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1.
Psychopharmacol Bull ; 51(1): 59-68, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33897063

RESUMO

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Telemedicina/estatística & dados numéricos , Assistência à Saúde/métodos , Pesquisas sobre Serviços de Saúde , Humanos , Psiquiatria/métodos , Psiquiatria/estatística & dados numéricos
2.
Eur Arch Psychiatry Clin Neurosci ; 271(2): 259-270, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33544227

RESUMO

On March 11th, 2020, the outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic. Governments took drastic measures in an effort to reduce transmission rates and virus-associated morbidity. This study aims to present the immediate effects of the pandemic on patients presenting in the psychiatric emergency department (PED) of Hannover Medical School. Patients presenting during the same timeframe in 2019 served as a control group. A decrease in PED visits was observed during the COVID-19 pandemic with an increase in repeat visits within 1 month (30.2 vs. 20.4%, pBA = 0.001). Fewer patients with affective disorders utilized the PED (15.2 vs. 22.2%, pBA = 0.010). Suicidal ideation was stated more frequently among patients suffering from substance use disorders (47.4 vs. 26.8%, pBA = 0.004), while patients with schizophrenia more commonly had persecutory delusions (68.7 vs. 43.5%, pBA = 0.023) and visual hallucinations (18.6 vs. 3.3%, pBA = 0.011). Presentation rate of patients with neurotic, stress-related, and somatoform disorders increased. These patients were more likely to be male (48.6 vs. 28.9%, pBA = 0.060) and without previous psychiatric treatment (55.7 vs. 36.8%, pBA = 0.089). Patients with personality/behavioral disorders were more often inhabitants of psychiatric residencies (43.5 vs. 10.8%, pBA = 0.008). 20.1% of patients stated an association between psychological well-being and COVID-19. Most often patients suffered from the consequences pertaining to social measures or changes within the medical care system. By understanding how patients react to such a crisis situation, we can consider how to improve care for patients in the future and which measures need to be taken to protect these particularly vulnerable patients.


Assuntos
Emergências/psicologia , Transtornos Mentais/terapia , Pandemias , Psiquiatria/estatística & dados numéricos , Adulto , Idoso , Efeitos Psicossociais da Doença , Feminino , Alemanha , Humanos , Masculino , Transtornos Mentais/classificação , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtornos Neuróticos/epidemiologia , Transtornos Neuróticos/psicologia , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Fatores Sexuais , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ideação Suicida
3.
PLoS One ; 15(12): e0240376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332380

RESUMO

BACKGROUND: The rapid integration of Artificial Intelligence (AI) into the healthcare field has occurred with little communication between computer scientists and doctors. The impact of AI on health outcomes and inequalities calls for health professionals and data scientists to make a collaborative effort to ensure historic health disparities are not encoded into the future. We present a study that evaluates bias in existing Natural Language Processing (NLP) models used in psychiatry and discuss how these biases may widen health inequalities. Our approach systematically evaluates each stage of model development to explore how biases arise from a clinical, data science and linguistic perspective. DESIGN/METHODS: A literature review of the uses of NLP in mental health was carried out across multiple disciplinary databases with defined Mesh terms and keywords. Our primary analysis evaluated biases within 'GloVe' and 'Word2Vec' word embeddings. Euclidean distances were measured to assess relationships between psychiatric terms and demographic labels, and vector similarity functions were used to solve analogy questions relating to mental health. RESULTS: Our primary analysis of mental health terminology in GloVe and Word2Vec embeddings demonstrated significant biases with respect to religion, race, gender, nationality, sexuality and age. Our literature review returned 52 papers, of which none addressed all the areas of possible bias that we identify in model development. In addition, only one article existed on more than one research database, demonstrating the isolation of research within disciplinary silos and inhibiting cross-disciplinary collaboration or communication. CONCLUSION: Our findings are relevant to professionals who wish to minimize the health inequalities that may arise as a result of AI and data-driven algorithms. We offer primary research identifying biases within these technologies and provide recommendations for avoiding these harms in the future.


