1
|
Ruco A, Moineddin R, Sutradhar R, Tinmouth J, Li Q, Rabeneck L, Del Giudice ME, Dubé C, Baxter NN. Duration of risk reduction in colorectal cancer incidence and mortality after a complete colonoscopy in Ontario, Canada: a population-based cohort study. Lancet Gastroenterol Hepatol 2024:S2468-1253(24)00084-0. [PMID: 38761808 DOI: 10.1016/s2468-1253(24)00084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Colorectal cancer guidelines recommend screening colonoscopy every 10 years after a negative procedure. If risk reduction extends past 10 years, the recommended interval could be extended, reducing the burden on the individual and health-care system. We aimed to estimate the duration that patients remain at reduced risk of colorectal cancer incidence and mortality after a complete colonoscopy. METHODS We did a population-based cohort study of individuals aged 50-65 years between Jan 1, 1994, to Dec 31, 2017. We excluded individuals with previous exposure to colonoscopy or colorectal surgery, those previously diagnosed with colorectal cancer, or a history of hereditary or other bowel disorders. We followed up participants until Dec 31, 2018, and identified all colonoscopies performed in this time period. We used a 9-level time-varying measure of exposure, capturing time since last complete colonoscopy (no complete colonoscopy, ≤5 years, >5-10 years, >10-15 years, and >15 years) and whether an intervention was performed (biopsy or polypectomy). A Cox proportional hazards regression model adjusting for age, sex, comorbidity, residential income quintile, and immigration status was used to estimate the association between exposure to a complete colonoscopy and colorectal cancer incidence and mortality. FINDINGS 5 298 033 individuals (2 609 060 [49·2%] female and 2 688 973 [50·8%] male; no data on ethnicity were available) were included in the cohort, with a median follow-up of 12·56 years (IQR 6·26-20·13). 90 532 (1·7%) individuals were diagnosed with colorectal cancer and 44 088 (0·8%) died from colorectal cancer. Compared with those who did not have a colonoscopy, the risk of colorectal cancer in those who had a complete negative colonoscopy was reduced at all timepoints, including when the procedure occurred more than 15 years earlier (hazard ratio [HR] 0·62 [95% CI 0·51-0·77] for female individuals and 0·57 [0·46-0·70] for male individuals. A similar finding was observed for colorectal cancer mortality, with lower risk at all timepoints, including when the procedure occurred more than 15 years earlier (HR 0·64 [95% CI 0·49-0·83] for female participants and 0·65 [0·50-0·83] for male participants). Those who had a colonoscopy with intervention had a significantly lower colorectal cancer incidence than those who did not undergo colonoscopy if the procedure occurred within 10 years for females (HR 0·70 [95% CI 0·63-0·77]) and up to 15 years for males (0·62 [(0·53-0·72]). INTERPRETATION Compared with those who do not receive colonoscopy, individuals who have a negative colonoscopy result remain at lower risk for colorectal cancer incidence and mortality more than 15 years after the procedure. The current recommendation of repeat screening at 10 years in these individuals should be reassessed. FUNDING Canadian Institutes of Health Research.
Collapse
Affiliation(s)
- Arlinda Ruco
- Interdisciplinary Health Program, St Francis Xavier University, Antigonish, NS, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada; Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada; VHA Home HealthCare, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Jill Tinmouth
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Linda Rabeneck
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - M Elisabetta Del Giudice
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Catherine Dubé
- Department of Medicine, The Ottawa Hospital-University of Ottawa, Ottawa, ON, Canada
| | - Nancy N Baxter
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
2
|
Tinmouth J, Chen B, Niu Y, Silveira K, Rabeneck L, Dubé C. Measuring Postcolonoscopy Colorectal Cancers: Variations in Methodology to Address Indicator Timeliness and Use in High-Risk Populations. Gastroenterology 2024:S0016-5085(24)00476-1. [PMID: 38670285 DOI: 10.1053/j.gastro.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Jill Tinmouth
- Ontario Health, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Yue Niu
- Ontario Health, Toronto, Ontario, Canada
| | | | - Linda Rabeneck
- Ontario Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Dubé
- Ontario Health, Toronto, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Tinmouth J, Dubé C. Dressing Up an Old Friend in New Clothes: A New Approach to Measuring Adenoma Detection Rate. Gastroenterology 2023; 165:534-535. [PMID: 37419423 DOI: 10.1053/j.gastro.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Jill Tinmouth
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Health, Toronto, Ontario, Canada.
| | - Catherine Dubé
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ontario Health, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Kandel R, Merlano M, Tan P, Brar G, Mallick R, Macdonald B, Dubé C, Murthy S, Stiell I, McCurdy JD. Persistently High Rates of Abdominal Computed Tomography Imaging Among Patients With Inflammatory Bowel Disease Who Present to the Emergency Department. J Can Assoc Gastroenterol 2022; 6:64-72. [PMID: 37025509 PMCID: PMC10071298 DOI: 10.1093/jcag/gwac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Recent guidelines recommended judicious use of abdominal computed tomography (CT) in the emergency department (ED) for inflammatory bowel disease. Trends in CT utilization over the last decade, including since the implementation of these guidelines, remain unknown.
Methods
We performed a single-centre, retrospective study between 2009 and 2018 to assess trends in CT utilization within 72 h of an ED encounter. Changes in the annual rates of CT imaging among adults with IBD were estimated by Poisson regression and CT findings by Cochran-Armitage or Cochran-Mantel Haenszel tests.
Results
A total of 3000 abdominal CT studies were performed among 14,783 ED encounters. CT utilization increased annually by 2.7% in Crohn’s disease (CD) (95% confidence interval [CI], 1.2 to 4.3; P = 0.0004), 4.2% in ulcerative colitis (UC) (95% CI, 1.7 to 6.7; P = 0.0009) and 6.3% in IBD unclassifiable (95% CI, 2.5 to 10.0; P = 0.0011). Among encounters with gastrointestinal symptoms, 60% with CD and 33% with UC underwent CT imaging in the final year of the study. Urgent CT findings (obstruction, phlegmon, abscess or perforation) and urgent penetrating findings alone (phlegmon, abscess or perforation) comprised 34% and 11% of CD findings, and 25% and 6% of UC findings, respectively. The CT findings remained stable overtime for both CD (P = 0.13) and UC (P = 0.17).
Conclusion
Our study demonstrated persistently high rates of CT utilization among patients with IBD who presented to the ED over the last decade. Approximately one third of scans demonstrated urgent findings, with a minority demonstrating urgent penetrating findings. Future studies should aim to identify patients in whom CT imaging is most appropriate.
