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By: Bertram G. Katzung MD, PhD

  • Professor Emeritus, Department of Cellular & Molecular Pharmacology, University of California, San Francisco

This presses the skirt very well and keeps the shine off and will cheap motegrity 1mg free shipping, I think cheap motegrity 1 mg visa, give more satisfaction than if pressed with a damp cloth or ironed on the wrong side generic motegrity 2mg otc. The music cabinet was full to buy discount motegrity 2mg on line overflowing and there was no closet shelf that could be utilized, as so often happens in an ordinary house. An unused shirtwaist box was suggested and has been found to answer every purpose, besides providing an extra seat when such a seat was desirable. The box seems to fit in as an article of furnishing and the reason for its being there would never be asked. No danger with the bottle thus equipped of taking by mistake, in the dark, the dangerous medicine. An ordinary china teacup is half filled with cottonseed oil, the little floating wick placed in this, and a match touched to the upright wick. While the sides of the cup prevent thc direct light of the flame being visible to the person in bed, a pleasant dim light is cast over the room. Sew back and forth, leaving a small space in the center, three or four times where the buttonhole is wanted, and cut in the space left, being careful not to cut the stitching. In making little dresses, or slips after the skirts are sewed up, attach the gatherer to the machine and gather the top and bottom of sleeves and skirt. When the steak is to be used without being ground, select only tender, young, pinkish pieces; otherwise it will be tough in spite of prolonged cooking. Do not use anything that comes handy, but get squares of five-cent cheese cloth or silkoline, fold a neat hem, and whip it nicely around, then turn and go back the other way. The goods takes up dust very readily, and is easily rinsed out; or a piece can be thrown away without waste. The coffee may then be put away as usual, and when used it will be found as clear as amber. Take two thicknesses, cut in squares, bind all around with some bias pieces left from calico dresses and sew a brass ring on one corner. When the outside is dry and hot remove the loaf and it can scarcely be detected from a new one. She cut the felt so that it would just come together, not overlap anywhere, and caught the edges together with close stitches. It bids fair to last her as long again, and it is certain that just now the wringer does as good work as any new one. If the flour is shaken all over the grease, and the tins rapped, you will have no difficulty with sticky cakes which break when you try to get them out. Get a clean wooden box with a thick bottom, from your grocer and use it instead of your bowl. Pin together to form a ring, slip over the burner, and all the heat will be concentrated where wanted. Have a tiny cupboard with tight closing door, or a well-fitted curtain, and there is gain in looks and convenience. Such "loaded" covers do not blow off easily, consequently they save quite a bit of annoyance and laundering. If the label comes off or is discolored, the marker remains as a warning that the bottle contains poison. The odor will soon evaporate if the article is exposed to the air for a short time. Ravelings from these pieces are invaluable for mending old cloths, and ought to be saved for that purpose, 87. This not only gives a nice, smooth finish and makes the ironing easier, but it prevents the starch from boiling over. The sheets and bed clothes are constantly pulling out at the foot, so one day I sewed three buttons on to my mattress with strong thread, and worked buttonholes in the hems of the sheets to correspond, and since then have not had trouble with their pulling up in the middle of the night. This is also excellent for bathing an invalid as it greatly hastens the work and lessens the danger of catching cold. It acts like a charm for the child who dreads a bath, this is usually a nervous child who does not like the feeling of the towel, on the wet surface of its skin; complains of feeling damp; and refuses to don its clothing when a less sensitive child would be perfectly comfortable. He caught up the velvet in a hurry one day to take a spot off a shoe, and now has it laid away as a treasure in his shoe kit. He says it is the best polisher he ever had, and uses it on my fine shoes to his own entire satisfaction. I have a small vestpocket note book hanging by a string and pencil near my kitchen range. When groceries are purchased, the date, article and price are noted, and summed up at the end of each month. It makes a handy, permanent record, showing how long supplies last, the expense of one month compared with another, and the monthly average of each year. She took a common red brick, topped it with a flat oblong cushion size and shape of the brick, covering the whole neatly with a bright chintz cover. This standing on the edge of her cutting table was in constant use, and proved a great convenience. It was to leave the last three loops loose enough so that I could pass the thread back through them after completing the eyelet. This obviates the necessity of any knots that are so unsightly, and at the same time, the thread is firmly secured. It is a great scheme, and saves a lot of needles, as I have proved to my own satisfaction. This arrangement saves time in dressing the little ones and their upper and lower petticoats are always of the same length and set evenly. On each of the six days in the week one room is thoroughly cleaned and put in order.

