Florida Traffic Law Highlights
Bicycle regulations (see Section 316.2065, F. S.)
- Bicyclists must obey all traffic controls and signals.
- Bicyclists must use a fixed, regular seat for riding.
- A bicycle may not be used to carry more persons at one time than the number for which it is designed or equipped.
- An adult bicyclist may carry a child in a backpack or sling, child seat or trailer designed to carry children.
- A bicyclist may not allow a passenger to remain in a child seat or carrier when not in immediate control of the bicycle.
- Bicyclists and passengers under age 16 must wear a helmet approved by ANSI, Snell or any other standard recognized by Florida.
- At least one hand must be kept on the handlebars while riding.
- Parents and guardians must not knowingly allow a child or minor ward to violate any provisions of this section.
- Every bicycle must be equipped with a brake or brakes which allow the rider to stop within 25 feet from a speed of 10 miles per hour on dry, level, clean pavement.
Sidewalk Riding (see Section 316,2065, F.S.)
- When riding on sidewalks or in crosswalks, a bicyclist has the same rights and duties as a pedestrian.
- A bicyclist riding on sidewalks or in crosswalks must yield the right-of-way to pedestrians and must give an audible signal before passing.
Lighting (see Section 316.2065, F.S.)
- A bicycle operated between sunset and sunrise must be equipped with a lamp on the front exhibiting a white light visible from 500 feet to the front and both a red reflector and a lamp on the rear exhibiting a red light visible from 600 feet to the rear.
- Additional lighting is permitted and recommended. See the “Night Riding” section for safety tips.
Roadway Position (see Section 316.2065, F.S.)
- A bicyclist who is not traveling at the same speed of other traffic must ride as close as practicable to the right hand curb or edge of roadway. A bicyclist may leave the right-most portion of the road in the following situations: when passing, making a left turn, to avoid hazards, or when a lane is too narrow for a bicycle and a car to share it safely.
- A bicyclist operating on a one-way street with two or more traffic lanes may ride as close to the left hand edge of the roadway as practicable.
- Riding single file is required except on bike paths or parts of roadways set aside for the exclusive use of bicycles, or when two people riding side-by-side within one lane will not impede traffic flow.
Left Turns (see Subsections 316.155(1)(b)(c), F.S.)
- A bicyclist intending to make a vehicle left turn is entitled to full use of the lane from which the turn is made. After scanning, signaling and moving to the center of that lane, the bicyclist must check the signal, then proceed when it is green and safe to do so.
- In addition to the normal vehicle left turn, a bicyclist may proceed through the right-most portion of the intersection and turn as close to the curb or edge as possible at the far side. After complying with any official traffic control device, the bicyclist may proceed in the new direction of travel.
- Another option available to a bicyclist is to dismount and walk through the intersection in the crosswalk like a pedestrian.
Signaling Turns (see Subsection 316.155(2) and 316.157(2), F.S.)
- A signal or intention to turn must be given during the last 100 feet traveled by the vehicle before turning. If a bicyclist needs both hands for control, the signal need not be given continuously
- A bicyclist may signal intent to turn right either by extending the left hand and arm upward or by extending the right hand and arm horizontally to the right side of the bicycle.
Headsets (see Section 316.304, F.S.)
- A bicyclist must not wear a headset, headphone or other listening device other than a hearing aid when riding. Wearing a headset blocks out important audio cues needed to detect the presence of other traffic.
Civil Penalties (see Subsections 316.2065 and 318.18 F.S.)
- Civil penalties may be issued for violations of bicycle laws as well as for moving and non-moving violations if applicable.
- The local governments of counties, cities, towns and other municipalities can adopt ordinances regulating bicycle riding. Some towns may also have registration and licensing ordinances. Sidewalk riding may be prohibited entirely or only in certain areas such as business districts. Local law enforcement agencies can provide copies of local ordinances.

Treoirlínte um Thrácht Florida
Rialacháin rothair (féach Alt 316.2065, F. S.)
- Ní mór do rothaithe na rialacháin agus na comharthaí tráchta go léir a chomhlíonadh.
- Ní mór do rothaithe suíochán seasta rialta a úsáid chun marcaíocht a dhéanamh.
- Ní fhéadfar rothar a úsáid chun níos mó daoine a iompar ag an am céanna ná an líon do a ndearnadh an rothar a dhearadh nó a trealamh.
- Féadfaidh rothairéir fásta leanbh a iompar i mbabhla nó i sling, i suíochán páiste nó i trealaimh atá deartha chun leanaí a iompar.
- Ní féidir le rothair a cheadú do phaisinéir fanacht i suíochán páiste nó i gcarraig nuair nach bhfuil sé i riocht láithreach an rothar a rialú.
- Ní mór do rothaithe agus do phaisinéirí faoi 16 bliana d'aois casc a cheadú ag ANSI, Snell nó aon chaighdeán eile a aithníonn Florida.
- Ní mór lámh amháin ar a laghad a choinneáil ar an stiúideo agus tú ag marcaíocht.
- Ní mór do thuismitheoirí ná do chaomhnóirí a ligean do leanbh nó do chúram mionaoiseach aon fhorálacha den alt seo a shárú.
- Ní mór gach rothar a bheith feistithe le briseadh nó briseadh a cheadaíonn an rothair chun stopadh laistigh de 25 troigh ó luas 10 míle in aghaidh na huaire ar thraschur tirim, leibhéal, glan.
Rith ar Chonair (féach Alt 316,2065, F.S.)
- Nuair a bhíonn sé ag marcaíocht ar thráthbhealaí nó i gcrosbhealaí, tá na cearta agus na dualgais chéanna ag rothairí agus ag coisithe.
- Ní mór d'rothaitheoir atá ag marcaíocht ar thráthbhealaí nó ar thrasbhealaí an ceart chun dul ar aghaidh a thabhairt do choisithe agus ní mór dó comhartha fuaime a thabhairt sula rachaidh sé thar.
Solas (féach Alt 316.2065, F.S.)
- Ní mór lampa a bheith ar rothar a fheidhmítear idir an ghrian a thuirlingt agus an ghrian a ardú a thaispeánann solas bán atá le feiceáil ó 500 troigh chun tosaigh agus léargas dearg agus lampa ar chúl a thaispeánann solas dearg atá le feiceáil ó 600 troigh chun cúl.
- Ceadaítear agus moltar solas breise. Féach an chuid " Rith Oíche " le haghaidh leideanna sábháilteachta.
Críochfort (féach alt 316.2065, F.S.)
- Ní mór do rothair nach bhfuil ag taisteal ag an luas céanna le trácht eile dul chomh gar agus is féidir leis an mbóthar nó le imeall an bhóthair ar dheis. Féadfaidh rothair an chuid is deise den bhóthar a fhágáil sna cásanna seo a leanas: nuair a bhíonn sé ag dul thart, ag casadh ar chlé, chun contúirtí a sheachaint, nó nuair a bhíonn léine ró-chrom le haghaidh rothar agus carr a roinnt go sábháilte.
- Féadfaidh rothair atá ag feidhmiú ar shráid aon-bhóthar le dhá shraith tráchta nó níos mó rothaíocht a dhéanamh chomh gar do imeall chlé an bhóthair agus is féidir.
- Ní mór an tsraith aonair a thiomáint ach amháin ar shlí rothaíochta nó ar chodanna bóithre a bhfuil siad curtha ar leataobh le húsáid rothaíochta amháin, nó nuair nach gcuirfidh dhá dhuine ag rith taobh le taobh laistigh de aon tsraith bac ar shreabhadh tráchta.
Cúlra ar chlé (féach Fo-Ailt 316.155 (b) (c), F.S.)
- Tá an rothair a bhfuil sé ar intinn aige feithicil a thiomáint ar chlé i dteideal úsáid iomlán a bhaint as an tslí a ndéantar an tiomáint as. Tar éis scanadh, comharthaíocht agus bogadh go lár an tslí sin, ní mór don rothair a sheiceáil an comhartha, ansin leanúint ar aghaidh nuair a bhíonn sé glas agus sábháilte é sin a dhéanamh.
- Chomh maith leis an gnáth-bhreathnú ar chlé, féadfaidh rothair dul tríd an chuid is mó ar dheis den chroisbhealach agus dul chomh gar don chrób nó don imeall agus is féidir ar an taobh is faide. Tar éis dó aon fheiste rialaithe tráchta oifigiúil a chomhlíonadh, féadfaidh an rothair dul ar aghaidh sa treo nua taistil.
- Rogha eile atá ar fáil d'rothaitheoir ná dul as agus siúl tríd an gcruinniú sa chrosbhealach mar chodlaí.
Tuairimí comharthaíochta (féach Fo-alt 316.155 (((2) agus 316.157 (((2), F.S.)
