LRIG1 engages ligand VISTA and impairs tumor-specific CD8+ T cell responses.

Immune checkpoint blockade is a promising approach to activate antitumor immunity and improve the survival of patients with cancer. V-domain immunoglobulin suppressor of T cell activation (VISTA) is an immune checkpoint target; however, the downstream signaling mechanisms are elusive. Here, we identify leucine-rich repeats and immunoglobulin-like domains 1 (LRIG1) as a VISTA binding partner, which acts as an inhibitory receptor by engaging VISTA and suppressing T cell receptor signaling pathways. Mice with T cell-specific LRIG1 deletion developed superior antitumor responses because of expansion of tumor-specific cytotoxic T lymphocytes (CTLs) with increased effector function and survival. Sustained tumor control was associated with a reduction of quiescent CTLs (TCF1+ CD62Lhi PD-1low) and a reciprocal increase in progenitor and memory-like CTLs (TCF1+ PD-1+). In patients with melanoma, elevated LRIG1 expression on tumor-infiltrating CD8+ CTLs correlated with resistance to immunotherapies. These results delineate the role of LRIG1 as an inhibitory immune checkpoint receptor and propose a rationale for targeting the VISTA/LRIG1 axis for cancer immunotherapy.

Safety and efficacy of vitamin B in cancer treatments: A systematic review.

BACKGROUND: With rising rates of complementary and alternative medicine use, the exploration of complementary and alternative medicine integration into oncology treatments is becoming increasingly prevalent. Vitamin B compounds including B1, B2, B3, B5, B6, B9, and B12, have all been proposed as potentially beneficial in cancer prevention and treatment as well as side effect management; however, many studies contain contradicting evidence regarding the utility of B vitamins within oncology. Thus, the aim of this study was to evaluate the safety and efficacy of Vitamin B supplementation in the oncology setting. DESIGN: A systematic review was conducted following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews guidelines, using pre-specified search terms in PubMed to include randomized control trials, clinical trials, and case studies. Two reviewers independently reviewed titles, abstracts, and full-text articles for inclusion, with a third reviewer resolving conflicts, before the included articles underwent data extraction and quality appraisal. Data extraction was conducted through COVIDENCE, which was used to manage and track the data during the search process. RESULTS: Out of 694 articles initially identified, 25 articles met the inclusion criteria and were included in the review. Designs of the studies varied, including randomized control trials, clinical trials, and case/cohort studies. The impact of vitamin supplementation on cancer risk varied. Several studies found that certain B vitamin supplementation lowered cancer risk: B9 and B6 in nasopharyngeal carcinoma (n = 1200 patients) and in pancreatic cancer (n = 258 patients); B3 in hepatocellular carcinoma (n = 494,860 patients); B6 in breast cancer (n = 27,853 patients); and B9 in BRCA1-positive breast cancer (n = 400 patients). However, some studies found that certain B vitamin supplementation increased the risk or negative outcomes of cancer: B6 during nasopharyngeal carcinoma treatment (n = 592 patients); B6 in risk of hepatocellular carcinoma (n = 494,860 patients); and B9 plasma levels in breast cancer (n = 164 patients). Due to the many adverse effects that occur in cancer treatment, the effectiveness of Vitamin B supplementation in alleviating adverse effects was evaluated. In two separate studies, Vitamin B6 and Vitamin B12 supplementation with acupuncture was found to be effective as adjunct therapies aimed to reduce chemotherapy-induced peripheral neuropathy (n = 23 patients and n = 104 patients, respectively). No significant findings were established regarding B vitamin supplementation in chemotherapy-induced hand-foot syndrome. CONCLUSIONS: In this systematic review we concluded that B vitamin supplements have varying data regarding safety and efficacy in cancer. Taking into account the etiology of the cancer, the specific B-vitamin, and the presence of any side effects could help guide utilization of the data found in this review. Large, randomized controlled trials are needed to confirm these findings among various cancer diagnoses and stages. Given the widespread utilization of supplements, healthcare providers should understand the safety and efficacy of vitamin B supplementation to address questions that arise in caring for those with cancer.

Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study.

