Evaluation of [18F]2FP3 in pigs and non‐human primates

So far, no suitable 5‐HT₇R radioligand exists for clinical positron emission tomography (PET) imaging. [¹⁸F]2FP3 was first tested in vivo in cats, and the results were promising for further evaluations. Here, we evaluate the radioligand in pigs and non‐human primates (NHPs). Furthermore, we investigate species differences in 5‐HT₇R binding with [³H]SB‐269970 autoradiography in post‐mortem pig, NHP, and human brain tissue. Specific binding of [¹⁸F]2FP3 was investigated by intravenous administration of the 5‐HT₇R specific antagonist SB‐269970. [³H]SB‐269970 autoradiography was performed as previously described. [¹⁸F]2FP3 was synthesized in an overall yield of 35% to 45%. High brain uptake of the tracer was found in both pigs and NHPs; however, pretreatment with SB‐269970 only resulted in decreased binding of 20% in the thalamus, a 5‐HT₇R–rich region. Autoradiography on post‐mortem pig, NHP, and human tissues revealed that specific binding of [³H]SB‐269970 was comparable in the thalamus of pig and NHP. Despite the high uptake of [¹⁸F]2FP3 in both species, the binding could only be blocked to a limited degree with the 5‐HT₇R antagonists. We speculate that the affinity of the radioligand is too low for imaging the 5‐HT₇Rs in vivo and that part of the PET signal arises from targets other than the 5‐HT₇R.     

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Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review

ObjectiveGeneral practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective.Design, setting, and subjectsA scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations’ websites.Main outcome measuresWe identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR).ResultsA total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient.ConclusionThis scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.

KEY POINTS

• Identified healthcare practices in general practice that increase the quality of care in cancer trajectories:
• Listen carefully to the full story
• Use action plans and time-out-consultations
• Plan and provide proactive care
• Act as an interpreter of diagnosis, treatment options, and its consequences for the patient
• Coordinate care with specialists, patients, and caregivers with mutual respect
• Identified barriers for quality of care in cancer trajectories are:
• Time constraints in consultations
• Limited accessibility for patients and caregivers
• Health practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.

     

Long-term posttreatment functioning among patients with unipolar depression: an integrative model

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources.     

Global assessment of functioning (GAF) ratings: determinants and role as predictors of one-year treatment outcomes

OBJECTIVE: To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994). METHOD: We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one-year symptom and psychosocial functioning outcomes. RESULTS: Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one-year psychological, social, and occupational functioning outcomes. CONCLUSIONS: These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning.     

Smoking Is a Risk Factor for Recurrence of Groin Hernia

Studies of connective tissue from patients with inguinal hernia have shown that smoking may be associated with hernia formation due to a defective connective tissue metabolism. Whether smoking is a risk factor for recurrence, too, was examined in this study. From December 1990 through December 1995, 649 patients underwent hernia repair as open sutured repair (Cooper ligament or abdominal ring repair) or as open mesh repair. Five hundred forty-four eligible patients were evaluated for recurrence 2 years postoperatively. Association between recurrence and 17 patient-, disease-, and intraoperative variables were analyzed by multiple logistic regression. The results showed that smoking was significantly and independently associated with recurrence compared to nonsmoking [odds ratio (OR = 2.22; 95% confidence interval (95% CI) = 1.19–4.15)]. Open sutured repair compared to open mesh repair was the most significant predictor for recurrence (OR = 7.23; 95% CI = 3.01–17.37). Surprisingly, local anesthesia was associated with a higher risk of recurrence compared to general anesthesia (OR = 2.44; 95% CI = 1.19–5.09). Potential confounders and other risk factors for hernia recurrence such as age, alcohol consumption, previous surgery, and anatomical characteristics of the hernia were adjusted for in the analysis. In conclusion, smoking is an important risk factor for recurrence of groin hernia, presumably due to an abnormal connective tissue metabolism in smokers.