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Nguyen‐Vu T, Chin Y, Malvar C, Cabral‐Prodigalidad PA, De Lusong M, Maulahela H, Mekaroonkamol P, Ong A, Djajakusuma A, Myint T, Nurmalihah H, Asokkumar R, Francisco C, Liu J, Rerknimitr R, Shergill A, Sanduleanu S, Kaltenbach T, Soetikno R. The synergistic role of virtual coaching with simulation-based mastery learning for upper endoscopy. DEN Open 2024; 4:e317. [PMID: 38226397 PMCID: PMC10788588 DOI: 10.1002/deo2.317] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 01/17/2024]
Abstract
Introduction Our simulation-based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. Methods We conducted a 1-week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands-on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation-based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees' scores to our cohort trained using in-person SBML training using non-inferiority t-tests. Results We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in-person cohort (4.7 ± 0.5, p = 0.49). The knowledge-based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in-person control. Conclusions VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.
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Affiliation(s)
- Tiffany Nguyen‐Vu
- Department of MedicineUniversity of CaliforniaSan FranciscoUSA
- Division of Gastroenterology and HepatologySan Francisco VA Medical CenterSan FranciscoUSA
| | - YungKa Chin
- Department of Gastroenterology and HepatologySingapore General HospitalSingaporeSingapore
| | - Carmel Malvar
- Department of MedicineUniversity of CaliforniaSan FranciscoUSA
- Division of Gastroenterology and HepatologySan Francisco VA Medical CenterSan FranciscoUSA
| | | | - Mark De Lusong
- Department of GastroenterologyUniversity of the PhilippinesPhilippine General HospitalManilaPhilippines
| | - Hasan Maulahela
- Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineUniversity of Indonesia‐Cipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Parit Mekaroonkamol
- Department of Gastroenterology, Center of Excellence for Innovation and Endoscopy in Gastrointestinal OncologyChulalongkorn UniversityBangkokThailand
| | - Andrew Ong
- Department of Gastroenterology and HepatologySingapore General HospitalSingaporeSingapore
| | - Angela Djajakusuma
- Department of GastroenterologyUniversity of the PhilippinesPhilippine General HospitalManilaPhilippines
| | - Thomas Myint
- Department of Gastroenterology and HepatologyCalifornia Pacific Medical CenterSan FranciscoUSA
| | - Hilda Nurmalihah
- Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineUniversity of Indonesia‐Cipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Ravishankar Asokkumar
- Department of Gastroenterology and HepatologySingapore General HospitalSingaporeSingapore
| | - Carlos Francisco
- Institute of Digestive and Liver DiseasesSt. Luke's Medical CenterTaguig CityPhilippines
| | - Jesse Liu
- Department of Gastroenterology and HepatologyCalifornia Pacific Medical CenterSan FranciscoUSA
| | - Rungsun Rerknimitr
- Department of Gastroenterology, Center of Excellence for Innovation and Endoscopy in Gastrointestinal OncologyChulalongkorn UniversityBangkokThailand
| | - Amandeep Shergill
- Department of MedicineUniversity of CaliforniaSan FranciscoUSA
- Division of Gastroenterology and HepatologySan Francisco VA Medical CenterSan FranciscoUSA
| | - Silvia Sanduleanu
- Division of Gastroenterology and HepatologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Tonya Kaltenbach
- Department of MedicineUniversity of CaliforniaSan FranciscoUSA
- Division of Gastroenterology and HepatologySan Francisco VA Medical CenterSan FranciscoUSA
| | - Roy Soetikno
- Department of MedicineUniversity of CaliforniaSan FranciscoUSA
- Division of Gastroenterology and HepatologySan Francisco VA Medical CenterSan FranciscoUSA
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Nassar AH, El-Am E, Denu R, Abou Alaiwi S, El Zarif T, Macaron W, Abdel-Wahab N, Desai A, Smith C, Parikh K, Abbasi M, Bou Farhat E, Williams JM, Collins JD, Al-Hader A, McKay RR, Malvar C, Sabra M, Zhong C, El Alam R, Chehab O, Lima J, Phan M, Dalla Pria HF, Trevino A, Neilan TG, Kwan JM, Ravi V, Deshpande H, Demetri G, Choueiri TK, Naqash AR. Clinical Outcomes Among Immunotherapy-Treated Patients With Primary Cardiac Soft Tissue Sarcomas: A Multicenter Retrospective Study. JACC CardioOncol 2024; 6:71-79. [PMID: 38510282 PMCID: PMC10950431 DOI: 10.1016/j.jaccao.2023.11.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 03/22/2024] Open
Abstract
Background Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes. Objectives The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs). Methods A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0. Results Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively (P < 0.0001), and median OS was 3.0 vs 24.0 months, respectively (P = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3. Conclusions Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity.
