clinical factors

临床因素
  • 文章类型: Journal Article
    本研究旨在分析过去十年(2013-2023年)新生儿死亡率的决定因素。确定在COVID-19大流行之前和期间影响新生儿结局的关键因素。利用以PRISMA方法为指导的系统文献综述方法,这项研究评估了从Scopus等索引数据库收集的91篇论文,PubMed,和WebofScience。该审查涵盖了全球范围内进行的研究,提供有关新生儿死亡率研究的演变以及COVID-19危机对新生儿健康的影响的见解。分析揭示了一系列复杂的风险决定因素,分为社会经济因素,临床因素,以及医疗保健和质量。值得注意的因素包括农村和城市的医疗保健差距,产前和产后护理质量,以及医疗基础设施对新生儿结局的影响。这项研究强调了应对全球健康挑战的新生儿死亡率研究的重点转移。包括大流行。研究结果强调了需要多学科方法来解决新生儿死亡率,强调加强医疗系统的重要性,改善孕产妇教育,并确保公平获得优质护理。未来的研究应该探讨COVID-19大流行对新生儿健康的长期影响,并调查不同医疗机构中干预措施的有效性。
    This study aimed to analyze the determinants of neonatal mortality over the last decade (2013-2023), identifying key factors that have influenced neonatal outcomes both before and during the COVID-19 pandemic. Utilizing a systematic literature review approach guided by the PRISMA method, this study evaluates 91 papers collected from indexed databases such as Scopus, PubMed, and Web of Science. The review encompasses studies conducted globally, offering insights into the evolution of neonatal mortality research and the impact of the COVID-19 crisis on neonatal health. The analysis revealed a complex array of risk determinants, categorized into socioeconomic factors, clinical factors, and healthcare access and quality. Notable factors include rural versus urban healthcare disparities, prenatal and postnatal care quality, and the influence of healthcare infrastructure on neonatal outcomes. This study highlights the shifting focus of neonatal mortality research in response to global health challenges, including the pandemic. The findings underscore the need for multidisciplinary approaches to address neonatal mortality, emphasizing the importance of enhancing healthcare systems, improving maternal education, and ensuring equitable access to quality care. Future research should explore the long-term effects of the COVID-19 pandemic on neonatal health and investigate the efficacy of interventions in diverse healthcare settings.
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  • 文章类型: Journal Article
    牙种植体骨折对长期治疗成功构成重大挑战。本系统综述旨在全面检查影响牙种植体骨折(IFs)的临床因素。此外,解决了选择正确类型的植入物和预防这种并发症的策略。在PubMed进行了系统的搜索,Scopus,和WebofScience数据库。符合条件的研究包括回顾性病例对照,前瞻性队列研究,和临床试验。最初的搜索产生了361篇文章,其中312项被排除在这些评论之外,病例报告,无关紧要,或用英语以外的其他语言写的。这留下了49篇文章,只有6人符合深入审查的资格标准。这些研究,所有回顾性病例对照,检查植入物特性,患者人口统计学,手术和假体变量,生物力学和功能因素,临床和程序变量,并发症和维护问题。使用ROBINS-I工具评估偏倚风险较低。主要研究结果表明,植入物直径和结构阻力之间存在相关性,更广泛的植入物显示骨折风险降低。此外,后部区域,尤其是磨牙和前磨牙,由于咀嚼力的增加,对IFs的敏感性更高。植入物的设计和材料可能会显著影响骨折风险,锥形植入物和螺钉保留假体显示出更高的脆弱性。生物力学过载,尤其是磨牙症患者,成为IFs的主要促成因素。假体类型显著影响骨折发生率,悬臂假体由于应力增加而带来更高的风险。种植体周围骨丢失与IFs密切相关,强调需要细致的术前评估和个性化管理策略。未来的研究应该优先考虑更大的和异质的群体与长期随访和标准化的方法,以提高结果的普遍性和可比性。在受控条件下进行随机对照试验和生物力学研究对于阐明导致IFs的复杂相互作用和制定有效的预防策略也至关重要。此外,整合患者报告的结局可以全面了解IFs对生活质量的影响.
    Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies included retrospective case-control, prospective cohort studies, and clinical trials. The initial search yielded 361 articles, of which 312 were excluded being these reviews, case reports, irrelevant, or written in languages other than English. This left 49 articles, with only 6 meeting the eligibility criteria for an in-depth review. These studies, all retrospective case-control, examine implant characteristics, patient demographics, surgical and prosthetic variables, biomechanical and functional factors, clinical and procedural variables, complications and maintenance issues. The risk of bias was assessed as low using the ROBINS-I tool. Key findings suggest a correlation between implant diameter and structural resistance, with wider implants demonstrating reduced fracture risk. Additionally, posterior regions, especially molars and premolars, exhibit higher susceptibility to IFs due to increased masticatory forces. Implant design and material may considerably influence fracture risk, with conical implants and screw-retained prostheses showing higher vulnerability. Biomechanical overload, particularly in patients with bruxism, emerges as a primary contributing factor to IFs. Prosthesis type significantly influences fracture incidence, with cantilever prostheses posing a higher risk due to increased stress. Peri-implant bone loss is strongly associated with IFs, emphasizing the need for meticulous preoperative assessments and individualized management strategies. Future research should prioritize larger and heterogeneous populations with long-term follow-up and standardized methodologies to enhance the generalizability and comparability of findings. Randomized controlled trials and biomechanical studies under controlled conditions are also essential to elucidate the complex interactions contributing to IFs and developing effective prevention strategies. Additionally, integrating patient-reported outcomes may offer a comprehensive understanding of the impact of IFs on quality of life.
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  • 文章类型: Systematic Review
    乳腺癌是全球女性癌症相关死亡的主要原因。传统的筛查和风险预测模型主要依靠人口统计学和患者临床病史来制定政策和估计可能性。然而,人工智能(AI)技术的最新进展,特别是深度学习(DL),在开发个性化风险模型方面表现出了希望。这些模型利用从医学成像和相关报告获得的个体患者信息。在这次系统审查中,我们彻底调查了现有的关于DL在数字乳腺X线摄影中应用的文献,影像组学,基因组学,和乳腺癌风险评估的临床信息。我们批判性地分析了这些研究并讨论了他们的发现,强调DL技术预测乳腺癌风险的前景。此外,我们探索了正在进行的研究计划和AI驱动方法的潜在未来应用,以进一步提高乳腺癌风险预测,从而促进更有效的筛选和个性化的风险管理策略。
    本研究全面概述了使用传统和AI模型进行乳腺癌风险预测的成像和非成像特征。这项研究中回顾的特征包括影像学,影像组学,基因组学,和临床特征。此外,这项调查系统地介绍了用于乳腺癌风险预测的DL方法,旨在对初学者和高级研究人员都有用。
    总共确定了600篇文章,其中20个符合设定的标准并被选中。DL模型的并行基准测试,随着自然语言处理(NLP)应用于成像和非成像特征,可以使临床医生和研究人员在考虑临床部署或开发新模型时获得更大的认识。这篇综述为了解使用AI进行乳腺癌风险评估的现状提供了全面的指导。
    这项研究为研究人员提供了一个不同的观点,即使用人工智能进行乳腺癌风险预测。结合了许多成像和非成像特征。
    UNASSIGNED: Breast cancer is the leading cause of cancer-related fatalities among women worldwide. Conventional screening and risk prediction models primarily rely on demographic and patient clinical history to devise policies and estimate likelihood. However, recent advancements in artificial intelligence (AI) techniques, particularly deep learning (DL), have shown promise in the development of personalized risk models. These models leverage individual patient information obtained from medical imaging and associated reports. In this systematic review, we thoroughly investigated the existing literature on the application of DL to digital mammography, radiomics, genomics, and clinical information for breast cancer risk assessment. We critically analyzed these studies and discussed their findings, highlighting the promising prospects of DL techniques for breast cancer risk prediction. Additionally, we explored ongoing research initiatives and potential future applications of AI-driven approaches to further improve breast cancer risk prediction, thereby facilitating more effective screening and personalized risk management strategies.