- Ní mór comhartha nó intinn cas a thabhairt le linn na 100 troigh deireanach a thaistil an fheithicil sula casfar. Má theastaíonn an dá lámh ó rothair chun an t-údarás a rialú, ní gá an comhartha a thabhairt go leanúnach
- Féadfaidh rothair a chur in iúl go bhfuil sé ar intinn aige dul ar dheis trí lámh agus lámh chlé a shíneadh suas nó trí lámh agus lámh dheis a shíneadh go cothrománach ar thaobh na rothair.
Ceannairí agus córais chun ceallraí a úsáid
- Ní féidir le rothair a bheith ag caitheamh cluasáin, cluasáin nó feiste éisteachta eile seachas cabhair éisteachta agus é ag marcaíocht. Má bhíonn headset ar do chluas, ní bheidh aon fhuaim á fháil agat ar na comharthaí fuaime tábhachtacha a theastaíonn chun teacht ar thrácht eile.
Ní dhéantar aon athruithe ar na rialacha maidir le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna a bhaineann le saincheisteanna.
- Féadfar pionóis shibhialta a eisiúint i gcás sárú ar dhlíthe rothair chomh maith le sárú ar ghluaiseacht agus neamh-gluaiseacht más infheidhme.
- Is féidir le rialtais áitiúla contae, cathracha, bailte agus bailte eile ordúcháin a ghlacadh lena rialaítear rothaíocht. D'fhéadfadh go mbeadh ordúcháin clárúcháin agus ceadúnaithe ag roinnt cathracha freisin. D'fhéadfadh cosc a bheith ar rothaíocht ar an mbóthar go hiomlán nó i gceantair áirithe amháin, mar shampla ceantair ghnó. Féadfaidh gníomhaireachtaí forfheidhmithe dlí áitiúla cóipeanna d'ordúcháin áitiúla a sholáthar.


This was 175th day of the year and 190 days remained in the year.
June 24 in History
Early American feminist Margaret Brent demanded a seat and vote in the Maryland Assembly, but was ejected from that body.
King Philip's War, the most devastating war between the colonists and Indians, began with Indians attacking the Swansea (Mass.) settlement.
Kenneth Arnold, an American pilot, reported seeing strange objects near Mt. Rainier, Washington. He described them as "saucers skipping across the water," hence the term "flying saucers" was born.
The U.S. Air Force released The Roswell Report, closing the case on the 1947 Roswell, N.M. incident concerning UFOs and alien bodies.
New York passes a law to allow same-sex marriage, becoming the largest state that allows gay and lesbian couples to marry.
Lonesome George, the last known Pinta Island Tortoise, died at a Galapagos National Park, making the subspecies extinct.
Return to perpetual calendar
Note: Dates in the Islamic calendar are provided for planning purposes only, and calculated with the hdate Islamic calendar program for moonrise in Boston, Masschusetts. Depending on your location and other factors, this result may differ from actual religious observances by one day. Please consult your local religious authority for any religious determinations of hejiric date.

Ba é seo an 175ú lá den bhliain agus bhí 190 lá fágtha sa bhliain.
24 Meitheamh sa Stair
D'éiligh an t-eagraí feimineach Mheiriceá Margaret Brent suíochán agus vóta i dToghchán Maryland, ach cuireadh as an gcomhlacht sin í.
Thosaigh Cogadh Rí Philip, an cogadh is tubaisteacha idir na coilíneoirí agus na hIndiaigh, le hIndiaigh ag ionsaí an Swansea (Mass.) socrú.
D'aithin Kenneth Arnold, píolótach Meiriceánach, go bhfaca sé rudaí aisteach in aice le Mt. Rainier, Washington. Chuir sé síos orthu mar "saucers ag léim thar an uisce", dá bhrí sin rugadh an téarma "saucers eitilte".
D'eisigh Air Force na Stát Aontaithe The Roswell Report, ag dúnadh an cháis ar thuras Roswell, NM i 1947 maidir le UFOanna agus comhlachtaí eachtracha.
Éiríonn Nua-Eabhrac an stát is mó a cheadaíonn pósadh a lánúin ghnéas céanna.
Fuair Lonesome George, an Turtle Oileán Pinta is déanaí a bhí ar eolas, bás i bPáirc Náisiúnta Galapagos, rud a fhágann go ndeachaigh an fho-chineál as an ngnáth.
Fill ar ais go dtí an féilire síoraí
Nóta: Tá dáta sa féilire Ioslamach ar fáil chun críocha pleanála amháin, agus tá sé ríofa leis an gclár féilire Ioslamach hdate le haghaidh moonrise i Boston, Massachusetts. Ag brath ar do shuíomh agus ar fhachtóirí eile, d'fhéadfadh an toradh seo a bheith difriúil ó na ceiliúradh reiligiúnacha iarbhír trí lá amháin. Déan teagmháil le do údarás reiligiúnach áitiúil le haghaidh aon chinntí reiligiúnacha maidir le dáta heicriúil.


Published on 13.03.18 in Vol 4, No 1 (2018): Jan-Jun
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/9635, first published Dec 11, 2017.
Improving Internal Medicine Residents’ Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study
Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge.
Objective: The objective of our study was to assess the improvement in internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app.
Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents’ knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance.
Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases.
Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening.
JMIR Med Educ 2018;4(1):e10
- colorectal cancer;
- cancer screening;
- early detection of cancer;
- residents’ education;
- mobile apps
Colorectal cancer (CRC) is the third most commonly diagnosed cancer among both men and women in the United States. It is the second leading cause of cancer-related death overall. Incidence and mortality rates have been declining because of increased awareness of risk factors such as smoking and red meat consumption, and improvement in screening rates and treatment modalities [- ]. According to the American Cancer Society (ACS), 135,430 new cases and 50,260 deaths from CRC were expected to occur in 2017, and the lifetime risk of developing CRC is about 1 in 21 (4.7%) for men and 1 in 23 (4.4%) for women [ ]. The management of CRC is associated with substantial health care costs, with national expenditures exceeding US $14 billion annually [ , ]. There are striking disparities by age, race, and tumor subsite despite a reduction in CRC incidence and mortality overall. The goal of further reducing CRC incidence and mortality can be achieved by ensuring access to high-quality health care, incentivizing healthy lifestyles, and increasing CRC screening. Meester and colleagues and others estimated that achieving the US National Colorectal Cancer Roundtable’s goal of increasing screening prevalence to 80% by 2018 would prevent 277,000 CRC cases and 203,000 deaths by 2030 [ - ]. About one in three adults in the United States is not getting CRC screening as recommended. According to the US National Health Interview Survey, CRC screening in accordance with the guidelines among adults 50 years of age and older increased from 34% in 2000 to 63% in 2015 [ ].
Generally, it is expected that as resident physicians advance in their training, CRC screening rates should improve with the expected improvement in knowledge of CRC screening. Wong measured performance outcomes in multiple screening categories over 3 years of training and found that actual patient screening rates were similar across all years . One of the reasons for this lack of improvement in CRC screening could be residents’ deficient knowledge about CRC screening, even though guidelines from the American College of Gastroenterology (ACG), ACS, and US Preventive Services Task Force (USPSTF) are mostly in agreement about screening modalities and age [ - ]. Akerman et al [ ] assessed residents’ CRC screening knowledge via a Web-based survey and concluded that there were many deficiencies. They concluded that fecal occult blood testing for screening purposes remains undervalued, and confusion about administering the test persists. The distinction between screening and prevention needs further reinforcement [ ].
Primary medical care of many underserved populations is dependent on resident outpatient practices. The physician-in-training role in health maintenance and screening has been assessed by various studies [- ]. Other factors could be responsible for the compromise in effective health maintenance and screening in resident practice in addition to residents’ knowledge deficiencies. One of these factors could be provider turnover every few years. Some studies even estimate that as many as 50% of patients are lost to follow-up of their chronic medical conditions and screenings when resident physicians graduate and pass their patients on to new providers [ ].
Besides addressing other factors to improve health maintenance and screening in residents’ practice, improving medical knowledge about preventive health and screening is the key. One of the reasons for residents’ deficient knowledge about CRC screening is lack of training and educational tools. We conducted this comprehensive study to improve internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app.
This pilot study was completed in 3 parts. Initially, we designed a questionnaire based on the CRC screening guidelines of the ACS, ACG, and USPSTF; we then requested institutional review board approval. The institutional review board of the University of Toledo Medical Center then granted the request for approval after reviewing the app and the survey questionnaire (no. 201713). The survey contained 14 questions on 7 areas of CRC screening,outlines. We emailed the questionnaire via a SurveyMonkey (SurveyMonkey Inc, San Mateo, CA) link to all the residents of an internal medicine department. We analyzed the responses after 4 weeks. The first question simply asked for the year of training, to create a subset for analysis by year of training. Respondents had the ability to answer with multiple correct choices for some questions, reflecting the multiple options presented in the source guidelines. shows the survey form.
