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Burningham TA, Day LW. American Indian and Alaska Native Digestive Health: Challenges, Opportunities, and a Path Forward. Clin Gastroenterol Hepatol 2023; 21:3203-3208. [PMID: 38007243 DOI: 10.1016/j.cgh.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Tyson A Burningham
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lukejohn W Day
- Division of Gastroenterology, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Burningham TA, Day LW. American Indian and Alaska Native Digestive Health: Challenges, Opportunities, and a Path Forward. Gastroenterology 2023; 165:1318-1322. [PMID: 37981353 DOI: 10.1053/j.gastro.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Tyson A Burningham
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lukejohn W Day
- Division of Gastroenterology, University of California, San Francisco, and, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Kwok K, Levin TR, Dominitz JA, Panganamamula K, Feld AD, Bardall B, Newbury K, Day LW. Transportation barriers and endoscopic procedures: barriers, legal challenges, and strategies for GI endoscopy units. Gastrointest Endosc 2023; 98:475-481. [PMID: 37632487 DOI: 10.1016/j.gie.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Karl Kwok
- Department of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Theodore R Levin
- Division of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California, USA
| | - Jason A Dominitz
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Andrew D Feld
- Division of Gastroenterology, Kaiser Permanente and Division of Medicine, University of Washington, Seattle, Washington, USA
| | - Bruce Bardall
- The Joint Commission, Oakbrook Terrace, Illinois, USA
| | - Kara Newbury
- Ambulatory Surgery Center Association, Alexandria, Virginia, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Nalluri H, Marmor S, Prathibha S, Jenkins A, Dindinger-Hill K, Kihara M, Sundberg MA, Day LW, Owen MJ, Lowry AC, Tuttle TM. Evaluating Disparities in Colon Cancer Survival in American Indian/Alaskan Native Patients Using the National Cancer Database. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01706-2. [PMID: 37432562 DOI: 10.1007/s40615-023-01706-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Studies demonstrate higher mortality rates from colon cancer in American Indian/Alaskan Native (AI/AN) patients compared to non-Hispanic White (nHW). We aim to identify factors that contribute to survival disparities. METHODS We used the National Cancer Database to identify AI/AN (n = 2127) and nHW (n = 527,045) patients with stage I-IV colon cancer from 2004 to 2016. Overall survival among stage I-IV colon cancer patients was estimated by Kaplan-Meier analysis; Cox proportional hazard ratios were used to identify independent predictors of survival. RESULTS AI/AN patients with stage I-III disease had significantly shorter median survival than nHW (73 vs 77 months, respectively; p < 0.001); there were no differences in survival for stage IV. Adjusted analyses demonstrated that AI/AN race was an independent predictor of higher overall mortality compared to nHW (HR 1.19, 95% CI 1.01-1.33, p = 0.002). Importantly, compared to nHW, AI/AN were younger, had more comorbidities, had greater rurality, had more left-sided colon cancers, had higher stage but lower grade tumors, were less frequently treated at an academic facility, were more likely to experience a delay in initiation of chemotherapy, and were less likely to receive adjuvant chemotherapy for stage III disease. We found no differences in sex, receipt of surgery, or adequacy of lymph node dissection. CONCLUSION We found patient, tumor, and treatment factors that potentially contribute to worse survival rates observed in AI/AN colon cancer patients. Limitations include the heterogeneity of AI/AN patients and the use of overall survival as an endpoint. Additional studies are needed to implement strategies to eliminate disparities.
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Affiliation(s)
- Harika Nalluri
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Saranya Prathibha
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Asher Jenkins
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Michelle Kihara
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael A Sundberg
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary J Owen
- Department of Family Medicine and BioBehavioral Health, University of Minnesota, Duluth, MN, USA
- Center for American Indian and Minority Health, University of Minnesota, Duluth, MN, USA
| | - Ann C Lowry
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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5
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Keswani RN, Duloy A, Nieto JM, Panganamamula K, Murad MH, Bazerbachi F, Shaukat A, Elmunzer BJ, Day LW. Interventions to improve the performance of ERCP and EUS quality indicators. Gastrointest Endosc 2023; 97:825-838. [PMID: 36967249 DOI: 10.1016/j.gie.2022.12.010] [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] [Received: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 04/21/2023]
Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anna Duloy
- Division of Gastroenterology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jose M Nieto
- Digestive Disease Consultants, Jacksonville, Florida, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, Minnesota, USA
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Bazerbachi F, Panganamamula K, Nieto JM, Murad MH, Keswani RN, Shaukat A, Day LW. Interventions to improve the performance of upper GI endoscopy quality indicators. Gastrointest Endosc 2022; 96:184-188.e4. [PMID: 35680470 DOI: 10.1016/j.gie.2022.04.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023]
Abstract
The promotion of quality and best practices in gastroenterology and endoscopy is an ongoing effort. For upper GI endoscopy, quality indicators derived from clinical studies and expert consensus have been long established but remain variably obtained. To date, data on interventions aimed to improve these indicators are scarce. We systematically reviewed the literature to identify interventions and measures demonstrated to improve the performance of previously established upper endoscopy quality indicators. We also identified evidence gaps and opportunities for improvement in this area.
