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2.
Crit Care Med ; 49(10): 1739-1748, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1475872

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING: An urban safety-net hospital ICU. PATIENTS: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.


Subject(s)
COVID-19/therapy , Crisis Intervention/standards , Resource Allocation/methods , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/epidemiology , Crisis Intervention/methods , Crisis Intervention/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Massachusetts , Middle Aged , Resource Allocation/statistics & numerical data , Retrospective Studies , Safety-net Providers/organization & administration , Safety-net Providers/statistics & numerical data , Standard of Care/standards , Standard of Care/statistics & numerical data , Urban Population/statistics & numerical data
3.
Psychiatr Serv ; 72(10): 1199-1208, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1463087

ABSTRACT

BACKGROUND: Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries such as Mozambique. Implementation of the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach to address problem drinking is recommended. However, evidence regarding the best strategies to implement SBIRT at scale is needed. METHODS: Guided by the Reach Effectiveness Adoption Implementation Maintenance model, the authors will conduct a 2-year, cluster-randomized, hybrid type-2 implementation-effectiveness trial in 12 districts in Mozambique evaluating implementation, clinical effectiveness, outcomes, and cost. Eight districts will be randomly assigned to a mobile application-based health SBIRT condition and four to SBIRT-Conventional Training and Supervision. Interventions will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide the authors' mixed-methods assessments throughout the study. RESULTS: The study arm showing better cost-effectiveness will be scaled up in the other arms' districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with providing training, clinical activities, and supervision in all 12 districts without research team support. The SBIRT scale-up phase is critical to identify facilitators and barriers for tracking internal and external factors in clinics that continue using the superior arm and those that switch to it. NEXT STEPS: In a multistep process with stakeholders from multiple sectors, outcomes and lessons learned from this study will inform the development of an implementation tool kit to guide SBIRT scale-up of community services addressing hazardous drinking in other low- and middle-income countries and low-resource settings in high-income countries.


Subject(s)
Substance-Related Disorders , Telemedicine , Community Health Workers , Crisis Intervention , Humans , Mozambique , Randomized Controlled Trials as Topic , Referral and Consultation
7.
Soc Work Public Health ; 36(5): 577-587, 2021 07 04.
Article in English | MEDLINE | ID: covidwho-1294637

ABSTRACT

Summary: The main purpose of the current study was to assess whether there are significant differences among variables, such as social workers' familiarity with the crisis intervention model, receiving up-to-date information about the latest developments in COVID-19, having adequate information about what the symptoms of COVID-19 are, and willingness to work with COVID-19 patients, and social workers' ability to apply the crisis intervention model when they are working with clients and its three sub-scales (assessing and identifying the problem, establishing a relationship, and formulating an action plan). The cross-sectional survey method was used to conduct the sample of the study. The sample (N = 274) used in the study consisted of social workers in Kuwait.Findings: The results showed that CIS is valid and reliable and can be trusted to measure levels according to the purpose of the study. Analysis using T-test showed significant relationships between the CIS and study's variables at p < .05.Application: This study would help to raise the knowledge and awareness about the ability of social workers to apply the crisis intervention model during COVID-19 pandemic when they are working with clients and what variables may be associated with it.


Subject(s)
COVID-19 , Crisis Intervention , Health Knowledge, Attitudes, Practice , Social Workers , COVID-19/epidemiology , COVID-19/psychology , Crisis Intervention/organization & administration , Cross-Sectional Studies , Humans , Kuwait/epidemiology , Models, Organizational
8.
J Psychiatr Pract ; 27(3): 152-163, 2021 May 05.
Article in English | MEDLINE | ID: covidwho-1290432

ABSTRACT

Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.