In the second part, we designed a smartphone app. The decision to use a smartphone app for education was purely experimental and was based on the recent advancement in technology of smartphones and gadgets and the subsequent growth of the smartphone app industry. First, we collected information about CRC screening based on the ACG, ACS, and USPSTF guidelines, and then made a screen tree based on this information. The screen tree consisted of a total of 9 screens, including the main screen, as, , , and show. The smartphone app was created on an online app creation portal (Mobincube, San Francisco, CA, USA). We designed the app keeping in mind simplicity yet ensuring good visibility of the information. The portal subscription we obtained for the app creation and publication was without advertisements to avoid any conflicts of interest. We tested the trial version of the app on a smartphone and a tablet before publication.
Then we uploaded the app onto the Google Developers Console (Google Inc, Mountain View, CA, USA) and published it the Google Play Store (Google Inc) for Android users. We also sent the app to Apple support for testing before publication in the App Store (Apple Inc, Cupertino, CA, USA). All the residents were introduced to the app via emails and flyers. We tracked the number of app downloads via a developer account in both the Play Store and the App Store. The app was purely educational and there were no interactive components in the app. The purpose of the app was to improve residents’ knowledge about CRC screening.
In the third and final part, we repeated the survey after 4 weeks and compared the responses with those of the first survey. Weekly reminders were sent to residents to complete both the surveys. We gave residents no incentives to complete the surveys. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance.
Survey Response Rates
We analyzed and compared the data in 3 subsets. In the first subset, we compared responses to the survey questions from respondents in the same training year to determine improvement in knowledge in each training year individually after publication of the smartphone app. In the second subset analysis, we compared responses between each of the 3 resident training years (ie, postgraduate year [PGY]-1, PGY-2, and PGY-3) to look for differences in knowledge between different training levels at baseline and differences in knowledge improvement after publication of the smartphone app. In the third and final analysis, we analyzed responses in aggregate to look for overall improvement in knowledge.
We emailed the survey link to 59 residents during the first phase and allowed 4 weeks for completion of the survey, with weekly reminders sent via email. A total of 50 residents completed the survey, for response rate of 85%. Of the 50 respondents, there were 22 PGY-1 residents, 15 PGY-2 residents, and 13 PGY-3 residents. After publication of the app, we emailed the survey link again. A total of 41 residents responded to the second survey, for a response rate of 69%; of the respondents, there were 20 PGY-1 residents, 11 PGY-2 residents, and 10 PGY-3 residents.
Assessment of Residents’ Knowledge
The first few survey questions assessed the resident’s knowledge about CRC screening in average-risk patients and with a family history of CRC (). Most of the residents correctly identified the screening age in such patients. The residents were lacking knowledge about the ACG recommendation to start screening for CRC in African Americans at age 45 years. But after using the smartphone app, their knowledge improved significantly, from only 4 residents (8%) responding correctly before using the app to 29 residents (71%) responding correctly after using the app (P<.001). Although not statistically significant, knowledge about offering preventive tests first (P=.01) and offering colonoscopy every 5 years to patients with family history of CRC in a first-degree relative at age less than 60 years (P=.17) all improved.
When asked to identify screening modalities for CRC screening, many residents were lacking the knowledge about the various tests that can be offered. The number of correct responses indicating their knowledge about computed tomography (CT) colonography every 5 years, double-contrast barium enema every 5 years, sigmoidoscopy every 10 years with annual fecal immunochemical testing at home, and fecal DNA testing every 1 to 3 years increased with statistical significance after intervention (). The residents were also tested on their ability to identify preventive tests, which can detect precancerous polypoid lesions. Most residents could identify only colonoscopy every 10 years as a preventive test at baseline, but after the intervention, more of them, at all training levels, correctly identified flexible sigmoidoscopy every 5 years, CT colonography every 5 years, and double-contrast barium enema every 5 years as preventive tests ( ).
Detection methods only can detect CRC; they can’t prevent it as prevention methods do by detecting precancerous polypoid lesions. Stool-based CRC screening tests are the detection methods. Residents knowledge for correctly identifying detection methods was not satisfactory at baseline but improved significantly after education with the app, and they were able to identify annual fecal immunochemical testing, fecal occult blood testing at home, and fecal DNA testing every 1 to 3 years as CRC detection methods (). Most residents could identify sigmoidoscopy and fecal occult blood testing as the tests that are to be followed by colonoscopy if the test result is positive. At baseline, they did not all know that positive results on CT colonography, double-contrast barium enema, fecal immunochemical testing, and fecal DNA testing should also be followed by colonoscopy. After using the smartphone app, however, more of the residents identified these tests as needing to be followed by colonoscopy ( ).
The residents were also tested on the recommended follow-up after colonoscopy screening. Overall, the residents’ knowledge was not satisfactory on the follow-up periods of 10 years in the case of small hyperplastic rectal polyps being found, 5 years for 1 or 2 small tubular adenomas, 3 years for 3 to 10 adenomas, 1 to 3 years for more than 10 adenomas, and 2 to 6 months for sessile adenomas. Knowledge improved, but this was statistically significant only in the case of knowledge about the follow-up of sessile adenomas and of more than 10 adenomas (). Finally, residents were asked about surveillance for CRC in familial adenomatous polyposis, Lynch syndrome, and inflammatory bowel disease. Residents’ knowledge about CRC surveillance in familial adenomatous polyposis was lacking before using the smartphone app but improved significantly after the educational intervention ( ).
Most of the recommendations for CRC screening from the ACG, ACS, and USPSTF are similar. For our study, we extracted commonalities and only tested recommendations that were similar between all of these guidelines. Apart from these organizations, others also publish guidelines, most of which reinforce the already-stated recommendations, but they also make some new recommendations, adding to the confusion for residents and other health care professionals. Recently, the US Multi-Society Task Force on Colorectal Cancer made new recommendations, in which they divided the screening tests into three tiers based on performance features, costs, and practical considerations . In our study, we tested the knowledge of residents to identify these screening tests but didn’t test for division of these tests into three tiers.
Our study showed that, regardless of the levels of training, residents in one internal medicine department were lacking knowledge about CRC screening. This finding agrees with that of Sharma et al [, ], who investigated the understanding of CRC screening among primary care physicians and internists. There was no difference in residents’ knowledge between baseline and after the educational intervention in the form of a smartphone app: knowledge improved equally among all 3 PGY levels. This finding is consistent with a study in 2005 [ ], which showed no statistically significant difference in CRC screening rates between different years of training.
Our study was different from previously reported ones in that, first, ours was very comprehensive and covered all aspects of CRC screening and, second, it used the novel approach of a smartphone app for education of the residents. Previously reported studies, such as that of Akerman et al , only tested for identification of CRC screening tests. Beyond testing for knowledge of CRC screening in average-risk patients and with a family history of CRC, we also tested the important concept of differentiation between prevention and detection tests, which is acknowledged in the ACG and ACS guidelines. Residents were lacking knowledge in other areas of CRC screening, such as identifying tests other than colonoscopy, screening in African American patients, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and surveillance for CRC in various diseases such as familial adenomatous polyposis, Lynch syndrome, and inflammatory bowel disease.
Our study showed that residents were knowledgeable about screening of average-risk patients with colonoscopy at age 50 years and those with a family history of CRC. Because ACS guidelines state that colonoscopy should be offered at age 40 years to patients with a family history of CRC in a first-degree relative at or over age 60 years and ACG guidelines state that screening in these patients should be the same as for average-risk patients, we considered both responses correct in our survey analysis. The areas that showed improved knowledge after use of the smartphone app were correctly identifying all of the CRC screening tests, differentiating between prevention and detection tests, and correctly identifying these tests. Also, the postsurvey results showed improved knowledge of screening tests that need to be followed by colonoscopy if the test result is positive. The areas that didn’t improve much were the follow-up of a screening colonoscopy in case of findings, as well as surveillance for CRC in various diseases.
Residents’ knowledge about alternative CRC screening methods is important, as some patients do not wish to have colonoscopies because of the invasive nature of the test. Residents can only offer alternative, less-invasive methods if they have knowledge about them. Although the use of screening colonoscopies has increased over the last few years, it is still far from the National Colorectal Cancer Roundtables’ goal of achieving 80% by 2018, and awareness of alternative methods is important in achieving this target. It is important for residents to know about follow-up after colonoscopy findings and surveillance for CRC in various diseases, as residents ultimately take care of the primary needs of these patients in the clinic.
Various educational strategies have been employed in the past for improving knowledge of CRC screening, ranging from didactic lectures, as shown by Lane et al , to an interactive case-based model, as shown by Schroy et al [ ]. These educational methods showed variable improvement in knowledge, and additional interventions may be needed to improve screening performance. In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool can work very well for residents’ education, as shown by Shaw and Tan [ ]. Using a smartphone app to improve internal medicine residents’ knowledge of CRC screening is a novel idea and worked very well in our study.
