Nutritional status and outcomes of veterans undergoing curative surgery for colorectal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18585-e18585
Author(s):  
Urvashi Mitbander ◽  
Timothy Frankel ◽  
Irina Y. Dobrosotskaya
Keyword(s):  
Colorectal Cancer ◽  
Weight Loss ◽  
Tertiary Care ◽  
Veterans Health ◽  
Health Administration ◽  
Significant Weight Loss ◽  
Curative Surgery ◽  
Curative Intent ◽  
Post Surgery ◽  
One Year

e18585 Background: Malnutrition is highly prevalent within the cancer population. Malnourishment has various negative surgical and oncologic impacts. The Veterans Health Administration (VHA) provides comprehensive care to patients in a single-payer system allowing for capture of peri-operative data and the opportunity for focused pre-operative (pre-op) interventions to improve outcomes. We sought to study the effect of pre-op weight and albumin on post-operative (post-op) complications in a contemporaneous group of veterans with colorectal cancer (CRC) at a tertiary care Veterans Affairs (VA) hospital. Methods: This is a retrospective review of 105 patients with colorectal malignancies treated with curative intent surgery at the VA Ann Arbor Healthcare System between January 2015 and January 2020. Patients with distant metastatic disease, neoadjuvant therapy, non-adenocarcinoma histology, or those receiving majority of care outside of the VHA were excluded. We examined BMI trends from one year prior to one year post surgery, rates of nutrition consults, and post-op complications defined as abnormal clinical developments such as, but not limited to, infection and delayed wound healing. Fisher’s exact test was used for analysis. Results: At time of CRC diagnosis, the mean age was 70.3 ± 9.1 and the median stage was T2N0. Surgical resections were 65% (n = 68) laparoscopic. Pre-op weight loss from 6 months prior to diagnosis to time of surgery was observed in the majority of patients (n = 47, 64%). Significant weight loss, defined as ≥3% weight reduction, was seen in 45% (n = 33) of patients. A quarter of patients were identified to have a low pre-op albumin of less than 3.5 (n = 25, 25%). Significant weight loss and low pre-op albumin were each independently associated with increased post-op complications (p < 0.01). Post-op weight loss was seen in 81% (n = 73) and 69% (n = 48) of patients at 30- and 60-days post-op, respectively, and was not associated with post-op complications. Inpatient post-op nutrition consultation was performed in 96% (n = 101) of patients; nutritional supplements were recommended in only 23% (n = 23) of cases. In patients with significant weight loss, pre-op nutrition evaluation was performed in 15% (n = 5) of cases and post-op outpatient nutrition follow up occurred in 18% (n = 6) of cases. Conclusions: 45% of patients had ≥3% weight loss 6 months prior to diagnosis of CRC and 25% of patients had low albumin levels. These led to greater post-operative complications. An intensive nutrition pre-habilitation program to address weight loss and low albumin prior to surgery for CRC is needed and may reduce associated complications.

scholarly journals Increasing enrolment in a national VA transitions of care programme: a pre–post evaluation of a data dashboard and nudge-based intervention

2021 ◽  
Vol 28 (1) ◽  
pp. e100416
Author(s):  
Brigid Connelly ◽  
Chelsea Leonard ◽  
David Gaskin ◽  
Theodore Warsavage ◽  
Heather Gilmartin
Keyword(s):  
Performance Metrics ◽  
Transitions Of Care ◽  
Audit And Feedback ◽  
Veterans Health ◽  
Health Administration ◽  
Care Programme ◽  
Post Evaluation ◽  
The Difference ◽  
Two Phases ◽  
One Year