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Affiliation(s)
- Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, Minnesota, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jose M Nieto
- Division of Gastroenterology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Shaukat A, Tuskey A, Rao VL, Dominitz JA, Murad MH, Keswani RN, Bazerbachi F, Day LW. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96:171-183. [PMID: 35680469 DOI: 10.1016/j.gie.2022.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anne Tuskey
- Division of Gastroenterology, Department of Medicine, University of Virginia, Arlington, Virginia, USA
| | - Vijaya L Rao
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, Washington, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, CentraCare, Interventional Endoscopy Program, St Cloud, Minnesota, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
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Taunk P, Shimpi R, Singh R, Collins J, Muthusamy VR, Day LW. GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies. Gastrointest Endosc 2022; 95:1048-1059.e2. [PMID: 35303991 DOI: 10.1016/j.gie.2021.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pushpak Taunk
- Division of Gastroenterology, University of South Florida, Tampa, Florida, USA
| | - Rahul Shimpi
- Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ravi Singh
- Department of Gastroenterology, Great South Bay Endoscopy Center, LLC, East Patchogue, New York, USA
| | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California.
| | - Thomas J Savides
- Chief Experience officer, University of California San Diego Health, San Diego, California; Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California
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Kwok K, Hasan N, Duloy A, Murad F, Nieto J, Day LW. American Society for Gastrointestinal Endoscopy radiation and fluoroscopy safety in GI endoscopy. Gastrointest Endosc 2021; 94:685-697.e4. [PMID: 34399965 DOI: 10.1016/j.gie.2021.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Karl Kwok
- Department of Medicine, Division of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nazia Hasan
- Department of Medicine, Division of Gastroenterology, NorthBay Healthcare, Fairfield, California, USA
| | - Anna Duloy
- Department of Medicine, Division of Gastroenterology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Faris Murad
- Department of Gastroenterology, FHN Memorial Hospital, Freeport, Illinois, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - Lukejohn W Day
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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11
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Muniraj T, Day LW, Teigen LM, Ho EY, Sultan S, Davitkov P, Shah R, Murad MH. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. Gastroenterology 2021; 160:1799-1808. [PMID: 33832655 DOI: 10.1053/j.gastro.2021.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/13/2022]
Affiliation(s)
- Thiruvengadam Muniraj
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Edith Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Raj Shah
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center Cleveland, Ohio
| | - M Hassan Murad
- Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
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12
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Day LW, Kwok K, Visrodia K, Petersen BT. American Society for Gastrointestinal Endoscopy Infection Control Summit: updates, challenges, and the future of infection control in GI endoscopy. Gastrointest Endosc 2021; 93:1-10. [PMID: 32819676 DOI: 10.1016/j.gie.2020.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Karl Kwok
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kavel Visrodia
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Day LW, Muthusamy VR, Collins J, Kushnir VM, Sawhney MS, Thosani NC, Wani S. Multisociety guideline on reprocessing flexible GI endoscopes and accessories. Gastrointest Endosc 2021; 93:11-33.e6. [PMID: 33353611 DOI: 10.1016/j.gie.2020.09.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | | | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St Louis, Missouri, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Carethers JM, Quezada SM, Day LW, Day LW. Diversity Within US Gastroenterology Physician Practices: The Pipeline, Cultural Competencies, and Gastroenterology Societies Approaches. Gastroenterology 2019; 156:829-833. [PMID: 30452917 PMCID: PMC6453700 DOI: 10.1053/j.gastro.2018.10.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 12/02/2022]
Affiliation(s)
- John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine and Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109-5368
| | - Sandra M. Quezada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Medical Center, Baltimore, MD 21201
| | - Lukejohn W. Day
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA 94110
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California
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Issaka RB, Singh MH, Rachocki C, Day LW, Horton C, Somsouk M. Missed Opportunities in Colorectal Cancer Prevention in Patients With Inadequate Bowel Preparations. Clin Gastroenterol Hepatol 2018; 16:1533-1534. [PMID: 29330098 PMCID: PMC6037614 DOI: 10.1016/j.cgh.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Rachel B Issaka
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
| | - Maneesh H Singh
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Carly Rachocki
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Lukejohn W Day
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Claire Horton
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California
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Calderwood AH, Day LW, Muthusamy VR, Collins J, Hambrick RD, Brock AS, Guda NM, Buscaglia JM, Petersen BT, Buttar NS, Khanna LG, Kushnir VM, Repaka A, Villa NA, Eisen GM. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc 2018; 87:1167-1179. [PMID: 29573782 DOI: 10.1016/j.gie.2017.12.009] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 02/08/2023]
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Selvig D, Sewell JL, Tuot DS, Day LW. Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload. BMC Health Serv Res 2018; 18:16. [PMID: 29321069 PMCID: PMC5763538 DOI: 10.1186/s12913-017-2819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/22/2017] [Indexed: 11/21/2022] Open
Abstract
Background To reduce unnecessary ambulatory gastroenterology (GI) visits and increase access to GI care, San Francisco Health Network gastroenterologists and primary care providers implemented guidelines in 2013 that discharged certain patients back to primary care after endoscopy with formal written recommendations. This study assesses the longer-term impact of this policy on GI clinic access, workflow, and provider satisfaction. Methods An email-based survey assessed gastroenterologist and primary care provider (PCP) opinions about the discharge process. Administrative data and chart review were used to assess clinic access, intervention fidelity, and re-referral rates. Results 102/299 (34%) of PCPs and 5/7 (71%) of gastroenterologists responded to the survey. 74% of PCPs and 100% of gastroenterologists were satisfied or very satisfied with the discharge process. 80% of gastroenterologists believed the discharge process decreased their workload, while 53.5% of primary care providers believed it increased their workload. 6.7% of patients discharged to primary care in 2013 had re-referrals to GI. Wait time for the third-next-available new outpatient GI clinic appointment had previously decreased from 158 days (2012, pre-intervention) to 74 days (2013, post-intervention). In 2015, wait time was 19 days (p < 0.001 for 2012 vs. 2015). Conclusions Primary care providers and gastroenterologists are satisfied with an intervention to discharge patients from gastroenterology to primary care after certain endoscopic procedures, although this conclusion is limited by a relatively low PCP survey response rate. Discharging appropriate patients using consensus criteria from the gastroenterology clinic was instrumental in sustainably reducing clinic wait times with low re-referral rates. Electronic supplementary material The online version of this article (10.1186/s12913-017-2819-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Selvig
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Justin L Sewell
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Delphine S Tuot
- Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,UCSF Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA. .,San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA, 94110, USA.
