***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Depression is independently associated with poor outcomes among patients with acute cardiac disease .  Collaborative care depression management programs have been used in out patients to improve depression outcomes , but such a program had never been initiated in the hospital or used for patients with a wide range of cardiac illnesses . Methods and Results — This was a prospect i ve , r and omized trial of a low-intensity , 12-week collaborative care program versus usual care for 175 depressed patients hospitalized for acute coronary syndrome , arrhythmia , or heart failure . Study outcomes , assessed using mixed regression models to compare groups at 6 weeks , 12 weeks , and 6 months , included mental health ( depression , cognitive symptoms of depression , anxiety , and mental health-related quality of life ) and medical ( physical health-related quality of life , adherence to medical recommendations , and cardiac symptoms ) outcomes . Collaborative care subjects ( n=90 ) had significantly greater improvements on all mental health outcomes at 6 and 12 weeks , including rates of depression response ( collaborative care , 59.7 % versus usual care 33.7 % ; odds ratio , 2.91 ; P=0.003 at 6 weeks ; 51.5 % versus 34.4 % ; odds ratio , 2.02 ; P=0.04 at 12 weeks ) , though these effects decreased after intervention . At 6 months , intervention subjects had significantly greater self-reported adherence and significantly reduced number and intensity of cardiac symptoms . Conclusions — Among patients with a broad range of cardiac diagnoses , a collaborative care depression management program initiated during hospitalization led to significant improvements in multiple clinical ly important mental health outcomes and had promising effects on relevant medical outcomes after intervention . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00847132 Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare re sources . A recent r and omised trial ( SMaRT , Symptom Management Research Trials , Oncology-2 ) found that a collaborative care treatment programme ( Depression Care for People with Cancer , DCPC ) was highly effective in treating depression in patients with cancer . This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective . Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality -adjusted life-years ( QALYs ) . Incremental cost-effectiveness of  DCPC  compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data . Uncertainty was characterised using cost-effectiveness acceptability curves . The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence 's ( NICE ) cost-effectiveness threshold range of £ 20,000 to £ 30,000 per QALY gained . Results DCPC  cost on average £ 631 more than usual care per patient , and result ed in a mean gain of 0.066 QALYs , yielding an incremental cost-effectiveness ratio of £ 9549 per QALY . The probability of DCPC  being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £ 20,000 per QALY for the base case and scenario analyses . Conclusions Compared with usual care , DCPC is likely to be cost-effective at the current thresholds used by NICE . This study adds to the weight of evidence that collaborative care treatment models  are cost-effective for depression , and provides new evidence regarding their use in specialist medical setting BACKGROUND Patients with depression and poorly controlled diabetes , coronary heart disease , or both have an increased risk of adverse outcomes and high health care costs . We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients . METHODS We conducted a single-blind , r and omized , controlled trial in 14 primary care clinics in an integrated health care system in Washington State , involving 214 participants with poorly controlled diabetes , coronary heart disease , or both and coexisting depression . Patients were r and omly assigned to the usual-care group or to the intervention group , in which a medically supervised nurse , working with each patient 's primary care physician , provided guideline -based , collaborative care management , with the goal of controlling risk factors associated with multiple diseases . The primary outcome was based on simultaneous modeling of glycated hemoglobin , low-density lipoprotein ( LDL ) cholesterol , and systolic blood-pressure levels and Symptom Checklist-20 ( SCL-20 ) depression outcomes at 12 months ; this modeling allowed estimation of a single overall treatment effect . RESULTS As compared with controls , patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels ( difference , 0.58 % ) , LDL cholesterol levels ( difference , 6.9 mg per deciliter [ 0.2 mmol per liter ] ) , systolic blood pressure ( difference , 5.1 mm Hg ) , and SCL-20 depression scores ( difference , 0.40 points ) ( P<0.001 ) . Patients in the intervention group also were more likely to have one or more adjustments of insulin ( P=0.006 ) , antihypertensive medications ( P<0.001 ) , and antidepressant medications ( P<0.001 ) , and they had better quality of life ( P<0.001 ) and greater satisfaction with care for diabetes , coronary heart disease , or both ( P<0.001 ) and with care for depression ( P<0.001 ) . CONCLUSIONS As compared with usual care , an intervention involving nurses who provided guideline -based , patient-centered management of depression and chronic disease significantly improved control of medical disease and depression . ( Funded by the National Institute of Mental Health ; Clinical Trials.gov number , NCT00468676 . ) Depression management for patients with chronic medical illnesses , including cancer , is often inadequate . " Depression Care for People with Cancer " ( DCPC ) has been design ed to be integrated into specialist cancer services and is being evaluated in the Symptom Management Research Trials ( SMaRT ) Oncology series of r and omized controlled trials . The intervention is an extended form of the collaborative care model and is delivered by a care manager , who receives regular supervision from a psychiatrist . The care manager coordinates the patient 's depression management , by liaising with both their primary care physician and their cancer team , and provides a brief talking treatment . This article describes the design and delivery of DCPC as given in the SMaRT Oncology trials OBJECTIVE To determine whether evidence -based socioculturally adapted collaborative depression care improves receipt of depression care and depression and diabetes outcomes in low-income Hispanic subjects . RESEARCH DESIGN AND METHODS This was a r and omized controlled trial of 387 diabetic patients ( 96.5 % Hispanic ) with clinical ly significant depression recruited from two public safety-net clinics from August 2005 to July 2007 and followed over 18 months .  Intervention ( INT group ) included problem-solving therapy and /or antidepressant medication based on a stepped-care algorithm ; first-line treatment choice ; telephone treatment response , adherence , and relapse prevention follow-up over 12 months ; plus systems navigation assistance . Enhanced usual care ( EUC group ) included st and ard clinic care plus patient receipt of depression educational pamphlets and a community re source list . RESULTS INT patients had significantly greater depression improvement ( ≥50 % reduction in Symptom Checklist-20 depression score from baseline ; 57 , 62 , and 62 % vs. the EUC group 's 36 , 42 , and 44 % at 6 , 12 , and 18 months , respectively ; odds ratio 2.46–2.57 ; P < 0.001 ) . Mixed-effects linear regression models showed a significant study group – by – time interaction over 18 months in diabetes symptoms ; anxiety ; Medical Outcomes Study Short-Form Health Survey ( SF-12 ) emotional , physical , and pain-related functioning ; Sheehan disability ; financial situation ; and number of social stressors ( P = 0.04 for disability and SF-12 physical functioning , P < 0.001 for all others ) but no study group – by – time interaction in A1C , diabetes complications , self-care management , or BMI . CONCLUSIONS Socioculturally adapted collaborative depression care improved depression , functional outcomes , and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics Background Major depressive disorder ( MDD ) has major consequences for both patients and society , particularly in terms of needlessly long sick leave and reduced functioning . Although evidence -based treatments for MDD are available , they show disappointing results when implemented in daily practice . A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners ( GPs ) and other health care professionals with occupational physicians ( OPs ) . The OP may play a more important role in the recovery of patients with MDD . Purpose of the present study is to tackle these obstacles by applying a collaborative care model , which has proven to be effective in the USA , with a focus on return to work ( RTW ) . From a societal perspective , the (cost)effectiveness of this collaborative care treatment , as a way of transmural care , will be evaluated in depressed patients on sick leave in the occupational health setting . Methods / Design A r and omised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherl and s. A transmural collaborative care model , including Problem Solving Treatment ( PST ) , a workplace intervention , antidepressant medication and manual guided self-help will be compared with care as usual ( CAU ) .  126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study .  Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist . The treatment is separated from the sickness certification . Data will be collected by means of question naires at baseline and at 3 , 6 , 9 and 12 months after baseline . Primary outcome measure is reduction of depressive symptoms , secondary outcome measure is time to RTW , tertiary outcome measure is the cost effectiveness . Discussion The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study . The intervention is an innovative approach , with trained OPs in a new role as care managers in the treatment of MDD . If this intervention proves to be cost-effective , implementation will be very relevant for individual patients as well as for society . Trial registration IS RCT BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 0 to 4 ) at 3 months after r and omisation . Analysis was by intention to treat . This trial is registered as IS RCT N84767225 . FINDINGS Primary outcome data were missing for four patients . For 196 patients for whom we had data at 3 months , the adjust 
    Output:
    
Best physical outcomes in CC were found for hypertension with comorbiddepression .
Overall , depression outcomes were better for CC than for CAU .
CC is more effective than CAU in terms of illness burden , physical outcomes and depression , in patients with comorbid depression in chronic medical conditions .