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[PMID]:29489684
[Au] Autor:Mongaret C; Quillet P; Vo TH; Aubert L; Fourgeaud M; Michelet-Huot E; Bonnet M; Bedouch P; Slimano F; Gangloff SC; Drame M; Hettler D
[Ad] Endereço:Pharmacy Department, University Hospital of Reims, Rue du General Koenig.
[Ti] Título:Predictive factors for clinically significant pharmacist interventions at hospital admission.
[So] Source:Medicine (Baltimore);97(9):e9865, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pharmaceutical care activities at hospital admission have a significant impact on patient safety. The objective of this study was to identify predictive factors for clinically significant pharmacist interventions (PIs) performed during medication reconciliation and medication review at patient hospital admission.A 4-week prospective study was conducted in 4 medicine wards. At hospital admission, medication reconciliation and medication review were conducted and PIs were performed by the pharmaceutical team. The clinical impact of PIs was determined using the clinical economic and organizational (CLEO) tool. Clinical characteristics, laboratory results, and medication data for each patient were collected and analyzed as potential predictive factors of clinically significant PIs. Univariate and multivariate binary logistic regression were subsequently used to identify independent predictive factors for clinically relevant PIs.Among 265 patients admitted, 150 patients were included. Among 170 PIs performed at hospital admission, 71 were related to unintentional discrepancies (41.8%) during medication reconciliation, and 99 were related to drug-related problems (DRPs) (58.8%) during medication review. Overall, 115 PIs (67.7%) were considered to have a clinical impact. By multivariate analysis, number of medications ≥5 (P = .01) based on the best possible medication history, and Charlson comorbidity index score ≥2 (P < .01) were found to be independent predictive factors of clinically significant PIs at hospital admission.Identifying predictive factors of clinically significant PIs is valuable to optimize clinical pharmacist practices at hospital admission during both medication reconciliation and medication review. These 2 steps of the pharmaceutical care process improve medication safety at hospital admission.
[Mh] Termos MeSH primário: Erros de Medicação/estatística & dados numéricos
Reconciliação de Medicamentos/métodos
Admissão do Paciente/estatística & dados numéricos
Serviço de Farmácia Hospitalar/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009865


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[PMID]:28453819
[Au] Autor:Cheen MHH; Goon CP; Ong WC; Lim PS; Wan CN; Leong MY; Khee GY
[Ad] Endereço:Department of Pharmacy, Singapore General Hospital, Singapore.
[Ti] Título:Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions.
[So] Source:Int J Qual Health Care;29(2):200-205, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: This study aimed to determine whether pharmacist-provided home-based medication review (HBMR) can reduce readmissions in the elderly. Design: Retrospective cohort study. Setting: Patient's home. Participants: Records of patients referred to a care transition program from March 2011 through March 2015 were reviewed. Patients aged 60 years and older taking more than 5 medications and had at least 2 unplanned admissions within 3 months preceding the first home visit were included. Intervention: Pharmacist-provided HBMR. Main outcome measures: Primary outcome was readmission rate over 6 months after the first home visit. Secondary outcomes included emergency department (ED) visits, outpatient visits and mortality. Drug-related problems (DRPs) were reported for the HBMR group. Multivariate incidence rate ratios (IRR) and hazard ratio (HR) were calculated with adjustments for covariates. Results: The study included 499 patients (97 HBMR, 402 no HBMR). Pharmacist-provided HBMR reduced readmissions by 26% (IRR = 0.74, 95% CI: 0.59-0.92, P = 0.007), reduced ED visits by 20% (IRR = 0.80, 95% CI: 0.66-0.98, P = 0.030) and increased outpatient visits by 16% (IRR = 1.16, 95% CI: 0.95-1.41, P = 0.150). There were 8 and 44 deaths in the HBMR and no HBMR groups respectively (HR = 0.73, 95% CI: 0.29-1.81, P = 0.492). Pharmacists identified 464 DRPs, with 169 (36.4%) resolved within 1 month after the home visit. Conclusions: The study suggests that pharmacist-provided HBMR is effective in reducing readmissions and ED visits in the elderly. More studies in the Asian population are needed to determine its long term benefits and patient's acceptability.
[Mh] Termos MeSH primário: Reconciliação de Medicamentos/métodos
Alta do Paciente
Readmissão do Paciente/estatística & dados numéricos
Farmacêuticos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Serviço Hospitalar de Emergência/utilização
Feminino
Seres Humanos
Masculino
Meia-Idade
Mortalidade
Serviço de Farmácia Hospitalar/métodos
Estudos Retrospectivos
Singapura
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzw150