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Baumgardner JM, Sewell JL, Day LW. Assessment of quality indicators among nurse practitioners performing upper endoscopy. Endosc Int Open 2017; 5:E818-E824. [PMID: 28879227 PMCID: PMC5585072 DOI: 10.1055/s-0043-115384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/07/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs). PATIENTS AND METHODS Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed. RESULTS Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period. CONCLUSION In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States.
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Affiliation(s)
- Jeffrey M. Baumgardner
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States,Corresponding author Jeffrey M. Baumgardner Zuckerberg San Francisco General Hospital and Trauma Center1001 Potrero AveSan Francisco CA 941101-415-206-5199
| | - Justin L. Sewell
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States
| | - Lukejohn W. Day
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States
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Kouanda AM, Somsouk M, Sewell JL, Day LW. Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86:107-117.e1. [PMID: 28174123 DOI: 10.1016/j.gie.2017.01.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Lower GI bleeding (LGIB) is a common cause of morbidity and mortality. Colonoscopy is indicated in all hospitalized patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Prior studies of outcomes in urgent versus elective colonoscopy have yielded conflicting results and were often underpowered. Our study objective was to compare several outcomes between urgent and elective colonoscopy in patients hospitalized for LGIB. METHODS Systematic review and meta-analysis were performed on studies that compared urgent and elective colonoscopy in patients with LGIB. Pooled rates were calculated for specific outcomes, and rate ratios were determined for selected comparison groups. RESULTS Twelve studies met inclusion criteria, with a total sample size of 10,172 patients in the urgent colonoscopy arm and 14,224 patients in the elective colonoscopy arm. Urgent colonoscopy was associated with increased use of endoscopic therapeutic intervention (RR, 1.70; 95% CI, 1.08-2.67). There were no significant differences in bleeding source localization (RR, 1.08; 95% CI, .92-1.25), adverse event rates (RR, 1.05; 95% CI, .65-1.71), rebleeding rates (RR, 1.14; 95% CI, .74-1.78), transfusion requirement (RR, 1.02; 95% CI, .73-1.41), or mortality (RR, 1.17; 95% CI, .45-3.02). CONCLUSIONS Urgent colonoscopy appears to be safe and well tolerated, but there is no clear evidence that it alters important clinical outcomes.
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Affiliation(s)
- Abdul M Kouanda
- Department of Medicine, University of California, San Francisco, California, USA
| | - Ma Somsouk
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Justin L Sewell
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
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Lee A, Aditi A, Bhat YM, Binmoeller KF, Hamerski C, Sendino O, Kane S, Cello JP, Day LW, Mohamadnejad M, Muthusamy VR, Watson R, Klapman JB, Komanduri S, Wani S, Shah JN. Endoscopic ultrasound-guided biliary access versus precut papillotomy in patients with failed biliary cannulation: a retrospective study. Endoscopy 2017; 49:146-153. [PMID: 28107764 DOI: 10.1055/s-0042-120995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background and aims Precut papillotomy is widely used after failed biliary cannulation. Endoscopic ultrasound (EUS)-guided biliary access techniques are newer methods to facilitate access and therapy in failed cannulation. We evaluated the impact of EUS-guided biliary access on endoscopic retrograde cholangiopancreatography (ERCP) success and compared these techniques to precut papillotomy. Patients and methods We retrospectively compared two ERCP cohorts. One cohort consisted of biliary ERCPs (n = 1053) attempted in patients with native papillae and surgically unaltered anatomy in whom precut papillotomy and/or EUS-guided biliary access were routinely performed immediately after failed cannulation. This cohort was compared with a similar ERCP cohort (n = 1062) in which only precut papillotomy was available for failed cannulation. The following outcomes were compared: conventional cannulation success, rates of attempted advanced access techniques (precut or EUS), precut success, EUS-guided biliary access success, and ERCP failure rates. Results Although conventional cannulation success, rates of attempted advanced access technique (precut or EUS), and precut success were similar, the ERCP failure rate was lower when both EUS-guided biliary access and precut were available (1.0 % [95 % confidence interval (CI) 0.4 - 1.6]), compared with when only precut was possible for failed access (3.6 % [95 %CI 2.5 - 4.7]; P < 0.001). Success for EUS-guided biliary access (95.1 % [95 %CI 89.7 - 100]) was significantly higher than for precut (75.3 % [95 %CI 68.2 - 82.4]; P < 0.001), and mainly due to superiority in malignant obstruction (93.5 % vs. 64 %; P < 0.001). Conclusions EUS-guided biliary access decreases the rate of therapeutic biliary ERCP failure. Our results support the use of EUS-guided biliary access to optimize single-session ERCP success. In experienced hands, these techniques appear as effective, if not more so, than precut papillotomy.
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Affiliation(s)
- Alexander Lee
- Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
| | - Anupam Aditi
- Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
| | - Yasser M Bhat
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Chris Hamerski
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Oriol Sendino
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Steve Kane
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - John P Cello
- Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
| | - Lukejohn W Day
- Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
| | - Medi Mohamadnejad
- Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
| | - V Raman Muthusamy
- Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
| | - Rabindra Watson
- Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
| | - Jason B Klapman
- Department of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sri Komanduri
- Department of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Sachin Wani
- Department of Gastroenterology, University of Colorado, Denver, Colorado, USA
| | - Janak N Shah
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
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Issaka RB, Singh MH, Oshima SM, Laleau VJ, Rachocki CD, Chen EH, Day LW, Sarkar U, Somsouk M. Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System. Am J Gastroenterol 2017; 112:375-382. [PMID: 28154400 PMCID: PMC6597438 DOI: 10.1038/ajg.2016.555] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). Understanding system and patient factors affecting follow-up of abnormal screening tests is essential to optimize care for high-risk cohorts. METHODS This retrospective cohort study was conducted in an integrated safety-net system comprised of 11 primary-care clinics and one Gastroenterology referral unit and included patients 50-75 years, with a positive FIT between April 2012 and February 2015. RESULTS Of the 2,238 patients identified, 1,245 (55.6%) completed their colonoscopy within 1-year of the positive FIT. The median time from positive FIT to colonoscopy was 184 days (interquartile range 140-232). Of the 13% of FIT positive patients not referred to gastroenterology, 49% lacked documentation addressing their abnormal result or counseling on the increased risk of CRC. Of the patients referred but who missed their appointments, 62% lacked documentation following up on the abnormal result in the absence of a completed colonoscopy. FIT positive patients never referred to gastroenterology or who missed their appointment after referrals were more likely to have comorbid conditions and documented illicit substance use compared with patients who completed a colonoscopy. CONCLUSIONS Despite access to colonoscopy and a shared electronic health record system, colonoscopy completion after an abnormal FIT is inadequate within this safety-net system. Inadequate follow-up is in part explained by inappropriate screening, but there is an absence of clear documentation and systematic workflow within both primary care and GI specialty care addressing abnormal FIT results.
