Assessment of Clinical Reasoning During a High Stakes Medical Student OSCE.

Background & Need For Innovation: Objective Structured Clinical Examinations (OSCEs) are commonly employed to assess clinical skills. While several existing tools address components of clinical reasoning, including the Assessment of Reasoning Tool, none are calibrated for competency-based assessment of medical students (UME) in an OSCE setting.

Goal Of Innovation: We sought to create a clinical reasoning assessment for use in a high-stakes, summative medical student OSCE.

When and How Should Clinicians View Discharge Planning as Part of a Patient's Care Continuum?

Inpatient admission of unhoused patients from an emergency department is becoming more frequent. Clinicians have ethical obligations to engage early in thorough discharge planning for these vulnerable patients, as discharge to the street or even to a shelter can produce poor health outcomes. This commentary on a case considers factors that influence safe discharge planning and execution, including linkage to follow-up, patient engagement, and multidisciplinary teamwork.

Chlamydia and Gonorrhea Testing Patterns Among Women with and Without Serious Mental Illness.

Rates of the sexually transmitted infections (STIs) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have risen in women by 13% and 40%, respectively, since 2015. Women with Serious Mental Illness (SMI) are at disproportionate risk for STIs. A retrospective chart review was performed at a safety-net healthcare system in the Southeastern United States (US) from 2014 to 2017.

When Communication Breaks Down: Handling Hostile Patients.

Difficult patient encounters are common in clinical practice, with many arising from patient hostility owing to a breakdown in communication and the health care alliance. Patient anger may be a manifestation of fear, grief, or discontent with prior experiences in the health care system, but there may also be contributions from specific patient, physician, or situational factors. Physicians may intervene with specific actions based on these individual factors, while focusing on self-reflection to better understand their part in creating a hostile physician-patient dyad.

Increasing Psychiatrists' Role in Addressing the Cardiovascular Health of Patients With Severe Mental Illness.

The early mortality of individuals with serious mental illness has long been documented yet persists despite calls for change. Individuals with serious mental illness have a higher rate of medical morbidity than those in the general population across all categories of disease. Cardiovascular disease is particularly prevalent in this population, and it is the leading cause of death for persons with serious mental illness.

Flattening the emotional distress curve: A behavioral health pandemic response strategy for COVID-19.

This article proposes a framework for managing the behavioral health impacts of the COVID-19 global pandemic. This framework aligns and should be integrated with an existing public health pandemic intervals model. It includes six phases of a behavioral health pandemic response strategy: preplanning, response readiness, response mobilization, intervention, continuation, and amelioration.

Reverse Integration Pilot in a Public Safety-Net Hospital's Outpatient Behavioral Health Clinic.

Individuals with severe mental illness are at a higher risk for medical illness and premature death and yet receive poorer quality healthcare. Often mental healthcare is the only care this population receives, thus models of integration are being explored. This study examined medical outcomes and care utilization patterns among patients at an outpatient behavioral health center where primary care was integrated with psychiatric and behavioral healthcare.

Navigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness.

Objective: This study's purpose was to examine attitudes and perceptions of resident psychiatrists regarding the sexual and reproductive health needs of their female patients with severe mental illness. The three aims were to investigate resident psychiatrists' (1) perceptions regarding the importance of providing sexual and reproductive health services to female patients in the outpatient behavioral health setting, (2) current engagement in providing sexual and reproductive health services to their female patients, and (3) perceived barriers and facilitators to addressing sexual and reproductive health in this vulnerable patient population.

Methods: Fifteen resident psychiatrists were recruited from the behavioral health clinic at a safety-net public sector hospital for a structured interview.

Psychiatry's Role in Improving the Physical Health of Patients With Serious Mental Illness: A Report From the American Psychiatric Association.

The American Psychiatric Association Integrated Care Workgroup recently convened an expert panel charged with addressing the role of psychiatry in improving the physical health of persons with serious mental illness. The group reviewed the peer-reviewed and gray literature and developed a set of recommendations grounded in this review. This column summarizes the panel's primary findings and recommendations to key stakeholders, including clinicians, health care organizations, researchers, and policy makers.

Reverse Integration Initiatives for Individuals With Serious Mental Illness.

Medical progress has greatly extended the life span of individuals living in the United States, yet certain groups have lagged behind in achieving wellness and longevity. Prominent among these are individuals with serious mental illness. Because of this, various initiatives have been launched at the community, state, and national level to improve the medical care of those with serious mental illness.

Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study.

Objective: Behavioral health homes provide primary care health services to patients with serious mental illness treated in community mental health settings. The objective of this study was to compare quality and outcomes of care between an integrated behavioral health home and usual care.

Method: The study was a randomized trial of a behavioral health home developed as a partnership between a community mental health center and a Federally Qualified Health Center.

Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.

Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia.

The epidemiology of diabetes in psychotic disorders.

Diabetes is highly prevalent in people with psychotic disorders, including schizophrenia and schizoaffective disorders. Exact prevalence is difficult to estimate, since diabetes is often underdiagnosed in people with psychosis. Results of several studies show that the prevalence of diabetes exceeds that in the general population, with documented prevalence in those with psychosis ranging from 1·26% to 50% across studies (median 13%).

A meta-review of lifestyle interventions for cardiovascular risk factors in the general medical population: lessons for individuals with serious mental illness.

Objective: Individuals with serious mental illness die years younger than members of the general population, with cardiovascular disease and related risk factors accounting for the majority of deaths. Lifestyle interventions targeting these risk factors have begun to be developed for those with serious mental illness, but they have largely been created de novo rather than with information from work already done in the general population. This review aims to synthesize for a mental health audience the common factors for success in nonpharmacologic lifestyle interventions and identify specific considerations in adapting these models for those with serious mental illness.

High-stage urachal adenocarcinoma can be associated with microsatellite instability and KRAS mutations.

Urachal adenocarcinoma (UAC) is a rare tumor of the urinary bladder, which can show intestinal, mucinous, and signet ring cell histology. The morphology is similar to that of colorectal adenocarcinoma (CAC). Microsatellite instability (MSI), KRAS, and BRAF have been more extensively studied in CAC.

Challenges in pharmacologic management of the hospitalized patient with psychiatric comorbidity.

Background: Psychiatric comorbidity is common in the inpatient medical population. Hospitalists are frequently faced with decisions regarding the psychopharmacologic management of medically ill patients, yet receive limited psychiatric training. This review aims to assist the hospitalist in making an informed decision about the continuation of home psychotropic medications in the medically ill patient.