Making Disease Management Research Articles

Ivermectin induces oxidative stress and mitochondrial damage in Haemonchus contortus

Haemonchus contortus poses a severe threat to livestock, leading to substantial economic losses. The extensive use of ivermectin (IVM), an effective anthelmintic drug, has resulted in the development of resistant strains, reducing the drug's effectiveness and making disease management more challenging. Hence, understanding the underlying mechanisms of IVM resistance is crucial. IVM has been shown to induce apoptosis and oxidative stress imbalance in cancer cells, thereby inhibiting tumor growth; however, whether there is a similar impact on H. contortus has not been well-documented. In this study, the biological functions of previously identified resistance-associated genes were investigated, revealing their involvement in apoptosis and oxidative stress. Experiments were conducted to compare cell apoptosis, mitochondrial function, and oxidative stress markers in IVM-treated and untreated sensitive and resistant strains isolated from the field. The findings demonstrated that mitochondrial dysfunction and increased apoptosis were induced by IVM treatment in sensitive strains, as indicated by elevated mitochondrial membrane potential and apoptosis rates. Conversely, stable mitochondrial function and apoptosis levels under IVM exposure were observed in resistant strains. These results provide novel insights into the resistance mechanisms of H. contortus and offer a theoretical basis for future research on overcoming IVM resistance.

Enhancing Cardiovascular Health with the Implementation of Digitalis

Cardiovascular diseases (CVDs) are a major global health problem that cause a lot of illness, death, and high healthcare costs. As medical science advances, the number of people with CVDs continues to rise, necessitating the development of new methods for their prevention, diagnosis, and treatment. In recent years, using digital health technologies in cardiovascular care has become an excellent way to improve patient outcomes and make disease management better. It is possible for digitalis medicines, which come from the foxglove plant (Digitalis purpurea), to improve heart health in the digital age. In the field of cardiovascular medicine, this in-depth review looks at digitalis's historical importance, pharmacology, clinical uses, safety concerns, and digital transformation. The review starts with an overview of the epidemiological setting and the problems that CVDs cause, emphasizing the urgent need for creative solutions to deal with this worldwide health event. This article deals with how it has changed over time, from herbal remedies to modern drug therapy. It informs about the pharmacology of digitalis, mostly the way it works, its pharmacokinetics, and its pharmacodynamics. Pharmaceuticals that contain digitalis mainly work by stopping the Na+/K+ ATPase pump. The medication can help with heart failure, atrial fibrillation, and some types of arrhythmias. Digitalis's digital transformation is looked at with a focus on the way digital health technologies are used in its management, monitoring, and effectiveness. The review highlights that digitalis-based interventions could change the way cardiovascular medicine is done in the modern era.

Systemic Juvenile Idiopathic Arthritis: The Challenges and Opportunities

Systemic juvenile idiopathic arthritis (SJIA), presently included under the broad taxonomy of Still’s disease along with ‘Adult-onset Stills disease’, is a unique disease entity, characterised predominantly by features of systemic inflammation at disease onset and running a heterogenous course, evolving into a disabling chronic, destructive arthritis in a sizable proportion of patients. With a better understanding of the disease biology, there has been a paradigm shift in therapeutic strategy targeting immunological remission. With the evolution of better biomarkers (to guide diagnosis, predict complications and predict treatment responses) and robust therapeutic options and treatment targets, newer challenges such as refractory disease states and SJIA-associated lung disease have risen to the fore, making disease management all the more challenging.

The diverse roles of sphingolipids in inflammatory bowel disease.

The incidence of inflammatory bowel disease (IBD) has increased over the last 20 years. A variety of causes, both physiological and environmental, contribute to the initiation and progression of IBD, making disease management challenging. Current treatment options target various aspects of the immune response to dampen intestinal inflammation; however, their effectiveness at retaining remission, their side effects, and loss of response from patients over time warrant further investigation. Finding a common thread within the multitude causes of IBD is critical in developing robust treatment options. Sphingolipids are evolutionary conserved bioactive lipids universally generated in all cell types. This diverse lipid family is involved in a variety of fundamental, yet sometimes opposing, processes such as proliferation and apoptosis. Implicated as regulators in intestinal diseases, sphingolipids are a potential cornerstone in understanding IBD. Herein we will describe the role of host- and microbial-derived sphingolipids as they relate to the many factors of intestinal health and IBD.

