Purpose: To discuss the diagnosis and management of pediatric constipation by nurse practitioners in primary care.
Colorectal cancer is the second leading cause of cancer deaths in the United States for both men and women. Colorectal cancer screening is an important means for reducing morbidity and mortality. The American Cancer Society recommends five different screening regimens for adults of average risk, age 50 years and older. The optimal effectiveness of a screening program is dependent on the accuracy of the screening test used. An accurate screening test would have high sensitivity (positive) when an adenomatous polyp or cancer is present and high specificity (negative) in their absence. In April 2002, the American Cancer Society Colorectal Cancer Advisory Group concluded that the immunochemical fecal occult blood test has some advantages that merit revision of their guideline statement for fecal occult blood testing, to include the immunochemical fecal occult blood test. The advantages cited were the possibility of improved sensitivity and specificity and the lack of required dietary restrictions, which make it a more patient-friendly test. Several types of immunochemical fecal occult blood tests are discussed in this article, including their advantages and disadvantages compared with those of the traditional guaiac fecal occult blood testing.
The purpose of this pilot study was to determine if a community education program based on the Health Belief Model effectively promotes awareness of the need for colorectal cancer (CRC) prevention and screening. An education program was given to 20 employees of an accounting firm in a midwestern city. A survey evaluated the participants' beliefs about CRC, before and after the presentation. The results support a significant increase in the belief that CRC is preventable, and in 5 of 6 screening factors from the Health Belief Model. Participants were encouraged to share what they learned and reported that they anticipate sharing with at least 31 others. A screening questionnaire was distributed as a "cue to action" to discuss CRC screening with their physicians. Participants' intention to discuss CRC with their physicians also increased. The actual effectiveness will be evaluated with 11 participants who volunteered for a 1-year follow-up study. This community education concept had several advantages, including simultaneous access to many participants who share personal testimonials and who invite peers to become screened. The program was effective in increasing awareness of the need for CRC prevention and screening, even beyond those in attendance. The results of the 1-year follow-up study may provide more insight to what education factors promote screening most effectively.
The stool DNA test is considered an emerging technology in screening for colorectal cancer. The stool DNA test detects DNA markers which are shed from cells of premalignant adenomas and cancers into the stool. Potentially, both preclinical and clinical colorectal cancer may be detected. Panels of multiple DNA markers are used to ensure a high sensitivity for colorectal cancer. In this article, several advantages of the stool DNA test (compared with current colorectal cancer screening methods) are discussed. The stool DNA test may be more patient-friendly and has a higher degree of sensitivity and specificity for colorectal cancer. No bowel or dietary preparation is required and the test is noninvasive. The stool DNA test screens the entire colon and may detect some other types of cancers proximal to the colon. In the future, there may be potential to use the stool DNA test to screen for aerodigestive cancers (lung, esophageal, gastric, and pancreatic), in addition to colorectal cancer. An improved noninvasive screening test would help allocate colonoscopy resources to those patients who would benefit the most. Colorectal cancer screening cost-effectiveness may also be improved. Some limitations of the stool DNA test include the need for clinical studies in average-risk populations and marker refinement. An automated testing system may help reduce costs and turnaround times. Despite recognized limitations, the stool DNA test is a promising new diagnostic tool with the potential to improve effectiveness of colorectal cancer screening.
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