RESUMEN
This study considered the monitoring and evaluation of a large-scale and domestic and global strategic change programme implementation. It considers the necessary prerequisites to overcome challenges and barriers that prevent systematic and effective monitoring and evaluation to take place alongside its operationalisation. The work involves a case study based on a major industrial company from the energy sector. The change programme makes particular reference to changes in business models, business processes, organisation structures as well as Enterprise Resource Planning infrastructure. The case study focussed on the summative evaluation of the programme post-implementation. This assessment involved 25 semi-structured interviews with employees across a range of managerial strata capturing more than 65 roles within the change programme at both local and global levels. Data relating to their perception of evaluation effectiveness and shortcomings were analysed by means of template analysis. The study identifies responsibilities for executing an evaluation alongside various methods and tools that are appropriate, thereby focussing on the "Who" (roles, responsibility for particular activities) and "How" (methods and tools) rather than "What" to monitor and evaluate. The findings are presented generically so they offer new insights and transferability for practitioners involved in managing strategic change and its associated evaluation.
Asunto(s)
Estudios de Evaluación como Asunto , Industrias/organización & administración , Toma de Decisiones , Humanos , Industrias/normas , Entrevistas como Asunto , Estudios de Casos Organizacionales , Evaluación de Programas y Proyectos de Salud , Gestión de la Calidad TotalRESUMEN
BACKGROUND: To compare venlafaxine and selective serotonin reuptake inhibitors (SSRIs; fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram) in the treatment of depression. METHODS AND MATERIALS: Meta-analysis of 34 randomized, double-blind studies identified by a worldwide search of all research sponsored by Wyeth Pharmaceuticals through January 2007. Patients were treated with venlafaxine (n = 4191; mean dose 151 mg/day) or SSRIs (n = 3621); nine studies also included a placebo control group (n = 932). The primary outcome measure was intent-to-treat (ITT) remission rates (Hamilton Rating Scale for Depression
Asunto(s)
Ciclohexanoles/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Citalopram/uso terapéutico , Femenino , Fluoxetina/uso terapéutico , Fluvoxamina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Paroxetina/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Inducción de Remisión , Sertralina/uso terapéutico , Clorhidrato de VenlafaxinaRESUMEN
Epidemiologic data consistently report an elevated prevalence of major depressive disorder (MDD) in women. This increase begins during adolescence and continues through the menopausal transition. Population-based clinical studies report an increase in the incidence of MDD during perimenopause compared to either the premenopausal or postmenopausal period. Evidence suggests that fluctuations and decline of hormonal levels are correlated with this observed increase in risk for MDD. A strong predictor of depression in the perimenopausal period is a previous history of MDD. However, recent studies revealed an increased risk of new onset depression in perimenopausal women without a history of MDD. Additionally, recent reports have indicated that the presence of vasomotor symptoms may be associated with an increased the risk for MDD. The objective of this paper is to review evidence that would support our hypothesis that neurotransmitter systems are affected by changes in hormonal status over the course of a woman's life, leading to increase vulnerability to perimenopausal depression. Relevant data from nonclinical experiments will be discussed in the context of observed clinical evidence of the risk for MDD before, during, and after the menopausal transition. A testable hypothesis will be proposed to advance our understanding of hormonal effects on mood.
Asunto(s)
Trastorno Depresivo Mayor/psicología , Hormonas Esteroides Gonadales/fisiología , Menarquia/psicología , Menopausia/psicología , Ciclo Menstrual/psicología , Salud de la Mujer , Adolescente , Adulto , Anciano , Animales , Trastorno Depresivo Mayor/fisiopatología , Femenino , Humanos , Menarquia/fisiología , Menopausia/fisiología , Ciclo Menstrual/fisiología , Persona de Mediana Edad , Receptores Adrenérgicos/metabolismo , Receptores de Serotonina/metabolismoRESUMEN
Throughout their childbearing years, women are twice as likely as men to experience an episode of major depression. The exact etiology of this difference is unclear, but psychosocial and neurobiologic factors likely contribute. Clinicians should consider gender differences in the phenomenology of depression and response to antidepressant treatment when screening for depressive illness, selecting appropriate treatment and assessing therapeutic response. Treatment considerations when selecting an antidepressant should include the patient's gender, age, and, in women, menopausal status, including the use of concomitant HRT. Further research is needed to refine and extend the existing knowledge base regarding the effect of gender on treatment of depression, including the role of endogenous and exogenous gonadal hormones in response to antidepressant treatment.
Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Adulto , Trastornos de Ansiedad/epidemiología , Comorbilidad , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posmenopausia/psicología , Premenopausia/psicología , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores Sexuales , Trastornos Somatomorfos/epidemiologíaRESUMEN
Major depressive disorder is currently the fourth largest contributor to the worldwide burden of disease. Direct and indirect costs associated with depression place a significant burden on the health care system and society. Despite the development of new antidepressant medications, the management of patients with depression remains a therapeutic challenge. Obtaining a response in antidepressant therapy-commonly defined in clinical trials as an improvement of >erotonergic and noradrenergic neurotransmission, will increase the likelihood of remission.
Asunto(s)
Depresión , Trastorno Depresivo Mayor , Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Trastorno Depresivo Mayor/tratamiento farmacológico , Humanos , Psicoterapia , Resultado del TratamientoRESUMEN
Epidemiologic studies have shown that the prevalence of depression is about twice as high in women than in men. Both neurobiologic and psychosocial factors may contribute to this difference. Gender differences in depression have also been noted with regard to symptom presentation, comorbid disorders, course of illness, and response to treatment. This article provides an overview of gender differences in the phenomenology and treatment of depression, particularly the effect of gender on antidepressant treatment response. Clinicians should consider gender as a factor in both the assessment and treatment of depression.