The use of smartphones throughout the United States continues to rise. Although smartphones have increased our capacity to access information, there is concern if excessive use may impact mental health. The purpose of this study was to examine whether a relationship exists between smartphone use and the presence of obsessive-compulsive symptoms (OCS) or behaviors. A 33-item online survey was developed with 19 items relating to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for obsessive-compulsive disorder (OCD). A survey response was considered positive for possible OCS if participants answered at least 3 questions as Most of the time or All of the time for the OCD-related questions structured around the DSM-5 criteria for OCD while also using their smartphone for greater than 2 or more hours per day. A total of 308 of 550 subjects identified spending 2 or more hours on their smartphone per day and also answered positively on 3 or more questions designed to identify OCS. A statistically significant difference was discovered between those who used their smartphone for 2 or more hours per day and those who met 3 or more positive criteria for OCS compared to those who used their smartphone less than 2 hours per day (P < .00001). The results of this study demonstrate a possible relationship between smartphone use and OCS. Additional research needs to be conducted to further investigate these results to determine their significance in clinical practice.Abstract
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The objectives of this study were to describe health professional students' experiences and opinions about patients with opioid-use disorder (OUD), to summarize evaluation results from an OUD educational event and to compare results by sex, discipline, and clinical experience. The OUD educational event lasted 75 minutes and covered the epidemiology of the opioid epidemic, evidence-based prevention and treatment services, stigma, and recommendations on how to improve care. An anonymous pre-event survey collected information on attendees' experiences and opinions about patients with OUD. The postevent survey collected information on the attendees' evaluation of the event. Forty percent of students reported having a friend or family member who has/had an OUD. A minority (29.1%) reported that they would be uncomfortable working with patients with OUD or would prefer not to interact with patients with OUD (27.7%). Overall, the event evaluation results were very positive, and 85.5% reported that the information would change or influence their clinical practices. The open-ended responses found that the content was informative (n = 36); the attendees liked the inclusion of statistics (n = 19) and that the content was locally focused (n = 13). Health professional students participating in this event had fewer negative opinions of patients with OUD than previous research has found, and this may, in part, be explained by their personal experiences. Overall, health professional students want to learn more about patients with OUD.Abstract
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Differentiating between a urinary tract infection and asymptomatic bacteriuria is an important distinction to make, especially in noncommunicative patients. An algorithm meant to aid in the diagnosis and treatment of urinary tract infections in this population was implemented within a psychiatric emergency department in January 2019. The primary objective of this project was to assess the impact of the algorithm (the intervention) regarding symptom documentation and antibiotic use. Secondary objectives included assessing changes in inappropriate prescribing and urine culture orders. Preintervention outcomes were measured from August 1, 2018, through November 30, 2018, while the postintervention cohort included patients admitted after January 31, 2019 and discharged before June 1, 2019. Adults admitted to psychiatry with a urinalysis ordered in the emergency department and an ICD-10 code representing dementia, delirium, autism spectrum disorder, or intellectual disability were included; pregnant patients were excluded. The preintervention (n = 56) and postintervention (n = 34) cohorts were well balanced with an average age of 66.5 and 70 years, respectively. Neurocognitive disorder was the diagnosis for inclusion in approximately two-thirds of both groups. Numerically, postalgorithm implementation, symptoms were documented more frequently (20.6% vs 10.7%, P = .23) and antibiotics used less often (2.9% vs 14.3%, P = .15). Inappropriate prescribing occurred in 12.5% of preintervention cohort compared to no patients postintervention (P = .04). The creation and implementation of an algorithm assisting in the diagnosis and treatment of urinary tract infections in noncommunicative patients was associated with a trend toward increased symptom documentation and decreased overall antibiotic use, and significantly increased appropriate antibiotic prescribing.Abstract
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Intentional ingestion of ethanol- or isopropanol-based hand sanitizer has been reported in the literature in a variety of settings within the health care system. Specifically in psychiatric units, case reports have only described ingestion of ethanol-based products. This report describes a case of intentional ingestion of isopropanol-based hand sanitizer by a patient while hospitalized on a psychiatric unit. The patient developed acute respiratory failure, acute kidney injury, and metabolic encephalopathy and was treated for 3 days in the intensive care unit before returning to the psychiatric unit. This case highlights the process of identifying suspected ingestion while hospitalized. In any patient who has a sudden change in level of consciousness, clinicians should consider the potential for ingestion of ethanol- or isopropanol-based hand sanitizer. Facilities should be aware of how accessible hand sanitizer is, particularly in areas with patients who have a history of substance dependence.Abstract
Urinary tract infection (UTI) is considered a common cause of mental status changes, particularly in elderly patients and patients with a psychiatric condition. Genitourinary symptoms are essential to confirm UTI diagnosis but may be unobtainable in patients with a communication barrier. Sparse guidance suggests assessing specific symptoms that do not rely on patient report. The primary objective of this project was to provide assistance in diagnosis and treatment of UTIs in noncommunicative patients through the creation of an algorithm. Through extensive interdisciplinary collaboration, the authors developed criteria to identify UTI symptoms that do not require communication. In order to make the algorithm comprehensive, we chose to include general information related to UTI diagnosis and treatment. The algorithm was implemented within the psychiatric emergency department as this is where patients are evaluated to determine need for psychiatric admission. Providers in the psychiatric emergency department were provided with detailed education on the algorithm as well as information about UTI diagnosis and treatment. Creating an algorithm within our institution required significant interdisciplinary collaboration. Providers were receptive to and appreciative of a comprehensive resource to assist in this difficult clinical situation. The authors plan to study the effects of algorithm implementation, specifically assessing changes in symptom documentation and antibiotic use.Abstract
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