Disentangling Shifts in the Soil Microbiome of Potatoes Infected with Rhizoctonia solani Anastomosis Group 3-PT in Search of Potential Biocontrol Agents

Rhizoctonia solani anastomosis group (AG) 3-PT is a devastating pathogenic fungus that causes several diseases in potatoes both in South Africa and globally. The removal of various fungicides from the market and strict regulations on the use of synthetic chemicals make disease management difficult. Therefore, alternative, environmentally safe control measures are being considered, such as the use of biological control agents (BCAs). BCAs are an attractive alternative for improving plant and soil health of economically important crops. To identify key microbial indicators of disease suppression against R. solani AG 3-PT, a greenhouse pot trial experiment was conducted using soil from a potato-growing region in KwaZulu-Natal, South Africa. High-throughput sequencing of fungal internal transcribed spacer and bacterial 16S ribosomal RNA was used to characterize the respective fungal and bacterial community composition in the soil with and without artificial inoculation with R. solani AG 3-PT. Results indicated that the pathogen caused dysbiosis in the potato soil microbiome, leading to a shift in fungal and bacterial community composition. Differentially abundant microbial taxa in R. solani AG 3-PT inoculated soils suggest a promising potential for disease-suppressive activity. Network analysis also confirmed the presence of key taxa involved in the microbial community shifts, which could support their role in the suppression of R. solani AG 3-PT. The identification of key microbial indicators against Rhizoctonia diseases can contribute to the development of environmentally sustainable potato production systems, which are particularly important considering the implementation of the European Green Deal.

An agent-based model of cardiac allograft vasculopathy: toward a better understanding of chronic rejection dynamics.

Cardiac allograft vasculopathy (CAV) is a coronary artery disease affecting 50% of heart transplant (HTx) recipients, and it is the major cause of graft loss. CAV is driven by the interplay of immunological and non-immunological factors, setting off a cascade of events promoting endothelial damage and vascular dysfunction. The etiology and evolution of tissue pathology are largely unknown, making disease management challenging. So far, in vivo models, mostly mouse-based, have been widely used to study CAV, but they are resource-consuming, pose many ethical issues, and allow limited investigation of time points and important biomechanical measurements. Recently, agent-based models (ABMs) proved to be valid computational tools for deciphering mechanobiological mechanisms driving vascular adaptation processes at the cell/tissue level, augmenting cost-effective in vivo lab-based experiments, at the same time guaranteeing richness in observation time points and low consumption of resources. We hypothesize that integrating ABMs with lab-based experiments can aid in vivo research by overcoming those limitations. Accordingly, this work proposes a bidimensional ABM of CAV in a mouse coronary artery cross-section, simulating the arterial wall response to two distinct stimuli: inflammation and hemodynamic disturbances, the latter considered in terms of low wall shear stress (WSS). These stimuli trigger i) inflammatory cell activation and ii) exacerbated vascular cell activities. Moreover, an extensive analysis was performed to investigate the ABM sensitivity to the driving parameters and inputs and gain insights into the ABM working mechanisms. The ABM was able to effectively replicate a 4-week CAV initiation and progression, characterized by lumen area decrease due to progressive intimal thickening in regions exposed to high inflammation and low WSS. Moreover, the parameter and input sensitivity analysis highlighted that the inflammatory-related events rather than the WSS predominantly drive CAV, corroborating the inflammatory nature of the vasculopathy. The proof-of-concept model proposed herein demonstrated its potential in deepening the pathology knowledge and supporting the in vivo analysis of CAV.

Characterization of the Virulence and Yield Impact of Fusarium Species on Canola (Brassica napus).

Multiple species of Fusarium can contribute to the development of root rot in canola (Brassica napus), making disease management difficult. We conducted field and greenhouse experiments to investigate the impacts of Fusarium avenaceum and Fusarium proliferatum, and the interaction between Fusarium oxysporum and F. proliferatum on root rot severity and canola yields. Inoculation with any of the three Fusarium spp. resulted in significant disease severity and reduced seedling emergence compared with non-inoculated controls, leading to yield reductions of up to 35%. Notably, there was a strong correlation (r = 0.93) between root rot severity at the seedling stage and at maturity. Regression analysis indicated a linear decline in seedling emergence with increasing disease severity. Furthermore, disease severity at maturity adversely affected the pod number per plant and the seed weight per plant, with both parameters ultimately approaching zero at a severity of 4.0 on a 0-4 scale. Co-inoculation with F. oxysporum and F. proliferatum induced more severe root rot than inoculation with each species on its own, suggesting synergistic interactions between these fungi. Knowledge of these interactions and the relative virulence of Fusarium spp. will contribute to the improved management of root rot in canola.