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As an astringent effective 1mg motegrity, Yarrow has been used to order motegrity 1 mg otc treat diarrhea order 1mg motegrity with amex, especially mucous diarrhea generic motegrity 2mg fast delivery, hemorrhoids and excessive menstruation and bladder conditions, particularly relating to involuntary urination in children. It is thought to lower blood pressure, help hypertension and protect against thrombosis after a stroke or heart attack. It is also believed to relax peripheral blood vessels and be good for thrombotic conditions, whereby a blood clot blocks a blood vessel or is formed in a heart cavity. Treatment: Considered an anti-inflammatory with pain-relieving qualities, Yarrow has been used to help ease the discomforts of rheumatism, gout and arthritis, and provide relief for menstrual pain and headache. Modern research confirms the historical use of Yarrow as a pain reliever for many conditions. Sterols and triterpenes stop the inflammatory processes, restore circulation and accelerate healing. These compounds stop the formation of enzymes for chemical reactions that cause inflammation and pain. The sesquiterpene lactones stop the action of pain-provoking hormones called prostaglandins. Yarrow has been used for centuries as a haemostatic, an agent that controls or stops the flow of blood. It has been used internally to control hemorrhaging from the lungs and the bowels, among other applications. Externally, the herb has been a reliable remedy for healing wounds and arresting the blood flow from shaving cuts, nosebleeds, etc. Because it is believed to be so effective and quick when used in this manner, it is always wise to clean a cut first (before applying Yarrow), because the herb may begin the healing process while the dirt and infection are still within the wound. In recent tests, Yarrow demonstrated antibiotic and antibacterial qualities that appeared to kill many kinds of bacteria found on human skin and destroyed pain-causing infection. It was also effective against yeast infections and microbial infections and boils. When used externally, Yarrow makes an excellent tonic lotion for oily skin (with eruptions), inflamed eyes, ulcers and wounds, and is a fine addition to a relaxing bath and steam facial. Precautions: Pregnant or nursing women should not use Yarrow, as it is a uterine stimulant, nor should women with heavy periods or pelvic inflammatory disease. Continued or long-term use of Yarrow may cause skin irritation and/or allergic reactions. If using Yarrow to treat wounds, be sure to clean the affected area first, as the herb can stop blood flow so quickly that it may seal in dirt or other contaminants. Pink eye usually makes you feel like you have something in one or both of your eyes that you cannot remove. Swelling causes small blood vessels in the conjunctiva to become more prominent, resulting in a pink or red spread to the whites of your eyes. Pink eye and red eye are conditions commonly used to refer to all Types: of conjunctivitis. Pink eye is an irritating infection to have to experience; it hardly ever affects your sight. This is especially important for preschool-age children, who commonly develop both viral and bacterial conjunctivitis. Diagnosis Your doctor may take a sample of eye secretions from the conjunctiva for laboratory analysis to find out which form of infection you have and to decide on the best way to treat it. If you have a young infant with recurrent pink eye or persistent eye tearing, your child may have a blocked tear duct. With either form of medicine, you should notice an improvement within one to two days. Like a common cold, you can use an over-the-counter remedy to relieve some Symptoms, but the virus just has to run its course. It may take up to two to three weeks from the time; you were infected for the virus to go away. If the irritation is allergic conjunctivitis, your doctor may prescribe one of many different Types: of eye drops. Prevention Practicing good hygiene is the best way to control the spread of pink eye. Usually after the pus comes out then you will notice that the sty then will begin to disappear. Tearing Causes the cause of a sty is a bacterial infection, usually staphylococcus. Diagnosis If the Symptoms of a sty continue or if you have had several infections, your doctor may want to rule out other possible causes. If a sty is ruled out, your doctor may refer you to an ophthalmologist for further tests and treatment. An ophthalmologist is a medical doctor who can provide complete eye and vision care. The balance center of the inner ear then sends information to the brain that conflicts with the visual clues of actually standing still in the inside cabin of a ship or airplane. Nausea, which may progress to vomiting From one third to one-half of airline passengers will experience some degree of motion sickness when encountering heavy turbulence. It can strike suddenly, progressing from a feeling of restlessness to a cold sweat, dizziness and then vomiting. For longer trips, a prescription medication called Transderm-Scop comes in the form of a patch can be worn behind the ear for up to three days at a time. Side effects of these medications usually consist of sedation and dry mouth and they should not be taken by people who have glaucoma or urinary obstruction.