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Affiliation(s)
- Amin H. Nassar
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Denu
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Talal El Zarif
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Walid Macaron
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caleb Smith
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kaushal Parikh
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Ahmad Al-Hader
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rana R. McKay
- Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Carmel Malvar
- Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Mohamad Sabra
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caiwei Zhong
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Joao Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Minh Phan
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | | | - Alexandra Trevino
- Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Vinod Ravi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hari Deshpande
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - George Demetri
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Abdul Rafeh Naqash
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Pan E, Urman D, Malvar C, McKay RR. Managing First-Line Metastatic Renal Cell Carcinoma: Favorable-Risk Disease. Hematol Oncol Clin North Am 2023; 37:943-949. [PMID: 37258352 DOI: 10.1016/j.hoc.2023.04.017] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Defining metastatic renal-cell carcinoma as a favorable risk depends on clinical risk-stratification tools such as the International Metastatic Renal Cell Carcinoma Database Consortium or the Memorial Sloan-Kettering Cancer Center scores. The favorable-risk disease tends to have better prognosis and survival compared with disease stratified as either intermediate or poor risk and can be attributed in part to an indolent tumor biology. Several phase 3 clinical trials have demonstrated an improvement in progression-free survival and objective response rate, but not overall survival benefit with combinations of immunotherapy and vascular endothelial growth factor tyrosine kinase inhibitors compared with sunitinib in favorable-risk disease.
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Affiliation(s)
- Elizabeth Pan
- University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, #0987, La Jolla, CA 92093-0987, USA
| | - Danielle Urman
- University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, #0987, La Jolla, CA 92093-0987, USA
| | - Carmel Malvar
- University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, #0987, La Jolla, CA 92093-0987, USA
| | - Rana R McKay
- University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, #0987, La Jolla, CA 92093-0987, USA.
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Kaltenbach T, Patel SG, Nguyen-Vu T, Malvar C, Keswani RN, Hall M, Aagaard E, Asokkumar R, Chin YK, Hammad H, Rastogi A, Shergill A, Simon V, Soetikno A, Soetikno R, Wani S. Varied Trainee Competence in Cold Snare Polypectomy: Results of the COMPLETE Randomized Controlled Trial. Am J Gastroenterol 2023; 118:1880-1887. [PMID: 37307537 DOI: 10.14309/ajg.0000000000002368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/27/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback and those who received conventional apprentice-based concurrent feedback. We hypothesized that video-based feedback would accelerate competence. METHODS We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1 cm, comparing video-based feedback with conventional feedback. We randomly assigned deidentified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool. We shared cumulative sum learning curves every 25 CSP with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume. RESULTS We enrolled and randomized 22 trainees, 12 to video-based feedback and 10 to conventional feedback, and evaluated 2,339 CSP. The learning curve was long; 2 trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control ( P = 0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSP ( P = 0.0004). DISCUSSION Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine whether such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov : NCT03115008.