Stepwise Regression Models-Based Prediction for Leaf Rust Severity and Yield Loss in Wheat

Leaf rust is a devastating disease in wheat crop. The disease forecasting models can facilitate the economic and effective use of fungicides and assist in limiting crop yield losses. In this study, six wheat cultivars were screened against leaf rust at two locations, during three consecutive growing seasons. Subsequently, the stepwise regression analysis was employed to analyze the correlation of six epidemiological variables (minimum temperature, maximum temperature, minimum relative humidity, maximum relative humidity, rainfall and wind speed) with disease severity and yield loss (%). Disease predictive models were developed for each cultivar for final leaf rust severity and yield loss prediction. Principally, all epidemiological variables indicated a positive association with leaf rust severity and yield loss (%) except minimum relative humidity. The effectiveness of disease predictive models was estimated using coefficient of determination (R2) values for all models. Then, these predictive models were validated to forecast disease severity and yield loss at another location in Faisalabad. The R2 values of all disease predictive models for each of the tested cultivars were high, evincing that our regression models could be effectively employed to predict leaf rust disease severity and anticipated yield loss. The validation results explained 99% variability, suggesting a highly accurate prediction of the two variables (leaf rust severity and yield loss). The models developed in this research can be used by wheat farmers to forecast disease epidemics and to make disease management decisions accordingly.

Blackgram-Macrophomina phaseolina Interactions and Identification of Novel Sources of Resistance.

Macrophomina phaseolina, a fungus that causes dry root rot, is a relatively new threat to blackgram in South Asia. Because this pathogen is a polyphagic necrotroph, it remains viable in the soil for several years, making disease management challenging. One of the most economical methods for managing dry root rot in blackgram is through an integrated approach that uses resistant varieties. This study examined M. phaseolina associated with dry root rot in blackgram and screened 41 blackgram genotypes for dry root rot resistance. The present work also characterized morphological features and internal transcribed sequence regions of the nuclear rDNA operon to identify M. phaseolina from blackgram. Evaluation of the 41 blackgram genotypes against M. phaseolina by the paper towel technique identified two genotypes, CO-5 and IPU 07-3, with dry root rot resistance (disease scores: ≤3) and 18 genotypes with moderate resistance (disease scores: >3 to ≤5). Five genotypes with disease scores <4.0 and two susceptible genotypes were reevaluated using the paper towel method, which revealed moderate resistance reactions of CO-5, IPU 07-3, and MASH 1-1. To confirm dry root rot resistance of these seven genotypes, further screening was done in a greenhouse using the sick pot assay. Results revealed moderate resistance of CO-5, IPU 07-3, and MASH 1-1 genotypes. As compared with susceptible check (VO 2135-B-BL), CO-5 consistently excelled in plant survival with 13.4% disease incidence, followed by IPU 07-3 (16.7%) and MASH 1-1 (19.9%). Therefore, these three genotypes can be used as parents in blackgram breeding programs for developing blackgram cultivars with improved dry root rot resistance.[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

A case report of hematidrosis: blood, sweat, and fear

Background: Hematidrosis is an extremely rare condition in which the patient spontaneously starts sweating blood. Even though, this disease has existed for many centuries, due to its rarity and perceived religious connection made little progress in correctly evaluating its pathogenesis. Therefore, rather than getting the medical and emotional help these cases need, such cases often end up at the doorsteps of shamans, especially in developing countries. Case Presentation: Here, we describe a case of hematidrosis and its clinical presentation and treatment outcome. A 10-year-old female patient presented with complaints of episodic bleeding from the skin, predominantly from the trunk, oral cavity, and forehead. Blood investigations, including coagulation profile, platelet antigen study, etc. were completely normal. The patient was treated with propranolol and atropine transdermal patches, which showed improvement in her condition, and the bleeding eventually stopped. Conclusion: Standardized diagnostic and management criteria is needed to be developed for treating such patients better. Reporting such cases of hematidrosis and discussing them will eventually make disease management more uniform and bring more patient awareness to this frightening disease.

