Content and implementation of clinical decisions in the routine care of people with severe mental illness.

BACKGROUND: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. AIMS: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. METHOD: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. RESULTS: Agreement between patients and staff regarding decision making was moderate (k = 0.21­0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. CONCLUSIONS: A variety of relevant decision topics were shown for mental health care.Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.

Enhanced expression of VEGF following bFGF inhibition in non-small cell lung cancer cell lines.

Inhibition of basic fibroblast growth factor (bFGF) leads to decreased proliferation of non-small cell lung cancer (NSCLC) cell lines. Although it is well known that bFGF stimulates vascular endothelial growth factor (VEGF) secretion, the influence of bFGF-inhibition is unclear. We therefore investigated the influence of bFGF inhibition on VEGF gene expression and secretion in NSCLC cell lines. In our experiments we demonstrated that inhibition of bFGF gene and protein expression induced increased secretion of VEGF. We also observed an increase of VEGF gene expression in these cells. Furthermore, inhibition of bFGF activated the p42/p44 mitogen-activated protein kinase (MAPK). These results demonstrate that inhibition of bFGF appears to stimulate VEGF production in a p42/44 MAPK-dependent manner. These findings suggest that inhibition of bFGF alone is not a promising strategy to inhibit angiogenesis.

Effects of Clinical Decision Topic on Patients' Involvement in and Satisfaction With Decisions and Their Subsequent Implementation.

OBJECTIVE: Clinical decision making is an important aspect of mental health care. Predictors of how patients experience decision making and whether decisions are implemented are underresearched. This study investigated the relationship between decision topic and involvement in the decision, satisfaction with it, and its subsequent implementation from both staff and patient perspectives. METHODS: As part of the Clinical Decision Making and Outcome in Routine Care for People With Severe Mental Illness study, patients (N=588) and their providers (N=213) were recruited from community-based mental health services in six European countries. Both completed bimonthly assessments for one year using the Clinical Decision Making in Routine Care Scale to assess the decision topic and implementation; both also completed the Clinical Decision Making Involvement and Satisfaction Scale. RESULTS: Three categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully implemented (OR=1.7, p=.03) than not implemented. CONCLUSIONS: Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of decisions to maximize satisfaction and decision implementation.

Influence of basic fibroblast growth factor on the proliferation of non-small cell lung cancer cell lines.

Basic fibroblast growth factor (bFGF) is closely involved in angiogenesis and tumor growth of various cancers, but its role in proliferation and differentiation of non-small cell lung cancer (NSCLC) remains to be defined. The majority of NSCLC cell lines produce elevated protein levels of bFGF but do not secrete comparable amounts. We therefore investigated the influence of bFGF on the proliferation of three human NSCLC cell lines. Our experiments demonstrate that intracellular bFGF level and bFGF mRNA expression correlated with the proliferation rate in all three cell lines. Delivery of a bFGF neutralizing monoclonal antibody, anti-sense oligonucleotides or a vector expressing bFGF antisense cDNA into the cells inhibited tumor cell growth. Delivery of recombinant bFGF into a bFGF-negative cell line led to increased proliferation. These findings suggest that bFGF stimulates the growth of tumor cells by intracrine mechanisms. Strategies to inhibit bFGF in NSCLC may therefore be a promising approach in NSCLC therapy.