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Fritz CDL, Oduyale O, Cao Y. Overcoming Racial and Ethnic Disparities in Rectal Cancer Treatment. JAMA Netw Open 2024; 7:e240018. [PMID: 38421655 DOI: 10.1001/jamanetworkopen.2024.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Cassandra D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
- Editorial Fellow, JAMA Network Open
| | - Oluseye Oduyale
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Yin Cao
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Fritz CDL, Otegbeye EE, Zong X, Demb J, Nickel KB, Olsen MA, Mutch M, Davidson NO, Gupta S, Cao Y. Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst 2023; 115:909-916. [PMID: 37138415 PMCID: PMC10407716 DOI: 10.1093/jnci/djad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise. METHODS We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis. RESULTS Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (Ptrend < .001), respectively, with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month). CONCLUSIONS Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
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Affiliation(s)
- Cassandra D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ebunoluwa E Otegbeye
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Xiaoyu Zong
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Demb
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret A Olsen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Mutch
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas O Davidson
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Samir Gupta
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Internal Medicine, University of California San Diego, San Diego, CA, USA
- Veteran Affairs San Diego Healthcare System, Department of Medicine, Division of Gastroenterology, San Diego, CA, USA
| | - Yin Cao
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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Worthington RO, Adams DR, Fritz CDL, Tusken M, Volerman A. Supporting Breastfeeding Physicians Across the Educational and Professional Continuum: A Call to Action. Acad Med 2023; 98:21-28. [PMID: 35921171 PMCID: PMC10423406 DOI: 10.1097/acm.0000000000004898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1-2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.
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Affiliation(s)
- Rebeca Ortiz Worthington
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center / Veterans Affairs Pittsburgh Healthcare, Pittsburgh, PA
| | - Dara R. Adams
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Cassandra D. L. Fritz
- Division of Gastroenterology, Director of Diversity, Equity, and Inclusion for Internal Medicine Residency Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Megan Tusken
- Department of Psychiatry, University of Texas at Southwestern, Dallas, TX
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL
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Pointer SD, Fritz CDL, Liang PS. Diversity, equity, and inclusion in gastroenterology training: a call to action. Lancet Gastroenterol Hepatol 2022; 7:904-906. [PMID: 36087591 DOI: 10.1016/s2468-1253(22)00277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Stephanie D Pointer
- Digestive and Liver Health Specialists, Quality Medical Research, Nashville Gastroenterology and Hepatology, Nashville, TN, USA
| | - Cassandra D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Peter S Liang
- Departments of Medicine and Population Health, NYU Langone Health Department of Medicine, VA New York Harbor Health Care System, New York, NY 10010, USA.
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Fritz CDL, Blaney E. Evaluation and Management Strategies for GI Involvement with Amyloidosis. Am J Med 2022; 135 Suppl 1:S20-S23. [PMID: 35077702 DOI: 10.1016/j.amjmed.2022.01.008] [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: 11/12/2021] [Accepted: 01/14/2022] [Indexed: 11/01/2022]
Abstract
Amyloidosis is a heterogeneous disease that can cause a wide array of nonspecific symptoms when the gastrointestinal (GI) tract is involved, including weight loss, early satiety, change in bowel habits with diarrhea, constipation, or alternating bowel pattern. Endoscopy with biopsy for Congo red staining establishes the diagnosis and fibril subtyping helps to guide targeted treatment options. Light chain amyloidosis is the most frequent subtype found throughout the GI tract. Transthyretin amyloidosis is most likely to be found on rectal biopsy. Management of the symptoms of GI tract involvement with amyloidosis relate to addressing the underlying symptom complex that is produced and generally abstracted from the management of severe forms of functional GI disorders. Attention to improving symptom management and nutrition status can improve quality of life in these patients.
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Affiliation(s)
- Cassandra D L Fritz
- Division of Gastroenterology, Washington University in Saint Louis, Saint Louis, Mo
| | - Elizabeth Blaney
- Division of Gastroenterology, Washington University in Saint Louis, Saint Louis, Mo.
