1
|
Niccum BA, Coughlin S, Clay D, Heiman J, Buckley KH, Dungan M, Daniel MG, Ruiz J, Maxwell KN, Domchek SM, Leung G, Ahmad NA, Ginsberg GG, Kochman ML, Katona BW. Prevalence of H. pylori and gastric intestinal metaplasia in BRCA1 and BRCA2 carriers. Cancer Prev Res (Phila) 2024:743154. [PMID: 38641403 DOI: 10.1158/1940-6207.capr-24-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BRCA1 and BRCA2 carriers may be at increased risk for gastric cancer (GC), however the mechanisms of gastric carcinogenesis remain poorly understood. We sought to determine the prevalence of GC risk factors Helicobacter pylori (H. pylori) infection and gastric intestinal metaplasia (GIM) among BRCA1/2 carriers to gain insight into the pathogenesis of GC in this population. 100 unselected BRCA1/2 carriers undergoing endoscopic ultrasound from 3/2022-3/2023 underwent concomitant upper endoscopy with non-targeted gastric antrum and body biopsies. The study population (70% women; mean age: 60.1) included 66% BRCA2 carriers. H. pylori was detected in one (1%) individual, 7 (7%) had GIM, 2 (2%) had autoimmune atrophic gastritis, and no GCs were diagnosed. Among BRCA1/2 carriers, H. pylori prevalence was low and GIM prevalence was similar to the general population, however identification of H. pylori or GIM may help inform future GC risk management strategies in BRCA1/2 carriers.
Collapse
Affiliation(s)
- Blake A Niccum
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah Coughlin
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Clay
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jordan Heiman
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kole H Buckley
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michaela Dungan
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael G Daniel
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jose Ruiz
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kara N Maxwell
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Galen Leung
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Nuzhat A Ahmad
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Michael L Kochman
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Bryson W Katona
- Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
2
|
Fudman DI, Perez-Reyes AE, Niccum BA, Melmed GY, Khalili H. Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review. Clin Gastroenterol Hepatol 2022; 20:1947-1970.e7. [PMID: 34481951 DOI: 10.1016/j.cgh.2021.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel disease (IBD) care and outcomes exhibit substantial variability, suggesting quality gaps. We aimed to identify interventions to narrow these gaps. METHODS We performed a systematic review of Medline, Embase, and Web of Science through May 2021 to find manuscripts and abstracts reporting quality improvement (QI) interventions in IBD. We included studies with interventions that addressed acute care utilization, vaccination, or Crohn's and Colitis Foundation quality indicators for care processes, including pre-therapy testing, tobacco cessation, colorectal cancer surveillance, Clostridium difficile infection screening in flares, sigmoidoscopy in patients hospitalized with ulcerative colitis, and use of steroid-sparing therapy. The primary objective was to identify successful QI interventions. Risk of bias assessment was conducted using the Joanna Briggs Institute critical appraisal checklist. RESULTS Twenty-three manuscripts and 23 meeting abstracts met inclusion criteria. Influenza and pneumococcal vaccination were the most studied indicators (24 references), followed by emergency room and/or hospital utilization, tobacco cessation, and pre-therapy testing (17, 11, and 10 references, respectively). Electronic medical record-based interventions were the most frequent, whereas other initiatives used strategies that included changes to care structure or delivery, vaccination protocols, or physician and patient education. Successful interventions matched the complexity of the metric to the intervention including making changes to care structure or delivery, empowered non-physician staff, and used electronic medical record changes to prompt clinicians. CONCLUSIONS The quality of IBD care can be improved with diverse interventions that range from simple to complex. However, these interventions are not universally successful. Clinicians should emulate successful interventions and design new initiatives to narrow gaps in care quality.
