Postgraduate medical journal
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Colon cancer is the second leading cause of cancer related death in American adults. The incidence and mortality are highest in African Americans (AAs) (incidence: 52 per 100,000) and lowest in American Hispanics (37 per 100,000). ⋯ Studies have suggested that risk is high because of excessive intakes of animal meat and fat products and differences in colonic bacterial metabolism, and that preventative and therapeutic management of colon cancer is compromised by the development of greater tumour virulence possibly resulting from disparities in educational and insurance status, screening behaviour, treatment patterns, social support, and access to and use of health care facilities. It should be possible to reduce the unacceptably higher rates of morbidity and mortality from colon cancer in AAs by dietary and lifestyle changes aimed at suppressing excessive intakes of animal meat and fat products, increasing the consumption of fresh fruit and vegetables, controlling energy balance, and by developing strategies to improve the availability, use and accessibility to health care resources.
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Anaphylaxis is a life threatening reaction where prompt and appropriate management can save lives. Epinephrine (adrenaline) is the treatment of choice; however, the recommended dose and route of administration of epinephrine used in the management of anaphylaxis is different from that used in the management of cardiac arrest. ⋯ Junior doctors may be called to make immediate management decisions in patients with anaphylaxis; however, widespread confusion exists regarding the dose and route of administration of epinephrine. Strategies to improve education and access to appropriate drugs are needed. A labelled "anaphylaxis box" on every resuscitation trolley, containing the dose of epinephrine with clear labelling for intramuscular use, may be one solution.
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Multicenter Study
A cross sectional survey of secondary prevention measures in patients with peripheral arterial disease in primary care.
The National Service Framework for coronary heart disease (CHD) defines standards for the secondary prevention of cardiovascular disease in at risk individuals, including those with peripheral arterial disease (PAD). ⋯ The cross sectional survey suggested the treatment received by some patients with established PAD is substandard. There is considerable potential to increase secondary prevention of CHD in patients with PAD disease in primary care.
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To assess the experience gained in digital rectal examination (DRE) by medical students in the Republic of Ireland by the completion of undergraduate training. ⋯ Undergraduate training in DRE is limited. Training in DRE can no longer be reasonably considered part of the core curriculum taught in Irish medical schools.
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Barrett's oesophagus is a frequent complication of gastro-oesophageal reflux disease predicting oesophageal adenocarcinoma. The majority of Barrett's patients will not develop cancer, so that specific methods of identification of those at risk are required. ⋯ The ASPECT trial in the UK aims to establish whether chemoprevention with aspirin and a proton pump inhibitor will reduce adenocarcinoma development and mortality in patients with Barrett's oesophagus. It will also validate biomarkers for progression and clinical response and further study disease pathogenesis.