Outpatient Medical Settings Research Articles

Interdisciplinary perspectives on accessing specialty evidence-based treatment for Medicaid-insured adolescents with eating disorders

BackgroundFamily-based treatment (FBT), the leading intervention for adolescents with anorexia nervosa (AN), is severely understudied in outpatient care settings that serve publicly-insured populations. Many individuals with public insurance are lower-income, racially and ethnically diverse, and experience barriers to accessing evidence-based interventions for eating disorders (EDs).MethodsSemi-structured interviews were conducted with ten interdisciplinary providers who provide specialty care to youth with EDs in an inpatient and/or outpatient medical setting. Interview questions were focused on the interdisciplinary providers’ experiences of caring for individuals with EDs, with a focus on differences in care for those with private insurance compared to public insurance. The interviews took place two years after training in FBT was delivered to mental health providers in San Francisco County, which created opportunities to explore provider perspectives on collaborating with newly-trained mental health providers in the community implementing FBT with publicly-insured youth.ResultsContent analysis converged on three themes: the critical importance of supporting mental health treatment within the context of medical care, complex challenges when helping patients and their families navigate publicly-funded health care systems, and the overall positive impact of the FBT rollout in San Francisco County. Participants emphasized greater confidence in patient outcomes when collaborating with FBT providers and noted discord when working with providers not trained in EDs or FBT. Referral systems, weight-based stigma, and a lack of appropriate services were highlighted as significant barriers to care. To facilitate treatment engagement in publicly-insured populations, participants stressed the importance of clinicians providing psychoeducation and providing services with a high degree of cultural competence. Participants expressed that patients’ ability to access FBT and providers’ ability to collaborate on cases markedly improved following the county training, increasing their sense of efficacy in delivering adequate patient care.ConclusionsThe discussed themes highlight the importance of access to FBT for individuals in underserved communities, which can significantly reduce both provider and patient burden. Despite various barriers to utilizing FBT in publicly-funded settings, clinicians stressed that cultural adaptations increase the implementation of and facilitate family engagement in FBT, which is consistent with previous literature examining evidence-based intervention implementation science.

Cannabis use, health problems, and criminal offences in Germany: national and state-level trends between 2009 and 2021.

The German federal government plans to decriminalise cannabis. The impact of this policy on use prevalence, cannabis-related health and legal problems cannot be fully anticipated and should be viewed in context with current trends. We used routine data on (a) cannabis use (population-based surveys), (b) cannabis-related diagnoses (ICD-10 code F12) in outpatient medical settings and (c) minor law offences (registered violations against the narcotics law for possessing small amounts) to analyse age and sex-specific trends by federal state between 2009 and 2021. To enable comparisons across time and federal state besides crude prevalence rates, age-standardised rates were calculated. Between 2009 and 2021, the age-standardised prevalence of cannabis use (5.7-10.6%), rate of diagnoses (1.1-3.7 per 1,000), and legal offences (1.8-3.1 per 1,000) increased, with the largest increase noted for cannabis-related diagnoses. Relatively, increases were most pronounced for older users (40-to-59-year-olds: use and offences; 35-to-44-year-olds: cannabis-related diagnoses) and rather stagnant for minors. Cannabis use and health problems appear to be more pronounced in Northern and city states, while no clear geographic trend was observed for law offences. Cannabis-related outpatient treatment demand has risen more steeply than use prevalence suggesting an increasing challenge for the health care system. Despite rising rates for documented offences, the long-term implications of law violations on social and occupational life are poorly understood but may be considered for evaluations of the proposed law changes.

Brief Interventions for Suicidal Youths in Medical Settings: A Meta-Analysis.

