Major depression treatment in Germany-descriptive analysis of health insurance fund routine data and assessment of guideline-adherence.

BACKGROUND: Guideline oriented treatment strategies of Major depressive disorder (MDD) improve treatment outcomes and reduce risks of chronicity and recurrence. AIMS: Description of routine treatment reality and analysis of guideline fidelity in first episode MDD in Germany. Indicators: patients with severe or psychotic depression or severe psychiatric comorbidities' treatment by specialists, adequate antidepressant pharmacotherapy, permanent treatment with more than one antidepressant, long-term benzodiazepine treatment and provision of psychotherapy. METHOD: Descriptive analysis of routine data of the German statutory health insurance fund Barmer GEK in the index year 2011 that covers a population of 7,501,110. RESULTS: 236,843 patients were diagnosed a depressive episode. 53.0% of the patients with severe depression, 34.4% with psychotic depression and 50.9% with severe psychiatric comorbidities were treated by specialists; of the patients treated by a general practitioner 48.1% with severe and 47.3% with psychotic depression received an antidepressant; 9.7% of all patients with MDD got two antidepressants simultaneously; 8.3% received longterm benzodiazepine prescriptions; 26.1% got psychotherapy. LIMITATIONS: the analyses depends on the indicators definitions that cannot cope with the variety of individual treatment path; comparison with guidelines was complicated by a large fraction of patients with recurrent MDD that was wrongly diagnosed with first episode depression; due to the data structure, not all guideline recommendations could be examined CONCLUSIONS: Routine practice was oriented upon the guidelines recommendations. However some aspects could be identified that bear potential for improvements.

Tunable photonic crystal circuits: concepts and designs based on single-pore infiltration.

We demonstrate that the infiltration of individual pores of certain two-dimensional photonic crystals with liquid crystals and (or) polymers provides an efficient platform for the realization of integrated photonic crystal circuitry. As an illustration of this principle, we present designs for monomode photonic crystal wave-guides and certain functional elements, such as waveguide bends, beam splitters, and waveguide intersections. These devices exhibit very low reflection over broad frequency ranges. In addition, we discuss the inherent tunability of these devices that originates in the tunability of the infiltrated material.