Phytoplasma diseases of plants: molecular diagnostics and way forward.

Phytoplasmas are obligate phytopathogenic bacteria associated with devastating diseases in hundreds of crops across the world. They have been responsible for huge economic losses in many crop plants for decades now. Isolation and establishment of axenic culture of phytoplasma in complex media is a recent progress in phytoplasma research. Earlier methods for phytoplasma disease detection included symptom profiling, microscopy, serology and dodder transmission studies. With advancement in the field of molecular biology, phytoplasma diagnostics and characterisation witnessed radical improvement. Starting from PCR amplification which often necessities a nested PCR on account of low titre of phytoplasmas, to the closed tube quantitative PCR assays and then the ddPCR, an array of diagnostics have been developed for phytoplasma. The isothermal diagnostic platforms are the latest addition to this and the Loop Mediated Isothermal Amplification (LAMP) assay has been applied for the detection of phytoplasma from several hosts. The futuristic approach in phytoplasma detection will be very likely provided by an integration of nanotechnology and molecular diagnostics. Phytoplasma disease management majorly relies on early detection, vector control, use of disease free planting materials and cultivation of resistant varieties. Hence understanding the molecular mechanism of phytoplasma-host interaction is as important as timely and accurate detection, in the management of phytoplasma diseases. Further, the changing climatic scenario and global warming may lead to an upsurge in the phytoplasma diseases spread and severity across the world, making disease management even more challenging.

When public health messages become stressful: Managing chronic disease during COVID-19.

To curb the spread of COVID-19, the United States has endorsed a variety of public health measures and distributed their content expediently. While these measures are critical for saving the lives of thousands, they may be sources of stress for individuals managing a chronic disease or make disease management more challenging. Forty-five percent of Americans live with chronic disease and already manage a range of everyday stressors related to their disease, making the additional stress produced by this public health guidance and their messages more difficult. Guided by Cohen and colleagues’ Stage Model of Stress and Disease (Cohen et al., 2016) and Ryan and Sawin’s Individual and Family Self-Management Theory (Ryan & Sawin, 2009), this paper identifies the various dimensions of these public health measures that may cause stress and negatively impact individuals managing chronic disease. Further, this paper presents a conceptual model for understanding how these stressors and common stressors associated with managing chronic disease interact and significantly impact chronic disease management. Considering the impact of these stressors on individuals managing chronic disease is paramount to ensure this population is empowered to manage this additional stress healthily and effectively. Recommendations for individuals managing chronic disease and health care professionals working with this population are provided.

When Public Health Messages Become Stressful: Managing Chronic Disease During COVID-19

In an effort to curb the spread of COVID-19, the United States has endorsed a variety of public health measures and distributed their content expediently. While these measures are critical for saving the lives of thousands, they may be sources of stress for individuals managing chronic disease or make disease management more challenging. Individuals living with chronic disease already manage a range of everyday stressors related to their disease, making the additional stress produced by this public health guidance and their messages more difficult. This paper identifies the various dimensions of these public health measures that may cause stress and negatively impact individuals managing chronic disease. Further this paper presents a conceptual model for understanding how these stressors and common stressors associated with managing chronic disease interact and significantly impact chronic disease management. Considering the impact of these stressors on individuals managing chronic disease is paramount to ensure this population is empowered to manage this additional stress in a healthy and effective manner. Recommendations for individuals managing chronic disease and health care professionals working with this population are provided.

Genomics of Autism.

Autism spectrum disorder (ASD) is a heterogeneous condition affecting >1% of all children, characterized by impaired social interactions, repetitive behavior and a widely variable spectrum of comorbidities. These comorbidities may include developmental delay, gastrointestinal problems, cardiac disorders, immune and autoimmune dysregulation, neurological manifestations (e.g., epilepsy, intellectual disability), and other clinical features. This wide phenotypic heterogeneity is difficult to predict and manifests across a wide range of ages and with a high degree of difference in severity, making disease management and prediction of a successful intervention very difficult. Recently, advances in genomics and other molecular technologies have enabled the study of ASD on a molecular level, illuminating genes and pathways whose perturbations help explain the clinical variability among patients, and whose impairments provide possible opportunities for better treatment options. In fact, there are now >1000 genes that have been linked to ASD through genetic studies of more than 10,000 patients and their families. This chapter discusses these discoveries and in the context of recent developments in genomics and bioinformatics, while also examining the trajectory of gene discovery efforts over the past few decades, as both better ascertainment and global attention have been given to this highly vulnerable patient population.