    UNASSIGNED: This study presents a comprehensive overview of imaging and non-imaging features used in breast cancer risk prediction using traditional and AI models. The features reviewed in this study included imaging, radiomics, genomics, and clinical features. Furthermore, this survey systematically presented DL methods developed for breast cancer risk prediction, aiming to be useful for both beginners and advanced-level researchers.
    UNASSIGNED: A total of 600 articles were identified, 20 of which met the set criteria and were selected. Parallel benchmarking of DL models, along with natural language processing (NLP) applied to imaging and non-imaging features, could allow clinicians and researchers to gain greater awareness as they consider the clinical deployment or development of new models. This review provides a comprehensive guide for understanding the current status of breast cancer risk assessment using AI.
    UNASSIGNED: This study offers investigators a different perspective on the use of AI for breast cancer risk prediction, incorporating numerous imaging and non-imaging features.
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  • 文章类型: Systematic Review
    背景:本文的目的是确定影响产后选择避孕方法的因素。
    方法:我们进行了定性系统综述,包括2000年至2021年发表的有关产后避孕及其相关影响因素的文章。依靠首选的报告项目进行系统审查和荟萃分析,并在没有荟萃分析清单的情况下进行综合,搜索策略依赖于应用于9个数据库的2个关键词列表的组合。在Cochrane的随机对照试验工具的帮助下进行偏倚评估,唐斯和布莱克的检查表,和报告定性研究的综合标准(CoreQ)。进行了专题分析,以确定影响因素的类别。
    结果:共有34项研究符合我们的纳入标准,使我们能够分离出4类因素:(1)人口和经济因素(地理和种族血统,年龄,生活环境,教育/财富),(2)临床要素(奇偶校验,怀孕的进化,分娩和之后,以前使用的避孕方法及其机制,怀孕计划),(3)保健分娩(妊娠监测、关于避孕的会议,卫生保健系统,交货地点),和(4)社会文化因素(关于避孕的知识和信念,宗教,家庭和社会的影响)。与产后避孕相关的决策过程受社会环境因素和临床因素的综合影响。
    结论:主要影响因素(平价,教育水平,关于避孕的知识和信念,和家庭的影响)需要由临床医生在咨询期间解决。进一步的多变量研究应提供有关该主题的定量数据。
    The objective of this article is to identify the factors that influence the choice of contraceptive methods in the postpartum period.
    We conducted a qualitative systematic review including articles published between 2000 and 2021 on postpartum contraception and its related influential factors. Relying on Preferred Reporting Items for Systematic Reviews and Meta-Analyses and synthesis without meta-analysis checklists, the search strategy relied on a combination of 2 lists of keywords applied to 9 databases. A bias assessment was carried out with the help of the Cochrane\'s randomized controlled trial tool, the checklist from Downs and Black, and Consolidated criteria for reporting qualitative research (CoreQ). A thematic analysis was performed to identify categories of influential factors.
    A total of 34 studies met our inclusion criteria and enabled us to isolate 4 categories of factors: (1) demographic and economic factors (geographic and ethnic origin, age, living environment, education/wealth), (2) clinical elements (parity, evolution of pregnancy, childbirth and afterwards, contraception used previously and its mechanism, pregnancy planning), (3) health care delivery (pregnancy monitoring, sessions about contraception, health care system, place of delivery), and (4) sociocultural factors (knowledge and beliefs about contraception, religion, the influence of family and society). The decision process related to postpartum contraception is influenced by a combination of socioenvironmental factors and clinical elements.
    The main influential factors (parity, level of education, knowledge and beliefs about contraception, and influence of family) need to be addressed by clinicians during consultations. Further multivariate research should provide quantitative data on this topic.