Subject(s)
COVID-19/psychology , Crisis Intervention , Family Therapy , Psychotherapy, Brief , Telemedicine , Crisis Intervention/methods , Crisis Intervention/standards , Family Therapy/methods , Family Therapy/standards , Humans , Psychotherapy, Brief/methods , Psychotherapy, Brief/standards , Telemedicine/methods , Telemedicine/standards
9.
BMJ ; 373: n784, 2021 05 19.
Article in English | MEDLINE | ID: covidwho-1238499

ABSTRACT

Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.


Subject(s)
Analgesics, Opioid/therapeutic use , Narcotic Antagonists/therapeutic use , Opiate Substitution Treatment/methods , Opioid-Related Disorders/drug therapy , Primary Health Care/methods , Behavior Therapy , Combined Modality Therapy , Counseling , Crisis Intervention , Global Health , Health Status Disparities , Humans , Opioid-Related Disorders/diagnosis , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/therapy , Psychiatric Rehabilitation/methods , Treatment Outcome , United States/epidemiology
10.
Australas Psychiatry ; 29(5): 529-534, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1218282

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 outbreak and its containment through public health strategies has resulted in a parallel pandemic of psychological distress. Increased loneliness and social isolation are associated with adverse health outcomes, yet there is a gap in brief interventions that specifically target loneliness. This article introduces a brief intervention to strengthen connectedness, LOVE. In a systematic way, this solution-focused approach encourages openness and sharing of current struggles with the existing circle of support. There are four steps in LOVE: List people in one's life, Organise them on the helpfulness-availability matrix, Verify what they know to map them onto circles of trust and Engage them through self-disclosure. CONCLUSION: The article details each concept, its importance, the pragmatics involved and top tips to guide practice. The memorable acronym provides logical sequence and structure. It is time efficient in training and delivery, with no former mental health knowledge required so there is potential for wide application. It facilitates collaboration between health professionals and people in distress and promotes empowerment and self-resilience. Adapted from the safety planning component of PROTECT, a pre-existing suicide prevention framework, LOVE has to be fine-tuned as a brief intervention in the wider context of the pandemic.


Subject(s)
COVID-19 , Crisis Intervention , Loneliness , COVID-19/epidemiology , Humans , Loneliness/psychology
12.
Can J Psychiatry ; 66(5): 446-450, 2021 05.
Article in English | MEDLINE | ID: covidwho-1207548

ABSTRACT

The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and also in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.


Subject(s)
Emergency Services, Psychiatric/organization & administration , Evidence-Based Practice , Hotlines , Public Health , Suicide/prevention & control , COVID-19 , Canada , Crisis Intervention/economics , Crisis Intervention/organization & administration , Emergency Services, Psychiatric/economics , Federal Government , Financing, Government , Health Priorities , Humans , Mental Health Services/economics , Mental Health Services/organization & administration , SARS-CoV-2
13.
J Gen Intern Med ; 36(4): 1086-1088, 2021 04.
Article in English | MEDLINE | ID: covidwho-1192068
14.
J Occup Environ Med ; 63(6): 482-489, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1132644

ABSTRACT

COVID-19 is a unique disaster, which has placed extreme stress on Healthcare Workers (HCWs) and the systems in which they work. Eradicating the pandemic requires sustainment of the healthcare workforce through actions that mitigate stress, promote resilience, and enhance performance. A major barrier is the lack of organizational practices and procedures designed to sustain HCWs during prolonged crisis events, such as COVID-19. Adapting existing best practices from other high-risk occupations allows for a more rapid, efficient response to optimize workforce well-being and preserve healthcare organizational functioning. This paper discusses current and emerging literature on the unique impacts of COVID-19 on HCWs and provides actionable, evidence-informed recommendations for individuals, teams, and leaders to enhance sustainment of HCWs that is critical to the preservation of national and global health security.