Collapse
Affiliation(s)
- Rana Kandel
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
| | - Maria Merlano
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
| | - Pearl Tan
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
| | - Gurmun Brar
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
| | - Blair Macdonald
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
- Department of Medical Imaging, The Ottawa Hospital , Ottawa, Ontario , Canada
| | - Catherine Dubé
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
- Department of Medicine, Division of Gastroenterology, The Ottawa Hospital , Ottawa, Ontario , Canada
| | - Sanjay Murthy
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
- Department of Medicine, Division of Gastroenterology, The Ottawa Hospital , Ottawa, Ontario , Canada
| | - Ian Stiell
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
- Department of Emergency Medicine, The Ottawa Hospital , Ottawa, Ontario , Canada
| | - Jeffery D McCurdy
- Faculty of Medicine, University of Ottawa , Ottawa, Ontario , Canada
- Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
- Department of Medicine, Division of Gastroenterology, The Ottawa Hospital , Ottawa, Ontario , Canada
| |
Collapse
|
5
|
Dubé C, Delacourt B, Masson-Trottier M, Ansaldo AI. COMPAs : une application pour soutenir la communication entre les personnes vivant avec de la démence et leurs soignants. Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Lapane KL, Dubé C, Ferrucci K, Khan S, Kuhn KA, Yi E, Kay J, Liu SH. Patient perspectives on health care provider practices leading to an axial spondyloarthritis diagnosis: an exploratory qualitative research study. BMC Fam Pract 2021; 22:251. [PMID: 34930136 PMCID: PMC8691008 DOI: 10.1186/s12875-021-01599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The average time to a diagnosis for people with axial spondyloarthritis (axSpA) is 7-10 years. Delayed diagnosis may result in increased structural damage, worse physical function, and worse quality of life relative to patients with a timely axSpA diagnosis. Understanding patient experiences may provide insights for how to reduce diagnostic delays. OBJECTIVE To provide foundational knowledge about patient experiences with healthcare providers leading to an axSpA diagnosis. METHODS We conducted an exploratory qualitative research study with six focus groups interviews with participants recruited from three rheumatology clinics within the United States (MA (n = 3); CO (n = 2); PA (n = 1)) that included a total of 26 adults (10 females, 16 males) with rheumatologist confirmed diagnosis of axSpA in 2019. Focus groups were ~ 2 h, audio recorded, transcribed, and subject to dual coding. The codes reviewed were in relation to the patients' diagnostic experiences. RESULTS Patients described frustrating and lengthy diagnostic journeys. They recognized that the causes of diagnostic delays in axSpA are multifactorial (e.g., no definitive diagnostic test, disease characteristics, lack of primary care provider's awareness about axSpA, trust). Patients described how doctors minimized or dismissed complaints about symptoms or told them that their issues were psychosomatic. Patients believed the healthcare system contributed to diagnostic delays (e.g., lack of time in clinical visits, difficulty accessing rheumatologists, health insurance challenges). Advice to physicians to reduce the diagnostic delay included allowing time for patients to give a complete picture of their illness experience, listening to, and believing patients, earlier referral to rheumatology, provision of HLA-B27 gene testing, and that physicians need to partner with their patients. CONCLUSIONS Patients desire a definitive test that could be administered earlier in the course of axSpA. Until such a test is available, patients want clinicians who listen to, believe, and partner with them, and who will follow them until a diagnosis is reached. Educating primary care clinicians about guidelines and referral for diagnosis of axSpA could reduce diagnostic delay.
Collapse
Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA.
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Katarina Ferrucci
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
| | - Kristine A Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01655, USA
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
7
|
Affiliation(s)
- Catherine Dubé
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
8
|
Dubé C, Lapane K, Ferrucci K, Beccia A, Khan S, Yi E, Kay J, Kuhn KA, Ogdie A, Liu SH. POS1474-HPR PERSONAL EXPERIENCES WITH DIAGNOSTIC DELAY AMONG AXIAL SPONDYLOARTHRITIS PATIENTS – A QUALITATIVE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The estimated prevalence of axial Spondyloarthritis (axSpA) in the U.S. is 0.4 to 1.3 percent. Undiagnosed axSpA patients suffer from symptoms on average 7 to 10 years, which can also contribute to psychological suffering and healthcare burden due to the prolonged search for diagnosis and treatment.Objectives:To explore the experiences of diagnostic delay of axSpA patients as part of the SpondyloArthritis Screening and Early Detection (SpA-SED) Study.Methods:We conducted exploratory semi-structured patient focus groups. English-speaking participants ≥18 years of age with a rheumatologist-verified clinical diagnosis of axSpA were recruited from three rheumatology practices in Massachusetts, Colorado, and Pennsylvania. Six focus groups were conducted with 26 total participants (16 men, 10 women, age range 21-76 years). Discussions ranged from 1.33 to 2.13 hours. Verbatim transcripts were deidentified, cleaned and coded using NVivo qualitative software. A coding list was generated and summary themes were constructed.Results:Participants described meandering and frustrating journeys in search of a diagnosis. When doctors gave up, it was experienced by patients as profoundly negative. Intermittent axSpA symptoms confused some physicians and caused some patients to either delay seeking medical care (e.g., sporadic flare-up) or use dramatic language to convey the magnitude of the impact on their symptoms. Patients explained their experiences where physicians presumed that patients were trying to obtain narcotics or were “imagining/exaggerating” symptoms. Early symptom stories fell into five areas of importance for patients: pain, stiffness and lack of mobility, impact on sleep, impact on daily life, and changes with weather. Tenacity on the part of the patient and/or their family, patient research and confidence to challenge their physicians were important. Self-advocacy was challenging but necessary and particularly difficult when patients were sick. During the typically lengthy time that participants waited to be diagnosed, they experienced frustration and mental suffering due to lack of answers and/or not being heard, believed, or taken seriously. Some participants described the fatigue they experienced after trying without success to obtain a diagnosis or receive treatment. Early administration of a definitive diagnostic test or screening tools for axSpA would have alleviated both physical and emotional suffering for these participants.Conclusion:Overall, participants expressed satisfaction with physicians who sought to understand them and believed them, took them seriously, and did not give up even with long delays. Patients with axSpA described significant suffering prior to diagnosis which could have been prevented and treated. Further research is needed with axSpA patients who are early in their diagnostic journey to determine best practices to support patients and reduce diagnostic delay.Disclosure of Interests:Catherine Dubé Grant/research support from: Novartis, as personnel on such studies, Kate Lapane: None declared, Katarina Ferrucci: None declared, Ariel Beccia: None declared, Sara Khan: None declared, Esther Yi Employee of: Novartis Pharmaceuticals, Jonathan Kay Consultant of: AbbVie, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Jubilant Radiopharma; Merck & Co.,Inc.; Pfizer Inc.; Samsung Bioepis; Sandoz Inc.; Scipher Medicine; UCB, Inc., Grant/research support from: (paid to UMass Medical School) Gilead Sciences Inc.; Novartis Pharmaceuticals Corp.; Pfizer Inc., Kristine A. Kuhn Consultant of: UCB, Eli Lilly, Novartis, Grant/research support from: Pfizer, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Shao-Hsien Liu Grant/research support from: Novartis
