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Item Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey(Endocrine Society, 2021) Pitt, Susan C.; Yang, Nan; Saucke, Megan C.; Marka, Nicholas; Hanlon, Bret; Long, Kristin L.; McDow, Alexandria D.; Brito, J.P.; Roman, Benjamin R.; Surgery, School of MedicineContext: Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. Objective: This work aimed to understand factors associated with the adoption of AS. Methods: We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases). Results: The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS. Conclusion: Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.Item Cardiovascular-specific mortality and risk factors in colorectal Cancer patients: A cohort study based on registry data of over 500,000 individuals in the US(Elsevier, 2024-02) Zhang, Taolan; Zhu, Hongxia; Hu, Hongjuan; Hu, Haihong; Zhan, Wendi; Jiang, Lingxiang; Tang, Ming; Escobar, David; Huang, Wei; Feng, Yaoguang; Zhou, Junlin; Zou, Mingxiang; Radiation Oncology, School of MedicineBackground Colorectal cancer (CRC) is one of the most common cancers worldwide, and recent studies have found that CRC patients are at increased risk for cardiovascular disease (CVD). This study aimed to investigate competing causes of death and prognostic factors among a large cohort of CRC patients and to describe cardiovascular-specific mortality in relation to the US standard population. Methods This registry-based cohort study identified patients diagnosed with CRC between 1973 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database in the US. Cumulative mortality functions, conditional standardized mortality ratios, and cause-specific hazard ratios were calculated. Results Of the 563,298 eligible CRC patients included in this study, 407,545 died during the follow-up period. CRC was the leading cause of death, accounting for 49.8% of all possible competing causes of death. CVD was the most common non-cancer cause of death, accounting for 17.8% of total mortality. This study found that CRC patients have a significantly increased risk of cardiovascular-specific mortality compared to the US standard population, with the risk increasing with age and extended survival time. Conclusion This study highlights the need to develop multidisciplinary prevention and management strategies for CRC and CVD to improve CRC patients' survival and quality of life.Item Core implementation strategies for improving cirrhosis care in the Veterans Health Administration(Wolters Kluwer, 2022) Yakovchenko, Vera; Morgan, Timothy R.; Miech, Edward J.; Neely, Brittney; Lamorte, Carolyn; Gibson, Sandra; Beste, Lauren A.; McCurdy, Heather; Scott, Dawn; Gonzalez, Rachel; Park, Angela; Powell, Byron J.; Bajaj, Jasmohan S.; Dominitz, Jason A.; Chartier, Maggie; Ross, David; Chinman, Matthew J.; Rogal, Shari S.; Emergency Medicine, School of MedicineBackground and aims: The Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention. Approach and results: VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18, n = 63; FY19, n = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews. Conclusions: In a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.Item Correction to: The Toxicology Investigators Consortium Case Registry-The 2017 Annual Report(Springer, 2018-12) Farrugia, Lynn A.; Rhyee, Sean H.; Campleman, Sharan L.; Judge, Bryan; Kao, Louise; Pizon, Anthony; Porter, Lauren; Riederer, Anne M.; Wiegand, Timothy; Calello, Diane P.; Wax, Paul M.; Brent, Jeffrey; On behalf of of the Toxicology Investigators Consortium (ToxIC) Study Group; Medicine, School of MedicineThe Toxicology Investigators Consortium (ToxIC) Case Registry was established by the American College of Medical Toxicology in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultations will be entered. The objective of this eighth annual report is to summarize the Registry's 2017 data and activity with its additional 7577 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2017. Detailed data was collected from these cases and aggregated to provide information which includes demographics (e.g., age, gender, race, ethnicity), reason for medical toxicology evaluation (e.g., intentional pharmaceutical exposure, envenomation, withdrawal from a substance), agent and agent class, clinical signs and symptoms (e.g., vital sign abnormalities, organ system dysfunction), treatments and antidotes administered, fatality, and life support withdrawal data. Females were involved in 50.4% of cases. Transgender demographic information collection was initiated in 2017 to better represent the population and there were 36 cases involving transgender patients. Adults aged 19-65 were the most commonly reported age group. Non-opioid analgesics were the most commonly reported agent class, with acetaminophen again the most common agent