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1.
Eur J Dent Educ ; 24(1): 71-78, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31518469

RESUMEN

BACKGROUND: Despite efforts to promote the effective use of the WHO surgical safety checklist, wrong tooth extractions have continued to occur within dentistry. METHOD: A training initiative combined methods of teaching comprising of a presentation, video and simulation to deliver LocSSIP training at an Oral Surgery Department of a UK dental hospital. Participant feedback was analysed to determine their perception of using combined methods to deliver the training. RESULT: Overall feedback was very positive with regard to relevance of the training, and its ability to meet the learning needs of all participants. Participants advocated that there should be regular re-training and incorporation of this training into the local induction programme. Almost About 94% of staff members Strongly Agreed or Agreed that they would recommend this format of training to other departments. CONCLUSION: Effective training is essential to maintain safe clinical practice within health care, and training methods that are inclusive of various learning styles are well received.


Asunto(s)
Lista de Verificación , Errores Médicos , Odontología , Humanos , Seguridad del Paciente , Extracción Dental
3.
Codas ; 32(2): e20190046, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31851217

RESUMEN

PURPOSE: Describe the implementation process of the International Classification of Functioning, Disability and Health (ICF) in a Specialized Rehabilitation Center based on the biopsychosocial approach to health. METHODS: This is a descriptive, analytical, longitudinal study. The ICF implementation process in the healthcare center encompassed four stages: a) training on the use of the ICF; b) preparation of checklists by the team; c) collection of relevant data based on the checklist from the healthcare center users; and d) construction of a database. RESULTS: A checklist was constructed for each sector involved, and the database included user information and the ICF results during evaluation and reevaluation. The findings indicate higher problem-solving capacity in all sectors throughout the study period, and that training was crucial to operationalize the ICF. Preparation of the instruments based on the reality of the healthcare center was essential to meet local demands and those of each sector. CONCLUSION: The ICF enabled greater practice of the biopsychosocial approach based on the engagement of the professionals in its operationalization, with evidence of healthcare problem-solving capacity and visibility and organization of the work process.


Asunto(s)
Personas con Discapacidad , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud/instrumentación , Creación de Capacidad , Lista de Verificación , Prestación de Atención de Salud , Evaluación de la Discapacidad , Personas con Discapacidad/rehabilitación , Femenino , Humanos , Estudios Longitudinales , Masculino , Centros de Rehabilitación
4.
Zentralbl Chir ; 144(6): 587-596, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31826293

RESUMEN

INTRODUCTION: In many locations, communication between patients and doctors is already actively taught as part of undergraduate medicine at many. Informed consent prior to surgery is a particular reason for communication that calls for differentiated feedback to students. Within the framework of communication training, the aim was to compare the feedback given from 5 different sources (by a medical expert, by tutors, by student peers, by the student obtaining informed consent and by the simulated patients) using evaluation checklists. MATERIALS AND METHODS: 171 medical students in their eighth semester at the University of Würzburg participated in a training module in obtaining informed consent prior to surgery. 50 students out of this group conducted a conversation. The emphasis laid on "communication" and "risks". Students were able to prepare using teaching materials from the University's own e-learning platform. The statistical evaluation focussed on assessing the test quality of the checklists, the scores in the scales, and interrater agreement based on the intraclass correlation coefficient. RESULTS: The checklists delivered satisfactory test values with respect to internal consistency, item difficulty and discriminatory index. The average scores from the five raters only differed significantly with respect to communicative skills, whereby the students seeking informed consent were strict in their self-assessment. The student raters where highly consistent with the expert rater. With respect to "risks and complications", there was high agreement between all raters. DISCUSSION/CONCLUSION: We were able to demonstrate that, within the highly specific setting of a simulation and after subtile preparation, a trained student tutor can provide just as effective feedback as a medical expert. Feedback from tutors or peers may be furnished with greater prominence in future, given the overall high agreement in the 360-degree feedback.


Asunto(s)
Consentimiento Informado , Estudiantes de Medicina , Lista de Verificación , Competencia Clínica , Comunicación , Humanos
6.
Medicine (Baltimore) ; 98(49): e18201, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804343

RESUMEN

BACKGROUND: Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation. METHODS: A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance. RESULTS: Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ±â€Š0.96) at HEP and 3.54 (SD ±â€Š0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ±â€Š1.24) at HEP and 2.21 (SD ±â€Š1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ±â€Š0.98) at HEP and 4.47 (SD ±â€Š0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ±â€Š1.82) versus 10.22 (SD ±â€Š1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.


