Being Stalked: A Psychiatrist\u27s Perspective

It is only recently that stalking has been criminalized after some highly publicized forensic cases. Psychiatric focus has been on erotomania, and in this article we primarily highlight stalking as a separate entity with psychiatric and legal implications. The case reports reveal our vulnerability as therapists, and we hope will raise our awareness of stalking as a potentially dangerous situation. The legal statutes vary in different states, but our recommendations may provide guidelines towards formulating policies and procedures for the safety of healthcare providers

Linezolid Induced Delirium in the Absence of Serotonin Syndrome: A Psychiatric Consultation/Liaison Case Report

Delirium is one of the most common mental illnesses that can affect elderly patients and patients with advanced medical problems. Because these patients are frequently on multiple medications and/or are more sensitive to medications secondary to their age, interactions with current medications, or existing medical problems; medication toxicity is frequently the etiology behind their delirium. This is a case report of a patient admitted for cellulitis that developed delirium from Linezolid however did not develop any other signs or symptoms of Serotonin Syndrome; a known side effect of Linezolid. This distinctive case highlights the importance of a careful analysis of a patient’s medications for potential deliriogenicity as well as the value of using a validated tool for assessing and following up a patient with suspected delirium. Specifically, this case should give clinicians warrant for suspicion of Linezolid as the cause of a patient’s delirium regardless of the presence or absence of Serotonin Syndrome

Oncology Hospital at Home: A retrospective chart review examining whether oncology patients placed under observation status by the ED could be managed in the home setting

Introduction: Hospital at Home (HaH) programs deliver hospital-level care in the home setting rather than in the traditional inpatient unit. In the US, this model of care has focused on the general medicine population, but no such models for adult oncologic care have been described in the literature to date. The current study seeks to identify whether certain diagnoses of patients with cancer admitted to observation status are predictive for early discharge and potentially model diagnoses on which to build a HaH program. Methods: Electronic medical records were reviewed for 130 adult cancer patients presenting to the Thomas Jefferson University Hospital ED from 2018-2019 who were subsequently placed under observation status. Patients were placed into 13 groups according to the primary conditions that warranted their update to observation status. Kruskal-Wallis analysis was done to identify differences in length of stay between groups. Chi-squared analysis was done to identify differences in likelihood of admission vs. discharge following observation. Results: There was no significant difference in length of stay between groups (p = 0.83). No significant differences were observed for either time in observation (��2 (24, N=130) = 46.05, p = 0.12) or observation end event (��2 (36, N=130) = 20.26, p = 0.68) among diagnostic groups

Patient-specific 3D Printed Liver Models for Pre-operative Planning and Improved Patient Adherence

Project Background: 3D anatomical relationships in the liver are not always visually accessible for surgeons performing resections even with advanced imaging options. Firm understanding of these relationships is essential for timely procedures, which can improve patient outcomes and lower hospital expenses. Patient-specific 3D modeling has existed for some time, though it is costly. New cost-effective techniques have surfaced which may yield opportunities for more effective preoperative planning in liver surgery and improved patient adherence. Methods: Digital patient-specific 3D reconstruction of a liver was completed by interpolating data from MRI scans using 3D Slicer, a segmenting program. The liver model was processed and 3D printed as a shell to be used as a mold. The liver shell, associated vasculature, and tumor were printed using polylactic acid (PLA) filament on an Ultimaker S5 3D printer. Transparent silicone was used as a cast, giving the model a solid form yet still allowing examination of the inside contents. Results: One completed liver model was used in pre-surgical consultation of a patient with hepatocellular carcinoma undergoing liver resection and during the surgical procedure as a guide for the surgical team. A follow-up survey concerning qualitative aspects of the model administered to the surgical team suggested high accuracy of the model compared to the anatomy observed during the procedure. Conclusion: Cost-effective techniques in producing patient specific 3D anatomical models appears not only feasible, but highly effective in improving communication between the surgical team during the procedure and also between the surgeon and the patient during pre-surgical consultation. Future research may be conducted concerning the model’s visual clarity as well as impact on patient adherence post-op

Impact of in-house specialty pharmacy on access to novel androgen axis inhibitors in men with advanced prostate cancer

Introduction: Novel androgen axis inhibitors are standard of care treatments in advanced prostate cancer. The billed amounts for these medications are often very high, which may create significant financial toxicity for patients and lead to delays in treatment. Our institution implemented an in-house specialty pharmacy in 2014, that provides these medications and evaluates copay assistance options for all patients. We evaluated the program’s impact on out of pocket cost (OOP) and turnaround time (TAT). Methods: We reviewed available internal specialty pharmacy records to identify prescriptions for abiraterone or enzalutamide filled between 1/1/17 and 12/31/18. Payments were stratified by primary payment (amount reimbursed by the patient’s prescription plan based on the benefit’s design) and copayment assistance. Turnaround times (TAT) in business days were stratified by prescriptions requiring intervention (prior authorization, copayment assistance, or insufficient inventory) and clean prescriptions (those requiring no intervention). Results: One thousand four hundred seventeen prescriptions for 175 unique patients requiring abiraterone (n=869, 61.3%) or enzalutamide (n=548, 38.7%) were filled through the institution’s specialty pharmacy. The average amount paid by primary payer was $9,492.96 for a 30 day supply (range:$3,382.48-$12,939.84). Average quoted copay was$577.53 (range $3.08-$10,560.39). 64% of patients received copayment assistance. Average OOP cost per prescription after co-pay assistance was $100.83 (range$0-$8556.64). Three patients declined treatment due to cost (1.7% of overall). Average TAT was 2.98 days for clean prescriptions and 3.36 days for prescriptions needing intervention (p=0.055). Discussion: OOP cost varied significantly based on plan design and copayment assistance eligibility. The majority of patients received copayment assistance, which markedly reduced OOP cost. Cost rarely precluded access to treatment. TAT was not significantly prolonged for prescriptions requiring intervention. Further studies to determine impact of pharmacy type on access to specialty medications are indicated