Browsing by Author "Fatima, Hala"
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Item Delayed Removal of Entrapped Snare in Colonoscopic Polypectomy(Wolters Kluwer, 2021-01-27) Phatharacharukul, Parkpoom; Wajid, Maryiam; Fatima, Hala; Medicine, School of MedicineSnare entrapment is a rare complication of hot snare polypectomy of large colon polyps. We report a case of snare entrapment in our unit and its management. This report highlights the method of delayed removal of snare followed by repeat colonoscopy.Item Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems(Cureus, 2022-03-21) Fatima, Hala; Wajid, Maryiam; Krier, Connie; Champion, Victoria; Carter-Harris, Lisa; Shedd-Steele, Rivienne; Imperiale, Thomas F.; Schwartz, Peter; Strom, Sylvia; Magnarella, Mark; Rawl, Susan M.; Medicine, School of MedicineBackground: Non-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling. Methodology: We produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence. Results: Patients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers. Conclusions: Patient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.Item Framework for Safely Reopening Endoscopy During the COVID-19 Pandemic: Redefining Adequate Preparation(LWW, 2020) Fatima, Hala; Shin, Andrea; Medicine, School of MedicineItem Impact of the development of an endoscopic eradication program for Barrett's esophagus with high grade dysplasia or early adenocarcinoma on the frequency of surgery(Thieme, 2018-09) Chilukuri, Prianka; Gromski, Mark A.; Johnson, Cynthia S.; Ceppa, Duy Khanh P.; Kesler, Kenneth A.; Birdas, Thomas J.; Rieger, Karen M.; Fatima, Hala; Kessler, William R.; Rex, Douglas K.; Al-Haddad, Mohammad; DeWitt, John M.; Medicine, School of MedicineBackground and aims The impact of the advent of an institutional endoscopic eradication therapy (EET) program on surgical practice for Barrett's esophagus (BE)-associated high grade dysplasia (HGD) or suspected T1a esophageal adenocarcinoma (EAC) is unknown. The aims of this study are to evaluate the different endoscopic modalities used during development of our EET program and factors associated with the use of EET or surgery for these patients after its development. Methods Patients who underwent primary endoscopic or surgical treatment for BE-HGD or early EAC at our hospital between January 1992 and December 2014 were retrospectively identified. They were categorized by their initial modality of treatment during the first year, and the impact over time for choice of therapy was assessed by multivariable logistic regression. Results We identified 386 patients and 80 patients who underwent EET and surgery, respectively. EET included single modality therapy in 254 (66 %) patients and multimodal therapy in 132 (34 %) patients. Multivariable logistic regression showed that, for each subsequent study year, EET was more likely to be performed in patients who were older ( P = 0.0009), with shorter BE lengths ( P < 0.0001), and with a pretreatment diagnosis of HGD ( P = 0.0054) compared to surgical patients. The diagnosis of EAC did not increase the utilization of EET compared to surgery as time progressed ( P = 0.8165). Conclusion The introduction of an EET program at our hospital increased the odds of utilizing EET versus surgery over time for initial treatment of patients who were older, had shorter BE lengths or the diagnosis of BE-HGD, but not in patients with EAC.Item Metal Stent Insertion for Malignant Obstruction of a Colostomy(Cureus, 2020-08-29) Wehbeh, Antonios; Rahal, Mahmoud; Fatima, Hala; Medicine, School of MedicineA 47-year-old female with metastatic cervical cancer and diverting colostomy presented with abdominal distention and minimal stool output from her colostomy. A computed tomography (CT) scan revealed a metastatic mass causing partial obstruction at the colostomy level and significant proximal colonic dilation. Her obstruction was relieved by the endoscopic placement of a metal stent through the stoma, with the stent’s distal edge visible externally but not protruding beyond skin level. Two months later, the stent remained patent and did not migrate. This case highlights a viable palliative treatment option for patients who are not operative candidates.Item Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial(Elsevier, 2016-01) Rex, Douglas K.; Clodfelter, Ryan; Rahmani, Farrah; Fatima, Hala; James-Stevenson, Toyia N.; Tang, John C.; Kim, Hak Nam; McHenry, Lee; Kahi, Charles J.; Rogers, Nicholas A.; Helper, Debra J.; Sagi, Sashidhar V.; Kessler, William R.; Wo, John M.; Fischer, Monika; Kwo, Paul Y.; Department of Medicine, School of MedicineBackground The value of narrow-band imaging (NBI) for detecting serrated lesions is unknown. Objective To assess NBI for the detection of proximal colon serrated lesions. Design Randomized, controlled trial. Setting Two academic hospital outpatient units. Patients Eight hundred outpatients 50 years of age and older with intact colons undergoing routine screening, surveillance, or diagnostic examinations. Interventions Randomization to colon inspection in NBI versus white-light colonoscopy. Main Outcome Measurements The number of serrated lesions (sessile serrated polyps plus hyperplastic polyps) proximal to the sigmoid colon. Results The mean inspection times for the whole colon and proximal colon were the same for the NBI and white-light groups. There were 204 proximal colon lesions in the NBI group and 158 in the white light group (P = .085). Detection of conventional adenomas was comparable in the 2 groups. Limitations Lack of blinding, endoscopic estimation of polyp location. Conclusion NBI may increase the detection of proximal colon serrated lesions, but the result in this trial did not reach significance. Additional study of this issue is warranted. (Clinical trial