The COVID-19 pandemic has significantly impacted people around the world, with asymptomatic infection to severe diseases and death. There is an increasing incidence of mental health problems in patients diagnosed with COVID-19. There are some studies that discuss possible mechanisms responsible for psychotic disorders due to coronavirus as well as risk factors for developing psychosis in patients infected with the virus. We report the case and a review of the literature in a 29-year-old female with no past psychiatric history who was diagnosed with a brief psychotic disorder following infection with COVID-19.
Introduction: Breaking bad news (BBN), especially in the pediatric emergency medicine department, requires significant skill and delicacy due to the acute context of a busy emergency department (ED) and the lack of prior rapport with the patients and families. Pediatric literature on breaking bad news has mostly focused on pediatric oncology and pediatric critical care, with limited literature focused on pediatric emergency medicine. Review of the literature also reveals that most existing studies solely assess the learners’ self-ratings of efficacy and comfort, and far fewer studies objectively evaluate learners’ actual performance using simulation. Our objectives for this study was to use an objective assessment tool to assess residents’ breaking bad news skills, pre- and post-simulation training, specifically in the setting of a pediatric emergency medicine department.Methods: 34 residents were evaluated on their performance in breaking bad news via videotaped simulation encounters before and after teaching intervention. The "Modified Breaking Bad News Assessment Scale” (mBAS) was used as the assessment tool. A paired t-test analysis was conducted to examine the mean difference in pre- and post-simulation scores in each of the five mBAS domains.Results: Breaking bad news performance score improves one to two weeks post-intervention, and was statistically significant in three of five domains.Conclusion: Our study shows that breaking bad news is a teachable skill that can be improved by simulated education in the pediatric emergency medicine department. This study demonstrates the utility of simulation course in improving breaking bad news skills in the pediatric emergency medicine department. Future work in developing focused simulation curriculums is important to improve provider communication skills and patient-physician relationships.
OBJECTIVES: Accuracy of pyuria for urinary tract infection (UTI) varies with urine concentration. Our objective of this study was to determine the optimal white blood cell (WBC) cutoff for UTI in young children at different urine concentrations as measured by urine specific gravity. METHODS:Retrospective cross-sectional study of children ,24 months of age evaluated in the emergency department for suspected UTI with paired urinalysis and urine culture during a 6year period. The primary outcome was positive urine culture result as described in the American Academy of Pediatrics clinical practice guideline culture thresholds. Test characteristics for microscopic pyuria cut points and positive leukocyte esterase (LE) were calculated across 3 urine specific gravity groups: low ,1.011, moderate 1.011 to 1.020, and high .1.020.RESULTS: Of the total 24 171 patients analyzed, urine culture result was positive in 2003 (8.3%). Urine was obtained by transurethral in-and-out catheterization in 97.9%. Optimal WBC cutoffs per high-power field (HPF) were 3 (positive likelihood ratio [LR1] 10.5; negative likelihood ratio [LR2] 0.12) at low, 6 (LR1 12; LR2 0.14) at moderate, and 8 (LR1 11.1; LR2 0.35) at high urine concentrations. Likelihood ratios for small positive LE from low to high urine concentrations (LR1 25.2, LR2 0.12; LR1 33.1, LR2 0.15; LR1 37.6, LR2 0.41) remained excellent.CONCLUSIONS: Optimal pyuria cut point in predicting positive urine culture results changes with urine concentration in young children. Pyuria thresholds of 3 WBCs per HPF at low urine concentrations whereas 8 WBCs per HPF at high urine concentrations have optimal predictive value for UTI. Positive LE is a strong predictor of UTI regardless of urine concentration.WHAT'S KNOWN ON THIS SUBJECT: The accuracy of pyuria for urinary tract infection varies with urine concentration in children. Previously, optimal diagnostic white blood cells (WBCs) per high-power field (HPF) cutoffs for pyuria have been established at 2 different urine concentrations.WHAT THIS STUDY ADDS: With this study, we identify optimal WBCs per HPF cut points for pyuria at 3 different urine concentrations. WBCs per HPF cutoffs of 3 at low, 6 at medium, and 8 at high urine concentrations should be used to improve pyuria accuracy for urinary tract infection in young children.
Paliperidone is an atypical antipsychotic medication commonly used to treat schizophrenia, schizoaffective disorder, and bipolar disorder. It is a metabolite of risperidone and has a similar mechanism of action, primarily blocking dopamine 2 receptors (D2 receptors) in the brain. Paliperidone has various adverse effects, including extrapyramidal symptoms, weight gain, and metabolic disturbances. Catatonia is rare but severe side effects can occur in the context of an underlying psychiatric, neurologic, or general medical condition. Paradoxically, antipsychotics for treating schizophrenia or bipolar spectrum disorders can precipitate or worsen catatonic symptoms. The report suggests that 17-19% of all cases diagnosed as catatonia due to other medical conditions are medication-induced. Catatonia is a neuropsychiatric syndrome that presents as a cluster of psychomotor signs and symptoms resulting in movement and behavior aberrations. Various symptoms, including mutism, stupor, rigidity, and abnormal movements, characterize catatonia. Catatonia is a potentially life-threatening condition requiring prompt recognition and management. Here, we present a case of a patient with catatonia associated with long-acting injectable paliperidone intramuscular therapy in a patient with schizophrenia.
Introduction Health systems are applying innovative solutions, such as telehealth and home visiting, to reduce unnecessary healthcare utilization, including emergency department (ED) visits. A large paediatric healthcare system implemented a telehealth-enhanced home visiting programme as an extension of primary care services. The purpose of this paper is three-fold: (1) Examine the process of implementation and the intermediate clinical outcomes; (2) Evaluate patient experiences and acceptability of the programme post-implementation; (3) Identify system, clinic and patient factors influencing implementation of the home visiting programme. Methods Implementation of the telehealth-enhanced home visiting programme occurred from July 2018 to March 2019. Longitudinal electronic health records (EHR) and surveys were triangulated with qualitative data to evaluate the preliminary effectiveness, feasibility, and acceptability of the programme. Results Of the 948 eligible families, clinical care staff referred 38% of families to the home visiting programme and 49 families (5%) completed the 12-week home visiting programme. Necessary ED utilization significantly increased post-implementation compared with pre-implementation. Families were overall highly satisfied with the programme and its content. Several factors influenced implementation including outer setting (i.e. patient needs and external policy), inner setting (e.g. poor leadership engagement, fully integrated network, and high tension for change), and individual characteristics (e.g. high self-efficacy). Conclusions Once families were enrolled, the programme was fairly successful in addressing patient outcomes. The programme and visit process was highly regarded by families and the unlicensed healthcare professionals. Future programme recommendations, such as small programmatic changes and major improvements in the clinic, should be implemented before widespread dissemination.
Lithium is a mood stabilizer frequently used in psychiatry to treat bipolar disorder. Because lithium has a narrow therapeutic index, it requires frequent monitoring for its toxicity. Lithium toxicity requires monitoring of serum lithium and clinical assessment by clinicians. Sialorrhea, also known as excessive drooling, hypersalivation, or ptyalism, is common among psychiatric patients. Sialorrhea, an infrequent and embarrassing side effect of lithium, has been reported at varying serum levels, either at subtherapeutic or in the normal range. Here, we present the case of a patient with sialorrhea associated with oral lithium therapy at the subtherapeutic serum level.
While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.