The peculiarities of patients with COVID-19 infection

Background: The surge demand and decreased availability of the health workers determined the designation of the Clinical Municipal Hospital of Phthisiopneumology (CMHP) into a hospital for the case-management of COVID-19 patients during the period of December 2020 – April 2021 for the treatment of the mild cases. The aim of the study was to assess the main peculiarities of the patients with COVID-19 through a cross-sectional study developed during the period February-April 2021 in the CMHP. Material and methods: A cross-sectional, analytical and prospective study was realized, which included 145 patients with COVID-19 hospitalized in the CMHP during February-April 2021. The inclusion criteria were: patient older 18 years, COVID-19 infection diagnosed by the pulmonologist with the positive polymerase chain reaction result for SARS-CoV-2 (COVID-19) and signed informed consent. Results: The peculiarities of patients with COVID-19 were dominated by the female sex, age over 60 years, residence in the urban districts of Chisinau and the infection acquired in the Republic of Moldova. Common clinical manifestations were: high temperature, profuse sweats, asthenia and headaches, productive cough, dyspnea, loss of smell or taste, and sore throat. The typical radiological findings such ground-glass pattern or consolidation with bilateral multifocal involvement were most frequent. Were cured most of the patients and the death rate was low. Conclusions: Peculiarities and clinical manifestations of the patients admitted in CMHP were typical for the COVID-19 infection. These findings did not show the real outcome of the standard case-management of the COVID-19 due to the restricted admission criteria.

Assessment of Left Ventricular Diastolic Function in Children with HIV/AIDS Attending a Tertiary Health Facility in Enugu, Nigeria: A Doppler Echocardiographic Study.

Objective:To determine the prevalence and factors associated with left ventricular diastolic dysfunction (LVDD) in children aged between 18 months and 14 years with HIV/AIDS. Method: echocardiography was performed on 90 children with HIV/AIDS and their age and gender matched healthy controls. Results: Forty three (47.8%) of the HIV/AIDS patients had LVDD.This was more pronounced in the AIDS group with all (100%) affected, compared to HIV+carriers (36.5%) and controls (2.2%), p = 0.03. The E/A ratio increased from 1.90±0.56 m/s in the carrier group to 2.09±0.46m/s in AIDS group, p=0.01. Left ventricular isovolumic relaxation time increased from 79.40 ± 20.12m/s (HIV carrier group) to 110.40 ± 10.12m/s (AIDS group), p=0.04, and deceleration time (DT) increased from 184.66 ± 76.27 m/s (HIV carrier group) to 230.66±36.27 (AIDS group), p=0.02. A restrictive filling pattern was the most described in both groups. Positive correlation was found between body surface area and LVDD. Stepwise linear regression analysis showed this to be the predictor of LVDD. In the HIV group, total white cell count correlated negatively with LVDD, while in the AIDS group, age correlated positively with LVDD (r = -0.459, p = 0.024 and r = 0.874, p = 0.023 respectively). Conclusion:There is a high prevalence of LVDD in children with HIV and AIDS. Need exists to integrate routine cardiovascular assessment using echocardiography, particularly in those with AIDS as part of their standard case management for early identification and appropriate interventions to save lives.

A capability framework to develop leadership for evidence-informed therapies in publicly-funded mental health services

Purpose It is difficult to replicate evidence-informed models of psychosocial and assertive care interventions in non-research settings, and means to determine workforce capability for psychosocial therapies have not been readily available. The purpose of this paper is to describe and provide a rationale for the Therapy Capability Framework (TCF) which aims to enhance access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies. Design/methodology/approach Guided by literature regarding the inadequacies and inconsistencies of evidence-informed practice provided by publicly-funded MHSs, this descriptive paper details the TCF and its application to enhance leadership and provision of evidence-informed psychosocial therapies within multi-disciplinary teams. Findings The TCF affords both individual and strategic workforce development opportunities. Applying the TCF as a service-wide workforce strategy may assist publicly-funded mental health leaders, and other speciality health services, establish a culture that values leadership, efficiency, and evidence-informed practice. Originality/value This paper introduces the TCF as an innovation to assist publicly-funded mental health leaders to transform standard case management roles to provide more evidence-informed psychosocial therapies. This may have clinical and cost-effective outcomes for public MHSs, the consumers, carers, and family members.

Fifteen-Month Follow-Up of an Assertive Community Treatment Program for Chronic Patients With Mental Illness

ObjectiveThis study was to evaluate the effect of an assertive community treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness.MethodsThirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS).ResultsAccording to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the group × time interactions between groups were not statistically significant.ConclusionsIn this study, we observed that ACT was significantly better at improving the GAF than case management. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. ACT, however, may have some advantages over a standard-case management approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Improving motivation and goal setting for return to work in a population on sick leave: A controlled study

Aim: Limited knowledge precludes evidence-based interventions targeting return to work among employees on sick leave. The objective of this study was to examine the vocational effect of an intervention focused on motivation, goal setting, and planning of return to work. Design and methods: A total of 2,795 people, across 6 municipalities, on sick leave for at least 21 days received a questionnaire; 1,256 with a self-assessed poor prognosis for fast return to work were eligible for the study. An examination by a specialist in social medicine, followed by additional counselling by a social worker, was offered to 510 residents in two municipalities and accepted by 264 (52%). The goal was to enhance motivation, goal setting, and planning of return to work. Residents in the remaining municipalities (n=746) received the standard case management offered by the municipalities; 845 (67%) persons completed a follow-up questionnaire gathering data on general health and employment status. The duration of the sick leave was analysed by Cox regression, and the chance of being gainfully employed was analysed by logistic regression analysis, both adjusted for several covariates. Results: The intervention neither shortened sick leave periods nor increased the likelihood of gainful employment after one year (OR 0.76; 95% CI 0.45—1.28). Conclusions: A low-cost counselling programme addressing motivation, goal setting, and planning of return to work did not improve vocational outcomes or reduce the duration of sick leave.