Collaborative Depression Trial (CADET): multi-centre randomised controlled trial of collaborative care for depression - study protocol

<p>Abstract</p> <p>Background</p> <p>Comprising of both organisational and patient level components, collaborative care is a potentially powerful intervention for improving depression treatment in UK primary Care. However, as previous models have been developed and evaluated in the United States, it is necessary to establish the effect of collaborative care in the UK in order to determine whether this innovative treatment model can replicate benefits for patients outside the US. This Phase III trial was preceded by a Phase II patient level RCT, following the MRC Complex Intervention Framework.</p> <p>Methods/Design</p> <p>A multi-centre controlled trial with cluster-randomised allocation of GP practices. GP practices will be randomised to usual care control or to "collaborative care" - a combination of case manager coordinated support and brief psychological treatment, enhanced specialist and GP communication. The primary outcome will be symptoms of depression as assessed by the PHQ-9.</p> <p>Discussion</p> <p>If collaborative care is demonstrated to be effective we will have evidence to enable the NHS to substantially improve the organisation of depressed patients in primary care, and to assist primary care providers to deliver a model of enhanced depression care which is both effective and acceptable to patients.</p> <p>Trial Registration Number</p> <p>ISRCTN32829227</p

The self-management of longer-term depression: learning from the patient, a qualitative study

Background Depression is a common mental health condition now viewed as chronic or long-term. More than 50 % of people will have at least one further episode of depression after their first, and therefore it requires long-term management. However, little is known about the effectiveness of self-management in depression, in particular from the patients’ perspective. This study aimed to understand how people with longer-term depression manage the condition, how services can best support self-management and whether the principles and concepts of the recovery approach would be advantageous. Methods Semi-structured in depth interviews were carried out with 21 participants, recruited from a range of sources using maximum variation sampling. Interpretative Phenomenological Analysis was used by a diverse team comprised of service users, practitioners and academics. Results Four super-ordinate themes were found: experience of depression, the self, the wider environment, self-management strategies. Within these, several prominent sub-themes emerged of importance to the participants. These included how aspects of themselves such as hope, confidence and motivation could be powerful agents; and how engaging in a wide range of chosen activities could contribute to their emotional, mental, physical, social, spiritual and creative wellbeing. Conclusions Services in general were not perceived to be useful in specifically facilitating self-management. Increased choice and control were needed and a greater emphasis on an individualised holistic model. Improved information was needed about how to develop strategies and locate resources, especially during the first episode of depression. These concepts echoed those of the recovery approach, which could therefore be seen as valuable in aiding the self-management of depression. Keywords: Depression; Patients’ perspective; Qualitative research; Recovery; Self-help; Self-managemen

Packages of Care for Schizophrenia in Low- and Middle-Income Countries

In the third in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Jair Mari and colleagues discuss the treatment of schizophrenia

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

An improved method for estimating individual growth variability in fish, and the correlation between von Bertalanffy growth parameters

A new method for estimating individual variability in the von Bertalanffy growth parameters of fish species is presented. The method uses a nonlinear random effects model, which explicitly assumes that an individual's growth parameters represent samples from a multivariate population of growth parameters characteristic of a species or population. The method was applied to backcalculated length-at-age data from the tropical emperor, Lethrinus mahsena. Individual growth parameter variability estimates were compared with those derived using the current "standard" method, which characterizes the joint distribution of growth parameter estimates obtained by independently fitting a growth curve to each individual data set. Estimates of mean von Bertalanffy growth parameters from the two methods were similar. However, estimated growth parameter variances were much higher using the standard method. Using the random effects model, the estimated correlation between population mean values of L-infinity and K was -0.52 or -0.42, depending on the marginal distribution assumed for K. The latter estimate had a 95% posterior credibility interval of -0.62 to -0.17. These represent the first reliable estimate of this correlation and confirm the view that these parameters are negatively correlated in fish populations; however, the absolute correlation value is somewhat lower than has been assumed

WCPFC‐SC10‐2014/MI‐WP‐01

Evaluation of risks of exceeding limit reference points for south Pacific albacore, bigeye, yellowfin and skipjack tunas with implications for target reference points: a case study using south Pacific albacor

The Biology of Coral Reefs

Coral reefs represent the most spectacular and diverse marine ecosystem on the planet as well as a critical source of income for millions of people. However, the combined effects of human activity have led to a rapid decline in the health of reefs worldwide, with many now facing complete destruction. This timely book provides an integrated overview of the function, physiology, ecology, and behaviour of coral reef organisms. Each chapter is enriched with a selection of 'boxes' on specific aspects written by internationally recognised experts. As with other books in the Biology of Habitats Series, the emphasis in this book is on the organisms that dominate this marine environment although pollution, conservation, climate change, and experimental aspects are also included. Indeed, particular emphasis is placed on conservation and management due to the habitat's critically endangered status. A global range of examples is employed which gives the book international relevance. This accessible text is intended for students, naturalists and professionals and assumes no previous knowledge of coral reef biology.It is particularly suitable for both senior undergraduate and graduate students (in departments of biology, geography, and environmental science) taking courses in coral reef ecology, marine biology, oceanography and conservation biology, as well as the many professional ecologists and conservation biologists requiring a concise overview of the topic. It will also be of relevance and use to reef managers, recreational divers, and amateur naturalists