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[PMID]:29292924
[Au] Autor:Nyhlén L; Modig S
[Ad] Endereço:SUS Primärvård/ VO Omkretsen - Lomma vårdcentral Lomma, Sweden SUS Primärvård/ VO Omkretsen - Lomma vårdcentral Lomma, Sweden.
[Ti] Título:Tidsbrist största hindret för att utföra basal läke­medelsgenomgång - Enkätstudie till primärvårdsläkare i Region Skåne..
[So] Source:Lakartidningen;114, 2017 Nov 09.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Clinical medication reviews can be useful in improving pharmacotherapy for elderly. This study aimed to investigate the view and knowledge of clinical medication reviews among primary care physicians in order to identify perceived barriers and facilitating factors. Data were collected via a questionnaire given to primary care physicians in southern Sweden. Eight out of ten of the respondents were familiar with the concept of clinical medication review, and four out of ten of these, used the method on a regular basis. Lack of time was identified as the greatest impeding factor. Although necessary for a medication review, medication reconciliation was often lacking. Regardless of the theoretical knowledge of medications which are potentially inappropriate for elderly, the respondents still perceived difficulties in decisions made for the individual patient. Further education about medication reviews should be offered to primary care physicians, irrespective of time in the profession.
[Mh] Termos MeSH primário: Reconciliação de Medicamentos
Médicos de Atenção Primária
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Competência Clínica
Feminino
Clínicos Gerais
Seres Humanos
Masculino
Reconciliação de Medicamentos/métodos
Reconciliação de Medicamentos/normas
Reconciliação de Medicamentos/utilização
Meia-Idade
Médicos de Família
Inquéritos e Questionários
Suécia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE


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[PMID]:29233279
[Au] Autor:Mead T; Schauner S
[Ad] Endereço:Goppert-Trinity Family Care, Kansas City, MO 64131, USA; University of Missouri-Kansas City School of Pharmacy, Kansas City, MO 64108, USA. Electronic address: meadt@umkc.edu.
[Ti] Título:Pharmacy student engagement in the evaluation of medication documentation within an ambulatory care electronic medical record.
[So] Source:Curr Pharm Teach Learn;9(3):415-420, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: An abundance of literature supports the benefits of electronic medical records (EMR) for improving overall healthcare quality. Identifying preventative care opportunities, reducing medical and medication related errors and incorporating clinical practice guidelines are just a few attributes of EMR implementation. The goals of this study were to engage experiential pharmacy students in the assessment of medication related documentation discrepancies in a newly implemented EMR system and to provide exposure to various aspects of conducting research. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy students screened patient charts over a three-month period to identify documentation discrepancies, including omissions of medications and medical problems and duplication of medications. Students conducted medication reconciliation for a total of one-hundred thirty-four patients. FINDINGS: Medication omissions were identified for 46% of patients, medical problem omissions were identified for 38% of patients, and thirty-two duplicate medications were identified. SUMMARY: Engaging pharmacy students in the quality improvement project afforded an interactive learning experience, highlighting firsthand the challenges associated with electronic documentation and the associated potential negative implications to patient care. Additionally, students gained exposure to various components of research including data collection, assessment, entry, analysis and future implications.
[Mh] Termos MeSH primário: Documentação/normas
Registros Eletrônicos de Saúde/normas
Garantia da Qualidade dos Cuidados de Saúde
Estudantes de Farmácia
[Mh] Termos MeSH secundário: Assistência Ambulatorial
Prescrições de Medicamentos
Feminino
Seres Humanos
Masculino
Erros de Medicação/prevenção & controle
Reconciliação de Medicamentos
Meia-Idade
Melhoria de Qualidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28457021
[Au] Autor:Nielsen TRH; Honoré PH; Rasmussen M; Andersen SE
[Ad] Endereço:Region Zealand Hospital Pharmacy, Logistics and Clinical Pharmacy, Roskilde, Denmark.
[Ti] Título:Clinical Effects of a Pharmacist Intervention in Acute Wards - A Randomized Controlled Trial.
[So] Source:Basic Clin Pharmacol Toxicol;121(4):325-333, 2017 Oct.
[Is] ISSN:1742-7843
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to investigate the clinical effect of a clinical pharmacist (CP) intervention upon admission to hospital on inpatient harm and to assess a potential educational bias. Over 16 months, 593 adult patients taking ≥4 medications daily were included from three Danish acute medicine wards. Patients were randomized to either the CP intervention or the usual care (prospective control). To assess a potential educational bias, a retrospective control group was formed by randomization. The CP intervention comprised medication history, medication reconciliation, medication review and entry of proposed prescriptions into the electronic prescribing system. The primary outcome of inpatient harm was identified using triggers from the Institute of Healthcare Improvement Global Trigger Tool. Harms were validated and rated for severity by two independent and blinded outcome panels. Secondary end-points were harms per patient, length of hospital stay, readmissions and 1-year mortality. Harm affected 11% of the patients in the intervention group compared to 17% in the combined control group, odds ratio (OR) 0.57 (CI 0.32-1.02, p = 0.06). The incidence of harm was similar in the intervention and prospective control groups, OR 0.80 (CI 0.40-1.59, p = 0.52) but occurred less frequently in the intervention than in the retrospective control group OR 0.46 (CI 0.25-0.85, p = 0.01). An educational bias from the intervention to the control group might have contributed to this negative outcome. In conclusion, the CP intervention at admission to hospital had no statistically significant effect on inpatient harm.
[Mh] Termos MeSH primário: Prescrição Eletrônica
Pacientes Internados
Reconciliação de Medicamentos
Sistemas de Medicação no Hospital
Conduta do Tratamento Medicamentoso
Farmacêuticos
Serviço de Farmácia Hospitalar
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Dinamarca
Interações Medicamentosas
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Feminino
Seres Humanos
Tempo de Internação
Masculino
Erros de Medicação/prevenção & controle
Meia-Idade
Admissão do Paciente
Segurança do Paciente
Polimedicação
Estudos Prospectivos
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE
[do] DOI:10.1111/bcpt.12802