Our response rate was good, but our study was limited by being a single-center study with a small sample size. This intervention can be expanded to other institutions to determine the validity of our results in a multicenter setting. In addition, this study did not check whether the residents’ improved knowledge translated into their clinical practice in terms of an improved CRC screening rate. A multi-institutional study is being planned, and the original study will be expanded to determine the app’s effect on the screening rate. Here it is important to mention that, although this study was not intended to observe a change in practice, a few residents reported that the app was a readily available tool on their smartphone and was helpful to them when they encountered the issue of CRC screening of their patients in an outpatient setting.
While residents seem knowledgeable about colonoscopic CRC screening in average-risk patients, we found significant deficiencies in other areas of the comprehensive evaluation. A smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening. A smartphone-based educational tool can be a part of residents’ orientation before the start of their residency to reinforce their knowledge about age-appropriate and specific screenings.
ZK designed the study, developed the smartphone app, collected data, conducted statistical analysis, drafted the manuscript, did critical revision, and approved the final manuscript. UD, MN, BK, YAA, and YA collected data and drafted the manuscript. MAK designed the study, collected data, and critically revised the study. WB did statistical analysis and drafted the manuscript. TS and AN did a critical revision for intellectual content and gave final approval of the manuscript.
Conflicts of Interest
Multimedia Appendix 1
Survey form emailed via SurveyMonkey to residents.PDF File (Adobe PDF File), 33KB
Multimedia Appendix 2
Screening in average-risk patients and with a positive family history of colorectal cancer.PDF File (Adobe PDF File), 24KB
Multimedia Appendix 3
Identification of colorectal cancer screening tests.PDF File (Adobe PDF File), 32KB
Multimedia Appendix 4
Identification of colorectal cancer prevention methods.PDF File (Adobe PDF File), 31KB
Multimedia Appendix 5
Identification of colorectal cancer detection methods.PDF File (Adobe PDF File), 29KB
Multimedia Appendix 6
Identification of positive tests to be followed by colonoscopy.PDF File (Adobe PDF File), 33KB
Multimedia Appendix 7
Identification of follow-up after colonoscopy.PDF File (Adobe PDF File), 32KB
Multimedia Appendix 8
Identification of surveillance for colorectal cancer in various diseases.PDF File (Adobe PDF File), 30KB
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|ACS: American Cancer Society|
|ACG: American College of Gastroenterology|
|CRC: colorectal cancer|
|CT: computed tomography|
|FIT: fecal immunochemical test|
|PGY: postgraduate year|
|USPSTF: US Preventive Services Task Force|
Edited by G Eysenbach; submitted 11.12.17; peer-reviewed by A Koskan, W Leclercq, I Wani; comments to author 24.01.18; revised version received 11.02.18; accepted 11.02.18; published 13.03.18
©Zubair Khan, Umar Darr, Muhammad Ali Khan, Mohamad Nawras, Basmah Khalil, Yousef Abdel-Aziz, Yaseen Alastal, William Barnett, Thomas Sodeman, Ali Nawras. Originally published in JMIR Medical Education (http://mededu.jmir.org), 13.03.2018.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on http://mededu.jmir.org/, as well as this copyright and license information must be included.

Foilsithe ar 13.03.18 i dTeach 4, Uimh. 1 (2018): Eanáir-Meitheamh
Tá réamhphriontaí (leaganacha níos luaithe) den pháipéar seo ar fáil ag http://preprints.jmir.org/preprint/9635, a foilsíodh den chéad uair an 11 Nollaig 2017.
Measúnú ar an eolas a bhaineann le scagadh ar ailse colórach ag baint úsáide as aip fón cliste: Staidéar píolótach
Cúlra: Is é ailse colórctal (CRC) an tríú cineál ailse is coitianta agus an dara cúis is mó de bhás ailse sna Stáit Aontaithe. Ní bhíonn thart ar duine as gach triúr daoine fásta sna Stáit Aontaithe ag déanamh scagadh CRC mar a mholtar. Tá easpa eolais ag cónaitheoirí leighis inmheánacha maidir le scagadh CRC.
Cuspóir: Ba é cuspóir ár staidéir feabhas a mheas i measc cónaitheoirí i gcógas inmheánach eolas scagthástála CRC trí chur chuige píolótach ag baint úsáide as app fón cliste.
Modhanna: D'eagraíomar ceistneoir bunaithe ar threoirlínte scagthástála CRC de chuid an American Cancer Society, American College of Gastroenterology, agus Tascfhórsa Seirbhísí Cosanta na SA. Chuir muid an cheistneoir ar ríomhphost trí nasc SurveyMonkey chuig gach cónaitheoir de roinn leigheas inmheánach chun a gcuid eolais ar threoirlínte scagála CRC a mheas. Ansin, d'eagraíomar idirghabháil oideachasúil i bhfoirm aip fón cliste ina bhfuil an t-eolas go léir faoi threoirlínte scagála CRC. Tugadh an aip ar na cónaitheoirí agus iarradh orthu é a íoslódáil ar a gcuid fón cliste. Rinneamar an suirbhé arís chun athruithe i eolas na n-áitritheoirí a thástáil tar éis an aip fón cliste a fhoilsiú agus rinneamar comparáid idir na freagraí agus an suirbhé roimhe seo. Rinneamar tástáil chi-chearnach Pearson agus tástáil chruinn Fisher chun tábhacht staidrimh a lorg.
Torthaí: Chuir 50 duine den daonra an chéad suirbhé i gcrích agus chuir 41 duine an dara suirbhé i gcrích tar éis an aip a fhoilsiú. Ba iad réimsí scagthástála CRC a léirigh feabhas suntasach go staitistiúil (P<. 05) an aois a thosaigh scagthástáil CRC i Meiriceánaigh Afracacha, tástálacha coisctheacha a ordú ar dtús, tástálacha scagthástála CRC a shainaithint, a shainaithint modhanna coisctheacha agus braite, leanúint suas le tástálacha dearfacha le colonoscopy, leantach tar éis torthaí colonoscopy, agus faireachán CRC i ghalair.
Conclúidí: Sa ré nua-aimseartha seo de fhóin chliste agus gaistí, is smaoineamh nua é app nó uirlis oideachais bunaithe ar fhóin chliste a fhorbairt agus is féidir leis cabhrú le feabhas a chur ar eolas na n-áitritheoirí faoi scagadh CRC.
JMIR Med Educ 2018;4(1):e10
- ailse colorectal;
- scagadh ar ailse;
- ailse a bhrath go luath;
- oideachas na n-áitritheoirí;
- feidhmchláir soghluaiste
Is é ailse colorectal (CRC) an tríú ailse is coitianta a dhiagnóisiú i measc fir agus mná sna Stáit Aontaithe. Is é an dara cúis is mó de bhás a bhaineann le hailse ar an iomlán. Tá rátaí teagmhála agus báis ag titim mar gheall ar fheasacht mhéadaithe ar fhachtóirí riosca amhail caitheamh tobac agus tomhaltas feola dearga, agus feabhas ar rátaí scagthástála agus ar mhodhanna cóireála [- ]. De réir an American Cancer Society (ACS), bhíthar ag súil go dtarlódh 135,430 cás nua agus 50,260 bás ó CRC in 2017, agus is é an baol ar feadh an tsaoil CRC a fhorbairt thart ar 1 as 21 (4.7%) d'fhir agus 1 as 23 (4.4%) do mhná [ ]. Tá bainistíocht CRC bainteach le costais chúnamh sláinte suntasacha, le caiteachas náisiúnta os cionn US $ 14 billiún in aghaidh na bliana [ , ]. Tá difríochtaí suntasacha ann de réir aoise, cine agus fo-áit tumor in ainneoin laghdú ar iontráil agus ar bháis CRC san iomlán. Is féidir an sprioc a bhaineann le hionchais agus bású CRC a laghdú tuilleadh a bhaint amach trí rochtain ar chúram sláinte ardchaighdeáin a chinntiú, stiúir a thabhairt ar stíl mhaireachtála sláintiúil, agus scagadh CRC a mhéadú. Meester agus a chomhghleacaithe agus daoine eile measta gur chuirfeadh sé cosc ar 277,000 cás CRC agus 203,000 bás faoi 2030 [ -  ], tar éis sprioc Thábla Cuardaigh Náisiúnta Ailse Colorectal na Stát Aontaithe a bhaint amach maidir le forleithne scagála a mhéadú go 80% faoi 2018. Ní bhíonn thart ar duine as gach triúr daoine fásta sna Stáit Aontaithe ag déanamh scagadh CRC mar a mholtar. De réir Suirbhé Náisiúnta Idirghabhála Sláinte na SA, tháinig méadú ó 34% i 2000 go 63% i 2015 ar scagadh CRC i gcomhréir leis na treoirlínte i measc daoine fásta 50 bliain d'aois agus níos sine [ ].
