SBH Behavioral Health

IntroductionThe coronavirus disease 19 (COVID-19) pandemic has prompted concerns regarding increased suicide rates and exacerbation of underlying mental illness symptoms. •There is evidence suggesting neurocognitive changes as well as immune response in COVID-19 infection may increase a patient’s propensity for suicidal ideation. • Patients who are diagnosed with COVID-19 may be affected by psychological factors of anxiety, stress related to having this novel virus as well as depression, post-traumatic stress disorder and sleep disorders throughout treatment and post-treatment of continued concerns. •The combination of psychiatric, neurological, and physical symptoms associated with COVID-19 may elevate suicide riskObjectivesWe present a case of a female with no prior psychiatric history who impulsively attempted suicide after a recent COVID-19 diagnosis and subsequent quarantine. Will explore possible link between increase of suicidal ideation and COVID-19 infection.MethodsA case report.ResultsLink between increase of suicidal ideation and COVID-19 infection has not been clearly established but there have been reports, as in our case, of the possible vulnerability to mental illness and new onset suicidal ideation that COVID-19 survivors may experience. It may be useful to screen all patients for depressive symptoms after a COVID-19 infection. Early identification and treatment of depression in recovered COVID-19 patients will help to improve psychological impact on COVID-19 survivors and potentially reduce suicide rates.Conclusions As COVID-19 infection may trigger new onset mental illness, exacerbate symptoms of underlying mental illness, and may increase suicidal ideation, further research is needed to evaluate links between COVID-19 infection and depression with suicidal ideationDisclosureNo significant relationships.

Few interdisciplinary research groups include basic scientists, pharmacists, therapists, nutritionists, lab technicians, as well as trauma patients and families, in addition to clinicians. Increasing interprofessional diversity within scientific teams working to improve trauma care is a goal of national organizations and federal funding agencies like the National Institutes of Health (NIH). This paper describes the design, implementation, and outcomes of a Trauma Interdisciplinary Group for Research (TIGR) at a Level 1 trauma center as it relates to increasing research productivity, with specific examples excerpted from an on-going NIH-funded study. We utilized a pre-test/post-test design with objectives aimed at measuring increases in research productivity following a targeted intervention. A SWOT (strengths, weaknesses, opportunities, threats) analysis was used to develop the intervention which included research skill-building activities, accomplished by adding multidisciplinary investigators to an existing NIH-funded project. The NIH project aimed to test the hypothesis that accelerated biologic aging from chronic stress increases baseline inflammation and reduces inflammatory response to trauma (projected N=150). Pre/Post-TIGR data related to participant screening, recruitment, consent, and research processes were compared. Research productivity was measured through abstracts, publications, and investigator-initiated projects. Research products increased from N =12 to N=42; (~ 400%). Research proposals for federal funding increased from N=0 to N=3, with success rate of 66%. Participant screenings for the NIH-funded study increased from N=40 to N=313. Consents increased from N=14 to N=70. Lab service fees were reduced from $300/participant to $5/participant. Adding diversity to our scientific team via TIGR was exponentially successful in 1) improving research productivity, 2) reducing research costs, and 3) increasing research products and mentoring activities that the team prior to TIGR had not entertained. The team is now well-positioned to apply for more federally funded projects and more trauma clinicians are considering research careers than before.

To examine the effect of treadmill training with body weight support (TBWS) on gait and gross motor function in children with spastic cerebral palsy (CP). Eight children with spastic CP participated in the study. Their temporal-distance gait parameters, Gross Motor Function Measure, muscle tone, and selective motor control were assessed three times: two times under their regular therapeutic treatment (condition A), and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments (condition B). There were two treatment schedules, AAB and ABA. Except for the first one (taken at study entry), the assessments were always taken after 12 wks of treatment. The children were equally divided into two groups and randomly assigned to the two schedules. The two groups were matched according to category of the Gross Motor Function Classification System. The TBWS treatment significantly improved the children's gait (increases in stride length and decreases in double-limb support percentage of gait cycle) and their Gross Motor Function Measure (dimension D and E scores as well as the total score). No significant improvements on muscle tone or selective motor control were noted. The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP.

Nature and Management of Penetrating Spinal Cord Missile Injuries at Shree Birendra Hospital, Chhauni from November 2001 to November 2004

To determine end-expiratory lung volumes (EELVs) and the distribution of gas and perflubron during low- and high-dose partial liquid ventilation (PLV) in healthy and oleic-acid-injured lungs. A prospective, randomized study. A university medical school laboratory approved for animal research. Adult sheep. A total of 18 sheep were randomly divided into two groups (healthy and oleic acid lung injury) and received PLV with perflubron at incremental doses. Animals were ventilated in a volume-control mode with a positive end-expiratory pressure of 5 cm H2O. Baseline computed tomographic scans of the entire lung were obtained during end-expiratory hold. Thereafter, the animals were randomized to undergo either PLV alone (healthy group) or after oleic acid lung injury was introduced (injury group). In both groups, PLV was induced by instilling 10 mL/kg perflubron into the endotracheal tube over 5 mins (low-dose PLV). At 60 mins after dosing, another set of computed tomographic scans during end-expiratory hold was obtained. Thereafter, another 20 mL/kg perflubron was instilled in both groups (cumulative dose, 30 mL/kg perflubron, high-dose PLV), and computed tomographic scanning was repeated 60 mins later. EELVs were calculated. To study density distribution patterns, the lungs were divided into nine segments, and the mean Hounsfield attenuation number was calculated for each segment. In healthy animals, low-dose PLV did not change EELV (47.5 +/- 8.1 mL/kg vs. 44.5 +/- 6.1 mL/kg at 10 mL/kg perflubron), whereas high-dose PLV significantly increased EELV (58.1 +/- 3.3 mL/kg, p <.01). Oleic acid lung injury significantly reduced EELV (53.9 +/- 7.5 mL/kg vs. 43.9 +/- 8.7 mL/kg, p <.01). Low-dose PLV reestablished baseline EELV (59.8 +/- 10.5 mL/kg), and high-dose PLV resulted in a significant increase in EELV (89.2 +/- 12 mL/kg, p =.003). PLV increased the mean Hounsfield attenuation number along the ventrodorsal axis in the three coronal blocks in a dose-dependent manner. In the oleic acid lung injury group, PLV produced a more homogeneous pattern of density distribution, with the highest Hounsfield attenuation numbers observed in the medial segments. High-dose PLV significantly increased EELV in both states, indicating lung distention. Healthy lungs were filled in a dose-dependent, gravity-governed fashion, showing steep craniocaudal and ventrodorsal gradients. In the oleic acid lung injury model studied, perflubron tended to accumulate on top of the most severely injured dorsal and diaphragmatic parts, rendering effective recruitment by liquid positive end-expiratory pressure in these regions questionable.

The struggle over health care reform in the United States pits two powerful myths against one another. The first myth, long held and strongly entrenched, promotes the illusion that the existing health care nonsystem allows broad freedom of choice and access to uniformly available, compassionate, component health providers. The second myth posits a new illusion. It suggests that competing organized care systems, under economic pressures for cost containment, will assure broad freedom of choice and access to uniformly available, compassionate, competent health providers. Both myths deny reality.