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1.
Contemp Clin Trials ; 142: 107564, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38704119

RESUMO

INTRODUCTION: Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy. METHODS/DESIGN: We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation. RESULTS/DISCUSSION: With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S. TRIAL REGISTRATION: NCT04496739.


Assuntos
Neoplasias da Mama , Quimioprevenção , Humanos , Feminino , Neoplasias da Mama/prevenção & controle , Quimioprevenção/métodos , Educação de Pacientes como Assunto/métodos , Técnicas de Apoio para a Decisão , Pessoa de Meia-Idade , Adulto , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Redução do Risco , Projetos de Pesquisa , Antagonistas de Estrogênios/uso terapêutico , Antagonistas de Estrogênios/administração & dosagem , Medidas de Resultados Relatados pelo Paciente
2.
Radiat Prot Dosimetry ; 137(3-4): 252-5, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19892806

RESUMO

Experiences from the action plan concerning noise abatement measures developed in the city of Modena are described. The paper shows noise levels measured after traffic calming measures, after the construction of a noise barrier and a roundabout and after the laying of low-noise pavements. A method for the new action plan design is tested on a large urban area based on a noise map and on a priority index for noise reduction actions taking into account the noise exposure levels and the number of exposed people.


Assuntos
Ruído dos Transportes/prevenção & controle , Proteção Radiológica/instrumentação , Proteção Radiológica/métodos , Itália
3.
Minerva Cardioangiol ; 38(7-8): 331-5, 1990.
Artigo em Italiano | MEDLINE | ID: mdl-2080022

RESUMO

Like hydrothorax, ascites and edema, pericardial effusion is present in decompensated hepatic cirrhosis. In order to evaluate the extent of effusion and to assess whether it is concomitant with left ventricular dysfunction, 21 patients who had been hospitalised for hepatic cirrhosis and ascites were studied following echocardiographic examinations and compared to 21 subjects without signs of cardiopathy. The following findings were statistically significant: the increased presence of pericardial effusion in patients with cirrhosis in comparison to controls, and likewise the higher ejection fraction in the former group. No differences were found between the two groups with regard to the size of the left ventricle. Within the group of patients affected by cirrhosis, the sole statistically significant difference between those patients with pericardial effusion and those without was observed with regard to the telediastolic diameter, which was greater in patients with pericardial effusion. In conclusion, pericardial effusion is common in patients with hepatic cirrhosis and ascites and is not accompanied by left ventricular dysfunction.


Assuntos
Cirrose Hepática/fisiopatologia , Derrame Pericárdico/epidemiologia , Função Ventricular Esquerda , Idoso , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pericárdico/fisiopatologia
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