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  • 文章类型: Journal Article
    双相情感障碍(BD)是一种由遗传高度定义的多因素慢性精神疾病,临床,环境和社会风险因素。本系统综述和荟萃分析旨在研究炎症和神经营养因子与临床,社会和环境因素参与BD的发展和表征。WebofScience,PubMed,PsycINFO,Scopus和ScienceDirect由两名独立审稿人进行了搜索。系统评价在PROSPERO(CRD42020180626)中注册。共选择51项研究,包括4547例诊断为BD的患者进行系统评价。其中,纳入18篇文章进行荟萃分析。该研究发现了BDNF和/或炎症因子与不同应激源以及功能和认知障碍之间存在关联的一些证据。但局限性阻碍了坚定的结论。荟萃分析的主要发现是BDNF循环水平与抑郁严重程度评分之间呈负相关(标准化平均差=-0.22,置信区间95%=-0.38,-0.05,p=0.01)。有证据表明BDNF在BD的抑郁成分中起作用。然而,在其他炎症介质中发现的不良一致性清楚地表明,需要进行高度对照的研究来确定该疾病的精确生物标志物.
    Bipolar disorder (BD) is a multifactorial chronic psychiatric disease highly defined by genetic, clinical, environmental and social risk factors. The present systematic review and meta-analysis aimed to examine the relationship between inflammatory and neurotrophic factors and clinical, social and environmental factors involved in the development and the characterization of BD. Web of Science, PubMed, PsycINFO, Scopus and Science Direct were searched by two independent reviewers. The systematic review was registered in PROSPERO (CRD42020180626). A total of 51 studies with 4547 patients with a diagnosis of BD were selected for systematic review. Among them, 18 articles were included for meta-analysis. The study found some evidence of associations between BDNF and/or inflammatory factors and different stressors and functional and cognitive impairment, but limitations prevented firm conclusions. The main finding of the meta-analysis was a negative correlation between circulating levels of BDNF and depression severity score (standardized mean difference = -0.22, Confidence Interval 95% = -0.38, -0.05, p = 0.01). Evidence indicates that BDNF has a role in the depressive component of BD. However, the poor consistency found for other inflammatory mediators clearly indicates that highly controlled studies are needed to identity precise biomarkers of this disorder.
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  • 文章类型: Journal Article
    The pulmonary route has long been used for drug administration for both local and systemic treatment. It possesses several advantages, which can be categorized into physiological, i.e., large surface area, thin epithelial membrane, highly vascularized, limited enzymatic activity, and patient convenience, i.e., non-invasive, self-administration over oral and systemic routes of drug administration. However, the formulation of dry powder for pulmonary delivery is often challenging due to restrictions on aerodynamic size and the lung\'s lower tolerance capacity in comparison with an oral route of drug administration. Various physicochemical properties of dry powder play a major role in the aerosolization, deposition, and clearance along the respiratory tract. To prepare suitable particles with optimal physicochemical properties for inhalation, various manufacturing methods have been established. The most frequently used industrial methods are milling and spray-drying, while several other alternative methods such as spray-freeze-drying, supercritical fluid, non-wetting templates, inkjet-printing, thin-film freezing, and hot-melt extrusion methods are also utilized. The aim of this review is to provide an overview of the respiratory tract structure, particle deposition patterns, and possible drug-clearance mechanisms from the lungs. This review also includes the physicochemical properties of dry powder, various techniques used for the preparation of dry powders, and factors affecting the clinical efficacy, as well as various challenges that need to be addressed in the future.
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  • 文章类型: Journal Article
    Numerous algorithms have been developed to guide warfarin dosing and improve clinical outcomes. We reviewed the algorithms available for various populations and the covariates, performances and risk of bias of these algorithms.
    We systematically searched MEDLINE up to 20 May 2020 and selected studies describing the development, external validation or clinical utility of a multivariable warfarin dosing algorithm. Two investigators conducted data extraction and quality assessment.
    Of 10 035 screened records, 266 articles were included in the review, describing the development of 433 dosing algorithms, 481 external validations and 52 clinical utility assessments. Most developed algorithms were for dose initiation (86%), developed by multiple linear regression (65%) and mostly applicable to Asians (49%) or Whites (43%). The most common demographic/clinical/environmental covariates were age (included in 401 algorithms), concomitant medications (270 algorithms) and weight (229 algorithms) while CYP2C9 (329 algorithms), VKORC1 (319 algorithms) and CYP4F2 (92 algorithms) variants were the most common genetic covariates. Only 26% and 7% algorithms were externally validated and evaluated for clinical utility, respectively, with <2% of algorithm developments and external validations being rated as having a low risk of bias.
