scholarly journals The effectiveness of telepsychiatry: a thematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S51-S51
Author(s):  
Gunjan Sharma ◽  
Karrish Devan
Keyword(s):  
Patient Satisfaction ◽  
Psychotic Disorders ◽  
Age Groups ◽  
Evidence Base ◽  
Appropriate Technology ◽  
Access To Treatment ◽  
Diagnostic Reliability ◽  
Clinician Satisfaction ◽  
Thematic Review ◽  
Professional Guidance

AimsThe authors conducted a thematic review on the effectiveness of Telepsychiatry in light of the COVID-19 pandemic. The study aimed to clarify the effectiveness of Telepsychiatry, providing an evidence base for the growing use of Telepsychiatry.MethodThe authors searched three databases - Cochrane, PubMed and PsychINFO - using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness.The authors excluded all papers that were not in English and that did not focus on the psychiatric consultation.Result961 papers were identified, reduced to 321 using exclusion criteria and removal of duplicates. Using thematic analysis the authors found five themes that occurred across all papers in relation to the effectiveness of Telepsychiatry.Patient & Clinician SatisfactionThere is consistently high patient satisfaction with telepsychiatry but lower clinician satisfaction, often as a result of cynicism and a lack of familiarity. Clinician satisfaction increases when clinicians trial Telepsychiatry and become more positive about its uses.Diagnostic ReliabilityTelepsychiatry was found to have high levels of inter-rater reliability equivalent to face-to-face consultations for common disorders including mood and psychotic disorders, substance misuse and dementia. It was also found to have high levels of diagnostic reliability across age groups.OutcomesTelepsychiatry has been found to reduce symptoms of common psychiatric disorders and improve quality of life in a variety of environments including emergency departments, inpatient units and prisons. Telepsychiatry increases access to specialised services resulting in quicker access to treatment and reduction in admissions.TechnologyWithout adequate internet connectivity clinicians are unable to conduct an appropriate mental state examination and the therapeutic relationship becomes challenging. Inadequate technology can impact the effectiveness of Telepsychiatry amongst those who are socioeconomically disadvantaged and may not have access to appropriate technology.Professional GuidanceThere is a concerning lack of guidance around the use of Telepsychiatry. Without clear protocols there is a lack of standardisation and clinicians are unwilling to integrate Telepsychiatry into their practice. Main concerns raised are around confidentiality, consent, the appropriateness of certain patient groups and emergencies.ConclusionThis review found evidence for the effectiveness of Telepsychiatry with greatest emphasis on technology and patient satisfaction. The main barrier is the reluctance amongst clinicians to facilitate Telepsychiatry into their practice, often due to cynicism and a lack of familiarity. The authors recommend training in the uses of Telepsychiatry and the provision of professional guidance from medical bodies to allay concerns and provide clear standards.

scholarly journals The effectiveness of telepsychiatry: thematic review

2021 ◽  
pp. 1-8
Author(s):  
Gunjan Sharma ◽  
Karrish Devan
Keyword(s):  
Cochrane Library ◽  
Clinical Implications ◽  
Diagnostic Reliability ◽  
Video Consultation ◽  
Clinician Satisfaction ◽  
Thematic Review ◽  
Continued Use ◽  
Main Barrier ◽  
Professional Guidance ◽  
Significant Factors

Aims and method This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. Results We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. Clinical implications The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results

2021 ◽  
Author(s):  
Juliano de Oliveira Sales ◽  
Wolfgang Gubisch ◽  
Rodrigo Ribeiro Ferreira Duarte ◽  
Aline Souza Costa Teixeira Moreno ◽  
Felipe Marques de Oliveira ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Age Groups ◽  
Functional Results ◽  
First Year ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Alar Retraction ◽  
Outcomes Evaluation ◽  
A New Technique ◽  
Extension Graft

AbstractHere we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.

Experience and expression of social isolation by inner-city high-rise residents

2014 ◽  
Vol 17 (3) ◽  
pp. 151-166 ◽  
Author(s):  
Love M. Chile ◽  
Xavier M. Black ◽  
Carol Neill
Keyword(s):  
Older Adults ◽  
Inner City ◽  
Social Isolation ◽  
Age Groups ◽  
Evidence Base ◽  
Structured Interviews ◽  
Content Type ◽  
High Rise ◽  
Starting Point ◽  
Health And Social Care

