Designing payment for Collaborative Care for Depression in primary care

Objective. To design a bundled case rate for Collaborative Care for Depression (CCD) that aligns incentives with evidence‐based depression care in primary care. Data Sources. A clinical information system used by all care managers in a randomized controlled trial of CCD for older primary care patients. Study Design. We conducted an empirical investigation of factors accounting for variation in CCD resource use over time and across patients. CCD resource use at the patient‐episode and patient‐month levels was measured by number of care manager contacts and direct patient contact time and analyzed with count data (Poisson or negative binomial) models. Principal Findings. Episode‐level resource use varies substantially with patient's time in the program. Monthly use declines sharply in the first 6 months regardless of treatment response or remission status, but it remains stable afterwards. An adjusted episode or monthly case rate design better matches payment with variation in resource use compared with a fixed design. Conclusions. Our findings lend support to an episode payment adjusted by number of months receiving CCD and a monthly payment adjusted by the ordinal month. Nonpayment tools including program certification and performance evaluation and reward systems are needed to fully align incentives.     

The effects of powdered fertilized eggs on depression

This 12-week, double-blind, placebo-controlled study investigated the effects of fertilized egg powder (Young Tissue Extract; YT?) intake on outcome measures for depression. Fifty-five patients with depression were randomly assigned to receive YTE, YTE plus Melissa officinalis, or placebo for 12 weeks. At baseline, there were no significant differences in scores on the Hamilton Depression Rating Scale (HAM-D) or Beck Depression Inventory II (BDI-II) among the 3 groups. At 12 weeks, the HAM-D scores in groups treated with YTE or YTE with M. officinalis were both significantly lower than those in the placebo group. In addition, both treatment groups showed a significant improvement in depression as measured by the change in HAM-D scores from baseline to 12 weeks, whereas the placebo group showed no significant change. There were no significant differences between the 2 treatment groups. The study indicates that the fertilized egg powder has an antidepressive effect and may be an alternative or adjunct to antidepressive medication for some patients, but further research is necessary.     

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Immune thrombocytopenia (ITP) is commonly encountered in clinical practice. In 1996 the American Society of Hematology published a landmark guidance paper designed to assist clinicians in the management of this disorder. Since 1996 there have been numerous advances in the management of both adult and pediatric ITP. These changes mandated an update in the guidelines. This guideline uses a rigorous, evidence-based approach to the location, interpretation, and presentation of the available evidence. We have endeavored to identify, abstract, and present all available methodologically rigorous data informing the treatment of ITP. We provide evidence-based treatment recommendations using the GRADE system in those areas in which such evidence exists. We do not provide evidence in those areas in which evidence is lacking, or is of lower quality--interested readers are referred to a number of recent, consensus-based recommendations for expert opinion in these clinical areas. Our review identified the need for additional studies in many key areas of the therapy of ITP such as comparative studies of "front-line" therapy for ITP, the management of serious bleeding in patients with ITP, and studies that will provide guidance about which therapy should be used as salvage therapy for patients after failure of a first-line intervention.     

Stereotactic body radiation therapy: the report of AAPM Task Group 101

Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.     

High prevalence of enteroinvasive Escherichia coli isolated in a remote region of northern coastal Ecuador

Enteroinvasive Escherichia coli (EIEC) causes dysentery; however, it is less widely reported than other etiological agents in studies of diarrhea worldwide. Between August 2003 and July 2005, stool samples were collected in case-control studies in 22 rural communities in northwestern Ecuador. Infection was assessed by PCR specific for LT and STa genes of enterotoxigenic E. coli (ETEC), the bfp gene of enteropathogenic E. coli (EPEC), and the ipaH gene of both enteroinvasive E. coli and Shigellae. The pathogenic E. coli most frequently identified were EIEC (3.2 cases/100 persons) and Shigellae (1.5 cases/100 persons), followed by ETEC (1.3 cases/100 persons), and EPEC (0.9 case/100 persons). EIEC exhibited similar risk-factor relationships with other pathotypes analyzed but different age-specific infection rates. EIEC was the predominant diarrheagenic bacteria isolated in our community-based study, a unique observation compared with other regions of the world.