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Affiliation(s)
- Rachel B. Issaka
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
| | - Maneesh H. Singh
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
| | - Sachiko M. Oshima
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California USA
| | - Victoria J. Laleau
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
| | - Carly D. Rachocki
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
| | - Ellen H. Chen
- Department of Public Health, San Francisco, California USA
| | - Lukejohn W. Day
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California USA
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California USA
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Day LW, Gonzalez S, Ladd AM, Bucobo JC, Pickett-Blakely O, Tilara A, Christie J. Diversity in gastroenterology in the United States: Where are we now? Where should we go? Gastrointest Endosc 2016; 83:679-83. [PMID: 26810008 DOI: 10.1016/j.gie.2015.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 02/08/2023]
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Abstract
Colorectal cancer is common worldwide, and the elderly are disproportionately affected. Increasing age is a risk factor for the development of precancerous adenomas and colorectal cancer, thus raising the issue of screening and surveillance in older patients. Elderly patients are a diverse and heterogeneous group, and special considerations such as comorbid medical conditions, functional status and cognitive ability play a role in deciding on the utility of screening and surveillance. Colorectal cancer screening can be beneficial to patients, but at certain ages and under some circumstances the harm of screening outweighs the benefits. Increasing adverse events, poorer bowel preparation and more incomplete examinations are observed in older patients undergoing colonoscopy for diagnostic, screening and surveillance purposes. Decisions regarding screening, surveillance and treatment for colorectal cancer require a multidisciplinary approach that accounts not only for the patient’s age but also for their overall health, preferences and functional status. This review provides an update and examines the challenges surrounding colorectal cancer diagnosis, screening, and treatment in the elderly.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center CA, USA
| | - Fernando Velayos
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA
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Chang JT, Sewell JL, Day LW. Prevalence and predictors of patient no-shows to outpatient endoscopic procedures scheduled with anesthesia. BMC Gastroenterol 2015; 15:123. [PMID: 26423366 PMCID: PMC4589132 DOI: 10.1186/s12876-015-0358-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Demand for endoscopic procedures scheduled with anesthesia is increasing and no-show to appointments carries significant patient health and financial impact, yet little is known about predictors of no-show. METHODS We performed a 16-month retrospective observational cohort study of patients scheduled for outpatient endoscopy with anesthesia at a county hospital serving the safety-net healthcare system of San Francisco. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show. RESULTS In total, 511 patients underwent endoscopy with anesthesia during the study period. Twenty-seven percent of patients failed to attend an appointment and were considered "no-show". In multivariate analysis, higher no-show rates were associated with patients with a prior history of no-show (odds ratio [OR] 6.4; 95% confidence interval [CI], 2.4- 17.5), those with active substance abuse within the past year (OR 2.2; 95% CI 1.4-3.6), those with heavy prescription opioids/benzodiazepines use (OR 1.6; 95% CI 1.0-2.6) and longer wait-times (OR 1.05; 95% CI 1.00-1.09). Inversely associated with patient no-show were active employment (OR 0.38; 95% CI 0.18-0.81), patients who attended a pre-operative appointment with an anesthesiologist (OR 0.52; CI 0.32-0.85), and those undergoing an advanced endoscopic procedure (OR 0.43; 95% CI 0.19-0.94). CONCLUSION In a safety-net healthcare population, behavioral and social determinants of health, including missed appointments, active substance abuse, homelessness, and unemployment are associated with no-shows to endoscopy with anesthesia.
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Affiliation(s)
- Jennifer T Chang
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Justin L Sewell
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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Day LW. Nonphysician Performance of Endoscopy. Gastroenterol Hepatol (N Y) 2015; 11:190-192. [PMID: 27099590 PMCID: PMC4836589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Lukejohn W Day
- Assistant Professor of Medicine UCSF School of Medicine Associate CMO for Specialty Care and Diagnostics San Francisco General Hospital and Trauma Center San Francisco, California
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Sewell JL, Telischak KS, Day LW, Kirschner N, Weissman A. Preconsultation exchange in the United States: use, awareness, and attitudes. Am J Manag Care 2014; 20:e556-e564. [PMID: 25741872] [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: 06/04/2023]
Abstract
OBJECTIVES Demand for specialty care exceeds supply in many healthcare systems in the United States. Preconsultation exchange has the potential to increase access to specialty care, and increase its timeliness and efficiency, by triaging need and urgency and streamlining the previsit workup. We sought to characterize attitudes toward, use of, and concerns regarding preconsultation exchange among US internists. STUDY DESIGN Prospective cross-sectional survey. METHODS We administered a Web-based survey to a large national panel of US internists maintained by the American College of Physicians. RESULTS Response rate was 55% (N=451) with minimal differences between responders and nonresponders. Of responders, only 13% were initially familiar with the term "preconsultation exchange," but once defined, 28% were classified as frequent users, 40% as occasional users, and 32% as rare/never users. Internists used preconsultation exchange to: guide the prespecialty visit workup (78%), answer clinical questions without a patient visit to the specialist (71%), triage referral urgency (67%), and transfer referrals to a more appropriate specialty (47%). Responders supported multiple benefits of preconsultation exchange, but also reported concerns regarding reimbursement, liability, physicians taking personal responsibility for patient care, and inadequate exchange of clinical information. Compared with primary care physicians, specialists recognized more benefits of preconsultation exchange, but also expressed more concerns. The majority of responders reported increased willingness to use preconsultation exchange if specific remedies were applied. CONCLUSIONS Most US internists participate in preconsultation exchange and agree with its potential benefits. However, important concerns and barriers exist. Methods to reduce barriers to preconsultation exchange should be identified.
