Search

PURPOSE Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients. METHODS We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population. RESULTS We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice. CONCLUSIONS Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application. Key words: lung cancer screening; preventive medicine; comorbidities; multimorbidity; clinical reasoning; judgment; paternalism; beneficence; personal autonomy; risk-benefit assessment; life expectancy; quality of life; counseling; education of patients; shared decision making; patient-centered care; holistic health; primary care; practice-based research, INTRODUCTION The United States Preventive Services Task Force (USPSTF) guidelines recommend lung cancer screening (LCS), with an annual low dose-computed tomography scan of the chest, for individuals who meet age [...]

Background Fear of cancer recurrence (FCR) affects virtually all patients who have been treated for cancer, to varying degrees. Breast cancer survivors who carry a BRCA1 or BRCA2 gene mutation are at high risk of cancer recurrence. No study has yet assessed FCR specifically in this population. Objectives This cross-sectional study, conducted in women who were treated for breast cancer and carrying a BRCA1/2 mutation, aimed to: (1) assess the mean level of FCR and estimate the proportion of patients with clinical levels of FCR; (2) examine the relationships between FCR and selected psychological variables (e.g., avoidance, intolerance to uncertainty) and quality of life; (3) explore whether FCR levels vary as a function of the past preventive treatment received; and (4) to assess the associations between FCR and the presence of decisional conflict or regret regarding the various preventive options. Method Participants were recruited through an e-mail sent to an oncogenetic network mailing list (Réseau ROSE). Participants were asked to complete a battery of questionnaires online assessing FCR and other psychological and quality of life variables. Results A total of 89 women completed the survey. Most participants had undergone a preventive mastectomy (62.9%) and a preventive salpingo-oophorectomy (75.3%) at the time of the study. The mean Fear of Cancer Recurrence Inventory-severity score was 16.8, which exceeds the clinical cut-off score of 13, and 70.8% of the participants showed a clinical level of FCR. FCR was significantly associated with higher levels of anxiety and depression, and higher avoidance and intolerance of uncertainty, but not with quality of life. No significant difference was observed on the total FCR score between women who had received preventive surgery (mastectomy and/or salpingo-oophorectomy) and those considering it, and those not considering it. The association was significant between higher FRC scores and greater decisional conflicts and regrets about choosing to undergo preventive surgery. Conclusion These data suggest that FCR is a significant problem for breast cancer survivors carrying a BRCA1/2 genetic mutation, even after undergoing a prophylactic surgery. This highlights the importance of providing these women with specific psychological intervention focusing on FCR. Keywords: Fear of cancer recurrence, Breast cancer, BRCA1/2 genetic mutation, Prophylactic surgery, Author(s): Alexandra Michel[sup.1,2,3], Michel Dorval[sup.2,3,4,6], Jocelyne Chiquette[sup.2,3,5] and Josée Savard[sup.1,2,3] Introduction Fear of cancer recurrence (FCR) is defined as the fear, worry, or concern about the possibility of cancer returning [...]

Byline: Kanika. Bhardwaj, Neelu. Rajawat, Nupur. Mathur Parkinson's disease (PD) is the most common neurodegenerative disease caused by the steady depletion of dopamine in the striatum due to the loss [...]

Introduction The rates of cervical cancer in Canada, as well as the associated morbidity and mortality, have decreased substantially over the past 40 years thanks to screening programmes and human [...]

This year 62 million Americans will, for the first time, have access to mental health and substance abuse benefits as a result of the Affordable Care Act (ACA). And most [...]

Pregnancy-associated malaria is a leading cause of maternal anemia and low birthweight (1). Measures to prevent pregnancy-associated malaria include insecticide-treated nets, treatment with effective antimalarial drugs, and administration of intermittent [...]

