scholarly journals Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 100
Author(s):  
Jonathan Kopel ◽  
Bojana Ristic ◽  
Gregory L. Brower ◽  
Hemant Goyal
Keyword(s):  
Colorectal Cancer ◽  
Flexible Sigmoidoscopy ◽  
Healthcare Delivery ◽  
The United States ◽  
The Body ◽  
Medical Procedures ◽  
Future Directions ◽  
Global Impact ◽  
Endoscopic Methods ◽  
The Impact

The coronavirus disease 2019 (COVID-19) pandemic has brought significant challenges to many aspects of healthcare delivery since the first reported case in early December 2019. Once in the body, SARS-CoV-2 can spread to other digestive organs, such as the liver, because of the presence of ACE2 receptors. Colorectal cancer (CRC) remains the second-leading cause of death in the United States (US). Therefore, individuals are routinely screened using either endoscopic methods (i.e., flexible sigmoidoscopy and colonoscopy) or stool-based tests, as per the published guidelines. At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended that all non-urgent surgical and medical procedures, including screening colonoscopies, be delayed until the pandemic stabilization. This article aims to review the impact of COVID-19 on CRC screening.

scholarly journals The Impact of an Evidence-Based Multi-component Intervention on Colorectal Cancer Screening in Primary Care at a Healthcare System

2021 ◽  
Author(s):  
◽  
Ahnnya Slaughter
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Healthcare System ◽  
The United States ◽  
The Body ◽  
Average Risk ◽  
Number Of Patients ◽  
The Impact

Practice Problem: Colorectal cancer is the second leading cause of cancer death in the United States; many of the deaths are preventable with early detection. Adherence rates for colorectal cancer screening with fecal immunochemical test kits (FIT) was below the national benchmark at this facility. PICOT: The PICOT question that guided this project was: Among veterans 50 – 75 years old requiring average risk colorectal cancer screening (CRCS) seen in primary care at a veterans affairs healthcare system facility (P), how does the use of a multi-component intervention (I), compared to the usual care (C), affect the number of patients completing CRCS (O) over a period of 12 weeks (T)? Evidence: Review of high-quality studies suggested a multi-component approach, including increasing provider awareness and increasing patient education and outreach, as the most effective approach to increase colorectal screening compliance. Intervention: The multi-component intervention included a standardized CRCS nurse navigation process through standard work which included the teach-back method, patient outreach, and provider feedback. Outcome: There were clinically significant improvements in adherence with returned FIT kits, follow up for abnormal FIT kits, and statistically significant improvements with nursing documentation of patient teaching. The number of patients overdue for CRCS decreased. Conclusion: The multi-component CRCS screening intervention demonstrated significant improvements in the intervention clinics which is consistent with the body of evidence.

scholarly journals Association of patients’ perception of quality of healthcare received and colorectal cancer screening uptake: An analysis of two national surveys in the United States

2020 ◽  
Author(s):  
Karan Chawla ◽  
Angesom Kibreab ◽  
Victor & Scott ◽  
Edward L. Lee ◽  
Farshad Aduli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
United States ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Crc Screening ◽  
Fair Poor ◽  
National Trends

Objective: It is unknown whether patients’ ratings of the quality of healthcare services they receive truly correlate with the quality of care from their providers. Understanding this association can potentiate improvement in healthcare delivery. We evaluated the association between patients’ ratings of the quality of healthcare services received and uptake of colorectal cancer (CRC) screening. Subject and Methods: We used two iterations of the Health Information National Trends Survey (HINTS) of adults in the United States. HINTS 2007 (4,007 respondents; weighted population=75,397,128) evaluated whether respondents were up-to-date with CRC screening while HINTS 4 cycle 3 (1,562 respondents; weighted population=76,628,000) evaluated whether participants had ever received CRC screening in the past. All included respondents from both surveys were at least 50 years of age, had no history of CRC, and had rated the quality of healthcare services that they had received at their healthcare provider’s office in the previous 12 months. Results: HINTS 2007 data showed that respondents who rated their healthcare as good, or fair/poor were significantly less likely to be up to date with CRC screening compared to those who rated their healthcare as excellent. We found comparable results from analysis of HINTS 4 cycle 3 data with poorer uptake of CRC screening as the healthcare quality ratings of respondents’ reduced. Conclusion: Our study suggested that patients who reported receiving lower quality of healthcare services were less likely to have undergone and be compliant with CRC screening recommendations. It is important to pay close attention to patient feedback surveys in order to improve healthcare delivery.