reported. There were 93 fatalities reported in 2017. Treatment interventions were frequently reported with 30.6% receiving specific antidotal therapy. Major trends in demographics and exposure characteristics remained similar to past years' reports. While treatment interventions were commonly required, fatalities were rare.Item Diagnosis and Management of Pancreatic Cysts: A Comprehensive Review of the Literature(MDPI, 2023-02-02) Singh, Ritu R.; Gopakumar, Harishankar; Sharma, Neil R.; Medicine, School of MedicineThe prevalence of pancreatic cysts has been rising due to the widespread use of cross-sectional imaging (CT scan and MRI) of the abdomen. While most pancreatic cysts are benign and do not require treatment or surveillance, a significant minority are premalignant and rarely malignant. The risk stratification of these lesions is not straightforward, and individual risk assessment, cyst size, distribution, and alarming morphologic features (when present) can guide the next steps in management. Neoplastic pancreatic cysts are mucinous or non-mucinous. Endoscopic ultrasound with fine-needle aspiration is often required to classify pancreatic cysts into mucinous and non-mucinous cysts and to assess the malignant potential. Advances in endoscopic techniques (confocal laser endomicroscopy, microforceps biopsy) can provide a definitive diagnosis of pancreatic cysts in some cases; however, the use of these techniques involves a higher risk of adverse events.Item Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study(JMIR, 2022-08-11) Vachon, Eric; Robb, Bruce W.; Haggstrom, David A.; School of NursingBackground: There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. Objective: The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. Methods: A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. Results: The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. Conclusions: This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.Item Influenza is more common than Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among hospitalized adult Saudi patients(Elsevier, 2017) Al-Tawfiq, Jaffar A.; Rabaan, Ali A.; Hinedi, Kareem; Medicine, School of MedicineBackground Since the initial description of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), we adopted a systematic process of screening patients admitted with community acquired pneumonia. Here, we report the result of the surveillance activity in a general hospital in Saudi Arabia over a four year period. Materials and methods All admitted patients with community acquired pneumonia from 2012 to 2016 were tested for MERS-CoV. In addition, testing for influenza viruses was carried out starting April 2015. Results During the study period, a total of 2657 patients were screened for MERS-CoV and only 20 (0.74%) tested positive. From January 2015 to December 2016, a total of 1644 patients were tested for both MERS-CoV and influenza. None of the patients tested positive for MERS-CoV and 271 (16.4%) were positive for influenza. The detected influenza viruses were Influenza A (107, 6.5%), pandemic 2009 H1N1 (n = 120, 7.3%), and Influenza B (n = 44, 2.7%). Pandemic H1N1 was the most common influenza in 2015 with a peak in peaked October to December and influenza A other than H1N1 was more common in 2016 with a peak in August and then October to December. Conclusions MERS-CoV was a rare cause of community acquired pneumonia and other viral causes including influenza were much more common. Thus, admitted patients are potentially manageable with Oseltamivir or Zanamivir therapy.Item Middle East respiratory syndrome coronavirus – The need for global proactive surveillance, sequencing and modeling(Elsevier, 2021) Al-Tawfiq, Jaffar A.; Petersen, Eskild; Memish, Ziad A.; Perlman, Stanley; Zumla, Alimuddin; Medicine, School of MedicineItem THE PERCEIVED AND REAL VALUE OF HEALTH INFORMATION EXCHANGE IN PUBLIC HEALTH SURVEILLANCE(2011-08-22) Dixon, Brian Edward; Jones, Josette F.; McGowan, Julie J.; Grannis, Shaun J.; Gamache, Roland E.Public health agencies protect the health and safety of populations. A key function of public health agencies is surveillance or the ongoing, systematic collection, analysis, interpretation, and dissemination of data about health-related events. Recent public health events, such as the H1N1 outbreak, have triggered increased funding for and attention towards the improvement and sustainability of public health agencies’ capacity for surveillance activities. For example, provisions in the final U.S. Centers for Medicare and Medicaid Services (CMS) “meaningful use” criteria ask that physicians and hospitals report surveillance data to public health agencies using electronic laboratory reporting (ELR) and syndromic surveillance functionalities within electronic health record (EHR) systems. Health information exchange (HIE), organized