The which shews buy motegrity 1mg free shipping, that the Contagion of the Plague depends more upon the Disposition of the Air buy 2mg motegrity with visa, then upon the Effluvia from the Bodies of Men order motegrity 2 mg fast delivery. Which also we prove by the sudden jumps discount motegrity 1 mg mastercard, which the Plague hath made, leaping in one Week from 118 to 927: and back again from 993 to 258: and from thence again the very next Week to 852. The which effects must surely be rather attributed to change of the Air, then of the Constitution of Mens bodies, otherwise then as this depends upon that. It may be also noted, that many times other Pestilential Diseases, as Purple-Feavers, Small-Pox, &c. T There have been Buried from the year 1628, to the year 1662, exclusive, 209436 Males, and but 190474 Females: but it will be objected, that in London it may indeed be so, though otherwise elsewhere; because London is the great Stage and Shop of business, wherein the Masculine Sex bears the greatest part. But we Answer, That there have been also Christned within the same time, 139782 Males, and but 130866 Females, and that the Country Accompts are consonant enough to those of London upon this matter. What the Causes hereof are, we shall not trouble our selves to conjecture, as in other Cases, onely we shall desire, that Travellers would enquire whether it be the same in other Countries. We should have given an Accompt, how in every Age these proportions change here, but that we have Bills of distinction but for 32 years, so that we shall pass from hence to some inferences from this Conclusion; as first, I. That Christian Religion, prohibiting Polygamy, is more agreeable to the Law of Nature, that is the Law of God, then Mahumetism, and others, that . The obvious Objection hereunto is, That one Horse, Bull, or Ram, having each of them many Females, do promote increase. To which I Answer, That although perhaps there be naturally, even of these species, moreMales then Females, yet artificially, that is, by making Geldings, Oxen, and Weathers, there are fewer. From whence it will follow, That when by experience it is found how many Ews (suppose twenty) one Ram will serve, we may know what proportion of male-Lambs to castrate, or geld, viz. And this I take to be truest Reason, why Foxes, Wolves, and other Vermin Animals that are not gelt, increase not faster then Sheep, when as so many thousands of these are daily Butchered, and very few of the other die otherwise then of themselves. We have hitherto said there are more Males, then Females; we say next, That the one exceed the other by about a thirteenth part; so that although more men die violent deaths then women, that is, more are slain in Wars, killed by mischance, drowned . And lastly, more remain unmarried, then of women, as Fellows of Colleges, and Apprentises, above eighteen, &c. Moreover, although a man be Proflique fourty years, and a woman but five and twenty, which makes the males to be as 560 to 325 Females, yet the causes above named, and the later marriage of the men, reduce all to an equality. It appearing, that there were fourteen men to thirteen women, and that they die in the same proportion also, yet I have heard Physicians say, that they have two women Patients to one man, which Assertion seems very likely; for that women have either the Green sickness, or other like Distempers, are sick of Breedings, Abortions, Child-bearing, Sore-breasts, Whites, Obstructions, Fits of the Mother, and the like. Now, from this it should follow, that more women should die then men, if the number of Burials answered in proportion to that of Sicknesses: but this must be salved, either by the alledging, that the Physicians cure those Sicknesses, so as few more die, then if none were sick; or else that men, being more intemperate then women, die as much by reason of their Vices, as the women do by the Infirmitie of their Sex, and consequently, more Males being born, then Females, more also die. Another pregnant Argument to the same purpose (which hath already been touched on) is, That although in the very year of the Plague, the Christnings decreased, by the dying and flying of Teeming women, yet the very next year after, they increased somewhat, but the second after, to as full a number as in the second year before the said Plague: for I say again, if there be encouragement for an hundred in London, that is a Way how an hundred may live better then in the Countrey, and if there be void housing there to receive them, the evacuating of a 1/4th, or 1/3 part of that number, must soon be supplied out of the Countrey; so as, the great Plague doth not lessen the Inhabitants of the City, but of the Countrey, who in a short time remove themselves from hence thither, so long, untill the City for want of receit and encouragement, regurgitates and sends them back. From the difference between Males and Females, we see the reason of making Eunuchs in those places where Polygamy is allowed, the latter being useless as to multiplication, without the former, as was said before in the case of Sheep and other Animals, usually gelt in these Countries. By consequence, this practise of Castracon serves as well to promote increase as to meliorate the Flesh of those Beasts that suffer it. For that Operation is equally practised