In this webinar, we talk about the risks associated with colorectal cancer – including everything from diet, lifestyle, age, family history and more. We review the risks of recurrence for colorectal cancer survivors. Join us to learn how to reduce your risk of colorectal cancer!
Presented by Harvey Murff, M.D, M.P.H. is an Associate Professor of Medicine in the Division of General Internal Medicine and Public Health at Vanderbilt University
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Nutrition is very important yet neglected in field of oncology.
Majority of healthcare providers know and practice very little on this burning issue!
It is proven that nutrition impacts on overall survival, treatment outcome & recovery in oncology.
This presentation will give you brief information regarding importance and need of nutrition in Oncology.
Report Back from San Antonio Breast Cancer Symposium (SABCS 2022)bkling
Curious about the latest developments in Early-Stage Breast Cancer and Metastatic Breast Cancer Research? Join us as Dr. Anne Blaes, the Division Director of Hematology/Oncology/Transplantation and Professor in Hematology/Oncology at the University of Minnesota, breaks down the most recent developments released at the annual San Antonio Breast Cancer Symposium regarding early-stage and metastatic breast cancer research.
Joanna Burgess, BSN, RN, CWOCN presented this informative webinar on living with, or preparing for an ostomy. Joanna shared insight and advice from her professional work as a wound, ostomy and continence nurse (WOCN), but she will also draw from her personal perspective from living with an ostomy.
Joanna will cover tips on how to care for your ostomy, how to prepare for surgery, diet and nutrition, ostomy reversal, and more! Joanna serves on the board of the United Ostomy Associations of America and chairs their advocacy committee.
Nutrition is very important yet neglected in field of oncology.
Majority of healthcare providers know and practice very little on this burning issue!
It is proven that nutrition impacts on overall survival, treatment outcome & recovery in oncology.
This presentation will give you brief information regarding importance and need of nutrition in Oncology.
Report Back from San Antonio Breast Cancer Symposium (SABCS 2022)bkling
Curious about the latest developments in Early-Stage Breast Cancer and Metastatic Breast Cancer Research? Join us as Dr. Anne Blaes, the Division Director of Hematology/Oncology/Transplantation and Professor in Hematology/Oncology at the University of Minnesota, breaks down the most recent developments released at the annual San Antonio Breast Cancer Symposium regarding early-stage and metastatic breast cancer research.
Joanna Burgess, BSN, RN, CWOCN presented this informative webinar on living with, or preparing for an ostomy. Joanna shared insight and advice from her professional work as a wound, ostomy and continence nurse (WOCN), but she will also draw from her personal perspective from living with an ostomy.
Joanna will cover tips on how to care for your ostomy, how to prepare for surgery, diet and nutrition, ostomy reversal, and more! Joanna serves on the board of the United Ostomy Associations of America and chairs their advocacy committee.
Presented at American Association for Cancer Research (AACR) at New Orleans 2016 annual conference. Fight Colorectal Cancer and Cancer Research Institute joint effort.
Presented by
Al B. Benson III, MD FACP FASCO
Professor of Medicine
Associate Director for Cooperative Groups Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Many colorectal cancer patients take chemotherapy as part of their treatment plan. Join Ashley Glode, Pharm.D, as she discusses chemo information and education, supportive care management for patients, and toxicity monitoring. She will discuss the importance of communicating with your doctors and care team to ensure you stay safe and comfortable throughout your treatment plan.
In this webinar our Medical Advisory Board member Dr. Dennis Ahnen will cover the basics of colorectal cancer – the hows, whats, and whys.
This August 2015 webinar is brought to you by Fight CRC’s Research Advocacy Training and Support (RATS) program. http://fightcolorectalcancer.org/do-something/support-research/research-advocacy-training-and-support-rats/
Each January, the best and brightest minds in colorectal cancer research meet at the Gastrointestinal Cancers Symposium. Fight Colorectal Cancer and the Colon Cancer Alliance are partnering to bring you the big news in colorectal cancer from the 2013 symposium.
Join us to learn more about these topics:
- Can aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) keep cancer from returning?