Collapse
|
9
|
Lapane K, Dubé C, Ferrucci K, Khan S, Kuhn KA, Ogdie A, Yi E, Kay J, Liu SH. AB0892-HPR PATIENT PERSPECTIVES ON PROVIDER PRACTICES LEADING TO AN AXIAL SPONDYLOARTHRITIS DIAGNOSIS: A QUALITATIVE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:People with Axial Spondyloarthritis (axSpA) experience a diagnostic delay between 7 to 10 years. (1-5) This delay contributes to increased depression and desperation in searching for an appropriate diagnosis. (6) Consequently, people with axSpA experience impaired physical function, structural damage, and overall worsened quality of life than those who experience a timely diagnosis. (7)Objectives:To gain knowledge and understand patients’ experiences with healthcare providers in diagnosis of axSpA.Methods:Using qualitative study design, we conducted six focus groups, with a total of 26 participants with a confirmed diagnosis of axSpA by rheumatologists from three different geographic locations: Worcester, MA, Aurora, CO and Philadelphia, PA. Focus groups were audio recorded and approximately 2 hours in duration. The focus groups were transcribed, deidentified, cleaned and stored in a secure location. NVivo software was used to code the data using a coding scheme which emerged from the focus group discussion topics. For intercoder reliability, two researchers coded the data and generated summary reports for data analysis.Results:Patients described their frustrating journeys to diagnosis and attributed the lengthy diagnosis delays to a multitude of factors. These elements include, lack of definitive diagnostic test, disease characteristics, lack of primary care providers’ awareness of axSpA, time, and trust. Patients felt that their physicians dismissed their complaints or would describe their symptoms as psychosomatic. The health care system also contributed to their diagnostic delays, including the lengthy referral process to a rheumatologist and the short clinical appointments. Patients believe that to reduce diagnostic delay, physicians must work with their patients; listening and believing their patients while allotting time for patients to discuss their experiences. In addition, patients believe earlier referral to a rheumatologist, and HLA-B27 genetic testing would decrease the diagnostic delay of axSpA.Conclusion:In this study, patients desire definitive testing in clinical practice for earlier diagnosis of axSpA. Additionally, more education regarding the guidelines to diagnose axSpA and earlier referral to rheumatologists might be needed. Until this is feasible, patients seek clinicians who will work with them until a diagnosis is made, listening, and believing their experiences and symptoms.References:[1]Deodhar A, Mease P, Reveille J, Curtis J, Karunaratne P, Malhotra K. Prevalence of axial spondyloarthritis among undiagnosed chronic back pain patients in the United States [abstract]. Ann Rheum Dis. 2014;73:198-199.[2]Deodhar A, Mease PJ, Reveille JD, et al. Frequency of Axial Spondyloarthritis Diagnosis Among Patients Seen by US Rheumatologists for Evaluation of Chronic Back Pain. Arthritis Rheumatol. 2016;68(2326-5205 (Electronic)):1669–1676.[3]Garrido-Cumbrera M, Poddubnyy D, Gossec L, et al. The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries. Curr Rheumatol Rep. 2019;21(1534-6307 (Electronic)):19.[4]Redeker I, Callhoff J, Hoffmann F, et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019;58(1462-0332 (Electronic)):1634–1638.[5]Strand V, Singh JA. Evaluation and Management of the Patient With Suspected Inflammatory Spine Disease. Mayo Clin Proc 2017;92(1942-5546 (Electronic)):555–564.[6]Martindale J. The impact of delay in diagnosing ankylosing spondylitis/axial SpA. . Rheumatology. 2014;53.[7]Yi EA-O, Ahuja A, Rajput T, George AT, Park Y. Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review. Rheumatol Ther 2020(2198-6576 (Print)):65-87.Disclosure of Interests:Kate Lapane: None declared, Catherine Dubé Grant/research support from: Novartis, as personnel on such studies, Katarina Ferrucci: None declared, Sara Khan: None declared, Kristine A. Kuhn Consultant of: UCB, Eli Lilly, Novartis, Grant/research support from: Pfizer, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Esther Yi Employee of: Novartis Pharmaceuticals, Jonathan Kay Consultant of: AbbVie, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Jubilant Radiopharma; Merck & Co.,Inc.; Pfizer Inc.; Samsung Bioepis; Sandoz Inc.; Scipher Medicine; UCB, Inc., Grant/research support from: (paid to UMass Medical School) Gilead Sciences Inc.; Novartis Pharmaceuticals Corp.; Pfizer Inc., Shao-Hsien Liu Grant/research support from: Novartis
Collapse
|
10
|
Delacourt B, Dubé C, Masson-Trottier M, Ansaldo AI. COMPAS : une application innovante pour soutenir la communication centrée sur la personne entre les personnes âgées atteintes de démence et leur proche-aidant. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Cenin DR, Tinmouth J, Naber SK, Dubé C, McCurdy BR, Paszat L, Rabeneck L, Lansdorp-Vogelaar I. Calculation of Stop Ages for Colorectal Cancer Screening Based on Comorbidities and Screening History. Clin Gastroenterol Hepatol 2021; 19:547-555. [PMID: 32450362 PMCID: PMC7982961 DOI: 10.1016/j.cgh.2020.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Routine screening for colorectal cancer typically is recommended until age 74 years. Although it has been proposed that a screening stop age could be determined based on sex and comorbidity, less is known about the impact of screening history. We investigated the effects of screening history on the selection of an optimal age to stop screening. METHODS We used the Microsimulation Screening Analysis-Colon model to estimate the harms and benefits of screening with biennial fecal immunochemical tests by sex, comorbidity status, and screening history. The optimal screening stop age was determined based on the incremental number needed for 1 additional life-year per 1000 screened individuals compared with the threshold provided by stopping screening at 76 years in the average-health population with a perfect screening history (attended all required screening, diagnostic, and follow-up tests) to biennial fecal immunochemical testing from age 50 years. RESULTS For persons age 76 years, 157 women and 108 men with a perfect screening history would need to be screened to gain 1 life-year per 1000 screened individuals. Previously unscreened women with no comorbid conditions and no history of screening could undergo an initial screening through 90 years, whereas unscreened men could undergo initial screening through 88 years, before this balance is reached. As screening adherence improved or as comorbidities increased, the optimal age to stop screening decreased to a point that, regardless of sex, individuals with severe comorbidities and a perfect screening history should stop screening at age 66 years or younger. CONCLUSIONS Based on the harm-benefit balance, the optimal stop age for colorectal cancer screening ranges from 66 years for unhealthy individuals with a perfect screening history to 90 years for healthy individuals without prior screening. These findings can be used to assist patients and clinicians in making decisions about screening participation.