BACKGROUND AND PURPOSE: Physical activity (PA) has many known benefits for people with Parkinson disease (PD); however, many people do not meet recommended levels of frequency or intensity. We designed Engage-PD, a PA coaching program delivered via telehealth and grounded in self-determination theory to promote PA uptake and facilitate exercise self-efficacy in people with Parkinson disease. This study aimed to determine the feasibility and preliminary efficacy of Engage-PD, and to explore whether baseline characteristics were associated with outcomes. METHODS: A single cohort of people with PD (n = 62, Hoehn and Yahr I-III) participated in the 3-month Engage-PD program, which consisted of up to 5 telehealth coaching sessions delivered by physical therapists. Feasibility was evaluated based on recruitment and retention rates, along with participants' feedback. Planned and unplanned PA, exercise self-efficacy (ESE), and individualized goals were assessed pre- and post-intervention. Relationships between baseline characteristics and changes in planned PA and ESE were also evaluated. RESULTS: Recruitment (62%) and retention (85%) rates were high, and the intervention was well accepted and perceived by the participants. From pre- to postintervention, participants increased planned PA (d = 0.33), ESE (d = 1.20), and individualized goal performance (d = 1.63) and satisfaction (d = 1.70). Participants with lower baseline planned PA experienced greater improvements in planned PA, and those with lower baseline ESE experienced greater improvements in ESE. DISCUSSION AND CONCLUSIONS: A telehealth PA coaching program for people with PD was feasible and potentially efficacious. Physical therapist-led coaching may be an important component of a consultative model of care starting early in the disease process.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A393).

HealthCare educational differences in pain management, adverse childhood experiences and their relationship to substance use disorder education.

BACKGROUND: In order to assist the State of Ohio in the United States in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles in the development of prevention and educational strategies for reducing substance use disorder (SUD). One area of focus for SCOPE was SUD education of healthcare professionals. The objective of the present was to identify the content and extent to which future healthcare professionals are trained in pain management, SUD, and adverse childhood experiences (ACEs). METHODS: In December of 2019, a survey was distributed to 49 healthcare professional schools in Ohio that included the following disciplines: medicine, pharmacy, advanced practice registered nurse (APRN), physician assistant, dentistry, and optometry. The survey included four domains: initial screening of patients, training in SUD, training in care for patients at high risk for SUD, and education in evaluating patients for ACEs. Descriptive statistics were calculated. RESULTS: Thirty one of the forty-nine schools completed the survey. Most disciplines indicated that some form of basic training in the principles of SUD were taught in their core curriculum. The training on ethical issues surrounding SUD were not as widely covered (range 0-62.5%). Medicine, APRN, physician assistant, and pharmacy schools had a "moderate" to "great" extent of pharmacologic therapy curriculum integration. Other pain management strategies were "somewhat" to "moderately" integrated. There were variations seen in training on risk of medication misuse based on various contributors to health. At least 67.7% of medicine, APRN, physician assistant, and pharmacy programs included motivational interviewing training. The extent to which schools integrated education regarding ACEs into their curriculum varied from 0 to 66.7%. CONCLUSIONS: The study finding suggests a need for a unified, consistent, and expanded training requirement in the foundations of pain management, SUD, and ACEs in professional healthcare education.

The impact of COVID-19 and social distancing on people with Parkinson's disease: a survey study.

As the COVID-19 pandemic continues to affect the international community, very little is known about its impact on the health and day-to-day activities of people with Parkinson's disease (PwPD). To better understand the emotional and behavioral consequences of the public health policies implemented to mitigate the spread of SARS-CoV-2 in PwPD, and to explore the factors contributing to accessing alternative health care mechanisms, such as telehealth, we administered an anonymous knowledge, attitude, and practice survey to PwPD and care partners, via the mailing lists of the Parkinson's Foundation and Columbia University Parkinson's Disease Center of Excellence with an average response rate of 19.3%. Sufficient information was provided by 1,342 PwPD to be included in the final analysis. Approximately half of respondents reported a negative change in PD symptoms, with 45-66% reporting mood disturbances. Telehealth use increased from 9.7% prior to the pandemic to 63.5% during the pandemic. Higher income and higher education were associated with telehealth use. Services were more often used for doctor's appointment than physical, occupational, speech, or mental health therapies. Almost half (46%) of PwPD preferred to continue using telehealth always or sometimes after the coronavirus outbreak had ended. Having received support/instruction for telehealth and having a care partner, friend, or family member to help them with the telehealth visit increased the likelihood of continuous use of telehealth after the pandemic ended. Taken together, PD symptoms and management practices were markedly affected by COVID-19. Given the observed demographic limitations of telehealth, expanding its implementation to include additional physical, occupational, psychological, and speech therapies, increasing support for telehealth, as well as reaching underserved (low income) populations is urgently required.