Go ginearálta, táthar ag súil go dtiocfaidh feabhas ar rátaí scagadh CRC de réir mar a théann dochtúirí cónaitheoirí chun cinn ina hoiliúint, agus go dtiocfaidh feabhas ar an eolas a bhíonn acu ar scagadh CRC. Rinne Wong torthaí feidhmíochta a thomhas i gcatagóirí scagadh iomadúla thar 3 bliana oiliúna agus fuair sé go raibh rátaí scagadh iarbhír na n-othar cosúil thar na blianta go léir . D'fhéadfadh go mbeadh eolas easnamh na n-áitritheoirí faoi scagadh CRC ar cheann de na cúiseanna leis an easpa feabhsaithe seo i scagadh CRC, cé go bhfuil treoirlínte ón gColáiste Mheiriceá Gastroenterology (ACG), ACS, agus Tascfhórsa Seirbhísí Coscála na Stát Aontaithe (USPSTF) i gcomhaontú den chuid is mó maidir le modhanna scagadh agus aois [ - ]. Rinne Akerman et al [ ] measúnú ar eolas na n-áitritheoirí maidir le scagadh CRC trí shuirbhé ar líne agus tháinig siad ar an gconclúid go raibh go leor easnaimh ann. Chinn siad go bhfuil tástáil fola oculta fecal chun críocha scagála fós faoi mheas, agus go leanann mearbhall ar an tástáil a riaradh. Ní mór an idirdhealú idir scagadh agus cosc a neartú tuilleadh [ ].
Tá cúram sláinte bunscoile a bhaineann le go leor daonra nach bhfuil seirbhís mhaith á fháil acu ag brath ar chleachtais ospidéil chónaitheacha. Rinneadh measúnú ar ról an liachta atá i mbun oiliúna i gcothabháil agus scagadh sláinte trí staidéir éagsúla [- ]. D'fhéadfadh go mbeadh tosca eile freagrach as an idirbheart maidir le cothabháil agus scagadh sláinte éifeachtach i gcleachtas cónaitheoirí chomh maith le heasnaimh eolais cónaitheoirí. D'fhéadfadh go mbeadh an láimhdeachas soláthraithe gach cúpla bliain ar cheann de na tosca sin. Measann roinnt staidéir fiú go gcailltear suas le 50% de othair chun leanúint ar aghaidh lena riochtaí leighis ainsealacha agus scagthástálacha nuair a bhíonn lianna cónaitheacha céim amach agus a gcuid othair a tharchur chuig soláthraithe nua [ ].
Chomh maith le dul i ngleic le tosca eile chun feabhas a chur ar chothabháil sláinte agus scagadh i gcleachtas na n-áitritheoirí, is é an eochair feabhas a chur ar an eolas leighis faoi shláinte choscála agus scagadh. Ceann de na cúiseanna a bhfuil eolas easnamh ag cónaitheoirí faoi scagadh CRC ná easpa oiliúna agus uirlisí oideachais. Rinneamar an staidéar cuimsitheach seo chun feabhas a chur ar eolas cónaitheoirí leigheas inmheánach maidir le scagadh CRC trí chur chuige píolótach a úsáideann aip smartphone.
Cuireadh an staidéar píolótach seo i gcrích i 3 chuid. Ar dtús, d'eagraíomar ceistneoir bunaithe ar threoirlínte scagthástála CRC an ACS, ACG, agus USPSTF; d'iarramar ceadúnas an bhoird athbhreithnithe institiúideach ansin. Thug an bord athbhreithnithe institiúideach de chuid Ionad Leighis Ollscoil Toledo an t-iarratas ar cheadú i ndiaidh athbhreithniú a dhéanamh ar an aip agus ar an gceistcheist suirbhé (uimh. 201713). Bhí 14 cheist sa suirbhé ar 7 réimse de scagadh CRC, léiríonn an suirbhé seo. Chuir muid an cheistneoir trí ríomhphost trí nasc SurveyMonkey (SurveyMonkey Inc, San Mateo, CA) chuig gach cónaitheoir de roinn leigheas inmheánach. Rinneamar anailís ar na freagraí tar éis 4 sheachtain. Ní raibh sa chéad cheist ach an bhliain oiliúna, chun fo-shraith a chruthú le haghaidh anailíse de réir na bliana oiliúna. Bhí an cumas ag na freagróirí freagra a thabhairt le roghanna iomadúla cearta do roinnt ceisteanna, ag léiriú na roghanna iomadúla a chuirtear i láthair sna treoirlínte foinse. léiríonn an fhoirm suirbhé.
Sa dara cuid, rinneamar aip fón cliste. Bhí an cinneadh chun aip fón cliste a úsáid le haghaidh oideachais go hiomlán turgnamhach agus bhí sé bunaithe ar an dul chun cinn le déanaí i dteicneolaíocht na bhfón cliste agus na ngléasra agus an fás ina dhiaidh sin ar thionscal na bpróiseála app fón cliste. Ar dtús, bhailímid faisnéis faoi scagadh CRC bunaithe ar threoirlínte ACG, ACS, agus USPSTF, agus ansin rinneamar crann scagadh bunaithe ar an bhfaisnéis seo. Bhí an crann scáileáin comhdhéanta de 9 scáileáin san iomlán, lena n-áirítear an príomhscáileáin, mar, , , agus taispeáint. Cruthaíodh an aip fón cliste ar phortal cruthaithe app ar líne (Mobincube, San Francisco, CA, SAM). Dearbhaíomar an aip ag cur simplíocht san áireamh agus ag cinntiú go bhfuil an fhaisnéis le feiceáil go maith. Bhí an síntiús tairseach a fuair muid le haghaidh an app a chruthú agus a fhoilsiú gan fógraí chun aon choimhlintí leasa a sheachaint. Rinneamar tástáil ar an leagan trialach den aip ar fhón cliste agus ar phláinéid sula foilsíodh é.
Ansin, chuir muid an aip ar an Google Developers Console (Google Inc, Mountain View, CA, USA) agus d'fhoilsigh muid é ar Google Play Store (Google Inc) d'úsáideoirí Android. Chuir muid an aip chuig tacaíocht Apple freisin chun tástáil a dhéanamh sula bhfoilseofar é san App Store (Apple Inc, Cupertino, CA, SAM). Tugadh an aip do na cónaitheoirí go léir trí ríomhphoist agus trí phléireacha. Rinneamar rian ar líon na n-uaslódálacha app trí chuntas forbartha i Play Store agus i App Store araon. Bhí an aip oideachasúil go hiomlán agus ní raibh aon chomhpháirteanna idirghníomhacha san aip. Ba é cuspóir an aip eolas na n-áitritheoirí a fheabhsú maidir le scagadh CRC.
Sa tríú cuid agus sa chuid dheireanach, rinneamar an suirbhé arís tar éis 4 sheachtain agus rinneamar comparáid idir na freagraí agus iad siúd sa chéad suirbhé. Seoltar meabhrúcháin seachtainiúla chuig cónaitheoirí chun an dá suirbhé a chomhlánú. Níor thugamar aon spreagadh do chónaitheoirí na suirbhéanna a chomhlánú. Rinneamar tástáil chi-chearnach Pearson agus tástáil chruinn Fisher chun tábhacht staidrimh a lorg.
Rátaí Freagra ar an Suirbhé
Rinneamar anailís agus comparáid idir na sonraí i 3 fho-shraith. Sa chéad fho-sórt, rinneamar comparáid idir freagraí na n-fhreagróirí ar cheisteanna an suirbhé sa bhliain oiliúna céanna chun feabhas ar an eolas a chinneadh i ngach bliain oiliúna ar leithligh tar éis an aip fón cliste a fhoilsiú. Sa dara anailís fo-sóite, rinneamar comparáid idir freagraí idir gach ceann de na 3 bhliain oiliúna cónaitheach (ie, bliain iarchéime [PGY]-1, PGY-2, agus PGY-3) chun difríochtaí i dtaithí a lorg idir leibhéil oiliúna éagsúla ag bunlíne agus difríochtaí i bhfeabhsú eolais tar éis foilsiú an aip fón cliste. Sa tríú anailís dheireanach, rinneamar anailís ar fhreagraí go forleathan chun feabhas forleathan ar eolas a lorg.
Chuir muid nasc an suirbhé chuig 59 cónaitheoir le linn an chéad chéim agus thugamar 4 sheachtain chun an suirbhé a chríochnú, agus cuireadh meabhrúcháin seachtainiúla ar fáil trí ríomhphost. Chuir 50 duine san iomlán an suirbhé i gcrích, agus bhí ráta freagartha 85% acu. I measc na 50 freagróir, bhí 22 cónaitheoir PGY-1, 15 cónaitheoir PGY-2 agus 13 cónaitheoir PGY-3. Tar éis an aip a fhoilsiú, chuir muid an nasc suirbhé ar ríomhphost arís. D'fhreagair 41 cónaitheoir san iomlán an dara suirbhé, le haghaidh ráta freagartha de 69%; de na freagróirí, bhí 20 cónaitheoir PGY-1, 11 cónaitheoir PGY-2 agus 10 cónaitheoir PGY-3.