Most youths who die by suicide have interfaced with a medical system in the year preceding their death, placing outpatient medical settings on the front lines for identification, assessment, and intervention. Review and consolidate the available literature on suicide risk screening and brief intervention with youths in outpatient medical settings and examine common outcomes. The literature search looked at PubMed, OVID, CINAHL, ERIC, and PsychInfo databases. Interventions delivered in outpatient medical settings assessing and mitigating suicide risk for youths (ages 10-24). Designs included randomized controlled trials, prospective and retrospective cohort studies, and case studies. Authors extracted data on rates of referral to behavioral health services, initiation/adjustment of medication, follow-up in setting of assessment, suicidal ideation at follow-up, and suicide attempts and/or crisis services visited within 1 year of initial assessment. There was no significant difference in subsequent suicide attempts between intervention and control groups. Analysis on subsequent crisis service could not be performed due to lack of qualifying data. Key secondary findings were decreased immediate psychiatric hospitalizations and increased mental health service use, along with mild improvement in subsequent depressive symptoms. The review was limited by the small number of studies meeting inclusion criteria, as well as a heterogeneity of study designs and risk of bias across studies. Brief suicide interventions for youth in outpatient medical settings can increase identification of risk, increase access to behavioral health services, and for crisis interventions, can limit psychiatric hospitalizations.

Prophylaxis with proton pump inhibitors in case of corticosteroid therapy: "less is more"

It is common to routinely prescribe gastric ulcer prophylaxis with proton pump inhibitors (PPIs) when administering high-dose glucocorticoids (GC) (> 30 mg/day of prednisone equivalent) or during prolonged time (> 15 days). This routine is due to a risk profile considered safe for PPIs in comparison to the possible severe consequences of developing a gastric ulcer. Given the numerous adverse effects associated with PPIs, it is preferable to question the risk-benefit balance when prescribing them. The objective of this article is to summarize the evidence for gastric ulcer prophylaxis with PPI in the event of GC treatment, in an outpatient medical setting or in acute care (excluding intensive care).

What medical providers need to elevate outpatient care for adolescents and young adults with binge-eating disorder: A novel protocol.

Binge-eating disorder (BED) in adolescents and young adults is underrecognized and understudied and no standardized guidelines exist for medical providers caring for this population. To highlight the lack of extant evidence, we examine the demographic characteristics of youth with BED in an academic eating disorders (EDs) program and primary care clinic and describe the needs of their medical care providers. A retrospective chart review was conducted for patients who met criteria for BED from July 2021 to June 2022. We surveyed their medical providers to understand their needs in caring for this population. A multidisciplinary team with expertise in the care of youth with EDs amalgamated current evidence in caring for youth with BED into a protocolized care schema designed for implementation in the outpatient medical setting. Eighteen youth with BED were reviewed, 14 identified as female, 3 as male, and 1 as "Other." Average age was 15.4 (2.7) years old, and mean body mass index was 35.90 (8.25). 33.3% (6) patients identified as White/Caucasian, followed by 22.2% (4) Hispanic/Latinx. Eleven of 18 were privately insured. The most common medical recommendations were for regular meals and snacks and for individual psychotherapy. Medical providers desired more education about identification and management of youth with BED. To address the lack of medical care guidelines for youth with BED, recommendations in this Forum include: increased education for medical providers, standardized medical monitoring, an emphasis on psychotherapy, and a weight-inclusive orientation. Adolescents and young adults with BED are underrecognized and undertreated. Little is known about the characteristics of these patients and the medical care these patients receive within academic EDs program. For the first time, preliminary recommendations for medical care are provided.

The association between patient experiences in outpatient care and their characteristics in Slovenia

