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Ananthakrishnan AN, Adler J, Chachu KA, Nguyen NH, Siddique SM, Weiss JM, Sultan S, Velayos FS, Cohen BL, Singh S. AGA Clinical Practice Guideline on the Role of Biomarkers for the Management of Crohn's Disease. Gastroenterology 2023; 165:1367-1399. [PMID: 37981354 DOI: 10.1053/j.gastro.2023.09.029] [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] [Indexed: 11/21/2023]
Abstract
BACKGROUND & AIMS Biomarkers are used frequently for evaluation and monitoring of patients with Crohn's disease (CD). This American Gastroenterological Association (AGA) guideline is intended to support practitioners in decisions about the use of biomarkers for the management of CD. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to formulate patient-centered clinical questions and review evidence on the performance of fecal calprotectin, serum C-reactive protein (CRP), and Endoscopic Healing Index in patients with established CD who were asymptomatic, had symptoms of varying severity, or were in surgically induced remission. Biomarker performance was assessed against the gold standard of endoscopic activity, defined as a Simple Endoscopic Score for Crohn's Disease ≥3. The panel used the Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision framework to develop recommendations for use of biomarkers in various settings. Implementation considerations were formulated for each recommendation to inform clinical practice. RESULTS The guideline panel made 11 conditional recommendations. In patients with CD in symptomatic remission, the panel suggests use of a biomarker- and symptom-based monitoring strategy over symptoms alone. In patients in symptomatic remission, a fecal calprotectin <150 μg/g and normal CRP rules out active inflammation, avoiding endoscopic evaluation for assessment of disease activity. However, elevated biomarkers in this setting merit confirmation with endoscopy before treatment adjustment. In patients with CD with mild symptoms, neither normal nor elevated biomarkers alone are sufficiently accurate to determine endoscopic activity. In patients with CD with moderate to severe symptoms, elevated fecal calprotectin or serum CRP suggests endoscopic activity, precluding routine endoscopic assessment for disease activity. In patients with CD in surgically induced remission in low-risk patients on pharmacologic prophylaxis, a normal fecal calprotectin reliably rules out endoscopic recurrence. In other postoperative settings, the panel suggests endoscopic assessment for establishing postoperative recurrence. CONCLUSIONS In patients with CD, fecal calprotectin and serum CRP can inform disease management in both asymptomatic and symptomatic disease. Discordance between symptom assessment and biomarker value may merit endoscopic evaluation for confirmation of status of disease activity.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeremy Adler
- Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Karen A Chachu
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
| | - Nghia H Nguyen
- Division of Gastroenterology, Kaiser Permanente Medical Group, Riverside, California
| | - Shazia M Siddique
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jennifer M Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, and Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Fernando S Velayos
- Division of Gastroenterology, Kaiser Permanente Medical Group, San Francisco, California
| | - Benjamin L Cohen
- Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Siddharth Singh
- Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
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Warden A, Liang J, Vanias KJ, Hetzel S, Hayney MS, Weiss JM, Caldera F, Caldera K. High but Inequitable COVID-19 Vaccine Uptake Among Rehabilitation Patients. WMJ 2023; 122:444-449. [PMID: 38180943] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
INTRODUCTION There is a paucity of studies evaluating vaccine uptake in adults with neurological and musculoskeletal medical conditions. We sought to evaluate the rates of COVID-19 vaccine uptake in patients seen in an outpatient rehabilitation clinic. METHODS We conducted a retrospective, single center study of adults seen at an outpatient rehabilitation clinic from December 1, 2020, through June 30, 2021, with an active Wisconsin Immunization Registry record. The primary outcome was completion of a COVID-19 primary vaccine series. RESULTS Of 1362 patients, 83.3% completed a COVID-19 vaccination series. Younger patients had increased odds of not completing a COVID-19 vaccination series (mean [SD] 46.7 [14.7] vs 54.3 [15.8]; OR 1.03; 95% CI, 1.02-1.04; P < 0.001). Those who identified as non-White (1.88; 95% CI, 1.16-3.04; P = 0.010) or current smoker (1.85, 95% CI, 1.85-2.79; P = 0.004) had increased odds of not completing a COVID-19 vaccination series. Those who resided in rural ZIP codes (1.81; 95% CI, 1.35-2.43; P < 0.001), had not received a 2019-2020 influenza vaccine (5.13; 95% CI, 3.79-6.96; P < 0.001), or had lower comorbidity scores (2.95; 95% CI, 1.98-4.41; P < 0.001) had higher odds of not completing a COVID-19 vaccination series. CONCLUSIONS There was a high rate of COVID-19 vaccine uptake among patients seen in a rehabilitation clinic, though racial, ethnic, and geographic differences did exist. Further studies are needed to determine why these disparities exist and investigate interventions to increase vaccine uptake in these populations.
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Affiliation(s)
- Alyssa Warden
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jonathan Liang
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kaitlyn J Vanias
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer M Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
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Legister CS, Morgan SJ, Samora JB, Weiss JM, Caird MS, Miller DJ. Policies, Practices, and Attitudes Related to Parental Leave for Practicing Pediatric Orthopaedic Surgeons. J Pediatr Orthop 2023; 43:337-342. [PMID: 36827610 DOI: 10.1097/bpo.0000000000002360] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Parental leave impacts family engagement, bonding, stress, and happiness. Because parental leave benefits are important to all surgeons regardless of sex, understanding parental leave practices in pediatric orthopaedic surgery is critical to promote equity within the profession and supporting balance in work and family life. The aim of this study was to survey pediatric orthopaedic surgeons about their knowledge of parental leave policies, attitudes towards parental leave, and their individual experiences taking leave. METHODS A 34-question anonymous survey was distributed to the Pediatric Orthopaedic Society of North America membership. Eligible respondents were attending pediatric orthopaedic surgeons practicing in the United States or Canada. The survey gathered information about employer parental leave policies, perceptions about and experiences with parental leave while practicing as a surgeon, and demographic information about respondents. RESULTS A total of 77 responses were completed and used for analysis. Most respondents were men (59.7%), <50 years old (67.5%), married (90.9%), and in urban communities (75.3%). A large majority were practicing in the United States (97.4%). Most respondents were unfamiliar with employer parental leave policies (maternity: 53.3%; paternity: 67.5%; and adoption: 85.7%). Those familiar with policies reported that employers offered 7 to 12 weeks for maternity leave (45.7%) and <1 week for paternity leave (50%) and adoption leave (45.5%). Most respondents believed 7 to 12 weeks should be offered for maternity leave (66.2%), 1 to 6 weeks for paternity leave (54.6%), and 7 to 12 weeks for adoption leave (46.8%). Many respondents reported taking 1 to 6 weeks of parental leave as a surgeon (53.3%) and that their colleagues were supportive of their parental leave (40.3%). CONCLUSIONS Most pediatric orthopaedic surgeons were unfamiliar with parental leave benefits provided by employers. Respondents who were familiar with these policies believed that more parental leave should be provided, especially for men who may feel social pressure to take less time for leave. Although respondents reported that their work environments were supportive, this study identified opportunities for improvement to support surgeons who wish to balance parental experiences with work responsibilities. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Sara J Morgan
- Research Department
- Department of Rehabilitation Medicine
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Julie B Samora
- Orthopaedics, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer M Weiss
- Orthopaedics Department, Southern California Permanente Medical Group, Los Angeles, CA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Daniel J Miller
- Department of Orthopaedics, Gillette Children's, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
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Heyworth BE, Ganley TJ, Liotta ES, Hergott KA, Miller PE, Wall EJ, Myer GD, Nissen CW, Edmonds EW, Lyon RM, Chambers HG, Milewski MD, Green DW, Weiss JM, Wright RW, Polousky JD, Nepple JJ, Carey JL, Kocher MS, Shea KG. Transarticular Versus Retroarticular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Multicenter Randomized Controlled Trial by the ROCK Group. Am J Sports Med 2023; 51:1392-1402. [PMID: 37039536 DOI: 10.1177/03635465231165290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND When stable osteochondritis dissecans (OCD) lesions of the femoral condyle in a skeletally immature patient fail to heal with nonoperative methods, the standard of care treatment is condylar OCD drilling. Two primary OCD drilling techniques have been described, but no prospective studies have compared their relative effectiveness. PURPOSE/HYPOTHESIS The purpose of this study was to compare the healing and function after transarticular drilling (TAD) with that after retroarticular drilling (RAD). It was hypothesized that there would be no difference in rate or time to healing, rate or time to return to sports, patient-reported outcomes (PROs), or secondary OCD-related surgery. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Skeletally immature patients with magnetic resonance imaging-confirmed stable OCD lesions of the medial femoral condyle who did not demonstrate substantial healing after a minimum of 3 months of nonoperative treatment were prospectively enrolled by 1 of 17 surgeon-investigators at 1 of 14 centers. Patients were randomized to the TAD or RAD group. Tourniquet time, fluoroscopy time, and complications were compared between the treatment groups. Postoperatively, serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. RESULTS A total of 91 patients were included, consisting of 51 patients in the TAD and 40 patients in the RAD group, who were similar in age, sex distribution, and 2-year PRO response rate. Tourniquet time and fluoroscopy time were significantly shorter with TAD (mean, 38.1 minutes and 0.85 minutes, respectively) than RAD (mean, 48.2 minutes and 1.34 minutes respectively) (P = .02; P = .004). In the RAD group, chondral injury from K-wire passage into the intra-articular space was reported in 9 of 40 (22%) patients, but no associated postoperative clinical sequelae were identified in these patients. No significant differences between groups were detected in follow-up Pediatric-International Knee Documentation Committee, Lysholm, Marx Activity Scale, or Knee injury and Osteoarthritis Outcome Score Quality of Life scores. Healing parameters were superior at 6 months and 12 months in the TAD group, compared with the RAD group, and secondary OCD surgery occurred in 4% of patients who underwent TAD and 10% of patients who underwent RAD (P = .40). Patients in the TAD group returned to sports earlier than those in the RAD group (P = .049). CONCLUSION TAD showed shorter operative time and fluoroscopy time and superior healing parameters at 6 and 12 months, but no differences were seen in 24-month healing parameters or PROs at all follow-up time points, when compared with RAD. REGISTRATION NCT01754298 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | - Roger M Lyon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - James L Carey
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Kevin G Shea
- Stanford University Hospital, Palo Alto, California, USA
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
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5
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Singh S, Ananthakrishnan AN, Nguyen NH, Cohen BL, Velayos FS, Weiss JM, Sultan S, Siddique SM, Adler J, Chachu KA. AGA Clinical Practice Guideline on the Role of Biomarkers for the Management of Ulcerative Colitis. Gastroenterology 2023; 164:344-372. [PMID: 36822736 DOI: 10.1053/j.gastro.2022.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND & AIMS Biomarkers are used frequently for noninvasive monitoring and treatment decision making in the management of patients with ulcerative colitis (UC). This American Gastroenterological Association (AGA) guideline is intended to support practitioners in decisions about the use of biomarkers for the management of UC. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis on the clinical performance of serum C-reactive protein (CRP), fecal calprotectin, and fecal lactoferrin as biomarkers of disease activity in patients with established UC in symptomatic remission or with active symptoms. The guideline panel used the Evidence-to-Decision framework to develop recommendations for the use of biomarkers for monitoring and management of UC and provided implementation considerations for clinical practice. RESULTS The guideline panel made 7 conditional recommendations. In patients with UC in symptomatic remission, the panel suggests the use of a biomarker- and symptom-based monitoring strategy over a symptom-based monitoring strategy. For patients in symptomatic remission, the panel suggests using fecal calprotectin <150 μg/g, normal fecal lactoferrin, and/or normal CRP to rule out active inflammation and avoid routine endoscopic assessment of disease. In patients with UC with moderate to severe symptoms, the panel suggests using fecal calprotectin >150 μg/g, elevated fecal lactoferrin, or elevated CRP to inform treatment decisions and avoid routine endoscopic assessment of disease. However, in patients in symptomatic remission but elevated biomarkers, and in patients with moderate to severe symptoms with normal biomarkers, the panel suggests endoscopic assessment of disease to inform treatment decisions. In patients with UC with mild symptoms, the panel suggests endoscopic assessment of disease activity to inform treatment decisions. The panel identified the use of a biomarker-based monitoring strategy over an endoscopy-based monitoring strategy as a knowledge gap. The panel also proposed key implementation considerations for optimal use of biomarkers, and identified areas for future research. CONCLUSIONS In patients with UC, noninvasive biomarkers, including fecal calprotectin, fecal lactoferrin, and serum CRP can inform disease monitoring and management.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nghia H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Benjamin L Cohen
- Division of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fernando S Velayos
- Division of Gastroenterology, Kaiser Permanente Medical Group, San Francisco, California
| | - Jennifer M Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Shazia M Siddique
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy Adler
- Division of Pediatric Gastroenterology, CS Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Karen A Chachu
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
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6
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Farah G, Volchenko E, Weiss JM, Smith JM, Mumuni S, Gonzalez MH, Mejia A. Building Blocks of Wellness: Where Do We Start When Our Tasks Have No End? Instr Course Lect 2023; 72:17-28. [PMID: 36534843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Surgeon wellness, and the means by which it may be realized, has recently come to the forefront as awareness of burnout among orthopaedic surgeons has increased. Individual surgeons face unique challenges toward finding their own path to thrive. It is important to incorporate varying perspectives regarding potential solutions to surgeons' stresses in both work and extracurricular life. Specifically, the goal is to initiate a discussion regarding wellness by providing insight into the challenges facing surgical residents, supplemented with the perspectives of women and minorities within the field. Peer coaching plays an essential role in optimizing mental health.
