RESUMO
BACKGROUND: Shared decision making (SDM) is advised in the treatment guideline for depressive disorders. However, it’s unclear if SDM contributes to the optimization of care. AIM: To provide an overview of the effects of SDM within the treatment of depression on treatment outcome, patient satisfaction and adherence through a meta-analysis and systematic review. METHOD: In a literature search (PubMed, PsycINFO, Embase), randomised controlled studies with patients who suffer from depression or depressive symptoms were selected. The effect of a SDM intervention previous to treatment was compared to no SDM intervention on the outcome measures. Effect sizes were computed with random effects models and risk of bias was assessed. RESULTS: Five studies were included (N = 850). SDM did not result in superior treatment outcome (Cohen’s d = 0.02;
95%-BI:-0.12-0,16; p = 0.773) and adherence (Cohen’s d = 0.29; 95%-BI:-0.01-0.58; p = 0.056). SDM did lead to higher patient satisfaction with a medium-large effect size (Cohen’s d = 0.53; 95%-BI:0,17-0.90; p = .004). CONCLUSION: SDM resulted in higher patient satisfaction, no effects were found regarding treatment outcome and adherence. However, operationalisation of SDM in the studies were variable. SDM appears to be a versatile construct in clinical practice.
Assuntos
Tomada de Decisão Compartilhada , Tomada de Decisões , Humanos , Depressão , Participação do Paciente , Cooperação do PacienteRESUMO
We have identified a novel gene, EMS1, that is consistently amplified and overexpressed in human carcinomas with an amplification of the chromosome 11q13 region. Comparisons of the EMS1 sequences with those present in the GenBank databases revealed a high identity with chicken cortactin. Southern and western blot analyses confirm the high sequence conservation during evolution. An antiserum specific for human cortactin, showed in gene transfer experiments that both human p80 and p85 isoforms are encoded by the EMS1 cDNA. Further comparisons demonstrated an high sequence and structural homology with HS1 that is implicated in signal transduction in lymphoid cells only. Expression of EMS1/cortactin mRNA was restricted to tumor cell lines derived from non-lymphoid origin. Cortactin contains (i) a filamentous actin binding tandem repeat domain, (ii) a proline-rich SH3-binding and (iii) a SH3 domain that is common in proteins involved in signal transduction. Our data suggest that human EMS1/cortactin has a function in signal transmission between cell-matrix contact sites and the cytoskeleton and, as such, its overexpression due to 11q13 amplification might effect adhesive properties of human carcinomas.