We're Not Just Horsing Around: Creating Innovative Community Clinical Experiences Utilizing Diverse Opportunities.

Community nursing clinical experiences are essential to the education of BSN prelicensure students. Because of limited traditional community clinical sites, faculty must identify innovative, nontraditional community sites that provide quality experiences. Faculty at Ohio University identified a unique opportunity to provide a multidisciplinary collaborative community clinical rotation in conjunction with the Center for Therapeutic Riding Center located at the Ohio Horse Park. Nineteen senior BSN students participated in a six-week community clinical experience caring for a variety of vulnerable populations participating in the therapeutic riding program. Faculty and students responded positively to the experience.

Gdown1 Associates Efficiently with RNA Polymerase II after Promoter Clearance and Displaces TFIIF during Transcript Elongation.

Pausing during the earliest stage of transcript elongation by RNA polymerase II (Pol II) is a nearly universal control point in metazoan gene expression. The substoichiometric Pol II subunit Gdown1 facilitates promoter proximal pausing in vitro in extract-based transcription reactions, out-competes the initiation/elongation factor TFIIF for binding to free Pol II and co-localizes with paused Pol II in vivo. However, we have shown that Gdown1 cannot functionally associate with the Pol II preinitiation complex (PIC), which contains TFIIF. In the present study, we determined at what point after initiation Gdown1 can associate with Pol II and how rapidly this competition with TFIIF occurs. We show that, as with the PIC, Gdown1 cannot functionally load into open complexes or complexes engaged in abortive synthesis of very short RNAs. Gdown1 can load into early elongation complexes (EECs) with 5-9 nt RNAs, but efficient association with EECs does not take place until the point at which the upstream segment of the long initial transcription bubble reanneals. Tests of EECs assembled on a series of promoter variants confirm that this bubble collapse transition, and not transcript length, modulates Gdown1 functional affinity. Gdown1 displaces TFIIF effectively from all complexes downstream of the collapse transition, but this displacement is surprisingly slow: complete loss of TFIIF stimulation of elongation requires 5 min of incubation with Gdown1. The relatively slow functional loading of Gdown1 in the presence of TFIIF suggests that Gdown1 works in promoter-proximal pausing by locking in the paused state after elongation is already antagonized by other factors, including DSIF, NELF and possibly the first downstream nucleosome.

THZ1 Reveals Roles for Cdk7 in Co-transcriptional Capping and Pausing.

The Cdk7 subunit of TFIIH phosphorylates RNA polymerase II (Pol II) during initiation, and, while recent studies show that inhibition of human Cdk7 negatively influences transcription, the mechanisms involved are unclear. Using in vitro transcription with nuclear extract, we demonstrate that THZ1, a covalent Cdk7 inhibitor, causes defects in Pol II phosphorylation, co-transcriptional capping, promoter proximal pausing, and productive elongation. THZ1 does not affect initiation but blocks essentially all Pol II large subunit C-terminal domain (CTD) phosphorylation. We found that guanylylation of nascent RNAs is length dependent and modulated by a THZ1-sensitive factor present in nuclear extract. THZ1 impacts pausing through a capping-independent block of DSIF and NELF loading. The P-TEFb-dependent transition into productive elongation was also inhibited by THZ1, likely due to loss of DSIF. Capping and pausing were also reduced in THZ1-treated cells. Our results provide mechanistic insights into THZ1 action and how Cdk7 broadly influences transcription and capping.

Palliative and end-of-life care training during the surgical clerkship.

BACKGROUND: In 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine. MATERIALS AND METHODS: In the 2007-08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback. RESULTS: All 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024). CONCLUSIONS: Early training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, "Conducting a Family Conference" proved to be the most challenging.