9. Integrating clinical microarray analyses in the myeloma diagnostic workup: Rationale for improving patient care with precision medicine while reducing overall cost of testing

Implementation of clinical cancer microarrays (CMA) in plasma cell myeloma carries significant advancement of precision medicine technologies that allow more effective diagnosis and therapeutic decisions, as well as the potential to provide improved patient care in the face of declining reimbursements. Traditionally, cytogenetic testing options for myeloma include both karyotypic analysis and multiple FISH assays to determine disease status. At our institution, ∼75% of total charges per myeloma specimen result from conventional cytogenetics and FISH service codes. A cost analysis of 202 bone marrow specimens determined total charges of ∼$4,000,000 with conventional cytogenetics and FISH charges of ∼$3,100,000 or 78% of total charges. Our laboratory recently validated CMA for neoplastic disorders, including plasma cell myeloma. Microarray analysis provides a high resolution whole-genome view in myeloma, thereby serving as an appropriate substitution for multiple individual enumeration and locus-specific FISH probes. Moreover, cost analyses accounting for reagents, consumables, and technologist time confirm that integration of microarrays into diagnostic testing options, could significantly lower the equivalent costs to the offering laboratory. With projected elimination of fee-for-service remuneration, the number of individual probes or hybridization events for which reimbursements are received may be limited. This, in turn, could result in a reduction in FISH probes ordered, adversely impacting the amount and quality of clinical information available to make disease management decisions. Therefore, integration of microarray analysis for myelomas would provide best patient care via cytogenomic testing, while reducing overall cost of service. Strategies for implementation and buy-in by clinicians and administration will be detailed.

Clinical measurement of gastrointestinal motility and function: who, when and which test?

Symptoms related to abnormal gastrointestinal motility and function are common. Oropharyngeal and oesophageal dysphagia, heartburn, bloating, abdominal pain and alterations in bowel habits are among the most frequent reasons for seeking medical attention from internists or general practitioners and are also common reasons for referral to gastroenterologists and colorectal surgeons. However, the nonspecific nature of gastrointestinal symptoms, the absence of a definitive diagnosis on routine investigations (such as endoscopy, radiology or blood tests) and the lack of specific treatments make disease management challenging. Advances in technology have driven progress in the understanding of many of these conditions. This Review serves as an introduction to a series of Consensus Statements on the clinical measurements of gastrointestinal motility, function and sensitivity. A structured, evidence-based approach to the initial assessment and empirical treatment of patients presenting with gastrointestinal symptoms is discussed, followed by an outline of the contribution of modern physiological measurement on the management of patients in whom the cause of symptoms has not been identified with other tests. Discussions include the indications for and utility of high-resolution manometry, ambulatory pH-impedance monitoring, gastric emptying studies, breath tests and investigations of anorectal structure and function in day-to-day practice and clinical management.

A model to predict the risk of infection of cucumber by Pseudoperonospora cubensis

