Caring for depression in the dying is complex and challenging – survey of palliative physicians

Background Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians’ reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. Methods In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. Results Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. Conclusions Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.

Analysis of the hydrogeological conditions in Bulgaria in connection with the radon potential

Natural radon (222Rn) is a radioactive noble gas that occurs in every rock or soil due to the content of radium (226Ra), part of the 238U family, in the lithosphere. Different types of rocks and soils possess different 226Ra content and different permeability. Radon has high mobility and is driven by diffusion and convection with the soil gas throughout connected and water-unsaturated pores and/or cracks in permeable rocks and soils. Therefore, the radon potential of the area could depend on hydrogeology and its particular settings. The study deals with the general characteristics of the groundwater depths in Bulgaria based on the published since 1960’s sources. After analysis of the collected data several distinct regions have been elaborated based on different depth of the groundwater table regarding lithological, tectonic and geomorphological conditions. In addition, zones for screening assessment of groundwater table influence of radon potential have been precised.

An enhanced version of Harris Hawks Optimization by dimension learning-based hunting for Breast Cancer Detection

Swarm intelligence techniques have a vast range of real world applications.Some applications are in the domain of medical data mining where, main attention is on structure models for the classification and expectation of numerous diseases. These biomedical applications have grabbed the interest of numerous researchers because these are most serious and prevalent causes of death among the human whole world out of which breast cancer is the most serious issue. Mammography is the initial screening assessment of breast cancer. In this study, an enhanced version of Harris Hawks Optimization (HHO) approach has been developed for biomedical databases, known as DLHO. This approach has been introduced by integrating the merits of dimension learning-based hunting (DLH) search strategy with HHO. The main objective of this study is to alleviate the lack of crowd diversity, premature convergence of the HHO and the imbalance amid the exploration and exploitation. DLH search strategy utilizes a dissimilar method to paradigm a neighborhood for each search member in which the neighboring information can be shared amid search agents. This strategy helps in maintaining the diversity and the balance amid global and local search. To evaluate the DLHO lot of experiments have been taken such as (i) the performance of optimizers have analysed by using 29-CEC -2017 test suites, (ii) to demonstrate the effectiveness of the DLHO it has been tested on different biomedical databases out of which we have used two different databases for Breast i.e. MIAS and second database has been taken from the University of California at Irvine (UCI) Machine Learning Repository.Also to test the robustness of the proposed method its been tested on two other databases of such as Balloon and Heart taken from the UCI Machine Learning Repository. All the results are in the favour of the proposed technique.

Croup as a manifestation of COVID-19 in infancy: a case series

The second wave of the COVID-19 pandemic in India brought with it an emerging clinical spectrum of the infection in children. Amongst these is the rarely reported presentation of croup, which otherwise remains a common clinical condition in infants caused by a variety of viruses and seen by pediatricians regularly. Airway manifestations of COVID-19 require reporting and unless their evaluation brings up any specific peculiarities, it is imperative to screen all such children presenting to the emergency department for SARS-CoV-2 infection. We hereby reported a series of three infants who were brought to us with typical features of croup including a mild fever, runny nose and indicators of subglottic inflammation including a hoarse voice, brassy cough and an inspiratory stridor. Each of them responded to conventional therapies for croup. However, the added conundrum of possible SARS-CoV-2 infection increases the relevance of rapid screening, assessment for complications and counselling in children presenting with croup.

Methodology for screening assessment of the presence of hospitalism in patients of gerontopsychiatric hospital

Summary. The aim of the study was to identify nosologically nonspecific signs of hospitalism in patients of a gerontopsychiatric hospital and to develop, on their basis, a method for screening diagnostics of hospitalism.Materials and methods. We examined 194 inpatients aged 55 to 91 years, hospitalism was detected in 102 people, 92 people made up the comparison group. The survey was carried out at the stage of preparation for discharge in the form of a semi-structured interview, supplemented by the collection of anamnestic and follow-up data.Results. The most common signs of hospitalism in this sample were the deterioration of the mental and somatic state before discharge (78% of the examined patients of the main group, a confidence interval (CI) of 68–85%), a long duration of the current hospitalization (73%, CI 64–82%), violations of compliance (73%, CI 63-81%), long duration of inpatient treatment in anamnesis (71%, CI 61-80%), deterioration soon after discharge (67%, CI 52-80%), a large number of hospitalizations during the entire period of illness (67%, CI 57-76%), lack of discharge intention (62%, CI 51-72%), tendency to increase the duration of hospitalizations (54%, CI 43-64%), high level of anxiety before discharge (50% , CI 34-66%), reduction in the intervals between hospitalizations (49%, CI 38-59%), p <0.05.Conclusion. The proposed methodology is intended for screening assessment of the presence of hospitalism and identification of the circle of persons for whom an in-depth assessment of social and psychological adaptation is advisable in order to prevent the adverse effects of hospitalization.