Assuntos
Ciência de Dados/métodos , Disparidades nos Níveis de Saúde , Saúde Mental/estatística & dados numéricos , Processamento de Linguagem Natural , Psiquiatria/métodos , Viés , Ciência de Dados/estatística & dados numéricos , Humanos , Colaboração Intersetorial , Linguística , Psiquiatria/estatística & dados numéricos
4.
Medicine (Baltimore) ; 99(51): e23708, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371117

RESUMO

ABSTRACT: Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.


Assuntos
Transtornos Mentais/diagnóstico , Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Psiquiatria/normas , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto Jovem
5.
Psychiatr Serv ; 71(11): 1143-1150, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32933411

RESUMO

OBJECTIVE: In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine. METHODS: From March 31 to April 9, 2020, semistructured interviews were conducted with 20 outpatient psychiatrists practicing in five U.S. states with significant early COVID-19 activity. Inductive and deductive approaches were used to develop interview summaries, and a matrix analysis was conducted to identify and refine themes. RESULTS: At the time of the interviews, all 20 psychiatrists had been using telemedicine for 2-4 weeks. Telemedicine encompassed video visits, phone visits, or both. Although many continued to prefer in-person care and planned to return to it after the pandemic, psychiatrists largely perceived the transition positively. However, several noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, diminished patient privacy, and increased distractions in the patient's home setting. Several psychiatrists noted that their disadvantaged patients lacked reliable access to a smartphone, computer, or the Internet. Participants identified several strategies that helped them improve telemedicine visit quality. CONCLUSIONS: The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Findings highlight that although psychiatrists expressed some concerns about the quality of these encounters, the transition has been largely positive for both patients and physicians.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/normas , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Humanos , Entrevistas como Assunto , Pacientes Ambulatoriais/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Psiquiatria/estatística & dados numéricos , Pesquisa Qualitativa , Estados Unidos
7.
Am J Psychiatry ; 177(10): 955-964, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32660300

RESUMO

OBJECTIVE: The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression. METHODS: A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire-9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores. RESULTS: Participants' mean OLBI score was 40.4 (SD=7.9) and mean PHQ-9 score was 5.1 (SD=4.9). A total of 78% (N=1,625) of participants had an OLBI score ≥35, suggestive of high levels of burnout, and 16.1% (N=336) of participants had PHQ-9 scores ≥10, suggesting a diagnosis of major depression. Presence of depressive symptoms, female gender, inability to control one's schedule, and work setting were significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores. A total of 98% of psychiatrists who had PHQ-9 scores ≥10 also had OLBI scores >35. Suicidal ideation was not significantly associated with burnout in a partially adjusted linear regression model. CONCLUSIONS: Psychiatrists experience burnout and depression at a substantial rate. This study advances the understanding of factors that increase the risk for burnout and depression among psychiatrists and has implications for the development of targeted interventions to reduce the high rates of burnout and depression among psychiatrists. These findings have significance for future work aimed at workforce retention and improving quality of care for psychiatric patients.


Assuntos
Esgotamento Profissional/epidemiologia , Depressão/epidemiologia , Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Idoso , Esgotamento Profissional/etiologia , Depressão/etiologia , Feminino , Nível de Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
9.
J Anesth Hist ; 6(2): 84-89, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32593382