scholarly journals Longitudinal impact of Welsh clinical leadership fellowship

2020 ◽  
Vol 33 (1) ◽  
pp. 1-11
Author(s):  
Suzanne Phillips ◽  
Alison Bullock
Keyword(s):  
Clinical Practice ◽  
Medical Training ◽  
Healthcare Delivery ◽  
The Body ◽  
Longitudinal Impact ◽  
Structured Interviews ◽  
Clinical Leadership ◽  
Content Type ◽  
Training Programmes ◽  
The Impact

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications Small participant numbers limit generalisability. Practical implications The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

scholarly journals Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors

2019 ◽  
Vol 110 (5) ◽  
pp. 430-442 ◽  
Author(s):  
Erin Laing ◽  
Nicole Kiss ◽  
Michael Michael ◽  
Meinir Krishnasamy
Keyword(s):  
Clinical Practice ◽  
Neuroendocrine Tumors ◽  
Dietary Habits ◽  
Somatostatin Analogs ◽  
The United States ◽  
The Body ◽  
Care Needs ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Vitamin Deficiencies ◽  
The Impact

Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40–90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.

Implications of postoperative complications on survival after cytoreductive surgery and HIPEC: A multi-institutional analysis of the United States HIPEC Collaborative.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 40-40
Author(s):  
Adriana C. Gamboa ◽  
Rachel M. Lee ◽  
Michael K. Turgeon ◽  
Ahmed Ahmed ◽  
Travis Edward Grotz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Cytoreductive Surgery ◽  
Colorectal Adenocarcinoma ◽  
The United States ◽  
Incomplete Resection ◽  
Appendiceal Neoplasm ◽  
Non Invasive ◽  
Heated Intraperitoneal Chemotherapy ◽  
The Impact

40 Background: Postoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) is unknown. Methods: US HIPEC Collaborative (2000-17) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. Analysis was stratified by non-invasive appendiceal neoplasm vs invasive appendiceal/colorectal adenocarcinoma. POCs were grouped into infectious, cardiopulmonary, thromboembolic and intestinal dysmotility. Primary outcomes were 3-yr overall survival (OS) and recurrence-free survival (RFS). Results: Of 1304 pts, median age was 55 yrs, 41% were male (n = 537), 33% had non-invasive appendiceal (n = 426) and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the non-invasive appendiceal cohort, POCs were identified in 55% (n = 233) and OS and RFS did not differ between patients who experienced a complication and those who did not (OS 94 vs 94% p = 0.26; RFS 68 vs 60% p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased OS (59 vs 74% p < 0.001) and RFS (32 vs 42% p < 0.001). Infectious POCs were most common (35%; n = 196). On MV analysis accounting for gender, PCI and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared to no complication (HR 2.08 95%CI 1.48-2.93 p < 0.01) or other types of complications (HR 1.7 95%CI 1.28-2.25 p < 0.01). This association persisted for infectious POCs and reduced RFS (HR 1.61 95%CI 1.23-2.10 p < 0.01). Conclusions: Postoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease like non-invasive appendiceal neoplasm. Of all complication types, infectious complications are the main driver for this association. The exact mechanism is not known, but may be immunologic. Efforts must target best practices and standardized prevention strategies to minimize infectious POCs.

scholarly journals Hasty Reduction of COVID-19 Lockdown Measures Leads to the Second Wave of Infection

2020 ◽  
Author(s):  
Yara Hazem ◽  
Suchitra Natarajan ◽  
Essam R. Berikaa
Keyword(s):  
United States ◽  
United Kingdom ◽  
The United States ◽  
Sir Model ◽  
Global Impact ◽  
The United Kingdom ◽  
The Impact ◽  
Second Wave

AbstractThe outbreak of COVID-19 has an undeniable global impact, both socially and economically. March 11th, 2020, COVID-19 was declared as a pandemic worldwide. Many governments, worldwide, have imposed strict lockdown measures to minimize the spread of COVID-19. However, these measures cannot last forever; therefore, many countries are already considering relaxing the lockdown measures. This study, quantitatively, investigated the impact of this relaxation in the United States, Germany, the United Kingdom, Italy, Spain, and Canada. A modified version of the SIR model is used to model the reduction in lockdown based on the already available data. The results showed an inevitable second wave of COVID-19 infection following loosening the current measures. The study tries to reveal the predicted number of infected cases for different reopening dates. Additionally, the predicted number of infected cases for different reopening dates is reported.