- The relationship of body mass index (BMI) and exercise in colorectal cancer
- What scientists are learning about how your immune system can fight cancer
- The latest on what biomarkers can tell us about your cancer
- Rectal cancer treatment that is based on your biological make-up
The webinar will be led by Dr. Richard Goldberg, an internationally renowned gastrointestinal oncologist who specializes in colorectal cancer. He is a tenured professor in the Department of Internal Medicine at The Ohio State University and serves as physician-in-chief at Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
CANSA advocates living a balanced, healthy lifestyle. This can be achieved by making smart food choices, doing regular exercise, maintaining a healthy weight, avoiding tobacco and alcohol. A recent study (by the World Cancer Research Fund International) has confirmed the link between obesity and 11 cancers. These findings emphasise the huge role that obesity plays in increasing cancer risk. Nutrition, physical activity and body composition all play a central part in cancer risk reduction.
Read more: http://www.cansa.org.za/a-balanced-lifestyle-linked-to-your-cancer-risk/
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
Presentation by Prof. George Gray, Director of the Centre for Risk Science and Public Health, George Washington University, at the Workshop on Risk Assessment in Regulatory Policy Analysis (RIA), Session 9, Mexico, 9-11 June 2014. Further information is available at http://www.oecd.org/gov/regulatory-policy/
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
You’ve been treated for uterine cancer. Now what? With surveillance strategies varying from doctor to doctor, it can be hard to know which advice you should follow. Dr. Jennifer Mueller, Head of the Endometrial Cancer Section, Gynecologic Oncology Service at Memorial Sloan Kettering Cancer Center, delves into surveillance guidelines, which tests to consider, and how to keep an eye out for any symptoms which could indicate recurrence.
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
Strategies for Long-term Management of Recurrent Ovarian Cancerbkling
A panel of doctors and patients will discuss decision-making in the recurrent setting of ovarian cancer, including how to understand and consider options like chemotherapy, surgery, and clinical trials. Panelists include Dr. Jason Wright and Dr. June Hou from Columbia University College of Physicians and Surgeons, survivor/research advocate Annie Ellis, and others living with recurrence.
Similar to Colorectal Cancer Risk & Risk Reduction: Jan 2017 #CRCWebinar (20)
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
Looking to kick start your physical activity? Hoping to learn about how body movement can be a huge benefit for CRC patients and survivors? Curious about Climb for a Cure? Join this interactive webinar featuring Karia Coleman, MSK, personal trainer and athletic strength coach, and Fight CRC advocates as they discuss the importance, challenges, and joys of physical activity.
From bowel frequency, pain, and more, many colorectal cancer treatments lead to digestive side effects. Join this webinar with Dr. Cathy Eng to learn all about the digestive system, the side effects that are common due to CRC treatment, and how to manage those side effects.
Maine recently passed major colorectal cancer (CRC) policy at the state level. Join us to listen to their story and learn what worked well for CRC state advocacy!
Indiana just passed major colorectal cancer (CRC) policy this year. Join us to listen to their story and learn what worked well for CRC advocacy in Indiana!
Kentucky was one of the first states in the US to pass major colorectal cancer (CRC) policy. Join us to listen to their story and learn what worked well for CRC state advocacy!
Join Fight CRC in a webinar about biomarkers. In this session, Dr. Chris Lieu will focus the discussion on the NTRK biomarker, in addition to ctDNA, and Next-Generation Sequencing.
Join us as Eden Stotsky-Himelfarb, BSN, RN from Johns Hopkins Medicine discusses how to manage after a colorectal cancer diagnosis. In this session, she will cover understanding diagnoses, shared decision making, managing mental health, talking to family and colleagues, and more.
Some colorectal cancer treatments lead to side effects of the skin. In this webinar, Dr. Nicole LeBoeuf will discuss these specific side effects. She will talk about why they occur, how to prepare for them, and how to manage them.
Hear about the latest breaking colorectal cancer research! Fight CRC will be joined by Dr. Axel Grothey who will spend the hour detailing the research presented at the 2020 Gastrointestinal (GI) Cancers Symposium hosted by the American Society of Clinical Oncology.
Anticipating the end of life and making decisions about medical care at this time can be difficult and distressing for people with cancer and their loved ones. However, it is incredibly important to plan for the transition to end-of-life care.
In this webinar, we will discuss questions to ask when considering an end to curative treatment, what to expect with hospice and end-of-life care, a new medical care team, advance directives and healthcare proxies, options for pain, the role of caregivers and loved ones, and more.