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[PMID]:29049325
[Au] Autor:Wang JS; Fogerty RL; Horwitz LI
[Ad] Endereço:Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, United States of America.
[Ti] Título:Effect of therapeutic interchange on medication reconciliation during hospitalization and upon discharge in a geriatric population.
[So] Source:PLoS One;12(10):e0186075, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Therapeutic interchange of a same class medication for an outpatient medication is a widespread practice during hospitalization in response to limited hospital formularies. However, therapeutic interchange may increase risk of medication errors. The objective was to characterize the prevalence and safety of therapeutic interchange. METHODS AND FINDINGS: Secondary analysis of a transitions of care study. We included patients over age 64 admitted to a tertiary care hospital between 2009-2010 with heart failure, pneumonia, or acute coronary syndrome who were taking a medication in any of six commonly-interchanged classes on admission: proton pump inhibitors (PPIs), histamine H2-receptor antagonists (H2 blockers), hydroxymethylglutaryl CoA reductase inhibitors (statins), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and inhaled corticosteroids (ICS). There was limited electronic medication reconciliation support available. Main measures were presence and accuracy of therapeutic interchange during hospitalization, and rate of medication reconciliation errors on discharge. We examined charts of 303 patients taking 555 medications at time of admission in the six medication classes of interest. A total of 244 (44.0%) of medications were therapeutically interchanged to an approved formulary drug at admission, affecting 64% of the study patients. Among the therapeutically interchanged drugs, we identified 78 (32.0%) suspected medication conversion errors. The discharge medication reconciliation error rate was 11.5% among the 244 therapeutically interchanged medications, compared with 4.2% among the 311 unchanged medications (relative risk [RR] 2.75, 95% confidence interval [CI] 1.45-5.19). CONCLUSIONS: Therapeutic interchange was prevalent among hospitalized patients in this study and elevates the risk for potential medication errors during and after hospitalization. Improved electronic systems for managing therapeutic interchange and medication reconciliation may be valuable.
[Mh] Termos MeSH primário: Hospitalização
Reconciliação de Medicamentos
Alta do Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186075


