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BACKGROUND: Low implementation of colorectal cancer screening in ethnic minorities is the main reason for racial and ethnic disparities in colorectal cancer morbidity and mortality. Peer support is widely used for promoting health care in ethnic minorities. However, whether it improves their acceptance to undergo the screening remains controversial. OBJECTIVE: We performed a meta-analysis of the currently available studies to further explore its effectiveness. DATA SOURCES: This meta-analysis was undertaken using PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for randomized controlled trials. STUDY SELECTION: We included studies that compared peer support interventions among ethnic minorities versus other interventions to promote uptake of colorectal cancer screening. RESULTS: Thirteen studies comprising 8090 participants met the eligibility criteria. Peer support intervention can increase colorectal cancer screening implementation and raise awareness and intention to undergo the screening in ethnic minorities more significantly than fecal occult blood test outreach, print, and usual care. Subgroup analysis showed that peer support intervention achieved great results in Asian Americans and intervention of peer counseling. LIMITATIONS: The results of subgroup analysis had substantial heterogeneity, which may decrease the precision of our estimates. CONCLUSIONS: Peer support can significantly improve the awareness about and the intention for receiving colorectal cancer screening in ethnic minorities and is an ideal choice for promoting the screening among ethnic minorities, particularly in a diverse community. Peer support intervention is recommended to promote the implementation of screening in Asian Americans. Peer counseling is worth promoting; however, church-based peer counseling programs require enhanced management to maintain their fidelity.

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Hypoxia is a common cause of poor wound healing, for which a variety of oxygen therapies have been developed. In order to overcome the limitations of traditional methods of treatment, namely the type of equipment, its setting, safety and cost, local haemoglobin therapy has been developed, although no reviews have so far been published. Here, we systematically review the current evidence to establish the efficacy, scope, adverse reactions, and required precautions of this new form of therapy. A search of the literature was conducted in the PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of science databases, with 17 studies meeting the eligibility criteria, comprising one animal model study and 16 clinical studies. Local haemoglobin therapy is able to safely and effectively promote the healing of a variety of wounds, especially those that are chronic and non‐healing. However, premature discontinuation of this treatment can result in impediment to wound healing and even deterioration of the wound. The distinct benefit of the elimination of slough and relief of pain suggests that this technique may represent a new generation of debridement technology. Furthermore, its ease of use and convenience enables patient self‐management, thereby greatly reducing health care costs.

BACKGROUND: We describe our experiences caring for a patient with a peristomal fistula (PF), characterized by suppuration from a peristomal abscess. The challenges associated with this case included management of a complex fistula and prevention of abdominal necrotizing fasciitis and peritonitis. CASE: A 63-year-old man presented with severe peristomal swelling and pain resulting from an abscess adjacent to his ileostomy. He was malnourished and depressed. He underwent a low anterior resection (Dixon procedure) for rectal cancer 2 years ago and an abdominoperineal resection (Miles procedure) for the recurrence of rectal carcinoma 1 year later. In addition, he underwent bowel resection with the creation of an ileostomy due to intestinal obstruction caused by a second recurrence approximately 1 month prior to this admission. Following evaluation of the fistula anatomy, incision and drainage of the abscess was performed. Diversion of the effluent was used to control infection and promote fistula closure. A registered dietitian and a psychologist were consulted to optimize nutrition and treat his depression. After 20 days of treatment, the patient recovered and was safely discharged. CONCLUSION: Peristomal fistula management should include anatomical assessment, incision and drainage of the abscess, diversion to control effluent, and skin protection. For complex cases, the coordinated efforts of the interdisciplinary team are imperative.

589 Background: Treatment patterns of breast cancer in Asian-American women have not been well studied. Existing studies suggest higher mastectomy rates compared to Whites, but have been unable to control for differences in access to healthcare. The objective was to describe primary and adjuvant treatment patterns of Asian women in an equal-access healthcare system. Methods: Data were extracted from the tumor registry to include women diagnosed with T1-T2, M0 breast cancer between 1989 and 2004 and treated at the Naval Medical Center San Diego, an equal-access system. Self-reported data was used to classify race. Military rank was used as a proxy for socioeconomic status and education level. Characteristics and treatment patterns of Asian and White women were compared by the two-sided Fisher’s exact test and multiple logistic regression with consideration of covariates. Results: 574 non-Hispanic White and 226 Asian-American women resulted from the query. Asian women received mastectomy more often than Whites. From 1989 to 2004, mastectomy rates declined for both groups at an equal rate until 1997. On secondary analysis based on the initial results, differences in mastectomy rates existed only until 1997, which was coincident with the opening of a multidisciplinary Breast Health Center. Asians were much less likely to receive breast reconstruction. There was no difference in rates of adjuvant radiation or chemotherapy, but a suggestion of higher hormone therapy rates in Asians. Conclusions: Even in the setting of an equal-access healthcare system, Asian-American women were more likely to receive mastectomy than Whites, suggesting that barriers to healthcare access do not explain these treatment disparities. This difference disappeared in recent years. The contrasting reconstruction rates suggest a difference in cultural attitudes regarding the significance of the breast in the setting of cancer treatment. The multidisciplinary Breast Health Center may have ameliorated factors leading to higher mastectomy rates in Asians. [Table: see text] No significant financial relationships to disclose.