Discovery of antivirulence agents against methicillin-resistant Staphylococcus aureus.

Antivirulence agents inhibit the production of disease-causing virulence factors but are neither bacteriostatic nor bactericidal. Antivirulence agents against methicillin-resistant Staphylococcus aureus (MRSA) strain USA300, the most widespread community-associated MRSA strain in the United States, were discovered by virtual screening against the response regulator AgrA, which acts as a transcription factor for the expression of several of the most prominent S. aureus toxins and virulence factors involved in pathogenesis. Virtual screening was followed by similarity searches in the databases of commercial vendors. The small-molecule compounds discovered inhibit the production of the toxins alpha-hemolysin and phenol-soluble modulin α in a dose-dependent manner without inhibiting bacterial growth. These antivirulence agents are small-molecule biaryl compounds in which the aromatic rings either are fused or are separated by a short linker. One of these compounds is the FDA-approved nonsteroidal anti-inflammatory drug diflunisal. This represents a new use for an old drug. Antivirulence agents might be useful in prophylaxis and as adjuvants in antibiotic therapy for MRSA infections.

Excising squamous cell carcinomas: comparing the performance of GPs, hospital skin specialists and other hospital specialists.

BACKGROUND: GPs have no defined role in the excision of squamous cell carcinomas (SCCs). Current guidelines recommend that all skin lesions suspicious of SCC should be referred urgently to secondary care. Evidence regarding current management of SCC in primary care is limited. Existing audit data suggest that up to 10% of SCCs may be excised in primary care. GPs may be able to have a greater role in the management of SCC but more evidence is required before this can be advocated. OBJECTIVE: To compare the practice of GPs, skin specialists (dermatologists and plastic surgeons) and other hospital specialists in excising SCCs. Methods . A retrospective analysis of all SCCs excised in the Grampian region between 1 January and 31 December 2005. A total of 1184 reports were rated for source and adequacy of excision. RESULTS: GPs excised 23.7% of all SCC-positive biopsies. Whether the biopsy had been performed by a GP or a hospital skin specialist made no significant difference to excision adequacy. However, GPs were significantly more likely to excise adequately than hospital non-specialists (P < 0.001). Infrequent GP excisers appear to perform as well as frequent excisers in adequately excising SCCs. CONCLUSIONS: GPs excise a considerable number of SCCs in primary care. GPs compare favourably to skin specialists in excising SCCs. The performance of infrequent GP excisers does not appear to differ significantly from that of frequent GP excisers. Further work is required to define more clearly the role of GPs in the management of SCCs.

Comparing diagnostic delay in cancer: a cross-sectional study in three European countries with primary care-led health care systems.

BACKGROUND: The principal aim of this study was to determine the feasibility of a large-scale comparative study, between the UK, the Netherlands and Sweden, to investigate whether delays in the diagnostic pathway of cancer might explain differences in cancer survival between countries. METHODS: Following a planning meeting to agree the format of a data collection instrument, data on delays in the cancer diagnostic pathway were abstracted from primary care-held medical records. Data were collected on 50 cases each (total of 150) from practices in each of Grampian, Northeast Scotland; Maastricht, the Netherlands and Skane, Sweden. Data were entered into SPSS 18.0 for analysis. RESULTS: Data on delays in the cancer diagnostic pathway were readily available from primary care-held case records. However, data on demographic variables, cancer stage at diagnosis and treatment were less well recorded. There was no significant difference between countries in the way in which cases were referred from primary to secondary care. There was no significant difference between countries in the time delay between a patient presenting in primary care and being referred to secondary care. Median delay between referral and first appointment in secondary care [19 (8.0-47.5) days] was significantly longer in Scotland that in Sweden [1.0 (0-31.5) days] and the Netherlands [5.5 (0-31.5) days] (P < 0.001). Secondary care delay (between first appointment in secondary care and diagnosis) in Scotland [22.5 (0-39.5) days] was also significantly longer than in Sweden [14.0 (4.5-31.5) days] and the Netherlands [3.5 (0-16.5) days] (P = 0.003). Finally, overall delay in Scotland [53.5 (30.3-96.3) days] was also significantly longer than in Sweden [32.0 (14.0-71.0) days] and the Netherlands [22.0 (7.0-60.3) days] (P = 0.003). CONCLUSIONS: A large-scale study comparing cancer delays in European countries and based on primary care-held records is feasible but would require supplementary sources of data in order to maximize information on demographic variables, the cancer stage at diagnosis and treatment details. Such a large-scale study is timely and desirable since our findings suggest systematic differences in the way cancer is managed in the three countries.