In this webinar, Dr. Angela Nicholas, Dr. Chris Heery, and Wenora Johnson discuss all things clinical trials. Dr. Nicholas, a family practitioner and caregiver to her late husband, John MacCleod will dive into her experience searching for clinical trials along with advice to those currently searching, or planning on searching in the future. Dr. Heery, Chief Medical Officer for Precision Biosciences will spend time dispelling myths around clinical trials and challenges to enrollment, and Wenora Johnson, a stage III colon cancer survivor will describe the process and her point of view curating trials in the Fight CRC trial finder.
In this webinar, Dr. Popp will discuss everything you need to know about palliative care! This is an important webinar for colorectal cancer patients and their loved ones.
eeling worn out and exhausted all the time? You may be experiencing cancer-related fatigue. Tune in to this webinar to learn what cancer-related fatigue is, how to spot it, and how to manage it.
In this webinar, Dr. Azad discusses colorectal cancer recurrence. She addresses things to do to help reduce the risk of recurrence, in addition to what steps should be taken if colon or rectal cancer returns.
Join Fight CRC and Dr. Scott Kopetz to learn about the latest breaking colorectal cancer research from the American Society of Clinical Oncology 2019 Annual Conference.
May 2019 – What You Need to Know About Chemotherapy Induced Neuropathy WebinarFight Colorectal Cancer
Neuropathy is a common side effect for colorectal cancer patients. It is a side effect that can be incredibly challenging to manage, and can affect daily living. Join this informative webinar to learn all about neuropathy—why it happens, how to prepare for it, and methods to try and reduce its effects. This is an important webinar for all survivors and patients! Dana will speak from both the medical professional and patient angle, as she is a colon cancer survivor herself!
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
2. • Speaker: Dr. Harvey Murff
• Archived Webinars: FightCRC.org/Webinars
• AFTER THE WEBINAR: Expect an email with links to the
material & a survey. If you fill it out, we’ll send you an “I
booty” bracelet.
• Ask a question in the panel on the RIGHT SIDE of your
screen
• Follow along via Twitter – use the hashtag #CRCWebinar
Today’s Webinar:
4. Disclaimer
:
The information and services provided by Fight Colorectal
Cancer are for general informational purposes only. The
information and services are not intended to be substitutes
for professional medical advice, diagnoses or treatment.
If you are ill, or suspect that you are ill, see a doctor
immediately. In an emergency, call 911 or go to the nearest
emergency room.
Fight Colorectal Cancer never recommends or endorses any
specific physicians, products or treatments for any condition.
5. Speaker:
Harvey Murff, M.D, M.P.H. is an Associate Professor of
Medicine in the Division of General Internal Medicine and Public
Health at Vanderbilt University. Dr. Murff completed an Internal
Medicine residency at Mount Sinai Medical Center in New York
City and a fellowship in General Internal Medicine at the
Brigham and Women’s Hospital in Boston, MA.
He obtained a Masters in Public Health at the Harvard School of
Public Health. His research interests includes colorectal cancer
screening and health disparities, chemoprevention of colorectal
cancer, and the impact of genetic factors and dietary intake of
polyunsaturated fatty acids on inflammation and cancer risk.
Dr. Murff has received support for his research from the
National Institutes of Health and the Department of Veterans
Affairs. Dr. Murff is a practicing General Internist at the
Tennessee Valley Healthcare System, Nashville Veterans Affairs
Hospital.