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Affiliation(s)
- Justin L Sewell
- San Francisco General Hospital, Division of Gastroenterology, 1001 Potrero Ave, Unit NH 3D3, San Francisco, CA 94110. E-mail
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Abstract
OPINION STATEMENT Colorectal cancer (CRC) disproportionately affects the elderly. Older age is a strong risk factor for both the development of precancerous adenomas and CRC, thus raising the issue of screening and surveillance in older patients. However, screening and surveillance decisions in the elderly can be complex and challenging. Elderly patients are a diverse and heterogeneous group and special considerations such as co-morbid medical conditions, functional status, and cognitive ability play a role in one's decisions regarding the utility of screening and surveillance. Such considerations also play a role in factors related to screening modalities, such as colonoscopy, as well as CRC treatment options and regimens. This review addresses many of the unique factors associated with CRC of the elderly and critically examines many of the controversies and challenges surrounding CRC in older patients.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA, 94110, USA,
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Siao D, Sewell JL, Day LW. Assessment of delivery methods used in the informed consent process at a safety-net hospital. Gastrointest Endosc 2014; 80:61-8. [PMID: 24518119 DOI: 10.1016/j.gie.2013.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/31/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Informed consent is legally and ethically required before a patient undergoes an endoscopic procedure, yet current literature suggests that patient comprehension of key components of informed consent is poor. OBJECTIVE To evaluate specific aspects of and patient satisfaction with the informed consent process in patients who attended an endoscopy education class versus gastroenterology clinic. DESIGN Prospective survey that examined all components of the informed consent process. SETTING Safety-net hospital. PATIENTS Outpatients undergoing endoscopy. INTERVENTION Endoscopy education class versus gastroenterology clinic. MAIN OUTCOME MEASUREMENTS Patient recall of the components of and satisfaction with the informed consent process. RESULTS A total of 301 patients completed the survey, 52.0% of whom attended and were consented in an endoscopy education class. Patients who attended an endoscopy education class reported that a greater number of individual components of the informed consent process were explained to them as compared with patients who were consented in clinic. In multivariate analysis, patients who attended an education class were more likely to recall having had the alternatives (odds ratio [OR] 4.8; 95% confidence interval [CI], 2.0-11.8), details of the procedure (OR 3.0; 95% CI, 1.3-6.8), and what to expect after the procedure (OR 3.0; 95% CI, 1.5-5.6) explained to them by a provider. These patients were more likely to know they could refuse the procedure (OR 4.1; 95% CI, 1.0-16.8), compared with patients consented in the gastroenterology clinic. LIMITATIONS Non-randomized trial. CONCLUSION Patients from a diverse, urban population who attended a multilingual endoscopy education class reported having more elements of the informed consent process explained to them compared with patients who were consented in gastroenterology clinic.
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Affiliation(s)
- Derrick Siao
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - Justin L Sewell
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA
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Abstract
BACKGROUND AND STUDY AIMS Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of this study was to characterize non-physician performance of lower and upper endoscopic procedures. PATIENTS AND METHODS Bibliographical searches were conducted in Medline, EMBASE, and Cochrane Library databases. Studies were included where patients underwent flexible sigmoidoscopy, colonoscopy, or upper endoscopy done by a non-physician (nurse, nurse practitioner, physician assistant) and outcome measures were reported (detection of polyps, adenomas, cancer, and/or adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups. RESULTS Most studies involved nurses performing flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse-practitioners/physician assistants performing flexible sigmoidoscopies showed pooled polyp detection rates of 9.9 % and 23.7 %, adenoma detection rates of 2.9 % and 7.2 %, colorectal cancer detection rates of 1.3 % and 1.2 %, and adverse event rates of 0.3 and 0 per 1000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in sigmoidoscopy performance studies comparing nurses or nurse-practitioners/physician assistants with physicians. For the 3 studies of non-physician performance of colonoscopy, pooled adenoma detection rate was 26.4 %, cecal intubation rate was 93.5 %, and adverse event rate was 2.2 /1000 colonoscopies. In the few studies examining upper endoscopies, 99.4 % of upper endoscopy procedures performed by nurses were successful with no reported adverse events. CONCLUSION Available studies suggest that when non-physicians perform endoscopic procedures, especially lower endoscopies, outcomes and adverse events are in line with those of physicians.
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Affiliation(s)
- Lukejohn W. Day
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California,GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California
| | - Derrick Siao
- Gastroenterology Division, Department of Medicine, University of California, San Francisco, California
| | - John M. Inadomi
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Washington, Seattle
| | - Ma Somsouk
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California,GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California
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Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J, Day LW, Early DS. Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 2014; 79:363-72. [PMID: 24485393 PMCID: PMC3980655 DOI: 10.1016/j.gie.2013.12.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/12/2022]
Abstract
Historically, safety in the gastrointestinal (GI) endoscopy unit has focused on infection control, particularly around the reprocessing of endoscopes. Two highly publicized outbreaks where the transmission of infectious agents were related to GI endoscopy have highlighted the need to address potential gaps along the endoscopy care continuum that could impact patient safety.