In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended byWHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HtV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. Resume En 1991, la 44e Assemblee mondiale de la Sante a fixe deux objectifs essentiels a la lutte mondiale contre la tuberculose (TB) a atteindre d'ici 2000 : detection, dans le cadre de la strategie DOTS preconisee par l'OMS, de 70 % des cas de TB a frottis positif pour les bacilles acido-alcooloresistants et succes du traitement chez 85 % des cas detectes. Le present article decrit le passage a l'echelle superieure de la lutte antituberculeuse pour realiser ces objectifs. Il etudie aussi les obstacles rencontres dans cette realisation, en s'interessant particulierement a l'impact des infections a VIH sur la lutte antituberculeuse. Il sera plus facile de renforcer la lutte contre la TB en elargissant les activites de collaboration TB/VlH recommandees par l'OMS et en ameliorant la coordination entre les programmes de lutte anti-VlH et anti-TB, notamment pour endiguer les TB pharmacoresistantes. Il est entre autre necessaire de renforcer les activites de conseil et de depistage concernant le VIH aupres des malades tuberculeux, d'elargir l'utilisation et l'acceptation de l'isoniazide comme traitement preventif chez les individus infectes par le VIH, de depister les tuberculoses actives dans les etablissements dispensant des soins lies au VIH/sida et d'offrir un acces universel au traitement antiretroviral a tous les individus porteurs du VIH remplissant les criteres pour beneficier d'un tel traitement. Une integration des services accueillant les malades tuberculeux et de ceux affectes au VlH/sida s'impose dans tous les etablissements (a savoir des unites de soins en rapport avec leVIH et de celles de traitement de la TB), et tout particulierement dans les etablissements peripheriques, pour traiter avec efficacite les personnes atteintes des deux maladies, prolonger leur survie et tirer la maximum de moyens humains limites. La realisation des objectifs mondiaux de la lutte antituberculeuse suppose en particulier un regain d'interet pour les activites de collaboration TB/VIH, accompagne d'une volonte et d'un investissement tres forts sur le plan politique. Resumen En 1991, la 44a Asamblea Mundial de la Salud establecio dos metas decisivas para la lucha mundial contra la tuberculosis con miras al ano 2000, a saber, detectar el 70% de los casos baciliferos en el marco de la estrategia de DOTS recomendada por la OMS, y tratar satisfactoriamente el 85% de los casos detectados. En este articulo se describe como se expandio la lucha antituberculosa para lograr esas metas, analizandose tambien los obstaculos que se interpusieron en el camino, en particular la influencia de la infeccion por VIH en el control de la enfermedad. La eficacia de la lucha antituberculosa se vera potenciada por la expansion de las actividades en colaboracion contra la coinfeccion tuberculosis/VlH recomendadas por la OMS y por la mejora de la coordinacion entre los programas de control del VIH y de la tuberculosis, en particular de los destinados a combatir la tuberculosis farmacorresistente. Las actividades requeridas abarcan una intensificacion del asesoramiento y pruebas del VIH para los pacientes con tuberculosis, un mayor uso y aceptacion de la isoniazida como tratamiento preventivo de las personas infectadas por el VIH, el cribado de la tuberculosis activa en los entornos de atencion de la infeccion por VIH, y el acceso universal a la terapia antirretroviral para todos los seropositivos que reunan las condiciones para recibir ese tratamiento. Es necesario integrar los servicios contra la tuberculosis y el VIH en todos los establecimientos (esto es, en los entornos de atencion para los infectados por el VIH y en los consultorios antituberculosos), especialmente en la periferia, para poder tratar eficazmente a quienes sufren ambas infecciones, a fin de prolongar su supervivencia y de maximizar unos recursos humanos limitados. Es posible alcanzar las metas mundiales de control de la tuberculosis, sobre todo si se presta una renovada atencion a las actividades colaborativas en materia de tuberculosis/VIH con el respaldo de un enorme compromiso y voluntad politicos. [TEXT NOT REPRODUCIBLE IN ASCI.], Introduction In 1991, the 44th World Health Assembly (WHA) recognized the importance and previous neglect of tuberculosis (TB), and set two key global targets to be reached by 2000: 70% [...]

Abstract Anti-stress activity was carried out on glyco-peptido-lipid (AF) fraction from the alcoholic extract of Trichopus zeylanicus Gaerten and demonstrated against a battery of tests in rats and mice. AF [...]

Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents. (Am J Public Health. 2005;95:331-337. doi: 10.2105/AJPH.2003.028357)

Background The greater Darfur region of Sudan comprises three states (Northern Darfur, Southern Darfur and Western Darfur) with a total population of approximately 6 558 698 residents. During the past [...]

Alcohol has many dramatic and varied effects on the bone marrow, blood production, and blood cell function. Decreased cell numbers, impaired cell function, and decreased blood-clotting ability in alcoholic patients [...]

Some concurrent use of alcohol and prescribed drugs is inevitable. Health care professionals must be aware of the interactions between alcohol and such drugs to guide them in prescribing and [...]

clinical aspects and mechanisms of injury The pancreas plays a vital in digestion of food and maintenance of appropriate blood sugar levels. Chronic alcoholic pancreatitis, though relatively rare, is irreversible [...]

Heavy alcohol consumption can have chronic and acute effects on the nervous system. Chronic alcoholics experience neurological disorders as severe as loss of memory and muscle control caused by cell [...]

Alcohol is associated with several metabolic bone disorders, and it increases the incidence and severity of fractures. Early detection may help prevent the skeletal pain, deformity, and disability of advanced [...]

Alcohol consumption may have harmful consequences, some of which directly affect mental or, physical health. Others, such as loss of a job or divorce, are not health related per se [...]

Americans are paying for their tobacco use, poor diets, and lack of exercise with health care dollars. New attitudes toward the preventive aspects of health care may not only help [...]

Context.--Prostate cancer remains a significant public health problem. Recent publications of randomized trials and the US Preventive Services Task Force recommendations have drawn attention to overtreatment of localized, low-risk prostate cancer. Active surveillance, in which patients undergo regular visits with serum prostate-specific antigen tests and repeat prostate biopsies, rather than aggressive treatment with curative intent, may address overtreatment of low-risk prostate cancer. It is apparent that a greater awareness of the critical role of pathologists in determining eligibility for active surveillance is needed. Objectives.--To review the state of current knowledge about the role of active surveillance in the management of prostate cancer and to provide a multidisciplinary report focusing on pathologic parameters important to the successful identification of patients likely to succeed with active surveillance, to determine the role of molecular tests in increasing the safety of active surveillance, and to provide future directions. Design.--Systematic review of literature on active surveillance for low-risk prostate cancer, pathologic parameters important for appropriate stratification, and issues regarding interobserver reproducibility. Expert panels were created to delineate the fundamental questions confronting the clinical and pathologic aspects of management of men on active surveillance. Results.--Expert panelists identified pathologic parameters important for management and the related diagnostic and reporting issues. Consensus recommendations were generated where appropriate. Conclusions.--Active surveillance is an important management option for men with low-risk prostate cancer. Vital to this process is the critical role pathologic parameters have in identifying appropriate candidates for active surveillance. These findings need to be reproducible and consistently reported by surgical pathologists with accurate pathology reporting. (Arch Pathol Lab Med. 2014;138:1387-1405; doi: 10.5858/arpa.2014-0219-SA), In December 2011, the National Institutes of Health conducted a state-of-the-science conference with a summary statement on the role of active surveillance in the management of men with localized prostate [...]

Byline: Surajit. Nayak, Basanti. Acharjya Sir, Thanks for such valuable comments and pointing out of some mistakes by authors. [sup][1] According to US preventive services task force's recommended statement, screening [...]