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Pesquisa : N04.452.758.849.775 [Categoria DeCS]
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[PMID]:29181926
[Au] Autor:Haug MK; Willumsen J; Fossmo HL
[Ti] Título:Kjenner du de hemmelige tjenestene?.
[So] Source:Tidsskr Nor Laegeforen;137(22), 2017 11 28.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:nor
[Mh] Termos MeSH primário: Competência Clínica
Doenças Neuromusculares
Atenção Secundária à Saúde
[Mh] Termos MeSH secundário: Pessoal de Saúde/normas
Seres Humanos
Doenças Neuromusculares/diagnóstico
Doenças Neuromusculares/terapia
Encaminhamento e Consulta
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0882


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[PMID]:29244881
[Au] Autor:Tomkins S; Chapman C; Myland M; Tham R; de Nobrega R; Jackson B; Keshav S
[Ad] Endereço:NEMEA Centre of Excellence for Retrospective Studies, IQVIA, London, United Kingdom.
[Ti] Título:Treating iron deficiency in patients with gastrointestinal disease: Risk of re-attendance in secondary care.
[So] Source:PLoS One;12(12):e0189952, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with gastrointestinal disease may have comorbid iron deficiency anaemia (IDA) and an increased risk of hospitalisation and re-attendance in hospital. The purpose of this study was to determine if oral and intravenous (IV) treatment of IDA in patients with gastrointestinal disease attending hospital were associated with differential rates of subsequent re-attendance. METHODS AND FINDINGS: Data from the Clinical Practice Research Datalink (primary care) and Hospital Treatment Insights (secondary care) databases in England were used to conduct this retrospective cohort study. Patients with a coded gastrointestinal disease and IDA who attended hospital (inpatient or outpatient) and were dispensed oral or IV iron between 01/01/2010-31/10/2013 were included. Elective and emergency re-attendances in secondary care within 30 days of the initial attendance were determined. Demographics, medical diagnoses and treatments were extracted. Re-attendance rates following oral or IV iron were compared using chi-square tests and a step-wise logistic regression model to adjust for confounders. 2,844 patients contributed 6,294 initial attendances; 80% of patients received oral iron, 14% received intravenous iron, and 6% received both. Of initial attendances recording oral iron, 77% resulted in re-attendance in hospital, compared to 34% of those recording IV iron (unadjusted odds ratio [OR]: 0.16; adjusted OR: 0.52 [95% CI: 0.44-0.61]). Initial attendances using IV treatment were more likely to result in elective re-attendance (84%) than those recording oral treatment (43%) (p<0.001). Median length of stay in hospital tended to be shorter for patients using IV iron (1.4 days; interquartile range 0.5-3.6 days; oral iron: 5.1 days; interquartile range: 2.2-9.6 days). CONCLUSIONS: Patients with gastrointestinal disease and IDA who received IV iron were less likely to re-attend hospital, more likely to re-attend electively, and tended to have a shorter length of stay in hospital. The mode of IDA treatment could have a real-world impact on healthcare utilisation.
[Mh] Termos MeSH primário: Anemia Ferropriva/tratamento farmacológico
Gastroenteropatias/tratamento farmacológico
Ferro/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Anemia Ferropriva/complicações
Anemia Ferropriva/epidemiologia
Anemia Ferropriva/patologia
Serviço Hospitalar de Emergência
Inglaterra
Feminino
Gastroenteropatias/complicações
Gastroenteropatias/epidemiologia
Gastroenteropatias/patologia
Seres Humanos
Infusões Intravenosas
Ferro/deficiência
Ferro/metabolismo
Modelos Logísticos
Masculino
Meia-Idade
Aceitação pelo Paciente de Cuidados de Saúde
Atenção Secundária à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
E1UOL152H7 (Iron)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189952


