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This worldwide health crisis forced hospitals to adapt their activities to this new confinement environment. Innovation was required to maintain a social bound between cohorting service's patients and their families, to guarantee a dedicated listening time and prevent as much as possible from the isolation due to this COVID-19 unusual situation. With that aim, the army training hospital Legouest created an information and support listening cell dedicated to COVID-19 hospitalized patients' families. It also provided several tablets for creating a patient and family digital gate.The SARS-Cov-2 pandemic took health care players across the world by surprise, including caregivers, managers and logisticians. In the absence of a vaccine or a specific therapy, detecting the disease at an early stage and isolating confirmed cases from the rest of the healthy population was soon considered to be essential. The RT-PCR technique was the gold standard method for testing for infection with the virus. It has high specificity but moderate sensitivity. It was difficult to access it during the first weeks of the pandemic. On the basis of the observations of the Chinese and Italian scientific community in particular, the recommendation was to combine use of the RT-PCR with a low-dose thoracic CT scan. In the absence of easy access to the RT-PCR, the use of the lung CT scan for a rapid triage of patients within emergency departments proved effective.Despite the recent emergence of COVID-19 and the absence of a specific cure, the hospital treatment of patients affected by this virus is well established. It is based on symptomatic treatments including oxygen therapy, physiotherapy and anticoagulation therapy. The treatment plan and potential therapeutic limitations must be well defined and adapted to the severity, predisposition and wishes of the patient.COVID-19 was initially considered exclusively as a respiratory disease. It now appears that it is also a systemic disease with vascular inflammation and thromboses. In the most severe forms, these plurifactorial pulmonary lesions are responsible for acute respiratory distress syndrome. The treatment of this syndrome, which causes hypoxemia, requires urgent oxygen therapy. While initial recommendations favoured the rapid use of intubation and mechanical ventilation, experience seems to confirm that it must be delayed as long as possible, in favour of non-invasive ventilation, less aggressive for the patient.To combat SARS-Cov-2, hygiene is essential for the safety of caregivers and saves lives. NSC 641530 order In hospital as well as in everyday social and professional environments, everyone is concerned by hygiene and distancing rules. It is an opportunity for us to reinvent ourselves, protect ourselves and protect the most vulnerable. In hospital, at the heart of the crisis, the action of the infection control team, which includes the infection control nurse, is one of the cornerstones of the fight against COVID-19.The health crisis in France has led military and health authorities to call on military student nurses and military medicine and pharmacy students. Students from the military health schools of Lyon-Bron provided reinforcements to the eight French military training hospitals, as well as to the field intensive care hospital deployed in Mulhouse. An original experience for the trainee health professionals, in service of the nation, and which required operational expertise, technical and cognitive skills and empathy in the face of a poorly controlled infection risk.The militaryintensive care field hospital is a new tool set up by the military medical service as part of Operation Resilience to provide medical support in the regions of France most affected by the SARS-Cov-2 pandemic. Deployed in Mulhouse and Mayotte, this hospital facility is a functional intensive care unit set up to support an existing hospital structure. The caregivers and logistics specialists are all from the military medical service, active personnel or reservists, predominantly nurses. The implementation of this intensive care field hospital in a constrained environment requires an efficient provision of care in accordance with medical guidelines, while protecting the healthcare staff and, notably, the frontline nursing staff.The Legouest military training hospital is one of the eight hospitals of the armed forces health service. Situated in the Grand-Est region, one of the regions most affected by the COVID-19 epidemic in spring, it had to reorganise itself within a few days with its regional and national partners. While continuing to support forces sent abroad, to overseas territories or located in the East of France, the armed forces hospital had three major missions the support of other military hospital facilities, the continued care of non-COVID patients and the care of patients affected by COVID-19 requiring non-intensive hospital care.The coronavirus SARS-CoV-2 pandemic has forced frontline health care teams to make radical and rapid adjustments. Aside from the danger of catalysing and integrating, the crisis provides an opportunity to rediscover the very essence of the art of caring an ability to be present for oneself, for others and for the world. This pandemic is shattering everyone's comfort zones, on the social, professional, psychological and ethical level. It is reviving our profound humanity, imposing with humility coordinated actions, while allowing a degree of subsidiarity in the adjustments.Since 2000, opioid use disorder (OUD) has become an epidemic in the United States with more than 600,000 total deaths and a $51 billion annual cost. Patients with OUD require services from community-based organizations, local and state health departments, and health systems, all of which necessitate communication and collaboration among these groups to develop an effective strategy for diagnosis, treatment, and coordination of care. Academic health centers (AHCs) are poised to make significant contributions to the care of patients with OUD given in-house expertise across multiple medical specialties and the mission to care for patients in need. Despite the potential for AHCs to provide necessary services and address this public health crisis, progress has been slow. link2 Many AHCs lack a clear roadmap for moving this agenda forward in their local regions. In response to rising deaths due to OUD, the authors' AHC undertook a significant redesign effort to facilitate the necessary processes and interdepartmental collaboration to provide patient-centered, comprehensive care for patients with OUD. In this article, using an organizational development framework (McKinsey 7S model), the authors describe their transformation process, and articulate strategies and potential barriers to implementing this framework. The goal of the article is to highlight the structural, procedural, and cultural changes that have occurred in one AHC so we can assist other AHCs in addressing the opioid epidemic.