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7
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Yigit BI, Fernandez-Orth J, Weiss JM, Molnar C, Andrieux G, Gonzalez-Mendez I, Börries M, Niemeyer CM, Teichert-von Lüttichau I, Erlacher M. Identification of functional defects promoting leukemogenesis in
GATA2-deficient individuals. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- BI Yigit
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
- Kinderklinik Muenchen Schwabing, Department of Pediatrics and
Children's Cancer Research Center, TUM School of Medicine, Technical
University of Munich, Munich, Germany
| | - J Fernandez-Orth
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
| | - JM Weiss
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
| | - C Molnar
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
| | - G Andrieux
- University Medical Center Freiburg, Institute of Medical Bioinformatics
und Systems Medicine IBSM, Freiburg, Germany
| | - I Gonzalez-Mendez
- University of Tübingen, Institute of Pathology and
Neuropathology, Tübingen, Germany
| | - M Börries
- University Medical Center Freiburg, Institute of Medical Bioinformatics
und Systems Medicine IBSM, Freiburg, Germany
| | - CM Niemeyer
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
| | - I Teichert-von Lüttichau
- Kinderklinik Muenchen Schwabing, Department of Pediatrics and
Children's Cancer Research Center, TUM School of Medicine, Technical
University of Munich, Munich, Germany
| | - M Erlacher
- University Medical Center Freiburg, Center for Pediatrics, Department
of Pediatric Hematology and Oncology, Freiburg, Germany
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8
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Hagenbourger F, Fernandez-Orth J, Bohler S, Weiss JM, Andrieux G, Börries M, Niemeyer CM, Erlacher M. Characterization of cooperating mechanisms in GATA2
syndrome. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Hagenbourger
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
- MOTI-VATE Graduate School, Faculty of Medicine, University of Freiburg,
Freiburg, Germany
| | - J Fernandez-Orth
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
| | - S Bohler
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
| | - JM Weiss
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
| | - G Andrieux
- University Medical Center Freiburg, Institute of Medical Bioinformatics
und Systems Medicine IBSM, Freiburg, Germany
| | - M Börries
- University Medical Center Freiburg, Institute of Medical Bioinformatics
und Systems Medicine IBSM, Freiburg, Germany
| | - CM Niemeyer
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
| | - M Erlacher
- University Medical Center Freiburg, Center for Pediatrics and
Adolescent Medicine, Department of Pediatric Hematology and Oncology, Freiburg,
Germany
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9
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Farah F, Patel SG, Espinoza JM, Jensen N, Katona BW, Muller C, Kupfer SS, Weiss JM, Hinton A, Stanich PP. Yield of upper gastrointestinal screening in colonic adenomatous polyposis of unknown etiology: a multicenter study. Endosc Int Open 2022; 10:E528-E533. [PMID: 35433207 PMCID: PMC9010079 DOI: 10.1055/a-1784-0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background and study aims The majority of patients with 10 or more cumulative colorectal adenomas have uninformative genetic testing and meet criteria for colonic adenomatous polyposis of unknown etiology (CPUE). The yield of upper gastrointestinal screening in patients with CPUE after multi-gene panel testing is unknown and our objective was to characterize this. Patient and methods A multicenter, retrospective analysis of screening upper endoscopies in adults with CPUE after multi-gene panel testing was performed. Those with a history of gastroduodenal neoplasia prior to CPUE diagnosis were excluded. Demographic and clinical variables were collected and compared. Results One hundred and twenty-eight patients with CPUE were included from five participating centers. Nine (7.0 %) had gastroduodenal neoplasia on initial screening upper endoscopy. Those with over 100 colorectal adenomas had a significantly higher rate of gastroduodenal neoplasia than those with 20-99 or 10-19 colorectal adenomas (44.4 % vs 4.1 % vs 4.4 %, P = 0.002). Similar results were seen when the analysis was restricted to only duodenal or ampullary adenomas. The only malignancy was a gastric cancer in a patient with 20 to 99 colorectal adenomas. When comparing patients with gastroduodenal neoplasia to those without, the only significantly different characteristic was the cumulative number of colorectal adenomas. Conclusions We found a 7 % rate of gastroduodenal neoplasia in patients with CPUE after multi-gene panel testing. Although patients with ≥ 100 colorectal adenomas had a significantly higher risk, over 4 % of patients with 10 to 99 colorectal adenomas had gastroduodenal neoplasia. Given this, we recommend a screening upper endoscopy at the time of a colonoscopy after CPUE diagnosis.
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Affiliation(s)
- Filsan Farah
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Swati G. Patel
- Division of Gastroenterology, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
- Division of Gastroenterology, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, Colorado, United States
| | - Jeannine M. Espinoza
- Division of Gastroenterology, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
- Division of Gastroenterology, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, Colorado, United States
| | - Nicholas Jensen
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Bryson W. Katona
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Charles Muller
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois, United States
| | - Sonia S. Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois, United States
| | - Jennifer M. Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Alice Hinton
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, United States
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Peter P. Stanich
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Nissen CW, Albright JC, Anderson CN, Busch MT, Carlson C, Carsen S, Chambers HG, Edmonds EW, Ellermann JM, Ellis HB, Erickson JB, Fabricant PD, Ganley TJ, Green DW, Grimm NL, Heyworth BE, Po JHH, Kocher MS, Kostyun RO, Krych AJ, Latz KH, Loveland DM, Lyon RM, Mayer SW, Meenen NM, Milewski MD, Myer GD, Nelson BJ, Nepple JJ, Nguyen JC, Pace JL, Paterno MV, Pennock AT, Perkins CA, Polousky JD, Saluan P, Shea KG, Shearier E, Tompkins MA, Wall EJ, Weiss JM, Willimon SC, Wilson PL, Wright RW, Zbojniewicz AM, Carey JL. Descriptive Epidemiology From the Research in Osteochondritis Dissecans of the Knee (ROCK) Prospective Cohort. Am J Sports Med 2022; 50:118-127. [PMID: 34818065 DOI: 10.1177/03635465211057103] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) occurs most commonly in the knees of young individuals. This condition is known to cause pain and discomfort in the knee and can lead to disability and early knee osteoarthritis. The cause is not well understood, and treatment plans are not well delineated. The Research in Osteochondritis Dissecans of the Knee (ROCK) group established a multicenter, prospective cohort to better understand this disease. PURPOSE To provide a baseline report of the ROCK multicenter prospective cohort and present a descriptive analysis of baseline data for patient characteristics, lesion characteristics, and clinical findings of the first 1000 cases enrolled into the prospective cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients were recruited from centers throughout the United States. Baseline data were obtained for patient characteristics, sports participation, patient-reported measures of functional capabilities and limitations, physical examination, diagnostic imaging results, and initial treatment plan. Descriptive statistics were completed for all outcomes of interest. RESULTS As of November 2020, a total of 27 orthopaedic surgeons from 17 institutions had enrolled 1004 knees with OCD, representing 903 patients (68.9% males; median age, 13.1 years; range, 6.3-25.4 years), into the prospective cohort. Lesions were located on the medial femoral condyle (66.2%), lateral femoral condyle (18.1%), trochlea (9.5%), patella (6.0%), and tibial plateau (0.2%). Most cases involved multisport athletes (68.1%), with the most common primary sport being basketball for males (27.3% of cases) and soccer for females (27.6% of cases). The median Pediatric International Knee Documentation Committee (Pedi-IKCD) score was 59.9 (IQR, 45.6-73.9), and the median Pediatric Functional Activity Brief Scale (Pedi-FABS) score was 21.0 (IQR, 5.0-28.0). Initial treatments were surgical intervention (55.4%) and activity restriction (44.0%). When surgery was performed, surgeons deemed the lesion to be stable at intraoperative assessment in 48.1% of cases. CONCLUSION The multicenter ROCK group has been able to enroll the largest knee OCD cohort to date. This information is being used to further understand the pathology of OCD, including its cause, associated comorbidities, and initial presentation and symptoms. The cohort having been established is now being followed longitudinally to better define and elucidate the best treatment algorithms based on these presenting signs and symptoms.
