Cohort profile: The Forzani & MacPhail Colon Cancer Screening Centre biorepository, Calgary, Alberta.

PURPOSE: The Colon Cancer Screening Centre (CCSC) biorepository (Calgary, Canada) supports a wide range of research topics related to colorectal cancer (CRC) by collecting, and storing biospecimens (blood, urine, normal colon tissue) from consenting patient participants. Housing unique biospecimens along with detailed participant lifestyle and health history questionnaire data, the CCSC biorepository can support a variety of research related to CRC risk factors, biomarkers, genetic causes and more. PARTICIPANTS: Currently, 2292 average risk CRC patients have consented to participate in the CCSC cohort and have provided stored biospecimens. The collected samples and data provide important high-quality materials for research, discovery and evaluation related to CRC screening and carcinogenesis and is available for access by outside researchers. In addition to biological samples, the CCSC collects detailed patient information on their lifestyle, physical activity and dietary patterns through questionnaires at the time of their enrolment. FINDINGS TO DATE: The majority of participants (75%) are between 50 and 64 years of age. Women make up 46% (1055) of the cohort. Additional characteristics of the cohort included 44% reporting a body mass index of 25-30 kg/m2 (overweight), 53% having never smoked tobacco and 13% having a family member with CRC. FUTURE PLANS: The CCSC cohort plans to include the recruitment of high risk CRC cohorts. High-risk participants would comprise patients with a positive faecal immunochemical test and family history of CRC.

Using a single map display both for navigational planning and for turn-by-turn vehicle guidance: configural spatial knowledge acquisition.

Navigational driving systems have used traditional track-up map displays for guiding immediate turn-by-turn decisions and traditional north-up map displays for facilitating navigational planning and learning about environmental layout (configural spatial knowledge), because no single map display has been usable for both purposes. Rizzardo and Colle (2013) showed that north-up map displays could successfully guide turn decisions when a new spatial plus verbal advisory turn indicator was used, raising the possibility of designing single map displays that also are usable for spatial learning. Multimedia instructional design models, modified for spatial learning from navigation and driving, identified the sources of extraneous cognitive load that limit spatial learning from moving maps. Predictions include that participants can learn more from north-up map displays with the new advisory indicator than the traditional indicator. Experiment 1 showed that after college students (N = 96) drove through a virtual city guided by 1 of 3 map types or voice commands, most configural spatial knowledge was acquired using the new north-up display, then the traditional north-up map display, and the least with the traditional track-up map display. In Experiment 2, college students (N = 192) watched the same map sequences from either the new north-up or the track-up map display, but with a limited duration of their glances to the map display (no driving). Viewing spatial plus verbal north-up map displays produced significant spatial learning even with short glance durations, but not when viewing track-up displays even with long glance durations. Theoretical and design implications are discussed.

Factors related to use of prostate cancer screening: the Alberta Tomorrow Project.

BACKGROUND: Very few data are available on the determinants of PSA testing in Canada, and it is a matter of debate whether prostate-specific antigen (PSA) screening in asymptomatic men age 50 and older with no risk factors for prostate cancer is useful. If PSA screening is introduced into the periodic health examination, it will be important to know what factors influence its use. OBJECTIVES: The purpose of this study is to determine the factors associated with PSA testing among asymptomatic men age 50 and older participating in the Tomorrow Project in Alberta. METHODS: The Tomorrow Project is a population-based cohort study with over 11,000 participants accrued in Alberta since February 2003. Information was collected on medical history, sociodemographic factors, health status and lifestyle characteristics. This analysis includes 2136 men 50 years of age and older. The independent association between various factors and recent PSA screening is estimated using logistic regression. RESULTS: Approximately 50% of of the study group had received one or more PSA tests in their lifetime. Of these, 58% were asymptomatic for prostate disease at the time of their most recent PSA test. Variables independently associated with recent PSA screening for prostate cancer in this population include older age (>/= 65 versus < 55 years: adjusted odds ratio [OR] 2.60; 95% confidence interval [CI] 1.77-3.83), higher income (>/= $80,000 versus < $20,000, OR 1.97; 95% CI 1.09-3.55), region of health care delivery, perception of health status (good versus excellent health status; OR 0.65, CI 0.43-0.96], increased number of chronic health conditions (OR 1.73, 95% CI 1.10-2.71), and history of colorectal cancer screening with fecal occult blood test (OR 2.21; 95% CI 1.73-2.83). CONCLUSIONS: An increasing proportion of men in Alberta are receiving a PSA test. A number of significant predictors of having a PSA test were identified, suggesting that factors other than having a clinical indication for prostate disease can influence decisions about PSA screening.

Colorectal cancer screening: practices and attitudes of gastroenterologists, internists and surgeons.

BACKGROUND: The Canadian Task Force on Preventive Health Care has recommended the use of annual or biennial fecal occult blood testing (FOBT) and flexible sigmoidoscopy in the periodic health examination of asymptomatic people over 50 years of age. Therefore, we decided to ascertain the current colorectal cancer (CRC) screening practices and attitudes of surgeons, gastroenterologists and internists. METHODS: In June 2002 (with a final mailing in December 2002), a questionnaire was sent to all gastroenterologists, internists and surgeons in Alberta. It included items on demographic and practice characteristics, CRC screening practices and opinions about CRC screening. RESULTS: Responses were received from 42 gastroenterologists, 83 internists and 68 surgeons. Overall, 141 of 187 respondents (75.4%, 95% confidence interval [CI] 68.6%-81.4%) recommended that average-risk adults undergo CRC screening. Internists were less likely to recommend screening than either gastroenterologists or surgeons (95% CI for the difference 7.2%-32.8%). The most commonly recommended screening test was colonoscopy (70%), followed by FOBT (65%), flexible sigmoidoscopy (47%) and air-contrast barium enema (31%). Colonoscopy was the only test recommended by 7 (22.6%) of 33 gastroenterologists, 9 (16.4%) of 59 surgeons and 3 (6.1%) of 49 internists. Respondents were more likely to list barriers to the use of colonoscopy (mean 5 barriers) for screening than for either FOBT or flexible sigmoidoscopy (mean 2 barriers for both tests). Only 3 respondents indicated that they themselves would not undergo screening. Colonoscopy was the only screening test that 135 (70.0%) of the 193 would themselves undergo. CONCLUSIONS: The majority of Alberta specialists recommend CRC screening for average-risk adults. Colonoscopy was the most commonly recommended test, despite the perception of more barriers to that technique and the 2001 guidelines prepared by the Canadian Task Force for Preventive Health Care, which did not support colonoscopy.

Acute management of pituitary apoplexy--surgery or conservative management?

BACKGROUND AND OBJECTIVE: The rarity of pituitary apoplexy renders it a difficult subject for audit; hence there are no evidence-based standards of optimum care for such patients. The key controversy in management relates to the role of acute neurosurgical intervention. In recent years we have adopted a relatively conservative approach towards patients presenting with pituitary apoplexy. Against this background, we aimed to determine whether our less-interventional approach affected long-term clinical outcome in these patients. PATIENTS AND DESIGN: A retrospective analysis was performed to evaluate clinical presentation, management and clinical outcomes in a cohort of patients who presented acutely with pituitary apoplexy during the period 1994-2004. Data from 33 patients (13 female) were included, with a mean age of 52 (range 27-79) years and mean follow-up duration of 3.7 (0.4-10.1) years. RESULTS: The most common presenting symptoms were headache (97%), visual deficits (82%) and nausea/vomiting (78%). Fifteen patients (46%) underwent transsphenoidal surgery while 18 were managed conservatively. Indications for surgery were deteriorating visual deficit (n = 13), hemiparesis (n = 1) and altered conscious level (n = 1). Eight patients in the surgical group had ocular paresis that resolved in 63% following surgery, and seven had visual field defects with recovery in 57% postsurgery. Conservative management was reserved for patients with absent, or evidence of resolving, visual deficits at presentation. In this group, seven presented initially with ocular paresis and six with visual field defects but all made full recoveries. Of the patients managed neurosurgically, 87% required long-term glucocorticoid replacement and 60% required long-term thyroid hormone replacement. Conservatively managed patients required glucocorticoid replacement in 72% and thyroid hormone replacement in 72% of cases (P = NS between the two groups). Sex steroid replacement was required in 67% and 83% of patients managed neurosurgically and conservatively respectively (P = NS). At latest follow-up one patient in the conservatively managed group had required surgery and one in the surgically managed group had received pituitary radiotherapy, in both instances due to evidence of tumour regrowth on magnetic resonance imaging (MRI). CONCLUSION: Our findings suggest that patients presenting with pituitary apoplexy in whom visual deficits are stable or improving may be managed expectantly as there is no identifiable deleterious effect on visual or endocrine outcome. One patient from each group experienced tumour regrowth that necessitated further treatment intervention, highlighting the importance of long-term follow-up in patients with pituitary apoplexy.