RESUMO

PURPOSE: One of the most interesting signs of growth in a medical specialty is the addition of pain medicine as a clinical subspecialty to it. The aim of this study was to analyze publication-based academic interest in pain medicine among clinical specialties with long-standing involvement in pain management. METHODS: We assessed the activity within several specialties in the development of an academic foundation for pain medicine by measuring the frequency of the most common pain topics (1998-2017) in academic journals representing such specialties. The selection of materials for the analysis of publication-based academic interest associated with the development of pain medicine followed a three-step process: (1) Medical specialties, limited to those with accredited fellowship training in pain medicine for more than 20 years - anesthesiology, neurology, physiatry, and psychiatry; (2) Pain topics, based on the degree of topic association with the work of pain clinics - a total of 34 topics; (3) Specialty journals, mostly official journals of societies publishing articles representing all aspects of a specialty - four journals per specialty. Specialty-related academic interest was characterized in two dimensions: its breadth (the number of different topics of interest with distinctly high shares of publications) and its intensity (maximal number of publications on a particular topic). RESULTS: According to the number of topics with a distinctly high share of articles per topic (≥ 5%), the rank order of specialties was as follows (of 34 topics): anesthesiology (22), physiatry (20), neurology (10), and psychiatry (0). Regarding comparative intensity of interest, anesthesiology has prevailing interest in 16 topics (especially in postoperative pain and pharmacologic pain treatment), physiatry in 13 topics (especially in physical methods of pain therapy), and neurology in one topic (headache disorders). CONCLUSION: Publication-based academic interest in pain management was most intensive in two specialties, anesthesiology and physiatry, with anesthesiology being somewhat more multifaceted, especially in the methods of pain treatment.


Assuntos
Anestesiologia/estatística & dados numéricos , Neurologia/estatística & dados numéricos , Manejo da Dor , Medicina Física e Reabilitação/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Publicações/estatística & dados numéricos , Bibliometria , Humanos
11.
Nervenarzt ; 91(5): 404-410, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32232534

RESUMO

People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.


Assuntos
Neoplasias/complicações , Cuidados Paliativos , Psiquiatria , Transtornos Psicóticos/complicações , Comorbidade , Humanos , Oncologia/estatística & dados numéricos , Neoplasias/psicologia , Psiquiatria/estatística & dados numéricos , Transtornos Psicóticos/terapia
12.
Psiquiatr. biol. (Internet) ; 27(1): 3-8, ene.-abr. 2020. ilus, tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-193254

RESUMO

INTRODUCCIÓN: Actualmente disponemos de un amplio abanico de antipsicóticos para el tratamiento de las psicosis, pero a excepción de la clozapina en pacientes resistentes, las guías clínicas no aclaran qué antipsicótico ha de prescribirse en primer lugar. Teniendo en cuenta la eficacia contrastada de olanzapina y su perfil de efectos secundarios, existe un interés en investigar su patrón de prescripción en nuestro país y sus factores asociados. MATERIAL Y MÉTODOS: Se administró una encuesta autoaplicada de 62 ítems, de carácter anónimo y voluntario, a 118 psiquiatras del territorio nacional. RESULTADOS: El perfil más frecuente entre los participantes fue el de un psiquiatra de entre 30-50 años que trabajaba en un centro de salud mental (76%). Respecto a los patrones generales de prescripción, la eficacia fue lo más valorado a la hora de elegir un antipsicótico. El uso de una combinación de antipsicóticos fue reportado por el 95% de los encuestados y la formulación preferida fue la oral. Olanzapina fue seleccionada como el antipsicótico con mayor adherencia y eficacia. El motivo del uso más señalado fueron los primeros episodios psicóticos en un 32%, siendo la dosis más utilizada la de 10 mg/día. Se prefiere olanzapina especialmente en cuadros con elevada agitación y síntomas psicóticos acusados. El aumento de peso y el síndrome metabólico son los efectos adversos que más motivan al facultativo a descartar olanzapina como tratamiento. CONCLUSIONES: Este estudio constató la relevancia de la eficacia a la hora de elegir un tratamiento antipsicótico. La muestra encuestada percibe la olanzapina como un fármaco efectivo, de uso habitual y especialmente útil para determinados perfiles clínicos


