Decision making in cancer primary prevention and chemoprevention

Background:We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention.Purpose: The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research.Methods: Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices. Decision aids for the human papillomavirus (HPV) vaccine, Hormone Replacement Therapy (HRT), and tamoxifen were systematically examined.Results: Traditional concepts such as decisional balance and cues to action are relevant to understanding cancer primary prevention choices; Motivational Interviewing, Self-Determination Theory, and the Preventive Health Model may also explain the facilitators of decision making. There are no well-tested HPV vaccine decision aids, although there have been some studies on aids for HPV testing. There are several effective decision aids for HRT and tamoxifen; evidence-based decision aid components have also been identified.Conclusions: Additional theory-based empirical research on decision making in cancer primary prevention and chemoprevention, particularly at the interface of psychology and behavioral economics, is suggested. We thank Dr. Karen Glanz for her contributions to the literature review for this article and her coleadership of one of the break-out sessions.We also thank an anonymousAnnals of Behavioral Medicine reviewer for suggestions to the text that enriched this article. We thank Dr. Karen Glanz for her contributions to the literature review for this article and her coleadership of one of the break-out sessions.We also thank an anonymous Annals of Behavioral Medicine reviewer for suggestions to the text that enriched this article.     

牡丹江市正常成人尿液红、白细胞定量分析参考值调查

目的尿液沉渣分析红、白细胞由传统的定性报告方式改为定量分析(××/μl).由于使用的检查方法不同,其参考值也不一样,国内目前尚未有统一的参考值,为使牡丹江市有一个统一的判断标准.方法我们对1109名健康成人其中男性591人,女性518人进行尿中红细胞及白细胞的参考值调查.方法采用国内的专用尿沉渣计数板,显微镜下计数.对体检者在统一时间清晨7点钟留取尿液20～30毫升,按统一操作规程进行操作,对不同性别的人群进行参考值的调查.结果男性红细胞x是1.12,S是1.42,95%可信界限0～3.96,参考值范围0～4/μl;男性白细胞x是1.84,是S 2.05,95%可信界限0～5.94,参考值范围0～6/μl.女性红细胞x是2.46,S是3.26,95%可信界限0～8.98,参考值范围0～9/μl;女性白细胞x是2.25,S是3.82,95%可信界限0～9.89,参考值范围0～10/μl.结论通过1109名正常成人尿液红细胞及白细胞含量的调查,建立了牡丹江市的参考值.     

Infected pancreatic fluid collections: percutaneous catheter drainage

Thirty-eight infected pancreatic fluid collections in 23 patients with acute or chronic pancreatitis were drained percutaneously following initial diagnosis with computed tomography and fine-needle aspiration. Fifteen (65.2%) patients were cured completely without surgery. Eight (34.8%) patients required some type of surgery despite successful treatment of the fluid collection, and in two (6.5%) the collection recurred after catheter removal. Complications occurred in three (13%) patients, but only one complication (4%), empyema, was a direct result of catheter drainage. Catheter drainage time averaged 29 days for 16 patients with isolated collections and 96 days and 104 days for patients with collections with pancreatic duct fistulas (nine patients) or gastrointestinal fistulas (14 patients), respectively. This study confirms that infected pancreatic fluid collections can be safely and effectively treated with percutaneous catheter techniques in most patients.     

Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy

Over a 10-year period, 276 pulmonary arteriovenous malformations (PAVMs) were occluded with balloon embolotherapy in 76 patients, 67 (88%) of whom had hereditary hemorrhagic telangiectasia. Eleven patients (14%) were discovered by means of family screening with measurement of arterial blood gases and chest radiography. Epistaxis, dyspnea, hemoptysis, and hemothorax occurred in 79%, 71%, 13%, and 9% of patients, respectively. Clinical histories of strokes and transient ischemic attacks were present in 18% and 37% of patients, respectively. Computed tomographic scans of 59 patients showed stroke in 36%. Sixty-five percent of PAVMs were located in the lower lobes, which correlated with the finding of more pronounced hypoxemia in the upright position. After embolotherapy, symptomatic hypoxemia was corrected, and serial values have remained constant for 5 years. Complications were minimal, and no patient required surgery. Balloon embolotherapy is effective long-term therapy for PAVMs, and family screening should be pursued because of the possibility of a higher frequency of paradoxical embolization (stroke) than previously recognized.