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The guideline “consultation psychiatry” of the Netherlands Psychiatric Association.
J Psychosom Res. 2009 Jun;66(6):531-5
Authors: Leentjens AF, Boenink AD, Sno HN, Strack van Schijndel RJ, van Croonenborg JJ, van Everdingen JJ, van der Feltz-Cornelis CM, van der Laan NC, van Marwijk H, van Os TW,
BACKGROUND: In 2008, the Netherlands Psychiatric Association authorized a guideline “consultation psychiatry.” AIM: To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? METHOD: Systematic literature review. RESULTS: Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of “collaborative care.” Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a “consultation letter” increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. CONCLUSION: Psychiatric consultations are effective and constitute a useful contribution to the patients’ treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.
PMID: 19446712 [PubMed - in process]
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Montag, 08. Juni 2009
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Single-item and multiple-item measures of adherence to public health behavior guidelines were incongruent.
J Clin Epidemiol. 2009 May 14;
Authors: van Keulen HM, Mesters I, van Mechelen W, de Vries H
OBJECTIVE: Physical activity (PA) and fruit and vegetable consumption may prevent or delay the development of hypertension and cardiovascular diseases. We examined adherence rates to single and combinations of Dutch public health guidelines for these behaviors by comparing and combining two self-report measurements. STUDY DESIGN AND SETTING: The behaviors of 2,568 Dutch participants aged 45-70 years were measured using one item and multiple items. Patients were classified as meeting or not meeting a guideline using both measurements separately and combined. RESULTS: Substantially more participants met guidelines when measured with multiple items than when measured with one item, with differences of 21-39%. Combined measurements resulted in fewer participants meeting guidelines than multiple-item measurements used alone. Combined measurements showed that 17%, 12%, and 34% of participants met the guidelines for fruit and vegetable consumption and PA, respectively; only 3% met all three guidelines. Sociodemographic variables explained less than 4% of the variance of congruency between single- and multiple-item measurements. CONCLUSION: When assessing adherence rates, the level appears dependent on the method of self-report chosen. Hence, more research must analyze which adherence measurement will result in valid responses and which variables are associated with congruency between single- and multiple-item measurements.
PMID: 19447006 [PubMed - as supplied by publisher]
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Montag, 08. Juni 2009
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An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis.
Spine J. 2009 May 15;
Authors: Watters WC, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O'Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RB, Toton JF
BACKGROUND CONTEXT: The objective of the North American Spine Society (NASS) evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spondylolisthesis is to provide evidence-based recommendations on key clinical questions concerning the diagnosis and treatment of degenerative lumbar spondylolisthesis. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of January 2007. The goal of the guideline recommendations is to assist the practitioner in delivering optimum, efficacious treatment of and functional recovery from this common disorder. PURPOSE: To provide an evidence-based, educational tool to assist spine care providers in improving the quality and efficiency of care delivered to patients with degenerative lumbar spondylolisthesis. STUDY DESIGN: Systematic review and evidence-based clinical guideline. METHODS: This report is from the Degenerative Lumbar Spondylolisthesis Work Group of the NASS Evidence-Based Clinical Guideline Development Committee. The work group was comprised of multidisciplinary spine care specialists, all of whom were trained in the principles of evidence-based analysis. Each member participated in the development of a series of clinical questions to be addressed by the group. The final questions agreed on by the group are the subject of this report. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology) and four additional, evidence-based, databases. The relevant literature was then independently rated by at least three reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final grades of recommendation for the answer to each clinical question were arrived at via face-to-face meetings among members of the work group using standardized grades of recommendation. When Level I-IV evidence was insufficient to support a recommendation to answer a specific clinical question, expert consensus was arrived at by the work group through the modified nominal group technique and is clearly identified as such in the guideline. RESULTS: Nineteen clinical questions were formulated, addressing issues of prognosis, diagnosis, and treatment of degenerative lumbar spondylolisthesis. The answers to these 19 clinical questions are summarized in this document. The respective recommendations were graded by the strength of the supporting literature that was stratified by levels of evidence. CONCLUSIONS: A clinical guideline for degenerative lumbar spondylolisthesis has been created using the techniques of evidence-based medicine and using the best available evidence as a tool to aid practitioners involved with the care of this condition. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, is available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.
PMID: 19447684 [PubMed - as supplied by publisher]
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