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Affiliation(s)
- Carl W Nissen
- PRISM Sports Medicine, Hartford, Connecticut; Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Cathy Carlson
- College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Henry G Chambers
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | - Eric W Edmonds
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - Henry B Ellis
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - John B Erickson
- Children's Hospital of Wisconsin, Greenfield, Wisconsin, USA
| | | | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | - Regina O Kostyun
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Roger M Lyon
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Norbert M Meenen
- Asklepios Hospital St. George, Children's Sports Medicine, Hamburg, Germany
| | | | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, Georgia; Emory Sports Medicine Center, Atlanta, Georgia; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jie C Nguyen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Andrew's Institute, Children's Health, Plano, Texas, USA
| | - Mark V Paterno
- Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Pennock
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - John D Polousky
- Akron Children's Hospital Department of Orthopedics, Akron, Ohio, USA
| | | | - Kevin G Shea
- Stanford Children's Hospital, Sunnyvale, California, USA
| | - Emily Shearier
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | - Marc A Tompkins
- Gillette Children's Specialty Healthcare; University of Minnesota; TRIA Orthopaedic Center, Minneapolis, Minnesota, USA
| | - Eric J Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Weiss
- Southern California Permanente Medical Group, Los Angeles, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew M Zbojniewicz
- Michigan State University; Advanced Radiology Services, Grand Rapids, Michigan, USA
| | - James L Carey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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- Investigation performed at multiple sites
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11
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Bonham-Werling J, DeLonay AJ, Stephenson K, Hendricks KA, Bednarz L, Weiss JM, Gigot M, Smith MA. Using Statewide Electronic Health Record and Influenza Vaccination Data to Plan and Prioritize COVID-19 Vaccine Outreach and Communications in Wisconsin Communities. Am J Public Health 2021; 111:2111-2114. [PMID: 34878860 PMCID: PMC8667834 DOI: 10.2105/ajph.2021.306524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 08/16/2021] [Indexed: 11/04/2022]
Abstract
The University of Wisconsin Neighborhood Health Partnerships Program used electronic health record and influenza vaccination data to estimate COVID-19 relative mortality risk and potential barriers to vaccination in Wisconsin ZIP Code Tabulation Areas. Data visualization revealed four groupings to use in planning and prioritizing vaccine outreach and communication based on ZIP Code Tabulation Area characteristics. The program provided data, visualization, and guidance to health systems, health departments, nonprofits, and others to support planning targeted outreach approaches to increase COVID-19 vaccination uptake. (Am J Public Health. 2021;111(12):2111-2114. https://doi.org/10.2105/AJPH.2021.306524).
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Affiliation(s)
- Jessica Bonham-Werling
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Allie J DeLonay
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Kristina Stephenson
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Korina A Hendricks
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Lauren Bednarz
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Jennifer M Weiss
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Matthew Gigot
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
| | - Maureen A Smith
- Jessica Bonham-Werling, Allie J. DeLonay, Kristina Stephenson, Korina A. Hendricks, Lauren Bednarz, and Maureen A. Smith are with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison. Jennifer M. Weiss is with the Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison. Matthew Gigot is with the Wisconsin Collaborative for Healthcare Quality, Madison
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12
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Weiss JM, Gupta S, Burke CA, Axell L, Chen LM, Chung DC, Clayback KM, Dallas S, Felder S, Gbolahan O, Giardiello FM, Grady W, Hall MJ, Hampel H, Hodan R, Idos G, Kanth P, Katona B, Lamps L, Llor X, Lynch PM, Markowitz AJ, Pirzadeh-Miller S, Samadder NJ, Shibata D, Swanson BJ, Szymaniak BM, Wiesner GL, Wolf A, Yurgelun MB, Zakhour M, Darlow SD, Dwyer MA, Campbell M. NCCN Guidelines® Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 1.2021. J Natl Compr Canc Netw 2021; 19:1122-1132. [PMID: 34666312 DOI: 10.1164/jnccn.2021.0048] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Identifying individuals with hereditary syndromes allows for timely cancer surveillance, opportunities for risk reduction, and syndrome-specific management. Establishing criteria for hereditary cancer risk assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provides recommendations for the assessment and management of patients at risk for or diagnosed with high-risk colorectal cancer syndromes. The NCCN Genetic/Familial High-Risk Assessment: Colorectal panel meets annually to evaluate and update their recommendations based on their clinical expertise and new scientific data. These NCCN Guidelines Insights focus on familial adenomatous polyposis (FAP)/attenuated familial adenomatous polyposis (AFAP) syndrome and considerations for management of duodenal neoplasia.
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Affiliation(s)
| | | | - Carol A Burke
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - William Grady
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Bryson Katona
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - David Shibata
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Mae Zakhour
- UCLA Jonsson Comprehensive Cancer Center; and
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13
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Benson M, Johannes A, Weiss JM, Lucey M, Pier J, Pfau P. Colorectal Cancer Screening After Changes in US Preventive Services Task Force Guidelines With Increased Screening Options. WMJ 2021; 120:127-130. [PMID: 34255952] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In 2016, the US Preventive Services Task Force (USPSTF) added multitarget stool DNA and computed tomography colonography (CTC) as accepted colorectal cancer screening modalities to the already recommended tests: fecal immunochemical test (FIT), sigmoidoscopy, and colonoscopy. The aim of our study was to determine trends in screening after the USPSTF update, with the effect of additional tests on the use of existing colorectal cancer screening modalities and overall screening rates. METHODS We prospectively compared monthly colorectal cancer overall screening rates and the mean total numbers of patients screened by multitarget stool DNA, colonoscopy, sigmoidoscopy, CTC, and FIT 6 months prior to the new USPSTF guidelines until 30 months after. RESULTS At completion of the study, 72,202 patients were eligible for screening. The overall rate of eligible patients screened for colorectal cancer did not change (80.9% vs 81.3%; P = 0.287). There was a significant increase in the percent of patients screened with multitarget stool DNA (1.6% to 15.6%; P = .001) and a significant decrease in the percent of patients screened using CTC (3.8 % to 1.5%; P = .004), FIT (9.3% to 4.9%; P = .003), and sigmoidoscopy (2.4% to 1.5%, P = .024). There was a nonsignificant decrease in the percent use of screening colonoscopy, from 82.9 % to 76.5% (P = .313). CONCLUSION While the overall colorectal cancer screening rate did not increase after the USPSTF update with additional recommended screening tests, practice patterns did change with a shift in the type of screening test used.
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Affiliation(s)
- Mark Benson
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin
| | - Andrew Johannes
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin
| | - Jennifer M Weiss
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin
| | - Michael Lucey
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin
| | - Jeff Pier
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin
| | - Patrick Pfau
- University of Wisconsin School of Medicine and Public Health, Division of Gastroenterology and Hepatology, Department of Medicine, Madison, Wisconsin,
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14
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MacFarland SP, Ebrahimzadeh JE, Zelley K, Begum L, Bass LM, Brand RE, Dudley B, Fishman DS, Ganzak A, Karloski E, Latham A, Llor X, Plon S, Riordan MK, Scollon SR, Stadler ZK, Syngal S, Ukaegbu C, Weiss JM, Yurgelun MB, Brodeur GM, Mamula P, Katona BW. Phenotypic Differences in Juvenile Polyposis Syndrome With or Without a Disease-causing SMAD4/BMPR1A Variant. Cancer Prev Res (Phila) 2020; 14:215-222. [DOI: 10.1158/1940-6207.capr-20-0348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
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15
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Grimm NL, Pace JL, Levy BJ, Arthur D, Portman M, Solomito MJ, Weiss JM. Demographics and Epidemiology of Discoid Menisci of the Knee: Analysis of a Large Regional Insurance Database. Orthop J Sports Med 2020; 8:2325967120950669. [PMID: 32999890 PMCID: PMC7506788 DOI: 10.1177/2325967120950669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background: A discoid meniscus is a morphological variant of normal knee joint meniscus
shape and ultrastructure that can lead to traumatic tearing of this tissue
and early joint osteoarthritis. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of discoid menisci
in a large, ethnically diverse regional cohort and to evaluate possible risk
factors. The hypothesis was that there would be no difference in the
epidemiological distribution of discoid menisci based on ethnicity or
sex. Study Design: Descriptive epidemiology study. Methods: The study population was from a regional, integrated health care system
cohort from Kaiser Permanente of Southern California that, as of 2016,
included more than 4.5 million patients. Patient demographics included age,
sex, and ethnicity within this cohort. Potential risk factors analyzed
included age, sex, ethnicity, and body mass index (BMI). Unique
characteristics of a discoid meniscus were analyzed, including a symptomatic
versus asymptomatic meniscus, location of meniscal tear and type of
meniscus, and frequency of meniscal surgical treatment. Results: A total of 223 patients with a confirmed discoid meniscus were identified,
yielding an overall prevalence rate of 4.88 per 100,000 patients. Those
identifying as Black had the lowest prevalence (2.68/100,000), while
Hispanic ethnicity had the highest (6.01/100,000). However, there was no
significant difference with regard to ethnicity (P = .283),
nor any significant difference between sexes. BMI did not significantly
influence the rate of discoid menisci (P = .504). A
majority (77.5%) of patients were symptomatic, while 22.5% of patients with
discoid menisci were asymptomatic and discovered incidentally. Symptomatic
discoid menisci were more likely to be operated on compared with
asymptomatic discoid menisci (71% vs 14%, respectively; P =
.001; odds ratio, 14.8 [95% CI, 5.8-37.2]). Horizontal and bucket-handle
tears were the more common tear types. Of the discoid menisci in this
cohort, 55.6% underwent surgery, with 95.2% undergoing reported
saucerization. Conclusion: In this very diverse population-based cohort of patients, there did not seem
to be a significant predilection of discoid menisci with regard to
ethnicity. Neither sex nor BMI significantly influenced the rate of discoid
menisci. More than three-quarters of those with a diagnosed discoid meniscus
were symptomatic. Of the tears that occurred with discoid menisci,
horizontal and bucket-handle tears made up the largest proportion.
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Affiliation(s)
- Nathan L Grimm
- Idaho Sports Medicine Institute, Boise State University, Boise, Idaho, USA.,Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA
| | - James Lee Pace
- Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA.,Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Quinnipiac University, Hamden, Connecticut, USA
| | - Benjamin J Levy
- Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA
| | - D'Ann Arthur
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | - Mark Portman
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | | | - Jennifer M Weiss
- Department of Orthopedic Surgery, Los Angeles Medical Center, Kaiser Permanente, Los Angeles, California, USA
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16
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Provenzale D, Ness RM, Llor X, Weiss JM, Abbadessa B, Cooper G, Early DS, Friedman M, Giardiello FM, Glaser K, Gurudu S, Halverson AL, Issaka R, Jain R, Kanth P, Kidambi T, Lazenby AJ, Maguire L, Markowitz AJ, May FP, Mayer RJ, Mehta S, Patel S, Peter S, Stanich PP, Terdiman J, Keller J, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1312-1320. [PMID: 33022639 DOI: 10.6004/jnccn.2020.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel's recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.