Asunto(s)
Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/normas , Liderazgo , Grupo de Atención al Paciente/normas , Postura , Mejoramiento de la Calidad , Adulto , Lista de Verificación , Estudios Transversales , Toma de Decisiones , Educación de Postgrado en Medicina , Femenino , Humanos , Malasia , Masculino , Proyectos Piloto , Entrenamiento Simulado , Encuestas y Cuestionarios , Grabación en Video
7.
Soins ; 64(840): 11-16, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31847962

RESUMEN

In surgery and anaesthesia safety rules and criteria must be respected. Checks need to be made by caregivers at certain stages. The patient should also be involved in these checks. The surgical patient self-check list is the tool used in this approach.


Asunto(s)
Lista de Verificación , Seguridad del Paciente , Cuidadores , Humanos , Pacientes
8.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 58-66, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31767377

RESUMEN

OBJECTIVE: Potential sources for errors or critical incidents in healthcare may arise not just within a healthcare facility, but also between healthcare facilities (e. g., in the communication between in- and outpatient care). This study aims to test the content validity of the reporting sheet and to optimize the cross-sectoral critical incident reporting system (CIRS-CS). METHOD: The CIRS-CS was developed as a part of the project "solimed ePflegebericht" based on the expertise of the participating organizations as well as existing literature and existing reporting systems (e. g., the recommendations of the "German Coalition for Patient Safety"). In addition, a pre-test was conducted among the organizations participating in the "solimed ePflegebericht" to assess the content validity of the reporting sheet. Content validity was assessed using cognitive interviews (N=11) with health professionals. The interviews were conducted on the basis of predefined scenarios and probing questions. RESULTS: The reporting sheet that was used for the pre-test consisted of 16 components such as reason for reporting/description of the problem, location of the patient at the time of reporting and suggested solution to the problem. The results of the pre-test indicated that participants found it challenging to relate to components such as In which type of healthcare service did the problem occur, What was the cause of the problem and Which factors contributed to the problem. For instance, some participants found it difficult to decide in which type of healthcare service (e. g., emergency care, routine care) the underlying problem occurred as this component could be reported from different perspectives, i. e. where the incident arose versus where the problem occurred. Thus, depending on the interpretation of this component, the participants questioned the feasibility since there was a lack of knowledge as to under which circumstances the incident arose. CONCLUSION: The results of the pre-test of the CIRS-CS suggest that the description of the causes as well as potential solutions via the cross-sectoral reporting sheet is unfeasible and may be better approached with an interdisciplinary investigation team panel as part of the reporting system, in which the participating representatives are able to enter a structured dialogue based on the reported problems. Furthermore, the results indicate that investigation team panels enable an interprofessional exchange and may thus promote transparency between healthcare facilities. At this point, there is little research on the content validity of reporting sheets for cross-sectoral reporting systems. Hence, our results may contribute to the development of comprehensible and feasible cross-sectoral CIRS.


Asunto(s)
Prestación de Atención de Salud , Servicios Médicos de Urgencia , Seguridad del Paciente , Gestión de Riesgos , Lista de Verificación , Alemania , Humanos , Gestión de Riesgos/métodos , Gestión de Riesgos/normas , Autoevaluación
9.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 120-126, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31757658

RESUMEN

OBJECTIVE: To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING: Literature review followed by group discussions and consensus building. RESULTS: The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION: Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.


Asunto(s)
Lista de Verificación , Equidad en Salud , Guías de Práctica Clínica como Asunto , Consenso , Alemania , Humanos
10.
Zhonghua Nei Ke Za Zhi ; 58(11): 829-831, 2019 Nov 01.
Artículo en Chino | MEDLINE | ID: mdl-31665860

RESUMEN

The study was to investigate whether the application of checklist during ward rounds could improve the prognosis of critical ill patients.The results suggested that the checklist used during ward rounds could not improve the inhospital mortality of critically ill patients, but it increased the proportion of deep vein thrombosis prophylaxis, and shortened prophylaxis treatment of gastric stress ulcer.


Asunto(s)
Lista de Verificación/métodos , Rondas de Enseñanza , China , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Mortalidad Hospitalaria , Humanos , Pronóstico , Rondas de Enseñanza/métodos , Rondas de Enseñanza/normas
11.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 619-626, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31721598

RESUMEN

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations.


Asunto(s)
Equipos y Suministros/economía , Modelos Económicos , Evaluación de la Tecnología Biomédica/métodos , Lista de Verificación , Análisis Costo-Beneficio/métodos , Humanos , Evaluación de la Tecnología Biomédica/economía
12.
Int Heart J ; 60(6): 1366-1372, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735775

