@SultanMahmoodMD @GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter
1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of CRC
https://t.co/P0SCUGxmne
2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.
3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific guidelines.
https://t.co/ysjo3zRhXb
4/ In a survey of different clinical scenarios on CRC surveillance carried out in 1432 physicians by Patel et al., Only 37% correctly answered the questions according to the recommendations (CPG9)
https://t.co/RYPlT6hKnA
5/ This revealed that the knowledge of gastroenterologists about CPG was poor. Although there are many reasons for lack of adherence, adequate knowledge of their recommendations is essential to achieve an acceptable level of adherence.
6/ Lack of adherence can manifest itself in the form of overindication as well as underindication, and both can undermine the effectiveness of a prevention program.
7/ Regarding overindication, a retrospective study of 1500 patients showed a shortening of the surveillance interval in almost 30% of the sample and up to 50% in those patients who had adenomas detected in the index colonoscopy
https://t.co/gwxKqC6euL
8/ Although colonoscopy is a safe study, it is not exempt from complications such as perforation (0.05%), bleeding (0.25%) and death (0.003%), and its overindication generates a net increase in these adverse events
https://t.co/07geSpoUA2
9/ Overuse then generates an increase in costs with marginal benefits ...
https://t.co/ZBT321p0T9
10/ ... and only contributes to the overload and subsequent fatigue of endoscopy units that must attend a higher percentage of patients under unnecessary surveillance.
https://t.co/rIo3OLKFvT
11/ Overindication can also generate a delay in screening, follow-up, or surveillance studies in patients with the correct indication, threatening the effectiveness of CRC prevention.
12/ In order to incorporate new individuals into the programs and perform colonoscopies in this naive population, unnecessary repetition of studies should be avoided, the overuse of the practice should be minimized ...
13/ ... and put more energy into also identifying people at increased risk of CRC who have not yet performed screening procedures.
4/ On the other hand, underindication also carries significant risks, since we can delay the control of patients at high risk of developing metachronous lesions and cancer
15/ A longitudinal cohort study showed that 76% of deaths from CRC were due to failures in the indication of screening and surveillance studies, and that patients with delays in surveillance studies …
16/ .... showed up to 7 times increase the risk of developing CRC
https://t.co/JI4yU3NTbl
17/ For all the aforementioned, the adequate indication for colonoscopic surveillance is considered a quality marker of endoscopy units and represents a key element in achieving an effective prevention program.
https://t.co/90wfYZYUns
That's all folks!

More from Health

🚨Important changes to lockdown/self-isolation regulations from 5pm

The Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

£800 'house party' FPN & police can now access track & trace data

https://t.co/k9XCpVsXhC


“Large gathering offence”

As trailed by Home Secretary last week there is now a fixed penalty notice of £800 (or £400 if you pay within 14 days) for participating in an gathering of over 15 people in a private residence


Fixed Penalty Notices double for each subsequent “large gathering offence” up to £6,400

Compare:
- Ordinary fixed penalty notice is £200 or £100 if paid in 14 days
- Holding or being involved in the holding of a gathering of over 30 people is £10,000


Second big change:

Since September has been a legal requirement to sell-isolate if you test positive/notified by Track & Trace of exposure to someone else who tested positive

Police can now be given access to NHS Track & Trace data if for the purpose of enforcement/prosecution


This will make it easier for police to enforce people breaking self-isolation rules. Currently there has been practically no enforcement.

Data says only a small proportion of people meant to be self-isolating are fully doing so.

You May Also Like

First thread of the year because I have time during MCO. As requested, a thread on the gods and spirits of Malay folk religion. Some are indigenous, some are of Indian origin, some have Islamic


Before I begin, it might be worth explaining the Malay conception of the spirit world. At its deepest level, Malay religious belief is animist. All living beings and even certain objects are said to have a soul. Natural phenomena are either controlled by or personified as spirits

Although these beings had to be respected, not all of them were powerful enough to be considered gods. Offerings would be made to the spirits that had greater influence on human life. Spells and incantations would invoke their


Two known examples of such elemental spirits that had god-like status are Raja Angin (king of the wind) and Mambang Tali Arus (spirit of river currents). There were undoubtedly many more which have been lost to time

Contact with ancient India brought the influence of Hinduism and Buddhism to SEA. What we now call Hinduism similarly developed in India out of native animism and the more formal Vedic tradition. This can be seen in the multitude of sacred animals and location-specific Hindu gods