Benefits and Challenges of Video Consulting for Mental Health Diagnosis and Follow-Up: A Qualitative Study in Community Care.

Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists' and general practitioners' (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness.

Pericardial calcification: A case report of a three-dimensional disease.

INTRODUCTION: Constrictive pericarditis is an important cause of diastolic heart failure. The relationship between the presence and degree of pericardial calcification with constrictive pericarditis is variable, however this should be an early warning sign to initiate appropriate investigations. PRESENTATION OF CASE: A 64-year-old gentleman presented with dyspnoea and dizziness on exertion. Plain posterior-anterior chest X-ray showed mild to moderate pericardial calcification. He had an episode of atrial fibrillation which resolved spontaneously and thought to be the cause of his symptoms. Patient symptoms progressed. Further investigations including CT scan confirmed extensive constrictive pericarditis. He underwent a successful percardiectomy and full recovery. DISCUSSION: Constrictive pericarditis can be the consequence of different conditions such as tuberculosis, radiation, idiopathic or many others. Pericardial calcification is present in less than 25% of all cases of constrictive pericarditis, and patient with it are prone to develop atrial fibrillation. The presence of pericardial calcification on plain chest radiograph is an important indicator for the possibility of pericardial dysfunction. Many cases of pericardial calcification are benign without any clinical significance; however three-dimensional imaging is required to determine the calcium load and aid in reaching appropriate diagnosis. CONCLUSION: Chest X-ray is valuable detector of pericardial calcification, a surrogate of pericardial constriction, but it is important to remember that pericardial calcification is a three-dimensional condition, and should be further investigated by lateral chest X-ray, CT scan and then appropriate functional imaging.