European differences in cancer survival: report of an international symposium of general practitioners from three countries exploring primary and secondary care delay.

BACKGROUND: There are several potential delays in the cancer diagnostic pathway: patient delay, primary care delay and secondary care delay. People in the UK have poorer five-year survival from many cancers compared with people in European countries with similar healthcare systems. The reasons for this are not clear, although it has been postulated that UK patients may present with cancer at a later stage. We are conducting a study to investigate the feasibility of comparing diagnostic delays in different European countries. METHODS: (conduct of the symposium): A half-day, round-table symposium was convened with seven general practitioners (GPs) and single primary care researchers from Sweden (Malmö), the Netherlands (Maastricht) and Scotland (Aberdeen). In Session One the group had a broad-ranging discussion comparing and contrasting their different working contexts and how these might impact on the cancer diagnostic pathway. In Session Two the group considered two case studies from Scotland, applying their own local experience and the insights generated in Session One to identify common and divergent issues. When it had finished the facilitator drafted a detailed report of the symposium which was supported by reference to the individual participants' notes which had been collected at the end of the symposium. RESULTS: (consensus views reached): Sweden, the Netherlands and Scotland have strong traditions of primary care acting in a gate-keeping role. People with cancer in the three countries following a broadly similar cancer diagnostic pathway. In Sweden and the Netherlands GPs have direct unscreened access to a greater range of investigations than in Scotland. In Scotland there is a greater reliance on specialist guidelines than in the Netherlands or Sweden. Future research in the UK could explore the potential contribution of increased GP access to investigations and revised referral guidelines.

Fluid therapy using a balanced crystalloid solution and acid-base stability after cardiac surgery.

OBJECTIVE: To evaluate the effect of fluid therapy using Accusol (Baxter Healthcare, McGaw Park, Ill, USA), a crystalloid solution containing sodium bicarbonate and other electrolytes and having a strong ion difference of 35 mEq/L, on acid-base stability after cardiac surgery. DESIGN: Retrospective per-protocol comparison. SETTING: Intensive care unit of St Vincent's Hospital, a teaching hospital in Melbourne, Australia. PARTICIPANTS: Consecutive adult patients admitted in daytime hours after elective on-pump coronary artery bypass graft surgery between May and October 2008 constituted the "pre-Accusol group" (n=40), and those admitted between May and October 2009 and who were treated with Accusol constituted the "Accusol group" (n=51). MAIN OUTCOME MEASURES: The fluids and their component electrolytes administered; change in standard base excess (SBE) between the time of intensive care admission and 04:00 h the next day. RESULTS: The Accusol group received a median Accusol dose of 1.86 mL/kg/h (interquartile range, 1.51-2.20 mL/ kg/h), which accounted for 38% (SD, 10%) of the total volume of fluid administered. The change in SBE was +0.03mmol/L (95% CI, -0.57 to 0.64 mmol/L; P = 0.91) in the Accusol group compared with -2.05mmol/L (95% CI, -2.64 to -1.45; P < 0.01) in the pre-Accusol group. The strong ion difference of the electrolytes administered as components of fluid therapies was higher in the Accusol group by 55.5mEq (95% CI, 40.0 to 71.0mEq; P < 0.01). Only 8% of the Accusol group received albumin compared with 48% of the pre-Accusol group (P < 0.01). CONCLUSIONS: SBE was more stable in patients treated with Accusol. Further studies are needed to determine whether use of solutions such as Accusol influences important patient outcomes.

Energy drinks: a new health hazard for adolescents.

