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Background: Stroke prevention therapy decisions for patients with atrial fibrillation (AF) are complex and require trade-offs, but few validated patient decision aids (PDAs) are available to facilitate shared decision making. Objective: To evaluate the effects of a novel PDA on decision-making parameters for AF patients choosing stroke prevention therapy. Methods: We developed an evidence-based individualized online AF PDA for stroke prevention therapy and evaluated it in a prospective observational pilot study. The primary outcome was decisional conflict. Secondary outcomes were knowledge, usability/acceptability, patient preferences, effects on therapy choices, and participant feedback. Results: 37 participants completed the PDA. The PDA could be completed independently and was well accepted. It significantly decreased the mean decisional conflict score ( P < 0.001) and all its subscales and increased participant AF knowledge ( P = 0.02). 76% of participants indicated that their individualized therapy attribute ranking was congruent with their values. The PDA-generated best-match therapy was chosen by 70% of participants in decision 1 (no therapy, aspirin, or oral anticoagulant), and 17% for decision 2 (choice of anticoagulant). Among AF patients, 60% chose a different drug than that currently prescribed to them. Conclusion and Relevance: Our PDA was effective for reducing decisional conflict, increasing patient knowledge, eliciting patients’ values, and presenting therapy options that aligned with patients’ values and preferences. Using the PDA revealed that many patients have therapy preferences different from their currently prescribed treatment. The PDA is a practical and potentially valuable tool to facilitate decision making about stroke prevention therapy for AF.

Out-of-hospital PIP-AAD can be an effective for highly selected patients; however, the rates of treatment failure and adverse events are clinically relevant, which limits the widespread application of a PIP-AAD approach.

Summary The family histories of 131 patients with histologically defined Hodgkin's disease (HD) were studied and 2,517 first and second degree relatives and spouses were identified and followed-up. The causes of death in deceased relatives were ascertained from death certificates. The numbers of deaths from selected causes were compared with the numbers that would be expected if the relatives had suffered the same mortality rates as the Scottish national population. A 4-fold increase in deaths due to HD was found among first and second degree relatives of patients with the disease (6 cases observed compared with 1.4 expected). Five of the 6 familial cases were related to index patients with the mixed cellularity form of the disease, the remaining case was the brother of a patient with the lymphocyte-depleted form of the disease. The increased risk was seen among relatives of both young and older patients and there was no consistent intrafamilial similarity in age of onset or time of onset of disease. (Thompson, 1981) suggests an autosomal recessive HD-susceptibility gene. Case reports of HD occurring in families with known immunodeficiency disorders (McBride & Fenelly, 1977;Buehler et al., 1975;Harris et al., 1981) and the suggested association between HD and certain HLA haplotypes are consistent with the hypothesis that inherited susceptibility to HD may be determined by immune response genes (Marshall et al., 1977;Bowers et al., 1977). Recent epidemiological data suggest that HD, at least in young people, may be a rare sequel to a common virus infection. It has been postulated that a decreased exposure to infections in childhood and a later-than-average age at infection with a common virus may predispose towards the development of the disease (Gutensohn & Cole, 1981).It is also possible that there is more than one aetiology for the disease depending upon histological type (Lukes et al., 1966) onset (Cole et al., 1968;Gutensohn & Cole, 1977). With these possibilities in mind we have investigated the causes of death of first and second degree relatives and spouses of patients with HD. Materials and methods Index casesTwo hundred and three cases of HD were identified in the pathology records of the Dundee hospitals for the 31-year period, 1950-1980 (Lukes et al., 1966).Pedigrees of first and second degree relatives were completed for 131 (71%) of these 170 patients. The histological subtypes and ages at onset are shown in Table I. PedigreesDeceased patients First and second degree relatives and spouses of decreased patients were identified using Scottish Registration records which contain details of all births, marriages, and deaths in Scotland since 1855. Annual indexes are arranged alphabetically by surname for each sex, listing the place of registration and, from 1929 onwards, the mother's maiden name. Sibships were assembled by searching through the birth indexes from the year of the parent's marriage to the year in which the

1318 cases of primary malignant melanoma of the skin first presenting in Scotland in the years 1979-83 and registered with the Scottish Melanoma Group are described. The annual age-adjusted incidence rate is 4.75 per 100 000 for females and 2.77 per 100 000 for males. Incidence rose by an annual average of 2.5% over the five-year period. The female: male ratio was 2:1, and 48.5% of all cases were of the superficial spreading histogenetic variety. Five-year survival rates for the patients registered in 1979 confirm the prognostic value of the tumour-thickness (Breslow) measurement. They were 93% for patients with tumours less than 1.5 mm thick (39% of patients), 67% for those with tumours 1.5-3.49 mm thick (30%), and 37% for those with tumours thicker than 3.5 mm (31%). This study shows that methods for early recognition of thin tumours should be encouraged.