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1.
BMJ ; 369: m1068, 2020 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-32269035
2.
Rev Med Liege ; 75(1): 53-59, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920045

RESUMO

Psychiatric disorders in children may be the expression of underlying organic conditions. These are numerous and varied. The clinical presentation is often frustrating : psychiatric signs can remain isolated for years before other more specific organic signs appear. More recently, new treatments have been developed, making it possible to improve the prognosis of some of these organic diseases; screening them is therefore a daily concern for the child psychiatrist. This literature review discusses various paediatric treatable organic disorders that may have an isolated psychiatric presentation, to finally propose a decision tree algorithm based on somatic and psychiatric complaints reported.


Assuntos
Sintomas Inexplicáveis , Transtornos Mentais , Criança , Humanos , Transtornos Mentais/complicações
4.
Lancet Psychiatry ; 7(2): 191-207, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31732482

RESUMO

Cognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Around a quarter of patients presenting to memory clinics received diagnoses that might indicate the presence of functional cognitive disorders, which were associated with affective symptoms, negative self-evaluation, negative illness perceptions, non-progressive symptom trajectories, and linguistic and behavioural differences during clinical interactions. Those with functional cognitive disorder phenotypes are at risk of iatrogenic harm because of misdiagnosis or inaccurate prediction of future decline. Further research is imperative to improve diagnosis and identify effective treatments for functional cognitive disorders, and better understanding these phenotypes will also improve the specificity of diagnoses of prodromal degenerative brain disease.


Assuntos
Sintomas Afetivos/fisiopatologia , Atitude Frente a Saúde , Transtornos Cognitivos/fisiopatologia , Sintomas Inexplicáveis , Transtornos da Memória/fisiopatologia , Sintomas Afetivos/epidemiologia , Transtornos Cognitivos/epidemiologia , Humanos , Transtornos da Memória/epidemiologia
5.
Clin Child Psychol Psychiatry ; 25(1): 62-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30818976

RESUMO

BACKGROUND: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. OBJECTIVES: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. METHODS: Parents of 27 children aged 7-17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. RESULTS: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. CONCLUSION: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.


Assuntos
Sintomas Inexplicáveis , Cooperação do Paciente/psicologia , Satisfação do Paciente , Transtornos Somatoformes/terapia , Adolescente , Criança , Estudos Transversais , Terapia Familiar , Feminino , Humanos , Masculino , Pais , Psicoterapia/métodos , Estudos Retrospectivos , Transtornos Somatoformes/psicologia , Resultado do Tratamento
6.
Clin Child Psychol Psychiatry ; 25(1): 45-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31079473

RESUMO

BACKGROUND: Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. METHODS: A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11-15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. RESULTS: Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants' illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. CONCLUSIONS: The label 'functional disorder' was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.


Assuntos
Sintomas Inexplicáveis , Transtornos Somatoformes/psicologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Criança , Terapia Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais , Pesquisa Qualitativa , Transtornos Somatoformes/terapia , Estresse Psicológico/terapia
7.
Clin Child Psychol Psychiatry ; 25(1): 273-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232094

RESUMO

BACKGROUND: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30-60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. OBJECTIVES: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. METHODS: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. RESULTS: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. CONCLUSIONS: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non-cognitive behavioural therapy interventions is recommended.


Assuntos
Sintomas Inexplicáveis , Saúde Mental , Psicoterapia , Transtornos Somatoformes/terapia , Adolescente , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Somatoformes/psicologia
9.
PLoS One ; 14(12): e0225364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856259

RESUMO

We evaluated to define the clinically significant chronic nausea in general population and to assess the prevalence of chronic unexplained nausea after exclusion of organic causes through the meticulous medical examination. Two phase studies were conducted. In phase 1, telephone survey was conducted to define the clinically significant nausea in 5000 representative subjects for a general population. Clinically significant nausea was identified by lowered quality of life if the frequency was 'more than one day per week'. Its prevalence was 1.6% (1.4-1.8%) and about 90% of nausea was not accompanied with vomiting. In phase 2, 5096 participants in a comprehensive health-screening cohort were enrolled. We investigated demographics, gastrointestinal symptoms, somatization symptoms and health related quality of life using validated questionnaire. All participants underwent meticulous medical examinations including endoscopy, abdominal ultrasound, thyroid function test, and blood testing. Among a total of 5096 subjects (men 51.8%, mean age 47.5 ± 10.0 years), organic diseases associated with chronic nausea were reflux esophagitis, duodenal ulcer and hyperthyroidism. The prevalence of chronic unexplained nausea was 0.6% (95% CI 0.4-0.8%) and there were significant overlap with functional dyspepsia and irritable bowel syndrome. HRQoL is significantly lower in people with nausea occurring 'more than one day per week' in a general population. Most chronic nausea was not accompanied with vomiting. Chronic unexplained nausea is uncommon affecting only 0.6% of the population but are more likely to report functional dyspepsia and irritable bowel syndrome.