Abstract Background The aim of the cross-sectional study was to measure adult patients’ experiences in the outpatient specialist medical settings in the fields of neurology and neurosurgery, cardiology, ophthalmology, gynaecology and obstetrics, orthopaedics and oncology with radiotherapy, and explore the association between the general score of the healthcare service given by patients and their socio-demographic characteristics and health status. Methods The survey used mixed mode design (i.e. paper questionnaire and online survey), took into account various aspects of healthcare such as waiting period to the visit, admission, waiting time in the waiting room, physician work, nurse work, privacy, patient rights information, and familiarity with continuation of treatment. As part of the study, patients evaluated overall care at a specialist outpatient clinic on a scale of 0 to 10. The questionnaire used has been recently developed, based on a review of the literature and focus groups with patients. The questionnaire was also cognitively tested and piloted before national rollout. Multi-level regression analysis was used as the main method of statistical analysis. Results The national survey was conducted in autumn 2022. A total of 10,533 valid completed questionnaires from 210 specialist outpatient clinics were received. 82.4% of the surveyed patients rated the medical treatment with a score of 9 or 10 with the average rating 9.34. Preliminary statistical analysis indicates the presence of association between socio-demographic/health status variables on one hand and overall assessment of treatment on the other. Conclusions A possible association between socio-demographic and health status factors with overall score on specialist outpatient clinic rating calls for caution when comparing outpatient clinics that care for patients with different socio-demographic characteristics and health status. Key messages • There is an association between sociodemographic factors and health status of patients with overall score of healthcare experiences in specialist outpatient clinics. • The association calls for caution when comparing outpatient clinics.

H - 71 Development and Implementation of a Neuropsychology Program for Spanish-Speaking Patients at Cleveland Clinic Nevada.

There is a significant need for culturally-informed neuropsychology services for patients from underrepresented communities, particularly those with limited English proficiency. Given the finite number of bilingual neuropsychologists, working with interpreters and bilingual psychometrists is important for increasing access to equitable care, though many neuropsychologists lack training in these approaches. We present a model for the development and implementation of a neuropsychology program for Spanish-speaking patients in an outpatient academic medical setting. To develop our service, we first identified the primary patient population to be served and common referral questions. We then consulted with national and international experts to identify best practices for establishing a new clinical service line for Spanish-speaking patients, which included a survey of available Spanish-language tests and normative data, resources for interpretation, and case consultation. After consulting with colleagues at Cleveland Clinic Ohio and UCLA, we established a formal consultation agreement with a multilingual neuropsychologist with expertise in program development. Consultation focused on best practices for working with interpreters and Hispanic patients, selection of tests and normative sources, and ongoing clinical case consultation. The new service was initiated in March 2023 and includes conducting clinical interviews with virtual interpreters and testing by a bilingual psychometrist. Comprehensive assessments are currently being provided for Spanish-speaking patients, and trainees also receive experience and supervision with these cases. Developing clinical neuropsychology services for culturally- and linguistically-diverse patients is critically needed. In addition to addressing barriers to care, ensuring high-quality evaluations through prospective consultation with dedicated experts is important for program development.

The Brief Multidimensional Assessment Scale (BMAS): A Broad Measure of Patient Well-Being.

This article discusses the development and initial clinimetric and psychometric properties of the Brief Multidimensional Assessment Scale (BMAS). The BMAS is an ultrabrief multidimensional measure of global patient well-being that can be used at every clinic visit to assess several facets of patients' perception of themselves, regardless of their diagnosis, at a moment in time and over the course of treatment. Data were collected from 499 adults in the community as well as from psychiatric and medical inpatient and outpatient settings. Participants completed questionnaires as part of their standard care at inpatient and outpatient medical and psychiatric settings or completed them online (community sample). Results indicate that the BMAS measures four discrete dimensions: the ability to get things done, emotional support in important relationships, quality of life, and sense of purpose in life. The scale demonstrates concurrent validity with other measures and discriminates between nonclinical participants and participants from most clinical contexts. The BMAS demonstrates promising initial psychometric properties. It offers clinicians a multidimensional measure of their patients' well-being, regardless of diagnosis, that can be used to monitor well-being at each routine appointment and over time.

Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review.

Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.