Measúnú ar Chónaitheoirí  Eolas
Bhí an t-eolas a bhí ag na cónaitheoirí faoi scagadh CRC i ndaltaí a raibh riosca meánach acu agus a raibh CRC ina stair teaghlaigh acu, á mheasúnú sna chéad chúpla ceist suirbhé. D'aithin an chuid is mó de na cónaitheoirí go ceart an aois scagála i gcás na n-othair sin. Bhí easpa eolais ag na cónaitheoirí faoi mholadh ACG chun triail a thosú le haghaidh CRC i Meiriceánaigh Afracacha ag aois 45 bliana. Ach tar éis dóibh an aip fón cliste a úsáid, tháinig feabhas suntasach ar a gcuid eolais, ó 4 chónaitheoir (8%) amháin a d'fhreagair i gceart sula n-úsáidtear an aip go dtí 29 chónaitheoir (71%) a d'fhreagair i gceart tar éis an aip a úsáid (P<.001). Cé nach raibh sé suntasach ó thaobh staidrimh de, tháinig feabhas ar an eolas maidir le tástálacha coisctheacha a thairiscint ar dtús (P=. 01) agus colonoscopy a thairiscint gach 5 bliana d' othair a bhfuil stair teaghlaigh CRC acu i gcairde den chéad chéim atá níos lú ná 60 bliain d' aois (P=.17) go léir.
Nuair a iarradh orthu modail scagthástála a aithint le haghaidh scagthástáil CRC, bhí eolas ag go leor cónaitheoirí faoi na tástálacha éagsúla is féidir a thairiscint. D' éirigh líon na bhfreagraí ceart a léiríonn a gcuid eolais faoi colúnagrafaíocht tomagrafaíochta ríomhaireachta (CT) gach 5 bliana, enema báire dúbailte-choimeádais gach 5 bliana, sigmoidoscópáil gach 10 mbliana le tástáil inimhiocimic fecal bliantúil sa bhaile, agus tástáil DNA fecal gach 1 go 3 bliana le suntas staidrimh tar éis idirghabhála (). Rinne na cónaitheoirí tástáil freisin ar a gcumas tástálacha coisctheacha a aithint, ar féidir leo leo leoinmneacha polipoideacha réamh-ailseacha a bhrath. Ní raibh an chuid is mó de na cónaitheoirí in ann colonoscopy a aithint gach 10 mbliana mar thástáil choscála ag tús an chórais, ach tar éis an idirghabhála, aithin níos mó acu, ag gach leibhéal oiliúna, sigmoidoscopy solúbtha gach 5 bliana, colonography CT gach 5 bliana, agus enema báiream dhá-choinbhleacht gach 5 bliana mar thástálacha coscála ( ).
Ní féidir le modhanna braite ach CRC a bhrath; ní féidir leo é a chosc mar a dhéanann modhanna coscála trí léisiúin polipoid réamh-ailseacha a bhrath. Is iad na modhanna braite a bhaineann le CRC ná tástálacha scagála CRC atá bunaithe ar an stoc. Ní raibh eolas na n-áitritheoirí maidir le modhanna braite a shainaithint go ceart sásúil ag tús an phróisis ach tháinig feabhas suntasach orthu tar éis oideachas a fháil leis an aip, agus bhí siad in ann tástáil bhliantúil imdhíonachta fecal, tástáil fola occult fecal sa bhaile, agus tástáil DNA fecal gach 1 go 3 bliana a aithint mar mhodhanna braite CRC (). D'fhéadfadh an chuid is mó de na cónaitheoirí sigmoidoscopy agus tástáil fola occult fecal a aithint mar na tástálacha a bheidh le leanúint le colonoscopy má tá toradh dearfach an tástála. Ag tús an staidéir, ní raibh a fhios ag gach duine go gcaithfear colonoscóp a dhéanamh freisin tar éis torthaí dearfacha ar colonagrafaíocht CT, enema báire dúbailte-choimeádach, tástáil imdhíonachta fecal, agus tástáil DNA fecal. Tar éis dóibh an aip fón cliste a úsáid, áfach, d'aithin níos mó de na cónaitheoirí go raibh gá le colonoscóp a dhéanamh i ndiaidh na dtástálacha sin ( ).
Rinne na cónaitheoirí tástáil freisin ar an leanúint-suas a mholtar tar éis scagadh colonoscopy. Go ginearálta, ní raibh eolas na n-áitritheoirí sásúil maidir le tréimhsí leantacha 10 bliana i gcás póilíní mionsonraithe mionsonraithe beaga a bheith le fáil, 5 bliana i gcás 1 nó 2 adenoma beag tubular, 3 bliana i gcás 3 go 10 adenoma, 1 go 3 bliana i gcás níos mó ná 10 adenoma, agus 2 go 6 mhí i gcás adenomaí sessile. Bhí feabhas ar an eolas, ach ní raibh sé seo suntasach ó thaobh staidrimh ach i gcás eolas faoi leanúint adenomas sessile agus níos mó ná 10 adenomas (). Ar deireadh, d'iarradh ar chónaitheoirí faireachán a dhéanamh ar CRC i bpoilipós adenomatous teaghlaigh, i siondróm Lynch, agus i ghalair athlastach an intestine. Bhí easpa eolais ag cónaitheoirí maidir le faireachán ar CRC i bpoiliposis adenomatous teaghlaigh sular úsáideadh an aip smartphone ach feabhsaíodh go suntasach tar éis an idirghabhála oideachais ( ).
Tá an chuid is mó de na moltaí maidir le scagadh CRC ó ACG, ACS, agus USPSTF cosúil. Chun ár staidéar, rinneamar na comhpháirteanna a bhaint agus níor thástáil muid ach moltaí a bhí cosúil idir na treoirlínte seo go léir. Seachas na heagraíochtaí seo, foilsíonn daoine eile treoirlínte freisin, a chuireann an chuid is mó acu na moltaí a luaitear cheana féin a neartú, ach déanann siad roinnt moltaí nua freisin, ag cur leis an mearbhall do chónaitheoirí agus do ghairmithe cúraim sláinte eile. Le déanaí, rinne an Tascfhórsa Il-Sochaí Mheiriceá ar Ailse Colorectal moltaí nua, ina roinn siad na tástálacha scagála ina thrí thrí ar bhonn gnéithe feidhmíochta, costais, agus machnamh praiticiúil . Sa staidéar a rinneamar, rinneamar tástáil ar eolas na n-ionadaithe chun na tástálacha scagála seo a aithint ach níor rinneamar tástáil ar na tástálacha seo a roinnt ina dtrí thréimhse.
Léirigh ár staidéar, is cuma cé chomh oiliúna a bhí acu, go raibh easpa eolais ag cónaitheoirí i roinn amháin leighis inmheánaí faoi scagadh CRC. Tá an toradh seo ag teacht le Sharma et al [, ], a rinne imscrúdú ar an tuiscint ar scagadh CRC i measc lianna príomhchothabhála agus internists. Ní raibh aon difríocht i eolas na n-áitritheoirí idir an bunlíne agus tar éis an idirghabhála oideachais i bhfoirm app fón cliste: tháinig feabhas ar an eolas go cothrom i measc na 3 leibhéal PGY. Tá an toradh seo comhoiriúnach le staidéar a rinneadh in 2005 [ ], nach léirigh aon difríocht shuntasach ó thaobh staidrimh de i rátaí scagála CRC idir blianta éagsúla oiliúna.
Bhí ár staidéar difriúil ó na cinn a tuairiscíodh roimhe sin, ar an gcéad dul síos, bhí an staidéar againn an-chuimsitheach agus chlúdaigh sé gach gné de scagadh CRC agus, ar an dara dul síos, d'úsáid sé cur chuige nua app smartphone chun oideachas a thabhairt do na cónaitheoirí. Ní dhéantar staidéar a thuairiscigh roimhe seo, mar shampla staidéar Akerman et al , ach amháin chun tástálacha scagthástála CRC a shainaithint. Chomh maith le tástáil a dhéanamh ar eolas faoi scagadh CRC i n-othair atá i mbaol meán agus a bhfuil stair teaghlaigh CRC acu, rinneamar tástáil freisin ar an gcoincheap tábhachtach maidir le difríocht idir tástálacha cosc agus braite, a aithnítear i dtreoirlínte ACG agus ACS. Bhí easpa eolais ag cónaitheoirí i réimsí eile scagadh CRC, mar shampla tástálacha seachas colonoscopy a shainaithint, scagadh i n-othair Mheiriceá Afracacha, leanúint suas tástálacha dearfacha le colonoscopy, leanúint suas tar éis torthaí colonoscopy, agus faireachán ar CRC i ghalair éagsúla mar polyposis adenomatous teaghlaigh, siondróm Lynch, agus galar inchinn athlastach.
