Articles: disease.
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Cochrane Db Syst Rev · Jul 2007
ReviewWITHDRAWN: Antidepressants for depression in medical illness.
Depression in the physically unwell is common and an important cause of morbidity. There are problems with diagnosing depression in the physically ill which may lead to under-recognition and under-treatment. In clinical practice antidepressants are available and a feasible option for treating depressive disorders. Therefore we thought it would be a reasonable first step in addressing this problem to describe the literature of randomised controlled trials in this area. ⋯ The review provides evidence that antidepressants, significantly more frequently than either placebo or no treatment, cause improvement in depression in patients with a wide range of physical diseases. About 4 patients would need to be treated with antidepressants to produce one recovery from depression which would not have occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4). Antidepressants seem reasonably acceptable to patients, in that about 10 patients would need to be treated with antidepressants to produce one dropout from treatment which would not have occurred had they been given placebo (NNH 9.8, 95% CI 5.4-42.9).The evidence is consistent across the trials, apart from 2 trials in cancer, where the "atypical" antidepressant mianserin produced significantly less dropout than placebo. Trends towards tricyclics being more effective than SSRIs, but also more likely to produce dropout were noted, but these are based on non-randomised comparisons between trials. Problems with the evidence include most of the trials' use of observers, rather than patients, to decide on improvement, and concentration mainly on symptoms rather than function and quality of life. There is also a possibility of undetected negative trials.Nevertheless, the review provides evidence that use of antidepressants should at least be considered in those with both physical illness and depression. Regarding diagnosis, the existence of a cheap and readily available treatment for depression should encourage detailed assessment of persistent low mood in the physically ill.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2007
[International curriculum for medical coders. Recommendations of the Education Committee of the WHO Family of International Classifications Network].
Nationally collected data for mortality and morbidity are coded according to the International Classification of Diseases (ICD). From the coded data international statistics are compiled. ⋯ With the development of core curricula for mortality and morbidity coding, the Education Committee of the WHO Family of International Classifications Network developed an entry level standard for the education of medical coders. Through this enhanced and internationally consistent level of education the quality of the collected data can be increased.
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Multicenter Study
Predictors of psychosocial adjustment in people with physical disease.
The purpose of this paper was to examine the demographic, medical and psychosocial variables that result in the deterioration of psychosocial adjustment in patients with physical disease, the meaning their illness has for them and their coping style. ⋯ The study indicated some predictors in the assessment of psychosocial adjustment and care of patients with physical illness. In daily clinical practice, among the patients with physical illness, those with a negative perception of their illness and those who define depression should be given special attention for psychosocial support.