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A 90 year-old man underwent endoscopic mucosal resection for lesions in the descending and sigmoid colons as well as endoscopic submucosal dissection (ESD) for a lesion in the rectal peritoneal reflection (Ra) 1 month before undergoing laparoscopic resection and D3 dissection for advanced cancer in the descending colon. One year later, he underwent a surveillance colonoscopy, and advanced colorectal cancer was detected on the ESD scar. The history suggested that this newly detected recurrent colorectal neoplasm on the ESD scar may have originated from cancer cells derived from the descending colon cancer that were implanted in the ESD ulcer, thereby initiating a new colorectal neoplasm. Cancer genomic testing further indicated that three of the four pathogenic variants detected in the recurrent colorectal neoplasm were consistent with pathogenic variants of descending colon cancer. This finding strongly supports our contention that cancer cells derived from the descending colon cancer were implanted in the post-ESD ulcer of the rectal Ra and proliferated, forming the recurrent colorectal neoplasm. This case report highlights the potential for tumor cell implantation on endoscopic resection ulcers and the utility of cancer genomic testing in validating this phenomenon. [ABSTRACT FROM AUTHOR]

Primary care is the basic level of care, where patients start their treatment journey. Proactive management at primary care level improves health access and quality of care through proactive approach for specific patient sub-groups, improves integration of care at different levels of the health care system, and improves patient outcomes. The aim of the study was to describe family nursesâ perceptions of high-risk patientsâ proactive management and identify further training needs; therefore, a descriptive and empirical two-stage study design was used. A convenience sample of 16 family nurses was recruited in the first stage. The study was conducted at five Estonian primary health centers. Data were collected by Modified Patient Assessment of Chronic Illness Care (MPACIC) online questionnaire between September and December 2020. Ethical approval was obtained. The nurses evaluated their proactive management of high-risk patients positively. Higher results were related to patient support, encouragement, involvement in everyday care, and individual goal setting questions. Lower results were related to referral to professionals, follow-up visits, and suggesting specific health related programs and events from which the patients could benefit. As a second stage of the study, a training program was developed based on the acquired results and training was conducted for 18 nurses at one primary health center, where care management has been used since 2017. The training program was found to be useful. Nurses need specific knowledge about the proactive management and care plan of high-risk patients, which can be ensured through systematic training. The subject of nursesâ perceptions could benefit from further study by qualitative methods.

The increasing prevalence of cancer and the decreasing number of oncology specialists in Europe's workforce have led patients having to self-manage their conditions with the help of a health care professional. Ensuring cancer patients' good understanding of molecular profiling data is crucial for their active participation in illness-related decisions. Although shared decision making improves patients' knowledge and consideration of their needs, several difficulties remain in implementing shared decision making in cancer care. The objective of the research is to examine the relationship between sociodemographic aspects and knowledge of cancer-related topics and willingness to participate in cancer care. A cross-sectional study using a web-based questionnaire was conducted, including 1066 respondents among the population of Estonia. Logistic regression was used to answer research questions. There is a lack of knowledge and willingness of patients and their relatives to participate in shared decision making. Unlike in previous studies, higher readiness was observed among the ethnic minority and rural citizens. In addition to the factors previously identified, there is a need to consider a potential role of cultural and historical background of the health care system in determining the willingness and readiness of the general public to participate in shared decision making. These findings highlight the potential uniqueness of societies, in which paternalistic and autonomous approaches to patient care clash, and similar results may be found in other countries with a Soviet legacy. If there is a lack of readiness or willingness of a patient to participate, a physician should provide alternative means of support. [ABSTRACT FROM AUTHOR]