Antimicrobial drug consumption in the Russian Federation (2008–2022): pharmacoepidemiological study

Objective. To assess the dynamics of antimicrobial drug consumption in the Russian Federation. Materials and Methods. Data on antimicrobials for systemic use (ATC class J01) sales for the period 2008–2022 in the hospital and outpatient segment were downloaded from the IQVIA database. The absolute quantities of purchased antimicrobials were transferred to the defined daily doses (DDD) separately for the outpatient and hospital segments for each year of observation. Results. Over the period 2008-2022 there was an increase in antimicrobials consumption from 9.7 to 14.2 DDDs per 1000 inhabitants/day with a transient rise of up to 18.7 DDDs per 1000 inhabitants/day in 2020. In the outpatient segment, antimicrobials consumption was increased from 9.7 to 12.04 DDDs per 1000 population/day (a transient rise to 15.6 DDDs in 2020), and in the inpatient segment from 266.3 to 412.2 DDDs per 100 bed-days, respectively. When analyzing antimicrobials by access group (WHO classification AWaRe), there was a decrease in consumption «Access» group antimicrobials from 62% to 45%, an increase of «Watch» group antimicrobials from 38% to 63.4% and «Reserve» antimicrobials from 0.005% to 1.6%. Conclusions. The increase in consumption of «Watch» group antimicrobials requires effective use control measures to be implemented at both outpatient and inpatient medical care settings at the national level.

Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis.

The efficacy of brief intervention (BI) for unhealthy drug use in outpatient medical care has not been sufficiently substantiated through meta-analysis despite its ongoing global delivery. This study aims to determine the efficacy of BI for unhealthy drug use and the expected length of effects, and describe subgroup analyses by outpatient setting. Trials comparing BI with usual care controls were retrieved through four databases up to January 13, 2021. Two reviewers independently screened, selected, and extracted data. Primary outcomes included drug use frequency (days used) and severity on validated scales at 4-8 months and were analyzed using random-effects model meta-analysis. In total, 20 studies with 9182 randomized patients were included. There was insufficient evidence to support the efficacy of BI for unhealthy drug use among all outpatient medical care settings for use frequency (SMD = -0.07, 95% CI = -0.17, 0.02, p = 0.12, I2 = 37%, high certainty of evidence) and severity (SMD = -0.27, 95% CI = -0.78, 0.24, p = 0.30, I2 = 98%, low certainty of evidence). However, post hoc subgroup analyses uncovered significant effects for use frequency by setting (interaction p = 0.02), with significant small effects only in emergency departments (SMD = -0.15, 95% CI = -0.25, -0.04, p < 0.01). Primary care, student health, women's health, and HIV primary care subgroups were nonsignificant. Primary care BI revealed nonsignificant greater average use in the treatment group compared to usual care. BI for unhealthy drug use lacks evidence of efficacy among all outpatient medical settings. However, small effects found in emergency departments may indicate incremental benefits for some patients. Clinical decisions for SBI or specialty treatment program referrals should be carefully considered accounting for these small effects in emergency departments. PROSPERO (CRD42020157733).

Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice.

To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting. A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12-25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. A pilot phase to acclimate office staff to screening procedures preceded data collection. A convenience sample of 271 pediatric medical outpatients was screened for suicide risk. Patients, their parents, and medical staff reported their experiences and opinions of the screening procedures. Thirty-one (11.4%) patients screened positive for suicide risk, with 1 patient endorsing imminent suicide risk (3% of positive screens; 0.4% of total sample). Over half of the patients who screened positive reported a past suicide attempt. Most patients, parents, and medical staff supported the implementation of suicide risk screening procedures into standard care. A mental health clinical pathway for suicide risk screening in outpatient settings was developed to provide outpatient medical settings with guidance for screening. Screening for suicide risk in pediatric primary care is feasible and acceptable to patients, their families, and medical staff. A clinical pathway used as guidance for pediatric health care providers to implement screening programs can aid with efficiently detecting and managing patients who are at risk for suicide.