Collapse
Affiliation(s)
- David I Fudman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Andrea Escala Perez-Reyes
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake A Niccum
- Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gil Y Melmed
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, New York, New York
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| |
Collapse
|
3
|
Chu AL, Ziperstein JC, Niccum BA, Joice MG, Isselbacher EM, Conley J. STAT: Mobile app helps clinicians manage inpatient emergencies. Healthcare (Basel) 2021; 9:100590. [PMID: 34700138 PMCID: PMC8536501 DOI: 10.1016/j.hjdsi.2021.100590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Andrew L Chu
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Healthcare Transformation Lab, Massachusetts General Hospital, 50 Stanford Street, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Joshua C Ziperstein
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Blake A Niccum
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Melvin G Joice
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Eric M Isselbacher
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Healthcare Transformation Lab, Massachusetts General Hospital, 50 Stanford Street, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jared Conley
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Healthcare Transformation Lab, Massachusetts General Hospital, 50 Stanford Street, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| |
Collapse
|
4
|
Niccum BA, Stine JG, Wynter JA, Kelly V, Caldwell SH, Shah NL. Success of Direct-Acting, Antiviral-Based Therapy for Chronic Hepatitis C Is Not Affected by Type 2 Diabetes. Clin Diabetes 2020; 38:40-46. [PMID: 31975750 PMCID: PMC6969670 DOI: 10.2337/cd18-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic hepatitis C virus (HCV) is a risk factor for type 2 diabetes. In the era of interferon-based HCV therapy, type 2 diabetes was associated with decreased likelihood of sustained virologic response (SVR). Preliminary studies suggest that type 2 diabetes may not reduce the efficacy of regimens involving direct-acting antiviral (DAA) medications. We aimed to determine whether preexisting type 2 diabetes is associated with a reduced rate of SVR achieved 12 weeks after treatment of HCV with DAA-based regimens.
Collapse
Affiliation(s)
- Blake A. Niccum
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonathan G. Stine
- Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Javelle A. Wynter
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Virginia Kelly
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Stephen H. Caldwell
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Neeral L. Shah
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
5
|
Stine JG, Niccum BA, Zimmet AN, Intagliata N, Caldwell SH, Argo CK, Northup PG. Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis. Clin Transl Gastroenterol 2018; 9:140. [PMID: 29511162 PMCID: PMC5862151 DOI: 10.1038/s41424-018-0002-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Objective Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. Methods Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained. Cases with VTE were matched by age, gender, and model for end stage liver disease (MELD) score to corresponding controls without VTE. Results Two hundred and ninety subjects (145 matched pairs) with mean age of 58.4 ± 11.8 years and MELD score of 16.0 ± 7.2 were included. Baseline characteristics were similar between cases and controls. Independent adjusted risk factors for VTE included NASH (OR: 2.46, 95% CI: 1.07–5.65, p = 0.034), prior VTE (OR: 7.12, 95% CI: 1.99–25.5, p = 0.003), and presence of PVT (OR: 2.18, 95% CI: 1.03–4.58, p = 0.041). Thrombocytopenia was associated with decreased risk (OR: 0.49, 95% CI: 0.26–0.95, p = 0.035). Conclusions NASH is an independent risk factor for VTE among cirrhosis patients and provides further evidence that NASH is a hypercoagulable state. While all hospitalized patients with cirrhosis at risk for VTE should be considered for medical thromboprophylaxis, those with NASH cirrhosis are at particularly increased risk and therefore a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis.
Collapse
Affiliation(s)
- Jonathan G Stine
- Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA. .,Division of Gastroenterology and Hepatology, The Pennsylvania State University, Hershey, PA, USA.