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Affiliation(s)
| | | | | | | | | | - Gregory Cooper
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S Early
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Amy L Halverson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Rachel Issaka
- Fred Hutchinson Cancer Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Robert J Mayer
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Shivan Mehta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Peter P Stanich
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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17
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Burke CA, Dekker E, Lynch P, Samadder NJ, Balaguer F, Hüneburg R, Burn J, Castells A, Gallinger S, Lim R, Stoffel EM, Gupta S, Henderson A, Kallenberg FG, Kanth P, Roos VH, Ginsberg GG, Sinicrope FA, Strassburg CP, Van Cutsem E, Church J, Lalloo F, Willingham FF, Wise PE, Grady WM, Ford M, Weiss JM, Gryfe R, Rustgi AK, Syngal S, Cohen A. Eflornithine plus Sulindac for Prevention of Progression in Familial Adenomatous Polyposis. N Engl J Med 2020; 383:1028-1039. [PMID: 32905675 DOI: 10.1056/nejmoa1916063] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficacy and safety of combination therapy with eflornithine and sulindac, as compared with either drug alone, in delaying disease progression in patients with familial adenomatous polyposis are unknown. METHODS We evaluated the efficacy and safety of the combination of eflornithine and sulindac, as compared with either drug alone, in adults with familial adenomatous polyposis. The patients were stratified on the basis of anatomical site with the highest polyp burden and surgical status; the strata were precolectomy (shortest projected time to disease progression), rectal or ileal pouch polyposis after colectomy (longest projected time), and duodenal polyposis (intermediate projected time). The patients were then randomly assigned in a 1:1:1 ratio to receive 750 mg of eflornithine, 150 mg of sulindac, or both once daily for up to 48 months. The primary end point, assessed in a time-to-event analysis, was disease progression, defined as a composite of major surgery, endoscopic excision of advanced adenomas, diagnosis of high-grade dysplasia in the rectum or pouch, or progression of duodenal disease. RESULTS A total of 171 patients underwent randomization. Disease progression occurred in 18 of 56 patients (32%) in the eflornithine-sulindac group, 22 of 58 (38%) in the sulindac group, and 23 of 57 (40%) in the eflornithine group, with a hazard ratio of 0.71 (95% confidence interval [CI], 0.39 to 1.32) for eflornithine-sulindac as compared with sulindac (P = 0.29) and 0.66 (95% CI, 0.36 to 1.24) for eflornithine-sulindac as compared with eflornithine. Among 37 precolectomy patients, the corresponding values in the treatment groups were 2 of 12 patients (17%), 6 of 13 (46%), and 5 of 12 (42%) (hazard ratios, 0.30 [95% CI, 0.07 to 1.32] and 0.20 [95% CI, 0.03 to 1.32]); among 34 patients with rectal or ileal pouch polyposis, the values were 4 of 11 patients (36%), 2 of 11 (18%), and 5 of 12 (42%) (hazard ratios, 2.03 [95% CI, 0.43 to 9.62] and 0.84 [95% CI, 0.24 to 2.90]); and among 100 patients with duodenal polyposis, the values were 12 of 33 patients (36%), 14 of 34 (41%), and 13 of 33 (39%) (hazard ratios, 0.73 [95% CI, 0.34 to 1.52] and 0.76 [95% CI, 0.35 to 1.64]). Adverse and serious adverse events were similar across the treatment groups. CONCLUSIONS In this trial involving patients with familial adenomatous polyposis, the incidence of disease progression was not significantly lower with the combination of eflornithine and sulindac than with either drug alone. (Funded by Cancer Prevention Pharmaceuticals; ClinicalTrials.gov number, NCT01483144; EudraCT number, 2012-000427-41.).
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Affiliation(s)
- Carol A Burke
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Evelien Dekker
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Patrick Lynch
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - N Jewel Samadder
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Francesc Balaguer
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Robert Hüneburg
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - John Burn
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Antoni Castells
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Steven Gallinger
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Ramona Lim
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Elena M Stoffel
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Samir Gupta
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Alex Henderson
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Frank G Kallenberg
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Priyanka Kanth
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Victorine H Roos
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Gregory G Ginsberg
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Frank A Sinicrope
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Christian P Strassburg
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Eric Van Cutsem
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - James Church
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Fiona Lalloo
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Field F Willingham
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Paul E Wise
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - William M Grady
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Molly Ford
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Jennifer M Weiss
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Robert Gryfe
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Anil K Rustgi
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Sapna Syngal
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
| | - Alfred Cohen
- From the Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland (C.A.B., J.C.); the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (E.D., F.G.K., V.H.R.); the Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston (P.L.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix (N.J.S.), and Cancer Prevention Pharmaceuticals, Tucson (A. Cohen) - both in Arizona; the Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona (F.B., A. Castells); the Department of Internal Medicine I, University of Bonn (R.H., C.P.S.), and the National Center for Hereditary Tumor Syndromes (R.H., C.P.S.), Bonn, Germany; Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne (J.B., A.H.), and Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester (F.L.) - both in the United Kingdom; Mount Sinai Hospital, Toronto (S. Gallinger, R.G.); the Division of Population Sciences, Dana-Farber Cancer Institute, the Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, and Harvard Medical School - all in Boston (R.L., S.S.); the Division of Gastroenterology, University of Michigan, Ann Arbor (E.M.S.); Veterans Affairs San Diego Healthcare System, San Diego, and the Division of Gastroenterology, University of California San Diego, La Jolla (S. Gupta); Huntsman Cancer Center, Salt Lake City (P.K.); the University of Pennsylvania, Philadelphia (G.G.G., A.K.R.); Mayo Clinic, Rochester, MN (F.A.S.); University Hospital Gasthuisberg, Leuven, Belgium (E.V.C.); Emory University School of Medicine, Atlanta (F.F.W.); Washington University School of Medicine, St. Louis (P.E.W.); University of Washington Medical Center, Seattle (W.M.G.); Vanderbilt University Medical Center, Nashville (M.F.); and the University of Wisconsin School of Medicine and Public Health, Madison (J.M.W.)
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Pickhardt PJ, Graffy PM, Weigman B, Deiss-Yehiely N, Hassan C, Weiss JM. Diagnostic Performance of Multitarget Stool DNA and CT Colonography for Noninvasive Colorectal Cancer Screening. Radiology 2020; 297:120-129. [PMID: 32779997 DOI: 10.1148/radiol.2020201018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundMultitarget stool DNA (mt-sDNA) screening has increased rapidly since simultaneous approval by the U.S. Food and Drug Administration and Centers for Medicare and Medicaid Services in 2014, whereas CT colonography screening remains underused and is not covered by Centers for Medicare and Medicaid Services.PurposeTo report postapproval clinical experience with mt-sDNA screening for colorectal cancer (CRC) and compare results with CT colonography screening at the same center.Materials and MethodsIn this retrospective cohort study, asymptomatic adults underwent clinical mt-sDNA screening during a 5-year interval (2014-2019). Electronic medical records were searched to verify test results and document subsequent optical colonoscopy and histopathologic findings. A similar analysis was performed for CT colonography screening during a 15-year interval (2004-2019), with consideration of thresholds for positivity of both 6-mm and 10-mm polyp sizes. χ2 or two-sample t tests were used for group comparisons.ResultsA total of 3987 asymptomatic adult patients (mean age, 64 years ± 9 [standard deviation]; 2567 women) underwent mt-sDNA screening and 9656 patients (mean age, 57 years ± 8; 5200 women) underwent CT colonography. Test-positive rates for mt-sDNA and for 6-mm- and 10-mm-threshold CT colonography were 15.2%, 16.4%, and 6.7%, respectively. Optical colonoscopy follow-up rates for positive results of mt-sDNA and 6-mm- and 10-mm-threshold CT colonography were 13.1%, 12.3%, and 5.9%, respectively. Positive predictive values (PPVs) for any neoplasm 6 mm or greater, advanced neoplasia, and CRC for mt-sDNA were 54.2%, 22.7%, and 1.9% respectively; for 6-mm-threshold CT colonography, PPVs were 76.8%, 44.3%, and 2.7%; for 10-mm-threshold CT colonography, PPVs were 84.5%, 75.2%, and 5.2%, respectively (P < .001 for mt-sDNA vs CT colonography for all except 6-mm CRC at CT colonography). For mt-sDNA versus 6-mm-threshold CT colonography, overall detection rates for advanced neoplasia were 2.7% and 5.0%, respectively (P < .001); corresponding detection rates for CRC were 0.23% and 0.31%, respectively (P = .43).ConclusionThe detection rates of advanced neoplasia at CT colonography screening were greater than those of multitarget stool DNA. Detection rates were similar for colorectal cancer.© RSNA, 2020See also the editorial by Yee in this issue.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Peter M Graffy
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Benjamin Weigman
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Nimrod Deiss-Yehiely
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Cesare Hassan
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Jennifer M Weiss
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
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19
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Navarro RA, Reddy NC, Weiss JM, Yates AJ, Fu FH, McKee M, Lederman ES. Orthopaedic Systems Response to and Return from the COVID-19 Pandemic: Lessons for Future Crisis Management. J Bone Joint Surg Am 2020; 102:e75. [PMID: 32675663 PMCID: PMC7396222 DOI: 10.2106/jbjs.20.00709] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become the dominant health-care issue of this generation and has reached every corner of the health-care delivery spectrum. Our 3 orthopaedic departments enacted a response to the COVID-19 pandemic within our organizations. We discuss our health-care systems' response to the outbreak and offer discussion for the recovery of the orthopaedic service line within large health-care systems.
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Affiliation(s)
| | - Nithin C. Reddy
- Kaiser Permanente Southern California, San Diego, California
| | | | - Adolph J. Yates
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Freddie H. Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael McKee
- University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
- Banner Health, Phoenix Arizona
| | - Evan S. Lederman
- University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
- Banner Health, Phoenix Arizona
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20
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Pilarski R, Weiss JM, Domchek SM, Tuya Pal MB. Current Insights: Evolving Principles and Controversies of Cancer Risk Assessment and Management of Hereditary Cancers. J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2020.5013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the introduction of panel and direct-to-consumer testing, genetic testing has become commonplace in recent years, paving the way for both increased awareness around prevalent genetic cancer risks, and also an onslaught of misinformation. At the NCCN 2020 Virtual Annual Conference, Dr. Tuya Pal led a panel of experts in discussing the utility and difficulties associated with multigene testing, the emerging role of moderate-penetrance genes in defining risks for hereditary cancer, and the controversies associated with direct-to-consumer genetic testing services.
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21
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Biller LH, Ukaegbu C, Dhingra TG, Burke CA, Chertock Y, Chittenden A, Church JM, Koeppe ES, Leach BH, Levinson E, Lim RM, Lutz M, Salo-Mullen E, Sheikh R, Idos G, Kastrinos F, Stoffel E, Weiss JM, Hall MJ, Kalady MF, Stadler ZK, Syngal S, Yurgelun MB. A Multi-Institutional Cohort of Therapy-Associated Polyposis in Childhood and Young Adulthood Cancer Survivors. Cancer Prev Res (Phila) 2020; 13:291-298. [PMID: 32051178 DOI: 10.1158/1940-6207.capr-19-0416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022]
Abstract
Prior small reports have postulated a link between gastrointestinal polyposis and childhood and young adulthood cancer (CYAC) treatment (therapy-associated polyposis; TAP), but this remains a poorly understood phenomenon. The aim of this study was to describe the phenotypic spectrum of TAP in a multi-institutional cohort. TAP cases were identified from eight high-risk cancer centers. Cases were defined as patients with ≥10 gastrointestinal polyps without known causative germline alteration or hereditary colorectal cancer predisposition syndrome who had a history of prior treatment with chemotherapy and/or radiotherapy for CYAC. A total of 34 TAP cases were included (original CYAC: 27 Hodgkin lymphoma, three neuroblastoma, one acute myeloid leukemia, one medulloblastoma, one nephroblastoma, and one non-Hodgkin lymphoma). Gastrointestinal polyposis was first detected at a median of 27 years (interquartile range, 20-33) after CYAC treatment. A total of 12 of 34 (35%) TAP cases had ≥50 colorectal polyps. A total of 32 of 34 (94%) had >1 histologic polyp type. A total of 25 of 34 (74%) had clinical features suggestive of ≥1 colorectal cancer predisposition syndrome [e.g., attenuated familial adenomatous polyposis (FAP), serrated polyposis syndrome, extracolonic manifestations of FAP, mismatch repair-deficient colorectal cancer, or hamartomatous polyposis] including 8 of 34 (24%) with features of multiple such syndromes. TAP is an apparently acquired phenomenon that should be considered in patients who develop significant polyposis without known causative germline alteration but who have had prior treatment for a CYAC. Patients with TAP have features that may mimic various hereditary colorectal cancer syndromes, suggesting multiple concurrent biologic mechanisms, and recognition of this diagnosis may have implications for cancer risk and screening.