Collapse
Affiliation(s)
- Dayna R Cenin
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
| | - Jill Tinmouth
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Steffie K Naber
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Catherine Dubé
- Cancer Care Ontario, Toronto, Ontario, Canada,The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Lawrence Paszat
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Linda Rabeneck
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Iris Lansdorp-Vogelaar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| |
Collapse
|
12
|
Tinmouth J, Dong S, Stogios C, Rabeneck L, Rey M, Dubé C. Estimating the Backlog of Colonoscopy due to Coronavirus Disease 2019 and Comparing Strategies to Recover in Ontario, Canada. Gastroenterology 2021; 160:1400-1402.e1. [PMID: 33301778 DOI: 10.1053/j.gastro.2020.11.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jill Tinmouth
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario.
| | - Steven Dong
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario
| | - Christine Stogios
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario
| | - Linda Rabeneck
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario
| | - Michelle Rey
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario
| | - Catherine Dubé
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario; Department of Medicine, University of Ottawa, Ottawa, Ontario
| | | |
Collapse
|
13
|
Lapane KL, Dubé C, Hume AL, Tjia J, Jesdale BM, Pawasauskas J, Khodyakov D. Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study. Drugs Aging 2021; 38:327-340. [PMID: 33624228 DOI: 10.1007/s40266-021-00836-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence to guide clinical decision making for pain management in nursing home residents is scant. OBJECTIVE Our objective was to explore the extent of consensus among expert stakeholders regarding what analgesic issues should be prioritized for comparative-effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents. METHODS Two stakeholder panels (nurses only and a mix of clinicians/researchers) were engaged (n = 83). During a three-round online modified Delphi process, participants rated and commented on the need for new evidence on nonopioid analgesic regimens and opioid regimens, short-term adverse effects, long-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1 = not essential to 9 = very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approach from the RAND/UCLA Appropriateness Method User's Manual. The qualitative data, consisting of participant explanations of their numeric ratings, were thematically analyzed by an experienced qualitative researcher. RESULTS For nursing home residents, evidence generation was deemed essential for opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors [SNRIs]), and nonsteroid anti-inflammatory drugs with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects, including delirium, cognitive decline, and decline in activities of daily living (ADLs). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Coprescribing analgesic regimens with benzodiazepines, sedating medications, serotonergic medications, and non-SNRI antidepressants were considered essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs. CONCLUSIONS Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, coprescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.
Collapse
Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Anne L Hume
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Jennifer Tjia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jayne Pawasauskas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | | |
Collapse
|
14
|
Lapane KL, Khan S, Shridharmurthy D, Beccia A, Dubé C, Yi E, Kay J, Liu SH. Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study. BMC Fam Pract 2020; 21:204. [PMID: 32993510 PMCID: PMC7526414 DOI: 10.1186/s12875-020-01274-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The average delay in diagnosis for patients with axial spondyloarthritis (axSpA) is 7 to 10 years. Factors that contribute to this delay are multifactorial and include the lack of diagnostic criteria (although classification criteria exist) for axSpA and the difficulty in distinguishing inflammatory back pain, a key symptom of axSpA, from other highly prevalent forms of low back pain. We sought to describe reasons for diagnostic delay for axSpA provided by primary care physicians. METHODS We conducted a qualitative research study which included 18 US primary care physicians, balanced by gender. Physicians provided informed consent to participate in an in-depth interview (< 60 min), conducted in person (n = 3) or over the phone (n = 15), in 2019. The analysis focuses on thoughts about factors contributing to diagnostic delay in axSpA. RESULTS Physicians noted that the disease characteristics contributing to diagnostic delay include: back pain is common and axSpA is less prevalent, slow progression of axSpA, intermittent nature of axSpA pain, and in the absence of abnormal radiographs of the spine or sacroiliac joints, there is no definitive test for axSpA. Patient characteristics believed to contribute to diagnostic delay included having multiple conditions in need of attention, infrequent interactions with the health care system, and "doctor shopping." Doctors noted that patients wait until the last moments of the clinical encounter to discuss back pain. Problematic physician characteristics included lack of rapport with patients, lack of setting appropriate expectations, and attribution of back pain to other factors. Structural/system issues included short appointments, lack of continuity of care, insufficient insurance coverage for tests, lack of back pain clinics, and a shortage of rheumatologists. CONCLUSION Primary care physicians agreed that lengthy axSpA diagnosis delays are challenging to address owing to the multifactorial causes (e.g., disease characteristics, patient characteristics, lack of definitive tests, system factors).
Collapse
Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA. .,Sherman Center, University of Massachusetts Medical School, 55 Lake Avenue North, 6th floor, Worcester, MA, 01655, USA.
| | - Sara Khan
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Divya Shridharmurthy
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Ariel Beccia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, 59 Route 10, East Hanover, NJ, 07936, USA
| | - Jonathan Kay
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, 55 Lake Avenue North, Worcester, MA, 01605, USA.,Division of Rheumatology, UMass Memorial Medical Center, 119 Belmont St, Worcester, MA, 01605, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, 55 Lake Avenue North, Worcester, MA, 01605, USA
| |
Collapse
|
15
|
Vergneau-Grosset C, Dubé C, Fitzgerald G, Lair S. Characteristics of antebrachial fractures associated with a successful outcome among free-ranging birds of prey that received treatment in a rehabilitation program. J Am Vet Med Assoc 2020; 256:580-589. [PMID: 32068512 DOI: 10.2460/javma.256.5.580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify characteristics of antebrachial fractures associated with a successful outcome (ie, bird released back into the wild after regaining normal flight ability, without being returned to the rehabilitation program within 1 month afterward) for free-ranging birds of prey admitted to a rehabilitation program. ANIMALS 620 birds of prey (representing 24 species) with antebrachial fractures admitted alive to a rehabilitation program from August 1986 through December 2015. PROCEDURES The medical record of each bird was reviewed to obtain information on species, age, sex, year of admission, fracture characteristics, and treatments administered. Outcome was classified as successful or unsuccessful on the basis of available data. Multivariable logistic regression was used to identify fracture characteristics associated with outcome. RESULTS 519 of 620 (84%) birds received treatment, and a successful outcome was recorded for 245 (47%) treated birds. Birds with closed (vs open) fractures were significantly more likely to have a successful outcome. Birds with concomitant radial and ulnar fractures involving the same third of the antebrachium (vs other types of antebrachial fractures) were significantly less likely to have a successful outcome, although birds with this type of fracture were significantly more likely to have a successful outcome when the fracture was localized to the middle or distal (vs proximal) third of the antebrachium. CONCLUSIONS AND CLINICAL RELEVANCE The characteristics of antebrachial fractures associated with a successful or unsuccessful outcome in this study may be useful in the development of triage protocols for birds of prey in other rehabilitation centers.