Pathological Traits and Interpersonal Difficulties in Depressed Older Adults: Clinical versus Community Sampling

Personality pathology, represented by high neuroticism and low agreeableness in the Five Factor Model of Personality, has been identified as a predictor of depression in mixed-age samples and preliminary studies of older adults. Research on older people, however, has not examined the differential impact of pathological personality traits and processes on depression or examined them across treatment settings. This secondary analysis examined personality traits and processes as predictors of depression, evaluated the moderating effect of interpersonal problems, and assessed stratification of these personality variables across community and clinical settings. Older adults (N=395) ranging in age from 55 to 99 (M = 72.06; SD = 10.10) from inpatient psychiatric, outpatient medical, and community settings completed self-report measures of personality traits (NEO-FFI Agreeableness and Neuroticism), processes (Inventory of Interpersonal Problems), and depression (GDS-30). Higher neuroticism predicted worsened depressive symptoms (β = .765, p < .001), as did lower agreeableness (β = -.163, p = .002) and more interpersonal problems (β = .459, p < .001). Findings partially supported the stratification of personality traits and processes by setting. Interpersonal problems moderated neither the neuroticism-depression or agreeableness-depression relationships. Personality traits and processes predict depression in older adults across care settings but do not significantly interact. Levels of pathological traits and processes vary across community and clinical settings.

Improving the Delivery of High-Quality Cancer Care in Medically Underserved Communities: A Formative Evaluation Method.

In 2015, the American Society of Clinical Oncology launched a new program: Improving Quality of Care in Underserved Communities with the overarching aim of serving patients with cancer who have traditionally had difficulty accessing the care they need. Cancer care requires intense coordination of complex services to provide safe, effective, timely, and equitable care. If chemotherapy and/or radiation is needed, patients must navigate a complex system of care many times, a formidable challenge for many disadvantaged patients. Many practices believe that these patients face such significant issues that it is almost impossible to provide high-quality care. A grant from the Stavros Niarchos Foundation allowed us to select 4 oncology practices serving high proportions of racial minorities and persons of low socioeconomic status to participate in the new American Society of Clinical Oncology program. The program had 2 objectives: (1) to improve the capacity and capability of the participating practices to provide evidence-based, high-quality care; and (2) to identify and disseminate lessons learned for improving quality of care among oncology practices serving underserved patients. The program leveraged existing programs including the Quality Oncology Practice Initiative, which is a national performance measurement and improvement program that collects data about processes of care provided in the outpatient medical oncology setting, and the American Society of Clinical Oncology Quality Training Program, which provides training in how to apply the tools and methods of quality improvement in routine care settings. Training was provided in face-to-face and virtual meetings and participants were provided mentors throughout the program. At the conclusion, a formative evaluation method was used to assess whether the goals had been achieved. Objectives, activities, and desired outcomes were identified for each of the goals and thus became the framework for the evaluation. The program met the stated goals and objectives. The evaluation revealed many successes, some surprises, and a list of improvements that were incorporated in the next iteration of this program. Based on data from the evaluation, the Niarchos Foundation provided funds for an additional 10 practices to participate in a similar program in 2020. This article outlines the evaluation of a new program demonstrating that medical oncology practices can make improvements in the care of their underserved populations if provided with the proper tools, methods, and coaching. The use of formative evaluation methodology also identified opportunities for improvement and ultimately resulted in additional funding for more practices to participate in the program.

Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Adult patients affected by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are at an increased risk of death by suicide. Based on the scientific literature and our clinical/research experiences, we identify risk and protective factors and provide a guide to assessing and managing suicidality in an outpatient medical setting. A clinical case is used to illustrate how information from this article can be applied. Characteristics of ME/CFS that make addressing suicidality challenging include absence of any disease-modifying treatments, severe functional limitations, and symptoms which limit therapies. Decades-long misattribution of ME/CFS to physical deconditioning or psychiatric disorders have resulted in undereducated healthcare professionals, public stigma, and unsupportive social interactions. Consequently, some patients may be reluctant to engage with mental health care. Outpatient medical professionals play a vital role in mitigating these effects. By combining evidence-based interventions aimed at all suicidal patients with those adapted to individual patients’ circumstances, suffering and suicidality can be alleviated in ME/CFS. Increased access to newer virtual or asynchronous modalities of psychiatric/psychological care, especially for severely ill patients, may be a silver lining of the COVID-19 pandemic.