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Affiliation(s)
- Tonya Kaltenbach
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Gastroenterology, Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado, USA
| | - Tiffany Nguyen-Vu
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Carmel Malvar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Matt Hall
- Biostatistics, Children's Hospital Association, Kansas City, Kansas, USA
| | - Eva Aagaard
- Department of Medicine, Division of General Internal Medicine, Washington University School of Medicine at St. Louis, St. Louis, Missouri, USA
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yung Ka Chin
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Hazem Hammad
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA; and
| | - Amandeep Shergill
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alan Soetikno
- Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Roy Soetikno
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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5
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Alaiwi SA, Nassar A, Zarif T, El-Am E, Denu R, Macaron W, Malvar C, Cortellini A, Korolewicz J, Sackstein P, Nana FA, Woodford R, Long GV, Kwan J, Grynberg S, Shapira R, Herrera-Juárez M, Foderaro S, Vasbinder A, Asnani A, Tandon A, Hayek S, Neilan TG, Choueiri T, Naqash AR. CLINICAL FEATURES AND OUTCOMES OF CARDIAC INVOLVEMENT IN PATIENTS WITH CANCER TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Alaiwi SA, Nassar A, Zarif T, Macaron W, Denu R, Freeman D, Abdel-Wahab N, El-Am E, Al-Hader A, Malvar C, McKay R, Padera R, Neilan TG, Choueiri T, Naqash AR. CLINICAL OUTCOMES AND TOXICITY PROFILE OF PATIENTS WITH PRIMARY CARDIAC TUMORS TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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7
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Alaiwi SA, Nassar A, Zarif T, El-Am E, Denu R, Macaron W, Malvar C, Cortellini A, Korolewicz J, Sackstein P, Nana FA, Woodford R, Long GV, Kwan J, Grynberg S, Shapira R, Herrera-Juárez M, Foderaro S, Vasbinder A, Asnani A, Tandon A, Hayek S, Neilan TG, Choueiri T, Naqash AR. CLINICAL FEATURES AND OUTCOMES OF CARDIAC INVOLVEMENT IN PATIENTS WITH CANCER TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Alaiwi SA, Nassar A, Zarif T, Macaron W, Denu R, Freeman D, Abdel-Wahab N, El-Am E, Al-Hader A, Malvar C, McKay R, Padera R, Neilan TG, Choueiri T, Naqash AR. CLINICAL OUTCOMES AND TOXICITY PROFILE OF PATIENTS WITH PRIMARY CARDIAC TUMORS TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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9
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Muething L, Wani S, Hall M, Simon V, Ezekwe E, Nguyen-Vu T, Malvar C, Duloy A, Kaltenbach T, Keswani R, Patel SG. Adding efficiency to proficiency: a study of trainee polypectomy efficiency metrics. Endoscopy 2020; 52:1122-1126. [PMID: 32650345 DOI: 10.1055/a-1192-4250] [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: 12/10/2022]
Abstract
BACKGROUND Although validated colonoscopy assessment tools exist, they do not measure efficiency. This study aimed to assess content validity of polypectomy efficiency (PE) and neoplastic polypectomy efficiency (NPE) as colonoscopy efficiency indices. METHODS Data from a randomized controlled trial evaluating polypectomy among gastroenterology trainees were utilized. PE and NPE were defined as number of polyps (or neoplastic polyps) removed/withdrawal time × 100. Content validity was assessed by determining the association between efficiency indices and polypectomy times. RESULTS 20 trainees performed 601 colonoscopies. There was a strong association between PE/NPE and actual polypectomy times: as polypectomy time increased by 1 minute, the PE decreased by 0.48 (P = 0.001) and NPE decreased by 0.24 (P = 0.03). CONCLUSIONS The study proposed and provided content validity for PE and NPE as colonoscopy efficiency indices.
