The Use of Telemedicine for Patients with Mental Illness and COVID-19 Infection

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health of the public. Social distancing and quarantining during the pandemic have affected mental health as well. This study set out to determine the impact of COVID-19 and the use of telemedicine on managing patients with mental illness. It evaluates the impact of the COVID-19 infection on 403 patients who are United States military veterans: 160 patients with chronic mental illnesses and 243 without mental illness. The patients were observed remotely using a telehealth clinic until they were free of COVID-19 symptoms or tested negative for coronavirus RNA. Telemedicine was used successfully to manage patients with mental illness and acute COVID-19 infections. These patients maintained their therapeutic engagement using telephone or video-on-demand encounters. The use of this technology allowed for follow-up visits over an extended period of time, including resolution of their symptoms, re-test results, and management of their comorbidities. The outcomes of their infections mirrored those of patients without preexisting mental illness. They did require more intense psychiatric interventions, primarily with medications, but no hospitalizations for mental health occurred. Although the pandemic has several elements known to impact greatly on mental health (social illness, loneliness, fear, and uncertainty), the effect on patients with COVID-19 infection and mental illness diagnosis does not appear to cause psychiatric decompensation. Telemedicine offered a means for more intense engagement on follow-up of these patients, which may have played a role. Because of the small numbers in this study and the unique resources available for veterans, more extensive study is required to determine the effect of the pandemic in patients with mental illness who are not veterans

Teaching residents to communicate: The use of a telephone triage system in an academic ambulatory clinic

This study evaluated the use of a telephone triage system in an academic primary care clinic and its impact on communication, patient management and satisfaction. A “telephone clinic” was created using a triage nurse to answer patients’ calls to an academic primary care clinic, staffed by house staff physicians. Chart reviews were conducted of all medical records of patients who called and were referred to the telephone clinic during a six month period. A total of 1135 patient calls were monitored. Using a random selection process, 366 patient calls were studied and 42% of these patients were called back two weeks after the initial call and were interviewed. Of the 336 calls, 68% of the calls were serious enough to be referred to a house staff physician. Symptom complaints accounted for 64% of the telephone calls; 4% of patients were sent to the emergency room or admitted to the hospital directly based on the information from the call. Telephone calls enhanced patients’ access to specialty care consultative services and 14% of patients who called received a new medication prescription. Patients’ satisfaction with the communication and the overall care provided by the “telephone clinic” was highly rated. The telephone contact initiated by the patients resulted in expedited access for patients whose symptoms were serious enough to require immediate referral to the emergency room or direct hospital admission. In a primary care practice, the telephone can be a major source of communication for practitioners, office staff and patients. The creation of a “telephone clinic” which utilizes nurses and house staff physicians trained and dedicated to telephone communication directly with patients resulted in more efficient management and greater satisfaction for patients

Case Reports of COVID 19 Recurrence

CASE REPORT OF COVID 19-Recurrence We describe as case series of 7 patients who presented with a recurrence of COVID 19 by PCR test an average of 94.9 days after their initial symptomatic presentation of illness. Patients had tested negative by PCR or had evidence of antibodies in between the 2 episodes. The majority of patients were asymptomatic on the second presentation and were found incidentally on prescreen for procedures, surgery. The subsequent positive COVID-19 PCR tests resulted in cancellations of clinic, procedures, surgery, and impacted patients' home and employment status. Further studies are needed to understand the mechanisms and ultimate outcomes of these recurrences

Hypertension in the Hispanic-American population

According to the 1988 census, there are 19.4 million Hispanics living in the United States. They represent 8.1 percent of the nation's population, and that percentage is expected to rise significantly in the next 25 years. Demographic projections indicate that Hispanics will become the largest minority group in the United States by the year 2000, yet they remain a seriously understudied population. This article examines available clinical data, epidemiologic findings, and sociologic observations regarding the incidence of hypertension in this minority group and summarizes what is known about the detection, evaluation, treatment, and control of high blood pressure in Hispanics. In addition, the preliminary results of a multi-center, placebo-controlled trial comparing the efficacy and safety of a potassium-sparing diuretic (Dyazide®; Smith Kline & French Laboratories) in Hispanic-American patients with mild-to-moderate hypertension are presented

Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment

OBJECTIVESMedical decisions concerning the prolongation of life, the right to die, and euthanasia are among the most extensively discussed decisions within medicine and law today. The responses of 360 physicians, housestaff, and medical students to a questionnaire were analyzed to identify attitudes toward these issues. DESIGNCase vignettes were utilized to simulate the clinical context within which to survey decisions regarding whether or not to allow and assist patients requesting to die. MEASUREMENTS AND MAIN RESULTSThe majority of respondents (76%) consider withholding and withdrawing life-support therapy consistent with passive euthanasia. Passive euthanasia is more acceptable to the majority of the respondents (77%) and all three groups (physicians, housestaff, and students) are similarly more disturbed by active euthanasia. Of all respondents, 51% would accede to the patientʼs wishes when lifesaving treatment is refused, but only 16% would do so when a patient requested assistance in dying. Despite the fact that a majority (68%) agree that there is a moral justification for assisting patients to die and feel “understanding” for a physician who assists a patient in dying, only 6% of those persons surveyed were willing to deliberately terminate the life of a patient by administering medication to cause respiratory arrest, and only 1.1% of those persons surveyed were willing to do so to cause cardiac arrest.In the case vignettes, the faculty placed their highest value on disease-based information as strongly determinative to their decisions, while students and housestaff preferred quality-of-life factors. Respondents uniformly found it easier to perform “passive” actions; they were more willing to perform “active” actions in case vignettes where patients had terminal illnesses. CONCLUSIONSSocially and legally created “shades of gray” have blurred the distinctions between withholding or withdrawing therapies and euthanasia and have left physicians without guidelines. Health ethics education should focus on case-based teaching and on reducing the uncertainty at the bedside. (Crit Care Med 1992; 20:683–690

Raising awareness of human trafficking in key professional fields via a multidisciplinary educational approach

Purpose Human trafficking (HT) for sex and labor services is among the fastest growing criminal enterprises, causing significant physical and psychological morbidity to victims. Although many survivors encounter medical, legal and social work professionals during their captivity, lack of awareness of HT in these fields results in under-recognition of victims. The purpose of this study is to evaluate the effectiveness of a multidisciplinary educational conference on raising awareness of HT in these fields. Design/methodology/approach A single-day educational conference on HT was hosted in Miami, Florida. Participants were recruited from medical, law enforcement, social work and political fields. The research team issued a ten-item HT survey at the start and end of the conference. Results were analyzed for improvement in survey score using an exact Wilcoxon sign rank test. The results were analyzed both as a single cohort and stratified by profession. Findings For all participants, there was a significant improvement in post-survey score (0.355, p < 0.05). When stratified by profession, significant improvement was noted in the legal subgroup (0.561, p < 0.05). No significant changes were noted for the other individual professional cohorts, although all subgroups trended toward improvement. Research limitations/implications A multi-disciplinary educational conference may be effective in raising awareness of HT. Further research is needed to determine the effect of increased awareness on actual outcomes for trafficking survivors. Originality/value This study represents unique, original research which provides valuable data as to the effectiveness of educational conferences on raising awareness of HT for professionals with the best opportunity to make meaningful interventions

A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders

Background: Managed care in the American health care system may limit access to health care specialists. Objective: We assessed primary care providers' abilities at diagnosing and treating patients with a previously undiagnosed skin disorder. Methods: Patients with previously undiagnosed skin disorders were seen and examined sequentially by three groups of physicians: (1) internal medicine residents, (2) board-certified internal medicine attending physicians and (3) dermatology faculty. The internal medicine residents and attending physicians' diagnoses were compared with the dermatologists'. Appropriateness of therapy ordered by the internal medicine residents and attending physicians was assessed. Results: Medical residents' diagnoses were correct in 43% of the patients whereas the attending physicians diagnosed 52% of cases correctly. Attending physicians and residents frequently ordered therapy inappropriate for the patient's diagnosis. Internal medicine residents and attending physicians were more likely to order skin biopsies than dermatologists. Conclusion: Our results confirm earlier studies that nondermatologists perform poorly in the diagnosis and treatment of skin disease. Primary care providers should receive more training in dermatology, or dermatologists should be permitted to act as primary caregivers to patients with skin disease