Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis

Background: Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment. Methods: Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ. Results: 298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment. Conclusions: These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression

Limiting distributions for explosive PAR(1) time series with strongly mixing innovation

This work deals with the limiting distribution of the least squares estimators of the coefficients a r of an explosive periodic autoregressive of order 1 (PAR(1)) time series X r = a r X r--1 +u r when the innovation {u k } is strongly mixing. More precisely {a r } is a periodic sequence of real numbers with period P \textgreater{} 0 and such that P r=1 |a r | \textgreater{} 1. The time series {u r } is periodically distributed with the same period P and satisfies the strong mixing property, so the random variables u r can be correlated

Catálogo de autoridades da Rede BIM (DPHDM): Estudo de caso no tratamento de registros de pontos de acesso

Identificar possíveis problemas na alimentação da base de autoridades de assuntos da Rede BIM através da utilização do software Pergamum, e contribuir para padronização de seus pontos de acesso. A partir da revisão da literatura proposta, considera a importância da recuperação da informação para sua disseminação e ainda faz um breve levantamento dos padrões internacionais utilizados para esse fim. A metodologia utilizada envolveu a análise da base, limitada à letra “c” do alfabeto, e se propôs a detectar possíveis inconsistências existentes. Os principais problemas encontrados foram: falhas de grafia, falhas de entrada de cabeçalhos e duplicidade de assuntos. Os resultados práticos para a Rede BIM são: agilização dos serviços de catalogação e referência da Rede BIM, maior controle bibliográfico e facilidade na recuperação de itens nas pesquisas dos usuários. O Estudo de caso se propõe a contribuir com esclarecimentos quanto a equívocos cometidos, de forma a auxiliar na padronização e documentação do processo de alimentação da base de autoridades de assuntos pelos bibliotecários das 45 organizações militares, possibilitando benefícios aos serviços de catalogação e referência e finalmente, propiciando um atendimento mais prático e ágil ao usuário da Rede BIM