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Affiliation(s)
- Larissa Muething
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.,Gastroenterology, Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado, United States
| | - Sachin Wani
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Matt Hall
- Biostatistics, Children's Hospital Association, Kansas City, Kansas, United States
| | - Violette Simon
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Ezenwanyi Ezekwe
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Tiffany Nguyen-Vu
- Gastroenterology, University of California, San Francisco, California, United States
| | - Carmel Malvar
- Gastroenterology, University of California, San Francisco, California, United States
| | - Anna Duloy
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Tonya Kaltenbach
- Gastroenterology, University of California, San Francisco, California, United States.,San Francisco Veterans Affairs Medical Center, San Francisco, California, United States
| | - Rajesh Keswani
- Gastroenterology, Northwestern University, Chicago, Illinois, United States
| | - Swati G Patel
- Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.,Gastroenterology, Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado, United States
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Malvar C, Nguyen-Vu T, Shergill A, Chin YK, Baniya A, McAnanama M, Kaltenbach T, Soetikno R. The structure and delivery of a novel training course on endoscope reprocessing and standard precautions in the endoscopy unit. VideoGIE 2020; 5:176-179. [PMID: 32426562 PMCID: PMC7221475 DOI: 10.1016/j.vgie.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Carmel Malvar
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Tiffany Nguyen-Vu
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Amandeep Shergill
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Yung Ka Chin
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Aruna Baniya
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michelle McAnanama
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Tonya Kaltenbach
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, San Francisco, California.,Advanced Gastrointestinal Endoscopy, Mountain View, California
| | - Roy Soetikno
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Advanced Gastrointestinal Endoscopy, Mountain View, California.,Academy of Endoscopy, Woodside, California
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11
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Nguyen-Vu T, Malvar C, Chin YK, Kaltenbach T, Liu A, Myint T, Asokkumar R, Shergill A, Soetikno R. Simulation-based mastery learning (SBML) for rapid acquisition of upper endoscopy knowledge and skills-initial observation. VideoGIE 2020; 5:222-225. [PMID: 32529151 PMCID: PMC7280157 DOI: 10.1016/j.vgie.2020.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Key Words
- AASLD, American Association for the Study of Liver Diseases
- APC, argon plasma coagulation
- ASA, American Society of Anesthesiologists
- EOE, eosinophilic esophagitis
- GE, gastroesophageal
- IEE, image-enhanced endoscopy
- NVUGIB, nonvariceal upper GI bleeds
- TTS, through the scope
- UGI, upper gastrointestinal
- VUGIB, variceal upper GI bleeds
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Affiliation(s)
- Tiffany Nguyen-Vu
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Carmel Malvar
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Yung Ka Chin
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Tonya Kaltenbach
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Andy Liu
- California Pacific Medical Center, San Francisco, California, USA
| | - Thomas Myint
- California Pacific Medical Center, San Francisco, California, USA
| | | | - Amandeep Shergill
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Roy Soetikno
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Academy of Endoscopy, Woodside, California, USA
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12
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Kaltenbach T, Asokkumar R, Kolb JM, Malvar C, Soetikno R. Use of the Endoscopic Clipping Over the Scope Technique to Treat Acute Severe Lower Gastrointestinal Bleeding in the Colon and Anal Transition Zone. Gastrointest Endosc Clin N Am 2020; 30:13-23. [PMID: 31739960 PMCID: PMC7094812 DOI: 10.1016/j.giec.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic treatment of lower gastrointestinal bleeding can be challenging. This article reports on the use of the endoscopic clipping over the scope technique to treat acute severe lower gastrointestinal bleeding. In particular, it describes the approaches and outcomes of using the technique for acute severe bleeding in the colon and the anal transition zone. The following synopsis is the one that you supplied, but lightly copyedited. Please confirm OK. Please note that the synopsis will appear in PubMed: Endoscopic treatment of lower gastrointestinal bleeding can be challenging. This article reports on the use of the endoscopic clipping over the scope technique to treat acute severe lower gastrointestinal bleeding. In particular, it describes the approaches and outcomes of using the technique for acute severe bleeding in the colon and the anal transition zone.
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Affiliation(s)
- Tonya Kaltenbach
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;,Division of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA;,Advanced Gastrointestinal Endoscopy, Mountain View, CA, USA;,Corresponding author. Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Jennifer M. Kolb
- Division of Gastroenterology, University of Colorado, Aurora, CO, USA
| | - Carmel Malvar
- Section of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;,Division of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA
| | - Roy Soetikno
- Advanced Gastrointestinal Endoscopy, Mountain View, CA, USA
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Asokkumar R, Malvar C, Nguyen-Vu T, Sanduleanu S, Kaltenbach T, Soetikno R. Endoscopic Assessment of the Malignant Potential of the Nonpolypoid (Flat and Depressed) Colorectal Neoplasms: Thinking Fast, and Slow. Gastrointest Endosc Clin N Am 2019; 29:613-628. [PMID: 31445686 DOI: 10.1016/j.giec.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Current endoscopy training methodology does not meet the learning traits, skills, and needs of the newer generation of gastroenterologists. This article provides information on assessment of the malignant potential of colorectal neoplasms. It takes a modern approach on the topic and integrates relevant information that aligns with the thinking process. The theory of thinking fast (reflex) and slow (rational) is used. By doing so, it is hoped that the learning process can be expedited and practiced immediately. The focus is on preresection assessment of nonpolypoid colorectal neoplasms. Assessment of polypoid, sessile-serrated adenoma/polyp, or inflammatory bowel disease dysplasia is briefly discussed.