| | - Blake A Niccum
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Alex N Zimmet
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Nicolas Intagliata
- Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Stephen H Caldwell
- Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Curtis K Argo
- Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Patrick G Northup
- Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
6
|
Niccum BA, Sarker A, Wolf SJ, Trowbridge MJ. Innovation and entrepreneurship programs in US medical education: a landscape review and thematic analysis. Med Educ Online 2017; 22:1360722. [PMID: 28789602 PMCID: PMC5653943 DOI: 10.1080/10872981.2017.1360722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/25/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Training in innovation and entrepreneurship (I&E) in medical education has become increasingly prevalent among medical schools to train students in complex problem solving and solution design. OBJECTIVE We aim to characterize I&E education in US allopathic medical schools to provide insight into the features and objectives of this growing field. DESIGN I&E programs were identified in 2016 via structured searches of 158 US allopathic medical school websites. Program characteristics were identified from public program resources and structured phone interviews with program directors. Curricular themes were identified via thematic analysis of program resources, and themes referenced by >50% of programs were analyzed. RESULTS Thirteen programs were identified. Programs had a median age of four years, and contained a median of 13 students. Programs were led by faculty from diverse professional backgrounds, and all awarded formal recognition to graduates. Nine programs spanned all four years of medical school and ten programs required a capstone project. Thematic analysis revealed seven educational themes (innovation, entrepreneurship, technology, leadership, healthcare systems, business of medicine, and enhanced adaptability) and two teaching method themes (active learning, interdisciplinary teaching) referenced by >50% of programs. CONCLUSIONS The landscape of medical school I&E programs is rapidly expanding to address newfound skills needed by physicians due to ongoing changes in healthcare, but programs remain relatively few and small compared to class size. This landscape analysis is the first review of I&E in medical education and may contribute to development of a formal educational framework or competency model for current or future programs. ABBREVIATIONS AAMC: American Association of Medical Colleges; AMA: American Medical Association; I&E: Innovation and entrepreneurship.
Collapse
Affiliation(s)
- Blake A Niccum
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| | - Arnab Sarker
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| | - Stephen J Wolf
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Trowbridge
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
- CONTACT Matthew J Trowbridge Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
7
|
Zhang J, Zhou SK, Xiang X, Bautista ML, Niccum BA, Dickinson GS, Tan IC, Chan W, Sevick-Muraca EM, Rasmussen JC. Automated analysis of investigational near-infrared fluorescence lymphatic imaging in humans. Biomed Opt Express 2012; 3:1713-1723. [PMID: 22808440 PMCID: PMC3395493 DOI: 10.1364/boe.3.001713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 06/10/2012] [Indexed: 06/01/2023]
Abstract
ALFIA (Automated Lymphatic Function Imaging Analysis), an algorithm providing quantitative analysis of investigational near-infrared fluorescence lymphatic images, is described. Images from nine human subjects were analyzed for apparent lymphatic propagation velocities and propulsion periods using manual analysis and ALFIA. While lymphatic propulsion was more easily detected using ALFIA than with manual analysis, statistical analyses indicate no significant difference in the apparent lymphatic velocities although ALFIA tended to calculate longer propulsion periods. With the base ALFIA algorithms validated, further automation can now proceed to provide a clinically relevant analytic tool for quantitatively assessing lymphatic function in humans.
Collapse
Affiliation(s)
- Jingdan Zhang
- Whole Body and Oncology Image Analytics Program, Siemens Corporate Research, 755 College Road East, Princeton, New Jersey, 08540, USA
| | - Shaohua Kevin Zhou
- Whole Body and Oncology Image Analytics Program, Siemens Corporate Research, 755 College Road East, Princeton, New Jersey, 08540, USA
- (algorithm)
| | - Xiaoyan Xiang
- Whole Body and Oncology Image Analytics Program, Siemens Corporate Research, 755 College Road East, Princeton, New Jersey, 08540, USA
| | - Merrick L. Bautista
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| | - Blake A. Niccum
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| | - Gabriel S. Dickinson
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| | - I-Chih Tan
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| | - Wenyaw Chan
- Division of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Herman Pressler St., Houston, Texas, 77030, USA
| | - Eva M. Sevick-Muraca
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, 1825 Pressler Street, Houston, Texas, 77030, USA
| |
Collapse
|