Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis

Background: Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment. Methods: Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ. Results: 298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment. Conclusions: These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression

Insight into Protein–Polymer Conjugate Relaxation Dynamics: The Importance of Polymer Grafting

The bio and chemical physics of protein–polymer conjugates are related to parameters that characterize each component. With this work, it is intended to feature the dynamical properties of the protein–polymer conjugate myoglobin (Mb)–poly(ethyl ethylene phosphate), in the ps and ns time scales, in order to understand the respective roles of the protein and of the polymer size in the dynamics of the conjugate. Elastic and quasi-elastic neutron scattering is performed on completely hydrogenated samples with variable number of polymer chains covalently attached to the protein. The role of the polymer length in the protein solvation and internal dynamics is investigated using two conjugates formed by polymers of different molecular weight. It is confirmed that the flexibility of the complex increases with the number of grafted polymer chains and that a sharp dynamical transition appears when either grafting density or polymer molecular weight are high. It is shown that protein size is crucial for the polymer structural organization and interaction on the protein surface and it is established that the glass properties of the polymer change upon conjugation. The results give a better insight of the equivalence of the polymer coating and the role of water on the surface of proteins

Buried volcanic structures in the Gulf of Naples (Southern Tyrrhenian Sea, Italy) resulting from high resolution magnetic survey and seismic profiling

In this paper we present a correlation between volcanic structures and magnetic anomalies in the Gulf of Naples (Southern Tyrrhenian Sea) based on high resolution magnetic profiling. A densely spaced grid of magnetic profiles coupled with multichannel seismics (seismic source Watergun 15 cubic inch) was recorded in the Gulf of Naples, representing an active volcanic area during the Late Quaternary (volcanic centers of Somma-Vesuvius, Phlegraean Fields and Ischia and Procida islands). The dataset was collected during the oceanographic cruise GMS00-05 which took place during October-November 2000 in the South Tyrrhenian Sea onboard of the R/V Urania (National Research Council, Italy). Shallow volcanic structures in the subsurface of the gulf were recognized by seismo-stratigraphic analysis of high resolution profiles; the volcanic nature of some of these structures was inferred identifying the magnetic anomalies on a high resolution magnetic anomaly map of the gulf. Even if qualitative, the correlations between seismic and magnetic profiles allow us to better assess the geological structure of the Gulf of Naples

Surgical ‘damage control’ treatment of a large retroperitoneal liposarcoma encasing a horseshoe kidney

Damage control is a surgical strategy for severely compromised trauma patients based on speed control of life-threatening injuries that aims to rapidly resuscitate patients in an intensive care unit (ICU). We report on the use of such therapeutic strategy in a patient affected by a retroperitoneal sarcoma concomitant to a horseshoe kidney, a relatively rare anatomical malformation

Fluorodeoxyglucose-positron emission tomography/computed tomography in the staging and evaluation of treatment response in a patient with Castleman's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Castleman's disease is a rare lymphatic polyclonal disorder that is characterised by unicentric or multicentric lymph node hyperplasia and non-specific symptoms and signs including fever, asthenia, weight loss, enlarged liver and abnormally high blood levels of antibodies.</p> <p>Case presentation</p> <p>We present the case of a 74-year-old man with Castleman's disease. The disease was detected with a contrast-enhanced computed tomography (CT) scan and a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT study; diagnosis was made with histopathology. After treatment with surgical excision followed by chemotherapy, the disease response was evaluated using both diagnostic techniques. However, only the PET study was able to identify the spread of the disease to the abdominal lymph nodes, which were both enlarged and normal size, and, after treatment, to evaluate the disease response.</p> <p>Conclusion</p> <p>Based on the results of previous case reports and on those of the present study, it seems that Castleman's disease has a high glucose metabolic activity. Therefore, the use of PET can be considered appropriate in order to stage or restage the disease and to evaluate the response of the disease to treatment.</p