VA Problem-Solving Training During COVID-19 for Clinicians of Patients With Complex Comorbidities

To address the shortage of mental health providers in geriatrics, VA has implemented clinician training in a VA Problem Solving Training (PST) protocol adapted to the needs of mostly older patients with complex comorbidities. This presentation will summarize PST implementation adaptations during COVID-19, and compare Veteran treatment outcomes before (2019) and during COVID-19 (2020). Sixty-one clinicians attended a workshop and small-group consultation for two training cases. Consultants provided ongoing feedback to program leadership about pandemic-related implementation challenges. Program adaptations during COVID-19 addressed challenges related to delivering treatment by telephone, video, or in-person and recruitment barriers. Veterans in both cohorts (N = 122) had significant reductions in mental health symptoms from baseline to posttreatment in paired t-test comparisons (ps < .01). Flexibilities afforded to clinicians in the training during the pandemic did not diminish the effectiveness of the intervention, thus supporting continued implementation of the training program with added flexibility.

Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

Diffuse cutaneous systemic sclerosis may occur in women of childbearing age. Pregnancies in this population are associated with a markedly increased risk of adverse obstetric and maternal outcomes even before the onset of symptoms related to sclerosis. We report a case involving the management and outcome of pregnancy in a 30-year-old woman with diffuse cutaneous systemic sclerosis. The course of her pregnancy was good and was assisted by a group consultation including obstetricians and rheumatologists. Vaginal delivery was the patient’s preferred choice because she had irregular skin tightness in her lower abdominal skin. She underwent induction of labor and combined spinal-epidural analgesia, and successfully delivered. Importantly, these pregnancies need to be planned, where possible, to allow the opportunity to counsel women and their partners in advance and to decrease any risks. These pregnancies should be considered high risk, and they require close antenatal monitoring and good supervision from an expert multidisciplinary team experienced in high-risk pregnancies. The management of delivery for patients with cutaneous systemic sclerosis is challenging, and vaginal delivery with labor analgesia is an alternative option to cesarean section.

The effectiveness of group counseling based on problem- solving solution on sexual function and sexual satisfaction of women after mastectomy surgery

Background: Breast cancer is the second cause of death due to cancers and it is the most common cancer in women, which threatens different aspects of individual and mental health, quality of life, sexual function and sexual satisfaction, because of such treatments as mastectomy. Consultation can help patients to and a reasonable solution for their problems. Considering the effect of consultation on quality and quantity of patients’ life and the importance of the role of midwife in sexual health consultation, this research is carried out in order to determine the effect of group consultation based on problem-solving solution on sexual function and satisfaction of women who have had mastectomy surgery. Method: The present research is a semi-empirical study, with pretest, post-test and one month follow-up period. 32 women who referred to Tehran Breast Cancer Institute were selected by convenience sampling.The group received 8 sessions (90-minute) of problem-solving solution conselling. The data collection tool was Female Sexual function Index and Larson sexual satisfaction questionnaires and filled before intervention, immediately after intervention and one month after it.Data analysis was performed by using SPPSS21 statistical software application at the certainty level of 95% (P≤0.05).Results: The results of the study showed that there is a meaningful difference between the average sexual function (18.37, 20.88, 22.95) and the sexual satisfaction (65.27, 68.08, 70.46) in three stages before the intervention, immediately after the intervention and one month after the intervention. Conclusions: Although the average score of women’s sexual performance and the average score of sexual function of women who had mastectomy operation have improved, and this change was significant, but we have to note that the sexual function and sexual satisfaction are still in an inappropriate situation which require the continued trend of counseling in these patients. Considering the fact that the outbreak of breast cancer is very high, counseling can transfer to patients the information that is necessary for creating a desirable sexual life. In addition, through counseling process, we can teach patients how to live with their disease.

Preoperative Group Consultation Prior to Surgery for Colorectal Cancer—an Explorative Study of a New Patient Education Method

Patients with colorectal cancer may lack information about the disease and treatment. In 2017, a group consultation before start of surgery was introduced at a university hospital in western Sweden to inform about the disease, treatment, and ongoing scientific studies. The primary aim of this study was to explore the experience of the patients attending the group consultation. Based on semi-structured interviews with patients with colorectal cancer, a questionnaire was constructed and administered to patients, both those attending and those not attending the group consultation. In total, 124 patients were included and the response rate was 86%. A majority of patients attending the group consultation would recommend it to someone else with the same illness. Of the patients attending the group consultation, 81% (30/37) patients agreed, fully or partially, that attending the group consultation had increased their sense of control and 89% (33/37) that the information they received at the group consultation increased their feeling of participation in the treatment. Preoperative group consultation is a feasible modality for informing and discussing the upcoming treatment for colorectal cancer with the patients, and the patients who attended the group setting appreciated it. Attending the group consultation increased the patients’ feeling of active participation in their treatment and their sense of control, which could possibly both improve their experience of their illness and facilitate recovery. ClinicalTrials.gov identifier NCT03888313

Pneumonite de Hipersensibilidade Crónica: evolução de um Caso Clínico

INTRODUCTION Hypersensitivity pneumonitis (PH) or extrinsic allergic alveolitis is an inflammatory interstitial lung disease caused by recurrent exposure to a variety of environmental and/ or occupational antigens by immunologically susceptible individuals. The differential diagnosis with other interstitial lung diseases (ILD) is stimulating, but essential for a correct approach and implementation of appropriate therapy. CASE REPORT We present a case of a 55-year-old female worker, non-smoker, with no important pathological personal history. She had professional exposure to multiple paints (Gouache; Acrylics; Watercolors; Oil) inherent in her profession as an art teacher since she was 23 years old. After 24 years of performing these functions, without the use of proper personal protective equipment (protective mask, gloves, goggles, appropriate uniform), she develops a persistent cough, dyspnoea and fatigue, motivating observation in pulmonology consultation. Taking into account clinical, radiological and laboratory elements, she presented suggestive alterations of interstitial pulmonary pathology, and the diagnosis of Chronic Hypersensitivity Pneumonitis was assumed in a Multidisciplinary Group Consultation later assumed and characterized as an Occupational Disease. In the follow-up, the causal agent of the disease was removed, having the worker been mobilized internally, assuming functions associated with school coordination, for which she was able to work. Since 2011 under immunosuppression therapy with Prednisolone, Azathioprine from July 2014 to August 2016 and Mycophenolate Mofetil since March 2019, having remained clinically and functionally stable until today, without the need for oxygen therapy. As complementary diagnostic tests it has a respiratory function in 2019: FEV1 51%; FVC 55%; 73% TLC. 33% DLCO; DLCO/VA: 51%. Chest CT with scattered, bilateral ground glass densification areas; some cystic images, bilaterally, corresponding to areas of bronchial ectasia/ fibrosis; traction bronchiectasis, mainly in the upper lobes and the middle lobe; reticulation areas in the anterior right pulmonary field; calcified granuloma in the lower right lobe and upper left lobe; infracentimetric nodularities at both apexes. DISCUSSION/ CONCLUSION Chronic HP is an irreversible disease. Removal of the disease-causing antigen and immunosuppressive therapy are the usual interventions in these cases. In this worker, once the relationship between the pathology and the causal agent of the disease was assumed, was assigned a definitive incapacity for the current job, having been replaced in another compatible activity within the same company. Thus, occupational health surveillance becomes essential in the prevention/ attenuation of this occupational disease.