Assuntos
Gastroenteropatias/complicações , Sintomas Inexplicáveis , Náusea/epidemiologia , Qualidade de Vida , Adulto , Doença Crônica/epidemiologia , Feminino , Gastroenteropatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico por imagem , Náusea/etiologia , Prevalência , República da Coreia/epidemiologia , Inquéritos e Questionários , Ultrassonografia , Adulto Jovem
12.
Muscle Nerve ; 60(6): 687-692, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31478199

RESUMO

INTRODUCTION: Nerve imaging has a limited role in axonal and muscle fiber loss. In this study, we sought to explore the utility of standardized muscle ultrasound (US) assessment in these clinical scenarios. METHODS: We performed a prospective study from March to August 2018 of patients attending the neuromuscular clinic. All patients underwent clinical evaluation and standardized muscle thickness measurement by US in seven muscles. RESULTS: The study cohort consisted of 114 participants, including patients with polyneuropathy, motor neuron disease, and myopathy. The smallest distal muscle thickness was found in patients with polyneuropathy, while the smallest proximal muscle thickness was found in patients with myopathy. Muscle thickness was strongly correlated with muscle strength (r 2 = 0.62), electrophysiological findings (r 2 : 0.44-0.55), and disability score (r 2 = 0.53). DISCUSSION: Standardized muscle thickness measured by US shows diagnostic usefulness in a spectrum of neuromuscular disorders and correlates with clinical and electrophysiological findings.


Assuntos
Músculo Esquelético/diagnóstico por imagem , Doenças Neuromusculares/diagnóstico por imagem , Potenciais de Ação/fisiologia , Adulto , Idoso , Esclerose Amiotrófica Lateral/diagnóstico por imagem , Esclerose Amiotrófica Lateral/patologia , Esclerose Amiotrófica Lateral/fisiopatologia , Eletromiografia , Feminino , Humanos , Masculino , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Atrofia Muscular Espinal/diagnóstico por imagem , Atrofia Muscular Espinal/patologia , Atrofia Muscular Espinal/fisiopatologia , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/patologia , Doenças Musculares/fisiopatologia , Condução Nervosa/fisiologia , Doenças Neuromusculares/patologia , Doenças Neuromusculares/fisiopatologia , Tamanho do Órgão , Polineuropatias/diagnóstico por imagem , Polineuropatias/patologia , Polineuropatias/fisiopatologia , Estudos Prospectivos , Radiculopatia/diagnóstico por imagem , Radiculopatia/patologia , Radiculopatia/fisiopatologia , Ultrassonografia
13.
Complement Ther Clin Pract ; 37: 68-72, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31491603

RESUMO

BACKGROUND AND PURPOSE: Somatic symptom disorder (SSD) refers to a significant impairment in daily activities due to a dysfunctional preoccupation with one or more physical symptoms. This study reports the effectiveness of herbal medicine (HM) on SSD patient. MATERIALS AND METHODS: A 58-year-old woman had somatic atypical gastrointestinal symptoms for 5 years; i.e., an uncomfortable feeling going from the stomach to the ear as well as related severe anxiety. A Korean medicine (KM) doctor presumed she had SSD and phlegm-dampness syndrome, consequently, Xiao Ban Xia Jia Fu Ling Tang was administered. Her anxiety symptoms were rated using the numerical rating scale and the Beck anxiety inventory. RESULTS: The somatic symptoms originating in the stomach and chest, as well as the severe anxiety, improved markedly after 2 months of KM treatment. CONCLUSION: HMs used for treating phlegm-dampness syndrome may be effective in treating conditions involving somatic symptoms and related anxiety.


Assuntos
Ansiedade/terapia , Preparações de Plantas/administração & dosagem , Plantas Medicinais/química , Transtornos Somatoformes/terapia , Feminino , Gastroenteropatias/psicologia , Gastroenteropatias/terapia , Humanos , Sintomas Inexplicáveis , Pessoa de Meia-Idade
14.
Artigo em Inglês | MEDLINE | ID: mdl-31487943

