Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer:A Systematic Review and Meta-Analysis

Importance: Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes. Objective: To report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation. Data Sources: PubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023. Study Selection: Studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included. Data Extraction and Synthesis: Data extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model. Main Outcomes and Measures: Outcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis. Results: Of the 12859 unique articles initially retrieved, 81 studies with 24908126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies). Conclusions and Relevance: In this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution..</p

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer:A Systematic Review and Meta-Analysis

Importance: Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes. Objective: To report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation. Data Sources: PubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023. Study Selection: Studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included. Data Extraction and Synthesis: Data extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model. Main Outcomes and Measures: Outcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis. Results: Of the 12859 unique articles initially retrieved, 81 studies with 24908126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies). Conclusions and Relevance: In this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution..</p

Neo-villeiny and the service sector: the case of hyper flexible and precarious work in fitness centres

This article presents data from a comprehensive study of hyper flexible and precarious work in theservice sector. A series of interviews were conducted with self-employed personal trainers alongwith more than 200 hours of participant observation within fitness centres in the UK. Analysis ofthe data reveals a new form of hyper flexible and precarious work that is labelled neo-villeiny inthis article. Neo-villeiny is characterized by four features: bondage to the organization; payment ofrent to the organization; no guarantee of any income; and extensive unpaid and speculative workthat is highly beneficial to the organization. The neo-villeiny of the self-employed personal traineroffers the fitness centre all of the benefits associated with hyper flexible work, but also mitigatesthe detrimental outcomes associated with precarious work. The article considers the potential foradoption of this new form of hyper flexible and precarious work across the broader service sector

Being There: Partners in PBL

In 2010, the School of Medicine implemented a radical change in its core curriculum with less didactic sessions and more active learning opportunities like problem-based learning (PBL). The librarian liaison had a part in one block but was looking for additional ways to meet course objectives. Partnering with the PBL curriculum seemed a natural fit. The librarian created an online guide (using libguides) for the students that provided a mini-tutorial for searching and in support of each specific PBL case, a new tab would appear with suggestions for books, synthesized search tools, links to pertinent databases, national organizations, and included short tutorials on using resources. The use of libguides for this purpose is not novel, but the case specific guidance is unique. The PBL curriculum in the first year was in development and because there was little time to develop the guide before the case, the librarian started attending cases, listening to the questions the students had and developing the guide around them. Although each case has specific learning objectives, creating the guide from them is often too specific and does not facilitate the students exploring and learning on their own. As the curriculum grew, so did the librarian’s activity. The second year included new cases for the now second year medical students necessitating two guides - one for each year. For the third year, the librarian started attending the “Just in Time” (JIT) tutor sessions. This allowed the librarian to partner with the faculty tutors – addressing their needs and helping develop additional material for the students. It was due to a family issue that the idea of “being there” within the PBL and JIT sessions became something tangible instead of anecdotal. Anecdotal evidence suggested that the librarian’s presence encouraged greater use. During the winter quarter, 2014, the librarian was unable to attend PBL sessions and the statistics from the guide’s usage proved the value of “being there” as only about one-third of the students continued to use the guide once I was no longer attending. Benefits of being there: Reinforce the availability of the online guide Encourage students to seek assistance Capture tutor best practice using resources Reinforce the availability of assistance in using or finding resources Increase faculty awareness of remote access to library resources Assist faculty in accessing resources off-campus Facilitate dissemination of tutor recommended resources Presented at the annual meeting of the Western Group on Educational Affairs (AAMC) 2015 in San Diego, CA

Searching the Literature Using Medical Subject Headings versus Text Word with PubMed

Objective/Hypothesis: This study was conducted to investigate the performance of two search strategies in the retrieval of information from the National Library of Medicine (NLM) on otolaryngology–head and neck surgery related conditions and diagnoses using PubMed.Methods: Two search strategies—one based on the use of Medical Subject Headings (MeSH) and the second based on text word searching—were compared.Results: The MeSH search provided a more efficient search than the text word search.Conclusions: Head and neck surgeons can most efficiently search the NLM using PubMed as a search engine by initiating the search with MeSH terms. Once a key article is identified, the searcher should use the “Related Articles” feature

Searching the Literature Using Medical Subject Headings versus Text Word with PubMed

Objective/Hypothesis: This study was conducted to investigate the performance of two search strategies in the retrieval of information from the National Library of Medicine (NLM) on otolaryngology–head and neck surgery related conditions and diagnoses using PubMed.Methods: Two search strategies—one based on the use of Medical Subject Headings (MeSH) and the second based on text word searching—were compared.Results: The MeSH search provided a more efficient search than the text word search.Conclusions: Head and neck surgeons can most efficiently search the NLM using PubMed as a search engine by initiating the search with MeSH terms. Once a key article is identified, the searcher should use the “Related Articles” feature

Deceptive Publishing Workshop

This is workshop designed to provide information and support for publication venue regardless of discipline, role, and rank