Purpose – The purpose of this paper is to examine the significance of social isolation and the factors that create social isolation for residents of inner-city high-rise apartment communities. We critically examine how the physical environment and perceptions of safety in apartment buildings and the inner-city implicate the quality of interactions between residents and with their neighbourhood community. Design/methodology/approach – The authors used mixed-methods consisting of survey questionnaires supplemented by semi-structured interviews and focus group discussions using stratified random sampling to access predetermined key strata of inner-city high-rise resident population. Using coefficient of correlation we examine the significance of the association between social isolation, age and ethnicity amongst Auckland's inner-city high-rise residents. Findings – The authors found the experience and expression of social isolation consistent across all age groups, with highest correlation between functional social isolation and “being student”, and older adults (60+ years), length of tenure in current apartment and length of time residents have lived in the inner-city. Research limitations/implications – As a case study, we did not seek in this research to compare the experience and expressions of social isolation in different inner-city contexts, nor of inner-city high-rise residents in New Zealand and other countries, although these will be useful areas to explore in future studies. Practical implications – This study is a useful starting point to build evidence base for professionals working in health and social care services to develop interventions that will help reduce functional social isolation amongst young adults and older adults in inner-city high-rise apartments. This is particularly important as the inner-city population of older adults grow due to international migration, and sub-national shifts from suburbs to the inner-cities in response to governmental policies of urban consolidation. Originality/value – By identifying two forms of social isolation, namely functional and structural social isolation, we have extended previous analysis of social isolation and found that “living alone” or structural social isolation did not necessarily lead to functional social isolation. It also touched on the links between functional social isolation and self-efficacy of older adults, particularly those from immigrant backgrounds.

scholarly journals 956 Patient Satisfaction of Teleconsultation in Plastic Surgery During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Rafii ◽  
A Freethy ◽  
J Chan
Keyword(s):  
Patient Satisfaction ◽  
Plastic Surgery ◽  
Quality Care ◽  
Age Groups ◽  
Patient Perceptions ◽  
Interaction Quality ◽  
Telephone Interviews ◽  
Key Indicator ◽  
Significant Difference ◽  
Safety Studies

Abstract Introduction The COVID-19 pandemic has witnessed an increased reliance on telemedicine. Patient satisfaction is a key indicator of whether telephone consultations deliver high-quality care. This study evaluates patient perceptions of telephone consultations conducted in a single plastic surgery outpatient department. Method Structured telephone interviews using an adapted Telehealth Usability Questionnaire and the NHS Friends and Family Test were conducted in 98 patients who had undergone outpatient telephone consultations with a plastic surgeon. 13 questions explored domains of usefulness, interaction quality, reliability, patient satisfaction, and future use of telehealth. Results 72 of 98 (73%) completed the survey. Male(49):Female(23). Mean age 59 (range 17-91). 50.4% Strongly agreed (SA) and 24.3% agreed (A) to questions addressing usefulness of the platform. For interaction quality; 63% SA and 21% A. 47% disagreed with questions pertaining to reliability. Overall, 75% were either SA/A for satisfaction and 81% would use telehealth again. No significant difference was found in domain scores when comparing sex or age groups. Conclusions Overall, patient perceptions were positive towards the usefulness and interaction quality of telephone consultations. However, reliability scored poorly. Most patients were satisfied with the care provided. Comparison to other telehealth mediums e.g. video consultation and patient safety studies are needed.

The use of clozapine in a rural and remote region of Australia

2020 ◽  
pp. 103985622097527
Author(s):  
Bridson Tahnee ◽  
Abeysundera Hesitha ◽  
Arunachalam Arulmathy ◽  
Lam Anthea ◽  
Mora Linda ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Torres Strait Islander ◽  
Psychotic Disorders ◽  
Clinical Information ◽  
Antipsychotic Treatment ◽  
Rural And Remote ◽  
Access To Treatment ◽  
Regional Area ◽  
The Mean ◽  
Torres Strait

Objective: Clozapine is the most effective antipsychotic available for treatment-resistant schizophrenia. Unfortunately, it is often underutilised or administered late in the treatment course, if at all. This issue is further augmented in rural and remote regions where access to treatment is sparse. This study is the first of its kind to investigate the use of clozapine in a remote and regional area of Australia with a high proportion of Aboriginal and/or Torres Strait Islander individuals. Methods: This study includes all individuals who were commenced on clozapine between June 2013 and June 2018. Relevant clinical information was sourced from electronic medical records and descriptive statistical analysis performed. Results: A total of 3850 patients with psychotic disorders were reviewed over 5 years, of whom 63 were commenced on clozapine. The majority were male ( n = 50, 79.4%) with a mean age of 33.9 years (standard deviation 11.0). A total of 34.9% ( n = 22) identified as Aboriginal and/or Torres Strait Islander. The mean length of time between diagnosis and commencement of clozapine was 7.2 years (standard deviation ±4.6 years), while the mean number of antipsychotic medications tried prior to clozapine was 4.2 (standard deviation ±1.6 antipsychotics). Clozapine was discontinued in 57.1% of the individuals in this study (41% within the first 12 months). The most common cause for cessation was poor compliance ( n = 19, 30.2%). Conclusion: While clozapine remains the most effective antipsychotic treatment, it is often commenced late in the treatment or ceased prematurely. Further work is required, particularly in remote and regional populations, to ensure treatment adherence for optimal patient outcomes.