    Most warfarin dosing algorithms have been developed in Asians and Whites and may not be applicable to under-served populations. Few algorithms have been externally validated, assessed for clinical utility, and/or have a low risk of bias which makes them unreliable for clinical use. Algorithm development and assessment should follow current methodological recommendations to improve reliability and applicability, and under-represented populations should be prioritized.
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  • 文章类型: Systematic Review
    背景:精神病患者的临床和功能结局改善对研究者来说是一个挑战。最近的进展为改善疾病早期的病程和识别耐药患者提供了机会。对两种不同的抗精神病药没有反应的患者,以正确的剂量给予足够的时间,在操作上可以被认为是抗治疗的。现有证据表明,抗精神病药物治疗的反应轨迹表明,一小部分受试者是不良反应者(8.2%),大多数患者有中等反应(76.4%),只有15.4%的人可以被认为是反应最大的快速反应者。首次发作精神病的患者通常会获得更有利的反应特征。然而,在这些患者中约有25%的精神病症状持续存在,长期病程较差。目标:本综述的目的是报告精神病早期患者治疗无反应的主要预测因素的最新证据。方法:我们使用了一个特定的字符串,保证了在pubmed中的高敏感性搜索。我们纳入了以下类型的出版物:随机对照试验,观察性研究,纵向研究,回顾性研究,病例对照研究,开放标签调查,队列研究,和评论。出版物必须关注早期精神病治疗抵抗的预测因素。结果:包括47条记录:5条评论,3元分析,22项纵向研究,2个回顾性研究,1自然主义研究,6项随机对照试验,2个开放标签研究,2个病例对照研究,4项队列研究,2个回顾性研究。确定了几个因素作为治疗抵抗的预测因素:病前功能降低;教育水平较低;首次精神病发作的阴性症状;合并症使用;发病年龄较小;缺乏早期反应;不坚持治疗;以及未经治疗的精神病持续时间较长。性别和婚姻状况的作用仍然存在争议。需要更多关于神经生物学的证据,遗传,和神经影像学因素。结论:确定首发精神病患者治疗抵抗的特定预测因素可改善精神分裂症关键早期患者的临床管理质量。
    Background: Clinical and functional outcome improvement in psychotic disorders is a challenge for the investigators. Recent advances offered opportunities for ameliorating the course of the illness during its early stages and for identifying treatment-resistant patients. Patients who had not response to two different antipsychotics, administered at correct doses for a sufficient period, can be operationally considered treatment-resistant. Available evidence suggested that the response\'s trajectory to the antipsychotic treatment revealed that a small proportion of subjects are poor responders (8.2%), the majority of patients have a moderate response (76.4%), and only 15.4% can be considered rapid responders with the greatest magnitude of response. Patients with first episode of psychosis generally obtain a more favorable response profile. Nevertheless, in around 25% of these patients symptoms of psychosis persist with a worse long-term course of illness. Objectives: The aim of this review is to report current evidences on the main predictors of treatment non-response in patients at early stage of psychosis. Methods: We used a specific string that guaranteed a high sensitive search in pubmed. We included the following types of publications: randomized-controlled trials, observational studies, longitudinal studies, retrospective studies, case-control studies, open-label investigations, cohort studies, and reviews. Publications must concern predictors of treatment resistance in early psychosis. Results: Forty-seven records were included: 5 reviews, 3 meta-analyses, 22 longitudinal studies, 2 retrospective studies, 1 naturalistic study, 6 randomized controlled trials, 2 open-label studies, 2 case-control studies, 4 cohort studies, 2 retrospective studies. Several factors were identified as predictors of treatment resistance: lower premorbid functioning; lower level of education; negative symptoms from first psychotic episode; comorbid substance use; younger age at onset; lack of early response; non-adherence to treatment; and longer duration of untreated psychosis. The role of gender and marital status is still controversial. More evidences are needed about neurobiological, genetic, and neuroimaging factors. Conclusions: The identification of specific predictive factors of treatment resistance in patients with first episode of psychosis ameliorates the quality of clinical management of these patients in the critical early phase of schizophrenia.
