Trends in Psychiatric Emergency Department Visits in Northern Israel During the COVID-19 Outbreak.

Background: During the spread of coronavirus disease (COVID-19), mandatory quarantines increased social isolation and anxiety, with inevitable consequences on mental health and health seeking behavior. We wished to estimate those trends. Methods: We examined all psychiatric visits to the emergency department (ED) during March, April 2020, compared to identical months in 2018, 2019. We evaluated both number and nature of referrals. Results: Throughout the years, psychiatric referrals comprised about 5% of the total number of ED visits. In March-April 2020, 30% decreases were observed in overall ED visits and in psychiatric referrals in the ED. Compared to 2018-2019, in 2020, the proportions of these diagnoses were higher: anxiety disorders (14.5 vs. 5.4%, p < 0.001), personality disorders (6.7 vs. 3.2%, p = 0.001), psychosis (9.5 vs. 6.7%, p = 0.049), post-traumatic stress disorder (3.2 vs. 1.5%, p = 0.023). Compared to 2018-2019, in 2020, proportions were lower for adjustment disorder (5.8 vs. 8.9%, p = 0.036) and for consultation regarding observation (11.7 vs. 31.6%, p < 0.001). Differences were not observed between 2018-2019 and 2020 in the proportions of other diagnoses including suicide and self-harm disorders. Referrals concerning suicide and self-harm in a rural hospital and community clinic were 30% lower in the COVID-19 lockdown than in the same months in 2018, 2019. Conclusion: Psychiatric ED visits decreased by the same proportion as overall visits to the ED, apparently driven by fears of COVID-19. Referrals relating suicidality and self-harm shown nominal decrease, but their proportioned share remained constant. Increased anxiety and delayed care may eventually lead to increased mental health needs.

Corneal Cross-Linking as a Treatment for Fungal Keratitis Associated with Corneal Melting.

We present the case of a young male that suffered from fungal corneal abscess and corneal melting. The patient was treated successfully by corneal cross-linking. Taking into account our experience from this case, we offer to consider corneal cross-linking as a therapeutic option in cases of fungal keratitis.

Are doctors risk takers?

OBJECTIVE: Risk taking affects human behavior in general and decisions in medicine in particular. We used game theory to assess physicians' risk-taking tendencies. METHODS: Physicians were recruited to the study by advertisement. It was explained that they would receive a sum of money for correct prediction of the flipping of a coin. They could try to sell their opportunity to flip the coin for an amount of money they determined. The sum offered by the participants was considered an indicator of risk taking. A demographic questionnaire assessed age, sex, seniority, and area of specialization of the participants. A multivariate analysis assessed associations between risk-taking behavior and, seniority, and specialization. RESULTS: Sixty-two physicians participated, 36 males and 26 females, seniority 1-34 years. Of a possible range of 0-10, the mean score for risk taking was 5.5 - just slightly more than indifference. Negative correlations were found between risk taking and seniority, and between risk taking and age (ß =-0.45, P<0.001 for both). Surgeons and anesthesiologists showed greater risk taking than did other physicians (ß =0.69, P<0.05); and females less than males, though the latter correlation was not statistically significant. CONCLUSION: Understanding the tendency of physicians to risk taking may elucidate their decision-making processes and contribute to understanding of causes of adverse events and to the education of physicians.