RESUMEN

The Kihon Checklist (KCL) is a reliable tool for determining frailty status in the elderly. However, there is no information in the literature about the relationship between frailty status and exercise capacity. Here, we examined the associations between cardiopulmonary exercise testing parameters and frailty status in elderly patients with stable heart failure (HF).Ninety-two elderly patients with stable HF were evaluated using cardiopulmonary exercise testing and the KCL. A KCL score of 0-3 was classified as robust, 4-7 as pre-frail, and ≥ 8 as frail.Mean age, peak VO2, and KCL score were 81.7 years, 13.2 mL/kg/minute, and 10.7, respectively. KCL score was significantly correlated with peak VO2 (r = -0.527, P < 0.001) and peak work rate (r = -0.632, P < 0.001). In patients with frailty (n = 63), the peak work rate (WR) was significantly lower than it was in patients without frailty (n = 29; 39.9 versus 69.5 W, respectively; P < 0.001). Multivariate analysis revealed that peak WR and peak systolic blood pressure were significant, independent predictors of frailty (ß = -0.108 and -0.045, respectively). In a diagnostic performance plot analysis, a cutoff value for peak WR of 51.9 W was the best predictor of frailty.Frailty status was significantly associated with peak WR and peak systolic blood pressure in elderly patients with stable HF. Therefore, cardiopulmonary exercise testing may be useful for assessing frailty status in this patient population.


Asunto(s)
Tolerancia al Ejercicio/fisiología , Ejercicio/fisiología , Fragilidad/diagnóstico , Fragilidad/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Lista de Verificación , Prueba de Esfuerzo , Femenino , Fragilidad/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Consumo de Oxígeno/fisiología , Valor Predictivo de las Pruebas
13.
J Comput Assist Tomogr ; 43(6): 892-897, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31738212

RESUMEN

OBJECTIVE: The objective of this study was to assess the impact of preprocedural time-out on workflow and patient safety in computed tomography (CT)-guided procedures. METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, preprocedure time-out was assessed by an independent observer in CT-guided procedures performed from January 16, 2018, to May 15, 2018. Anonymous survey of 302 radiology team members involved in image-guided procedures about preprocedure time-out was performed using REDCap. RESULTS: Preprocedure time-out for 100 CT-guided procedures (biopsies, drainages, ablations) was observed. Procedures were recruited per observer availability and thus were nonconsecutive and nonrandom. Preprocedure time-out was performed in 100 procedures (100%). Median duration was 60 seconds (interquartile range, 60-71 seconds). Scripted checklist was followed in 52 cases (52/100, 52%). Omissions from the preprocedure time-out were identified in 40 cases (40/100, 40%) and were much more frequent when scripted checklist was not used (30/48 [63%] vs 10/52 [19%], P < 0.005). One case (1/100, 1%) was postponed due to abnormal coagulation parameters discovered during the time-out. Three cases (3/100, 3%) were delayed by 3 minutes to address other safety issues. In additional 14 cases (14/100, 14%), safety issues were raised during the time-out, which were resolved in less than 30 seconds.A total of 137 (45%) of 302 survey responses from 54 radiologists (39%), 55 technologists (40%), and 28 nurses (20%) were received. Forty-eight respondents (48/137, 35%) encountered a procedure that was cancelled or delayed as a result of information identified during time-out. Ninety-six percent (131/137) of respondents stated that time-out improves teamwork, 98% (134/137) stated that it enhances communication between the team members, and 93% (127/137) stated that it identifies and resolves problems and ambiguities. CONCLUSIONS: Scripted preprocedure time-out for CT-guided procedures takes approximately 1 minute to execute and detects safety issues in 18% of cases.


Asunto(s)
Lista de Verificación/métodos , Radiografía Intervencional/métodos , Femenino , Humanos , Masculino , Seguridad del Paciente , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Tomografía Computarizada por Rayos X , Flujo de Trabajo
14.
Am J Disaster Med ; 14(2): 75-87, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637688

RESUMEN

OBJECTIVE: To assess emergency medical services (EMS) and hospital disaster plans and communication and promote an integrated pediatric disaster response in the state of Connecticut, using tabletop exercises to promote education, collaboration, and planning among healthcare entities. DESIGN: Using hospital-specific and national guidelines, a disaster preparedness plan consisting of pediatric guidelines and a hospital checklist was created by The Connecticut Coalition for Pediatric Disaster Preparedness. SETTING: Five school bus rollover tabletop exercises were conducted, one in each of Connecticut's five EMS regions. Action figures and playsets were used to depict patients, healthcare workers, vehicles, the school, and the hospital. PARTICIPANTS: EMS personnel, nurses, physicians and hospital administrators. INTERVENTION: Participants had a facilitated debriefing of the EMS and prehospital response to disasters, communication among prehospital organizations, public health officials, hospitals, and schools, and surge capacity, capability, and alternate care sites. A checklist was completed for each exercise and was used with the facilitated debriefing to generate an afteraction report. Additionally, each participant completed a postexercise survey. MAIN OUTCOME MEASURES: Each after-action report and postexercise survey was compared to established guidelines to address gaps in hospital specific pediatric readiness. RESULTS: Exercises occurred at five hospitals, with inpatient capacity ranging 77-1,592 beds, and between 0 and 221 pediatric beds. There were 27 participants in the tabletop exercises, and 20 complete survey responses for analysis (74 percent). After the exercises, pediatric disaster preparedness aligned with coalition guidelines. However, methods of expanding surge capacity and methods of generating surge capacity and capability varied (p < 0.031). CONCLUSION: Statewide tabletop exercises promoted coalition building and revealed gaps between actual and ideal practice. Generation of surge capacity and capability should be addressed in future disaster education.