External validation of a rapid, non-invasive tool for periodontitis screening in a medical care setting

ObjectivesMedical professionals should advise their patients to visit a dentist if necessary. Due to the lack of time and knowledge, screening for periodontitis is often not done. To alleviate this problem, a screening model for total (own teeth/gum health, gum treatment, loose teeth, mouthwash use, and age)/severe periodontitis (gum treatment, loose teeth, tooth appearance, mouthwash use, age, and sex) in a medical care setting was developed in the Academic Center of Dentistry Amsterdam (ACTA) [1]. The purpose of the present study was to externally validate this tool in an outpatient medical setting.Materials and methodsPatients were requited in an outpatient medical setting as the validation cohort. The self-reported oral health questionnaire was conducted, demographic data were collected, and periodontal examination was performed. Algorithm discrimination was expressed as the area under the receiver operating characteristic curve (AUROCC). Sensitivity, specificity, and positive and negative predictive values were calculated. Calibration plots were made.ResultsFor predicting total periodontitis, the AUROCC was 0.59 with a sensitivity of 49% and specificity of 68%. The PPV was 57% and the NPV scored 55%. For predicting severe periodontitis, the AUROCC was 0.72 with a sensitivity of 54% and specificity of 81%. The PPV was 34% and the NPV 81%.ConclusionsThe performance of the algorithm for severe periodontitis is found to be sufficient in the current medical study population. Further external validation of periodontitis algorithms in non-dental school populations is recommended.Clinical relevanceBecause general physicians are obligated to screen patients for periodontitis, it is our general goal that they can use a prediction model in medical settings without an oral examination.

Prescription Drug Monitoring Program: Access in the First Year.

Prescription Drug Monitoring Programs (PDMP) detect high-risk prescribing and patient behaviors. This study describes the characteristics associated with documented PDMP access when prescribing opioids. Retrospective chart review of 695 opioid prescriptions written from inpatient and outpatient medical and psychiatric settings. Data were abstracted and analyzed to identify characteristics associated with documented PDMP access. One-third of the charts had PDMP access documented within the week of opioid prescription; 12% showed PDMP consultation on the same day. Services varied greatly from 10.5% (inpatient medicine) to 57% (inpatient psychiatry) with regard to same-day PDMP access (P < .0001). Patient characteristics associated with PDMP access include having acute pain, current mental health treatment, and current and past substance use disorders (all P < .05). Logistic regression modeling identified three variables associated with the odds of PDMP access (c-statistic = 0.66): if the prescription originated from the inpatient medicine unit (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32, 0.68), or if the patient received a prescription for an opioid in the past 30 days (OR = 0.30, 95% CI = 0.10, 0.90) or had a urine toxicology screen in the past year (OR = 2.00, 95% CI = 1.40, 2.90). Utilization of the PDMP varied by specialty and setting. This study is among the first to compare rates of PDMP access in a large sample by specialty and practice setting in a healthcare system with a policy requiring its access and appropriate documentation. With less than one-third adherence to the policy, additional steps to increase consistent PDMP access are warranted. (Am J Addict 2021;00:00-00).

SARS-CoV-2 Antibody Positivity and Prevalence in an Outpatient Medical Setting in Las Vegas, NV.

SARS-CoV-2 antibody testing shows the prevalence of COVID-19 disease in different communities and has epidemiological significance. SARS-CoV-2 IgM and IgG were tested in 319 patients, staff and visitors of a primary care clinic in Las Vegas, NV on a continuous as-requested basis. Prevalence of SARS-CoV-2 antibodies was 3.76% in a primary care office in Las Vegas, NV. Positivity of IgM was 0.31% and IgG 3.44%. The most common symptoms reported amongst those who tested positive were cough, shortness of breath and loss of smell and taste. The most common comorbidities included hypertension, chronic lung disease, seasonal allergies, and type 2 diabetes mellitus, in that order. Prevalence was 2.3% in Washoe County, NV in June 2020 and 3.76% in Clark County, NV in April-June 2020. This has important implications for heavily populated urban areas.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

The Role of C-L Psychiatrists in Assessing Suicide

The Role of C-L Psychiatrists in Assessing Suicide