registration number: NCT01572428.)Item Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection(Baishideng Publishing Group, 2016-12-16) Ballard, Darren D.; Choksi, Neel; Lin, Jingmei; Choi, Eun-Young; Elmunzer, B. Joseph; Appelman, Henry; Rex, Douglas K.; Fatima, Hala; Kessler, William; DeWitt, John M.; Department of Pathology and Laboratory Medicine, IU School of MedicineAIM: To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments. METHODS: Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC. RESULTS: Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified. CONCLUSION: Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.Item Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial(Oxford University Press, 2024) Rawl, Susan M.; Perkins, Susan M.; Tong, Yan; Katz, Mira L.; Carter-Bawa, Lisa; Imperiale, Thomas F.; Schwartz, Peter H.; Fatima, Hala; Krier, Connie; Tharp, Kevin; Shedd-Steele, Rivienne; Magnarella, Mark; Malloy, Caeli; Haunert, Laura; Gebregziabher, Netsanet; Paskett, Electra D.; Champion, Victoria; School of NursingBackground: Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. Purpose: Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. Methods: Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. Results: Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. Conclusions: Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.Item Primary Care Patients Who Complete Colonoscopy after Referral and Those Who Do Not: Are they Different?(Office of the Vice Chancellor for Research, 2014-04-11) Olofinkua, Oluwakemi Blessing; Rawl, Susan M.; Habermann, Barbara; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Gebregziabher, Netsanet; Mabis, Michelle; Krier, Connie; Mirchandani, Amit; Fatima, HalaUp to 50% of people in one safety net hospital in the Midwest who received a recommendation for colonoscopy from their healthcare provider failed to complete the test. Research is needed to understand the complex interplay between individual, social, and health care systems and their influence on colonoscopy completion. The purpose of this study was to compare people who completed colonoscopy after receiving a referral with those who did not on demographic and clinical characteristics, CRC knowledge, and health beliefs (perceived risk, perceived benefits, perceived barriers). Quantitative data were collected via telephone interviews from 90 patients; 46 who completed colonoscopy and 44 non-completers. In-depth interviews were conducted with 42 participants to examine perceptions of barriers and facilitators to test completion. Data were analyzed using two-sample t-tests, chi-square tests, Fisher’s exact tests and content analysis. People who completed colonoscopy had a higher mean CRC knowledge score (p=.0008), and a smaller proportion had hypertension (p=.03). No group differences in perceived risk (p=0.81), perceived benefits (p=0.66), and perceived barriers scores (p=0.24) were observed. Non-completers frequently reported that life events interfered with their ability to keep their appointments. While receipt of a provider recommendation is the most important predictor of CRC screening, results showed that receipt of a recommendation with immediate referral to an endoscopist and automatic colonoscopy appointment-making were not sufficient to insure test completion. Education and tailored counseling about the need for and benefits of colonoscopy, along with reminders and tangible assistance to complete the test in the context of competing demands, may be required to increase completion rates.Item Process Evaluation of a Mailed Interactive Educational DVD in a Comparative Effectiveness Trial to Promote Colorectal Cancer Screening(Sage, 2022) Katz, Mira L.; Emerson, Brent; Champion, Victoria L.; Schwartz, Peter H.; Impleriale, Thomas F.; Fatima, Hala; Paskett, Electra D.; Perkins, Susan M.; Tong, Yan; Gebregziabher, Netsanet; Krier, Connie; Tharp, Kevin; Malloy, Caeli; Strom, Sylvia; Rawl, Susan M.; School of NursingA process evaluation was conducted as part of a comparative effectiveness trial of a mailed interactive educational DVD intervention to promote colorectal cancer screening among average-risk patients who did not attend a scheduled colonoscopy. Participants (n = 371) for the trial were randomized to (1) mailed DVD, (2) mailed DVD plus patient navigation, or (3) usual care. Participants (n = 243) randomized to the two DVD intervention arms were called 2 weeks after mailing materials to complete a process evaluation interview about the DVD (September 2017-February 2020). Forty-nine (20%) participants were not reached, and 194 (80%) participants watched the DVD and completed the interview. The process evaluation assessed whether (1) the DVD content was helpful, (2) any new information was learned by participants, (3) the appropriate amount of information was included in the DVD, (4) participants were engaged when watching the DVD, (5) the DVD content was relevant, (6) participants were satisfied with the DVD (7) participants would recommend the DVD to others, and (8) their opinion about colorectal cancer screening was changed by watching the DVD. Among participants who watched the DVD, 99% reported the screening information was very or somewhat helpful, 47% learned new information, 75% said the DVD included the right amount of information, they were engaged (M = 3.35 out of 4, SD = 0.49), 87% reported all or most information applied to them, they were satisfied (M = 3.42 out of 4, SD = 0.39) with DVD content, 99% would recommend the DVD to others, and 45% reported changing their opinion about screening. To understand the effects of interventions being tested in trials and to plan the dissemination of evidence-based interventions, process evaluation is critical to assess the dose received and acceptability of behavioral interventions.