RESUMEN
A 40-year-old Japanese woman presented to the outpatient clinic with fever and palpitations 2 days after receiving the influenza vaccine (Influenza HA Vaccine 'KMB') following the second dose of coronavirus disease 2019 (COVID-19) vaccine (COVID-19 vaccine Moderna intramuscular injection). At the first visit, the patient presented with a swollen thyroid gland with mild tenderness, and she was diagnosed with subacute thyroiditis (SAT) based on the presence of thyrotoxicosis (free T3: 5.42 pg/mL;free T4: 2.34 ng/dL;and thyroid-stimulating hormone (TSH): <0.01 muIU/mL), a high C-reactive protein level (5.77 mg/dL), a negative TSH receptor antibody, and characteristic ultrasound findings. The patient's human leukocyte antigen types were A2, A11, B35, B51, DR4, and DR1403. Prednisolone (15 mg/day) was given as an initial dose, after which the fever subsided, and the dose was tapered and discontinued after 6 weeks. The patient was thought to have developed SAT due to influenza vaccination. SAT after influenza vaccination may be overlooked. For patients with SAT, it is necessary to obtain information regarding their vaccination history.Copyright © 2023 The authors.
RESUMEN
Background: Current mental healthcare needs exceed the capacity of available psychiatric providers, necessitating novel healthcare delivery systems such as collaborative care to scale limited resources. While a national survey of general psychiatry residency program directors suggests 78% of programs offer an integrated care rotation, only 47% of these experiences offer supervision during direct patient care (Reardon, 2015). Barriers to implementing trainee experiences in integrated care may include limited faculty development and comfort with the collaborative care model (Huang, 2016). Telebehavioral health posits an advantage in connecting geographically disparate residents, faculty, interdisciplinary staff, and patient populations to capitalize upon quality preceptorship (Ratzliff, 2018). Method(s): BIDMC Psychiatry Residency and Lahey Hospital & Medical Center Division of Psychiatry partnered to pilot a 3- or 6-month half-day elective rotation in integrated behavioral health, including Collaborative Care, during the 2021-2022 academic year. The rotation was adapted for remote work and telepsychiatric consultation in the setting of the COVID-19 pandemic. Trainees were exposed to multidisciplinary care collaboration, population health patient registries, empirically validated instruments for mental health symptoms, and supervised telepsychiatry consultations. Modes of education included direct observation and live-time feedback of interviewing, case review with behavioral health clinicians, and documentation of decision-support to primary care physicians. Informal qualitative feedback and course evaluation surveys were solicited from participating residents during and upon completion of the rotation. Result(s): Qualitative assessment of a pilot elective in integrated behavioral care suggests improved resident comfort with outpatient consultation-liaison work in a primary care setting, and that the virtual offering allowed for greater scheduling accommodation for trainees. In addition, both trainees noted that this clinical experience influenced their post-graduate employment plans and led them to consider opportunities involving collaborative care. Course evaluation survey results remain pending following completion of an ongoing rotation. Discussion(s): As the collaborative care model is increasingly implemented, psychiatric resident education must adapt clinical offerings for trainees. Exposure to a supervised integrated care elective increased resident learning and promoted career development in this field. In addition to improving patient access, eliminating geographic barriers via virtual rotations may facilitate resident participation across healthcare systems. This poses a potential solution to leverage qualified faculty preceptors, with possible added benefits of cross-system partnership and physician recruitment. References: Osofsky, et al. (2016). Collaborative Health Care and Emerging Trends in a Community-Based Psychiatry Residency Model. Academic Psychiatry, 40(5), 747-754. Huang, et al. (2016). Developing a Collaborative Care Training Program in a Psychiatry Residency. Psychosomatics;58(3), 245-249. Ratzliff, et al. (2018). Tele-Behavioral Health, Collaborative Care, and Integrated Care: Learning to Leverage Scarce Psychiatric Resources over Distance, Populations, and Time. Academic Psychiatry, 42(6), 834-840. Copyright © 2022