Care Evaluation (care + evaluation)

Distribution by Scientific Domains

Kinds of Care Evaluation

  • primary care evaluation

  • Selected Abstracts

    Panic disorder and suicidal ideation in primary care

    Daniel J. Pilowsky M.D., M.P.H.
    Abstract The purpose of this study was to ascertain whether panic disorder (PD) and suicidal ideation are associated in an inner-city primary care clinic and whether this association remains significant after controlling for commonly co-occurring psychiatric disorders. We surveyed 2,043 patients attending a primary care clinic using the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, a screening instrument that yields provisional diagnoses of selected psychiatric disorders. We estimated the prevalence of current suicidal ideation and of common psychiatric disorders including panic disorder and major depression. A provisional diagnosis of current PD was received by 127 patients (6.2%). After adjusting for potential confounders (age, gender, major depressive disorder [MDD], generalized anxiety disorder, and substance use disorders), patients with PD were about twice as likely to present with current suicidal ideation, as compared to those without PD (adjusted odds ratio [AOR]=1.84; 95% confidence interval [CI]: 1.06,3.18; P=.03). After adjusting for PD and the above-mentioned potential confounders, patients with MDD had a sevenfold increase in the odds of suicidal ideation, as compared to those without MDD (AOR=7.00; 95% CI: 4.42,11.08; P<.0001). Primary care patients with PD are at high risk for suicidal ideation, and patients with PD and co-occurring MDD are at especially high risk. PD patients in primary care thus should be assessed routinely for suicidal ideation and depression. Depression and Anxiety 23:11,16, 2006. 2005 Wiley-Liss, Inc. [source]

    A new US,UK diagnostic project: mood elevation and depression in first-year undergraduates at Oxford and Stanford universities

    R. A. Chandler
    Objective:, To investigate differences in prevalence of mood elevation, distress and depression among first-year undergraduates at Oxford and Stanford universities. Method:, An online survey was sent to Oxford and Stanford first-year undergraduate students for two consecutive years in the winter of 2005 and 2006. Students completed a survey that assessed mood symptoms and medication use. Results:, Both universities had similar rates of distress by General Health Questionnaire (Oxford , 42.4%; Stanford , 38.3%), depression by Primary Care Evaluation of Mental Disorders (Oxford , 6.2%; Stanford , 6.6%), and psychotropic and non-psychotropic medication usage (psychotropic: Oxford , 1.5%; Stanford 3.5%; non-psychotropic: Oxford , 13.3%; Stanford , 18%). Oxford had higher rates of mood elevation by Mood Disorder Questionnaire (MDQ) (Oxford , 4%; Stanford , 1.7%). Conclusion:, Oxford and Stanford students have similar rates of mood distress, depression and general medication usage. Students at Oxford have a higher prevalence of MDQ scores that possibly indicate a bipolar disorder, while Stanford students are prescribed more psychotropics. [source]

    Inappropriate eating behaviors during pregnancy: Prevalence and associated factors among pregnant women attending primary care in southern Brazil,

    Rafael Marques Soares RD
    Abstract Objective: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care. Method: The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed. Results: Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5,20.0], followed by excessive shape (5.6%; 95% CI 4,8) and weight concerns (5.5%; 95% CI 4,8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2,4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3,2.4), and prepregnancy BMI < 19.8 kg/m2 (PR = 1.6; 95% CI 1.1,2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01,1.11). Discussion: Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety. 2008 by Wiley Periodicals, Inc. Int J Eat Disord, 2009 [source]

    Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life Depression

    Eric J. Lenze MD
    OBJECTIVES: To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture. DESIGN: Prospective naturalistic study. SETTING: University of Pittsburgh Medical Center,Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia. PARTICIPANTS: One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded. MEASUREMENTS: Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD. RESULTS: Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03,1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels. CONCLUSION: The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events. [source]

    Prevalence of depression and anxiety in hospitalized chronic obstructive pulmonary disease patients and their quality of life: a pilot study

