Factors Associated with Survival of Veterans with Gastrointestinal Neuroendocrine Tumors

Background. Gastrointestinal (GI) neuroendocrine tumor (NET) incidence has been increasing; however, GI NET within the national Veterans Affairs (VA) health system has not been described. Methods. We used the VA Central Cancer Registry to identify the cohort of patients diagnosed with GI NET in 1995–2009. Cox regression models were constructed to explore factors associated with survival. Results. We included 1793 patients with NET of the stomach (9%), duodenum (10%), small intestine (24%), colon (19%) or rectum (38%). Twenty percent were diagnosed in 1995–1999, 35% in 2000–2004, and 45% in 2005–2009. Unadjusted 5-year survival rates were: stomach 56%, duodenum 66%, small intestine 52%, colon 67%, and rectum 84%. Factors associated with shorter survival were increasing age, hazard ratio (HR) 1.05 (95% CI 1.04–1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68–3.05), duodenum HR 1.70 (95% CI 1.26–2.28), small intestine HR 1.85 (95% CI 1.42–2.42), and colon 1.83 (95% CI 1.41–2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90–1.47), distant HR 2.38 (95% CI 1.87–3.05)], and earlier period of diagnosis [compared to 1995–1999: 2000–2004 HR 0.70 (95% CI 0.59–0.85), 2005–2009 HR 0.43 (95% CI 0.34–0.54)]. Conclusions. The incidence of GI NET has also increased over time in the VA system with similar survival rates to those observed in non-VA settings. Worsened survival was associated with older age, tumor site, advanced stage, and earlier year of diagnosis

Emergencies after endoscopic procedures

Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-prancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs’ frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation

Recent advances in management of acalculous cholecystitis [version 1; referees: 2 approved]

Acalculous cholecystitis is a life-threatening gallbladder infection that typically affects the critically ill. A late diagnosis can have devastating outcomes because of the high risk of gallbladder perforation if untreated. The diagnosis is not straightforward as Murphy’s sign is difficult to illicit in the critically ill and many imaging findings are either insensitive or non-specific. This article reviews the current imaging literature to improve the interpretation of findings. Management involves a percutaneous cholecystostomy, surgical cholecystectomy, or more recently an endoscopically placed metal stent through the gastrointestinal tract into the gallbladder. This article reviews the current literature assessing the outcomes of each treatment option and suggests a protocol in determining the modality of choice on the basis of patient population. Specifically, endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery and obviates the need for a percutaneous drain and all its complications. It has promising results but has caveats in its uses

An integrated marketing communications campaign for Twin Oaks Place cosmopolitan living redefined

The Philippine landscape is changing most major cities are composed of old, new and even under construction office, retail or residential buildings that practically make most of the areas dense and compact. Thus, such developments are by several big time players in the real estate industry that already established their quality and brand equity. Despite the fact the developer of Twin Oaks Place Greenfield Development Corporation has multitude of joint venture partners with other key players in the industry, it is still evident that this is the first solo high-rise residential condominium project of the company as well as the first major building in the soon to be launch Greenfield District, the old Crossing and EDSA Central area and just one of the few compounds in the city with ample of land that can be joint together to form a master-planned community. As a proponent and author of this Integrated Marketing Communications campaign for Twin Oaks Place, I have conducted a research about the current real estate industry situation considering the global financial crisis happening today to be able to comprehend the effect of this phenomenon to the industry and I have scanned major high rise developments form prominent development areas to know the trends in pricing and by doing this I was able to identify the direct competitors of the project and the right positioning of the project a typical from its competitors. Furthermore, by studying the results of the Focus Group Discussion conducted by the Greenfield Condominium Division together with AC Nielsen, I was able to obtain the insights of people about condominium living and I was able to identify the primary and secondary target about condominium living and I was able to identify the primary and secondary target market that is not just based on the age and income of a person but an individuals current life stage as well as their insight and major considerations in buying a condominium unit that became a guide and will be reflected in the creative executions and marketing plan of Twin oaks Place. Awareness and information dissemination about the Twin Oaks Place of Greenfield Development Corporation are the main objectives of this campaign associating it together with its location as one of the projects selling points. Creating aggressive and strategic marketing plan will support on the sales velocity of the development to hit the target sales for the year. Thus, it is important that the launch of Twin Oaks Place will contribute to the brand equity of Greenfield Development Corporation as a developer that signifies a company that builds not just a city but a SURBIA community

Factors associated with survival of veterans with gastrointestinal neuroendocrine tumors.

Contains fulltext : 107877.pdf (publisher's version ) (Open Access)Background. Gastrointestinal (GI) neuroendocrine tumor (NET) incidence has been increasing; however, GI NET within the national Veterans Affairs (VA) health system has not been described. Methods. We used the VA Central Cancer Registry to identify the cohort of patients diagnosed with GI NET in 1995-2009. Cox regression models were constructed to explore factors associated with survival. Results. We included 1793 patients with NET of the stomach (9%), duodenum (10%), small intestine (24%), colon (19%) or rectum (38%). Twenty percent were diagnosed in 1995-1999, 35% in 2000-2004, and 45% in 2005-2009. Unadjusted 5-year survival rates were: stomach 56%, duodenum 66%, small intestine 52%, colon 67%, and rectum 84%. Factors associated with shorter survival were increasing age, hazard ratio (HR) 1.05 (95% CI 1.04-1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68-3.05), duodenum HR 1.70 (95% CI 1.26-2.28), small intestine HR 1.85 (95% CI 1.42-2.42), and colon 1.83 (95% CI 1.41-2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90-1.47), distant HR 2.38 (95% CI 1.87-3.05)], and earlier period of diagnosis [compared to 1995-1999: 2000-2004 HR 0.70 (95% CI 0.59-0.85), 2005-2009 HR 0.43 (95% CI 0.34-0.54)]. Conclusions. The incidence of GI NET has also increased over time in the VA system with similar survival rates to those observed in non-VA settings. Worsened survival was associated with older age, tumor site, advanced stage, and earlier year of diagnosis

Factors associated with survival of veterans with gastrointestinal neuroendocrine tumors

Background. Gastrointestinal (GI) neuroendocrine tumor (NET) incidence has been increasing; however, GI NET within the national Veterans Affairs (VA) health system has not been described. Methods. We used the VA Central Cancer Registry to identify the cohort of patients diagnosed with GI NET in 1995--2009. Cox regression models were constructed to explore factors associated with survival. Results. We included 1793 patients with NET of the stomach (9%), duodenum (10%), small intestine (24%), colon (19%) or rectum (38%). Twenty percent were diagnosed in 1995--1999, 35% in 2000--2004, and 45% in 2005--2009. Unadjusted 5-year survival rates were: stomach 56%, duodenum 66%, small intestine 52%, colon 67%, and rectum 84%. Factors associated with shorter survival were increasing age, hazard ratio (HR) 1.05 (95% CI 1.04--1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68--3.05), duodenum HR 1.70 (95% CI 1.26--2.28), small intestine HR 1.85 (95% CI 1.42--2.42), and colon 1.83 (95% CI 1.41--2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90--1.47), distant HR 2.38 (95% CI 1.87--3.05)], and earlier period of diagnosis [compared to 1995--1999: 2000--2004 HR 0.70 (95% CI 0.59--0.85), 2005--2009 HR 0.43 (95% CI 0.34--0.54)]. Conclusions. The incidence of GI NET has also increased over time in the VA system with similar survival rates to those observed in non-VA settings. Worsened survival was associated with older age, tumor site, advanced stage, and earlier year of diagnosis