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  • 文章类型: Journal Article
    目的:系统回顾文献,以确定哪些临床因素影响半月板根部修复后患者的预后。
    方法:对多个数据库进行了系统评价。纳入标准包括英语,评估与半月板根部修复结果相关的临床和/或影像学因素的研究,内侧或外侧后根修复,和人类研究。排除标准包括半月板切除术研究,半月板身体研究,技术描述,仅报告半月板修复失败率的研究,多韧带修复,摘要,对照实验室研究,荟萃分析,和系统的审查。
    结果:纳入5项研究进行最终分析,包括4项病例系列和1项回顾性队列研究。在五项研究中,共有178例患者接受了半月板后根修复(总共179个膝盖)。平均年龄为51.4岁。平均随访时间为34.5个月。病例系列研究的平均Moga质量评分为15分(83.3%),回顾性比较研究的NOS评分为8分。在3/3评估BMI的研究中,体重指数(BMI)与结局无关。在1/5的研究中,年龄增加与较差的结果相关,在4/5的研究中没有相关性。在3/3的研究中,膝内翻>5°与较差的预后相关。
    结论:后半月板根部修复后临床效果差的危险因素包括预先存在的高级别(Outerbridge等级≥3)软骨损伤和内侧根部修复的严重内翻膝对齐(>5°)。
    方法:IV,系统回顾。
    OBJECTIVE: To systematically review the literature to determine what clinical factors influence patient outcomes after meniscal root repairs.
    METHODS: A systematic review of multiple databases was performed. The inclusion criteria included English language, studies evaluating clinical and/or radiographic factors related to meniscal root repair outcomes, medial or lateral posterior root repairs, and human studies. The exclusion criteria included meniscectomy studies, meniscal body studies, technique descriptions, studies reporting only failure rate of meniscal repairs, multiligament repairs, abstracts, controlled laboratory studies, meta-analyses, and systematic reviews.
    RESULTS: Five studies were included for final analysis including four case series and one retrospective cohort study. A total of 178 patients in the five studies underwent posterior meniscal root repair (179 knees total). The mean age was 51.4 years. The mean duration of follow-up was 34.5 months. The mean Moga quality rating for case series studies was 15 points (83.3%) and NOS score for the retrospective comparative study was 8. Body mass index (BMI) was not associated with outcomes in 3/3 studies assessing BMI. Increased age was associated with worse outcome in 1/5 studies and had no association in 4/5 studies. Knee varus >5° was associated with worse outcomes in 3/3 studies.
    CONCLUSIONS: Risk factors for poor clinical outcomes after posterior meniscal root repair include pre-existing high-grade (Outerbridge grade ≥ 3) chondral lesions and severe varus knee alignment (>5°) for medial root repairs.
    METHODS: IV, systematic review.
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  • 文章类型: Journal Article
    BACKGROUND: There is a modest but consistent association between violence and schizophrenia. The consequences of serious violence could be catastrophic for the victims, as well as the patients themselves and the community. Any knowledge that would help to prevent acts of serious violence would be of considerable value for the individual and the society.
    OBJECTIVE: To identify external and clinical risk factors for serious violence in schizophrenia, in addition to considering the strength of the association between the factors assessed and severe violence.
    METHODS: This was accomplished by a literature survey. One-hundred and two relevant papers were identified that were published during the past 20 years. Forty-four papers were assessed for eligibility. In all, 27 studies including clinical or cognitive variables were reviewed systematically. An effect size was reported where an odds ratio (OR) could be identified or calculated from available data. Five external factors and six clinical domains were evaluated.
    RESULTS: Substance abuse is robustly linking schizophrenia and violence. Among the clinical factors, insight, impulsivity, psychopathy, motor speed and a global measure of cognition are the factors with the strongest empirical evidence for an association with severe violence.
    CONCLUSIONS: This is the first systematic review of risk factors for severe violence in schizophrenia, in which a great number of clinical and external factors have been evaluated. Most of the clinical factors have been compared on effect size. The identified factors that represent an increased risk of violence in patients with schizophrenia should be included in risk assessments.
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