Reduced incidence and mortality from colorectal cancer with flexible-sigmoidoscopy screening: A meta-analysis

AIM:To conduct a systematic review and meta-analysis of published population-based randomized controlled trials(RCTs).METHODS:RCTs evaluating the difference in mortality and incidence of colorectal cancer(CRC)between a screening flexible sigmoidoscopy(FS)group and control group(not assigned to screening FS)with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August 2013.Random effects model was used for meta-analysis.RESULTS:Four RCTs with a total of 165659 patientsin the FS group and 249707 patients in the control group were included in meta-analysis.Intention-totreat analysis showed that there was a 22%risk reduction in total incidence of CRC(RR=0.78,95%CI:0.74-0.83),31%in distal CRC incidence(RR=0.69,95%CI:0.63-0.75),and 9%in proximal CRC incidence(RR=0.91,95%CI:0.83-0.99).Those who underwent screening FS were 18%less likely to be diagnosed with advanced CRC(OR=0.82,95%CI:0.71-0.94).There was a 28%risk reduction in overall CRC mortality(RR=0.72,95%CI:0.65-0.80)and 43%in distal CRC mortality(RR=0.57,95%CI:0.45-0.72).CONCLUSION:This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.

Information seeking and anxiety among colonoscopy-na?ve adults: direct-to-colonoscopy vs traditional consult-first pathways

AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve patients.METHODS Colonoscopy-na?ve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation.Survey items included clinical pathway(direct or consult),procedure indication(cancer screening or symptom investigation),telephone and written contact from the physician endoscopist office,information sources,and pre-procedure anxiety.Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed"(1) and "very nervous"(10).At least three months following the procedure,patient medical records were reviewed to determine sedative dose,procedure indications and any adverse events.The primary comparison was between the direct and consult pathways.Given the very different implications,a secondary analysis considering the patient-reported indication for the procedure(symptoms or screening).Effects of pathway(direct vs consult) were compared both within and between the screening and symptom subgroups.RESULTS Of 409 patients who completed the survey,34% followed a direct pathway.Indications for colonoscopy were similar in each group.The majority of the participants were women(58%),married(61%),and internet users(81%).The most important information source was family physicians(Direct) and specialist physicians(Consult).Use of other information sources,including the internet(20% vs 18%) and Direct family and friends(64% vs 53%),was similar in the Direct and Consult groups,respectively.Only 31% of the 81% who were internet users accessed internet health information.Most sought fundamental information such as what a colonoscopy is or why it is done.Pre-procedure anxiety did not differ between care pathways.Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3,95%CI: 5.0-5.7(10 point Likert scale)] than those for screening colonoscopy(4.3,95%CI: 3.9-4.7).CONCLUSION Procedure indication(cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.

Enumeration of Family Fabaceae from Sechu Tuan Nalla Wildlife Sanctuary,Chamba District,Himachal Pradesh(India)

An account of 20 species under 11 genera of the family Fabaceae is presented based upon a thorough study of the collected specimens and field surveys in this paper from Sechu Tuan Nalla Wildlife Sanctuary,Chamba district,Himachal Pradesh.Of these,five taxa are reported first time from the Chamba district of the state.The updated nomenclature of the species,local name if any,a brief description of the plant,flowering and fruiting period,distribution in the study area,habitat and ecology and specimen examined have been provided.