RESUMO

BACKGROUND: Emotional exhaustion causes adverse effects in those who suffer from it. Housewives are not excluded. Domestic and care chores, which are considered to be sources of stress, increase when taking on the role of caregiver for a family member with Alzheimer's disease. OBJECTIVE: To analyse the influence of emotional exhaustion, somatic symptoms and social dysfunction, based on the activity they carry out. METHODOLOGY: Cross-sectional survey. 193 women participated, of which: housewives (HWs) (n = 97), and Alzheimer's patient caregiver-housewives (CHWs) (n = 96). The evaluation tools were: sociodemographic/working data questionnaire (ad hoc), Maslach Burnout Inventory (MBI) and Goldberg General Health Questionnaire (GHQ-28). RESULTS: High rates of emotional exhaustion are observed, as well as an existing positive link between chronic diseases, somatic symptoms and social dysfunction. The structural model indicates that emotional exhaustion predicts the amount and extent of diseases, somatic symptoms and social dysfunction. The influence is higher in CHWs. LIMITATIONS: Sample procedure implemented at convenience; the variable of the grade of dependence of the Alzheimer's patient caregiver was not included in the study. CONCLUSIONS: The domestic and care chores that HWs and CHWs carry out affect their health. Hence the need to develop psychoeducative programmes that are adapted to the particular needs of these women and focused on the different areas of their everyday lives.


Assuntos
Doença de Alzheimer , Esgotamento Psicológico , Cuidadores/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Emoções , Feminino , Humanos , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Isolamento Social , Inquéritos e Questionários , Adulto Jovem
15.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31488696

RESUMO

BACKGROUND: In May 2016, the American Academy of Pediatrics published a clinical practice guideline for brief resolved unexplained events (BRUEs). We evaluated for changes in the management of BRUE after guideline publication. METHODS: Using a pediatric multicenter administrative database, we compared rates of admission, testing, revisits, and diagnoses in patients diagnosed with a BRUE or apparent life-threatening event (ALTE) during 2017 with rates of admission, testing, revisits, and diagnoses in patients diagnosed with ALTE during 2015. We used interrupted time series analysis to test if the guideline was associated with changes in admission rate for all patients with ALTE or BRUE between 2015 and 2017. We stratified analyses by age (0-60 and 61-365 days). RESULTS: A total of 9501 patients were included (5608 in 2015 and 3893 in 2017). The admission rate decreased by 5.7% (95% confidence interval, 3.8% to 7.5%) for infants 0 to 60 days and by 18.0% (95% confidence interval, 15.3% to 20.7%) for infants 61 to 365 days from 2015 to 2017. Patients in 2017 had lower rates of EEG, brain MRI, chest radiography, laboratory testing, and urinalyses compared with patients in 2015. In the interrupted time series analysis model (n = 13 977), guideline publication was associated with decreasing admission rates (0.2% per week) for infants 61 to 365 days (P < .001). CONCLUSIONS: Compared with patients evaluated in 2015, patients with BRUE or ALTE in 2017 have lower rate of admissions and testing. Findings may be due to changes in the definition of BRUE and guideline recommendations.


Assuntos
Hospitalização/estatística & dados numéricos , Sintomas Inexplicáveis , Guias de Prática Clínica como Assunto , Intervalos de Confiança , Eletroencefalografia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida , Imagem por Ressonância Magnética/estatística & dados numéricos , Radiografia Torácica/estatística & dados numéricos
16.
Z Psychosom Med Psychother ; 65(3): 288-303, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476999

RESUMO

Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study Objectives: The aim of this study is to prove if religious faith, spirituality and religious praxis are joined with lower depression, anxiety and physical pain-level and if subjects with traumatic experiences report more spirituality. Methods: In this consecutive study, 2508 adults of a representative sample in Germany were interviewed about religious faith and spirituality in relation to depression, anxiety, physical disorders as well as traumatic experiences. Results: Unlike our hypotheses people who are charged with mental (PHQ-4; Löwe et al. 2010) or physical disorders (GBB_8; Kliem et al. 2017) report more spirituality and more private religious/spiritual praxis than people without mental or physical problems. As expected people with traumatic experiences in their childhood (CTS; Grabe et al. 2012) describe significantly more spirituality than people without these experiences. Conclusions: Other than expected people with more mental or physical disorders report more spirituality and more private religious/spiritual praxis. It is to discuss if spirituality is less a protective factor for mental or physical disorders than disorders activate to look for spirituality and private religious/spiritual praxis.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Medo/psicologia , Sintomas Inexplicáveis , Trauma Psicológico/psicologia , Religião e Psicologia , Espiritualidade , Adulto , Ansiedade/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Alemanha/epidemiologia , Humanos , Entrevistas como Assunto , Trauma Psicológico/epidemiologia
17.
Scand J Prim Health Care ; 37(3): 319-326, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31409170

RESUMO

Objective: To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses. Design: Retrospective case control study 2013-2014. Setting: Primary health care, Sweden. Subjects. Patients with new onset sickness certificates with symptom diagnoses n = 222, and disease specific diagnoses (controls), n = 222. Main outcome measures: Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans. Results: Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, p = 0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days p = 0.018) and more certificates issued by telephone (23% vs. 15% p = 0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, p < 0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, p < 0.001), but less follow-up (16% vs. 26%, p < 0.008). In both groups contacts related to rehabilitation and with employers were scarce. Conclusion: Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing. KEY POINTS Symptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses. Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses. Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.


