Assessing depression severity using the UK Quality and Outcomes Framework depression indicators: a systematic review

BackgroundDepression is a major cause of chronic ill-health and is managed in primary care. Indicators on depression severity assessment were introduced into the UK Quality and Outcomes Framework (QOF) in 2006 and 2009. QOF is a pay-for-performance scheme and indicators should have evidence to support their use; potential unintended consequences should also have been considered.AimTo review the effectiveness of routine assessment of depression severity using structured tools in primary care, and to determine the views of GPs and patients regarding their use.DesignSystematic review.MethodStudies were identified by searching electronic databases; study selection, data abstraction, and quality assessment were carried out by one reviewer, with checks from other authors and GRADE (grading of recommendations, assessment, development and evaluation) tables completed for included effectiveness studies.ResultsEight studies met the eligibility criteria. There was very low-quality evidence that assessing severity in a structured way at diagnosis using a validated tool led to interventions that were appropriate to the severity of depression. Patients and GPs had different perceptions of the assessment of depression at diagnosis, with patients being more positive. GPs highlighted unintended consequences. There was low-quality evidence that structured assessment at follow-up led to increased rates of remission and response, but changes to management were not seen. Patients used this assessment to measure their own response to treatment.ConclusionAny estimate of the effect of structured assessment of depression severity in UK general practice is uncertain. GPs consider routine use of questionnaires as incentivised by the QOF has unintended consequences, which could adversely affect patient care.     

How to assess postsurgical scars: A review of outcome measures

Abstract

Purpose. Complications of surgical incision include pathological scars with functional, cosmetic or psychological consequences. Postsurgical scar assessment is fundamental for a complete functional evaluation and as an outcome measure. Scar assessment scales are here reviewed and discussed from a clinical and psychometric point of view, with a clear definition of different scar parameters.

Method. An extensive review of the English-language literature was conducted using the Medline database.

Results. Four scales that satisfy psychometrical criteria were identified: Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), Manchester Scar Scale (MSS) and Stony Brook Scar Evaluation Scale (SBSES). Conclusions. To date, VSS is the most widely used rating scale for scars but POSAS appears the most comprehensive, taking into account the important aspect of patient’s perspective. The MSS has been never used for research, while SBSES has only been very recently proposed.     

老年人工髋关节置换围术期应激性溃疡的预防性护理

目的：探讨我院老年人工髋关节置换围术期应激性溃疡预防性护理的临床疗效。方法选取2010年4月～2013年4月在我院骨科住院髋部骨折且接受手术的老年患者106例，随机分为对照组和观察组，每组53例。对照组采用常规护理，观察组采用预防性护理。比较两组患者应激性溃疡发生率，术后1d、5d、10d、14d消化性溃疡症状分级量化积分。结果观察组应激性溃疡发生率明显低于对照组（P＜0．01）；观察组术后1d、5d、10d、14 d消化性溃疡症状评分明显优于对照组，差异有显著意义（ P＜0．01）。结论中西医结合预防性护理干预对预防老年人工髋关节置换围术期应激性溃疡效果显著，促进了疾病的康复，提高了患者的生活质量。     

持续质量改进措施在医院卫生管理中的应用

目的分析在新时期医院卫生管理工作中实施持续质量改进措施的效果。方法选取2017年1月—2018年1月期间本院60名医务人员作为对照组,给予常规卫生管理,选取2018年2月—2019年2月期间本院60名医务人员作为观察组,给予持续质量改进管理,对比两组管理效果。结果组间对比,观察组手卫生执行率、手卫生合格率、无菌操作规范率均高于对照组,且观察组卫生知识考核评分及护理满意度评分也高于对照组(P<0.05)。结论在新时期医院卫生管理中实施持续质量改进措施,更有利于提高医院卫生管理的整体水平,进而为医院的安全、健康、稳定运行提供保障。     

Using cortical non-invasive neuromodulation as a potential preventive treatment in schizophrenia - A review

BackgroundEvidence suggests that schizophrenia constitutes a neurodevelopmental disorder, characterized by a gradual emergence of behavioral and neurobiological abnormalities over time. Therefore, applying early interventions to prevent later manifestation of symptoms is appealing.ObjectiveThis review focuses on the use of cortical neuromodulation in schizophrenia and its potential as a preventive treatment approach. We present clinical and preclinical findings investigating the use of neuromodulation in schizophrenia, including the current research focusing on cortical non-invasive stimulation and its possibility as a future preventive treatment.MethodsWe performed a search in Medline (PubMed) in September 2020 using a combination of relevant medical subject headings (MeSH) and text words. The search included human and preclinical trials as well as existing systematic reviews and meta-analysis. There were no restrictions on language or the date of publication.ResultsNeurodevelopmental animal models may be used to investigate how the disease progresses and thus which brain areas ideally should be targeted at a given time point. Here, abnormalities of the prefrontal cortex have been often identified as an early and persistent impairment in schizophrenia. Currently there is insufficient evidence to either support or refute the use of neuromodulation to the cortex in adult patients with already manifested symptoms. However, preclinical results show that early non-invasive neuromodulation to the prefrontal cortex of adolescent animals, sufficiently prevents later psychosis-relevant abnormalities in adulthood. This points to the promising potential of cortical non-invasive neuromodulation as a preventive treatment when applied early in the course of the disease.ConclusionPreclinical translational-oriented findings indicate, that neuromodulation to cortical areas offers the possibility of targeting early neuropathology and through this diminish the progression of a later schizophrenic profile. Further studies are needed to investigate whether such early cortical stimulation may serve as a future preventive treatment in schizophrenia.     

Acute noise stress impairs feedback processing

We examined the impact of acute noise stress on the feedback-related negativity (FRN) and whether this effect depended on stressor predictability. Participants performed a gambling task in a silence and a noise condition with either predictable or unpredictable noise. FRN amplitude was measured in three ways, either neglecting (mean amplitude) or correcting for overlap with other components (base-to-peak; mean amplitude minus average mean amplitude of surrounding peaks). Notably, results differed between measures. Valence and magnitude both affected the FRN. These effects were additive on the mean amplitude and base-to-peak measures, but interactive on the mean amplitude corrected for both peaks measure. Acute noise stress specifically modulated valence and magnitude effects on the FRN, although evidence differed between measures as to whether valence and/or magnitude were processed differently. These findings indicate that acute stress impairs cognitive control by the anterior cingulate cortex. Stressor predictability added little to the explanation of effects.