upon Horses which are not used for Food, as upon those that are. In Popish Countries where Polygamy is forbidden, if a greater number of Males oblige themselves to C? Now, if the same proportion of women oblige themselves to a single life likewise, then such obligation makes no change in the matter of encrease. From what hath been said, appears the reason why the Law is, and ought to be so strict against Fornications and Adulteries, for if there were universal liberty, the Increase of Man-kind would be but like that of Foxes at best. Now forasmuch as Princes are not only Powerfull but Rich, according to the number of their People (Hands being the Father, as Lands are the Mother, and Womb of Wealth) it is no wonder why states by encouraging Marriage, and hindering Licentiousness, advance their own Interest, as well as preserve the Laws of God from contempt, and Violation. It is a Blessing to Man-kind, that by this overplus of Males there is this natural Bar to Polygamy: for in such a state Women could not live in that parity, and equality of expence with their Husbands, as now, and here they do. The reason whereof is, not, that the Husband cannot maintain as splendidly three, as one; for he might, having three Wives, live himself upon a quarter of his Income, that is in a parity with all three, as-well as, having but one, live in the same parity at half with her alone: but rather, because that to keep them all quiet with each other, and himself, he must keep them all in great aw, and less splendor, which power he having will probably use it to keep them all as low, as he pleases, and at no more cost then makes for his own pleasure; the poorest Subjects (such as this plurality of Wives must be) being the most easily governed. Mthat of the 229250 which have died, we find not above fifty one to have been starved, excepting helpless Infants at Nurse, which being caused rather by carelessness, ignorance, and infirmity of the Milch-women, is not properly an effect, or sign of want of food in the Countrey, or of means to get it. The Observation, which I shall add hereunto, is, That the vast numbers of Beggars, swarming up and down this City, do all live, and seem to be most of them healthy and strong; whereupon I make this Question, Whether, since they do all live by Begging, that is, without any kind of labour; it were not better for the State to keep them, even although they earned nothing; that so they might live regularly, and not in that Debauchery, as many Beggars do; and that they might be cured of their bodily Impotencies, or taught to work, &c. To this some may Object; That Beggars are now maintained by voluntary Contributions, whereas in the other way the same must be done by a ge . To which we Answer; That in Holland, although no where fewer Beggars appear to charm up commiseration in the credulous, yet no where is there greater, or more frequent Charity: onely indeed the Magistrate is both the Beggar, and the disposer of what is gotten by begging; so as all Givers have a moral certainty, that their Charity shall be well applied. Moreover, I question; Whether what we give to a Wretch, that shews us lamentable sores, and mutilations, be always out of the purest charity? But most men will laugh to hear us suppose, That any able to work (as indeed most Beggars are, in one kind of measure, or another) should be kept without earning anything. But we Answer, That if there be but a certain proportion of work to be done; and that the same be already done by the not-Beggars; then to employ the Beggars about it, will but transfer the want from one hand to another; nor can a Learner work so cheap as a skilfull practised Artist can. The Reasons of this we conceive to be Two; One is the Government, and guard of the City by Citizens themselves, and that alternately. And the other is, the natural, and customary abhorrence of that inhumane Crime, and all Bloodshed by most Englishmen: for of all that are Executed few are for Murther. Besides the great and frequent Revolutions, and Changes of Government since the year 1650, have been with little bloodshed; the Usurpers themselves having Executed few in comparison, upon the . In brief, when any dead Body is found in England, no Algebraist, or Uncipherer of Letters, can use more subtile suppositions, and varietie of conjectures to finde out the Demonstration, or Cipher; then every common unconcerned Person doth to finde out the Murtherers, and that for ever, untill it be done. So that, this Casualty being so uncertain, I shall not force my self to make any inference from the numbers, and proportions we finde in our Bills concerning it: onely I dare ensure any man at this present, well in his Wits, for one in the thousand, that he shall not die a Lunatick in Bedlam, within these seven years, because I finde not above one in about one thousand five hundred have done so. The like use may be made of the Accompts of men, that made away themselves, who are another sort of Madmen, that think to ease themselves of pain by leaping into Hell; or else are yet more Mad, so as to think there is no such place; or that men may go to rest by death, though they die in self-murther, the greatest Sin. We shall say nothing of the numbers of those, that have been Crowned, Killed by falls from Scaffolds, or by Carts running over them, &c.