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Affiliation(s)
- Leah H Biller
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Ramona M Lim
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan Lutz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rania Sheikh
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Idos
- University of Southern California, Los Angeles, California
| | | | | | - Jennifer M Weiss
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Abstract
Although colorectal cancer (CRC) screening has reduced the incidence of and mortality from CRC, chemoprevention strategies have the potential to further reduce CRC incidence and mortality. Chemoprevention agents might be used for average-risk as well as high-risk groups, and to prevent CRC recurrence after therapy. CRC chemoprevention agents that have been studied include aspirin, nonaspirin nonsteroidal anti-inflammatory drugs, statins, agents that target metabolic pathways, and vitamins and minerals. We review the prospect of chemoprevention of CRC, results from preclinical and human studies, challenges, and future directions.
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Affiliation(s)
- Bryson W. Katona
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jennifer M. Weiss
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Weiss JM. Osteopontin regulatory functions in the hair follicle open a therapeutic approach for hypertrichosis. Br J Dermatol 2019; 182:1324-1325. [PMID: 31774146 DOI: 10.1111/bjd.18637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J M Weiss
- Department of Dermatology and Allergy, University of Ulm, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
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Provenzale D, Gupta S, Ahnen DJ, Markowitz AJ, Chung DC, Mayer RJ, Regenbogen SE, Blanco AM, Bray T, Cooper G, Early DS, Ford JM, Giardiello FM, Grady W, Hall MJ, Halverson AL, Hamilton SR, Hampel H, Klapman JB, Larson DW, Lazenby AJ, Llor X, Lynch PM, Mikkelson J, Ness RM, Slavin TP, Sugandha S, Weiss JM, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018. J Natl Compr Canc Netw 2019; 16:939-949. [PMID: 30099370 DOI: 10.6004/jnccn.2018.0067] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening outline various screening modalities as well as recommended screening strategies for individuals at average or increased-risk of developing sporadic CRC. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize 2018 updates to the NCCN Guidelines, with a primary focus on modalities used to screen individuals at average-risk for CRC.
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Weiss JM, Csoszi T, Maglakelidze M, Hoyer RJ, Beck JT, Domine Gomez M, Lowczak A, Aljumaily R, Rocha Lima CM, Boccia RV, Hanna W, Nikolinakos P, Chiu VK, Owonikoko TK, Schuster SR, Hussein MA, Richards DA, Sawrycki P, Bulat I, Hamm JT, Hart LL, Adler S, Antal JM, Lai AY, Sorrentino JA, Yang Z, Malik RK, Morris SR, Roberts PJ, Dragnev KH. Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial. Ann Oncol 2019; 30:1613-1621. [PMID: 31504118 PMCID: PMC6857609 DOI: 10.1093/annonc/mdz278] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER NCT02499770.
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Affiliation(s)
- J M Weiss
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, USA
| | - T Csoszi
- Oncology, Hetenyi Geza Korhaz, Onkologiai Kozpont, Szolnok, Hungary
| | - M Maglakelidze
- Department of Oncology, Research Institute of Clinical Medicine, Tbilisi, Georgia, USA
| | - R J Hoyer
- Department of Oncology, Memorial Hospital, University of Colorado Health, Colorado Springs, USA
| | - J T Beck
- Department of Medical Oncology and Hematology, Highlands Oncology Group, Fayetteville, USA
| | - M Domine Gomez
- Department of Oncology, University Hospital Fundacion Jimenez Diaz, IIS-FJD, Madrid, Spain
| | - A Lowczak
- Department of Pulmonology, Faculty of Health and Science, University of Warmia and Mazury in Olsztyn, Poland
| | - R Aljumaily
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, USA
| | - C M Rocha Lima
- Gibbs Cancer Center and Research Institute, Spartanburg, USA
| | - R V Boccia
- Center for Cancer and Blood Disorders, Bethesda, USA
| | - W Hanna
- Hematology/Oncology, University of Tennessee Medical Center, Knoxville, USA
| | - P Nikolinakos
- University Cancer & Blood Center, LLC, Athens, Greece
| | - V K Chiu
- Department of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - T K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
| | | | - M A Hussein
- Department of Oncology, Florida Cancer Specialists, Leesburg, USA
| | - D A Richards
- Department of Oncology, US Oncology Research, Tyler, USA
| | - P Sawrycki
- Department of Cancer Chemotherapy, Provincial Hospital, Toruń, Poland
| | - I Bulat
- ARENSIA Oncology Unit, Institute of Oncology, Chisinau, Moldova
| | - J T Hamm
- Department of Medical Oncology, Norton Health Care, Louisville, USA
| | - L L Hart
- Drug Development Program, Floridia Cancer Specialists, Fort Myers, USA
| | - S Adler
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J M Antal
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - A Y Lai
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - J A Sorrentino
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - Z Yang
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - R K Malik
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - S R Morris
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - P J Roberts
- Clinical Research, G1 Therapeutics, Inc., Research Triangle Park, USA
| | - K H Dragnev
- Department of Hematology/Oncology, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center, Lebanon, USA.
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Gupta S, Provenzale D, Llor X, Halverson AL, Grady W, Chung DC, Haraldsdottir S, Markowitz AJ, Slavin Jr TP, Hampel H, Ness RM, Weiss JM, Ahnen DJ, Chen LM, Cooper G, Early DS, Giardiello FM, Hall MJ, Hamilton SR, Kanth P, Klapman JB, Lazenby AJ, Lynch PM, Mayer RJ, Mikkelson J, Peter S, Regenbogen SE, Dwyer MA, Ogba N. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019. J Natl Compr Canc Netw 2019; 17:1032-1041. [DOI: 10.6004/jnccn.2019.0044] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.
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Affiliation(s)
| | | | | | - Amy L. Halverson
- 4Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - William Grady
- 5Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | - Lee-may Chen
- 14UCSF Helen Diller Family Comprehensive Cancer Center
| | - Gregory Cooper
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S. Early
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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Poon S, Abzug J, Caird M, Cho RH, Luong M, Weiss JM. A Five-year Review of the Designated Leadership Positions of Pediatric Orthopaedic Society of North America: Where Do Women Stand? Orthop Clin North Am 2019; 50:331-335. [PMID: 31084835 DOI: 10.1016/j.ocl.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/02/2023]
Abstract
Despite the growing number of women entering medical school, female representation among orthopedic surgery is the lowest compared with all areas of medicine. In 2014, 47.7% of students entering medical school were women, but only 13.7% of orthopedic residents were women. Pediatric orthopedics have been successful in enrolling women compared with other orthopedic subspecialties. This is an investigation of female representation among the Pediatric Orthopaedic Society of North America membership roster, providing insight into the effect on the increased gender diversity in the membership of an organization and its correlation with leadership positions at different levels within the organization.
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Affiliation(s)
- Selina Poon
- Orthopaedic Surgery Department, Shriners for Children Medical Center, 909 South Fair Oaks Avenue, Pasadena, CA 91105, USA.
| | - Joshua Abzug
- Department of Orthopaedics and Pediatrics, University of Maryland School of Medicine, 1 Texas Station Court, Suite 300, Timonium, MD 21093, USA
| | - Michelle Caird
- Pediatric Orthopaedic Department, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Robert H Cho
- Orthopaedic Surgery Department, Shriners for Children Medical Center, 909 South Fair Oaks Avenue, Pasadena, CA 91105, USA
| | - Marilan Luong
- Research Department, Shriners for Children Medical Center, 909 South Fair Oaks Avenue, Pasadena, CA 91105, USA
| | - Jennifer M Weiss
- Pediatric Orthopaedic Department, Kaiser Permanente, 4760 Sunset Boulevard, Los Angeles, CA 90027, USA
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Kessler JI, Jacobs JC, Cannamela PC, Weiss JM, Shea KG. Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents. Orthop J Sports Med 2018; 6:2325967118815846. [PMID: 30622996 PMCID: PMC6302285 DOI: 10.1177/2325967118815846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known. Purpose To assess the demographics and epidemiology of OCD of the elbow among children. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group. Results A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females (P < .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups. Conclusion In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.
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Affiliation(s)
| | - John C Jacobs
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | - Jennifer M Weiss
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Kevin G Shea
- Department of Orthopaedics, Stanford University, Stanford, California, USA
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Gupta S, Provenzale D, Regenbogen SE, Hampel H, Slavin TP, Hall MJ, Llor X, Chung DC, Ahnen DJ, Bray T, Cooper G, Early DS, Ford JM, Giardiello FM, Grady W, Halverson AL, Hamilton SR, Klapman JB, Larson DW, Lazenby AJ, Lynch PM, Markowitz AJ, Mayer RJ, Ness RM, Samadder NJ, Shike M, Sugandha S, Weiss JM, Dwyer MA, Ogba N. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 3.2017. J Natl Compr Canc Netw 2018; 15:1465-1475. [PMID: 29223984 DOI: 10.6004/jnccn.2017.0176] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the management of patients with high-risk syndromes associated with an increased risk of colorectal cancer (CRC). The NCCN Panel for Genetic/Familial High-Risk Assessment: Colorectal meets at least annually to assess comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights focus on genes newly associated with CRC risk on multigene panels, the associated evidence, and currently recommended management strategies.
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Abstract
BACKGROUND Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Little has been published on the epidemiology of OCD in adult patients. PURPOSE To assess the frequency of OCD lesions in adults and assess the risk by age, sex, and ethnicity. STUDY DESIGN Descriptive epidemiology study. METHODS The authors assessed all patients aged 20 to 45 years from the entire database of patients enrolled as members of Kaiser Permanente Southern California from January 2011 until December 2013. Kaiser Southern California is an integrated health care system serving a racially, ethnically, and socioeconomically diverse population of >3.5 million patients. A retrospective chart review was done on OCD during this period. Inclusion criteria included OCD of any joint. Exclusion criteria included traumatic osteochondral fractures and coexistence of intra-articular lesions other than OCD. Joint involvement/location, laterality, and all patient demographics were recorded. RESULTS Among 122 patients, a total of 124 OCD lesions were found. The majority of lesions were in the ankle (n = 76) and knee (n = 43), with 3 foot lesions and 2 elbow lesions identified. OCD lesions were identified in 75 men (62%) and 47 women (38%). Overall incidence rates per 100,000 person-years were 3.42 for all OCD, 2.08 for ankle OCD, and 1.21 for knee OCD. The relative risk of adult OCD for men was twice that of women. The relative risk of adult OCD for white patients was 2.3 that of Asians and 1.7 that of Hispanics. Risk of knee OCD was 3.6 times higher for men than women. As compared with women, men had a higher risk for lateral femoral condyle OCD lesions versus the medial femoral condyle ( P = .05; odds ratio [OR], 5.19). CONCLUSION This large cohort study of Southern California adults with OCD demonstrated an increased OR for men (vs women) of OCD in all joints. The majority of symptomatic lesions were present in the ankle rather than the knee, as previously found in children. White and black patients had the highest OR of OCD; men had a significantly greater OR of lateral femoral condyle knee lesions as compared with women.