BackgroundThe rural transitions nurse programme (TNP) is a care coordination intervention for high-risk veterans. An interactive dashboard was used to provide real-time performance metrics to sites as an audit and feedback tool. One-year post implementation, enrolment goals were not met. Nudge emails were introduced to increase TNP veteran enrolment. This study evaluated whether veteran enrolment increased when feedback occurred through a dashboard plus weekly nudge email versus dashboard alone.Setting/populationThis observational study included veterans who were hospitalised and discharged from four Veterans Health Administration hospitals participating in TNP.MethodsVeteran enrolment counts between the dashboard phase and dashboard plus weekly nudge email phase were compared. Nudge emails included run charts of enrolment data. The difference of means for weekly enrolment between the two phases were calculated. After 3 months of nudge emails, a survey assessing TNP transitions nurse and physician champion perceptions of the nudge emails was distributed.ResultsThe average enrolment for the four TNP sites during the ~20-month dashboard only phase was 4.23 veterans/week. The average during the 3-month dashboard plus nudge email phase was 4.21 veterans/week. The difference in means was −0.03 (p=0.73). Adjusting for time trends had no further effect. Four nurses responded to the survey. Two nurses reported neutral and two reported positive perceptions of the nudge emails.ConclusionDrawing attention to metrics, through nudge emails, maintained, but did not increase TNP veteran discharges compared to dashboard feedback alone.

Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration

Medical Care ◽  
2019 ◽  
Vol 57 (10) ◽  
pp. 773-780 ◽  
Author(s):  
Folasade P. May ◽  
Elizabeth M. Yano ◽  
Dawn Provenzale ◽  
William N. Steers ◽  
Donna L. Washington
Keyword(s):  
Mental Health ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Cancer Screening Disparities

scholarly journals SP4.1.7 Colorectal Cancer: Pathway Disruptions as a Result of COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Liana E Spyropoulou ◽  
Daniel Curley ◽  
Mimi Li ◽  
Estelle Martin ◽  
Greg Wynn ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Potential Risk ◽  
Advanced Disease ◽  
Delayed Presentation ◽  
Patient Contact ◽  
Curative Surgery ◽  
Curative Intent ◽  
Surgical Practice ◽  
Cancer Pathways ◽  
Operative Activity

Abstract Aims COVID-19 has impacted diagnosis and treatment of colorectal cancer. Efforts to minimise patient contact have caused delays in cancer pathways, generating a potential risk to patient care. We aim to identify the pandemic effect on colorectal referral pathways. Methods All cancer referrals during March-June 2020 were reviewed to obtain information on the timeline and planning of investigation and treatment. The data was compared to evidence from the same referral period in 2019. Results 681 referrals were received during March-June 2020, compared to 1032 in 2019, indicating a 34% decrease. The majority of patients were reviewed in telephone clinic (76.2%) rather than physical appointments (15.4%). Although the commonest mode of investigation was endoscopy(46.2%), there was increased use of CT scan(35.8%). 114(17.1%) patients were not investigated, of which 40(35.1%) declined investigation, primarily due to COVID-19 apprehension. 6 patients were re-referred and 67(58.8%) were removed from the pathway for unknown reasons. 1 patient was subsequently admitted as an emergency. There were 44 new diagnoses of colorectal cancer based on MDT discussion, of which 14(31.8%) breached the investigation and 20(45.5%) the treatment date. 18 underwent curative surgery compared to 47 in the same period in 2019, indicating 61.7% less operative activity. Conclusions COVID-19 has changed surgical practice, forcing alternative clinic, investigation and treatment methods. Disruption of colorectal pathways is causing reduced referrals, investigation delays and less surgical activity. Delayed presentation with advanced disease may deprive the opportunity of treatment with curative intent.

scholarly journals Zenker’s diverticulum in an 85-year-old Ugandan man

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Senai Goitom Sereke ◽  
Felix Bongomin ◽  
Zeridah Muyinda
Keyword(s):  
Weight Loss ◽  
Clinical Suspicion ◽  
Zenker’S Diverticulum ◽  
Barium Swallow ◽  
Significant Weight Loss ◽  
Inexpensive Method ◽  
Case Presentation ◽  
Zenker's Diverticulum ◽  
Proximal Esophagus ◽  
One Year

Abstract Background Zenker’s diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the cricopharyngeal muscle. Case presentation An 85-year-old male patient presented with odynophagia and dysphagia of initially solid food followed by fluids that was associated with a significant weight loss over a one-year period. Barium swallow videofluoroscopy demonstrated a posterior outpouching of proximal esophagus that was 2 cm from the epiglottis. With the diagnosis of medium sized ZD, the patient underwent endoscopy guided diverticulotomy. Six months after the procedure, he was asymptomatic and had gained weight. Conclusions Dysphagia and weight loss raises a clinical suspicion for a malignancy. Barium swallow examination is an inexpensive method for the diagnosis of ZD.

