Clinician Perspectives on Factors Affecting Shared Decision Making about Lung Cancer Screening

Background/Objective. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced coverage for annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for individuals who are 55 to 77 years of age, have \u3e 30 pack years of smoking history, and undergo shared decision making (SDM) prior to screening. Most referrals for LCS are initiated in primary care. Currently, little is known about how primary care physicians view SDM and barriers in practice to SDM about LCS. This study aimed to gather information to help fill these knowledge gaps. Methods. I worked with senior leadership in the Department of Medicine to identify a set of internal medicine physicians at Thomas Jefferson University (TJU) and contacted them via email requesting their participation in an interview about SDM in LCS. I developed an interview guide that included questions about the following: understanding of SDM, perceptions about SDM in LCS, and receptivity to use of an online decision support intervention (DSI). I completed in-person, audio recorded interviews, which were transcribed for analysis. I then analyzed the interview transcripts using NVivo qualitative analysis software. Results. Nine physicians were interviewed from a pool of twenty-three physicians over a period of three weeks. With regards to understanding of SDM, physicians were in agreement that SDM is a joint decision based on a discussion about the risks and benefits of an intervention that considers patient values and medical status. Physician perceptions of SDM in LCS was influenced by patient comorbidities, LCS controversies and complexity, and limited office time. Receptivity to using an online DSI was generally positive and particularly favored its patient education component and easing of physician workload. Conclusions. Observations from this study highlight a common general understanding of SDM, yet mixed approaches to SDM in LCS. Strong support also exists for a DSI that educates patients about LCS and saves physicians time. Future steps include interviewing a set of family medicine physicians to investigate potential differences in viewpoints compared to internal medicine physicians

Attitude of Syrian students toward GAD patients: An online cross-sectional study

Generalized Anxiety Disorder (GAD) is a prevalent condition and a significant cause of mental disability and poor quality of life. People with GAD have chronic worrying, restlessness, and discrimination from the general public; Little is known about the stigmatizing attitudes toward people with GAD among Syrian students. The questionnaires contained demographic data about age, gender, social status, personal stigma toward GAD scale, perceived stigma toward GAD scale, social distance with those with GAD, the participants' usual source of their knowledge about GAD, helpful interventions, and supporting information. A total of 1,370 replies were collected, but only 1,358 were used for analysis as 12 participants declined to complete the survey. About 44.1% of participants agreed that people with GAD could snap out of the problem, most of them being females (32.4% of the total population). Compared to medical students, more non-medical students (7.1% of the total population) believed that anxiety is a sign of personal weakness. This study demonstrated that Syrian college students showed a high level of stigmatizing and socially distancing attitudes toward people with GAD, particularly female and non-medical students

Study of mercury speciation and fate in coastal waters

Le mercure (Hg) est un élément métallique naturellement présent dans l'environnement qui connaît aussi un cycle d’émission anthropique. Le Hg est présent sous différentes formes inorganiques (mercure élémentaire Hg°; mercure ionique Hg2+) et organiques (e.g. méthylmercure MeHg). Le Hg peut être méthylé dans l'eau et les sédiments par le métabolisme des bactéries pour former du MeHg, la forme chimique la plus toxique qui est de plus bioamplifiée dans la chaîne alimentaire aquatique. Le travail effectué dans cette thèse « Etude de la spéciation et du devenir du mercure dans les eaux côtières » a répondu à trois objectifs: - Déterminer les formes chimiques du Hg dans les eaux côtières à des concentrations inférieures au ng/L (10-9 g/L).- Etudier les transformations du Hg (Méthylation, Deméthylation et Réduction) dans les eaux estuariennes et côtières et leur influence sur le cycle du Hg dans la zone littorale (panache turbide de l’Adour). Evaluer les émissions du Hg gazeux (Hg°) dans les zones estuariennes et côtières par l’utilisation des modèles semi-empirique d’échange gazeux à l’interface eau-atmosphère.Mercury (Hg) is a metallic element naturally found in all the environmental media that could also be released by anthropogenic processes. Mercury is present in various chemical forms, inorganic (elemental mercury Hg°, ionic mercury Hg2+) and organic (e.g. methylmercury MeHg). Hg can be methylated in water and sediments by the metabolism of the bacteria to form MeHg, the most toxic Hg form which is biomagnified in the aquatic food chain. This work "Study of mercury speciation and fate in coastal waters" had three objectives: - Determination of the chemical forms of Hg in coastal waters at low concentrations, lower than ng/L (10-9 g/L). - Determination of Hg transformations (Methylation, Demethylation and Reduction) in estuarine and coastal waters and their influence on the Hg cycle in the coastal zone (turbid plume of the Adour River). - Evaluation of the emission of gaseous Hg (Hg°) in coastal and estuarine zone using semi-empirical gas exchange models at the water-air interface

Duodenal-Type Follicular Lymphoma

This case report presents the clinical findings, diagnostic evaluation, and treatment options for a 71-year-old female patient with a medical history of hypertension, dyslipidemia, and recurrent urinary tract infections. The patient presented with chronic abdominal pain as the sole symptom. Despite normal laboratory investigations, esophagogastroduodenoscopy and ileocolonoscopy were performed. Biopsies were obtained from the duodenum and histopathological analysis confirmed a diagnosis of duodenal-type follicular lymphoma. This rare condition typically presents with minimal clinical symptoms and has a favorable prognosis. Treatment options for duodenal-type follicular lymphoma include a watch-and-wait strategy, rituximab monotherapy, and radiotherapy