exchange of clinical and financial health data among a network of trusted entities, may be a path towards achieving meaningful use and enhancing the nation’s public health surveillance infrastructure. Yet the evidence on the value of HIE, especially in the context of public health surveillance, is sparse. In this research, the value of HIE to the process of public health surveillance is explored. Specifically, the study describes the real and perceived completeness and usefulness of HIE in public health surveillance activities. To explore the real value of HIE, the study examined ELR data from two states, comparing raw, unedited data sent from hospitals and laboratories to data enhanced by an HIE. To explore the perceived value of HIE, the study examined public health, infection control, and HIE professionals’ perceptions of public health surveillance data and information flows, comparing traditional flows to HIE-enabled ones. Together these methods, along with the existing literature, triangulate the value that HIE does and can provide public health surveillance processes. The study further describes remaining gaps that future research and development projects should explore. The data collected in the study show that public health surveillance activities vary dramatically, encompassing a wide range of paper and electronic methods for receiving and analyzing population health trends. Few public health agencies currently utilize HIE-enabled processes for performing surveillance activities, relying instead on direct reporting of information from hospitals, physicians, and laboratories. Generally HIE is perceived well among public health and infection control professionals, and many of these professionals feel that HIE can improve surveillance methods and population health. Human and financial resource constraints prevent additional public health agencies from participating in burgeoning HIE initiatives. For those agencies that do participate, real value is being added by HIEs. Specifically, HIEs are improving the completeness and semantic interoperability of ELR messages sent from clinical information systems. New investments, policies, and approaches will be necessary to increase public health utilization of HIEs while improving HIEs’ capacity to deliver greater value to public health surveillance processes.Item Prevalence of Bacterial and Protozoan Pathogens in Ticks Collected from Birds in the Republic of Moldova(MDPI, 2022-05-27) Morozov, Alexandr; Tischenkov, Alexei; Silaghi, Cornelia; Proka, Andrei; Toderas, Ion; Movila, Alexandru; Frickmann, Hagen; Poppert, Sven; Biomedical Sciences and Comprehensive Care, School of DentistryEpidemiological knowledge on pathogens in ticks feeding on birds in Moldova is scarce. To reduce this gap of information, a total of 640 migrating and native birds of 40 species were caught from 2012 to 2015 and examined for the presence of ticks in the Republic of Moldova. Altogether, 262 ticks belonging to five tick species (Ixodes ricunus n = 245, Ixodes frontalis n = 12, Haemaphysalis punctata n = 2, Hyalomma marginatum n = 2 (only males), Dermacentor marginatus n = 1) were collected from 93 birds. Of these ticks, 250 (96%) were at the stage of a nymph and 9 at the stage of a larva (3%). One imago of I. frontalis and two imagoes of Hy. marginatum were found. Generally, ticks infested 14.1% of the assessed birds belonging to 12 species. DNA was extracted from individual ticks with subsequent PCR targeting Rickettsia spp., Borrelia spp. in general, as well as relapsing fever-associated Borrelia spp., in particular, Anaplasma phagocytophilum, Neoehrlichia mikurensis, Babesia spp. and Coxiella burnetii. The bird species Turdus merula showed the heaviest infestation with ticks and the highest incidence of infected ticks. Altogether, 32.8% of the assessed ticks (n = 86) were positive for one of the pathogens. DNA of Borrelia spp. was found in 15.2% (40/262) of the investigated ticks; in 7.6% of ticks (20/262), DNA of rickettsiae was detected; 6.9% (18/262) of the ticks were positive for A. phagocytophilum DNA; in 1.5% of the ticks (4/262), DNA of Neoehrlichia mikurensis was detected, followed by 1.5% (4/262) Babesia microti and 1.5% (4/262) Borrelia miyamotoi. Within the B. burgdorferi complex, B. garinii (n = 36) was largely predominant, followed by B. valaisiana (n = 2) and B. lusitaniae (n = 2). Among the detected Rickettsia spp., R. monacensis (n = 16), R. helvetica (n = 2) and R. slovaca (n = 1) were identified. In conclusion, the study provided some new information on the prevalence of ticks on birds in Moldova, as well as the presence of DNA of pathogens in the ticks. By doing so, it provided an additional piece in the puzzle of the global epidemiology of tick-transmitted infectious diseases from a geographic side from where respective surveillance data are scarce.