Subject(s)
COVID-19/psychology , Crisis Intervention , Health Personnel/psychology , Occupational Health , Resilience, Psychological , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Mental Health , Occupational Stress/diagnosis , Occupational Stress/prevention & control , Occupational Stress/psychology , Risk , SARS-CoV-2
16.
Nurs Leadersh (Tor Ont) ; 33(4): 29-34, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1094392

ABSTRACT

The COVID-19 pandemic is an unprecedented time for leaders to lead. The uncertainty and complexity have been overwhelming, and for many of us, the tools available in our leadership toolboxes have been tested during the pandemic. In my experience, for nurse leaders to best lead during such challenging times, we need to truly understand what the front line needs from us in a crisis. I believe that six leadership practices are key for nursing leaders to support front-line engagement while navigating and leading teams through a crisis.


Subject(s)
Crisis Intervention/methods , Interprofessional Relations , Leadership , COVID-19/prevention & control , COVID-19/psychology , COVID-19/transmission , Humans , Pandemics/prevention & control , Uncertainty
17.
Eur Addict Res ; 27(4): 239-241, 2021.
Article in English | MEDLINE | ID: covidwho-1066975

ABSTRACT

The ongoing COVID-19 pandemic is likely to have a profound impact on the lives of high-risk drug users and on the services responding to their needs in at least two important ways: first, through the restrictive measures introduced to mitigate the spread of the virus and, second, as a result of extensive economic downturn. Currently there is great uncertainty as to the future intensity and duration of the pandemic. In addition, the lessons we have been able to learn from previous economic downturns may be of limited applicability to the current situation, which differs in a number of significant respects. Experience nevertheless suggests that the potential consequences for drug users' health and well-being may be severe. The ongoing uncertainty serves to underline the importance of close monitoring of the drug situation and preparing flexible and innovative solutions to be able to meet new challenges which may arise.


Subject(s)
COVID-19/economics , COVID-19/prevention & control , Drug Users/statistics & numerical data , Economic Recession/statistics & numerical data , Physical Distancing , Substance-Related Disorders/rehabilitation , Crisis Intervention , Drug Users/psychology , Health , Humans , Pandemics , Substance-Related Disorders/economics , Uncertainty
19.
Am J Drug Alcohol Abuse ; 47(2): 154-159, 2021 03 04.
Article in English | MEDLINE | ID: covidwho-1066068

ABSTRACT

The ongoing pandemic has led to a sudden disruption of routine treatment services. Consequently, the already existing treatment gap for substance use disorders is likely to widen. There is an opportunity to expand the scope of Screening and Brief Intervention (SBI) to meet this unprecedented challenge. Its brevity, flexibility, and generalizability have positioned SBI to deal with additional systemic, structural, and attitudinal barriers that pertain to the pandemic. The standard content of SBI could be modified to adapt to the current context. SBI could also be used as a vehicle to render strategies for infection risk minimization. In this Perspective, we anticipate the challenges of expanding and implementing SBI in the present circumstances and present potential solutions. SBI, with adaptations, could bridge the augmented treatment gap for substance use disorders during COVID-19.


Subject(s)
COVID-19 , Crisis Intervention/methods , Substance-Related Disorders/therapy , Crisis Intervention/organization & administration , Humans , Substance-Related Disorders/diagnosis
20.
Encephale ; 46(3S): S66-S72, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065052

ABSTRACT

OBJECTIVE: The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic. METHODS: We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability. RESULTS: Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement. CONCLUSIONS: This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Suicide/psychology , Alcoholic Intoxication/psychology , Artificial Intelligence , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Cost of Illness , Crisis Intervention/instrumentation , Economic Recession , France/epidemiology , Humans , Inflammation , Loneliness/psychology , Models, Neurological , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Psychotherapy/methods , Psychotic Disorders/etiology , Psychotic Disorders/physiopathology , Psychotic Disorders/virology , Quarantine/psychology , Renin-Angiotensin System/physiology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/psychology , Social Isolation/psychology , Stress, Psychological/etiology , Stress, Psychological/therapy , Suicidal Ideation , Suicide/prevention & control , Suicide/statistics & numerical data , Suicide, Attempted/prevention & control , Suicide, Attempted/psychology , Telemedicine , Vulnerable Populations
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