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Affiliation(s)
- Jennifer M Weiss
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Kevin G Shea
- St Luke's Sports Medicine, St Luke's Children's Hospital, Boise, Idaho, USA
| | - John C Jacobs
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Peter C Cannamela
- St Luke's Sports Medicine, St Luke's Children's Hospital, Boise, Idaho, USA
| | - Ian Becker
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Mark Portman
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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31
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Weiss JM, Pandhi N, Kraft S, Potvien A, Carayon P, Smith MA. Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions. Clin Transl Gastroenterol 2018; 9:148. [PMID: 29691364 PMCID: PMC5915383 DOI: 10.1038/s41424-018-0014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/18/2018] [Accepted: 02/13/2018] [Indexed: 11/09/2022] Open
Abstract
Objective National colorectal cancer (CRC) screening rates have plateaued. To optimize interventions targeting those unscreened, a better understanding is needed of how this preventive service fits in with multiple preventive and chronic care needs managed by primary care providers (PCPs). This study examines whether PCP practices of other preventive and chronic care needs correlate with CRC screening. Methods We performed a retrospective cohort study of 90 PCPs and 33,137 CRC screening-eligible patients. Five PCP quality metrics (breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control) were measured. A baseline correlation test was performed between these metrics and PCP CRC screening rates. Multivariable logistic regression with clustering at the clinic-level estimated odds ratios and 95% confidence intervals for these PCP quality metrics, patient and PCP characteristics, and their relationship to CRC screening. Results PCP CRC screening rates have a strong correlation with breast cancer screening rates (r = 0.7414, p < 0.001) and a weak correlation with the other quality metrics. In the final adjusted model, the only PCP quality metric that significantly predicted CRC screening was breast cancer screening (OR 1.25; 95% CI 1.11–1.42; p < 0.001). Conclusions PCP CRC screening rates are highly concordant with breast cancer screening. CRC screening is weakly concordant with cervical cancer screening and chronic disease management metrics. Efforts targeting PCPs to increase CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact and success.
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Affiliation(s)
- Jennifer M Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Nancy Pandhi
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sally Kraft
- VP Population Health, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Aaron Potvien
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA
| | - Maureen A Smith
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.,Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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32
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Weins AB, Scharffetter-Kochanek K, Weiss T, Brockow K, Biedermann T, Psotta-Schachtner C, Mockenhaupt M, Weiss JM. Is neutrophilic desquamative erythroderma a form of acute generalized exanthematous pustulosis? J Eur Acad Dermatol Venereol 2017; 32:e230-e232. [PMID: 29224230 DOI: 10.1111/jdv.14751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A B Weins
- Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Munich, Germany.,Department of Dermatology and Allergy, University of Ulm, Ulm, Germany
| | | | - T Weiss
- Department of Dermatology and Allergy, University of Ulm, Ulm, Germany
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Munich, Germany
| | | | - M Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - J M Weiss
- Department of Dermatology and Allergy, University of Ulm, Ulm, Germany
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Prentice HA, Paxton EW, Hunt JJ, Grimsrud CD, Weiss JM. Pediatric Hip Fractures in California: Results from a Community-Based Hip Fracture Registry. Perm J 2017; 21:16-081. [PMID: 28241902 DOI: 10.7812/tpp/16-081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Hip fracture registries offer an opportunity to identify and to monitor patients with rare conditions and outcomes, including hip fractures in pediatric patients. OBJECTIVE To report patient demographics and surgical outcomes of pediatric patients treated surgically for hip fractures in a large integrated health care system. DESIGN Pediatric patients (< 21 years old at the time of fracture) with hip fractures were identified between 2009 and 2012 using our health care system's hip fracture registry. MAIN OUTCOME MEASURES Patient characteristics, type of fracture, surgical treatment, and short-term complications. RESULTS Among 39 patients identified, 31 (79.5%) were male, and the median age was 15 years old (interquartile range: 11-17 years). Most patients were Hispanic (n = 17, 43.6%) or white (n = 14, 35.9%). There were 8 patients (20.5%) with 15 comorbidities. Delbet Type IV (intertrochanteric) fractures were the most common fracture type (n = 22, 56.4%), and fixation method was equally distributed between intramedullary, screw and sideplate, and screws (n = 12, 30.8% for each). Most surgeries were performed by medium-volume surgeons (n = 22, 56.4%) at medium- and high-volume hospitals (n = 37, 94.9%). Three 90-day readmissions (7.7%), 1 infection (2.6%), 1 malunion (2.6%), and 1 revision (2.6%) were observed in this cohort during the study period. CONCLUSION In our series using registry data, hip fractures younger than age 21 years were more common in boys and Hispanic patients. Intertrochanteric fractures (Delbet Type IV) were the most frequently observed type in our community-based hip fracture registry. Short-term complications were infrequent.
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Affiliation(s)
- Heather A Prentice
- Research Scientist I Investigator in Surgical Outcomes and Analysis for the Southern California Permanente Medical Group in San Diego.
| | - Elizabeth W Paxton
- Director of Surgical Outcomes and Analysis for the Southern California Permanente Medical Group in San Diego.
| | - Jessica J Hunt
- Research Associate II in Surgical Outcomes and Analysis for the Southern California Permanente Medical Group in San Diego.
| | | | - Jennifer M Weiss
- Orthopedic Surgeon at the Sunset Medical Center in Los Angeles, CA.
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Genuneit J, Braig S, Logan CA, Weiss JM, Brenner H, Rothenbacher D. Stabile Inzidenz der atopischen Dermatitis über eine Dekade aber Diskrepanzen zwischen Eltern- und Arztberichten: die Ulmer Geburtskohorten. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Genuneit
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
| | - S Braig
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
| | - CA Logan
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
| | - JM Weiss
- Universitätsklinikum Ulm, Klinik für Dermatologie und Allergologie, Ulm
| | - H Brenner
- Deutsches Krebsforschungszentrum, Abteilung Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - D Rothenbacher
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
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35
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Smith MA, Weiss JM, Potvien A, Schumacher JR, Gangnon RE, Kim DH, Weeth-Feinstein LA, Pickhardt PJ. Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates. Radiology 2017; 284:717-724. [PMID: 28696184 DOI: 10.1148/radiol.2017170924] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
RSNA, 2017.
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Affiliation(s)
- Maureen A Smith
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Jennifer M Weiss
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Aaron Potvien
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Jessica R Schumacher
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Ronald E Gangnon
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - David H Kim
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Lauren A Weeth-Feinstein
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
| | - Perry J Pickhardt
- From the Department of Population Health Sciences (M.A.S.), Department of Family Medicine and Community Health (M.A.S.), Department of Surgery (M.A.S., J.R.S.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W., L.A.W.F.), Department of Biostatistics and Medical Informatics (R.E.G.), and Department of Radiology (D.H.K., P.J.P.), University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Room 210-31, Madison, WI 53705; University of Wisconsin Carbone Cancer Center, Madison, Wis (M.A.S., J.M.W., R.E.G., D.H.K., L.A.W.F., P.J.P.); and Department of Statistics, University of Wisconsin-Madison College of Letters & Science, Madison, Wis (A.P.)
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Schmocker RK, Vanness DJ, Greenberg CC, Havlena JA, LoConte NK, Weiss JM, Neuman HB, Leverson G, Smith MA, Winslow ER. Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma. HPB (Oxford) 2017; 19:465-472. [PMID: 28237627 PMCID: PMC5695546 DOI: 10.1016/j.hpb.2017.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is used for pancreatic adenocarcinoma staging and obtaining a tissue diagnosis. The objective was to determine patterns of preoperative EUS and the impact on downstream treatment. METHODS The Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database was used to identify patients with pancreatic adenocarcinoma. The staging period was the first staging procedure within 6 months of surgery until surgery. Logistic regression was used to determine factors associated with preoperative EUS. The main outcome was EUS in the staging period, with secondary outcomes including number of staging tests and time to surgery. RESULTS 2782 patients were included, 56% were treated at an academic hospital (n = 1563). 1204 patients underwent EUS (43.3%). The factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and a NCI or academic hospital (all p < 0.0001). EUS was associated with a longer time to surgery (17.8 days; p < 0.0001), and a higher number of staging tests (40 tests/100 patients; p < 0.0001). CONCLUSIONS Factors most associated with receipt of EUS are geographic, temporal, and institutional, rather than clinical/disease factors. EUS is associated with a longer time to surgery and more preoperative testing, and additional study is needed to determine if EUS is overused.
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Affiliation(s)
- Ryan K Schmocker
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
| | - David J Vanness
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, USA
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, USA
| | - Jeff A Havlena
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
| | - Noelle K LoConte
- Department of Medicine, Division of Oncology, University of Wisconsin School of Medicine and Public Health, USA
| | - Jennifer M Weiss
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine and Public Health, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
| | - Glen Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
| | - Maureen A Smith
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Emily R Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.
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Weiss JM, Kim DH, Smith MA, Potvien A, Schumacher JR, Gangnon RE, Pooler BD, Pfau PR, Pickhardt PJ. Predictors of primary care provider adoption of CT colonography for colorectal cancer screening. Abdom Radiol (NY) 2017; 42:1268-1275. [PMID: 27864601 DOI: 10.1007/s00261-016-0971-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/21/2022]
Abstract
PURPOSE To examine factors influencing primary care provider (PCP) adoption of CT colonography (CTC) for colorectal cancer (CRC) screening. MATERIALS AND METHODS We performed a retrospective cohort study linking electronic health record (EHR) data with PCP survey data. Patients were eligible for inclusion if they were not up-to-date with CRC screening and if they had CTC insurance coverage in the year prior to survey administration. PCPs were included if they had at least one eligible patient in their panel and completed the survey (final sample N = 95 PCPs; N = 6245 patients). Survey data included perceptions of CRC screening by any method, as well as CTC specifically. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for PCP and clinic predictors of CRC screening by any method and screening with CTC. RESULTS Substantial variation in CTC use was seen among PCPs and clinics (range 0-16% of CRC screening). Predictors of higher CTC use were PCP perceptions that CTC is effective in reducing CRC mortality, higher number of perceived advantages to screening with CTC, and Internal Medicine specialty. Factors not associated with CTC use were PCP perceptions of less organizational capacity to meet demand for colonoscopy, number of perceived disadvantages to screening with CTC, PCP age and gender, and clinic factors. CONCLUSION Significant variation in PCP adoption of CTC exists. PCP perceptions of CTC and specialty practice were related to CTC adoption. Strategies to increase PCP adoption of CTC for CRC screening should include emphasis on the effectiveness and advantages of CTC.
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Affiliation(s)
- Jennifer M Weiss
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4230, Madison, WI, 53705-2281, USA.
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maureen A Smith
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Aaron Potvien
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R Schumacher
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Patrick R Pfau
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4230, Madison, WI, 53705-2281, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Norrgran Engdahl J, Bignert A, Jones B, Athanassiadis I, Bergman Å, Weiss JM. Cats' Internal Exposure to Selected Brominated Flame Retardants and Organochlorines Correlated to House Dust and Cat Food. Environ Sci Technol 2017; 51:3012-3020. [PMID: 28192994 DOI: 10.1021/acs.est.6b05025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pet cats may be used as a biomarker for assessing exposures to organohalogen compounds (OHCs) adsorbed to household dust in home environments. This study explores two exposure routes of OHCs, ingestion of OHCs (i) via house dust and (ii) via cat food. House dust from 17 Swedish homes and serum from the participating families' pet cats were collected, and cat food was purchased matching the diet reported. Paired samples of cat serum, house dust, and cat food were analyzed for brominated flame retardants/natural products (polybrominated diphenyl ethers (PBDEs), decabromobiphenyl (BB-209), decabromodiphenyl ethane (DBDPE), 2,4,6-tribromophenol (2,4,6-TBP), OH-PBDEs) and organochlorines (polychlorinated biphenyls (PCBs), 1,1-bis(4,4'-dichlorodiphenyl)-2,2,2-trichloroethane (4,4'-DDT), 1,1-bis(4,4'-dichlorodiphenyl)-2,2-dichloroethene (4,4'-DDE), hexachlorobenzene (HCB), pentachlorophenol (PCP)). Significant correlations were found between serum and dust samples from the living rooms for BDE-47 (p < 0.035), BDE-99 (p < 0.035), and BDE-153 (p < 0.039), from the adult's bedroom for BDE-99 (p < 0.019) and from all rooms for BDE-99 (p < 0.020) and BB-209 (p < 0.048). This is the first time a correlation between cat serum levels and household dust has been established, a finding that supports the hypothesis that dust is a significant exposure route for cats. Serum levels were also significantly correlated with concentrations found in cat food for 6-OH-BDE47 (p < 0.002), 2,4,6-TBP (p < 0.035), and BB-209 (p < 0.007). DBDPE was found in high concentrations in all dust (median 154 pmol/g) and food samples (median 0.7 pmol/g lw) but was below detection in serum samples, suggesting low or no bioavailability for DBDPE in cats.
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Affiliation(s)
- J Norrgran Engdahl
- Department of Environmental Science and Analytical Chemistry, Stockholm University , SE-106 91 Stockholm, Sweden
| | - A Bignert
- Swedish Museum of Natural History , Frescativägen 40, SE-114 18 Stockholm, Sweden
| | - B Jones
- Department of Clinical Sciences, Swedish University of Agricultural Sciences , SE-750 07 Uppsala, Sweden
| | - I Athanassiadis
- Department of Environmental Science and Analytical Chemistry, Stockholm University , SE-106 91 Stockholm, Sweden
| | - Å Bergman
- Department of Environmental Science and Analytical Chemistry, Stockholm University , SE-106 91 Stockholm, Sweden
- Swedish Toxicology Sciences Research Centre (Swetox) , Forskargatan 20, SE-151 36 Södertälje, Sweden
| | - J M Weiss
- Department of Environmental Science and Analytical Chemistry, Stockholm University , SE-106 91 Stockholm, Sweden
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Kelly DM, Weiss JM, Martus JE. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2017; 99:353-359. [PMID: 28196040 DOI: 10.2106/jbjs.16.01192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Derek M Kelly
- 1Campbell Clinic, Department of Orthopaedic Surgery and Biomechanical Engineering, University of Tennessee, Memphis, Tennessee 2Division of Orthopedic Surgery, Southern California Kaiser Permanente Medical Group, Los Angeles, California 3Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Geitner M, Hoppe I, Biskup C, Runnebaum IB, Weiss JM. Ulipristal hemmt Progesteron-vermittelte Kalziumsignale und könnte mit der für die Spermienfunktion wichtigen Progesteronwirkung interagieren. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592780] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Neuman HB, Rathouz PJ, Winslow E, Weiss JM, LoConte NK, Lin CP, Wurm M, Smith MA, Schrag D, Greenberg CC. Use of a novel statistical technique to examine the delivery of breast cancer follow-up care by different types of oncology providers. J Eval Clin Pract 2016; 22:737-44. [PMID: 26991311 PMCID: PMC5026853 DOI: 10.1111/jep.12529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Frequent follow-up is recommended for the more than 3 million breast cancer survivors living in the USA. Given the multidisciplinary nature of breast cancer treatment, follow-up may be provided by medical oncologists, radiation oncologists, surgeons and primary care providers. This creates the potential for significant redundancy as well as gaps in care. The objective was to examine patterns of breast cancer follow-up provided by different types of oncologists and develop a statistical means of quantifying visit distribution over time. METHODS We identified stage I-III breast cancer patients who underwent breast conservation from 2000 to 2006 (n = 12 139) within the SEER-Medicare linked database. Provider type was defined using Medicare specialty provider codes and AMA Masterfile. The coefficient of variation (CV) for time between oncologist follow-up visits was calculated. Ordinal logistic regression assessed factors associated with CV. RESULTS Substantial variation in CV was observed. Sixty-seven per cent of patients with low CV (high visit regularity) received follow-up from a single oncologist type, versus 8% with high CV (low visit regularity). The number of oncologist types participating in follow-up had the greatest association with high CV (odds ratio 7.4 [6.7-8.3] and 15.4 [13.6-17.6] for two and three oncologist types). CONCLUSIONS Using a novel means of quantifying follow-up visit regularity, we determined that breast cancer patients with dispersed follow-up with more than one oncologist have more disordered care. The CV could be used in electronic medical records to identify cancer survivors with more disordered.
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Affiliation(s)
- Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, UW Madison School of Medicine and Public Health, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA.
| | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Emily Winslow
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jennifer M Weiss
- University of Wisconsin Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Noelle K LoConte
- University of Wisconsin Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, Division of Hematology and Oncology, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Chee Paul Lin
- Center for Clinical and Translational Science, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mike Wurm
- Department of Biostatistics and Medical Informatics, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Maureen A Smith
- University of Wisconsin Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Population Health Sciences, UW Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Family Medicine, UW Madison School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Schrag
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, UW Madison School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, UW Madison School of Medicine and Public Health, Madison, WI, USA
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Pickhardt PJ, Pooler BD, Mbah I, Weiss JM, Kim DH. Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm. Radiology 2016; 282:139-148. [PMID: 27552558 DOI: 10.1148/radiol.2016160582] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine the rate and types of polyps detected at repeat computed tomographic (CT) colonography screening after initial negative findings at CT colonography screening. Materials and Methods Among 5640 negative CT colonography screenings (no polyps ≥ 6 mm) performed before 2010 at one medical center, 1429 (25.3%; mean age, 61.4 years; 736 women, 693 men) patients have returned for repeat CT colonography screening (mean interval, 5.7 years ± 0.9; range, 4.5-10.7 years). Positive rates and histologic findings of initial and repeat screening were compared in this HIPAA-compliant, institutional review board-approved study. For all patients with positive findings at repeat CT colonography, the findings were directly compared against the initial CT colonography findings. Fisher exact, Pearson χ2, and Student t tests were applied as indicated. Results Repeat CT colonography screening was positive for lesions 6 mm or larger in 173 (12.1%) adults (compared with 14.3% at initial CT colonography screening, P = .29). In the 173 patients, 29.5% (61 of 207) of nondiminutive polyps could be identified as diminutive at the initial CT colonography and 12.6% (26 of 207) were missed. Large polyps, advanced neoplasia (advanced adenomas and cancer), and invasive cancer were seen in 3.8% (55 of 1429), 2.8% (40 of 1429), and 0.14% (two of 1429), respectively, at follow-up, compared with 5.2% (P = .02), 3.2% (P = .52), and 0.45% (P = .17), respectively, at initial screening. Of 42 advanced lesions in 40 follow-up screenings, 33 (78.6%) were right sided and 22 (52.4%) were flat, compared with 45.4% (P < .001) and 11.3% (P < .001), respectively, at initial screening. Large right-sided serrated lesions were confirmed in 20 individuals (1.4%), compared with 0.5% (P < .001) confirmed at initial screening. Conclusion Positive rates for large polyps at repeat CT colonography screening (3.7%) were lower compared with those at initial screening (5.2%). However, more advanced right-sided lesions were detected at follow-up CT colonography, many of which were flat, serrated lesions. The cumulative findings support both the nonreporting of diminutive lesions and a 5-10-year screening interval. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 30, 2016.
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Affiliation(s)
- Perry J Pickhardt
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - B Dustin Pooler
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - Ifeanyi Mbah
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - Jennifer M Weiss
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - David H Kim
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
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Afreen S, Bohler S, Kunze M, Weiss JM, Erlacher M. The role of the anti-apoptotic protein Bcl-xL for the maintenance of human hematopoiesis. Klin Padiatr 2016. [DOI: 10.1055/s-0036-1582503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, Kessler JI. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Orthop J Sports Med 2016; 4:2325967116635515. [PMID: 27047984 PMCID: PMC4797230 DOI: 10.1177/2325967116635515] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. Purpose: To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age. Study Design: Descriptive epidemiology study. Methods: A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Differences in progression toward surgery were compared between age groups, sex, and joint location. Logistical regression analysis was performed by sex, age, and ethnicity. Results: Overall, 317 patients with a total of 334 OCD lesions were found. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. The percentage of all OCD lesions progressing to surgery was 35.3%; surgical progression for knee, ankle, and elbow joints was 33.5%, 31.8%, and 55.0%, respectively. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Patients aged 12 to 19 years had a 7.4-times greater risk of progression to surgery for knee OCD lesions than 6- to 11-year-olds. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. Progression to surgery of ankle OCD did not significantly differ based on location. Three of 4 trochlear lesions progressed to surgery, along with 1 of 1 tibial, 1 of 3 patellar, 40.3% of lateral femoral condylar, and 28.2% of medial femoral condylar lesions. Conclusion: In this large cohort study of pediatric OCD patients, 35% progressed to surgery. Progression to surgery did not differ significantly between sexes with OCD of any joint. Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis. Clinical Relevance: The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD.
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Affiliation(s)
| | - Hooman Nikizad
- University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | | | | | - John C Jacobs
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kim DH, Matkowskyj KA, Lubner MG, Hinshaw JL, Munoz Del Rio A, Pooler BD, Weiss JM, Pickhardt PJ. Serrated Polyps at CT Colonography: Prevalence and Characteristics of the Serrated Polyp Spectrum. Radiology 2016; 280:455-63. [PMID: 26878227 DOI: 10.1148/radiol.2016151608] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To report the prevalence and characteristics of serrated polyps identified in a large, average-risk population undergoing screening computed tomographic (CT) colonography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board of the University of Wisconsin School of Medicine and Public Health. The need for informed consent was waived. Nine thousand six hundred examinations from 8289 patients were enrolled in a single-institution CT colonography-based screening program (from 2004 to 2011) and were evaluated for the presence of nondiminutive serrated lesions and advanced adenomas. The prevalence and characteristics of these lesions were tabulated. Generalized estimating equation regressions of polyp characteristics that may contribute to visualization of serrated lesions were investigated, including polyp size, location, and morphologic appearance; histologic findings; and presence or absence of contrast material tagging. Results Nondiminutive serrated lesions (≥6 mm) were seen at CT colonography-based screening with a prevalence of 3.1% (254 of 8289 patients). Sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs) constituted 36.8% (137 of 372) and 4.3% (16 of 372) of serrated lesions, respectively; hyperplastic polyps (HPs) accounted for 58.9% (219 of 372 lesions). SSA and TSA tended to be large (mean size, 10.6 mm and 14.1 mm, respectively), with size categories and polyp subgroups significantly associated (P < .0001). SSA tended to be proximal in location (91.2%, 125 of 137 lesions) and flat in morphologic appearance (39.4%, 54 of 137 lesions) compared with TSA and HP. The presence of high-grade dysplasia in serrated lesions was uncommon when compared with advanced adenomas (one of 372 lesions vs 22 of 395 lesions, respectively; P < .0001). Multivariate analysis showed that contrast material tagging markedly improved serrated polyp detection with an odds ratio of 40.4 (95% confidence interval: 10.1, 161.4). Conclusion Serrated lesions are seen at CT colonography-based screening with a nondiminutive prevalence of 3.1%. These lesions tend to be large, flat, and proximal in location. Adherent contrast material coating on these polyps aids in their detection, despite an often flat morphologic appearance. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- David H Kim
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Kristina A Matkowskyj
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Meghan G Lubner
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - J Louis Hinshaw
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Alejandro Munoz Del Rio
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - B Dustin Pooler
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Jennifer M Weiss
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Perry J Pickhardt
- From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
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Johnson SL, Palta M, Bartels CM, Thorpe CT, Weiss JM, Smith MA. Examining systemic steroid Use in older inflammatory bowel disease patients using hurdle models: a cohort study. BMC Pharmacol Toxicol 2015; 16:34. [PMID: 26643112 PMCID: PMC4672478 DOI: 10.1186/s40360-015-0034-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/18/2015] [Indexed: 01/15/2023] Open
Abstract
Background Interpreting clinical guideline adherence and the appropriateness of medication regimens requires consideration of individual patient and caregiver factors. Factors leading to initiation of a medication may differ from those determining continued use. We believe this is the case for systemic steroid therapy in inflammatory bowel disease (IBD), resulting in a need to apply methods that separately consider factors associated with initiation and duration of therapy. To evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use we apply a 2-part hurdle model to Medicare data. We do so in older patients with tumor necrosis factor antagonist (anti-TNFs) contraindications, as they are of special interest for compliance with Medicare-adopted, quality metrics calling for anti-TNFs and nonbiologic immune therapies to reduce steroid utilization. Many older patients have contraindications to anti-TNFs. However, nonbiologics cause adverse events that are concerning in older adults, limiting their use in this population and increasing reliance on systemic steroids. Methods We used a national Medicare sample for 2006–2009 including patients with 12 months or greater of Parts A and B and 6 months or greater of Part D coverage, IBD confirmed with at least 2 claims for ICD-9CM 555.xx or 556.xx, anti-TNF contraindications and without contraindications to nonbiologic agents. We applied a negative binomial-logit hurdle model to examine patient characteristics associated with systemic steroid utilization. Results Among the 1,216 IBD patients without baseline steroid use, 21 % used systemic steroids. Odds of receiving systemic steroids were greater in those younger, rural, and those receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration. Conclusions Our study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization patterns. Applying such a model to Medicare data, we determined that despite medical consensus that systemic steroid use should be minimized, its use was substantial. Findings indicate anticipated difficulties in implementing recently adopted quality measures to avoid systemic steroids.