A Neurological Outpatient Clinic for Patients With Post-COVID-19 Syndrome — A Report on the Clinical Presentations of the First 100 Patients

Background and Objectives: Neurological and psychiatric symptoms are frequent in patients with post-COVID-19 syndrome (PCS). Here, we report on the clinical presentation of the first 100 patients who presented to our PCS Neurology outpatient clinic ≥12 weeks after the acute infection with SARS-CoV-2. To date, PCS is only defined by temporal connection to SARS-CoV-2 infection. Identification of clinical phenotypes and subgroups of PCS is urgently needed.Design: We assessed clinical data of our first 100 ambulatory patients regarding clinical presentations; self-questionnaires focusing on daytime sleepiness, mood, and fatigue; and a screening assessment for detecting cognitive impairment.Results: A total of 89% of the patients presenting to the Neurology outpatient clinic had an initially mild course of COVID-19 and had not been hospitalized. The majority of the patients were female (67 vs. 33% male). The most frequent symptom reported was cognitive impairment (72%). There were 30% of patients who reported cognitive deficits and scored below 26 points on the Montreal Cognitive Assessment Scale. Fatigue (67%), headache (36%), and persisting hyposmia (36%) were also frequently reported; 5.5% of all patients showed signs of severe depression.Discussion: To our knowledge, this is the first report of patient data of a PCS Neurology outpatient clinic. Neurological sequelae also exist for more than 3 months after mainly mild SARS-CoV-2 acute infections. The reported symptoms are in accordance with recently published data of hospitalized patients.

Managing Cognitive Dysfunction in Multiple Sclerosis: A Snapshot of Changes in Screening, Assessment, and Treatment Practices

Background: Cognitive dysfunction is prevalent in multiple sclerosis (MS) and can have a negative effect on several aspects of the daily lives of persons with MS. In 2010, members of the Consortium of Multiple Sclerosis Centers (CMSC) were surveyed to understand MS clinicians’ screening, assessment, and treatment practices for cognitive problems. Given the advancements made in the field in the past decade, it was deemed time to reevaluate how cognitive dysfunction is managed in the clinical setting. Methods: An online questionnaire was completed by 56 CMSC members in which they were asked to describe their clinical practices, procedures for screening and further evaluation, and treatment recommendations for cognitive dysfunction. Participants were also asked whether their practice had changed in terms of the number of cognitive screenings, prescriptions for cognitive problems, and referrals for neuropsychological assessment and cognitive remediation in the past 5 years to allow for clinicians who had not been in practice for 10 years. Results: Participants reported an increase in the number of cognitive screenings and referrals for neuropsychological assessments and cognitive remediation during the past 5 years. Compared with 2010, participants endorsed greater use of person-administered screening measures, such as the Symbol Digit Modalities Test, and fewer prescriptions for medications to improve cognitive functioning. Conclusions: Clinical practices are becoming more in line with the literature, with increased use of cognitive screening and remediation. Continued attention to cognitive problems will be an ongoing important component of MS-related care.

On the Impact of Treatment Restrictions for the Indigent Suffering from a Chronic Disease: The Case of Compassionate Dialysis

We analyze a congested healthcare delivery setting resulting from emergency treatment of a chronic disease on a regular basis. A prominent example of the problem of interest is congestion in the emergency room (ER) at a publicly funded safety net hospital resulting from recurrent arrivals of uninsured end-stage renal disease patients needing dialysis (a.k.a. compassionate dialysis). Unfortunately, this is the only treatment option for un/under-funded patients (e.g., undocumented immigrants) with ESRD, and it is available only when the patient’s clinical condition is deemed as life-threatening after a mandatory protocol, including an initial screening assessment in the ER as dictated and communicated by hospital administration and county policy. After the screening assessment, the so-called treatment restrictions are in place, and a certain percentage of patients are sent back home; the ER, thus, serves as a screening stage. The intention here is to control system load and, hence, overcrowding via restricting service (i.e., dialysis) for recurrent arrivals as a result of the chronic nature of the underlying disease. In order to develop a deeper understanding of potential unintended consequences, we model the problem setting as a stylized queueing network with recurrent arrivals and restricted service subject to the mandatory screening assessment in the ER. We obtain analytical expressions of fundamental quantitative metrics related to network characteristics along with more sophisticated performance measures. The performance measures of interest include both traditional and new problem-specific metrics, such as those that are indicative of deterioration in patient welfare because of rejections and treatment delays. We identify cases for which treatment restrictions alone may alleviate or lead to severe congestion and treatment delays, thereby impacting both the system operation and patient welfare. The fundamental insight we offer is centered around the finding that the impact of mandatory protocol on network characteristics as well as traditional and problem-specific performance measures is nontrivial and counterintuitive. However, impact is analytically and/or numerically quantifiable via our approach. Overall, our quantitative results demonstrate that the thinking behind the mandatory protocol is potentially naive. This is because the approach does not necessarily serve its intended purpose of controlling system-load and overcrowding.