INTRODUCTION: Although there is a wide range of antipsychotic drugs currently available for the treatment of psychiatric disorders, apart from clozapine in resistant patients, the clinical guidelines are not clear on which antipsychotic drug should be prescribed in the first place. Taking into account the known efficacy of olanzapine and its side-effects profile, it would be of interest to study its prescription pattern as well as its associated factors in this country. MATERIAL AND METHODS: A self-administered, 62-item questionnaire was anonymously and voluntarily completed by 118 psychiatrists from all over the country. RESULTS: The most common profile of the participants was a psychiatrist of 30-50 years that worked in a mental health centre (76%). As regards the general prescribing patterns, efficacy was the most valued when choosing an antipsychotic drug. The use of a combination of antipsychotic drugs was reported by 95% of those that completed the questionnaire, and the preferred administration route was oral. Olanzapine was chosen as the antipsychotic drug with greater adherence and efficacy. The most stated reason for use was for the first psychotic episodes in 32%, with 10 mg/day being the dose most used. Olanzapine was preferred particularly in clinical pictures with increased agitation and marked psychotic symptoms. An increase in weight and metabolic syndrome are the side-effects that most motivate the psychiatrist to rule out olanzapine as a treatment. CONCLUSIONS: This study shows the importance of efficacy when choosing antipsychotic treatment. The surveyed sample perceived olanzapine as an effective drug, in routine use, and especially useful for certain clinical profiles


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Olanzapina/uso terapêutico , Antipsicóticos/uso terapêutico , Padrões de Prática Médica , Psiquiatria/estatística & dados numéricos , Transtornos Psicóticos/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde
13.
Health Info Libr J ; 37(1): 78-82, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32124551

RESUMO

This study is based on Gerardo Ruiz's doctoral thesis on the information seeking patterns of psychiatrists in Mexico City, which he completed in January 2018 from the Autonomous National University of Mexico. The paper presents the key findings from a survey and interview involving 92 psychiatrists to identify the differing roles and information behaviours of three types of mental health practitioners. Similarities and divergences were found in their behavioural patterns in obtaining information to make clinical decisions, depending on purpose for the sought information which aligned to the role of the psychiatrist and on the information contexts of institutions in which they work. The implications for practice highlighted in this study focus on the influencing factors of time and availability of sources in enabling the mental health specialist to search, disseminate and evaluate information to be used in clinical practice, as well as to have in place broader communication with colleagues in order to enrich clinical care for better diagnosis and treatment.F.J.


Assuntos
Comportamento de Busca de Informação , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/normas , Atitude do Pessoal de Saúde , Humanos , México , Psiquiatria/estatística & dados numéricos , Inquéritos e Questionários
14.
Int Rev Psychiatry ; 32(2): 151-156, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32114872

RESUMO

Little is known about psychiatric education among the Arab countries. This article aims at giving an overview on the current situation regarding the availability and quality of psychiatric undergraduate, postgraduate, and specialized training programmes in different Arab countries. A brief questionnaire was developed by the authors to assess the presence and duration of each programme as well as the teaching and assessment methods used. All participating countries reported having undergraduate programmes for medical students, most of them ranging from 3-7 weeks. A variety of teaching methods and objective assessment methods are used to evaluate the students. The duration of psychiatry residency training ranges from 3-5 years in the participating countries. All participating Arab countries have a national board of psychiatry in addition to the Arab board of psychiatry to certify the residency training programmes. Egypt offers a High Diploma, Master, and Doctorate (MD) degrees in psychiatry. Many residency training programmes in some Arab countries are based on and accredited from the American Board of Psychiatry and others are based on the Royal College of Psychiatrists curriculum in the UK. Great progress has been made in the past few years both in undergraduate and postgraduate psychiatric education among the different counties in the Arab world. However, still more effort is needed in order to reach standardization compared with other countries.


