Improving a Sanctioned Homeless Encampment for Veterans During COVID-19 Through Multilevel Partnerships.

A veteran-clinician-researcher partnership-the Care, Treatment, and Rehabilitation Service (CTRS)-enabled quality improvement within a U.S. Department of Veterans Affairs-sanctioned homeless encampment created in response to the COVID-19 pandemic. Although the differing concerns of clinicians and operational leaders led to challenges in defining CTRS's goals and quality metrics, partnering with frontline social work and peer staff (N=11) and veterans (N=21 of 381 CTRS participants) and considering their feedback resolved those differences. Multilevel partnerships improved care within the encampment, leading to the development of an encampment medicine team (providing onsite integrated health care) and a veteran engagement committee (providing feedback).

Refractory pain in a schizophrenic patient on clozapine.

A 36-year-old man with schizophrenia, on two times per day clozapine, presented with a 2-year history of diffuse intermittent body pain.Per chart review-and on presentation-his physical examination had been consistently unremarkable, without point-tenderness elicited at any major muscle groups or focal neurological deficits. Workup for myopathy, neuropathy and supratherapeutic clozapine levels had similarly been unrevealing.Given that prior interventions had been unsuccessful in alleviating these symptoms, we queried whether clozapine might have been contributory. As a result, we adopted a previously described strategy of scheduling the bulk of patients' medication during non-waking hours.At 1-month follow-up, the patient reported about a 50% improvement in his symptoms. At 6-month follow-up, this improvement in symptoms had been sustained.Our findings add to the limited anecdotal reports of this side effect whose true prevalence remains unknown. Timely recognition has the potential to promote adherence to therapy among patients in the maintenance phase.