6. Primary and Secondary Prevention of
Colorectal Cancer
Harvey J Murff, MD. MPH
Associate Professor
Division of General Internal Medicine
01/27/2017
7. Fast Stats: Colorectal Cancer
CA: A Cancer Journal for Clinicians
Volume 66, Issue 1, pages 7-30, 7 JAN 2016 DOI: 10.3322/caac.21332
http://onlinelibrary.wiley.com/doi/10.3322/caac.21332/full#caac21332-fig-0001
8. Trends in Incidence CRC Rates
CA: A Cancer Journal for Clinicians
Volume 66, Issue 1, pages 7-30, 7 JAN 2016 DOI: 10.3322/caac.21332
http://onlinelibrary.wiley.com/doi/10.3322/caac.21332/full#caac21332-fig-0003
9. How Risk is Presented
• Absolute
– Chance of developing the disease over a
certain period of time
• More relevant to the individual (i.e. 1 in a 100)
• Relative
– How much higher or lower the risk is in
individuals with a certain risk factor compared
to those without the risk factor
• To interpret relative risk it is important to know the
how common is the condition
– For something uncommon a big relative risk may not
impact the number of new cases much
10. 2
10,000
1
10,000
= RR = 2
0.01% to 0.02%,
absolute number of
new cases = 1
1% to 2%, absolute
number of new
cases = 100
RR = 2=
200
10,000
10,000
100
11. Risks of Developing CRC
• Adenoma
– Prevalence 20-53% in individuals ≥ 50
– 3.4-7.6% have advanced histopathology
– 0.2 – 0.6% adenocarcinoma
• CRC
– Risks are higher with family history
• 1 first-degree relative (parent/sibling) 2-fold increase
• 2 or more relatives 4-fold increases depending on age at onset
Birth to 49 50 to 59 60 to 69 ≥ 70 Birth to
Death
Male 0.3 (1 in 300) 0.7 (1 in 149) 1.2 (1 in 82) 3.7 (1 in 27) 4.7 (1 in 21)
Female 0.3 (1 in 318) 0.5 (1 in 195) 0.9 (1 in 117) 3.4 (1 in 30) 4.4 (1 in 23)
12. Prevention
• Primary
– Prevents a cancer from ever occurring
• Secondary
– Reduce the impact of cancer detecting and
treating at an early stage or preventing
recurrence
15. Why a Study Might Be Wrong
• Bias
– Systematic error in the design or conduct of a study
• participant selection or exposure outcome assessment
• Confounding
– Factor associated with both the disease and the risk
factor that is not on the causal pathway
• Chance
– False positive or false negative studies
Szklo et al Epidemiology Beyond the Basics 2nd edi 2007
16. Bias
• Selection
– Study only selects
cases from the
hospital
• Recall
– Asks cases about prior
exposures to food that
might be suspected to
be related to disease
Confounding
• Lung cancer
Matches
Lung Cancer
17. Bias
• Selection
– Study only selects
cases from the
hospital
• Recall
– Asks cases about prior
exposures to food that
might be suspected to
be related to disease
Confounding
• Lung cancer
Matches
Lung CancerSmoking
18. Observational Studies
• Case-control
– Starts with the disease
• Cohort study
– Starts with the exposure
• Big problems with bias
– Recall bias and case-control studies
• Big problem with confounding
– Lifestyle factors often cluster together
• (health lifestyle)
• Compares lowest to highest
19. Randomized Controlled Trials
• Randomization
– Evenly distributes confounders
• If the study is big enough
• Double-blind, placebo control
• “hard” outcomes
– Reduces bias
• Not all randomize trials follow these
designs and so they too can be misleading
20. Where are the RCT’s
• Lifestyle and behavioral interventions hard
to do in a RCT
• Contamination and cross-over
• Interventions with weaker effects need HUGE
sample sizes
• Choice of outcomes matter
• Surrogates do not always reflect the outcome of
interest
• CRC can take 20 years to develop
• Very expensive
22. Screening
• Benefits of screening
– RCT show reduction in incidence and
mortality
– Removes pre-cancerous lesions
– Screening believed to be responsible for
almost 53% of reduced CRC mortality
23. Types of Screening
Inadomi JM. N Engl J Med 2017;376:149-156.
Inadomi JM. N Engl J Med 2017;376:149-156.
24. Limits of Screening
• Colonoscopy
• Sedation, serous AE < 0.6%, expensive
• CT colonography
• Radiation exposure, extra-colonic lesions
• Flexible sigmoidoscopy
• Only visualizes lower-third, combined with annual FOBT
• Guaiac-based FOBT
• Limited sensitivity, annual testing
• FIT
• Variation in positive tests, more expensive that FOBT
• Stool DNA
• More costly than FIT or FOBT
Strum WB. N Engl J Med 2016;374:1065-1075.
25. Lifestyle
• Why lifestyle changes
– Pros
• Similar changes impact multiple conditions
– Cons
• Data for some exposures weak
• Hard to do
26. Diet
• Fiber
• Fruits and Vegetables
• Red Meat/Processed Meat
• Fish
• Vitamins and Minerals
27. Fiber
• Where does the data come from?
