Literature Collection

BACKGROUND: Patients with disorders of gut-brain interaction (DGBIs) presenting to specialist care have a high prevalence of psychiatric morbidity. Psychiatrists can provide effective treatments for these disorders; however, care is rarely delivered in an integrated manner. AIMS: This study aimed to characterise patients seen by psychiatrists in a multidisciplinary gastrointestinal (GI) clinic, describe the treatment provided and examine clinical outcomes. METHODS: In a single-centre multidisciplinary gastroenterology clinic, clinical records were retrospectively evaluated for patients with DGBIs seen by a psychiatrist. Patient demographics, medical and psychiatric history, records of adverse childhood experiences (ACEs) and adult trauma were collected. GI and mental health symptom outcomes were assessed using a five-point scale. RESULTS: Ninety-seven patients (median age, 35 years; 77% female) were seen by the psychiatrist (median treatment duration 2.5 months) between January 2017 and November 2021. Fifty-six per cent had irritable bowel syndrome and 18% had functional dyspepsia. Common psychiatric comorbidities were anxiety (51%) and depression (43%). Seventy-seven per cent had a history of ACEs and 26% had a history of sexual trauma. Seventy-five per cent had previously seen a psychiatrist or psychologist. DGBI-Clinic psychiatrists provided a range of treatments including psychoeducation (64%), insight-oriented psychotherapy (39%), medication changes (27%) and cognitive behavioural therapy (19%). A majority of patients had improvement (46%) or resolution (11%) in GI symptoms. Forty per cent experienced improvement in mental health symptoms. Improvement in GI and mental health symptoms were correlated (P = 0.002). CONCLUSIONS: A majority of patients with DGBI who were seen by psychiatrists within a multidisciplinary clinic demonstrated improvement in GI and mental health symptoms.

Mathematical and computational models are often used to forecast respiratory infectious disease burden, including to inform healthcare capacity. We aimed to characterize pathways of clinical progression associated with SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) infections using data from patients aged 0 to >90 years in an integrated healthcare system, whose encounters were monitored across all levels of acuity spanning virtual, ambulatory, and inpatient care settings. Using parametric survival models, we estimated probabilities of progression and distributions of time to progression from each setting to all higher-acuity settings on a cascade encompassing the following classes of events or encounters: symptoms onset; diagnostic testing; telehealth or other virtual care appointment; outpatient physician office visit; urgent care presentation; emergency department presentation; hospital admission; mechanical ventilation; and death. Our analyses included data from 59,668, 22,705, and 1,668 episodes associated with positive SARS-CoV-2, influenza, and RSV tests, respectively, between 1 April 2023 and 31 March 2024. First clinical encounters occurred in inpatient settings for only 4.7%, 3.4%, and 18.7% of SARS-CoV-2, influenza, and RSV episodes, respectively, with median times (interquartile range) of 6.8 (3.6-13.2), 6.6 (3.5-12.1), and 6.4 (3.8-10.6) days from symptoms onset to admission. Overall, 7.9% of SARS-CoV-2 episodes, 5.8% of influenza episodes, and 33.8% of RSV episodes resulted in inpatient admission, ventilation, or death. Between 40.4-62.1%, 71.6-87.3%, and 47.9-58.7% of SARS-CoV-2, influenza, and RSV infections, respectively, had encounters in lower-acuity virtual care, outpatient, or urgent care settings. For all three viruses, the proportions of cases receiving care at each level of acuity increased with older age and greater numbers of comorbid conditions. Median durations of hospital stay were 4.2 (2.6, 7.3), 4.0 (2.3, 6.8), and 4.3 (2.5, 7.4) days for SARS-CoV-2, influenza, and RSV episodes resulting in admission. These estimates provide a basis for modeling real-world clinical care requirements and the progression of respiratory viral infections.

This study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.