Assuntos
Serviços de Diagnóstico/normas , Atenção Primária à Saúde/normas , Licença Médica , Avaliação da Capacidade de Trabalho , Adulto , Estudos de Casos e Controles , Certificação , Comunicação , Feminino , Fidelidade a Diretrizes , Nível de Saúde , Humanos , Masculino , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Desempenho Físico Funcional , Reabilitação , Suécia , Telefone , Trabalho
18.
Mayo Clin Proc ; 94(9): 1753-1768, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31256854

RESUMO

OBJECTIVE: To demonstrate experience and feasibility of a precision medicine approach for patients with unexplained cytopenias, defined as low blood counts in one or more cell lineages, persistent for 6 months or longer, in the absence of known nutritional, autoimmune, infectious, toxic, and neoplastic (secondary) causes. PATIENTS AND METHODS: Patients were evaluated in our clinic between November 8, 2016, and January 12, 2018. After a thorough evaluation of known causes, family history, and appropriate clinical assays, genomic evaluation was performed in a stepwise manner, through Sanger, targeted, and/or whole-exome sequencing. Variants were analyzed and discussed in a genomics tumor board attended by clinicians, bioinformaticians, and molecular biologists. RESULTS: Sixty-eight patients were evaluated in our clinic. After genomic interrogation, they were classified into inherited bone marrow failure syndromes (IBMFS) (n=24, 35%), cytopenias without a known clinical syndrome which included idiopathic and clonal cytopenias of undetermined significance (CCUS) (n=30, 44%), and patients who did not fit into the above two categories ("others," n=14, 21%). A significant family history was found in only 17 (25%) patients (9 IBMFS, 2 CCUS, and 6 others), whereas gene variants were found in 43 (63%) patients (34 [79%] pathogenic including 12 IBMFS, 17 CCUS, and 5 others]. Genomic assessment resulted in a change in clinical management in 17 (25%) patients, as evidenced by changes in decisions with regards to therapeutic interventions (n=8, 47%), donor choice (n=6, 35%), and/or choice of conditioning regimen for hematopoietic stem cell transplantation (n=8, 47%). CONCLUSION: We show clinical utility of a real-world algorithmic precision medicine approach for unexplained cytopenias.


Assuntos
Contagem de Células Sanguíneas/métodos , /terapia , Sintomas Inexplicáveis , Medicina de Precisão/métodos , Medicina de Precisão/estatística & dados numéricos , Centros Médicos Acadêmicos , Adolescente , Adulto , Anemia/diagnóstico , Anemia/terapia , /mortalidade , Criança , Estudos de Coortes , Feminino , Genômica , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/terapia , Humanos , Leucopenia/diagnóstico , Leucopenia/terapia , Masculino , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Neutropenia/terapia , Pancitopenia/diagnóstico , Pancitopenia/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Resultado do Tratamento , Adulto Jovem
19.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31350360

RESUMO

In 2016, the American Academy of Pediatrics published a clinical practice guideline that more specifically defined apparent life-threatening events as brief resolved unexplained events (BRUEs) and provided evidence-based recommendations for the evaluation of infants who meet lower-risk criteria for a subsequent event or serious underlying disorder. The clinical practice guideline did not provide recommendations for infants meeting higher-risk criteria, an important and common population of patients. Therefore, we propose a tiered approach for clinical evaluation and management of higher-risk infants who have experienced a BRUE. Because of a vast array of potential causes, the initial evaluation prioritizes the diagnosis of time-sensitive conditions for which delayed diagnosis or treatment could impact outcomes, such as child maltreatment, feeding problems, cardiac arrhythmias, infections, and congenital abnormalities. The secondary evaluation addresses problems that are less sensitive to delayed diagnosis or treatment, such as dysphagia, intermittent partial airway obstruction, and epilepsy. The authors recommend a tailored, family-centered, multidisciplinary approach to evaluation and management of all higher-risk infants with a BRUE, whether accomplished during hospital admission or through coordinated outpatient care. The proposed framework was developed by using available evidence and expert consensus.


Assuntos
Diagnóstico Tardio/tendências , Hospitalização/tendências , Sintomas Inexplicáveis , Diagnóstico Tardio/prevenção & controle , Humanos , Recém-Nascido , Fatores de Risco
20.
Br J Gen Pract ; 69(685): 380-381, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31345804
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