    Herng Nieng Chan MBBS MMed (Psychiatry)
    Abstract Introduction: There is a high prevalence of psychiatric comorbidities in patients with Chronic Obstructive Pulmonary Disease (COPD). It has been reported that if left untreated, the psychiatric comobidities can lead to poorer quality of life. The present study was initiated to investigate the prevalence of major depressive disorder, generalized anxiety disorder and panic disorder in hospitalized COPD patients and their quality of life. Methods: The Patient Health Questionnaire (PHQ) of the Primary Care Evaluation of Mental Disorders (PRIME-MD) was administered to screen an opportunistic sample of COPD patients admitted to a general hospital for the abovementioned psychiatric disorders. The Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) was utilized to assess quality of life. Results: Fifty-one patients were analyzed. The prevalence of major depressive disorder in this sample on screening was 7.8% (95% CI 2.2,18.9) and that of anxiety disorders (generalized anxiety disorder and panic disorder) was 5.9% (95% CI 1.2,16.2). The quality of life of COPD patients with psychiatric comorbidities in the present study was severely impaired in seven of the eight domains measured by the SF-36. Discussion: Despite the small sample size of COPD patients, the prevalence of psychiatric comorbidities was not insignificant. The present study showed that the quality of life of hospitalized COPD patients with psychiatric illnesses was significantly lowered. Treatment of COPD should include addressing psychosocial issues. [source]

    Exploring differential attrition rates among system of care evaluation participants

    Kelly N. Rogers
    The purpose of the present study is to investigate differential attrition rates in terms of both demographic characteristics and initial levels of child functioning of participants in North Carolina's system of care evaluation. Participants included 303 families (78 dropped out of the study, a 26% attrition rate). Families dropped out of the evaluation for three main reasons: refusal to participate, moving, or inability to contact the family. The majority of families who dropped out of the study did so after completing only the baseline interview. Differential attrition did not exist in terms of demographic characteristics, but there was some support for possible differential attrition indicated by initial levels of child functioning in some cases. Additionally, higher parental education level predicted longer participation in longitudinal evaluation. Recommendations and implications for applied research are offered. 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 167,176, 2004. [source]

    Specificity and reliability of prognostic indexes in intensive care evaluation: the spontaneous cerebral haemorrhage case

    Alberto Barbieri PhD MD
    Abstract Objective, To determine the reliability of a generic index such as Simplified Acute Physiology Score II (SAPSII), compared with a specific one Intra Cerebral Haemorrhage score (ICH score), as an intensive care unit (ICU) outcome predictor when evaluating a general facility that frequently treats a specific type of patients , those with spontaneous cerebral haemorrhage. Methods, The study cohort consisted of a random sample of patients (81) admitted to Modena's Policlinico Teaching Hospital's ICU with spontaneous ICH over a 24-month period. Main outcome measure, SAPSII, ICH score, overall mortality. Results, The mean ICH score for the 32 surviving patients was 3.41 1.012 while for the 49 deceased patients was of 4.24 0.855 (P = 0.000). The mean SAPSII value for the 32 surviving patients was 49.09 16.58 while for the 49 deceased patients was 49.51 15.93. SAPSII, ICH scores were analysed for mortality, by receiver operating characteristic curves: the area under the curve was significant for ICH, not-significant for SAPSII. Conclusions, Regional quality controls use generic prognostic indexes (SAPSII) in relation to mortality and outcome to assess ICUs, which is appropriate when dealing with a general facility when there is not a predominant type of patient, but it may bias the evaluation if the population with specific pathologies (ICH), not included in the general index, is statistically considerable, leading to an incorrect criticality assessment, an inappropriate strategic plan and the subsequent inefficient resource allocation. [source]

    Incorrect and incomplete coding and classification of diabetes: a systematic review

    DIABETIC MEDICINE, Issue 5 2010
    M. A. Stone
    Diabet. Med. 27, 491,497 (2010) Abstract Aims, To conduct a systematic review to identify types and implications of incorrect or incomplete coding or classification within diabetes or between diabetes and other conditions; also to determine the availability of evidence regarding frequency of occurrence. Methods, Medical Subject Headings (MeSH) and free-text terms were used to search relevant electronic databases for papers published to the end of August 2008. Two researchers independently reviewed titles and abstracts and, subsequently, the full text of potential papers. Reference lists of selected papers were also reviewed and authors consulted. Three reviewers independently extracted data. Results, Seventeen eligible studies were identified, including five concerned with distinguishing between Type 1 and Type 2 diabetes. Evidence was also identified regarding: the distinction between diabetes and no-diabetes, failure to specify type of diabetes, and diagnostic errors or difficulties involving maturity-onset diabetes of the young, latent autoimmune diabetes in adults, pancreatic diabetes, persistence of foetal haemoglobin and acquired immune deficiency syndrome (AIDS). The sample was too heterogeneous to derive accurate information about frequency, but our findings suggested that misclassification occurs most commonly in young people. Implications relating to treatment options and risk management were highlighted, in addition to psychological and financial implications and the potential impact on the validity of quality of care evaluations and research. Conclusions, This review draws attention to the occurrence and implications of incorrect or incomplete coding or classification of diabetes, particularly in young people. A pragmatic and clinically relevant approach to classification is needed to assist those involved in making decisions about types of diabetes. [source]