Léirigh ár staidéar go raibh eolas ag cónaitheoirí maidir le scagadh ar othair a bhfuil riosca meánmhéide acu le colonoscopy ag aois 50 bliain agus iad siúd a bhfuil stair teaghlaigh CRC acu. Ós rud é go luaitear i dtreoirlínte ACS gur chóir colonoscopy a thairiscint ag aois 40 bliain d' othair a bhfuil stair teaghlaigh CRC acu i gcairde den chéad chéim ag aois 60 bliain nó níos sine agus a luaitear i dtreoirlínte ACG gur chóir go mbeadh an scagadh i ndaoine seo mar an gcéanna le haghaidh othair ar riosca meán, mheasamar go raibh an dá fhreagra ceart inár anailís suirbhé. Ba iad na réimsí a léirigh feabhas ar eolas tar éis an aip fón cliste a úsáid na tástálacha scagthástála CRC go léir a shainaithint i gceart, idirdhealú a dhéanamh idir tástálacha cosanta agus braite, agus na tástálacha seo a shainaithint i gceart. Chomh maith leis sin, léirigh torthaí an suirbhéigh feabhas ar an eolas faoi thástálacha scagála a chaithfear a leanúint le colonoscopy má tá toradh dearfach an tástála. Ba iad na réimsí nach ndearnadh mórán feabhsaithe orthu ná leanúint colonoscópáil scagála i gcás ina bhfaightear torthaí, chomh maith le faireachán ar CRC i ghalair éagsúla.
Tá sé tábhachtach go mbeadh eolas ag cónaitheoirí faoi mhodhanna scagála CRC malartacha, toisc nach mian le roinnt othair colonoscopes a bheith acu mar gheall ar nádúr ionrach an tástála. Ní féidir le cónaitheoirí modhanna eile, nach bhfuil chomh ionrach sin a thairiscint ach amháin má tá eolas acu faoi. Cé go bhfuil méadú tagtha ar úsáid colonoscópithe sgríbeacha le cúpla bliain anuas, tá sé i bhfad ó sprioc na nTaibléad Domhanda um Ailse Colórach Colórach 80% a bhaint amach faoi 2018, agus tá feasacht ar mhodhanna malartacha tábhachtach chun an sprioc seo a bhaint amach. Tá sé tábhachtach go mbeadh a fhios ag cónaitheoirí faoi leantach tar éis torthaí colonoscopy agus faireachán ar CRC i ghalair éagsúla, mar go ndéanann cónaitheoirí cúram de bhunriachtanais na n-othair seo sa chlinic sa deireadh.
Tá straitéisí oideachais éagsúla curtha i bhfeidhm san am atá thart chun feabhas a chur ar an eolas maidir le scagadh CRC, ó léachtaí didachtacha, mar a léiríonn Lane et al , go samhail idirghníomhach bunaithe ar chás, mar a léiríonn Schroy et al [ ]. Tá an t-eolas a fuarthas ó na modhanna oideachais seo feabhsaithe éagsúil, agus d'fhéadfadh go mbeadh gá le hiontrálacha breise chun feabhas a chur ar fheidhmíocht na sgríbe. Sa ré nua-aimseartha seo de fhóin chliste agus gaistí, is féidir le feidhmchlár nó uirlis oideachais bunaithe ar fhón cliste a fhorbairt a bheith ag obair go han-mhaith d'oideachas cónaitheoirí, mar a léiríonn Shaw agus Tan [ ]. Is smaoineamh nua é feidhmchlár smartphone a úsáid chun eolas cónaitheoirí leighis inmheánacha a fheabhsú maidir le scagadh CRC agus d'oibrigh sé go han-mhaith inár staidéar.
Bhí an ráta freagartha go maith, ach bhí teorainn ag ár staidéar mar go raibh staidéar ar ionad amháin ann agus go raibh méid samplach beag ann. Is féidir an idirghabháil seo a leathnú go hinstitiúidí eile chun bailíocht ár dtorthaí a chinneadh i suíomh il-ionad. Ina theannta sin, níor sheiceáil an staidéar seo an raibh an t-eolas feabhsaithe a bhí ag na cónaitheoirí á aistriú ina gcleachtas cliniciúil i dtéarmaí ráta scagála CRC feabhsaithe. Tá staidéar il-institiúideach á phleanáil, agus leathnófar an staidéar bunaidh chun éifeacht an aip ar ráta scagadh a chinneadh. Tá sé tábhachtach a lua anseo, cé nach raibh sé i gceist leis an staidéar seo athrú a fheiceáil sa chleachtas, gur thuairiscigh cúpla cónaitheoir go raibh an aip ar uirlis atá ar fáil go héasca ar a gcuid fón cliste agus go raibh sé cabhrach dóibh nuair a tháinig siad ar cheist scagadh CRC a gcuid othair i suíomh othair seachtracha.
Cé gur cosúil go bhfuil eolas ag cónaitheoirí faoi scagadh CRC colonoscopic i n-othair atá i meánriosca, fuair muid easnaimh shuntasacha i réimsí eile den mheastóireacht chuimsitheach. Is smaoineamh nua é aip nó uirlis oideachais atá bunaithe ar fhón cliste agus is féidir leis cabhrú le feabhas a chur ar eolas na n-áitritheoirí faoi scagadh CRC. Is féidir le huirlis oideachais ar fhón cliste a bheith mar chuid de threoir na n-ionadaithe roimh thús a n-ionadaíochta chun a gcuid eolais a threisiú maidir le scagthástálacha atá oiriúnach d'aois agus sonracha.
Dearbhaigh ZK an staidéar, d'fhorbair sé an aip fón cliste, bailíodh sonraí, rinne sé anailís staidrimh, d'fhorbair sé an lámhscríbhinn, rinne sé athbhreithniú criticiúil, agus cheadaigh sé an lámhscríbhinn deiridh. Ba é UD, MN, BK, YAA, agus YA na daoine a bhailiú sonraí agus a dhréacht an lámhscríbhinn. D'eagraigh MAK an staidéar, bailíodh sonraí, agus d'athbhreithnigh sé an staidéar go criticiúil. Rinne WB anailís staidrimh agus d'eagraigh sé an lámhscríbhinn. Rinne TS agus AN athbhreithniú criticiúil ar ábhar intleachtúil agus thug siad cead deiridh don lámhscríbhinn.
Comhtháthaithe Suim
Iarscríbhinn 1 um Ilmheán
Foirm suirbhé a chuirtear chuig cónaitheoirí trí ríomhphost trí SurveyMonkey.Faile PDF (Adobe PDF File), 33KB
Leas-Mheide 2
Screening i n-othair atá i meánriosca agus a bhfuil stair teaghlaigh dearfach ailse colorectal acu.Faile PDF (Adobe PDF File), 24KB
Iarscríbhinn 3 um Ilmheán
Tástálacha scagthástála ailse colorectal a shainaithint.Faile PDF (Adobe PDF File), 32KB
Leas-Mheide 4
Meáin chun ailse colorrectal a chosc a shainaithint.Faile PDF (Adobe PDF File), 31KB
Leas-Mheide 5
Meánanna chun ailse colorrectal a bhrath a shainaithint.Faile PDF (Adobe PDF File), 29KB
Leas-Mheide 6
Déanfar tástálacha dearfacha a shainaithint le colonoscóp a leanúint.Faile PDF (Adobe PDF File), 33KB
Leas-Mheide 7
Aithint na leantacha tar éis colonoscopy.PDF File (Adobe PDF File), 32KB
Leas-Mheide 8
Aithint faireachán ar ailse colorectal i ghalair éagsúla.Faile PDF (Adobe PDF File), 30KB
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ACS: American Cancer Society a bhí
ACG: American Coláiste Gastroenterology
CRC: ailse colorectal
CT: tomagraf ríomhaireachta
FIT: tástáil imdhíoncheimiceach fecal
PGY: bliain iarchéime
USPSTF: US Foras Tasc Seirbhísí Coscála
Arna eagarthú ag G Eysenbach; curtha isteach 11.12.17; athbhreithnithe ag A Koskan, W Leclercq, I Wani; tuairimí don údar 24.01.18; an leagan athbhreithnithe a fuarthas 11.02.18; glacadh 11.02.18; foilsithe 13.03.18
© Zubair Khan, Umar Darr, Muhammad Ali Khan, Mohamad Nawras, Basmah Khalil, Yousef Abdel-Aziz, Yaseen Alastal, William Barnett, Thomas Sodeman, Ali Nawras. Foilsíodh ar dtús i JMIR Medical Education (http://mededu.jmir.org), 13.03.2018.