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If necessary motegrity 2mg with amex, stimulate the rectum mildly; this can be done by holding the baby over a small chamber at exactly the same time after a meal each day and insert into the bowel a small cone of oiled paper buy generic motegrity 1 mg on line, or use a small castile soap suppository purchase motegrity 1 mg fast delivery. The child should not be allowed to purchase motegrity 1 mg otc go longer than twenty-four hours without a passage. A enema made up of one or two tablespoonfuls of sweet oil may be given with a bulb syringe, or an ounce of warm water to which has been added one-half teaspoonful of glycerin, or one-half pint of warm soap-suds. Begin at the right side groin and make a series of circular movements with your fingers, lightly at first, and then press down harder as the baby becomes accustomed to it; work your way up gradually to the ribs, then across to the ribs on the left side, and down to the left groin. This can be done twice daily for eight or ten minutes at a time, and always at the same time of day, but never soon after a meal. Olive oil may safely be given for constipation to a baby,-from twenty drops to one teaspoonful one or two times daily, but castor oil should not be given for constipation, as after a time it leaves the baby more constipated than ever. For older children, decrease the amount of white bread, toast, potatoes, and give green vegetables, oatmeal, and graham bread instead, with plenty of proper fruit twice daily; raw, scraped apples are sometimes the best fruit to use. Rid the system of the irritating matter by giving the baby one teaspoonful of castor oil. Then stop all solid food and give boiled water if there is only a moderate looseness. If the attack is more severe and attended by fever and vomiting all food and milk should be stopped at once in children of all ages, and only broth, barley water or some thin gruel given. In severe attacks with vomiting or frequent foul stools, stop all food for at least twelve hours and all milk for a longer time, and the bowels should be freely moved by a cathartic. Give baby one teaspoonful every one-half hour, and if he vomits all other food, give two ounces every two hours; barley gruel, wheat flour gruel, mutton broth may be given also. The soda and the peppermint will tone up the stomach and relieve any trouble present there, while the rhubarb will act on the bowels and carry off all impurities. You should always be suspicious if your baby has no teeth at the end of the first year. A hearty baby should have six or eight, and if the soft spot in the head just above the forehead is as much open as it was for months previously you should be doubly suspicious. This soft spot should be closed in a well-nourished infant between the fifteenth and twentieth months. If in addition to this the child sweats about the head whenever it sleeps, cries whenever it is handled (unless it has scurvy or rheumatism) and does not like to play, the indications of rickets are very nearly conclusive. Nursing babies who have a healthy mother are not troubled with this disease unless she nurses too long into the second year. Starchy foods, too little milk or other animal food, taking the infant to the family table and allowing it to eat whatever it wants, these are the most common errors in baby feeding which very often result in rickets. Babies who are brought up on condensed milk, or other foods that contain little fat are likely to have rickets. Insufficient clothing, damp and badly ventilated buildings, a lack of out-door air and sunshine, and inherited constitutional weakness, are other causes. The chest is poorly shaped and frequently has depressions at the sides, and little nodules or "beads" in the ribs where the ribs and breast-bone join. It is often very flat on the top and measures more around than a normal child at the same age. His abdomen is generally large and prominent, pot belly; his muscles are soft and flabby, and his wrists and ankles are enlarged a little later. He is pale and anemic, although he may be plump and fat, and when he begins to walk his legs bend easily, and he will have bow-legs. When he sits, his back will look as if curved and this alarms his parents, who may think his spine is diseased. If you recognize the condition, have the baby attended to immediately by a physician. A baby ten to twelve months old can suck a piece of boiled bacon for a few minutes every day. Give him his tub bath daily, and if he is apt to take cold easily he should have a little cold water dashed over his chest and spine, followed by a gentle brisk rubbing to start up the circulation. Cod liver oil alone with calcarea phosphoricum 3X (homeopathic) is splendid treatment also. It attacks infants who have been fed for a long time on a proprietary food or else on milk that has been over sterilized. The first symptoms a mother notices is that it seems to hurt very much when his legs are touched; sometimes both hurt, and then again only one is painful; at other times the arms will be most painful and again both arms and legs seem to pain alike. So it goes on; the joints enlarge somewhat and sometimes little red spots appear just under the skin and very often the gums will become red and spongy; this is especially noticeable around the incisor teeth of the upper gums, if they have already appeared. Stop the patent food at once, or if the milk has been sterilized, it must be discontinued and the baby put on unsterilized milk diluted to the proper strength for his special age. Strained juice of an orange should be given him every day; if under six months he can have the juice of one-half an orange; over that the juice of one orange. No matter how much or little they eat there is a constant wasting or fading away of the body. Syphilis, tuberculosis, chronic vomiting, persistent loose bowels, poor assimilation of the food. Convulsions may be due to brain trouble, but an overloaded stomach is the first thing a doctor thinks of, and so the mother should remember what was eaten that might be unusual. If the doctor can not be present soon, give baby a mustard foot bath in bed; use two tablespoonfuls to a gallon of water, some advise stronger. Have plenty of hot water ready, so the doctor can give a full tub bath when he comes, if he thinks it necessary. If the child can swallow, give him a teaspoonful of castor oil; or if the convulsions continue, wash out the bowels or give an injection as soon as possible.

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Anecdotal evidence from smaller New Zealand centres suggests that follow-up is shared effectively between primary care and specialist care using an online system effective 2 mg motegrity. It was agreed that the question of who should provide follow-up and where this should take place was really about access to purchase motegrity 2mg without a prescription scanning services motegrity 2mg without prescription. The group agreed that closing these gaps should be addressed by the team providing treatment discount motegrity 1 mg mastercard. Horizon scanning One protocol was identifed for a randomised controlled trial comparing follow-up conducted by surgeons compared with general practitioners. Management of early colorectal cancer 83 Chapter 12: Synoptic reporting Minimum data set for synoptic reporting Clinical question: What is the minimum data set for synoptic reporting? Pathological reporting Pathological reporting of resection specimens for colorectal cancer provides important information both for the clinical management of the affected patient and for the evaluation of health care systems as a whole. For the patient, it confrms the diagnosis and describes the variables that will affect prognosis, which will inform future clinical management. For health care evaluation, pathology reports provide information for cancer registries and clinical audit, for ensuring comparability of patient groups in clinical trials, and for assessing the accuracy of new diagnostic tests and preoperative staging techniques. In order to fulfl all of these functions, the information contained within the pathology report must be accurate and complete. Benefts of structured reporting Structured pathology reports with standardised defnitions for each component have been shown to signifcantly improve the completeness and quality of data provided to clinicians, and have been recommended both in North America and the United Kingdom. Several studies have highlighted defciencies in the content of colorectal cancer resection reports, including elements that are considered crucial for patient management. Many studies have shown that adherence to a checklist for colorectal cancer reporting signifcantly improves the rate of inclusion of these crucial features. There is no evidence that synoptic reporting makes a difference in terms of patient outcomes but a further consideration is what is done with the information in regard to patient management. Adrian Balasingham is the director of the Christchurch Radiology Group and collaborated academically with Professor Frank Frizelle. Teresa Lynch received fnancial support from the New Zealand Nurses Organisation to attend the Masters of Health Science in 2006 and from the Christchurch Gastro Day Unit to attend the Gastro Conference in 2004, 2005, 2006, 2007 and 2008 and is the bodytalk practitioner/trainee instructor for the Integrative Holistic Health System. Clinton Teague is a consultant pathologist at Aotea Pathology Ltd, a clinical lecturer in pathology at the Wellington School of Medicine & Health Sciences, and a member of the Ministry of Health Bowel Cancer Taskforce and has shares in Abano Healthcare Ltd and Sonic Healthcare Ltd. Iain Ward received fnancial support from Roche to attend the American Society of Clinical Oncology Conference in 2007. Guideline development process this section overviews the research methodology utilised during the development of this guideline. It describes how the clinical questions were developed, how the systematic and narrative reviews were undertaken, and the process by which the reviewed evidence was developed into recommendations. Scope the guideline aims to cover adults with early colorectal cancer clinically managed within secondary and tertiary healthcare settings. The issues of colorectal cancer screening in asymptomatic people or the prevention of colorectal cancer in the general population were excluded. The clinical management of people with advanced or metastatic disease, children or adolescents with colorectal cancer and high-risk familial colorectal cancer syndromes were also excluded from this guideline. These priority areas are those where practice varies widely, and/or there are gaps between practice and current evidence, and the development of recommendations would likely improve outcomes. In some cases (such as in the case of this guideline), an existing guideline is identifed as the starting point for developing guidance in these prioritised areas. In determining how best to use content from the existing guideline and reduce replication, a number of issues are considered. Firstly, there may be areas across that guideline where more recent evidence is available. However, a review of the evidence is not deemed critical if the recommended course of action is likely to remain the same as in the current guideline. However, new questions might only be proposed if it is clear that developing new recommendations would have a major impact on signifcant patient outcomes. A consequence of this strategic approach is that the guideline panels are not always able to form recommendations in all areas. Participants: People with colorectal cancer pre and post-surgery Interventions: Multidisciplinary team Comparison: Usual care Outcomes: Mortality, morbidity, survival, compliance with recommendations, protocols and standard practice Chapter 3: Preoperative assessments. Participants: People undergoing surgery for colorectal cancer Interventions: High-volume surgeons and hospitals Comparison: Low-volume surgeons and hospitals Outcomes: Mortality, survival, perioperative deaths, morbidity, respiratory and cardiac outcomes, complications 92 Management of early colorectal cancer Appendix 1: Guideline development Chapter 7: Elective surgery for rectal cancer. Participants: People undergoing surgery for colorectal cancer Interventions: High-volume surgeons and hospitals Comparison: Low-volume surgeons and hospitals Outcomes: Mortality, survival, perioperative deaths, morbidity, respiratory and cardiac outcomes, complications Chapter 8: Emergency surgery. Participants: People with colorectal cancer and bowel obstruction Interventions: Stent Comparison: Surgery Outcomes: Morbidity, survival Chapter 9: Adjuvant therapy for colon cancer. In patients with completely resected colorectal cancer, what is the effect of postoperative chemotherapy on survival at fve years? Participants: People with resected colon cancer Interventions: Any postoperative chemotherapy regimen Comparison: No postoperative chemotherapy/surveillance Outcomes: Overall survival, disease-free survival, recurrence, adverse events. In patients with completely resected colorectal cancer, what is the effect of adding other cytotoxic agents to postoperative fuoropyrimidine-based chemotherapy on survival at fve years? Participants: People with locally advanced rectal cancer Interventions: Short-course preoperative radiotherapy regimen (25 Gy in 5 fractions) Comparison: Long-course preoperative or postoperative chemoradiation (45?50 Gy in 25?28 fractions) Outcomes: Local recurrence, overall survival, disease-free survival Chapter 11: Follow-up after curative resection. Participants: People with locally advanced rectal cancer Interventions: Hospital, specialist, nurse specialist Comparison: General practitioner Outcomes: Local recurrence, mortality Other areas identifed as needing New Zealand?specifc content were narratively reviewed. These included epidemiological data for New Zealand, cultural disparities, supportive and rehabilitative care, and staging and reporting. In lieu of a formal systematic review, only good practice points were formulated for these sections.

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