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Affiliation(s)
- Sophia L Johnson
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-218, Baltimore, MD, 21201, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 53726 608-263-2520, Madison, Wisconsin, USA. .,Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Christie M Bartels
- Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, 800 Highland Avenue, 608-263-3457, Madison, Wisconsin, USA.
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Medical Center, 3501 Terrace Street, 412-624-7794, Pittsburgh, Pennsylvania, USA. .,Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.
| | - Jennifer M Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Room 4230, 608-263-1995, Madison, Wisconsin, USA.
| | - Maureen A Smith
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. .,Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. .,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Johnson SL, Bartels CM, Palta M, Thorpe CT, Weiss JM, Smith MA. Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study. BMJ Open 2015; 5:e008597. [PMID: 26346875 PMCID: PMC4563221 DOI: 10.1136/bmjopen-2015-008597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the frequency and predictors of antitumour necrosis factor (TNF) use, and to describe steroid utilisation among US patients with inflammatory bowel disease (IBD) aged 65 years and older prior to the publication of a new Medicare quality measure calling for the use of anti-TNFs and other steroid-sparing agents. DESIGN Retrospective cohort study. SETTING This study utilised 2006-2009 claims data for a national sample of Medicare beneficiaries. PARTICIPANTS Patients with IBD (>1 claim for ICD codes 555.xx, 556.xx) without anti-TNF contraindications, enrolled in Medicare parts A and B ≥12 months and part D ≥6 months were included (n=8502). OUTCOME MEASURES We estimated incidence rate ratios (IRR) and 95% CIs predicting new anti-TNF therapy using multivariable Poisson regression. RESULTS This nationally representative study of older patients with IBD estimated that only 3.7% received anti-TNFs. New anti-TNF use (1.4%) was associated with younger age, absence of Medicaid coverage, hospitalisation, and higher preceding use of burst (IRR=2.35, CI 1.59 to 3.47) and maintenance steroids (IRR=2.40, CI 1.05 to 5.48). Among anti-TNF users, we observed high rates of concurrent maintenance steroid use (19%). CONCLUSIONS Anti-TNF use was very low in this population of older patients with IBD and, importantly, was often combined with maintenance steroid use despite guidelines suggesting reduced needs. Expanding IBD-specific quality measures to include steroid taper plans may cue appropriate maintenance regimens that include anti-TNFs and other steroid sparing agents while reducing protracted concomitant steroid use as intended by current quality measures.
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Affiliation(s)
- Sophia L Johnson
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Christie M Bartels
- Department of Medicine, Rheumatology Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Jennifer M Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Pooler BD, Kim DH, Weiss JM, Matkowskyj KA, Pickhardt PJ. Colorectal Polyps Missed with Optical Colonoscopy Despite Previous Detection and Localization with CT Colonography. Radiology 2015; 278:422-9. [PMID: 26280354 DOI: 10.1148/radiol.2015150294] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To retrospectively evaluate and characterize nondiminutive colorectal polyps prospectively detected by using computed tomographic (CT) colonography but not confirmed with subsequent nonblinded optical colonoscopy (OC). MATERIALS AND METHODS This study was institutional review board approved; the need for signed informed consent was waived. Over 113 months, 9336 adults (mean age, 57.1 years) underwent CT colonography, which yielded 2606 nondiminutive (≥6 mm) polyps. Of 1731 polyps that underwent subsequent nonblinded OC (ie, endoscopists provided advanced knowledge of specific polyp size, location, and morphologic appearance at CT colonography), 181 (10%) were not confirmed with initial endoscopy (ie, discordant), of which 37 were excluded (awaiting or lost to follow-up). After discordant polyp review, 66 of the 144 lesions were categorized as likely CT colonography false-positive findings (no further action) and 78 were categorized as potential OC false-negative (FN) findings. RESULTS Thirty-one of 144 (21.5%) of all discordant lesions were confirmed as FN findings at OC, including 40% (31 of 78) of those with OC and/or CT colonography follow-up. OC FN lesions were an average of 8.5 mm ± 3.3 in diameter and were identified with higher confidence at prospective CT colonography (on a 3-point confidence scale: mean, 2.8 vs 2.3; P = .001). OC FN findings were more likely than concordant polyps to be located in the right colon (respectively, 71% [22 of 31] vs 47% [723 of 1535]; P = .010). Most (81% [21 of 26]) OC FN lesions that were ultimately resected were neoplastic (adenomas or serrated lesions), of which 43% (nine of 21) were characterized as advanced lesions, and 89% (eight of nine) of advanced lesions occurred in the right colon. CONCLUSION In clinical practice, polyps prospectively identified with CT colonography but not confirmed with subsequent nonblinded (ie, despite a priori knowledge of the CT colonography findings) OC require additional review because a substantial proportion may be FN findings. Most FN findings found with OC demonstrated clinically significant histopathologic results, and a majority of advanced lesions occurred in the right colon.
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Affiliation(s)
- B Dustin Pooler
- From the Department of Radiology (B.D.P., D.H.K., P.J.P.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W.), and Department of Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705
| | - David H Kim
- From the Department of Radiology (B.D.P., D.H.K., P.J.P.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W.), and Department of Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705
| | - Jennifer M Weiss
- From the Department of Radiology (B.D.P., D.H.K., P.J.P.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W.), and Department of Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705
| | - Kristina A Matkowskyj
- From the Department of Radiology (B.D.P., D.H.K., P.J.P.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W.), and Department of Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705
| | - Perry J Pickhardt
- From the Department of Radiology (B.D.P., D.H.K., P.J.P.), Department of Medicine, Division of Gastroenterology and Hepatology (J.M.W.), and Department of Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705
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Bacher JW, Sievers CK, Albrecht DM, Grimes IC, Weiss JM, Matkowskyj KA, Agni RM, Vyazunova I, Clipson L, Storts DR, Thliveris AT, Halberg RB. Improved Detection of Microsatellite Instability in Early Colorectal Lesions. PLoS One 2015; 10:e0132727. [PMID: 26252492 PMCID: PMC4529134 DOI: 10.1371/journal.pone.0132727] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 12/15/2014] [Accepted: 06/17/2015] [Indexed: 12/22/2022] Open
Abstract
Microsatellite instability (MSI) occurs in over 90% of Lynch syndrome cancers and is considered a hallmark of the disease. MSI is an early event in colon tumor development, but screening polyps for MSI remains controversial because of reduced sensitivity compared to more advanced neoplasms. To increase sensitivity, we investigated the use of a novel type of marker consisting of long mononucleotide repeat (LMR) tracts. Adenomas from 160 patients, ranging in age from 29–55 years old, were screened for MSI using the new markers and compared with current marker panels and immunohistochemistry standards. Overall, 15 tumors were scored as MSI-High using the LMRs compared to 9 for the NCI panel and 8 for the MSI Analysis System (Promega). This difference represents at least a 1.7-fold increase in detection of MSI-High lesions over currently available markers. Moreover, the number of MSI-positive markers per sample and the size of allelic changes were significantly greater with the LMRs (p = 0.001), which increased confidence in MSI classification. The overall sensitivity and specificity of the LMR panel for detection of mismatch repair deficient lesions were 100% and 96%, respectively. In comparison, the sensitivity and specificity of the MSI Analysis System were 67% and 100%; and for the NCI panel, 75% and 97%. The difference in sensitivity between the LMR panel and the other panels was statistically significant (p<0.001). The increased sensitivity for detection of MSI-High phenotype in early colorectal lesions with the new LMR markers indicates that MSI screening for the early detection of Lynch syndrome might be feasible.
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Affiliation(s)
- Jeffery W. Bacher
- Genetic Analysis Group, Promega Corporation, Madison, Wisconsin, United States of America
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Chelsie K. Sievers
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Dawn M. Albrecht
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Ian C. Grimes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jennifer M. Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Kristina A. Matkowskyj
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Rashmi M. Agni
- Department of Pathology & Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Irina Vyazunova
- Genetic Analysis Group, Promega Corporation, Madison, Wisconsin, United States of America
| | - Linda Clipson
- Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Douglas R. Storts
- Genetic Analysis Group, Promega Corporation, Madison, Wisconsin, United States of America
| | - Andrew T. Thliveris
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Richard B. Halberg
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail:
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Abstract
Cases of hip fracture recorded from 1/2009 to 12/2011 were ascertained using the Kaiser Permanente Hip Fracture Registry. The registry collects information on patient, procedure, surgeon, facility, and surgical outcomes. The population (N = 12,562) was predominantly white, women, and older (≥ 75 years), and 32% had at least 5 comorbidities. The average length of follow-up was 1.1 years. Hemiarthroplasty was the most common procedure (33.1%). Most fractures were treated by medium-volume surgeons at high-volume facilities. The 90-day readmission rate was 22.1%, and the mortality rate was 12.3%.
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Affiliation(s)
- Maria C S Inacio
- Epidemiologist in the Surgical Outcomes and Analysis Department at Kaiser Permanente in San Diego, CA.
| | - Jennifer M Weiss
- Orthopedic Surgeon at the Sunset Medical Center in Los Angeles, CA.
| | - Alex Miric
- Orthopedic Surgeon at the Sunset Medical Center in Los Angeles, CA.
| | - Jessica J Hunt
- Clinical Project Manager in the Surgical Outcomes and Analysis Department at Kaiser Permanente in San Diego, CA.
| | - Gary L Zohman
- Orthopedic Surgeon at the Orange County Medical Center in CA.
| | - Elizabeth W Paxton
- Director of the Surgical Outcomes and Analysis Department at Kaiser Permanente in San Diego, CA.
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