Collapse
|
16
|
Liu SH, Lapane K, Shridharmurthy D, Khan S, Ferrucci K, Dubé C, Yi E, Kay J. THU0560 PRIMARY CARE PHYSICIAN PERSPECTIVES ON DELAYS IN DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A QUALITATIVE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The average delay in diagnosis for patients with any form of spondyloarthritis (SpA) ranges from 7 to 10 years [1–5]. In axial spondyloarthritis (axSpA), a subgroup of SpA, it is 5 to 14 years [4, 6, 7]. Factors that contribute to this delay include the lack of diagnostic criteria for axSpA and the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA, from other highly prevalent forms of low back pain [8–10]. This impedes timely referral of these patients to rheumatologic care and initiation of appropriate treatment.Objectives:Describe understanding of, attitudes towards, and practices regarding axSpA among primary care physicians.Methods:We recruited 18 primary care physicians practicing in the United States as part of a larger qualitative study: theSpondyloArthritisScreening andEarlyDetection (SpA-SED) Study. We used purposive sampling with a goal of including an equal number of family medicine and internal medicine physicians who were balanced by gender. Physicians provided informed consent to participate in an in-depth interview (up to 60 minutes), conducted in person (n = 3) or over the phone (n = 15), between February and May 2019. The interview guide was developed by a multidisciplinary team, with input from rheumatologists. Topics included the physicians’ approaches to evaluating back pain, their awareness about axSpA, their differential diagnosis of axSpA, the laboratory tests and imaging studies ordered when axSpA is suspected, their referral patterns for patients with presumed axSpA, their thoughts about factors contributing to diagnostic delay in axSpA, and their opinions about an Inflammatory Back Pain Assessment – ASAS criteria screening tool [5].Results:Barriers to early diagnosis included patient factors (eg, multiple complaints, back pain not being the chief complaint), disease characteristics (eg, slow rate of disease progression), physician characteristics (eg, lack of rapport between patients and their primary care physicians), and structural/system issues (eg, lack of time). Most physicians reported that they would perform laboratory tests before referring a patient to a rheumatologist.Conclusion:Primary care physicians were surprised to learn of the average delay to axSpA diagnosis, considered that this lengthy delay was problematic, and agreed that improvements are needed in screening for and early detection of axSpA. Physicians believed that there would be a role for using a screening tool in the primary care setting to improve diagnostic delay, but that evidence to support its implementation is needed.References:[1]Dougados M et al.Arthritis Rheum.1991;34:1218–27.[2]Amor B et al.Rev Rhum Mal Osteoartic.1990;57:85–9.[3]van der Linden S et al.Arthritis Rheum.1984;27:361–8.[4]Deodhar A et al.Arthritis Rheumatol.2016;68:1669–76.[5]Sieper J et al.Ann Rheum Dis.2009;68:784–8.[6]Sykes MP et al.Rheumatology (Oxford).2015;54:2283–4.[7]Redeker I et al.Rheumatology (Oxford).2019;58:1634–8.[8]Strand V et al.Mayo Clin Proc.2017;92:555–64.[9]Proft F et al.Ther Adv Musculoskelet Dis. 2018;10:129–39.[10]Bohn R et al.Clin Exp Rheumatol.2018;36: 263–74.Acknowledgments:We thank the participants for sharing their insights as part of this study. This abstract was written using data from a research study originally funded by Novartis (Principal Investigator: Shao-Hsien Liu, Co-Investigators: Jonathan Kay, Kate Lapane, Catherine Dubé).Disclosure of Interests:Shao-Hsien Liu Grant/research support from: Novartis Pharmaceuticals Corporation, Kate Lapane Grant/research support from: Novartis Pharmaceuticals Corporation, Divya Shridharmurthy Grant/research support from: Novartis Pharmaceuticals Corporation, Sara Khan Grant/research support from: Novartis Pharmaceuticals Corporation, Katarina Ferrucci Grant/research support from: Novartis Pharmaceuticals Corporation, Catherine Dubé Grant/research support from: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Jonathan Kay Grant/research support from: Gilead Sciences, Inc., Pfizer, Novartis Pharmaceuticals Corporation, Consultant of: Alvotech Suisse AG; Arena Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Merck Sharp & Dohme Corp.; Mylan Inc.; Novartis AG; Samsung Bioepis; Sandoz, Inc; UCB, Inc.
Collapse
|
17
|
Bielawska B, Dubé C. The authors respond to “The future of colorectal cancer screening: Parentalism or shared decision-making?”. CMAJ 2020; 192:E485. [DOI: 10.1503/cmaj.74963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
18
|
Dossa F, Dubé C, Tinmouth J, Sorvari A, Rabeneck L, McCurdy BR, Dominitz JA, Baxter NN. Practice recommendations for the use of sedation in routine hospital-based colonoscopy. BMJ Open Gastroenterol 2020; 7:e000348. [PMID: 32128226 PMCID: PMC7039579 DOI: 10.1136/bmjgast-2019-000348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Objective Although sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice. Design We recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus. Results Twenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients. Conclusion The recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.
Collapse
Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Dubé
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anne Sorvari
- Department of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Jason A Dominitz
- Department of Medicine, Division of Gastroenterology, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Department of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Affiliation(s)
- Barbara Bielawska
- Division of Gastroenterology (Dubé, Bielawska), Department of Medicine, University of Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Dubé), Toronto, Ont.