Research has described subtypes with more internalizing and more externalizing symptoms in samples of patients with post-traumatic stress disorder (PTSD) and samples of patients with substance use disorders (SUD).

This study sought to examine the respective subtypes in female PTSD-SUD patients and potential relationships with substance use characteristics.

We performed a latent class analysis (LCA) in 343 adult female participants of a multisite therapy trial on PTSD and SUD. We derived externalizing symptoms from the Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire. We assessed internalization using the Symptom Checklist-27 (SCL-27) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). We collected substance use-related information using the Addiction Severity Index-Lite (ASI-lite).

LCA suggested four latent classes including an externalizing (10.8%), a moderately internalizing class (31.0%), and a highly internalizing class (22.0%), as well as a class with a lof patients, but also for their treatment, especially considering our results on differences in substance use.

Covid-19 confers substantial risk for the >400,000 patients who receive methadone for the treatment of opioid use disorder (OUD) and methods for safely dispensing large quantities of methadone to patients are lacking.

This study evaluated the MedMinder "Jon", an electronic and cellular-enabled pillbox that provides real-time monitoring to remotely manage take-home doses of methadone using a 12-week, within-subject, Phase II (NCT03254043) trial. We transitioned all participants from liquid to tablet methadone one week prior to randomization. Participants completed both treatment-as-usual and electronic pillbox conditions before choosing a condition in a final "choice phase". We assessed feasibility, satisfaction, and safety outcomes during the exit interview.

Overall, we randomized 25 participants, 24 (96.0%) completed >1 study session, and 21 (84.0%) completed the exit interview. We dispensed 167.92g (1,974 doses) of methadone. Participants would use the pillbox again (86.3%) and recommend it to onsing medication. Our data support remote monitoring of methadone take-home doses and may inform clinic practices related to Covid-19.Opioid use disorder has long been associated with psychiatric symptoms, including dissociative experiences. Medications used to treat opioid use disorder can potentially impact dissociative symptoms, but the existing literature has not explored this. We examined the relationship between dissociative symptoms and opioid use disorder using the Dissociative Experiences Scale (DES). We studied subjects who were taking prescribed methadone, buprenorphine, or naltrexone for opioid use disorder. We gave the DES, the Patient Health Questionairre-9 (PHQ-9), and the PTSD Checklist for DSM-5 (PCL-5) with Criterion A to subjects in three substance use treatment facilities in Ohio. We conducted Analysis of Variance (ANOVA) and Spearman's Rank Correlations to examine associations between the variables and outcomes. We developed three separate multiple linear regression models. We included 116 participants in our exploratory and naturalistic study. The majority of participants were female (51.7%), white (89.5%), ≤ 40 years tion scores, controlling for the other variables in the model. Dissociation scores were positively correlated with depression scores (r = 0.45; p less then .0001) and with PCL-5 scores (r = 0.51; p less then .0001). Our study highlights the importance of diagnosing and monitoring dissociative symptoms in individuals who are taking prescribed medications for opioid use disorder, especially since dissociative symptoms can interfere with substance use treatment.

Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. link3 Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes.

We randomized cannabis users with high DI (N=60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups.