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El objetivo del presente estudio fue analizar las características sociodemográficas, metodológicas y diagnósticas de los informes periciales en psiquiatría y psicología realizados en el Centro de Estudios en Derecho y Salud entre 2011 y 2020. Se optó por un enfoque cuantitativo, descriptivo con intención analítica, transversal, con diseño retrospectivo. Se analizó la información obtenida en 145 peritajes. Se adelantó un análisis univariado para todas las variables sociodemográficas, metodológicas y diagnósticas de los informes periciales, según su naturaleza cualitativa o cuantitativa, y un análisis bivariado a través de tablas de contingencia para las variables mencionadas, con intervalos de confianza del 95 % para cada una de las medidas de prevalencia. Se encontró que la mayoría de peritajes fueron solicitados por el área del derecho contencioso-administrativo. Los diagnósticos más prevalentes fueron el trastorno adaptativo, el trastorno por estrés postraumático y el trastorno depresivo. Si bien los informes revisados cumplen con los lineamientos mínimos de ley, se encontraron algunas falencias relacionadas con la ausencia de información. Se espera que estos hallazgos permitan la reflexión por parte de los auxiliares de la justicia sobre los requerimientos de los informes periciales con miras a la humanización de la justicia y el apoyo a la toma de decisiones legales.
The aim of this study was to analyse the socio-demographic, methodological and diagnostic characteristics of the expert reports in psychiatry and psychology carried out at the Centre for Law and Health Studies between 2011 and 2020. We opted for a quantitative, descriptive approach with analytical, cross-sectional, retrospective design. The information obtained from 145 expert opinions was analysed. A univariate analysis was carried out for all sociodemographic, methodological and diagnostic variables in the expert reports, according to their qualitative or quantitative nature, and a bivariate analysis through contingency tables for the aforementioned variables, with confidence intervals of 95 % for each of the prevalence measures. It was found that the majority of expert opinions were requested by the area of contentious-administrative law. The most prevalent diagnoses were adjustment disorder, post-traumatic stress disorder and depressive disorder. Although the reports reviewed comply with the minimum legal guidelines, there were some shortcomings related to the absence of information. It is hoped that these findings will allow for reflection on the part of justice officials on the requirements of expert reports with a view to the humanisation of justice and support for legal decision-making.
O objetivo deste estudo foi analisar as características sociodemográficas, metodológicas e diagnósticas dos laudos periciais em psiquiatria e psicologia realizados no Centro de Estudos em Direito e Saúde entre 2011 e 2020. Optou-se por uma abordagem quantitativa e descritiva com desenho analítico, transversal e retrospectivo. Foram analisadas as informações obtidas de 145 pareceres de especialistas. Foi realizada uma análise univariada para todas as variáveis sociodemográficas, metodológicas e diagnósticas dos laudos periciais, de acordo com sua natureza qualitativa ou quantitativa, e uma análise bivariada por meio de tabelas de contingência para as variáveis mencionadas, com intervalos de confiança de 95 % para cada uma das medidas de prevalência. Verificou-se que a maioria dos pareceres foi solicitada pela área de direito contencioso-administrativo. Os diagnósticos mais prevalentes foram transtorno de ajustamento, transtorno de estresse pós-traumático e transtorno depressivo. Embora os relatórios analisados estejam em conformidade com as diretrizes legais mínimas, houve algumas deficiências relacionadas à ausência de informações. Espera-se que esses resultados permitam uma reflexão por parte dos envolvidos no sistema judiciário sobre os requisitos dos laudos periciais, com vistas à humanização da justiça e ao apoio à tomada de decisões legais.
Subject(s)
HumansABSTRACT
@#OBJECTIVE To provide reference for guiding the individualized drug therapy management of imatinib for gastrointestinal stromal tumor （GIST）， with the goal of enhancing patient survival rates and improving their quality of life. METHODS Using a nominal group technique， a multidisciplinary （clinical， pharmaceutical and evidence-based） expert panel was formed to create the Consensus of Chinese Experts on Individualized Medication Management of Imatinib for Gastrointestinal Stromal Tumors outline through joint discussions. The expert panel conducted systematic retrieval， analysis， and summarization of the outline’s content， and reached relevant consensus based on China’s current situation， clinical needs， and research evidence. An external expert panel was also formed， comprising experienced multidisciplinary experts in clinical practice. Delphi method questionnaire was employed to openly collect the external experts’ opinions， which were then organized， summarized， analyzed， provided with feedback， revised， and finally formed into a consensus. RESULTS & CONCLUSIONS The drafting of this consensus included the clinical application of imatinib in neoadjuvant therapy for GIST patients， adjuvant therapy for adult patients with significant risk of recurrence after surgical resection， and drug therapy for patients with recurrent， metastatic， or unresectable tumors； pharmaceutical monitoring and long-term medication management. This consensus provides standardized processes and methods for medical institutions in individualized drug therapy management for GIST patients and holds significant importance in improving the clinical efficacy of imatinib and ensuring drug safety.
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In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.
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@# In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.
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ObjectiveTo evaluate the methodological and reporting quality of clinical practice guidelines for Chinese patent medicine （CPM） with internationally recognized tools the appraisal of guidelines for research and evaluation （AGEREE） Ⅱ and reporting items for practice guidelines in healthcare （RIGHT）， thereby providing refe-rence for the clinical application and future development of CPM guidelines. MethodsDatabases including CNKI， VIP， Wanfang and Sinomed were searched for CPM guidelines， as well as medlive.cn， websites of China Association of Chinese Medicine and Chinese Medical Association， and reference lists of the included papers. The quality of the guidelines was evaluated using the AGREE Ⅱand RIGHT tools， and consistency tests were performed using Interclass Correlation Coefficient， and descriptive analysis and chi-square test were used to analyze the reporting rate for each domain and the average score for each item. ResultsFinally， 140 CPM guidelines were included， of which 51 were disease-oriented and 89 were drug-oriented， all of which were issued by China. For 51 disease-oriented CPM guidelines， the highest average score of all six AGREE Ⅱ domains was 73.32% for clarity， and the lowest was 26.80% for application； for 89 drug-oriented CPM guidelines， the highest average score was 55.62% for scope and purpose， and the lowest was 31.32% for rigour of development. In terms of the seven domains of the RIGHT checklist， the highest reporting rate was 68.26% for background， and lowest was 27.45% for other areas regarding the disease-oriented CPM guidelines； the highest reporting rate was 61.31% for background， and the lowest was 4.49% for other areas regarding drug-oriented CPM guidelines. The average reporting rate was higher for disease-oriented than drug-oriented CPM guidelines in three domains of AGREE Ⅱ （rigour of development， clarity of presentation， editorial independence）， as well as four domains of RIGHT checklist （basic information， evidence， funding and declaration and management of interests， and other areas）. ConclusionThe overall methodology and reporting quality of the current CPM guidelines still need to be improved. It is recommended that future guideline development teams should strictly refer to the AGREE Ⅱ and RIGHT checklist， and take into account of the characteristics of CPM guidelines and relevant methodo-logical suggestions in the development and reporting of CPM guidelines， thereby guiding the clinical use of CPM in a better way.
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Recommendation formation is a key component of clinical practice guidelines for Chinese patent medicine （CPM）， and should encompass the determination of the strength and direction of the recommendation， the rationale for the recommendation， and the methodology for implementing the recommendation. Recommendations can be formed through formal consensus and informal consensus. The strength and direction of recommendations for CPM guidelines should be determined by considering the quality of evidence for CPMs， the priority of the clinical questions， the pros and cons of efficacy and adverse effects， patient acceptance， the feasibility of the recommendation and the availability of resources， social fairness， economic benefits， and other influencing factors. In order to better guide guideline developers to consider these factors more rationally， this article provideed a detailed explanation of each factor in the context of the characteristics of TCM.
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@#his consensus aims to introduce the applications of 4K high-definition technology and fluorescence technology in thoracic surgery, summarize and categorize the technical support for pulmonary segment surgery, and innovatively propose technical support for precise sleeve resection of pulmonary segments. It provides a reference for clinical use, points out the direction for the research and innovation of domestically produced high-end endoscopes, promotes the widespread application of excellent domestically produced medical endoscopes, and facilitates the development of domestically produced medical equipment.
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OBJECTIVE To provide a detailed report and interpretation of the method and results for determining the weights of the technical indicators from the “multi-dimensional and multi-criteria comprehensive evaluation index system （first edition）” stated in Guideline for Multi-dimensional and Multi-criteria Comprehensive Evaluation of Chinese Patent Medicine. METHODS Normalization calculations were performed on the comprehensive weight values calculated by the analytic hierarchy process and expert weighting method to obtain the objective weights of the indicators. RESULTS The weight results of the six primary dimensions in the current comprehensive evaluation indicator system of Chinese patent medicine showed effectiveness dimension＞ safety dimension＞standard dimension＞application dimension＞scientific dimension＞economic dimension， with weight values of 0.281 0， 0.268 5， 0.195 8， 0.107 3， 0.096 1 and 0.051 3 respectively， consistent with the results of most researches currently. CONCLUSIONS The process of weight determination in this indicator system is scientifically reasonable， with clear methods and clear interpretations， and is worthy of further optimization and widespread application.
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Pancreatic cancer is a relatively common tumor of the digestive system， with difficulties in early-stage diagnosis and an extremely high degree of malignancy. Molecular diagnostic technology based on tumor biomarkers， combined with the existing gold standard in clinical practice， is of great clinical significance to achieve early accurate identification， timely treatment and intervention， and reduction in mortality. Previous studies have shown that miRNAs show high specificity in terms of types and expression levels in different pathological stages of pancreatic cancer and can thus be used in monitoring the development and progression of pancreatic cancer. Since a single miRNA has a limited diagnostic potential， the combination of different miRNAs may effectively improve the diagnostic efficiency of early-stage pancreas carcinogenesis. Based on related research advances in recent years， this consensus document aims to fill the gap in molecular diagnostic technology in the guidelines for the clinical diagnosis and treatment of pancreatic cancer and provide expert guidance and recommendations.
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Stem cell clinical research is a hot frontier research. The ethical review of stem cell clinical research is full of challenges. Currently, clinical researches lack specific operational guidelines. Considered the related laws and regulations, and the operability of practical work, experts from the field of stem cells, such as law, ethics and management, will form a consensus on the basis of full discussion and continuous revision. It will provide reference for the operation of the ethics committee of corresponding institutions, and lay a certain foundation for the establishment of national expert consensus in the future, so as to promote the effective guidance of ethical review practice and quality evaluation of stem cell research.
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Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.
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Resumo A esfera das perícias comumente reduz a questão do estabelecimento do nexo de causalidade entre trabalho e saúde/doença apenas ao binômio trabalho/vida pessoal. Partindo dos pressupostos dos campos Saúde do Trabalhador (ST) e Saúde Mental Relacionada ao Trabalho (SMRT), este ensaio visa problematizar o resultado da questão, que reside na existência de dificuldades enfrentadas por trabalhadores na obtenção do nexo causal entre seus agravos/adoecimentos, cuja causalidade mais complexa se explica a partir de várias mediações pouco consideradas nos atos periciais circunscritos apenas às anamneses clínicas de cunho biomédicas pautadas nos pressupostos da Medicina do Trabalho, Higiene e Saúde Ocupacional. As formas de superação à ideia de causa-efeito passam pelo entendimento de que o processo de adoecimento é social e histórico e de que é preciso buscar mediações entre trabalho e adoecimento para elucidar sintomatologias singulares a partir da experiência do desgaste coletivo. Tal averiguação deve, ao mesmo tempo, problematizar os próprios processos de trabalho dos atores sociais envolvidos nas investigações periciais e partir das prioridades definidas pelos próprios trabalhadores que atuam como sujeitos da análise da nocividade do trabalho para a saúde.
Abstract Expert testimonies commonly reduce the establishment of causal links between work and health/illness solely to the dichotomy of work/personal life. Based on the assumptions from the fields of Workers Health and Work-Related Mental Health, this essay problematizes the results of this issue, namely the difficulties faced by workers in establishing the causal link between their ailments/illnesses, whose more complex causality is explained through several mediations that are often overlooked by the limited expert acts restricted only to clinical anamneses based on Occupational Medicine, Hygiene, and Occupational Health. Overcoming the idea of cause and effect involves understanding that the process of falling ill is social and historical, and requires exploring the mediations between work and illness to elucidate singular symptomatology based on the collective wear and tear experience. Such an investigation should simultaneously problematize the very work processes of the social actors involved in the expert investigations, starting from the priorities defined by the workers themselves who act as subjects in the analysis of work-related harm to health.
Subject(s)
Mental Health , Occupational Health , Delivery of Health CareABSTRACT
Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.
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At present， there is no consensus on the diagnosis， treatment， and management of pulmonary nodules with integrated traditional Chinese and Western Medicine in China. To establish the clinical management strategy of pulmonary nodules with integrated medicine， a consensus was formed after full discussion by the experts from the Cancer Committee of Chinese Association of Integrative Medicine and the Cancer Committee of Beijing Association of Chinese Medicine according to the guidelines for pulmonary nodules issued in recent years and the clinical practice of multiple hospitals in the treatment of cancers with integrated Chinese and Western medicine. This consensus involves the existing clinical management guidelines of pulmonary nodules and the intervention methods of traditional Chinese medicine （TCM）. Considering the therapeutic positioning and value of TCM， this consensus standardizes the whole-process management of pulmonary nodules with integrated traditional Chinese and Western medicine， which will help more patients.
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Introducción: una nueva metodología para el empleo del análisis estadístico implicativo contextualizado a las investigaciones médicas de causalidad brinda reglas y meta-reglas que deben corresponderse con la práctica médica, lo cual se desconoce. Objetivo: evaluar la calidad de las reglas derivadas de la aplicación del análisis estadístico implicativo en las investigaciones médicas de causalidad. Métodos: se realizó un estudio observacional con la aplicación de técnicas cualitativas de tipo criterio de expertos. Los 33 expertos de mayor puntuación emitieron su juicio, mediante una escala Likert de cinco puntos, acerca de la frecuencia con que se cumplen en la práctica médica 23 reglas derivadas de la aplicación del análisis estadístico implicativo en tres estudios para la identificación de factores pronósticos en cáncer de mama. Las opiniones se procesaron mediante el método Delphi en dos rondas y se trianguló con la validez racional de estas reglas. Resultados: los expertos consideraron que cerca del 74 % de las reglas se cumplen en la práctica médica siempre o frecuentemente y sólo una regla resultó absurda. En la segunda ronda se trataron las tres reglas en las que no existió un acuerdo perfecto, en la cual se ratificó una regla como absurda y aumentó el nivel de acuerdo. La triangulación permitió encontrar contradicciones literatura-experto que facilitaron la identificación de problemas en la redacción de la interpretación de las reglas. Conclusiones: las reglas evaluadas reflejan, en general, lo que ocurre en la práctica médica y aquellas que resultan absurdas alertan al investigador sobre un posible sesgo de confusión.
Introduction: A new methodology for the use of contextualized statistical implicative analysis in causality medical research provides rules and meta-rules that must correspond to medical practice, which is unknown. Objective: To evaluate the quality of the rules derived from the application of the statistical implicative analysis in causality medical research. Methods: An observational study was carried out applying qualitative techniques based on expert judgement. Using a five-point Likert scale, the 33 experts with the highest score expressed their judgment about the frequency of the fulfilment of the 23 rules derived from the application of the statistical implicative analysis in three studies in order to identify prognostic factors for breast cancer. Opinions were processed using the two-round Delphi method, and the rational validity of these rules was triangulated. Results: The experts considered that about 74% of the rules are always or frequently followed in medical practice; only one rule was absurd. In the second round, the three rules in which there was no perfect agreement were discussed; one rule was ratified as absurd and there was an increase in the level of agreement. The triangulation allowed us to find contradictions between literature and experts, which facilitated the identification of problems in the drafting of the interpretation of the rules. Conclusions: The rules evaluated generally reflect what happens in medical practice and those that are absurd warn the researcher about the possibility of a confusion bias.
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En Cuba, el acceso a los servicios farmacéuticos por parte de la población se ve afectado por la no disponibilidad de medicamentos y la lejanía de las farmacias. La falta de información acerca de la existencia de los medicamentos y la cantidad de estos en la red de farmacias cercanas a una ubicación geográfica, aparejados al poco suministro de medicamentos y la calidad de la prestación del servicio, genera descontento e inconformidad en la población. En la presente investigación se realiza un diseño para mejorar la problemática planteada a partir de un sistema basado en reglas como ayuda a la toma de decisiones para la obtención de los medicamentos por parte de la población. Se aplica un estudio de caso mediante el cual es posible sugerir al usuario las 5 farmacias más cercanas donde el paciente puede adquirir los medicamentos sobre las decisiones asumidas.
