This study did not employ a control group, making it difficult to ascribe the improvement in compliance solely to the training given (some improvement in processes may have occurred independent of the training).
Bottom line: A national education effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality.
Citation: Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcomes after a multicenter severe sepsis educational program in Spain. JAMA 2008;299(19):2294-2303.
Can SSRI and problem-solving therapy reduce the incidence of depression in non-depressed patients with a recent stroke?
Background: Depression occurs in more than half of previously non-depressed patients after a stroke. Post-stroke depression is associated with impaired recovery and increased mortality.
Study design: A multicenter randomized controlled trial.
Setting: Two urban university-affiliated hospitals and a suburban rehabilitation hospital in the U.S.
Synopsis: 178 patients age 50 to 90 were enrolled within three months of an index stroke in a 12-month trial. The patients were randomized into three groups of a double-blind placebo control comparison of escitalopram with placebo, and non-blinded problem-solving therapy group.
During the period of the trial, patients on escitalopram experienced significant reductions in the incidence of depression versus placebo (23.1% vs. 34.5%). Problem-solving therapy did not result in significant benefit over the placebo.
The study results were limited by several factors. The study did not include all patients with acute stroke, employed a relatively small sample size, used a non-blinded psychological problem-solving therapy group, and had a high drop out rate.
Bottom line: Consider SSRI use to prevent depression in post-stroke patients.
Citation: Robinson RG, Jorge RE, Moser DJ, et. al. Escitalopram and problem-solving therapy for prevention of post stroke depression: a randomized controlled trial. JAMA 2008;299 (20):2391-2400