The pediatric intermed: A new clinical -decision making tool for proactive evaluation of psychosocial stress in children with IBD
Notice bibliographique
Résumé
IBD manifest themselves in children and adolescents in up to 1/3 of those who will eventually develop these conditions. The chronic nature of the disease and treatments is often a significant stressor for children and families. Failure to address psychosocial issues may lead to greater risk for poor treatment adherence and disease relapse, higher heath care utilization, and increased psychiatric co-morbidity. As such, improvement in health care providers' capacity to systematically identify factors contributing to case complexity in a simplified reproducible manner offers significant potential for improving outcomes for children/youth with IBD. The adult INTERMED (Steifel et al., 2006) is a clinical decision-support tool that provides indicators of biological, psychological, social and health care needs, as well as an overall index of case complexity. The tool is efficient to administer and successfully detects psychosocial needs, referral to effective services and improved health care practices and outcomes. However, no comparable validated tools exist for use with children. To address the unique developmental and social contexts of children, a pediatric adaptation of the Intermed tool (PIM) was developed The PIM adopts a life-chart methodology to identify of areas of high need and risk. The focus of the present study was to examine the psychometric properties of the new PIM tool in children/youth diagnosed with IBD. Children and parents participated in a semi-structured interview with a clinical nurse who then rated the 34-PIM items. To examine the construct validity of each PIM domain (biological, psychological, social, caregiver/family, health system) participants completed questionnaires assessing social and psychological functioning, parent/family stress, and quality of life. Information about disease status, and health care utilization was obtained from medical chart review. Initial results from 48 patients indicate very good item inter-rater reliability for the PIM (mean reliability = 0.82). The Cronbach alphas for the overall complexity scale and for each of the domain scores were very acceptable (ranging from .56-.90). Correlational analyses suggest a high degree of validity for each of the PIM domains. PIM Biological score related significantly to PCDAI scores (r = 0.72) and child functional disability (r = 0.53). The PIM Psychological score was highly correlated with childhood depression (r = 0.55) and externalizing problems (r = 0.46). Higher PIM social needs were significantly related to decreased social and academic competence (r = −0.58 and 0.66, respectively) and less community participation (r = 0.39). PIM Family was significantly related to family life stress and decreased resources (r = 0.44) and greater parenting stress (r = 0.30). Finally, the overall PIM Complexity Score was associated with greater health care utilization (more calls to IBD nurse (r = 0.30) /extra GI outpatient visits (r = 0.32)), as well as IBD specific Quality of Life (r = −0.41). The PIM is an easily administered, psychometrically reliable and valid tool for identifying the psychosocial and health care needs of children with IBD, to facilitate individualized care planning. We speculate that early identification and intervention of health stressors will provide opportunities for improved care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».