| | - Catherine Dubé
- Division of Gastroenterology (Dubé, Bielawska), Department of Medicine, University of Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Dubé), Toronto, Ont
| |
Collapse
|
20
|
Bitton A, Devitt KS, Bressler B, Heatherington J, Jairath V, Jones J, Moayyedi P, Weizman AV, Dubé C, MacIntosh D, Nguyen GC. Development of a Global Rating Scale for Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2019; 3:4-16. [PMID: 34169223 PMCID: PMC8218537 DOI: 10.1093/jcag/gwz017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background The Global Rating Scale (GRS) is a web-based self-assessment quality improvement tool used to identify gaps in health care, change the focus to patient-centred care and standardize care. There are four levels of achievement ranging from basic-(D) to excellent-(A) service delivery. The goal was to develop a GRS for inflammatory bowel disease (IBD) to improve the quality of care for patients on a system level. Methods The IBD GRS was developed through an iterative process and modeled upon the successful endoscopy GRS programs in the United Kingdom and Canada. Dimensions, items and statements were drafted based on expert opinions, patient-informed quality indicators and best available evidence, then reviewed and modified by a core committee. A working group of IBD and GRS experts voted in-person to establish consensus on the inclusion and quality of statements. Results Two dimensions (Clinical Quality and Quality of Patient Experience), 10 items and 89 statements made up the IBD GRS. There was a 100% response rate for each of the 40 votes for statements in the IBD GRS. All statements within each level received a mean rating score between four (agree) and five (strongly agree). Revisions agreed upon during the voting process were incorporated into the IBD GRS. Group consensus was achieved on the inclusion of statements, and 10 items were selected as standards within the two dimensions. Conclusions We have developed the first IBD GRS with the aim of improving quality of care through ongoing evaluations and improvements by health care teams, focusing on patient-centred care.
Collapse
Affiliation(s)
- Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Katharine S Devitt
- Department of Research and Patient Programs, Crohn's and Colitis Canada, Toronto, Ontario, Canada
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan Heatherington
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jennifer Jones
- Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Moayyedi
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Adam V Weizman
- Division of Gastroenterology, Department of Medicine, Mount Sinai Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Dubé
- Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald MacIntosh
- Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology, Department of Medicine, Mount Sinai Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Llovet D, Serenity M, Conn LG, Bravo CA, McCurdy BR, Dubé C, Baxter NN, Paszat L, Rabeneck L, Peters A, Tinmouth J. Reasons For Lack of Follow-up Colonoscopy Among Persons With A Positive Fecal Occult Blood Test Result: A Qualitative Study. Am J Gastroenterol 2018; 113:1872-1880. [PMID: 30361625 PMCID: PMC6768592 DOI: 10.1038/s41395-018-0381-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Follow-up colonoscopy rates among persons with positive fecal occult blood test results (FOBT + ) remain suboptimal in many jurisdictions. In Ontario, Canada, primary care providers (PCPs) are responsible for arranging follow-up colonoscopies. The objectives were to understand the reasons for a lack of follow-up colonoscopy and any action plans to address follow-up. METHODS Semi-structured interviews were conducted with 30 FOBT+ persons and 30 PCPs in Ontario. Eligible FOBT+ persons were identified through administrative databases and included those aged 50-74, with a 6-12 month old FOBT+, no follow-up colonoscopy, and no prior colorectal cancer diagnosis or colectomy. Eligible PCPs had ≥1 rostered FOBT+ person without follow-up colonoscopy. Transcripts were analyzed inductively using Nvivo 11 (QSR International Pty Ltd., 2015). RESULTS Reasons for lack of follow-up colonoscopy were: person and/or provider believed the FOBT + was a false positive; person was afraid of colonoscopy; person had other health issues; and breakdown in communication of FOBT+ results or colonoscopy appointments. PCPs who initially recommended follow-up colonoscopy did not change the minds of the persons who dismissed the FOBT+ as a false positive and/or who were afraid of the procedure. These FOBT+ persons negotiated an alternative follow-up action plan including repeating the FOBT or not following-up. CONCLUSIONS PCPs may not adequately counsel FOBT+ persons who believe the FOBT+ is a false positive and/or fear colonoscopy. PCPs may lack fail-safe systems to communicate FOBT+ results and colonoscopy appointments. Using navigators may help address these barriers and increase follow-up rates.
Collapse
Affiliation(s)
- Diego Llovet
- 1Cancer Care Ontario, Toronto, Canada.,2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Lesley Gotlib Conn
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,3Sunnybrook Research Institute, Toronto, Canada
| | | | | | - Catherine Dubé
- 1Cancer Care Ontario, Toronto, Canada.,4Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Nancy N. Baxter
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,6Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Lawrence Paszat
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,7Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Linda Rabeneck
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Jill Tinmouth
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
22
|
Affiliation(s)
- Catherine Dubé
- Department of Medicine, University of Ottawa and Cancer Care Ontario, Toronto, Ontario, Canada.
| |
Collapse
|
23
|
Dubé C, Douketis JD, Moffat KA, Schulman S, Blais N. Basic coagulation tests as surrogates of dabigatran levels in a pre-operative setting: Analysis of five activated partial thromboplastin time reagents and thrombin time. Thromb Res 2018; 171:62-67. [DOI: 10.1016/j.thromres.2018.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
|
24
|
Mack DS, Epstein MM, Dubé C, Clark RE, Lapane KL. Screening mammography among nursing home residents in the United States: Current guidelines and practice. J Geriatr Oncol 2018; 9:626-634. [PMID: 29875079 DOI: 10.1016/j.jgo.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. MATERIALS AND METHODS Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. RESULTS Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. CONCLUSIONS These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
Collapse
Affiliation(s)
- Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Mara M Epstein
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Medicine, Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catherine Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
25
|
Murthy SK, Benchimol EI, Tinmouth J, James PD, Ducharme R, Rostom A, Dubé C. Temporal trends in postcolonoscopy colorectal cancer rates in 50- to 74-year-old persons: a population-based study. Gastrointest Endosc 2018; 87:1324-1334.e4. [PMID: 29317271 DOI: 10.1016/j.gie.2017.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/10/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancers (CRCs) diagnosed between 6 and 36 months after colonoscopy, termed postcolonoscopy CRCs (PCCRCs), arise primarily due to missed or inadequately treated neoplasms during colonoscopy. Introduction of multiple quality indicators and technological advances to colonoscopy practice should have reduced the PCCRC rate over time. We assessed temporal trends in the population rate of PCCRC as a measure of changing colonoscopy quality. METHODS We conducted a population-based retrospective cohort study of persons aged 50 to 74 years without advanced risk factors for CRC who underwent complete colonoscopy in Ontario, Canada between 1996 and 2010. We defined the PCCRC rate as the proportion of individuals diagnosed with CRC within 36 months of colonoscopy that had PCCRC. We compared age-adjusted and sex-adjusted rates of PCCRC over time based on 3 periods (1996-2001, 2001-2006 and 2006-2010) and assessed the independent association between time period and PCCRC risk through multivariable regression, with respect to all PCCRCs, proximal PCCRC and distal PCCRC. RESULTS There was a marked increase in colonoscopy volumes over the study period, particularly in younger age groups and non-hospital settings. Among 1,093,658 eligible persons the PCCRC rate remained stable at approximately 8% over the 15-year study period. The adjusted odds of PCCRC, distal PCCRC and proximal PCCRC, comparing the 2006 to 2010 period with the 1996 to 2001 period, were 1.14 (95% confidence interval [CI], 1.0-1.31), 1.11 (95% CI, 0.91-1.34), and 1.14 (95% CI, 0.94-1.38), respectively. Temporal trends in PCCRC risk did not differ by endoscopist specialty or institutional setting after covariate adjustment. CONCLUSION The PCCRC rate in Ontario has remained consistently high over time. Widespread initiatives are needed to improve colonoscopy quality.
Collapse
Affiliation(s)
- Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Paul D James
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences (Toronto) and ICES uOttawa, Ontario, Canada
| | - Alaa Rostom
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Dubé
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
26
|
Dubé C, Rabeneck L. Seven-day postcolonoscopy emergency department visits: What do they really measure? Gastrointest Endosc 2018; 87:526-528. [PMID: 29406932 DOI: 10.1016/j.gie.2017.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/22/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Catherine Dubé
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Cancer Care Ontario, Department of Medicine and Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Murthy SK, Dubé C, Rostom A, Benchimol EI, Ducharme R, Sutradhar R, Rabeneck L, Paszat L, Tinmouth J. Risk of colorectal cancer after a negative colonoscopy in low-to-moderate risk individuals: impact of a 10-year colonoscopy. Endoscopy 2017; 49:1229-1236. [PMID: 28915524 DOI: 10.1055/s-0043-117402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background and study aims National societies recommend colorectal cancer (CRC) screening 10 years after a normal ("negative") colonoscopy in low-risk individuals. We studied the impact of a 10-year repeat colonoscopy on the risk of early incident CRC. Patients and methods We used health administrative data from Ontario, Canada, to conduct a population-based retrospective cohort study in 50 - 74-year-old individuals at low-to-moderate risk of CRC who had a negative colonoscopy between 1996 and 2001. We approximated exposure to repeat colonoscopy using an 8 - 12-year window. We excluded individuals who underwent lower endoscopy or colectomy, developed CRC, or were lost to follow-up between the baseline and repeat colonoscopies. We matched exposed individuals 1:1 to individuals who did not undergo lower endoscopy within 12 years for age, sex, and calendar year of baseline colonoscopy, and followed matched pairs for incident CRC. The primary analysis was multivariable hazards regression, adjusting for competing risks. Results A total of 13 350 matched pairs were observed for a median of 4.5 years (interquartile range 3.2 - 5.9 years). The cumulative probability of CRC following the matching date was 0.70 % (95 % confidence interval [CI] 0.42 % - 1.11 %) in individuals who underwent repeat colonoscopy and 0.77 % (95 %CI 0.48 % - 1.2 %) in individuals who did not undergo repeat colonoscopy. The adjusted hazard ratio for CRC was 0.91 (95 %CI 0.68 - 1.22). Conclusions We did not find an association between a second colonoscopy performed 10 years after a negative colonoscopy and early incident CRC. Our findings support the need for further studies on the utility of 10-year re-screening with colonoscopy in this setting.
Collapse
Affiliation(s)
- Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Catherine Dubé
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Alaa Rostom
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Odette Cancer Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Dubé C, Yakubu M, McCurdy BR, Lischka A, Koné A, Walker MJ, Peirson L, Tinmouth J. Risk of Advanced Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality in People With Low-Risk Adenomas at Baseline Colonoscopy: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:1790-1801. [PMID: 29087393 DOI: 10.1038/ajg.2017.360] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 08/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis of the risk of advanced adenomas (AAs), colorectal cancer (CRC), and/or CRC-related death among individuals with low-risk adenomas (LRAs). METHODS We searched PubMed and Embase for studies published between January 2006 and July 2015. Quality and strength of the evidence were rated using the Newcastle-Ottawa Scale (NOS) and the GRADE framework, respectively. RESULTS Eleven observational studies (n=64,317) were included. A meta-analysis of eight cohort studies (n=10,139, 3 to 10 years' follow-up) showed a small but statistically significant increase in the incidence of AAs in individuals with LRAs compared with those with a normal baseline colonoscopy (RR 1.55 (95% CI 1.24-1.94); P=0.0001; I2=0%). The pooled 5-year cumulative incidence of AA was 3.28% (95% CI: 1.85-5.10%), 4.9% (95% CI: 3.18-6.97%), and 17.13% (95% CI: 11.97-23.0%) for the no adenoma, LRA, and AA baseline groups, respectively. Two studies, which could not be pooled, showed a reduction in the risk of CRC in individuals with LRAs compared with the general population (standardized incidence ratio 0.68 (95% CI 0.44-0.99) at a median follow-up of 7.7 years and OR 0.4 (95% CI 0.2-0.6) at 3-5 years). One large retrospective cohort study found a 25% reduction in CRC mortality in individuals with LRAs compared with the general population (SMR 0.75 (95% CI 0.63-0.88) at a median follow-up of 7.7 years). CONCLUSIONS We observed a small but significant increase in the risk of AAs in people with LRAs compared with those with a normal baseline colonoscopy, but compared with the general population, people with LRAs have significantly lower risks of CRC and of CRC-related mortality.
Collapse
Affiliation(s)
- Catherine Dubé
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Mafo Yakubu
- Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Anna Koné
- Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meghan J Walker
- Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jill Tinmouth
- Cancer Care Ontario, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Bruneau M, Bier N, Bourbonnais A, Ménard C, Dubé C. [P2–481]: BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: A TELECONSULTATION AND MENTORING PROJECT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Nathalie Bier
- Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal (CRIUGM)MontrealQCCanada
| | - Anne Bourbonnais
- Centre de Recherche de l'Institut Universitaire de Gériatrie de MontréalMontréalQCCanada
| | - Caroline Ménard
- Institut Universitaire de Gériatrie de MontréalMontréalQCCanada
| | - Catherine Dubé
- Centre de Recherche de l'Institut Universitaire de Gériatrie de MontréalMontréalQCCanada
| |
Collapse
|
30
|
Tinmouth J, Vella ET, Baxter NN, Dubé C, Gould M, Hey A, Ismaila N, McCurdy BR, Paszat L. Colorectal Cancer Screening in Average Risk Populations: Evidence Summary. Can J Gastroenterol Hepatol 2016; 2016:2878149. [PMID: 27597935 PMCID: PMC5002289 DOI: 10.1155/2016/2878149] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.
