HEMATOLOGY AND BIOCHEMISTRY IN CAPTIVE WHITE-NAPED CRANES (GRUS VIPIO).

In this retrospective study, 36 hematologic and biochemistry samples from white-naped crane (Grus vipio) were analyzed. All birds were housed at a single institution, and samples were obtained between 1990 and 2013. All cranes were healthy at the time of sample collection, and ages ranged from 1 mo to 33 yr old. Cranes below 18 mo old were considered juveniles. Comparisons were made between means for juveniles and adults and for males and females. Significant increases in adults (P < 0.05) were found in the following variables (differences shown in parentheses): packed cell volume (8.3%), mean cell volume (28 fl), monocyte percentage (3.2%), absolute monocyte count (200 × 10³/ml), total solids (1.0 g/dl), albumin (0.5 g/dl), and sodium (3 mM/L). Significant decreases in adults (P < 0.05) were found in phosphorus (1.7 mg/dl), creatine phosphokinase (1,146 U/L), alkaline phosphatase (451 U/L), lactate dehydrogenase (149 U/L), and glucose (25 mg/dl). Results from adult male and female cranes were also compared; calcium levels were higher in females (4.68 mg/dl, P < 0.05). Plasma electrophoresis and radioimmunoassay for bile acids were performed on 25 banked serum or plasma samples; results from juvenile and adult samples were also compared. Significant increases in adult birds were found in total protein (1.2 g/dl, P < 0.05) and in all absolute values for all protein types; however, no difference was found when protein fractions were compared. Bile acids were found to decrease in adults (19.9 µM/L, P < 0.05).

Challenges associated with being an off-site depression care manager.

Within the context of depression care, the U.S. Department of Veterans Affairs (VA) has an ongoing depression care manager (DCM) training program. The VA has already trained approximately 50 DCMs and plans to continue DCM training to facilitate the integration of primary care and mental health care. This article provides an overview of the role of a DCM, challenges encountered by an off-site DCM, and strategies to address those challenges. Specifically, this article addresses the following challenges from the perspective of the DCM: suicidal patients, different agendas between patients and DCMs, feeling isolated, maintaining boundaries, building trust, learning to read between the lines, and dealing with hard-to-contact patients. Care management in the context of a distributed care team is becoming increasingly popular in health care systems.

A Web-based clinical decision support system for depression care management.

OBJECTIVE: To inform the design of future informatics systems that support the chronic care model. STUDY DESIGN: We describe the development and functionality of a decision support system for the chronic care model of depression treatment, known as collaborative care. Dissemination of evidence-based collaborative care models has been slow, and fidelity to the evidence base has been poor during implementation initiatives. Implementation could be facilitated by a decision support system for depression care managers, the cornerstone of the collaborative care model. The Net Decision Support System (https://www.netdss.net/) is a free Web-based system that was developed to support depression care manager activities and to facilitate the dissemination of collaborative care models that maintain high fidelity to the evidence base. METHODS: The NetDSS was based on intervention materials used for a randomized trial of depression care management that improved clinical outcomes compared with usual care. The NetDSS was developed jointly by a cross-functional design team of psychiatrists, depression care managers, information technology specialists, technical writers, and researchers. RESULTS: The NetDSS has the following functional capabilities: patient registry, patient encounter scheduler, trial management, clinical decision support, progress note generator, and workload and outcomes report generator. The NetDSS guides the care manager through a self-documenting patient encounter using evidence-based scripts and self-scoring instruments. The NetDSS has been used to provide evidence-based depression care management to more than 1700 primary care patients. CONCLUSION: Intervention protocols can be successfully converted to Web-based decision support systems that facilitate the implementation of evidence-based chronic care models into routine care with high fidelity.