Browsing by Subject "CRC screening"

Now showing 1 - 3 of 3
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    Audit of hemostatic clip use after colorectal polyp resection in an academic endoscopy unit
    (Thieme, 2024-04-23) Stark, Easton M.; Lahr, Rachel E.; Shultz, Jeremiah; Vemulapalli, Krishna C.; Guardiola, John J.; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims Prophylactic closure of endoscopic resection defects reduces delayed hemorrhage after resection of non-pedunculated colorectal lesions ≥ 20 mm that are located proximal to the splenic flexure and removed by electrocautery. The risk of delayed hemorrhage after cold (without electrocautery) resection is much lower, and prophylactic clip closure after cold resection is generally unnecessary. The aim of this study was to audit clip use after colorectal polyp resection in routine outpatient colonoscopies at two outpatient centers within an academic medical center. Patients referred for resection of known lesions were excluded. Patients and methods Retrospective chart analysis was performed as part of a quality review of physician adherence to screening and post-polypectomy surveillance intervals. Results Among 3784 total lesions resected cold by 29 physicians, clips were placed after cold resection on 41.7% of 12 lesions ≥ 20 mm, 19.3% of 207 lesions 10 to 19 mm in size, and 2.8% of 3565 lesions 1 to 9 mm in size. Three physicians placed clips after cold resection of lesions 1 to 9 mm in 18.8%, 25.5%, and 45.0% of cases. These physicians accounted for 8.1% of 1- to 9-mm resections, but 69.7% of clips placed in this size range. Electrocautery was used for 3.1% of all resections. Clip placement overall after cold resection (3.9%) was much lower than after resection with electrocautery (71.1%), but 62.4% of all clips placed were after cold resection. Conclusions Audits of clip use in an endoscopy practice can reveal surprising findings, including high and variable rates of unnecessary use after cold resection. Audit can potentially reduce unnecessary costs, carbon emissions, and plastic waste.
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    Predictors of Colorectal Cancer Screening Adherence among Male Veterans
    (Office of the Vice Chancellor for Research, 2014-04-11) Van Antwerp, Leah R.; Christy, Shannon M.; Mosher, Catherine E.; Rawl, Susan M.; Haggstrom, David A.
    Colorectal cancer (CRC) is the second leading cause of cancer mortality. However, CRC risk can be decreased through regular CRC screening and removal of precancerous polyps during endoscopic screening tests. Indeed, it has been estimated that 75%-90% of CRC cases could be prevented through adherence to CRC screening guidelines. The CDC recommends CRC screening for average risk adults starting at age 50 with five test options including: (1) annual fecal occult blood test fecal (FOBT) or fecal immunochemical test (FIT); (2) flexible sigmoidoscopy every 5 years; (3) virtual colonoscopy every 5 years; (4) double-contrast barium enema every 5 years; or (5) colonoscopy every 10 years. In the U.S. population, demographic factors predict adherence to CRC screening guidelines such as completing high school, having a partner, and older age. Other predictors of CRC screening adherence in the general population include urban residency, White race, and having health insurance. However, few studies have examined predictors of CRC screening adherence among veterans. The present study focused on male veterans, as its primary aim was to examine masculinity beliefs as predictors of CRC screening. The proposed secondary analyses examine potential demographic and health correlates of adherence to CRC screening guidelines. In one prior study, increasing age was associated with decreased likelihood that male veterans were adherent to CRC screening guidelines. In the current study, 250 male veterans aged 51-75 at the Roudebush VA primary care clinic complete a survey on one occasion. Currently, 175 participants who are adherent to CRC screening and 64 non-adherent participants are enrolled. Participants’ CRC screening behaviors are collected via self-report and medical records. Correlations will be computed between demographic factors (e.g., age, race, education), BMI, and CRC screening guideline adherence. Findings will enhance our understanding of factors associated with veterans’ CRC screening behaviors.
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    A risk prediction tool for colorectal cancer screening: a qualitative study of patient and provider facilitators and barriers
    (BMC, 2020-02) Matthias, Marianne S.; Imperiale, Thomas F.; Medicine, School of Medicine
    Background: Despite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation. Methods: We conducted qualitative, semi-structured interviews with patients aged 50-75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis. Results: Thirty patients and PCPs participated. Among facilitators were the tool's potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool's accuracy, consistency with guidelines, and time constraints. Conclusions: Patients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.