Infection of cucurbits by Pseudoperonospora cubensis and subsequent development of cucurbit downy mildew (CDM) is primarily driven by prevailing weather factors. However, weather factors that influence the daily infection risk of cucurbits by P. cubensis have not been determined. Field experiments were conducted from 2012 to 2014 in Clayton, North Carolina and Charleston, South Carolina under naturally occurring inoculum. Weather factors were monitored during the study during which bioassay cucumber plants were exposed to prevailing weather conditions over a 24- and 48-h period. Disease severity was assessed 7 days after exposure and logistic regression models were developed to predict the probability of disease development on the bioassay plants. Hours of relative humidity >80% and day temperature were identified to be important predictors of the risk of infection for both the 24-h and 48-h cases. Threshold probability (PT) on the receiver operating characteristic curve (ROC) that minimized the overall error rate for the 24-h and 48-h model was 0.54 and 0.62, respectively. Model accuracy as estimated using area under ROC (AUC) ranged from 0.82 to 0.86, with a correct classification rate ranging from 0.73 to 0.80. Specificity rates of the models ranged from 0.72 to 0.86, while the sensitivity rates ranged from 0.71 to 0.76. External validation of the models using an independent dataset collected in South Carolina, showed good performance of the models with an AUC >0.91. Using estimates of economic damage and costs of management, optimal decision thresholds that minimized the average costs due to disease control and crop loss were determined. Optimal decision thresholds were dependent on disease prevalence and management decisions informed by the models reduced average costs when disease prevalence was ≤0.50 and ≤0.90 for the 24- and 48-h models, respectively. However, the value of using these models for making disease management decisions was greatest at low levels of disease prevalence. The PT for the validation models was 0.2 and under this threshold, the 24-h model had a correct classification, sensitivity and specificity rates of 0.88, 0.91 and 0.71, respectively, and the corresponding values for the 48-h model were 0.98, 0.97 and 1.0, respectively. These models provide accurate estimates of the daily infection risk of cucumber by P. cubensis and could serve as a useful decision support tool to guide fungicide applications to manage CDM during the growing season.

Psoriasis and Fat-soluble Vitamins: A Review

Fat-soluble vitamins exhibit numerous routes of immune modulation and specifically alter a variety of pathways in psoriasis pathology. Psoriasis, a chronic immune-mediated disease, often requires a combination of topical, oral, and occasionally, subcutaneous or intravenous therapies making disease management complex. With the complexity of treatment, patient adherence is reduced. Vitamin supplementation as an adjunctive treatment would minimize potential adverse effects from systemic medication, increase patient adherence and decrease overall cost. While vitamin A and D are effective topically, oral supplementation is not currently a mainstay of therapy although data exists to support such supplementation. Data on vitamin E and K implicate the significant role each has in the alteration of the inflammatory cascade responsible for psoriasis. Research showing fat-soluble vitamin deficiency in psoriasis exists and presents greater evidence for oral vitamin treatment in addition to first-line therapies. This review presents the mechanism of action in psoriasis of each fat-soluble vitamin and the data on the efficacy of oral fat-soluble vitamin supplementation in psoriasis and systemic inflammation. We also present fat-soluble vitamin deficiency data shown in psoriasis patients. With the evidence of their targeted mechanism of action, efficacy data with oral supplementation, and evidence of deficiency in patients, oral fat-soluble vitamins should be considered as an adjunct to therapy in psoriasis patients.

A rapid qualitative molecular method for the identification of Colletotrichum acutatum and C. gloeosporioides

Identification of the causal agent for anthracnose caused by C. acutatum and C. gloeosporioides based on morphological and cultural criteria is problematic as both are morphologically and genetically diverse. To evaluate a qualitative molecular method to readily distinguish between these two species, Restriction fragment length polymorphisms (RFLP) of a 1-kb intron of the glutamine synthetase (GS) gene was evaluated utilizing representative isolates from a world-wide collection. Unique band patterns of the 1-kb GS intron were obtained for C. acutatum (two fragments with 600 and 350 bp) and C. gloeosporioides (four fragments with 238–340, 252–254, 204, and 108–116 bp) based on PstI enzyme digestion of the amplified PCR product. These data were also confirmed by PstI digestion of the intron DNA sequences using BioEdit software. The identification based on RFLPs of the 1-kb GS intron was consistent with the identification based on previously evaluated species-specific primers (CaInt2 and CgInt). In addition, both species can be differentiated by multiplex PCR. CaInt2, CgInt and ITS4 in one PCR will distinguish between C. acutatum and C. gloeosporioides by differences in PCR product fragment size: 490 bp and 470 bp, respectively. Also, a rapid DNA extraction method was developed, which reduced the time for DNA extraction from two hours to five minutes. In summary, RFLP of the 1-kb GS intron is a reliable technique for identification and differentiation between both species, does not require a sequencing step, and may be useful to diagnostic clinics in helping to make disease management recommendations.

Pay-for-performance in disease management: a systematic review of the literature

BackgroundPay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs.MethodsA systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational.ResultsEight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs.ConclusionThe number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs.