No abstract

Recent drought in the Sahel has focussed attention on the important role played by natural resources in the rural economy and, together with the increasing environmental awareness of donors, has spawned a series of field projects aimed at improving the management of existing natural resources. This paper is a working document; a contribution to the discussion of how to evaluate the success or failure of natural resource management projects and of whether important components of successful projects can be replicated elsewhere.

Primary sclerosing cholangitis (PSC) is a progressive liver disease seen predominantly in patients who also have inflammatory bowel disease. PSC is characterised by inflammation and fibrosis of the intra- and extra-hepatic biliary ducts leading to progressive cholestasis, and it frequently leads to decompensated liver disease, necessitating liver transplantation. Patients with PSC and IBD have a predisposition to developing cancer, particularly in the colon and biliary tree. There are no available treatments for PSC; however, the efficacy of simtuzumab and obeticholic acid are being investigated. This article presents evidence and guidelines for screening and early detection of colorectal carcinoma, cholangiocarcinoma and gallbladder cancer, as well as other malignancies, including hepatocellular carcinoma and pancreatic cancer. Nurses have an important role in remaining vigilant for signs of cancer and helping patients make more informed decisions.