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Abstract
BACKGROUND AND STUDY AIMS Biliary and pancreatic diseases are common in the elderly; however, few studies have addressed the occurrence of adverse events in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Our objective was to determine the incidence rates of specific adverse events in this group and calculate incidence rate ratios (IRRs) for selected comparison groups. PATIENTS AND METHODS Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. The studies included documented the incidence of adverse events (perforation, pancreatitis, bleeding, cholangitis, cardiopulmonary adverse events, mortality) in patients aged ≥ 65 who underwent ERCP. Pooled incidence rates were calculated for each reported adverse event and IRRs were determined for available comparison groups. A parallel analysis was performed in patients aged ≥ 80 and ≥ 90. RESULTS Our literature search yielded 7429 articles, of which 69 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 ERCPs) in patients aged ≥ 65 were as follows: perforation 3.8 (95 %CI 1.8 - 7.0), pancreatitis 13.1 (95 %CI 11.0 - 15.5), bleeding 7.7 (95 %CI 5.7 - 10.1), cholangitis 16.1 (95 %CI 11.7 - 21.7), cardiopulmonary events 3.7 (95 %CI 1.5 - 7.6), and death 7.1 (95 %CI 5.2 - 9.4). Patients ≥ 65 had lower rates of pancreatitis (IRR 0.3, 95 %CI 0.3 - 0.4) compared with younger patients. Octogenarians had higher rates of death (IRR 2.4, 95 %CI 1.3 - 4.5) compared with younger patients, whereas nonagenarians had increased rates of bleeding (IRR 2.4, 95 %CI 1.1 - 5.2), cardiopulmonary events (IRR 3.7, 95 %CI 1.0 - 13.9), and death (IRR 3.8, 95 %CI 1.0 - 14.4). Conclusions ERCP appears to be safe in elderly patients, except in the very elderly who are at higher risk of some adverse events. These data on adverse event rates can help to inform clinical decision-making, the consent process, and comparative effectiveness analyses.
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Affiliation(s)
- Lukejohn W. Day
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, United States
- GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California, United States
| | - Lisa Lin
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States
| | - Ma Somsouk
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, United States
- GI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, California, United States
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Sewell JL, Somsouk M, Shah SC, Day LW. Commentary: Towards an effective and safe treatment of small intestine bacterial overgrowth - Authors' reply. Aliment Pharmacol Ther 2013; 38:1411. [PMID: 24206377 DOI: 10.1111/apt.12533] [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] [Received: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 12/08/2022]
Affiliation(s)
- J L Sewell
- Department of Medicine, Center for Innovation in Access and Quality, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; GI Health, Outcomes, Policy and Economics (GI-HOPE) Program, Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
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Abstract
Colorectal cancer and precancerous adenomas disproportionately affect the elderly, necessitating the need for screening and surveillance in this group. However, screening and surveillance decisions in the elderly can be challenging. Special considerations such as comorbid medical conditions, functional status, and cognitive ability play a role in one's decisions regarding the utility of screening and surveillance as well as the success and safety of various screening modalities. This article explores the evidence for screening and surveillance in the elderly, and addresses key challenges unique to this population.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA 94110, USA.
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Abstract
Colorectal cancer (CRC) is a common, but preventable, disease and is the second most common cause of cancer-related deaths in the U.S. CRC screening has proven effective at reducing both the incidence and mortality of this disease, using any of a number of screening tests available. The test options range from the least invasive and least expensive to more invasive and costly options. Fecal occult blood testing is the oldest, least expensive, and least invasive of these options and has evolved from the poorly sensitive standard guaiac test to the newer and diagnostically superior fecal immunochemical test (FIT) for hemoglobin. This article explores the evolutionary history of fecal occult blood testing, examines test performance characteristics among different FOBTs, and evaluates the role of the FIT in programmatic CRC screening.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA, 94110, USA,
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Shah SC, Day LW, Somsouk M, Sewell JL. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2013; 38:925-34. [PMID: 24004101 PMCID: PMC3819138 DOI: 10.1111/apt.12479] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/26/2013] [Accepted: 08/16/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is an under-recognised diagnosis with important clinical implications when untreated. However, the optimal treatment regimen remains unclear. AIM To perform a systematic review and meta-analysis comparing the clinical effectiveness of antibiotic therapies in the treatment of symptomatic patients with documented SIBO. METHODS Four databases were searched to identify clinical trials comparing effectiveness of: (i) different antibiotics, (ii) different doses of the same antibiotic and (iii) antibiotics compared with placebo. Data were independently extracted according to predetermined inclusion and exclusion criteria. Study quality was independently assessed. The primary outcome was normalisation of post-treatment breath testing. The secondary outcome was post-treatment clinical response. RESULTS Of 1356 articles identified, 10 met inclusion criteria. Rifaximin was the most commonly studied antibiotic (eight studies) with overall breath test normalisation rate of 49.5% (95% confidence interval, CI 44.0-55.1) (44.0%-55.1%) then (46.7%-55.5%), then (4.6%-17.8%). Antibiotic efficacy varied by antibiotic regimen and dose. Antibiotics were more effective than placebo, with a combined breath test normalisation rate of 51.1% (95% CI 46.7-55.5) for antibiotics compared with 9.8% (95% CI 4.6-17.8) for placebo. Meta-analysis of four studies favoured antibiotics over placebo for breath test normalisation with an odds ratio of 2.55 (95% CI 1.29-5.04). Clinical response was heterogeneously evaluated among six studies, but tended to correlate with breath test normalisation. CONCLUSIONS Antibiotics appear to be more effective than placebo for breath test normalisation in patients with symptoms attributable to SIBO, and breath test normalisation may correlate with clinical response. Studies were limited by modest quality, small sample size and heterogeneous design. Additional higher quality clinical trials of SIBO therapy are warranted.