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Affiliation(s)
- Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, 1 Hospital Drive, Singapore 169608, Singapore
| | - Carmel Malvar
- Department of Gastroenterology, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Tiffany Nguyen-Vu
- Department of Gastroenterology, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Silvia Sanduleanu
- Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Tonya Kaltenbach
- Department of Gastroenterology, Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Medicine, University of California, 500 Parnassus Avenue, San Francisco, CA 94143, USA; Advanced Gastrointestinal Endoscopy, Mountain View, CA, USA
| | - Roy Soetikno
- Advanced Gastrointestinal Endoscopy, Mountain View, CA, USA; University of Indonesia, Kampus Baru UI Depok, Jawa Barat, Jakarta 16424, Indonesia.
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Wang C, Puerta-Guardo H, Biering SB, Glasner DR, Tran EB, Patana M, Gomberg TA, Malvar C, Lo NTN, Espinosa DA, Harris E. Endocytosis of flavivirus NS1 is required for NS1-mediated endothelial hyperpermeability and is abolished by a single N-glycosylation site mutation. PLoS Pathog 2019; 15:e1007938. [PMID: 31356638 PMCID: PMC6687192 DOI: 10.1371/journal.ppat.1007938] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 08/08/2019] [Accepted: 06/22/2019] [Indexed: 12/22/2022] Open
Abstract
Arthropod-borne flaviviruses cause life-threatening diseases associated with endothelial hyperpermeability and vascular leak. We recently found that vascular leak can be triggered by dengue virus (DENV) non-structural protein 1 (NS1) via the disruption of the endothelial glycocalyx-like layer (EGL). However, the molecular determinants of NS1 required to trigger EGL disruption and the cellular pathway(s) involved remain unknown. Here we report that mutation of a single glycosylated residue of NS1 (N207Q) abolishes the ability of NS1 to trigger EGL disruption and induce endothelial hyperpermeability. Intriguingly, while this mutant bound to the surface of endothelial cells comparably to wild-type NS1, it was no longer internalized, suggesting that NS1 binding and internalization are distinct steps. Using endocytic pathway inhibitors and gene-specific siRNAs, we determined that NS1 was endocytosed into endothelial cells in a dynamin- and clathrin-dependent manner, which was required to trigger endothelial dysfunction in vitro and vascular leak in vivo. Finally, we found that the N207 glycosylation site is highly conserved among flaviviruses and is also essential for West Nile and Zika virus NS1 to trigger endothelial hyperpermeability via clathrin-mediated endocytosis. These data provide critical mechanistic insight into flavivirus NS1-induced pathogenesis, presenting novel therapeutic and vaccine targets for flaviviral diseases. Vascular leak is a hallmark of severe dengue disease. Recently, our group revealed a critical role for NS1 in induction of endothelial hyperpermeability and vascular leakage in an endothelial cell-intrinsic manner. However, the upstream pathway triggered by NS1, as well as the molecular determinants of NS1 required for this phenomenon, remain obscure. Gaining insight into this endothelial cell-intrinsic pathway is critical for understanding dengue pathogenesis, developing novel antiviral therapies, and developing NS1-based vaccine approaches that pose a minimal risk of antibody-dependent enhancement. Our current study expands our knowledge of this novel pathway not only by identifying the requirement of internalization of secreted NS1 via clathrin-mediated endocytosis, but also by pinpointing the NS1 molecular determinant (N207) required to trigger vascular leak. Further, our work identifies N207 as a residue conserved among multiple flaviviruses (Zika virus and West Nile virus, in addition to DENV), which is critical for NS1-mediated vascular leak in biologically relevant human endothelial cells modeling interstitial compartments in the lung or the blood-brain barrier. Thus, our study identifies endocytosis and a single amino acid (N207) of the NS1 viral toxin as critical for pan-flavivirus pathogenesis, representing a novel target for anti-flaviviral therapy and vaccine development.
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Affiliation(s)
- Chunling Wang
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Henry Puerta-Guardo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Scott B. Biering
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Dustin R. Glasner
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Edwina B. Tran
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Mark Patana
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Trent A. Gomberg
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Carmel Malvar
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Nicholas T. N. Lo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Diego A. Espinosa
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
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