BackgroundThe prevalence of colorectal cancer (CRC) is growing in Pakistan; however, there are no national screening programs or guidelines in place to curb its development. This study was conducted with the aim of ascertaining public awareness and attitudes regarding CRC and current screening practices. Furthermore, the study assessed perceived barriers which could impact future screening processes.MethodsA cross-sectional, questionnaire-based study was conducted among urban dwellers of Karachi, Pakistan. We excluded any individuals belonging to the medical profession, those diagnosed previously with CRC or having any significant co-morbidity. The validated and pre-tested questionnaire was administered among the study participants to record demographic information, awareness of CRC risk factors, symptoms and screening tests. Attitudes towards screening and perceived barriers to screening were also assessed. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20.0) (IBM Corp., Armonk, NY). A knowledge score, out of a total of 14 points was calculated to reflect a participant’s overall knowledge regarding CRC risk factors and signs/symptoms.ResultsThe prevalence of CRC screening in eligible individuals (50 years or older) was 2.6% in our study population. Positive attitudes towards CRC management and screening were observed, with 75.1% (n = 296) acknowledging the preventive role of screening tests. Despite this only 14.9% (n = 58) of study participants expressed a future desire to undergo screening. Major barriers to screening were reported to be “a lack of knowledge regarding the screening procedure”, a “lack of screening facilities” and that the “screening procedure is too expensive”. A majority (n = 285, 72.3%) of the participants expressed a greater willingness to undergo screening if their doctor recommended it.ConclusionA national CRC screening and awareness program should be launched to promote awareness and facilitate screening in risk groups. General practitioners are needed to play a key role in counseling patients and endorsing healthy screening practices.

The purpose of this paper is to find out the effect of Gamification on employee motivation, employee engagement, employee retention, employee loyalty and organizational commitment. We want to know this in order to check the viability of Gamification strategy for business development in Pakistan. Participants were 142 University students, who were working as well, we divided them into two groups, control group and Gamified group, we gave both groups pretest and post-test questionnaire. ANOVA and t-test were applied to pre-test and post-test data to analyze group difference and multivariate GLM model was applied to analyze the influence of gender and gamification preferences on employee related variables. The Gamification strategy used in the Gamified group was expected to influence the participants and increase their motivation, engagement, retention, loyalty and organizational commitment. The Gamified group did show significance in employee engagement, employee retention and organizational commitment, whereby loyalty and motivation were not significant for both gamified and non-gamified environment. In addition GLM analysis indicates that if employees are given playful environment that will lead to higher motivation, engagement and retention. Gamification strategy can help business development in Pakistan, as employees prefer a Gamified workplace over a non-Gamified one. Game elements in a work environment are likely to be highly positive for an employee's mental health, and allow employees to lead a healthier life with less stress. This study specifies predictors for business development through Gamification and emphasizes the importance of Gamification on all the variables.

BackgroundWe treated 26 patients with advanced pancreas cancer, including 21 Stage IV patients, in an outpatient setting with multiple cycles of gemcitabine-based empirical chemotherapy regimens (“gemcitabine regimens”), such as gemcitabine monotherapy, gemcitabine + cisplatin, gemcitabine + 5-FU, and gemcitabine + Xeloda.MethodsAnatomic imaging or fusion technology with combined anatomic and functional imaging using CT/MRI scans fused with whole body PET scans was employed along with serial cancer marker level measurements to monitor response to therapy and tailor the treatments to each patient according to their treatment response. Patients who showed evidence of progression on a given gemcitabine regimen were switched to a different gemcitabine regimen.ResultsFailure to respond to a particular gemcitabine regimen did not preclude objective responses to a different gemcitabine regimen. The average survival time was 14.3 months (n=26, 95% CI = 7.6-19.1, 18 died). The median survival time for Stage IV patients was 10.7 months (N=21; 95% CI = 6.9-19.1, 16 died). Notably, 47% of the patients survived more than one year following the diagnosis of distant metastases. Our results demonstrate that a significant portion of Stage IV pancreas cancer patients can live more than a year with an excellent quality of life on empirical gemcitabine-based outpatient treatments. By comparison, the overall average of the median survival times for more than 3,000 advanced pancreas cancer patients treated on a clinical trial arm from 9 major published clinical studies was 8.4 months (weighted mean effect size = 0.73, Z test = 42.7, p < .0001).ConclusionsFusion technology provides medical oncologists a powerful diagnostic tool for timely termination or modification of ineffective treatments. Patients with advanced pancreas cancer should be offered empirical patient-tailored chemotherapy as an alternative to the clinical trial and hospice options.

The objective of this study was to assess the prediction of peripheral inflammatory response indicators for the first-line systemic treatment response rate (RR) and progression-free survival (PFS) in MCRC.Methods: A retrospective chart review at Princess Norah Oncology Center (PNOC) included histopathology-proven MCRC from January 2013 to December 2018. Younger patients (< 18 years), and cranial and immeasurable metastases were excluded. RR was assessed by the chi-square/Fisher-exact and Mann-Whitney tests, whereas PFS was assessed by the Kaplan-Meier survival curve. Peripheral blood Pre-cycle 1 and Cycle 3 counts were checked for neutrophils (N), lymphocytes (L), monocytes (M), platelets (P), and ratios (R) of N/L (NLR), M/L (MLR), P/L (PLR), and mean platelet volume (MPV). The counts were classified as high, low, or normal, as per standard laboratory values.Results: Of 337 identified cases, 102 cases were analyzed. The median age of the cases was 58 years, 52.9% were male, and 82.4% had a left-side primary tumor location. In all, 53% received chemotherapy (FOLFOX, CAPOX or FOLFIRI) with targeted agents, and 47% were treated with chemotherapy alone. The peripheral blood cell count for N, L, M, P, and MPV, Pre-cycle 1 and Cycle 3, were not predictive of RR; however, prior to Cycle 1 and Cycle 3, PFS was better for normal platelet count vs high count (P ¼ .009 and P ¼ .038 respectively). A low PLR was associated with a better PFS than high PLR values (P ¼ .036 and P ¼ .029, respectively). Prior to Cycle 1, PFS was significantly higher with low vs high NLR (P ¼ .038). There was no prediction for MLR. Conclusion:Platelet peripheral blood count, PLR, and NLR could be predictors of systemic therapy outcomes in MCRC. Having a high platelet count prior to MCRC systemic therapy might be a biomarker for antiplatelet agent benefits and warrants investigation in clinical trials.

BackgroundWe treated 62 patients with advanced Stage IV colorectal cancer in an outpatient setting with multiple cycles of Xeloda-based empirical chemotherapy regimens (“Xeloda regimens”), including Xeloda monotherapy, Xeloda + irinotecan, Xeloda + oxaliplatin, and Xeloda + mitomycin. Of these 62 patients, 15 were not previously treated with a 5-fluorouracil (5-FU)-containing regimen, while 47 had failed one (N = 21) or more (N = 26) treatments, including at least one 5-FU containing regimen.MethodsFusion technology with combined anatomic and functional imaging using CT/MRI scans fused with whole body PET scans along with serial cancer marker level measurements was employed to monitor response to therapy and tailor the treatments to each patient according to their treatment response. Patients who showed evidence of progression on a given Xeloda regimen were switched to a different Xeloda regimen.ResultsFailure to respond to a particular Xeloda regimen did not preclude objective responses to a different Xeloda regimen. For the 15 5-FU-naive patients, the median survival was 16 months. Of the 47 patients who were previously treated with at least one 5-FU regimen, 37 (79%) died at a Kaplan-Meier calculated median of 10 months (95% CI 9-15 months; log normal mean ± SD = 11.4 ± 2 months). The remaining 10 patients (21%) are alive, surviving progression-free at 7 months, 12 months (N = 3), 15 months, 16 months, 17 months, 26 months, 27 months, and 30 months, respectively, with a median progression-free survival time of > 15 months. No patient was hospitalized because of treatment-related complications. Our results demonstrate that a significant portion of previously treated Stage IV colorectal cancer patients with liver, lung, and/or brain metastases can achieve long-term progression-free survival with an excellent quality of life on empirical Xeloda-based outpatient treatments. By comparison, the overall average of the median survival times for 449 Stage IV colorectal cancer patients treated on a clinical trial arm from 8 major published clinical studies was 10.9 months.ConclusionsFusion technology provides medical oncologists with a powerful diagnostic tool for timely termination or modification of ineffective treatments. Patients with advanced colorectal cancer should be offered empirical patient-tailored chemotherapy as an alternative to the clinical trial and hospice options.