nursing, and psychiatry to identify the current practices related to care of patients with neuropsychiatric illness who are medically and/or surgically unstable for transfer to inpatient psychiatry and who require urgent/emergent ECT. Goals of this project included education about prevalence, diagnosis, and associated morbidity of catatonia, the role of ECT in catatonia and related psychiatric conditions, and identification of barriers and solutions to providing timely access to ECT. Results: Stakeholders identified the emergent need for ECT and proposed either the creation of an on-call emergency ECT service akin to other on call services such as interventional radiology, dialysis, and surgical subspecialties, and/or the designation of a daily ECT emergency add-on slot. The barriers to intervention and proposed solutions were addressed by stakeholder group participants. Discussion: Neuropsychiatric conditions, including catatonia, can complicate and/or be driven by underlying medical-surgical illness. These patients can become too sick to transfer to inpatient psychiatry. More time on the medical and/or surgical units results in a positive feedback loop of worsening illness, further delaying transfer to inpatient psychiatry. By creating an on-call / designated add-on system for the provision of emergent ECT, we aim to reduce the overall morbidity associated with these conditions. Conclusion/Implications: Improving access to ECT services for medically-surgically ill patients with severe psychiatric comorbidities via an emergency ECT service allows for earlier treatment of these conditions and can improve patient outcomes. References: 1. Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives. Neuropsychiatr Dis Treat. 2020;16:2191-2208. Published 2020 Sep 25. 2. Ramakrishnan VS, Kim YK, Yung W, Mayur P. ECT in the time of the COVID-19 pandemic. Australas Psychiatry. 2020;28(5):527-529.

13.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S64-S65, 2022.
Article in English | EMBASE | ID: covidwho-1966672

ABSTRACT

Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012). Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 12 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65;one inpatient or two outpatient diagnoses of schizophrenia (F20-29), bipolar disorder (F31), or major depressive disorder with psychotic features (F32.3;F33.3) and one inpatient or two outpatient diagnoses of DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We compared food insecure and food secure particpants with level of social support and frequency of psychiatry symptoms. •Regression analysis was applied to examine the associations between food security status, social support, and mental health symptoms. Results: 624 patients with diabetes and psychosis were identified. 156 patients responded, giving a response rate of 26%. 25% of respondents were found to be food insecure. 16% of respondents demonstrated low social support while 43% showed moderate social support and 41% showed high social support. Mean CSI was 19.36, which suggests participants experienced symptoms several times per month (versus daily or weekly). Significantly lower social support was found in participants with food insecurity compared to those without (p=0.008). This relationship was driven by lower social support from family (p<0.001) compared to friends (p=0.61) or significant others (p=0.192). Additionally, greater psychiatric symptom severity was found in people with food insecurity (p <0.001). Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms. Discussion: This study showed that food insecurity was significantly associated with both low perceived social support and more frequent psychiatric symptoms. However, no evidence of a moderating effect of social support on the relationship between food insecurity and psychiatric symptom severity was found. Rate of food insecurity was found to be lower than previous studies, which showed approximately 50% of individuals who used public mental health services faced food insecurity (Adams et al., 2021). The study sample was not limited to public mental health service users, which is the likely cause of this lower rate. Conclusion/Implications: Food insecurity is associated with poorer mental health outcomes, which have been associated with poorer health outcomes. The presence of perceived social support does not mitigate the need for addressing food insecurity. There is a need for both medical and mental health providers who care for people with co-morbid diabetes and psychosis to specifically address food insecurity. References: 1. Adams WE, Rogers ES, Edwards JP, Lord EM, McKnight L, Barbone M. Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey. Psychiatr c Services. 2021 Jun 23:appi-ps. 2. Coleman-Jensen AJ. US food insecurity status: toward a refined definition. Social Indicators Research. 2010 Jan 1;95(2):215-30. 3. Hammami N, Leatherdale ST, Elgar FJ. Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study. Nutrition journal. 2020 Dec;19(1):1-1. 4. Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20. 5. Na M, Miller M, Ballard T, Mitchell DC, Hung YW, Melgar-Quiñonez H. Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries. Public health nutrition. 2019 Apr;22(5):874-81. 6. Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81. Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8. Stubbs B, Vancampfort D, De Hert M, Mitchell AJ.Acta Psychiatr Scand. 2015 Aug;132(2):144-57. Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms.