A new hazard for adolescents is the negative health effects of energy drink consumption. Adolescents are consuming these types of drinks at an alarming amount and rate. Specific effects that have been reported by adolescents include jitteriness, nervousness, dizziness, the inability to focus, difficulty concentrating, gastrointestinal upset, and insomnia. Health care providers report that they have seen the following effects from the consumption of energy drinks: dehydration, accelerated heart rates, anxiety, seizures, acute mania, and strokes. This article is a comprehensive literature review on the health effects of energy drinks. Findings from this article indicate the need for educational intervention to inform adolescents of the consequences of consuming these popular drinks. School nurses are in a unique position to teach adolescents about the side effects and possible health issues that can occur when energy drinks are consumed.

Menopause-related workload in general practice 1996-2005: a retrospective study in the UK.

BACKGROUND: Women with menopausal symptoms often consult with a health professional. Recently, hormone replacement therapy (HRT) prescribing has declined but the impact of this change on other aspects of general practice workload is unclear. OBJECTIVE: To investigate whether the menopause remains a workload issue. METHODS: A retrospective observational study of UK general practice (General Practice Research Database) using four random samples of 25000 women aged 45-64 years registered with a general practice during 1996, 1999, 2002 and 2005. We calculated the incidence and prevalence of menopause-related consultation; gynaecology referrals; prescriptions for HRT, clonidine and antidepressants during each year; examined patterns over time and investigated whether the types of preparations had changed. RESULTS: The prevalence and incidence of menopause-related consultation fell-from 18.1% of women aged 45-64 years consulting at least once in 1996 to 10.4% in 2005. Over time, the proportion of women consulting about the menopause who were not prescribed HRT or clonidine increased. The incidence and prevalence of HRT decreased, mainly between 2002 and 2005. The proportion of women prescribed oral HRT fell while the proportion prescribed cream or pessaries/suppositories increased, particularly among women without a hysterectomy. Referrals to gynaecology and the incidence and prevalence of clonidine prescribing increased but remained uncommon. Patterns of antidepressant prescribing did not appear menopause related. CONCLUSION: Although menopause-related workload has decreased over time, in 2005, over 10% of women aged 45-64 years consulted for a menopause-related matter. This suggests that the menopause remains an important part of UK general practice work.

GP-led melanoma follow-up: views and feelings of patient recipients.

OBJECTIVES: The aim of this study was to explore the practical experiences and feelings of people with cutaneous malignant melanoma about receiving structured melanoma follow-up from their general practitioner (GP) as an alternative to traditional hospital-based follow-up. DESIGN: Semi-structured audio-taped telephone interviews were conducted with patient recipients of a GP-led follow-up programme for people with cutaneous malignant melanoma. SUBJECTS: Eighteen people with cutaneous malignant melanoma that had received structured GP-led routine follow-up for cutaneous malignant melanoma took part in this study. RESULTS: GP-led melanoma follow-up worked well from the perspectives patients. Patients appreciated convenience of the system, less rushed appointments with more thorough examinations, a more pleasant atmosphere and greater continuity of care. They regarded the GP-led follow-up positively, irrespective of distance from the major cancer centre. Concerns expressed included awareness that most GPs had less experience of melanoma than hospital specialists. CONCLUSIONS: GP-led melanoma follow-up is feasible and is generally viewed positively by those patients that have experienced it.

GP-led melanoma follow-up: the practical experience of GPs.

OBJECTIVES: To explore how GP-led melanoma follow-up had actually worked from the perspective of GPs by exploring in detail the practical experience of GPs running the programme. DESIGN: Semi-structured audio-taped telephone interviews with GPs delivering a GP-led follow-up programme for people with cutaneous malignant melanoma. SUBJECTS: Seventeen GPs currently delivering structured GP-led routine follow-up for people with cutaneous melanoma. RESULTS: GP-led melanoma follow-up worked well from the perspectives of GPs. The GPs felt that they were well equipped and supported in undertaking the follow-up consultations and recognized that they were freeing up hospital consultant time. They felt that patients appreciated the convenience of GP-led follow-up. The GPs felt that a robust recall system, initial training with regular refreshers and effective consultant backup were vital components of a successful long-term programme. CONCLUSIONS: GP-led melanoma follow-up is feasible and, provided certain concerns can be addressed, GPs are willing to provide it.