– Observational studies
• 25 studies 10 g/day reduced CRC by 10%
– 10 slices of whole grain bread/day 3-4 cups wheat bran
cereal
– Randomized trials (adenomas)
• 2 studies results null
• Why the differences?
• Type of fiber (fiber from grains versus
fruit/vegetable/legume fiber)
• Outcome differences?
• Size of study or confounders?
28. Fruits and Vegetables
• Where does the data come from?
– Observational studies (14 studies)
• Why might this be true?
• Fiber/antioxidants?
• What is the estimated effect size?
• 9% decreased relative risk
• Not considered statistically significant
• Maybe an effect with distal CRC
29. Red Meat/Processed Meat
• Where does the data come from?
– Observational studies and animal studies
– Most studies (2/3) have found a statistical association
(̴ 30 studies)
• WHO in 2015 – group 1 carcinogen
• Why might this be true?
• Polyaromatic hydrocarbons or nitrates?
• What is the estimated effect size?
• 18% increase relative risk (100’s for smoking)
• 2-3 strips of bacon daily for 10+ years = 1
additional CRC case
30. Fish
• Where does the data come from?
– Observational
• Diet reported (41 studies)
• Biomarker studies (5 studies)
– Clinical Trials
• Reduced number of adenomas by 22% (FAP)
• Clinical trials underway
• Why might this be true?
– Anti-inflammatory effect (like aspirin)
• What is the estimated effect size?
– 12% (diet studies) 40% (biomarker)
31. Vitamin and Minerals
• Folate
– Dark leafy greens, broccoli, asparagus
– Observational Studies
• May be beneficial in very early stages
– Clinical Trials (Adenomas)
• Null or might even increase risk
– Why the difference
• Preparation folate versus folic acid
• Timing early stages versus late stages
• Study designs
32. Vitamin and Minerals
• Vitamin B6 (pyridoxine)
– Tuna, salmon, chicken, beef, spinach, seeds,
nuts
– Observational Studies
• Effect size 10-20% reduction of CRC
• Magnesium
– Very limited data
– Single study in women found 40% reduction
33. Calcium and Dairy
• Where does the data come from?
– Observational studies (19 cohorts)
– Mixed overall 18% risk reduction with milk only (?)
– Clinical trials
• 3 RCT adenomas 20% reduction in risk
• 1 RCT cancers: null
• Why might this be true?
• Unclear mechanisms – binds bile acids
• Major concerns with RCT, contamination, dose,
short duration
34. Vitamin D
• Where does the data come from?
– Observational studies
• 50% reduced risk of CRC
– Clinical trials
• 1 RCT null but used low dose
• Ongoing higher dose studies
• Why might this be true?
• Unclear mechanisms, cell proliferation,
inflammation
35. Physical Activity
• Where does the data come from?
– Observational studies (>20)
• Why might this be true?
• Unknown mechanisms
• What is the estimated effect size?
• 27% decrease relative risk
• Least active to most active
Closest thing to a “wonder drug”
Premature Death
Heart Disease
Stroke
Diabetes
High blood pressure
Multiple cancers
Depression
Dementia
36. Body Weight
• Where does the data
come from?
– Observational studies
• Why might this be
true?
– Insulin/ Adipose associate
inflammation
• What is the estimated
effect size?
– 23-45% increase relative risk
– Possible dose response
• BMI
– Weight/height2
• Overweight
– ≥ 27.3♀ ≥ 27.8 ♂
• Average height ♀(5’4”)
– 159 lbs
• Average height ♂(5’10”)
– 194 lbs
• Obese
– ≥ 30
• Average height ♀(5’4”)
– 175 lbs
• Average height ♂(5’10”)
– 209 lbs
37. Alcohol use
• Where does the data come from?
– Observational studies
– > 60 studies
• Why might this be true?
• Unknown by believed to be related to folate
• What is the estimated effect size?
• 21% increase relative risk for moderate drinkers
– 2-3 drinks per day
• 52% increased relative risk for heavy drinkers
– ≥ 4 drinks per day
38. Tobacco use
• Where does the data come from?
– Observational studies
– > 100 studies
• Why might this be true?
• At least 43 known carcinogens in tobacco smoke
• What is the estimated effect size?
• 18% increase relative risk
• Also associated with increased colon polyp risk
– Serrated polyps
39. Medications-Aspirin/NSAIDs
• Where does the data come from?
