Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

Background. Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design. CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion. Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands

Sleep quality of women with gynecological and breast cancer Calidad del sueño en mujeres con cáncer ginecólogo e mamario Qualidade do sono de mulheres portadoras de câncer ginecológico e mamário

Subjective sleep quality has been recognized as a valuable indicator of health and quality of life. This exploratory and descriptive study aimed at describing habitual sleep quality of women suffering from gynecological and breast cancer and comparing habitual versus sleep quality during hospitalization. Twenty-five women admitted in hospital for clinical treatment of cancer completed the Pittsburgh Sleep Quality Index (PSQI) within 72 hours after admission and again just before discharge. Fifty-two percent of subjects reported habitual bad sleep quality, and this proportion increased to 80% of subjects during hospital stay. Subjects indicated the following most frequent causes of night sleep disturbance: need to go to the toilet, waking up early and receiving nursing care during the night. Results point to the importance of including careful assessment of sleep quality and environment in nursing care planning for oncology patients, mainly during hospitalization.<br>Actualmente, la calidad de sueño referida por el propio individuo es reconocida como un indicador de salud y calidad de vida. Esto estudio exploratorio y descriptivo describe la calidad habitual del sueño de mujeres con cáncer ginecológico y mamario y la confronta con la hospitalización. Se desarrolló con 25 mujeres hospitalizadas para tratamiento clínico del cáncer ginecológico. Se colectaron informaciones mediante el Pittsburgh Sleep Quality Index (PSQI) y se verifico que el 52% de los sujetos poseía mala calidad del sueño habitualmente, mientras el 80% hubiera mala calidad en la hospitalización. Las orígenes de las perturbaciones del sueño nocturno apuntadas más frecuentemente fueron: usar el baño, despertarse temprano y ser cuidado por las enfermeras durante la noche. Los resultados muestran la necesidad de que el planeamiento de cuidados de enfermería para mujeres con cáncer ginecólogo incluya la evaluación de la calidad del sueño de las pacientes, inclusive en la hospitalización.<br>A qualidade de sono referida pelo próprio indivíduo é reconhecida atualmente como um indicador de saúde e de qualidade de vida. Este estudo exploratório e descritivo teve por objetivo descrever a qualidade habitual do sono de mulheres com câncer ginecológico e mamário e compará-la à qualidade do sono das mesmas na hospitalização. Participaram 25 mulheres hospitalizadas para tratamento clínico do câncer que responderam ao Índice de Qualidade de Sono de Pittsburgh (PSQI) até 72 horas após a admissão e quando prevista a alta hospitalar. Verificou-se que 52% das mulheres apresentavam má qualidade de sono habitual e que, na hospitalização, esse percentual elevou-se para 80%. Como causas mais freqüentes de perturbação do sono na hospitalização destacaram-se: necessidade de usar o banheiro; despertar precoce; cuidados prestados pela equipe de enfermagem. Os resultados apontam para a necessidade de cuidados oncológicos que englobem a qualidade de sono destes pacientes, sobretudo na hospitalização