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Affiliation(s)
- Shailja C. Shah
- Department of Medicine, University of California, San Francisco, CA
| | - Lukejohn W. Day
- Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA,GI Health, Outcomes, Policy and Economics (GI-HOPE) Program, Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Ma Somsouk
- GI Health, Outcomes, Policy and Economics (GI-HOPE) Program, Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Justin L. Sewell
- Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA,GI Health, Outcomes, Policy and Economics (GI-HOPE) Program, Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA
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Sewell JL, Day LW, Tuot DS, Alvarez R, Yu A, Chen AH. A brief, low-cost intervention improves the quality of ambulatory gastroenterology consultation notes. Am J Med 2013; 126:732-8. [PMID: 23791206 PMCID: PMC3730533 DOI: 10.1016/j.amjmed.2013.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Effective communication between primary care providers and specialty providers is important to facilitate high-quality specialty care. Few studies have assessed the quality of communication from specialist to primary care providers or implemented interventions to improve quality. We developed a brief, low-cost intervention designed to improve the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners in our urban health care system. METHODS Six physicians (3 specialists and 3 primary care providers) scored pre- and postintervention notes using an objective quality assessment instrument that had excellent inter-rater reliability. They were blinded to note date, author, and pre/postintervention status. The primary outcome was improvement in Composite Quality Score, an objective, comprehensive assessment of quality. Secondary outcomes included improvements in 3 specific domains, and Global Quality Score (a subjective measure of quality). RESULTS Two hundred pre- and 200 postintervention notes written by 6 fellows and 2 nurse practitioners were included. Composite Quality Score improved from 3.74 (of 5) to 4.09 (P <.001 in adjusted analysis). All secondary outcomes improved in adjusted analyses as well. The largest increase was seen in Communication Domain (22% increase). Fellow-written notes had higher scores than nurse practitioner-written notes, but nurse practitioner-written notes improved to a greater degree. CONCLUSION A brief, low-cost intervention significantly improved the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners. Communication between primary care providers and specialists is an important area for further study.
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Affiliation(s)
- Justin L Sewell
- Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
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Day LW, Bhuket T, Inadomi JM, Yee HF. Diversity of endoscopy center operations and practice variation across California's safety-net hospital system: a statewide survey. BMC Res Notes 2013; 6:233. [PMID: 23767938 PMCID: PMC3693938 DOI: 10.1186/1756-0500-6-233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/12/2013] [Accepted: 06/11/2013] [Indexed: 02/07/2023] Open
Abstract
Background Little is known about endoscopic services provided or operational practice variation within California public hospital endoscopy centers. Methods A survey was distributed to all 18 California public hospitals with endoscopy centers to assess operational practices. Results Eight of 18 hospitals responded to the survey. Six of the eight responding hospitals used a closed access system for patient referrals. Mean wait time for an endoscopic procedure was 42.4 ± 37.7 days (N = 8) with a mean procedure no-show/cancellation rate of 14.5 ± 8.0% (N = 7). All responding public hospitals performed colonoscopy, esophagogastroduodenoscopy, PEG tube placement, and endoscopic retrograde cholangiopancreatography (ERCP) with two hospitals performing endoscopic ultrasound. There was significant practice variation in the documentation of endoscopic quality and performance measurements among the responding hospitals. Multiple methods were used to communicate pathology results to patients: GI clinic visit (6/8), primary physician (4/8), telephone (2/8) or letter (1/8). Conclusion Our study highlights the diversity and practice variations of endoscopy center operations at California public hospitals and serves as a catalyst for future collaborations among safety-net hospitals.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74:885-96. [PMID: 21951478 PMCID: PMC3371336 DOI: 10.1016/j.gie.2011.06.023] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies suggest that advancing age is an independent risk factor for experiencing adverse events during colonoscopy. Yet many of these studies are limited by small sample sizes and/or marked variation in reported outcomes. OBJECTIVE To determine the incidence rates for specific adverse events in elderly patients undergoing colonoscopy and calculate incidence rate ratios for selected comparison groups. SETTING AND PATIENTS Elderly patients undergoing colonoscopy. DESIGN Systematic review and meta-analysis. MAIN OUTCOME MEASUREMENTS Perforation, bleeding, cardiovascular (CV)/pulmonary complications, and mortality. RESULTS Our literature search yielded 3328 articles, of which 20 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 colonoscopies) in patients 65 years of age and older were 26.0 (95% CI, 25.0-27.0) for cumulative GI adverse events, 1.0 (95% CI, 0.9-1.5) for perforation, 6.3 (95% CI, 5.7-7.0) for GI bleeding, 19.1 (95% CI, 18.0-20.3) for CV/pulmonary complications, and 1.0 (95% CI, 0.7-2.2) for mortality. Among octogenarians, adverse events (per 1000 colonoscopies) were as follows: cumulative GI adverse event rate of 34.9 (95% CI, 31.9-38.0), perforation rate of 1.5 (95% CI, 1.1-1.9), GI bleeding rate of 2.4 (95% CI, 1.1-4.6), CV/pulmonary complication rate of 28.9 (95% CI, 26.2-31.8), and mortality rate of 0.5 (95% CI, 0.06-1.9). Patients 80 years of age and older experienced higher rates of cumulative GI adverse events (incidence rate ratio 1.7; 95% CI, 1.5-1.9) and had a greater risk of perforation (incidence rate ratio 1.6, 95% CI, 1.2-2.1) compared with younger patients (younger than 80 years of age). There was an increased trend toward higher rates of GI bleeding and CV/pulmonary complications in octogenarians but neither was statistically significant. LIMITATIONS Heterogeneity of studies included and not all complications related to colonoscopy were captured. CONCLUSIONS Elderly patients, especially octogenarians, appear to have a higher risk of complications during and after colonoscopy. These data should inform clinical decision making, the consent process, public health policy, and comparative effectiveness analyses.