In Cuba, access to pharmaceutical services by the population is affected by the non-availability of medicines and the remoteness of pharmacies. The lack of information about the existence of medicines and the quantity of these in the network of pharmacies close to a geographical location, coupled with the low supply of medicines and the quality of service provision, generates discontent and nonconformity in the population. In the present investigation, a design is carried out to improve the problem raised from a system based on rules as an aid to decision-making to obtain medicines by the population. A case study is applied through which it is possible to suggest to the user the 5 closest pharmacies where the patient can acquire the medicines on the decisions made.
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This study describes the healthcare resource use and costs associated with anxiety assessing claim database outcomes and expert opinion from the perspective of the Brazilian Private Healthcare System. A retrospective analysis of the Orizon database was conducted, containing claims data of anxiety patients reported in Private Healthcare Systems (2015-2017) according to the ICD-10 code (F40 or F41 and their subtypes). Further, a 3-hour online meeting brought together five anxiety and Health Insurance Companies experts to discuss their perspectives. The total cost of the 18,069 patients identified in the database was BRL 490 million: related to medical appointments (2%), exams (16%), emergency room (5%), and others (77%). The mean number of appointments was 5.1 in a 4-year period, performed by 61% of the patients. Approximately 2,595 visits were made to psychiatrists by 923 patients, and 95% underwent at least one examination (100.6 examinations per patient, on average). The identification of anxiety patients and their corresponding burden is challenging to estimate. The higher impact is related to the frequency of healthcare use before the diagnosis than the treatment itself. These outcomes may help plan and implement adequate healthcare programs for patients with anxiety.
Este estudo descreve o uso de recursos de saúde e os custos relacionados à ansiedade associando resultados de uma base de dados administrativa e opinião de especialistas na perspectiva do Sistema Privado de Saúde Brasileiro. Foi realizada uma análise retrospectiva da base de dados da Orizon de pacientes com ansiedade em atendimento hospitalizar ou ambulatorial no Sistema Privado de Saúde (2015 - 2017) com o código CID-10 (F40 ou F41 e os seus subtipos), adicionalmente promovemos uma reunião online de 3 horas com cinco especialistas em ansiedade e em seguros de saúde para discutir as suas perspectivas. O custo total dos 18.069 pacientes identificados no banco de dados foi de R$ 490 milhões, relacionados a consultas médicas (2%), exames (16%), pronto-socorro (5%) e outros (77%). A média de consultas foi de 5,1 em um período de 4 anos, realizadas por 61% dos pacientes. Aproximadamente 2.595 visitas foram feitas a psiquiatras por 923 pacientes, e 95% realizaram pelo menos um exame (média de 100,6 exames por paciente. É desafiador identificar e estimar o impacto da doença no Sistema Privado de Saúde Brasileiro. O impacto maior está relacionado à frequência de uso de serviços de saúde antes do diagnóstico, em comparação com o próprio tratamento. Esses resultados podem ajudar a planejar e implementar programas de saúde adequados para pacientes com ansiedade.
Subject(s)
Phobic Disorders , Cost of Illness , Supplemental HealthABSTRACT
Objective: The study aimed to describe the profile and economic burden of patients with depression from the perspective of the Brazilian Private Healthcare System (PHS). Methods: A two-step methodological quantitative-qualitative research design was performed: retrospective descriptive analysis of the Orizon database of patients with at least one claim of depression (F33, F38, or F39) in PHS (2013-2019) and experienced physicians perspective from an expert meeting. Results: 1,802 patients fulfilling the eligibility criteria counted BRL 74,978 million across the 4-year period. Over this period, nearly 60% of patients had a medical appointment (6.6 appointments per patient, on average), 61% had a psychologist, 9.8% had a psychiatrist appointment, and an average of 115.2 exams and 8.7 emergency visits per patient were performed. According to the experts, the economic impact of depression is more significant when considering the indirect costs related to productivity loss and impairment in occupational and interpersonal functioning. Conclusion: Identifying and diagnosing patients with depression and their real burden is challenging; even with significant costs identified in the claim database analyses in the Brazilian PHS, the real impact must be higher if indirect costs are considered. The depressive disorder should be prioritized in the Brazilian PHS to establish more adequate health policies.