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[PMID]:27772554
[Au] Autor:Maatz A; Wainwright M; Russell AJ; Macnaughton J; Yiannakou Y
[Ad] Endereço:Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, Zurich CH-8032, Switzerland. Electronic address: anke.maatz@puk.zh.ch.
[Ti] Título:What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.
[So] Source:J Psychosom Res;90:1-9, 2016 11.
[Is] ISSN:1879-1360
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. SETTING: Three NHS trust secondary care hospitals in North-East England. PARTICIPANTS: 17 senior clinicians from seven medical and two surgical specialities. RESULTS: Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. CONCLUSIONS: This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
[Mh] Termos MeSH primário: Sintomas Inexplicáveis
Médicos/normas
Pesquisa Qualitativa
Atenção Secundária à Saúde/normas
Especialização/normas
[Mh] Termos MeSH secundário: Adulto
Assistência à Saúde
Inglaterra/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Médicos/psicologia
Atenção Secundária à Saúde/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28881249
[Au] Autor:Smith AF; Hall PS; Hulme CT; Dunn JA; McConkey CC; Rahman JK; McCabe C; Mehanna H
[Ad] Endereço:Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK; National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK. Electronic address: a.f.c.smith@leeds.ac.uk.
[Ti] Título:Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.
[So] Source:Eur J Cancer;85:6-14, 2017 Nov.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. METHODS: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. RESULTS: PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. CONCLUSIONS: This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/diagnóstico por imagem
Carcinoma de Células Escamosas/economia
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Neoplasias de Cabeça e Pescoço/economia
Custos de Cuidados de Saúde
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/economia
[Mh] Termos MeSH secundário: Carcinoma de Células Escamosas/mortalidade
Carcinoma de Células Escamosas/terapia
Quimiorradioterapia Adjuvante/economia
Simulação por Computador
Redução de Custos
Análise Custo-Benefício
Técnicas de Apoio para a Decisão
Feminino
Neoplasias de Cabeça e Pescoço/mortalidade
Neoplasias de Cabeça e Pescoço/terapia
Seres Humanos
Masculino
Cadeias de Markov
Modelos Econômicos
Esvaziamento Cervical/economia
Terapia Neoadjuvante/economia
Valor Preditivo dos Testes
Anos de Vida Ajustados por Qualidade de Vida
Atenção Secundária à Saúde/economia
Medicina Estatal/economia
Fatores de Tempo
Resultado do Tratamento
Reino Unido
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE


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[PMID]:28640732
[Au] Autor:Hill B
[Ad] Endereço:Senior Lecturer, Northumbria University.
[Ti] Título:Do nurse staffing levels affect patient mortality in acute secondary care?
[So] Source:Br J Nurs;26(12):698-704, 2017 Jun 22.
[Is] ISSN:0966-0461
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This systematic literature review explores and considers whether registered nurse staffing levels affect patient mortality in acute secondary care settings. A discussion makes particular reference to the philosophical foundations of contrasting research approaches used within the literature. At the time of writing, the author was a modern matron for surgery, managing the ear, nose and throat; head and neck; airway; and reconstructive plastic surgery services in a large acute teaching hospital in central London. Effective management and leadership of acute clinical areas requires appropriate nurse:patient ratios. In practice settings, patient to staff ratios are based on care being provided by highly skilled and competent nurses providing best-quality, evidence-based practice.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Recursos Humanos de Enfermagem no Hospital/provisão & distribuição
Segurança do Paciente/estatística & dados numéricos
Admissão e Escalonamento de Pessoal/organização & administração
Qualidade da Assistência à Saúde/organização & administração
Atenção Secundária à Saúde/organização & administração
Atenção Secundária à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Medicina Estatal/estatística & dados numéricos
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.12968/bjon.2017.26.12.698