Deriving Weight from Big Data: A Comparison of Body Weight Measurement Cleaning Algorithms (Preprint)

2021 ◽  
Author(s):  
Richard Evans ◽  
Jennifer Burns ◽  
Anne Annis ◽  
Michelle Freitag ◽  
Susan Raffa ◽  
...  
Keyword(s):  
Body Weight ◽  
Veterans Health Administration ◽  
Primary Care Visit ◽  
Veterans Health ◽  
Health Administration ◽  
Weight Measurement ◽  
Care Visit ◽  
Complex Models ◽  
One Year ◽  
Weight Data

BACKGROUND Patient body weight is a frequently utilized measure in biomedical studies, yet there are exist no standard methods for processing and cleaning weight data. Conflicting documentation on constructing body weight measurements presents challenges for research and program evaluation. OBJECTIVE We sought to describe and compare methods for extracting and cleaning weight data from electronic health record (EHR) databases to develop guidelines for standardized approaches that promote reproducibility. METHODS We conducted a systematic review of studies that used Veterans Health Administration (VHA) EHR weight data, published from 2008 – 2018 and documented the algorithms for constructing patient weight. We applied these algorithms to a cohort of veterans with at least one Primary Care visit in 2016. The resulting weight measures were compared at the patient and site levels. RESULTS We identified 496 studies and included 62 that utilized weight as outcome variables; 48% included a replicable algorithm. Algorithms varied from cut-offs of implausible weights to complex models using measures within patient over time. We found differences in the number of weight values after applying the algorithms (86% to 99% of raw data) and decreased variance (SD = 68 to 54), but little difference in average weights across methods (216 to 220 lbs.). The percent of patients with at least 5% weight loss over one year ranged from 18% to 24%. CONCLUSIONS Determining the best method to assess weight using EHR data can be computationally demanding. Our results suggest that for many studies, applying simple cut-offs that require fewer computing resources and are easier to understand may be sufficient. We present guidelines for situations where more complex approaches may be warranted.

Overeating: Treatment of Obesity and Anxiety by Auricular Acupuncture, An Analysis of 800 Cases

1996 ◽  
Vol 14 (2) ◽  
pp. 116-120 ◽  
Author(s):  
A Apostolopoulos ◽  
M Karavis
Keyword(s):  
Weight Loss ◽  
Acupuncture Point ◽  
Control Programme ◽  
The Body ◽  
Auricular Acupuncture ◽  
Significant Weight Loss ◽  
Treatment Of Obesity ◽  
Psychological Balance ◽  
One Year ◽  
Group B

Auricular acupuncture (placement of press needles) was applied at the stomach point (according to Nogier) and sometimes at the point of psychological balance (Shenmen) for the control of anxiety and for help in weight loss in 800 patients over a two year period. Press needles were inserted and left in for 10 to 15 days at the auricular acupuncture point and resited again after 4 to 5 days. At the same time, instructions were given for the standard treatment of obesity (information leaflet, low calorie diet, aerobic exercise, behaviour modification, psychological support, etc.). The patients were followed up for a period of one year. The participants were 683 women and 117 men aged between 15 and 76 years. The Body Mass Index (weight/height) was used to determine the degree of obesity, and cases were divided into three groups according to the number of acupuncture sessions as follows: 468 patients (Group A) had one acupuncture session, 278 (Group B) 2 to 4 sessions, and 54 (Group C) had over 4 sessions, all conducted at 15 to 20 day intervals. A reduction in overeating was reported by 81.1% of patients, and 46.7% of the 697 patients who had noted anxiety symptoms claimed that treatment had helped in the reduction of anxiety. Regular exercise was encouraged, and started by 43.4% of the 703 who had no such habit. There was no significant weight loss in 35.2% of patients. During the first 3 months there was an overall significant weight loss in 64.8% and 35.5% at 6–12 months. The percentage weight loss was higher in Groups B and C and remained higher at six months and one year after the start of acupuncture treatment. Group B presented a good six month result in 61.2% of patients and a good annual result in 39.1%. In Group C results were 88.9% and 77.8% respectively. The control of overeating and anxiety using auricular acupuncture al the stomach and Shenmen points in this audit has been beneficial. Its correct use in an integrated obesity control programme may prove of significant long tem help.

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