Prevalence and characteristics of post-colonoscopy colorectal cancers in a New Zealand regional centre: a 10-year analysis.

BACKGROUND: Post-colonoscopy colorectal cancers (PCCRC) are cancers that appear following a colonoscopy in which no cancer is diagnosed. The occurrence of PCCRC is thought to be multifactorial, reflecting both endoscopy quality and potential differences in tumour biology between detected colorectal cancers and PCCRC. AIM: To identify the prevalence and characteristics of PCCRC in a New Zealand regional centre over a 10-year period. METHOD: All cases of colorectal cancer (n = 1055) in the Bay of Plenty region between 1 February 2009 and 1 February 2019 were cross-referenced with endoscopy coding records to identify patients who had undergone colonoscopy within the preceding 6-60 months in which cancer was not identified. RESULTS: A total of 46 patients were identified to have PCCRC, giving a prevalence of 4.4%. The majority of these patients were older (80% aged 65 years or over) and female (67%). The mean interval between index colonoscopy and diagnosis of PCCRC was 3.03 years. Most (80%) patients had existent pathology (diverticular disease or colonic polyps) at index colonoscopy, and a significant proportion (43%) developed cancer in the same colonic segment. PCCRC were evenly distributed between the left (50%) and right (50%) colon. The majority of patients (63%) had early-stage cancer. CONCLUSIONS: The prevalence of PCCRC in a New Zealand cohort is consistent with other international reports. Most patients with PCCRC are older, female and have early-stage disease. Of interest, a high proportion of patients developed cancer within a colonic segment with existent pathology, suggesting either missed lesions or incomplete polyp resection.

Developing a predictive understanding of landscape importance to the Punan-Pelancau of East Kalimantan, Borneo.

In order for local community views to be incorporated into new development initiatives, their perceptions need to be clearly understood and documented in a format that is readily accessible to planners and developers. The current study sought to develop a predictive understanding of how the Punan Pelancau community, living in a forested landscape in East Kalimantan, assigns importance to its surrounding landscapes and to present these perceptions in the form of maps. The approach entailed the iterative use of a combination of participatory community evaluation methods and more formal modeling and geographic information system techniques. Results suggest that landscape importance is largely dictated by potential benefits, such as inputs to production, health, and houses. Neither land types nor distance were good predictors of landscape importance. The grid-cell method, developed as part of the study, appears to offer a simple technique to capture and present the knowledge of local communities, even where their relationship to the land is highly complex, as was the case for this particular community.

Artificial nutrition support in intestinal failure: principles and practice of parenteral feeding.

Patients with intestinal failure are at risk for malnutrition and its associated adverse consequences. In many of these patients it is not possible to feed via the gastrointestinal tract, and nutrients must be provided directly into the bloodstream. For some patients with irreversible intestinal failure, this is a lifelong requirement. Parenteral nutrient solutions may be tailored specifically to individual requirements and are usually administered directly into a central vein using an indwelling catheter. Serious complications related to both the indwelling catheter and metabolic consequences of the nutritional support may occur. A team approach to the provision and monitoring of parenteral nutrition in intestinal failure produces the best results.