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[PMID]:28610625
[Au] Autor:Jiao F; Wong CKH; Gangwani R; Tan KCB; Tang SCW; Lam CLK
[Ad] Endereço:Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, Hong Kong. francesj@connect.hku.hk.
[Ti] Título:Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications.
[So] Source:Health Qual Life Outcomes;15(1):125, 2017 Jun 13.
[Is] ISSN:1477-7525
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Health-related quality of life (HRQoL) and health preference of patients with diabetes mellitus (DM) are essential in health economic evaluations but data on Chinese population is rare. This study aims to evaluate HRQoL and health preference of diabetic patients with different diabetic complications in Chinese population. METHODS: A cross-sectional study was conducted in 1275 patients with DM, including 518 subjects with various DM-related complications. HRQoL and health preference were estimated using SF-12 and SF-6D questionnaires, respectively. Disease status of DM and complications were identified from documented clinical diagnosis. Multivariable regression was used to investigate the effects of specific complications on HRQoL and health preference, adjusting for socio-demographic and clinical parameters. RESULTS: The presence of any diabetic complication was associated with lower physical component summary (-3.81 points, P < 0.01), and end-stage renal disease (ESRD) showed greatest reduction (-7.05 points, P < 0.01). Mental component summary and mental health (MH) scores were not decreased in any of the diabetic complications. The health preference score for diabetic subjects without complications was 0.882 (95% CI, 0.778 to 0.989). The reductions of health preference score were significant for stroke (-0.042, 95% CI -0.072 to -0.012), ESRD (-0.055, 95% CI -0.093 to -0.017), and sight-threatening diabetic retinopathy (STDR) (-0.043, 95% CI -0.075 to -0.010), while heart disease had an insignificant reduction (-0.017, 95% CI -0.042 to 0.008). CONCLUSIONS: The presence of any of the four major diabetic complications (heart disease, stroke, ESRD and STDR) was associated with lower HRQoL and health preference scores. Findings of this study facilitated the cost-effectiveness studies of alternative management strategies for prevention of diabetic complications in Chinese population.
[Mh] Termos MeSH primário: Complicações do Diabetes/psicologia
Qualidade de Vida/psicologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Feminino
Hong Kong
Seres Humanos
Masculino
Meia-Idade
Atenção Primária à Saúde
Atenção Secundária à Saúde
Inquéritos e Questionários
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1186/s12955-017-0699-4


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[PMID]:28483284
[Au] Autor:Zoubian A; Bertoletti L; Frappé P
[Ad] Endereço:Université Jean-Monnet, faculté Jacques-Lisfranc, département de médecine générale, 42000 Saint-Étienne, France.
[Ti] Título:After deep vein thrombosis, which patients refer to vascular specialist for anticoagulant withdrawal? A Delphi study results between general practitioners and vascular specialists.
[So] Source:Presse Med;46(5):e77-e83, 2017 May.
[Is] ISSN:2213-0276
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:AIM: Deep vein thrombosis (DVT) is a potential serious common disease. Its management is, except in particular cases, on an outpatient basis. General practitioner's (GP) role usually includes the treatment risk/benefit reassessment. The treatment duration can vary and is difficult to define. The national and international guidelines do not explain clearly when to refer, or not, to a vascular specialist in order to stop treatment. The study's objective was to identify, for DVT, when a GP has to refer or not to a vascular specialist, for anticoagulant withdrawal. METHODS: A modified Delphi consensus study had been conducted by a panel of general practitioners and vascular specialists to identify, in which situations all clinicians agree that GPs can stop anticoagulation on their own and other situations in which GP have to refer to vascular specialists. Clinical situations and their respective duration of anticoagulant therapy have been identified by a DVT management guideline literature research. RESULTS: After two rounds, a strong agreement had been reached for each clinical situation. For 7 clinical situations, GPs were able to stop anticoagulation on their own, for 13 clinical situations; it was necessary to refer to a vascular specialist. We obtained a consensus regarding 3 modulating factors. DISCUSSION: Consensual situations, in which the general practitioners may be able to stop anticoagulation themselves, are isolated distal DVT without cancer and proximal DVT caused by a major reversible risk factor. Situations justifying a vascular medical advice were unprovoked DVT, DVT in a context of pregnancy, postpartum, cancer and proximal DVT in a context of hormonal therapy.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Cardiologistas
Tomada de Decisão Clínica
Médicos de Atenção Primária
Encaminhamento e Consulta
Trombose Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Técnica Delfos
Feminino
França
Seres Humanos
Masculino
Meia-Idade
Atenção Secundária à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE