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[PMID]:29019898
[Au] Autor:Elysee G; Herrin J; Horwitz LI
[Ad] Endereço:aHealth Information Technology Programs, Department of Computer Technology, Benjamin Franklin Institute of Technology, Boston, MA bSection of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT cDivision of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
[Ti] Título:An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
[So] Source:Medicine (Baltimore);96(41):e8274, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. Against this backdrop, we assessed the relationships between the 3 capabilities.We conducted an observational study applying partial least squares-structural equation modeling technique to 27 variables obtained from the 2013 American Hospital Association annual survey Information Technology (IT) supplement, which describes health IT capabilities.We included 1330 hospitals. In confirmatory factor analysis, out of the 27 variables, 15 achieved loading values greater than 0.548 at P < .001, as such were validated as the building blocks of the 3 capabilities. Subsequent path analysis showed a significant, positive, and cyclic relationship between the capabilities, in that decreases in the hospitals' adoption of one would lead to decreases in the adoption of the others.These results show that capability for high quality medication reconciliation may be impeded by lagging adoption of interoperability and health information exchange capabilities. Policies focused on improving one or more of these capabilities may have ancillary benefits.
[Mh] Termos MeSH primário: Disseminação de Informação/métodos
Reconciliação de Medicamentos
Sistemas de Medicação no Hospital/normas
[Mh] Termos MeSH secundário: Registros Eletrônicos de Saúde/estatística & dados numéricos
Seres Humanos
Registro Médico Coordenado/métodos
Reconciliação de Medicamentos/métodos
Reconciliação de Medicamentos/organização & administração
Determinação de Necessidades de Cuidados de Saúde
Melhoria de Qualidade/organização & administração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008274


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[PMID]:28898375
[Au] Autor:Rose AJ; Fischer SH; Paasche-Orlow MK
[Ad] Endereço:RAND Corporation, Boston, Massachusetts.
[Ti] Título:Medication Reconciliation vs Medication Review-Reply.
[So] Source:JAMA;318(10):966, 2017 09 12.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Reconciliação de Medicamentos
Alta do Paciente
[Mh] Termos MeSH secundário: Seres Humanos
Erros de Medicação
Readmissão do Paciente
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.10560


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[PMID]:28898372
[Au] Autor:Zimmerman KM; Salgado TM; Dixon DL
[Ad] Endereço:Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond.
[Ti] Título:Medication Reconciliation vs Medication Review.
[So] Source:JAMA;318(10):965-966, 2017 09 12.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Reconciliação de Medicamentos
Alta do Paciente
[Mh] Termos MeSH secundário: Seres Humanos
Erros de Medicação
Readmissão do Paciente
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.10552


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[PMID]:28895657
[Au] Autor:Kerr WT; Janio EA; Braesch CT; Le JM; Hori JM; Patel AB; Gallardo NL; Bauirjan J; D'Ambrosio SR; Chau AM; Hwang ES; Davis EC; Buchard A; Torres-Barba D; Al Banna M; Barritt SE; Cho AY; Engel J; Cohen MS; Stern JM
[Ad] Endereço:Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, California, U.S.A.
[Ti] Título:Identifying psychogenic seizures through comorbidities and medication history.
[So] Source:Epilepsia;58(11):1852-1860, 2017 Nov.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Low-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost. METHODS: Based on data from 1,365 adult patients with video-electroencephalography-confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications, and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizurelike events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database. RESULTS: Our model differentiated PNES only from ES only with a prospective accuracy of 78% (95% confidence interval =72-84%) and area under the curve of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain, and migraines (p < 0.01). Comorbidities associated with ES were diabetes mellitus and nonmetastatic neoplasm (p < 0.01). The population-level analysis suggested that patients with mixed PNES and ES may be a population distinct from patients with either condition alone. SIGNIFICANCE: An accurate patient-reported medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history.
[Mh] Termos MeSH primário: Reconciliação de Medicamentos/métodos
Convulsões/diagnóstico
Convulsões/tratamento farmacológico
Transtornos Somatoformes/diagnóstico
Transtornos Somatoformes/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Comorbidade
Eletroencefalografia/métodos
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Estudos Retrospectivos
Convulsões/psicologia
Transtornos Somatoformes/psicologia
Gravação em Vídeo/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13888



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