14.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S57-S58, 2022.
Article in English | EMBASE | ID: covidwho-1966670

ABSTRACT

Background/Significance: Primary care settings are often the first point of contact for psychiatric diagnosis, treatment, and referral – and primary care clinicians manage many psychiatric illnesses in the community. Integrated and collaborative care models have grown in response to the recognized need for psychiatric services in the primary care setting. Despite increased psychiatric presence, access to mental health services remains a challenge for patients and primary care providers. This challenge is particularly notable in racially diverse and socioeconomically disadvantaged patient populations and is further exacerbated by the COVID-19 pandemic, which disproportionately affects these groups. We describe an initiative to improve equity and access to mental health services among racially diverse and socioeconomically disadvantaged patients in a primary care clinic affiliated with an academic teaching hospital. Methods: We convened a meeting of internal medicine, psychiatry, social work, and administrative stakeholders affiliated with our university-based primary care clinic. This clinic primarily serves low income, racially diverse, and/or immigrant populations. We reviewed provider needs related to mental health referrals and compiled a comprehensive list of local outpatient, partial hospital, inpatient, addiction, and emergency resources. We then created an algorithm to direct providers to the appropriate resources based on the presenting mental health concern. This algorithm has been integrated into the electronic medical record (EMR) for easier access and use. Clinicians were surveyed pre-training and deployment of the algorithm and will be surveyed in follow up to measure its benefits. Results: The majority of primary care providers did not feel confident with psychiatric referral options. The most frequently described reason for psychiatric intervention was for depression and anxiety. Among mental health questions, a majority could be addressed with the assistance of a referral. Discussion: Despite increasing psychiatry presence in primary care, challenges remain in accessing mental health services. The COVID-19 pandemic has exacerbated existing challenges with increased demand for services. Our project builds on an existing integrated care model and introduces a resource that further streamlines mental health referrals. By having this resource available both physically in the clinic and embedded within the EMR, we hope to enhance the ease and efficiency of referral. Conclusion/Implications: A streamlined referral process can further aid in improving access to mental health services within a clinic already using an integrated care model. This is particularly important given the increased need for mental health services in low income, diverse, and immigrant populations hit hard by the COVID-19 pandemic. References: 1. Rothman S, Gunturu S, Korenis P. The mental health impact of the COVID-19 epidemic on immigrants and racial and ethnic minorities. QJM. 2020;113(11):779-782. 2. Jackson-Triche ME, Unützer J, Wells KB. Achieving Mental Health Equity: Collaborative Care. Psychiatr Clin North Am. 2020;43(3):501-510. 3. Lee-Tauler SY, Eun J, Corbett D, Collins PY. A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups. Psychiatr Serv. 2018;69(6):628-647.

15.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S52, 2022.
Article in English | EMBASE | ID: covidwho-1966667

ABSTRACT

Introduction: Kratom (mitragynine speciosa) is a tree native to Southeast Asia that has both opioid, stimulant, and other unknown properties. It is currently legal in the United States and used for therapeutic and recreational purposes. There is a dearth of literature on kratom’s effects on the body. At least half of reported kratom exposures resulted in a serious medical outcome, including death (1). In contrast, there are no controlled clinical trials on safety and efficacy of kratom as a treatment (2). Case: A 32-year-old Caucasian, currently unemployed, unmarried, mother of two children presented intubated to the MICU from an outside hospital with acute fulminant hepatic failure in the setting of significant kratom use. The patient also presented febrile with intracranial hemorrhage, cerebral edema, GI bleeding, acute renal failure, and diffuse intravascular coagulation. Psychiatry was consulted for potential liver transplant candidacy. Her previous history included six years of opioid use and transition to kratom 1-2 years prior to admission, with recent ingestion up to twenty-five times the patient’s usual amount (up to 125mg). Pertinent positive labs included elevated troponin (0.4), transaminitis ( >11,000), elevated PT/PTT (99/52), D-dimer ( >20), hematuria, pyuria, serum ferritin, prolonged QTc (514), and hypoglycemia. Pertinent negatives included unrevealing serum ethanol, phosphatidylethanol, viral hepatitis, HIV, COVID-19, EBV, CMV, other viral panels, acetaminophen level, toxicology screen, and EEG. Imaging revealed interstitial pulmonary edema and diffuse cerebral edema. Given lack of published information on kratom, the team emergently listed the patient for liver transplant despite significant concern for kratom use disorder. Over the course of three days, the patient’s mental status and labs continued to worsen, ultimately resulting in death. Interventions pursued included dialysis, mechanical ventilation, intracranial pressure monitoring with pressure optimization, anticonvulsant therapy, antibiotic therapy, N-acetylcysteine, and other routine MICU care. Due to relatively unremarkable health before ingestion, lack of other significant events, and severe rapid decline, multidisciplinary team consensus cause of death was due to kratom ingestion causing “acute liver failure with hepatic coma”. Discussion: This case report will go into further detail on kratom by analyzing kratom’s mechanism of action, therapeutic use, known side effects including addictive potential, effects on the liver including acute fulminant injury, and current laws and regulations surrounding kratom in the United States with relevance to public health. This is relevant to psychiatrists in the general consult, transplant, and addictions services. References: 1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011–2017. Clinical Toxicology. 2019 57:10,847-854. DOI:10.1080/15563650.2019.1569236 2. Prozialeck W. Update on the Pharmacology and Legal Status of Kratom. J of the AOA. 2016, 116, 802-809. DOI: https://doi.org/10.7556/jaoa.2016.156