Mobilizing the Invisible: Power and Marginality in the Black LGBTQ Community

2020 ◽  
Author(s):  
Ravi K. Perry ◽  
Aaron D. Camp
Keyword(s):  
United States ◽  
Political Institutions ◽  
Public Discourse ◽  
White Supremacy ◽  
Body Politic ◽  
The United States ◽  
The Body ◽  
Coalition Building ◽  
Structural Inequities ◽  
The Impact

Symbolic and structural inequities that seek to maintain White supremacy have sought to render Black LGBTQ Americans invisible in the body politic of powerful institutions that govern society. In the face of centuries-long oppression at the hands of the state, Black LGBTQ Americans have effectively mobilized to establish visibility on the national policymaking agenda. Members of this community have demonstrated a fierce resilience while confronting a violent anti-Black and anti-LGBTQ mainstream agenda narrative in media and politics. This sociopolitical marginalization—from members of their shared demographic, or not, is often framed in partisan or ideological terms in public discourse and in the halls of American political institutions. Secondary marginalization theory and opinion polling frame how personal identity and social experience shape the Black LGBTQ political movement’s expression of what participation in politics in the United States ought to earn them in return. Double-consciousness theory contextualizes the development of Black LGBTQ sociopolitical marginalization in the United States and the community’s responsive mobilization over time—revealing the impact of coalition building and self-identification toward establishing political visibility necessary to improve the lived conditions of the multiply oppressed.

The Impact of Colorectal Cancer Screening in a Veteran Hospital Population

2013 ◽  
Vol 79 (3) ◽  
pp. 296-300 ◽  
Author(s):  
John Trombold ◽  
Russellw Farmer ◽  
Michael McCafferty
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Operative Mortality ◽  
Cox Regression ◽  
Medical Center ◽  
The United States ◽  
Curative Intent ◽  
Colon And Rectal Cancer ◽  
The Impact

Colon and rectal cancer is the second most common cause of cancer death in the United States. Screening effectively decreases colorectal cancer mortality. This study aims to evaluate the impact of colorectal cancer screening within a Veterans Affairs Medical Center and treatment outcomes. Institutional Review Board approval was obtained for a retrospective analysis of all colorectal cancer cases that were identified through the Tumor Registry of the Robley Rex VA Medical Center from 2000 to 2009. Data collected included age at diagnosis, race, risk factors, diagnosis by screening versus symptomatic evaluation, screening test, tumor location and stage, operation performed, operative mortality, and survival. A value of P < 0.05 on Fisher's exact, χ2, analysis of variance, or Cox regression analyses was considered significant. Three hundred fifty-four patients with colorectal cancer (255 colon, 99 rectal) were identified. One hundred twenty-one patients (34%) were diagnosed by screening. In comparison with those diagnosed by symptom evaluation (n = 233), these patients had earlier stage cancers, were more likely to have a curative intent procedure, and had improved 5-year survival rates. Older patients (older than 75 years old) were more likely to present with symptoms. High-risk patients were more likely to have colonoscopic screening than fecal occult blood testing. More blacks had Stage IV disease than nonblacks. Curative intent 30-day operative mortality was 2.1 per cent for colectomy and 0 per cent for rectal resection. Screening for colorectal cancer in the veteran population allows for better survival, detection at an earlier stage, and higher likelihood of resection.

scholarly journals Something Old and Something New: Future Directions in Vocational Research With People of Color in the United States

2019 ◽  
Vol 27 (2) ◽  
pp. 187-208 ◽  
Author(s):  
Lisa Y. Flores ◽  
Leticia D. Martinez ◽  
Gloria G. McGillen ◽  
Johanna Milord
Keyword(s):  
The United States ◽  
People Of Color ◽  
Work Outcomes ◽  
Work Experiences ◽  
Future Directions ◽  
Environmental Disasters ◽  
Career Interventions ◽  
Mobility Strategies ◽  
The Impact

Vocational psychology scholarship has largely overlooked the work experiences of people of color. In this article, we present evidence that vocational research that addresses the work issues of people of color has been neglected in the key outlets for vocational research among vocational psychologists. We outline seven directions for research inquiry with people of color, namely using culturally sensitive research methods, increasing research on the effectiveness of career interventions, integrating interdisciplinary perspectives, merging psychological and educational science with vocational development, using intersectional approaches, examining collective mobility strategies and structural reforms, and assessing the impact of environmental disasters on long-term educational and work outcomes.

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