Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians

Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness.

The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.

Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians

Primary osteoporosis is characterized by decreasing bone mass and density and reduced bone strength that leads to a higher risk for fracture, especially hip and spine fractures. The prevalence of osteoporosis in the United States is estimated at 12.6% for adults older than 50 years. Although it is most frequently diagnosed in White and Asian females, it still affects males and females of all ethnicities. Osteoporosis is considered a major health issue, which has prompted the development and use of several performance measures to assess and improve the effectiveness of screening, diagnosis, and treatment. These performance measures are often used in accountability, public reporting, and/or payment programs. However, the reliability, validity, evidence, attribution, and meaningfulness of performance measures have been questioned. The purpose of this paper is to present a review of current performance measures on osteoporosis and inform physicians, payers, and policymakers in their selection of performance measures for this condition. The Performance Measurement Committee identified 6 osteoporosis performance measures relevant to internal medicine physicians, only 1 of which was found valid at all levels of attribution. This paper also proposes a performance measure concept to address a performance gap for the initial approach to therapy for patients with a new diagnosis of osteoporosis based on the current American College of Physicians guideline.

Chimerism analysis by sex determining region Y (SRY) and major histocompatibility complex markers in non-human primates using quantitative real-time polymerase chain reaction

The ability to discriminate and further quantify the proportion of donor and host cells is essential in hematopoietic stem cell transplant protocols. In human sex-mismatched transplants, this can be easily accomplished by the use of commercially available fluorescent in situ hybridization (FISH) probes. In many animal models, including non-human primates, this methodology is not possible due to the lack of commercially available FISH probes. In animal models, donor cell detection could be accomplished if there is a known species-specific sex determining region Y (SRY) (male) or other unique DNA sequence using either semiquantitative or quantitative real-time polymerase chain reaction (PCR). The use of real-time quantitative PCR has the obvious advantage of providing detailed enumeration of the percentage of donor cells present. We report the development of extremely sensitive primer and probe combinations for male (SRY) and major histocompatibility complex (MHC)-DQA sequences in the macaque and baboon non-human primate models. This assay has a sensitivity of a five-log range and can detect less than four target cells in the presence of 10(5) background cells (approximately 0.001%) and fetal DNA obtained from maternal serum from Macaca nemestrina. The SRY (male) primer and probe combination has similar sensitivity in Macaca fasicularis, Macaca mulatta, and Papio cynocephalus anubis.

Sharing international experiences in disasters: summary and action plan

INTRODUCTION

The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim.

METHODS

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

RESULTS

The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives.

DISCUSSION

The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories.

CONCLUSIONS

Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.

Subretinal Pseudomonas abscess after lung transplantation

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Optical waveguides formed by thermal migration of ions in glass

We present our results on optical waveguides formed by thermal diffusion of ions in glass. It was found that the peak of the ion-exchanged region can be shifted into the substrate interior by limiting the diffusion process. We also found that low loss films (<0.1 dB/cm) can be fabricated using this process and that the modal losses in these films do not agree with those losses predicted by existing theories. Also, the ion-exchange process has proved to be a simple means for fabricating tapered-edge couplers.