16.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-1966662

ABSTRACT

Background/Significance: Nationwide, the number of hospital emergency department (ED) visits has steadily increased over the past decade;since 2009, ED volumes have increased over 11%.1 The proportion of ED visits primarily involving psychiatric concerns (including substance use) has also been on the rise, from 6.6% of all visits in 2007 to 10.9% of all visits in 2016.2 A recent retrospective analysis of ED visit data from the National Emergency Department Sample examining the years 2010 through 2014 identified mental health concerns (including substance use) as the second-most frequent ED presentation, with abdominal pain ranking as the most frequent.3 Challenges to caring for patients with prominent psychiatric concerns in EDs include: prolonged lengths of stay (LOS),4 boarding and overcrowding,5 increased restraint use,6 financial sequelae,7 and safety implications for patients and staff.5 Many EDs have limited access to psychiatric expertise. Unique features of our innovative ED-based Psychiatry service line include: 1) joint administration by academic departments of Emergency Medicine and Psychiatry, and 2) concurrent, rather than consecutive, evaluations conducted by Emergency Medicine physicians and Psychiatrists for optimal efficiency and collaboration. Methods: The ED Psychiatry Program at Froedtert Hospital was implemented in 2019 to improve patient care, systems-based processes, and cross-specialty education. IRB approval was granted on 4/7/2020 to review data collected on all patients seen in the ED by the new ED Psychiatry service and compare metrics with primary psychiatric patients seen in the ED prior to program implementation. Patient care metrics from the first 12 months has been analyzed;cases in which the ED psychiatrist was involved total 382 (data from 5 patients seen during this period could not be reviewed due to erroneous recording of identifying information). 754 charts were reviewed in total—377 post-implementation (9/1/2019-8/31/2020) and 377 pre-implementation (9/1/2018-8/31/2019). The following metrics were recorded and analyzed using basic summary statistics: ED LOS, disposition, psychiatric diagnosis at discharge, medication class recommended, medication class administered, medication route recommended, and medication route administered. Statistical analysis was performed both on the 12-month groups in aggregate, as well as separately in 6-month groupings to assess for any COVID-19 related confounding effect. Results: Analysis of the first 12 months of data (n = 377 control and intervention patients) demonstrates statistically significant results across a number of domains, including disposition (decrease in hospital admissions and increases in transfers and ED discharges post-implementation), psychiatric diagnoses (increases in personality, intellectual developmental, and anxiety spectrum disorders post-implementation), and medication classes and administration routes utilized (decrease in benzodiazepine use and increases in both atypical antipsychotic use, as well as oral route of administration post-implementation). There were also notable decreases in ED LOS for patients being admitted and transferred from the ED;however, these differences were not statistically significant. Discussion: Analysis of the first year of service data suggests program efficacy and overall value to the health system, with relevant metrics including shorter ED LOS, improved diagnostic accuracy, increased provision of pharmacological treatment interventions in the ED setting and upon discharge, and more resource-appropriate dispositions for patients presenting to the ED with psychiatric concerns. Future directions for further study include: 1) review of the total data set, numbering over 1300 patients in 2 years;2) de-duplication of the data set to eliminate repeat patient encounters as a potential source of confounding;3) collaboration with a faculty biostatistician team for further statistical analysis;and 4) collection and analysis of additional relevant metrics, including restraint use (both f equency and duration), utility of 1:1 observers, patient insurance status (to aid in quantifying possible financial impact), additional patient demographic data (including age, race, gender, ethnicity), and time of patient presentation to the ED. Conclusion/Implications: Integration of psychiatric care into medical settings has been widespread in outpatient environments, but acute models are lacking. Complex psychiatric presentations impede ED workflows and often lead to inadequate care for this vulnerable population. Our jointly administered program that embeds CL Psychiatrists into our academic ED care team has improved and enhanced the care of ED patients presenting with psychiatric concerns as well as operational efficiencies within the department. References: 1. Agency for Healthcare Research and Quality. (2021, April). HCUP Fast Stats. Retrieved from Healthcare Cost and Utilization Project (HCUP): www.hcup-us.ahrq.gov/faststats/national/inpatienttrendsED.jsp 2. Theriault, K., Rosenheck, R., & Rhee, T. (2020). Increasing Emergency Department Visits for Mental Health Conditions in the United States. J Clin Psychiatry, 20m13241. 3. Hooker, E. A., Mallow, P. J., & Oglesby, M. M. (2019). Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med, 344-351. 4. Ding, R., McCarthy, M., Desmond, J., Lee, J., Aronsky, D., & Zeger, S. (2010). Characterizing waiting room time, treatment time, and boarding time in the emergency room using quantile regression. Acad Emerg Med, 813-823. 5. American College of Emergency Physicians. (2014). Polling Survey Results. 6. Zeller, S., Calma, N., & Stone, A. (2014). Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments. West J Emerg Med, 1-6. 7. Nicks, B. A., & Manthey, D. M. (2012). The impact of psychiatric patient boarding in emergency departments. Emerg Med Int.

17.
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

18.
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.

19.
Arts in Psychotherapy ; 80, 2022.
Article in English | EMBASE | ID: covidwho-1966275
20.
Psychiatrie (CZE) ; 25(3):120-125, 2021.
Article in Czech | EMBASE | ID: covidwho-1965448

ABSTRACT

Moral injury, known from military medicine, is getting more attention also in the context of healthcare provision related to COVID-19 pandemic. Moral injury represents an intense cognitive and emotional response to events that jeopardize one's moral or ethical beliefs. Healthcare professionals had to quickly learn how to provide care to an enormous amount of patients, making compromising decision, often giving up their professionals standards and preferring what had to be done instead of what should be done. The aim of this review is to map out the psychological impact of potentially morally injurious events in the context of current pandemic, describe specific risks related to ethical distress and to suggest effective strategies to mitigate the impact of moral injury on healthcare professionals' mental health.

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