Annual rates of low-density lipoprotein cholesterol testing differentially improved for beneficiaries with diabetes in the intervention group by 3.1 percentage points (95% CI, 1.4-4.8 percentage points; P < .001) and for those with cardiovascular disease by 2.5 percentage points (95% CI, 1.1-4.0 percentage points; P < .001), but performance on other quality measures did not differentially change.\n\nCONCLUSIONS AND RELEVANCE The AQC was associated with lower spending for Medicare beneficiaries but not with consistently improved quality. Savings among Medicare

beneficiaries BEZ235 and previously demonstrated savings among BCBS enrollees varied similarly across settings, services, and time, suggesting that organizational responses were associated with broad changes in patient care.”
“Background\n\nVaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitisation, have been proposed, and uncontrolled case series appear promising.\n\nObjectives\n\nTo assess the effects of different interventions for vaginismus.\n\nSearch methods\n\nWe searched the Cochrane Depression,

Anxiety and Neurosis Group’s Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to August 2012. This register contains relevant randomised controlled trials Nepicastat ic50 from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO(1967 to date). We searched reference lists and conference abstracts. We contacted experts in the field regarding unpublished material.\n\nSelection criteria\n\nControlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control.\n\nData collection and analysis\n\nThe review authors extracted data which we verified with the trial investigator where possible.\n\nMain results\n\nFive studies were included, of which four

with a total of 282 participants provided data. No meta-analysis was possible due to heterogeneity of comparisons within included studies as well as inadequate reporting of data. All studies were considered to be SNS-032 concentration at either moderate or high risk of bias. The results of this systematic review indicate that there is no clinical or statistical difference between systematic desensitisation and any of the control interventions (either waiting list control, systematic desensitisation combined with group therapy or in vitro (with women under instruction by the therapist) desensitisation) for the treatment of vaginismus. The dropout rates were higher in the waiting list groups.\n\nAuthors’ conclusions\n\nA clinically relevant effect of systematic desensitisation when compared with any of the control interventions cannot be ruled out. None of the included trials compared other behaviour therapies ( e.