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Fritz CDL, Sayuk GS, Elwing JE, Wilgus NC, Dieckgraefe BK, Presti ME. Colonoscopy Following COVID-19 Delays in Procedures: Risk Stratification for Procedures Is Critical. Gastro Hep Adv 2022; 1:546-548. [PMID: 35262068 PMCID: PMC8890980 DOI: 10.1016/j.gastha.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/15/2022] [Indexed: 11/22/2022]
Affiliation(s)
- C D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - G S Sayuk
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Gastroenterology, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - J E Elwing
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Gastroenterology, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - N C Wilgus
- Department of Pathology, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - B K Dieckgraefe
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Gastroenterology, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - M E Presti
- Department of Gastroenterology, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
- Division of Gastroenterology, Department of Medicine, St. Louis University, St. Louis, Missouri, USA
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Fritz CDL, Smith ZL, Elsner J, Hollander T, Early D, Kushnir V. Prolonged Cecal Insertion Time Is Not Associated with Decreased Adenoma Detection When a Longer Withdrawal Time Is Achieved. Dig Dis Sci 2018; 63:3120-3125. [PMID: 29721773 DOI: 10.1007/s10620-018-5100-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between withdrawal time and adenoma detection has been established; however, the effect of cecal insertion time on adenoma detection remains unclear. AIM To determine the association between cecal insertion time and adenoma detection. METHODS This study completed a retrospective analysis of data collected in 4 prospective randomized-controlled trials related to screening and surveillance colonoscopy at a single tertiary care from 2010 to 2016. The primary outcome was cecal insertion time and its association with mean number of adenomas per patient and adenoma detection rate (ADR). RESULTS 1303 patients met inclusion criteria (average age 59.7 ± 8.7 years; 759 females (58.3%), and 763 Caucasians (58.6%). Mean cecal insertion time was significantly longer in patients who were female (p < 0.001), received moderate sedation (p = 0.001), had fellow involvement (p < 0.001), older (p = 0.002), and lower Boston bowel preparation scale (p < 0.001). Withdrawal time was found to increase as mean cecal insertion time increased (p < 0.001). The mean cecal insertion time was not different in patients with or without adenomas (p = 0.94). Cecal insertion time did not correlate with the mean number of adenomas or advanced adenomas per patient (p > 0.05), which was also true on Poisson regression analysis. Adenomas and advanced adenomas per patient were found to decrease when cecal insertion to withdrawal time ratios were greater than 1 (p < 0.001). CONCLUSIONS Prolonged cecal insertion time was not associated with a decrease in ADR, mean number of adenomas or advanced adenomas per patient. When withdrawal times were longer than cecal insertion times, the number of adenomas and advanced adenomas detected per patient was significantly improved.
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Affiliation(s)
| | - Zachary L Smith
- Division of Gastroenterology, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, USA
| | - Jeffrey Elsner
- Division of Gastroenterology, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, USA
| | - Thomas Hollander
- Division of Gastroenterology, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, USA
| | - Dayna Early
- Division of Gastroenterology, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, USA.
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Press VG, Fritz CDL, Vela MB. First year medical student attitudes about advocacy in medicine across multiple fields of discipline: analysis of reflective essays. J Racial Ethn Health Disparities 2015; 2:556-64. [PMID: 26693136 PMCID: PMC4675051 DOI: 10.1007/s40615-015-0105-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advocacy is often described as a pillar of the medical profession. However, the impact of advocacy training on medical students' identity as advocates in the medical profession is not well-described. AIM/SETTING/PARTICIPANTS We sought to introduce an advocacy curriculum to a mandatory Health Care Disparities (HCD) course for 88 first year medical students. PROGRAM DESCRIPTION The 2013 HCD added advocacy curriculum that included: guest lecturers' perspectives on their advocacy experience; reflective essay assignments assessing self-identify as an advocate; advocacy-specific lectures and large group discussions; and participation in small group community projects. EVALUATION A mixed methods approached was used to evaluate 88 first year medical students' advocacy themed reflective essays, independently coded by three investigators, and Likert-response questions were compared to published benchmarked items. The IRB exempted this study. Analysis of student essays revealed that students were better able to identify as an advocate in medicine. The survey also revealed that 86% post-course vs. 73% precourse agreed/strongly agreed with the statement: "I consider myself an advocate" (p=0.006). DISCUSSION Exposing all medical students to advocacy within medicine may help shape and define their perceived professional role. Future work will explore adding advocacy and leadership skill training to the HCD course.
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Affiliation(s)
- Valerie G Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Monica B Vela
- Section of General Internal Medicine/Pritzker School of Medicine, Chicago IL
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Fritz CDL, Press VG, Nabers D, Levinson D, Humphrey H, Vela MB. SEALS: an Innovative Pipeline Program Targeting Obstacles to Diversity in the Physician Workforce. J Racial Ethn Health Disparities 2015; 3:225-32. [DOI: 10.1007/s40615-015-0131-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/10/2015] [Accepted: 05/11/2015] [Indexed: 11/24/2022]
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