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Day LW, Cello JP, Somsouk M, Inadomi JM. Prevalence of gastric cancer versus colorectal cancer in Asians with a positive fecal occult blood test. Indian J Gastroenterol 2011; 30:209-16. [PMID: 21948130 PMCID: PMC5518687 DOI: 10.1007/s12664-011-0123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 08/11/2011] [Indexed: 02/04/2023]
Abstract
AIM Prior studies have reported conflicting results on the yield of esophagogastroduodenoscopy (EGD) in patients with a positive fecal occult blood test (FOBT). Our aim was to compare the yield between EGD and colonoscopy performed in a racially diverse population with a positive FOBT. METHODS A retrospective, cross-sectional study of FOBT positive patients who underwent EGD and colonoscopy from January 1, 1999 to November 1, 2008. Endoscopic lesions deemed responsible for GI bleeding were identified. RESULTS Two hundred and eighty-seven patients met entry criteria, among which, 63% were Asian and 81% were immigrants to the U.S. Forty-four patients had EGD findings deemed responsible for a positive FOBT, the most common being esophagitis (25.0%) and gastric ulceration (15.9%). Forty-two patients had colonoscopic findings likely responsible for a positive FOBT with the most frequent lesion being colonic polyps ≥9 mm in diameter (76.2%). Prevalence of lower and upper GI tract lesions responsible for positive FOBT was similar (14.6% vs. 15.3%, p = 0.2). There was no association between a patient reporting upper GI symptoms, or the presence of anemia and the detection of upper GI tract lesions on endoscopy. Gastric adenocarcinoma (n = 3) was as prevalent as colorectal adenocarcinoma (n = 4). All three patients with gastric adenocarcinomas were Asian (prevalence 1.6%). CONCLUSIONS In our racially diverse population evaluated for a positive FOBT, gastric adenocarcinoma was as prevalent as colorectal adenocarcinoma; however, gastric adenocarcinoma was limited to Asian patients. EGD and colonoscopy should be considered in the evaluation of patient populations similar to ours, particularly Asian immigrants.
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Affiliation(s)
- Lukejohn W. Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USAGI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, CA, USA,L. W. Day, San Francisco General Hospital (3D-5), 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - John P. Cello
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USAGI Health Outcomes, Policy and Economics (HOPE) Research Program, Department of Medicine, University of California, San Francisco, CA, USA
| | - John M. Inadomi
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
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Day LW, Espey DK, Madden E, Segal M, Terdiman JP. Screening prevalence and incidence of colorectal cancer among American Indian/Alaskan natives in the Indian Health Service. Dig Dis Sci 2011; 56:2104-13. [PMID: 21234688 PMCID: PMC3112488 DOI: 10.1007/s10620-010-1528-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/09/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies on colorectal cancer (CRC) screening and incidence among American Indian/Alaska Natives (AI/AN) are few. AIMS Our aim was to determine CRC screening prevalence and to calculate CRC incidence among AI/AN receiving care within the Indian Health Service (IHS). METHODS A retrospective cohort study of AI/AN who utilized IHS from 1996 to 2004. AI/AN who were average-risk for CRC and received primary care within IHS were identified by searching the IHS Resource Patient Management System for selected ICD-9/CPT codes (n = 142,051). CRC screening prevalence was calculated and predictors of screening were determined for this group. CRC incidence rates were ascertained for the entire AI/AN population ages 50-80 who received IHS medical care between 1996 and 2004 (n = 283,717). RESULTS CRC screening was performed in 4.0% of average-risk AI/AN. CRC screening was more common among women than men (RR = 1.6, 95% CI 1.4-1.7) and among AI/AN living in the Alaska region compared to the Pacific Coast region (RR = 2.5, 95% CI 2.2-2.8) while patients living in the Northern Plains (RR = 0.4, 95% CI 0.3-0.4) were less likely to have been screened. CRC screening was less common among patients with a greater number of primary care visits. The age-adjusted CRC incidence among AI/AN ages 50-80 was 227 cancers per 100,000 person-years. CONCLUSIONS CRC was common among AI/AN receiving medical care within IHS. However, CRC screening prevalence was far lower than has been reported for the U.S. population.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital (3D), 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Older age is associated with a rise in colorectal cancer and adenomas, necessitating the need for CRC screening in older patients. However, decisions about CRC screening and surveillance in older adults are often difficult and challenging. The decision requires an individualized assessment that incorporates factors unique to performing colonoscopy in older adults in order to weigh the risks and benefits for each patient according to their overall health and preferences. This review addresses the factors unique to colorectal cancer and performing colonoscopy in older adults that are relevant in weighing the risks and benefits of screening and surveillance in this population.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA.
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Abstract
Diarrhea in patients with acquired immune deficiency syndrome (AIDS) has proven to be both a diagnostic and treatment challenge since the discovery of the human immunodeficiency virus (HIV) virus more than 30 years ago. Among the main etiologies of diarrhea in this group of patients are infectious agents that span the array of viruses, bacteria, protozoa, parasites, and fungal organisms. In many instances, highly active antiretroviral therapy remains the cornerstone of therapy for both AIDS and AIDS-related diarrhea, but other targeted therapies have been developed as new pathogens are identified; however, some infections remain treatment challenges. Once identifiable infections as well as other causes of diarrhea are investigated and excluded, a unique entity known as AIDS enteropathy can be diagnosed. Known as an idiopathic, pathogen-negative diarrhea, this disease has been investigated extensively. Atypical viral pathogens, including HIV itself, as well as inflammatory and immunologic responses are potential leading causes of it. Although AIDS enteropathy can pose a diagnostic challenge so too does the treatment of it. Highly active antiretroviral therapy, nutritional supplementation, electrolyte replacements, targeted therapy for infection if indicated, and medications for symptom control all are key elements in the treatment regimen. Importantly, a multidisciplinary approach among the gastroenterologist, infectious disease physician, HIV specialists, oncology, and surgery is necessary for many patients.
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Affiliation(s)
- John P Cello
- Department of Medicine, Gastroenterology Division, University of California, San Francisco, San Francisco General Hospital, San Francisco, California 94110, USA.
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