• RCT (adenomas)
– 4 trials reduced recurrent adenomas by 17%
• RCT (cancer)
– 1 trial which was null
• Secondary analysis of RCT
– 4 trials 24% reduction in CRC mortality
• Observational studies
» 22% and 34% reduction of adenomas (ASA,
NSAIDS)
• Why the discrepancies
• Dose, duration of therapy
40. Aspirin Recommendations
• United States Preventive Services
• Adults aged 50-59 years
– Low-dose aspirin for prevention of
cardiovascular disease and colorectal cancer
who have a 10% or greater 10-year CVD risk,
are not at increased risk of bleeding, have a
life expectancy of at least 10 years and are
willing to rake aspirin for at least 10 years
41. CVD Risk
Nonfatal MIs
Prevented
Nonfatal
Ischemic
Strokes
Prevented
CRC Cases
Prevented
Serious GI
Bleeding
Caused
Hemorrhagic
Strokes
Caused
Net Life-Years
Gained
QALYs Gained
Aged 50 to 59 years
10% 225 84 139 284 23 333 588
15% 267 86 121 260 28 395 644
20% 286 92 122 248 21 605 834
Aged 60 to 69 years
10% 159 66 112 314 31 -20 180
15% 186 80 104 298 24 96 309
20% 201 84 91 267 27 116 318
Table 1. Lifetime Events in 10,000 Men Taking Aspirin
Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication. U.S.
Preventive Services Task Force. November 2016.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-
disease-and-cancer
42. CVD Risk
Nonfatal
MIs
Prevented
Nonfatal
Ischemic
Strokes
Prevented
CRC Cases
Prevented
Serious GI
Bleeding
Caused
Hemorrhagic
Strokes
Caused
Net Life-Years
Gained
QALYs Gained
Aged 50 to 59 years
10% 148 137 139 209 35 219 621
15% 150 143 135 200 34 334 716
20% 152 144 132 184 29 463 833
Aged 60 to 69 years
10% 101 116 105 230 32 -12 284
15% 110 129 93 216 34 17 324
20% 111 130 97 217 33 48 360
Table 2. Lifetime Events in 10,000 Women Taking Aspirin*
Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication. U.S.
Preventive Services Task Force. November 2016.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-
disease-and-cancer
43. Hormone Replacement Therapy
• Where does the data come from?
– Clinical trials
– Women's Health Initiative
» Short term reduced CRC risk (44%)
» Long term HRT participants had more advanced
disease and higher mortality
» Increased risk of breast cancer, heart attacks, blood
clots, strokes
44. 10% 20% 30% 40% 50% 60%
Fiber
-20%-30%-40%-50%-60% -10%
Physical
Activity
Decrease CRC Risk Increase CRC Risk
Fish(D)
Vit D
Fruits and
Vegetables
B6Fish(b)
Calcium
(polyps)
Tobacco
Alcohol
(moderate)
Alcohol
(heavy)
Obesity
Red
meat/processed
ASA/NSAIDS
Colonoscopy
CRC Mortality
45. Surveillance after CRC
• Yearly colonoscopies until normal then
every 3-5 years
• Imaging and biomarkers
– Intensive surveillance appears to be
associated with a 20-25% reduced risk of
CRC mortality compared to less intense
• Still under considerable debate
46. Cancer Survivorship
• Diet
– Limited observational studies
• Western diet may increase recurrent (185%
relative risk increase) in Stage III
• Physical Activity
– Observational (6 studies)
• 43-61% reduced risk with high PA
• Obesity
– Observational
• Obesity associated with 38% worse disease-free
survival (Stage II and III)
48. Secondary Prevention
• Lifestyle and Chemoprevention
– Physical Activity
• Increases survival with colorectal, breast, prostate
– Calcium supplementation
• prevents recurrence
– Antioxidants (beta-carotene, vitamin C, vitamin E )
• null
– Aspirin
• Prevents recurrences but dose and duration
unclear
49. Ongoing Studies and Novel
Therapies
• VITAL
– Vitamin D and Omega 3
• N = 25,874, 4-years
• seAFOod Trial
• N = 755, n-3 + ASA
• Metformin
– Reduced polyp formation
• Difluromethyornithin (DFMO) + sulindac
– 70% reduction of recurrent adenomas
50. Question & Answer:
SNAP A
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