Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice

Abstract Background and aims Accurate sizing of polyps at time of colonoscopy is critical for determining surveillance intervals. Endoscopists routinely over- or underestimate the size of polyps at colonoscopy. We evaluated the variability in sizing of polyps among multiple endoscopists, and the effect of patient and physician related factors on polyp size estimation in a large community-based practice. Methods Adult patients who underwent a colonoscopy with polypectomy at five endoscopy centers in Minneapolis/St. Paul by one of 52 endoscopists in 2013 were included in this study. Association of patient, physician, and procedure related factors on polyp sizing was assessed. Results In the study time frame, 38 624 colonoscopies were performed at five ambulatory endoscopy centers. Of these, 16 336 had one or more polyp removed with size information available, and were included in this analysis. There was significant inter-physician variation for estimating polyp sizes larger than 5 mm (intraclass correlation coefficient [ICC] 0.13). Older patient age (OR 1.08, 95 %CI 1.06 – 1.11), and male physician gender (OR 1.92, 95 %CI 1.26 – 2.94) were associated with increased odds of physicians sizing polyps as larger in size. Surveillance procedures had a higher odds of larger polyp sizing compared to screening (OR 0.91, 95 %CI 0.86 – 0.97) and diagnostic procedures (OR 0.86, 95 %CI 0.78 – 0.94). Conclusion In a large community setting, variation of polyp sizing estimates exists between physicians. Male physicians were more likely to size polyps as larger in size. Older patients and patients undergoing surveillance procedures were more likely to have polyps that were sized as larger in size.

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Real-world evidence highlights sizeable gap in adopting early palliative care referral in patients with advanced cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24147 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24147-e24147

Author(s):

Suzanne Cole ◽

Sarah Storie ◽

Sonya Owens ◽

LaShanta Gipson ◽

Michael Hardy ◽

...

Keyword(s):

Palliative Care ◽

Real World ◽

Qualitative Methodology ◽

Treatment Options ◽

Community Setting ◽

Symptom Burden ◽

Community Practice ◽

Related Factors ◽

Early Integration ◽

Early Palliative Care

e24147 Background: Early referral to palliative care (PC) for patients w/ adv cancer is supported by compelling evidence from large RCTs demonstrating a lower symptom burden, higher QOL, and increased OS. However, these studies reflect pts who have self-selected to accept a PC referral and attend a PC visit. WHO/NCCN/ASCO guidelines support early integration of PC. We sought to characterize the referral patterns in our heme/onc practice to identify and mitigate the barriers to early PC adoption in the community setting. We began a concerted effort to discuss early PC referral w/ pts recently diagnosed w/ adv cancer at the time systemic therapy was initiated. Methods: To ensure real-world applicability of this study, we identified a large satellite clinic of a major academic center w/ access to PC on the main campus (located 20 miles from the satellite clinic). We retrospectively reviewed new pts age 18y+ w/ adv cancer, characterized PC referrals and outcomes. Using qualitative methodology, we identified pt-reported barriers to accepting PC care. Results: 407 new pts were seen; 168 w/ benign heme, 145 w/ early cancers, 94 w/ adv cancers. Of the 94 pts w/ adv cancers, 25 pts had one-time 2ndopinion visits, and 16 pts were not candidates for, or did not desire cancer treatment and directly enrolled on hospice. Our analysis cohort consisted of 53 pts w/ adv cancer pursuing life prolonging therapy. At initiation of treatment, 57 % (n=30) were not offered a PC referral, 22% (n=12) received a PC referral and attended the appt, however 21% (n=11) received a PC referral but did not attend the appt. A qualitative analysis of the 11 patients referred to early PC who did not attend the appt revealed; 5 patients scheduled an appt but did not attend (3-unknown reason, 2-hospitalized during appt, 1-lack of transportation), 2 pts were unreachable, and 4 pts were contacted but declined to schedule stating: “I feel pressured” “I want to hear what other treatment options I have” “I want to be treated first and then see if I need it” "I am overwhelmed with too many new doctors and visits". Conclusions: Despite the benefit of early PC referral in pts w/ adv cancer, we identified a considerable gap in its adoption in our community practice despite access to proximate PC clinic. Further studies are under design to address institutional and pt-related factors to improve real-world adoption of this critical service.

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AUTOMATED POLYP SIZE ESTIMATION WITH DEEP LEARNING REDUCES OVERESTIMATION BIAS

10.1055/s-0040-1704526 ◽

2020 ◽

Author(s):

J Suykens ◽

T Eelbode ◽

J Daenen ◽

P Suetens ◽

F Maes ◽

...

Keyword(s):

Deep Learning ◽

Size Estimation ◽

Polyp Size

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Reliability of a Modified Medication Appropriateness Index in Community Pharmacies

Annals of Pharmacotherapy ◽

10.1177/106002800303700101 ◽

2003 ◽

Vol 37 (1) ◽

pp. 40-46

Author(s):

Rosemin Kassam ◽

Linda G Martin ◽

Karen B Farris ◽

Homero A Monsanto ◽

Jean-Marie Kaiser

Keyword(s):

Community Pharmacy ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Community Setting ◽

Medication Appropriateness Index ◽

Paired Samples ◽

Psychometric Data ◽

Ambulatory Patients ◽

Pharmacy Setting ◽

Medication Appropriateness

Background The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined. Objective To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes. Methods Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, κ, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability. Results The κ statistics were >0.75 for indication and effectiveness, but good (0.41–0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall κ (0.65, 0.66, 0.61) were similar for the 3 schemes. Conclusions This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.

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Inaccurate polyp size estimation can affect patient management: endoscopic estimates of polyp size should be abandoned in favor of the pathologist's measurement

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(96)80312-9 ◽

1996 ◽

Vol 43 (4) ◽

pp. 368 ◽

Cited By ~ 1

Author(s):

C Margulies ◽

RE Schoen ◽

LD Gerber ◽

JL Weissfeld

Keyword(s):

Patient Management ◽

Size Estimation ◽

Polyp Size

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Factors Affecting Time to Surgery in Breast Cancer Patients

The American Surgeon ◽

10.1177/00031348211054714 ◽

2021 ◽

pp. 000313482110547

Author(s):

Anees B. Chagpar ◽

Marissa Howard-McNatt ◽

Akiko Chiba ◽

Edward A. Levine ◽

Jennifer S. Gass ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Stage ◽

Community Setting ◽

Partial Mastectomy ◽

Community Practice ◽

Breast Cancer Patients ◽

Factors Affecting ◽

Time To Surgery ◽

Modifiable Factors ◽

Timeliness Of Care

Background We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. Methods Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. Results The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days ( P = .001). There was significant variation in TTS by surgeon ( P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 ( P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. Conclusions Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.

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In-Practice Endocrine Surgery Fellowship: A Novel Training Model

Otolaryngology ◽

10.1177/0194599820962791 ◽

2020 ◽

pp. 019459982096279

Author(s):

Hien T. Tierney ◽

Leslie S. Eldeiry ◽

Jeffrey R. Garber ◽

Chia A. Haddad ◽

Mark A. Varvares ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Medical Center ◽

Academic Medical Center ◽

Training Model ◽

Time Frame ◽

Fellowship Training ◽

Endocrine Surgery ◽

Community Practice ◽

Senior Surgeon ◽

Academic Medical

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

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