Is alt rochtana oscailte é seo a dháileadh faoi théarmaí an Cheadúnais Creatúnais Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/), a cheadaíonn úsáid, dáileadh agus atáirgeadh gan srian in aon mheán, ar choinníoll go gcuirtear an obair bhunaidh, a foilsíodh den chéad uair i JMIR Medical Education, i láthair go cuí. Ní mór an fhaisnéis leabharlainne iomlán, nasc chuig an bhfoilseachán bunaidh ar http://mededu.jmir.org/, chomh maith leis an bhfaisnéis seo faoi chóipcheart agus ceadúnas a bheith san áireamh.


The urban farms sprouting up and across cities around the world aren’t just feeding mouths—they are “critical to survival” and a “necessary adaptation” for developing regions and a changing climate, according to a new study.
Urban farms—which include plain ol’ allotments, indoor vertical farms and rooftop gardens nestled amongst busy streets and skyscrapers—have become increasingly popular and important as the world’s population grows and more and more people move to cities.
The United Nations predicts that by 2030, two-thirds of the world’s population will be living in cities, with the urban population in developing countries doubling. That’s a lot of mouths to feed.
The new paper, published in the journal Earth’s Future and led by the Arizona State University and Google, finds that this expected urban population boom will benefit from urban farming in multiple ways.
As the Thomson Reuters Foundation explained from the study, “Urban farms could supply almost the entire recommended consumption of vegetables for city dwellers, while cutting food waste and reducing emissions from the transportation of agricultural products.”
According to the study, urban agriculture can help solve a host of urban environmental problems, from increasing vegetation cover (thus contributing to a decrease in the urban heat island intensity), improving the livability of cities, and providing enhanced food security to more than half of Earth’s population.
After analyzing multiple datasets in Google Earth Engine, the researchers calculated that the existing vegetation on urban farms around the world already provides some $33 billion annually in services from biocontrol, pollination, climate regulation and soil formation.
The future of urban agriculture has even more potential, the researchers found.
“We project potential annual food production of 100–180 million tonnes, energy savings ranging from 14 to 15 billion kilowatt hours, nitrogen sequestration between 100,000 and 170,000 tonnes, and avoided storm water runoff between 45 and 57 billion cubic meters annually,” the authors wrote.
“In addition, we estimate that food production, nitrogen fixation, energy savings, pollination, climate regulation, soil formation and biological control of pests could be worth as much as $80–160 billion annually in a scenario of intense [urban agriculture] implementation.”
Others have praised urban farming for its many benefits.
“Urban agriculture won’t resolve all food production and distribution problems, but it could help take pressure off rural land while providing other advantages,” wrote environmentalist Dr. David Suzuki.
He cited an example of how one patch of Detroit land, where 12 vacant houses were removed to grow food, “has supplied almost 200,000 kilograms of produce for 2,000 local families, provided volunteer experience to 8,000 residents and brought the area new investment and increased safety.”
“Local and urban agriculture can also help reduce greenhouse gas emissions and recycle nutrient-rich food scraps, plant debris and other ‘wastes,'” Suzuki continued. “Because maintaining lawns for little more than aesthetic value requires lots of water, energy for upkeep and often pesticides and fertilizers, converting them to food gardens makes sense.”
Writer and former Vancouver city councillor Peter Ladner also wrote in The Urban Food Revolution: Changing the Way We Feed Cities, “When urban agriculture flourishes, our children are healthier and smarter about what they eat, fewer people are hungry, more local jobs are created, local economies are stronger, our neighborhoods are greener and safer, and our communities are more inclusive.”

Tá feirmeacha uirbeacha ag fás suas agus ar fud cathracha ar fud an domhain nach bhfuil ach ag beathaint béilí - tá siad "criticiúil chun maireachtáil" agus "oiriúnú riachtanach" do réigiúin atá ag forbairt agus do chlima atá ag athrú, de réir staidéir nua.
Tá feirmeacha uirbeacha - lena n-áirítear allotmentí plain ol, feirmeacha ingearacha faoi thalamh agus gairdíní ar uachtar a bhfuil siad suite i measc sráideanna gnóthacha agus skyscrapers - ag éirí níos coitianta agus níos tábhachtaí de réir mar a fhásann daonra an domhain agus a théann níos mó agus níos mó daoine go cathracha.
Táthar ag súil go mbeidh dhá thrian de dhaonra an domhain ina gcónaí i gcathracha faoi 2030, agus go mbeidh an daonra uirbeach i dtíortha i mbéal forbartha ag dul in éag. Sin a lán de na béal a chothú.
Faigheann an páipéar nua, a foilsíodh sa iris Earth's Future agus a bhí faoi stiúir Ollscoil Stáit Arizona agus Google, go mbainfidh an borradh daonra uirbeach a bhfuiltear ag súil leis tairbhe as feirmeoireacht uirbeach ar bhealaí éagsúla.
Mar a mhínigh Fondúireacht Thomson Reuters ón staidéar, D'fhéadfadh feirmeacha uirbeacha tomhaltas glasraí beagnach iomlán na gceannairí cathrach a mholtar a sholáthar, agus dramhaíl bia a laghdú agus astaíochtaí ó thras-iompar táirgí talmhaíochta a laghdú.
De réir an staidéir, is féidir le talmhaíocht uirbeach cuidiú le go leor fadhbanna comhshaoil uirbeacha a réiteach, ó chlúdach plandaíochta a mhéadú (ag cur leis sin le laghdú ar an déine oileán teasa uirbeach), feabhas a chur ar inláimhsitheacht na gcathracha, agus slándáil bhia feabhsaithe a sholáthar do níos mó ná leath de dhaonra na Domhain.
Tar éis anailís a dhéanamh ar shraith sonraí i Google Earth Engine, rinne na taighdeoirí a ríomh go soláthraíonn na plandaí atá ann cheana féin ar fheirmeacha uirbeacha ar fud an domhain thart ar $ 33 billiún in aghaidh na bliana i seirbhísí ó bithrialú, pollú, rialáil aeráide agus foirmiú ithreach.
Tá níos mó féidearthachta ag feirmeoireacht uirbeach sa todhchaí, a fuair na taighdeoirí.
"Táthar ag súil go mbeidh táirgeadh bia bliantúil féideartha de 100-180 milliún tonna, go sábhálfar 14 go 15 billiún kilowatt uair an chloig fuinnimh, go ndéanfar idir 100,000 agus 170,000 tonna nítrigine a chealú, agus go seachnófar sreabhadh uisce stoirme idir 45 agus 57 billiún méadar ciúbach in aghaidh na bliana", a scríobh na húdair.
 Ina theannta sin, meastar go bhféadfadh táirgeadh bia, socrú nítrigine, sábháil fuinnimh, pollú, rialáil aeráide, foirmiú ithir agus rialú bitheolaíoch na n-easláin a bheith fiú $80160 billiún in aghaidh na bliana i gcás cur chun feidhme dian [talmhaíochta uirbeach].
Tá daoine eile tar éis moladh a thabhairt don fheirmeoireacht uirbeach mar gheall ar a chuid buntáistí iomadúla.
"Ní réitíonn talmhaíocht uirbeach gach fadhb maidir le táirgeadh agus dáileadh bia, ach d'fhéadfadh sé cabhrú le brú a bhaint as talamh tuaithe agus buntáistí eile a sholáthar", a scríobh an comhshaoil Dr. David Suzuki.
Thug sé sampla de conas a chuir sé leath amháin de thalamh Detroit, áit a ndearnadh 12 teach folamh a bhaint chun bia a fhás,  beagnach 200,000 cileagram táirge ar fáil do 2,000 teaghlach áitiúil, taithí dheonach a sholáthar do 8,000 cónaitheoir agus infheistíocht nua agus sábháilteacht níos mó a thabhairt don cheantar.
'Is féidir le talmhaíocht áitiúla agus uirbeach cuidiú freisin le hastaíochtaí gás ceaptha teasa a laghdú agus le haiscéimeanna bia atá saibhir i gcothaithigh, le scriosanna plandaí agus le 'dramhaíl' eile a athchúrsáil,' a dúirt Suzuki. Toisc nach gá go leor uisce, fuinnimh le haghaidh cothabhála agus go minic lotnaidicídí agus leasacháin chun gairdíní a chothabháil ar mhaithe le luach beag níos mó ná ealaíne, tá sé ciallmhar iad a thiontú go gairdíní bia.
Scríobh an scríbhneoir agus iar chomhairleoir cathrach Vancouver Peter Ladner freisin sa The Urban Food Revolution: Changing the Way We Feed Cities, "Nuair a fhásann talmhaíocht uirbeach, tá ár gcuid leanaí níos sláintiúla agus níos cliste faoi na rudaí a itheann siad, tá níos lú daoine gortaithe, cruthaítear níos mó post áitiúil, tá geilleagair áitiúla níos láidre, tá ár gcomharsanachtaí níos glaise agus níos sábháilte, agus tá ár bpobail níos cuimsithí".