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[PMID]:28394242
[Au] Autor:Sampson R; MacVicar R; Wilson P
[Ad] Endereço:a Cairn Medical Practice , Inverness , Scotland.
[Ti] Título:Development of an interface-focused educational complex intervention.
[So] Source:Educ Prim Care;28(5):265-273, 2017 Sep.
[Is] ISSN:1475-990X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In many countries, the medical primary-secondary care interface is central to the delivery of quality patient care. There is prevailing interest in developing initiatives to improve interface working for the benefit of health care professionals and their patients. AIM: To describe the development of an educational intervention designed to improve working at the primary-secondary care interface in NHS Scotland (United Kingdom) within the context of the Medical Research Council framework for the development and evaluation of complex interventions. METHODS: A primary-secondary care interface focused Practice-based Small Group Learning (PBSGL) module was developed building upon qualitative synthesis and original research. A 'meeting of experts' shaped the module, which was subsequently piloted with a group of interface clinicians. Reflections on the module were sought from clinicians across NHS Scotland to provide contextual information from other areas. FINDINGS: The PBSGL approach can be usefully applied to the development of a primary-secondary care interface-focused medical educational intervention.
[Mh] Termos MeSH primário: Educação Médica Continuada
Clínicos Gerais/educação
Atenção Primária à Saúde/métodos
Atenção Secundária à Saúde
Desenvolvimento de Pessoal/organização & administração
[Mh] Termos MeSH secundário: Assistência à Saúde
Seres Humanos
Assistência ao Paciente
Escócia
Reino Unido
[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:170411
[St] Status:MEDLINE
[do] DOI:10.1080/14739879.2017.1309690


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[PMID]:28367789
[Au] Autor:Carrion Martin AI; Pebody RG; Danis K; Ellis J; Niazi S; DE Lusignan S; Brown KE; Zambon M; Allen DJ
[Ad] Endereço:European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC),Stockholm,Sweden.
[Ti] Título:The emergence of enterovirus D68 in England in autumn 2014 and the necessity for reinforcing enterovirus respiratory screening.
[So] Source:Epidemiol Infect;145(9):1855-1864, 2017 07.
[Is] ISSN:1469-4409
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:In autumn 2014, enterovirus D68 (EV-D68) cases presenting with severe respiratory or neurological disease were described in countries worldwide. To describe the epidemiology and virological characteristics of EV-D68 in England, we collected clinical information on laboratory-confirmed EV-D68 cases detected in secondary care (hospitals), between September 2014 and January 2015. In primary care (general practitioners), respiratory swabs collected (September 2013-January 2015) from patients presenting with influenza-like illness were tested for EV-D68. In secondary care 55 EV-D68 cases were detected. Among those, 45 cases had clinical information available and 89% (40/45) presented with severe respiratory symptoms. Detection of EV-D68 among patients in primary care increased from 0.4% (4/1074; 95% CI 0.1-1.0) (September 2013-January 2014) to 0.8% (11/1359; 95% CI 0.4-1.5) (September 2014-January 2015). Characterization of EV-D68 strains circulating in England since 2012 and up to winter 2014/2015 indicated that those strains were genetically similar to those detected in 2014 in USA. We recommend reinforcing enterovirus surveillance through screening respiratory samples of suspected cases.
[Mh] Termos MeSH primário: Enterovirus Humano D/isolamento & purificação
Infecções por Enterovirus/epidemiologia
Infecções Respiratórias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Inglaterra/epidemiologia
Infecções por Enterovirus/diagnóstico
Infecções por Enterovirus/virologia
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Programas de Rastreamento
Meia-Idade
Filogenia
Prevalência
Atenção Primária à Saúde
Infecções Respiratórias/diagnóstico
Infecções Respiratórias/virologia
Estações do Ano
Atenção Secundária à Saúde
Proteínas Virais de Fusão/genética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Viral Fusion Proteins)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171125
[Lr] Data última revisão:
171125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1017/S0950268817000590


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[PMID]:28355424
[Au] Autor:Fusar-Poli P; Rutigliano G; Stahl D; Davies C; Bonoldi I; Reilly T; McGuire P
[Ad] Endereço:Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England2Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trus
[Ti] Título:Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis.
[So] Source:JAMA Psychiatry;74(5):493-500, 2017 May 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective: To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants: Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures: Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results: A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance: This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.
[Mh] Termos MeSH primário: Transtornos Mentais/epidemiologia
Serviços de Saúde Mental
Transtornos Psicóticos/epidemiologia
Sistema de Registros/estatística & dados numéricos
Medição de Risco/métodos
Atenção Secundária à Saúde/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seguimentos
Seres Humanos
Internet
Londres/epidemiologia
Masculino
Meia-Idade
Prognóstico
Transtornos Psicóticos/diagnóstico
Reprodutibilidade dos Testes
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170330
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.0284



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