Ultra-high-risk paradigm: lessons learnt and new directions

2018 ◽  
Vol 21 (4) ◽  
pp. 131-133 ◽  
Author(s):  
Patrick D McGorry ◽  
Cristina Mei
Keyword(s):  
High Risk ◽  
Mental Disorders ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Ultra High Risk ◽  
Underlying Mechanisms ◽  
Staging Model ◽  
Definition Of ◽  
New Generation

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

scholarly journals COVID-19 Infection in An HIV-Positive Patient

2021 ◽  
Vol 2 (1) ◽  
pp. 13-14
Author(s):  
Hulya Caskurlu ◽  
Yasemin Cag
Keyword(s):  
Immune Deficiency ◽  
At Risk ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Age Groups ◽  
Positive Patient ◽  
Hiv Positive ◽  
Hiv Patients ◽  
Access To Treatment ◽  
Continuous Access

The COVID-19 pandemic affects all age groups but follows a more mortal trajectory in patients with preexisting conditions such as immune deficiency, chronic lung disease, diabetes, and cardiovascular problems. Hence, HIV-positive patients with immune deficiency are at risk, therefore, these patients need to have continuous access to treatment during the pandemic. The number of defined COVID-19 positive HIV patients is very limited even though there are approximately 37.9 million HIV-positive patients globally. Therefore, we decided to publish this study reporting an HIV patient treated for COVID-19 in our clinic.

T1114 Correlation of Hypoxia, Clinician Satisfaction (CSSI), Patient Satisfaction (PSSI) and Recovery Time (RT) with Level of Sedation

2009 ◽  
Vol 136 (5) ◽  
pp. A-502
Author(s):  
Robert Hardi ◽  
Daniel J. Pambianco ◽  
John J. Vargo ◽  
Michael L. Weinstein
Keyword(s):  
Patient Satisfaction ◽  
Recovery Time ◽  
Clinician Satisfaction

scholarly journals Comparative effectiveness of sitagliptin vs sulphonylureas in older people

2019 ◽  
Vol 48 (5) ◽  
pp. 725-732
Author(s):  
Manuj Sharma ◽  
Irwin Nazareth ◽  
Irene Petersen
Keyword(s):  
Older People ◽  
Comparative Effectiveness ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Age Groups ◽  
Evidence Base ◽  
Lower Proportion ◽  
Multivariate Adjustment ◽  
Younger Age ◽  
Multivariable Regression

Abstract Background two common anti-diabetic treatments used are sitagliptin and sulphonylureas however evidence examining their comparative effectiveness in older people is limited. Objective to evaluate effectiveness of sitagliptin vs sulphonylureas when added to metformin in older (aged ≥75) vs younger people (18–75). Design retrospective cohort study. Setting UK Primary Care. Subjects 2,904 individuals prescribed sitagliptin (223 aged≥75) and 13,683 prescribed sulphonylureas (1,725 aged ≥75). Methods multivariable regression to analyse difference in HbA1c and weight, 12 months after add-on initiation and proportion achieving different glycaemic targets. Results after multivariate adjustment to remove baseline differences, the HbA1c after 12 months of treatment was on average 1 mmol/mol (95%CI −0.7 to 2.8) higher with sitagliptin vs sulphonylureas in older people though this was not statistically significant. The weight however, was significantly lower −1.4 kg (95%CI −2.1 to −0.7) with sitagliptin vs sulphonylureas. A lower proportion prescribed sitagliptin vs sulphonylureas recorded HbA1c < 48 mmol/mol by study end: Odds Ratio 0.63 (95%CI 0.42–0.95). In younger people, similar HbA1c reductions were also observed with both treatments, however weight after 12 months was even lower with sitagliptin vs sulphonylureas: −2.3 kg (95%CI −2.5 to −2.0). Conclusions similar HbA1c reduction was observed when sitagliptin or sulphonylureas were added to metformin in older and younger age-groups. Sitagliptin use led to modest comparative weight loss. There may be greater risk of over-treatment with sulphonylureas evidenced by greater proportion recording HbA1c < 48 mmol/mol by study end. This evidence supporting use of sitagliptin when add-on therapy is selected in older adults should be considered alongside the wider evidence-base and patient-preference.

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