Assuntos
Árabes , Currículo , Educação de Graduação em Medicina , Avaliação Educacional , Internato e Residência , Psiquiatria/educação , África Oriental , África do Norte , Educação de Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Oriente Médio , Psiquiatria/estatística & dados numéricos
15.
Ann Clin Psychiatry ; 32(1): 12-16, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990965

RESUMO

BACKGROUND: Psychiatric consultation services, particularly for emergencies, are limited in many parts of the United States. Telepsychiatry services are helping to bridge the gap, and are gaining acceptance and popularity. There is paucity of publications regarding comparison of turnaround time for consultations between video conferencing and traditional face-to-face psychiatric consultations in general hospital nonpsychiatric emergency departments (EDs). Our study aimed to address turnaround time and patient satisfaction. METHODS: Data regarding the turnaround time for emergency psychiatric consultations using telepsychiatry in general hospital EDs was collected retrospectively and compared with the time for face-to-face traditional consultations. A patient satisfaction survey was also conducted after the telepsychiatry consultation. Statistical analysis of the data was done after the study was completed. RESULTS: The telepsychiatry group included 206 participants and the control group had 186 participants. There was an 84% reduction in the turnaround time for telepsychiatry consults (95% confidence interval, 81% to 86%). A patient satisfaction survey showed 97% satisfaction with telepsychiatry services. Gender and age did not modify the effect of telepsychiatry on time to consult (P > .10). CONCLUSIONS: The reduction in the turnaround time and improved patient satisfaction indicate that telepsychiatry services can improve the quality of care for patients in need of emergency services.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
16.
Psychiatry Res ; 284: 112758, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31955056

RESUMO

BACKGROUND: The aim of this study was to investigate the effect that treating physicians have on the compliance of their psychiatric (schizophrenia (SP) and bipolar disorder (BP)) patients. METHODS: This retrospective study was based on data from the Disease Analyzer database (IQVIA). It included 2870 SP and 2327 BD patients who had received at least two neuroleptic prescriptions from 55 psychiatric practices between January 2016 and December 2018. The average proportion of days covered (PDC) per patient was calculated. Patients were considered adherent if their PDC was greater than or equal to 80%. Practice adherence was considered high if at least 70% of patients in the practice of interest were adherent. RESULTS: The mean PDC was 59.8% (SD: 13.9%) in SP and 65.0% (SD: 11.5%) in BD patients. The share of patients with an optimal PDC value (≥80%) differed considerably between practices (between 28% and 92% for SP and between 33% and 92% for BP). The prevalence of practices with high adherence was lower for schizophrenia than for bipolar disorder (21.9% versus 45.5%). CONCLUSION: Psychiatrists play an important role in the compliance of SP and BP patients treated with neuroleptics.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Adesão à Medicação/psicologia , Psiquiatria/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Adulto , Bases de Dados Factuais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Médico , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos
17.
Rev Paul Pediatr ; 38: e2018101, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778404

RESUMO

OBJECTIVE: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. METHODS: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. RESULTS: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. CONCLUSIONS: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.


Assuntos
Assistência ao Convalescente/tendências , Assistência Ambulatorial/estatística & dados numéricos , Doença Crônica/epidemiologia , Medicina/normas , Adolescente , Agendamento de Consultas , Brasil/epidemiologia , Criança , Pré-Escolar , Doenças Transmissíveis/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Estudos Transversais , Morte , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Medicina/estatística & dados numéricos , Transtornos Nutricionais/epidemiologia , Manejo da Dor/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Prevalência , Psiquiatria/estatística & dados numéricos , Adulto Jovem
18.
J Clin Epidemiol ; 119: 75-84, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31809848

RESUMO

OBJECTIVES: When reporting observational studies, authors should explicitly discuss the potential for confounding and other biases, but it is unclear to what extent this is carried out within the psychiatric field. STUDY DESIGN AND SETTING: We reviewed a random sample of 120 articles in the five psychiatric specialty journals with the highest 5-year impact factor in 2015-2018. We evaluated how confounding and bias was considered in the reporting of the discussion and abstract and assessed the relationship with yearly citations. RESULTS: The term "confounding" was explicitly mentioned in the abstract or discussion in 66 articles (55.0%; 95% confidence interval (CI): 46.1-63.6) and the term "bias" in 68 articles (56.7%; 95% CI: 47.7-65.2). The authors of 25 articles (20.8%; 95% CI: 14.5-28.9) acknowledged unadjusted confounders. With one exception (0.8%, 95% CI: 0.0-4.6), authors never expressed any caution, limitation, or uncertainty in relation to confounding or other bias in their conclusions or in the abstract. Articles acknowledging nonadjusted confounders were not less frequently cited than articles that did not (median 7.9 vs. 5.6 citations per year, P = 0.03). CONCLUSION: Confounding is overall inadequately addressed in the reporting and bias is often ignored in the interpretation of high-impact observational research in psychiatry.