Objetivo: O estudo teve como objetivo descrever o perfil e a carga econômica de pacientes com depressão na perspectiva do Sistema Único de Saúde (SUS). Métodos: Foi realizado um projeto de pesquisa quantitativo-qualitativo metodológico em duas etapas: análise descritiva retrospectiva do banco de dados Orizon de pacientes com pelo menos uma alegação de depressão (F33, F38 ou F39) no PHS (2013- 2019) e perspectiva de médicos experientes de uma reunião de especialistas. Resultados: 1.802 pacientes que preencheram os critérios de elegibilidade totalizaram R$ 74,978 milhões no período de 4 anos. Nesse período, cerca de 60% dos pacientes tiveram consulta médica (6,6 consultas por paciente, em média), 61% tiveram psicólogo, 9,8% consulta com psiquiatra e foram realizados em média 115,2 exames e 8,7 atendimentos de emergência por paciente . Segundo os especialistas, o impacto econômico da depressão é mais significativo quando considerados os custos indiretos relacionados à perda de produtividade e prejuízo no funcionamento ocupacional e interpessoal. Conclusão: Identificar e diagnosticar pacientes com depressão e sua real carga é desafiador; mesmo com custos significativos identificados nas análises da base de sinistros do SUS brasileiro, o impacto real deve ser maior se considerados os custos indiretos. O transtorno depressivo deve ser priorizado na APS brasileira para o estabelecimento de políticas de saúde mais adequadas.
Subject(s)
Costs and Cost Analysis , Depression , Supplemental HealthABSTRACT
The extent, purpose, and model of performance assessment should be guided by our understanding of clinical competence. We have come a long way from believing that competence is generic, fixed, and transferable across contents; to viewing competence as dynamic, incremental, contextual, and non-transferable. However, our pattern of assessment largely remains what it was many years ago. Contemporary educationists view competency assessment as different from traditional format. They place more emphasis on the role of expert subjective judgment, especially for performance and domain-independent competencies. Such assessments have conclusively shown their validity, reliability, and utility. They; however, require trained assessors, trust between the teachers and the taught, and above all, a political and administrative will for implementation.
ABSTRACT
Introducción: La validación de estrategias didácticas para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje, resulta necesaria para su posterior aplicación en la práctica pedagógica y posible generalización. Objetivo: Validar una estrategia didáctica para las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología. Métodos: Se realizó una investigación educativa entre enero y junio de 2022. Se asumieron métodos teóricos (analítico-sintético, inductivo-deductivo y sistematización), empíricos (consulta a expertos) y matemáticos-estadísticos (estadística descriptiva). Se seleccionó a los expertos según el nivel de competencia. Se elaboró y aplicó un cuestionario para valorar 16 aspectos de la estrategia en términos de: muy adecuado, bastante adecuado, adecuado, poco adecuado y no adecuado. Los criterios valorativos emitidos por los expertos se procesaron mediante el modelo matemático de Torgerson y se determinó el nivel de consenso de los expertos mediante el cálculo del coeficiente de concordancia de Kendall. Resultados: El coeficiente de competencia promedio de los expertos fue alto. De los 16 aspectos valorados, uno resultó "bastante adecuado" y el resto, "muy adecuado". Se estimó concordancia significativa entre los expertos consultados. Conclusiones: Los resultados de la consulta a expertos apuntan al reconocimiento del valor científico, teórico y práctico, de la estrategia didáctica diseñada para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología y le otorgan validez.
Introduction: The validation of didactic strategies to favor interdisciplinary relationships in the teaching-learning process is necessary for their subsequent application in pedagogical practice and possible generalization. Objective: To validate a didactic strategy for interdisciplinary relationships in the teaching-learning process of clinical subjects, with Pharmacology in the Stomatology career. Methods: Educational research was carried out, between January and June, 2022. Theoretical methods (analytical-synthetic, inductive-deductive and systematization), empirical (consultation to experts) and mathematical-statisticians (descriptive statistics). The experts were selected according to the level of competence. A questionnaire was developed and applied to assess 16 aspects of the strategy, in terms of: very suitable, quite suitable, suitable, not very suitable and not suitable. The evaluative criteria issued by the experts were processed using the Torgerson mathematical model and the level of consensus of the experts was determined by calculating the Kendall concordance coefficient. Results: The average competence coefficient of the experts turned out to be high. Of the 16 aspects assessed, one was "fairly adequate" and the rest, "very adequate". Significant agreement was estimated between the experts consulted Conclusions: The results of the expert consultation point to the recognition of the scientific, theoretical and practical value of the didactic strategy designed to favor interdisciplinary relationships in the teaching-learning process of clinical subjects with Pharmacology in the Stomatology career, and give validity to the same.