Asunto(s)
Planificación en Desastres , Desastres , Lista de Verificación , Niño , Connecticut , Humanos , Pediatría , Capacidad de Reacción
16.
Psychiatr Danub ; 31(3): 340-346, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31596827

RESUMEN

BACKGROUND: Autism is a widespread developmental disorder that occurs mostly among children. Children with autism are prone to problematic behaviors due to their deficiencies in language communication and social development. Thus, children with a high degree of autism suffer lower life satisfaction. Moreover, sensory integration dysfunction is closely related to autism. Therefore, the effect of Sensory Integration Training (SIT) on the behaviors and quality of life of children with autism was explored in this study. SUBJECTS AND METHODS: From September 2017 to December 2018, 108 patients from Fuzhou Fourth Hospital and Xiangtan Fifth Hospital were included in the intervention group (group A) and the control group (group B), with 54 members in each group. The 54 members in group B, with an average age of 5.18±2.94, received routine treatment. In addition to the same routine treatment, the members in group B also received sensory integration training and physical exercise intervention, which lasted for three months. The Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) were used before and after the intervention experiment to evaluate the curative effect. RESULTS: After the treatment, statistically significant differences were observed in the CARS and ABC scores (P<0.05); the total effective rate was 86.11% in group A and 64.10% in group B. The difference in the CARS score was statistically significant (P<0.05), whereas the difference in the ABC score was also statistically significant (P<0.05). In general, the difference in CARS is statistically significant. Specifically, group A is better than group B, t=3.492, df=73, and bilateral P=0.001<0.01. CONCLUSIONS: SIT intervention had a certain effect on autism and is of great value for the future development of SIT courses or intervention programs for children with autism.


Asunto(s)
Trastorno Autístico/psicología , Trastorno Autístico/terapia , Calidad de Vida , Lista de Verificación , Preescolar , Humanos
17.
Am J Orthod Dentofacial Orthop ; 156(4): 442-452.e12, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582116

RESUMEN

INTRODUCTION: This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A). METHODS: Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores. RESULTS: Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting. CONCLUSIONS: The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.


Asunto(s)
Medicina Basada en la Evidencia/normas , Ortodoncia/normas , Publicaciones Periódicas como Asunto/normas , Edición/normas , Revisiones Sistemáticas como Asunto , Bibliometría , Lista de Verificación , Humanos , Control de Calidad
19.
Br Dent J ; 227(5): 399-402, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31520044

RESUMEN

Introduction Standard practice for dental extractions is to provide treatment under local anaesthesia (LA) without additional sedation or general anaesthesia. Even in oral surgery departments, the majority of patients receive this anxiety-provoking treatment under LA alone. All patients undergoing extractions could benefit from information on relaxation and anxiety management. This study aims to perform an in-depth analysis of the quality of websites that provide information on dental extractions and anxiety.Materials and methods Key phrases were searched on Google. The content, reliability and readability of the top ten websites for each key phrase were qualitatively evaluated using three tools: DISCERN, Flesch-Kincaid, and a specialised oral surgery website checklist (OSWC).Results Patient education was limited, with 70% of websites being either advertisements, forums or articles for healthcare professionals. The majority of websites poorly described treatment such as sedation and only 16% provided methods for relaxation. Readability was poor, with 92% above average UK adult literacy ability.Conclusion Extraction patients should be signposted to effective resources before treatment or referral. Dental anxiety advice can easily be incorporated into all treatment plans, with recommended website links included in digital communication, such as text messages or practice websites.


Asunto(s)
Comprensión , Extracción Dental , Ansiedad , Lista de Verificación , Humanos , Internet , Educación del Paciente como Asunto , Reproducibilidad de los Resultados
20.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31562252

RESUMEN

BACKGROUND: Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS: Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children's Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS: Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F's sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS: Universal screening in primary care is possible when supported by electronic administration. In this "real-world" cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.


Asunto(s)
Trastorno del Espectro Autista/diagnóstico , Lista de Verificación , Tamizaje Masivo/normas , Pediatría/normas , Factores de Edad , Trastorno del Espectro Autista/epidemiología , Preescolar , Registros Electrónicos de Salud , Femenino , Estudios de Seguimiento , Hospitales Pediátricos , Humanos , Lactante , Masculino , Tamizaje Masivo/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Philadelphia/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Sensibilidad y Especificidad , Factores Sexuales , Factores Socioeconómicos
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