Assuntos
Viés , Estudos Epidemiológicos , Estudos Observacionais como Assunto/métodos , Estudos Observacionais como Assunto/normas , Psiquiatria/métodos , Relatório de Pesquisa/normas , Humanos , Estudos Observacionais como Assunto/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos
19.
Acad Psychiatry ; 44(1): 68-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31659714

RESUMO

OBJECTIVES: The authors investigated the attitudes, self-perceived competence, and the need for a dedicated curriculum on physical examination skills among chief residents in psychiatry. METHODS: A voluntary 28-item web-based questionnaire was distributed to psychiatry chief residents in the USA between January 2019 and February 2019. RESULTS: Of 181 chief residents, 79 (response rate, 44%) completed the online survey. The majority of chief residents want to improve their physical exam skills (64%) and believe that there should be a targeted curriculum aimed at incorporating these skills into everyday psychiatric practice (63%). However, most (57%) chief residents reported that they only conduct physical exams on a few selected patients (< 25% of the time) and almost half (48%) last used a stethoscope a year ago, if not longer. Self-perceived competence and comfort level with neurology-related exam findings was especially low: only 35% could identify discrepant neurological findings and 33% elicit Hoover's sign of leg paresis. A significant majority (86%) believed that performing a physical exam would not interfere with the therapeutic relationship. CONCLUSIONS: Although chief residents in psychiatry believe that developing competence in physical examinations is important to their education, the current educational landscape does not support the development of these skills. Future educational strategies should focus on addressing this need.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Currículo , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência , Exame Físico , Psiquiatria , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Psiquiatria/normas , Psiquiatria/estatística & dados numéricos , Autoavaliação
20.
Acad Psychiatry ; 44(1): 53-58, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31713078

RESUMO

OBJECTIVE: Clozapine is the gold standard treatment for treatment-resistant schizophrenia. Prior surveys of mental health providers have identified multiple causes for underutilization of clozapine; however, no previous survey has been conducted to assess US psychiatry residents' level of comfort in prescribing clozapine. METHODS: A survey was sent via email to program directors of Accreditation Council for Graduate Medical Education-affiliated psychiatry residency programs requesting the survey to be distributed to current residents. The survey included questions regarding demographics, clozapine-prescribing practices, comfort levels with prescription, and perceived barriers to prescription. RESULTS: A total of 164 psychiatric residents completed the survey, 37% PGY-1 and 2 residents and 63% PGY-3 or higher. One-third of the respondents had a clozapine clinic in their program. Only 18% of the residents felt "very" comfortable in initiating clozapine and 41% felt "somewhat" comfortable. Two main reasons for not starting clozapine were (1) side effect profile (41%) and (2) limited experience and inadequate training in clozapine use (38%). More than 4/5ths of the residents (83%) responded that they would feel more comfortable in prescribing clozapine if they were trained in a clozapine clinic. Major limitation of this study has been the small sample size, lack of representativeness, and generalization. CONCLUSIONS: Forty-one percent of the respondents did not feel comfortable with clozapine prescription. Major concerns cited included the side effect profile as well as lack of experience and training. The majority of the respondents felt that they would be more comfortable prescribing clozapine if they had the opportunity to train in a clozapine clinic.


Assuntos
Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Competência Clínica/estatística & dados numéricos , Clozapina/uso terapêutico , Internato e Residência/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Adulto , Humanos , Médicos/estatística & dados numéricos , Estados Unidos
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