Collapse
Affiliation(s)
- Jill Tinmouth
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily T. Vella
- Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | - Nancy N. Baxter
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Catherine Dubé
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
- Department of Medicine, Division of Gastroenterology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Michael Gould
- William Osler Health Centre, Etobicoke, ON, Canada
- Vaughan Endoscopy Clinic, Vaughan, ON, Canada
| | - Amanda Hey
- Northeast Cancer Centre Health Sciences North/Horizon Santé-Nord, Sudbury Outpatient Centre, Sudbury, ON, Canada
| | | | | | - Lawrence Paszat
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
31
|
Affiliation(s)
- Catherine Dubé
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Alaa Rostom
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
32
|
Abstract
In recent years, an important transformation has taken place in the field of gastrointestinal endoscopy training. Two important movements have helped initiate this transformation: patient centered quality and competency based training. Patient centered quality in endoscopy became an important focus for colorectal cancer screening programs, as it was acknowledged that colonoscopy services played a central role in the outcomes of screening. This prompted the need to close the quality loop through the development of innovative endoscopist training and upskilling programs. As well, the importance of leadership skills and leadership training was highlighted as a key factor in effective quality improvement. Competency-based training depends on well-defined goals of training and on the regular documentation and review of the learner's progress. This is facilitated by objective assessment and performance enhancing feedback, enabled by measurement tools that can provide a quantitative or qualitative assessment and identify areas in need of further development. Simulators and scope imagers can aid the acquisition of technical skills, particularly in the novice phase. These important advances in our evolving concepts around endoscopy training have also raised many questions, highlighting important knowledge gaps which, we hope, will be addressed in coming years.
Collapse
Affiliation(s)
- Catherine Dubé
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Alaa Rostom
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
33
|
Candas B, Jobin G, Dubé C, Tousignant M, Abdeljelil AB, Grenier S, Gagnon MP. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review. Endosc Int Open 2016; 4:E118-33. [PMID: 26878037 PMCID: PMC4751006 DOI: 10.1055/s-0041-107901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/05/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIM Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. METHODS We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. RESULTS We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. CONCLUSION Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.
Collapse
Affiliation(s)
- Bernard Candas
- Institut d’excellence en santé et services sociaux du Québec, Quebec City, Quebec, Canada
- Université Laval – Department of Social and Preventive Medicine, Quebec City, Quebec, Canada
| | - Gilles Jobin
- Université de Montréal – Department of Medicine, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital – Gastroenterology, Montreal, Quebec, Canada
| | - Catherine Dubé
- University of Calgary – Department of Community Health Sciences, Calgary, Alberta, Canada
| | - Mario Tousignant
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Anis Ben Abdeljelil
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Sonya Grenier
- CHU de Québec Research Center – Public Health and Practice-Changing Research, Quebec City, Quebec, Canada
| | - Marie-Pierre Gagnon
- Université Laval – Faculty of Nursing, Quebec City, Quebec, Canada
- CHU de Québec Research Center – Population Health and Optimal Health Practices, Quebec City, Quebec, Canada
| |
Collapse
|
34
|
Lewis N, Dorjee S, Dubé C, VanLeeuwen J, Sanchez J. Assessment of Effectiveness of Control Strategies Against Simulated Outbreaks of Highly Pathogenic Avian Influenza in Ontario, Canada. Transbound Emerg Dis 2015; 64:938-950. [PMID: 26666400 DOI: 10.1111/tbed.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Indexed: 11/28/2022]
Abstract
The North American Animal Disease Spread Model (NAADSM) is a stochastic model framework developed to simulate the spread of highly contagious diseases of livestock and poultry, such as foot-and-mouth disease and highly pathogenic avian influenza (HPAI). The objective of this study was to make recommendations on the most effective HPAI control policy for Canada, specifically, on the effect of different speeds of detection, effectiveness of movement restrictions and stamping-out and ring-culling strategies on the magnitude of an HPAI outbreak. In addition, the effect of introduction of infection in a range of multiple farms simultaneously was also evaluated. A total of 21 060 scenarios, defined as different combinations of parameters for various epidemiological conditions and control measures, were created to simulate the number of poultry flocks that would become infected as a result of an incursion of HPAI. Each scenario was parameterized in NAADSM and replicated 1000 times, generating the median number of flocks infected at the end of the simulated outbreak for each scenario. Negative binomial regression analysis was used to model significant explanatory variables of the median number of flocks infected at the end of each simulated outbreak for each of the 21 060 scenarios. The final model included the following explanatory variables: number and type initially infected flock(s), density of flocks within the county where the initially infected flock(s) was located, probability of transmission through indirect contact, subclinical spread of the infection, speed of detection and a two-way interaction between intensity of bird destruction strategy and movement restriction effectiveness to reduce transmission through direct and indirect contacts. The modelling results suggested that stamping out of the detected infected flocks, without ring culling, in combination with effective movement restrictions on direct and indirect contacts, would be the most appropriate policy for Ontario.
Collapse
Affiliation(s)
- N Lewis
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - S Dorjee
- Bhutan Agriculture and Food Regulatory Authority, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - C Dubé
- Canadian Food Inspection Agency, Ottawa, ON, Canada
| | - J VanLeeuwen
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - J Sanchez
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| |
Collapse
|
35
|
Affiliation(s)
- Silvia Sanduleanu
- Division of Gastroenterology and Hepatology, GROW, School for Oncology and Developmental Biology, Maastricht UMC, Maastricht, The Netherlands
| | - Catherine Dubé
- Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, Canada
| |
Collapse
|
36
|
Dubé C, Monetta L, Martínez-Cuitiño MM, Wilson MA. Independent effects of imageability and grammatical class in synonym judgement in aphasia. Psicothema 2014; 26:449-56. [PMID: 25340890 DOI: 10.7334/psicothema2014.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The grammatical class effect in aphasia, i.e. dissociated processing of words according to their respective grammatical class, has been attributed to either grammatical, lexical or semantic (i.e., imageability) deficits. This study explores the hypotheses of impaired semantic treatment as the source of the grammatical class effect in aphasia. METHOD A synonym judgement task that includes nouns and verbs of high and low imageability has been administered to 30 Spanish-speaking patients suffering from receptive or productive aphasia and 30 controls. RESULTS Normal controls performed significantly better than aphasic patients. Although globally the productive aphasics performed significantly better than the receptive aphasics, grammatical class (nouns better than verbs) and imageability (high imageability better than low imageability) affected performance in both subgroups. No significant interaction emerged between these two factors. CONCLUSION The results suggest that the grammatical class effect may emerge from semantic impairment and that it is -at least partially- independent of the imageability of words.
Collapse
|
37
|
Sanson R, Dubé C, Cork S, Frederickson R, Morley C. Simulation modelling of a hypothetical introduction of foot-and-mouth disease into Alberta. Prev Vet Med 2014; 114:151-63. [DOI: 10.1016/j.prevetmed.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/23/2014] [Accepted: 03/06/2014] [Indexed: 11/28/2022]
|
38
|
Rostom A, Ross ED, Dubé C, Rutter MD, Lee T, Valori R, Bridges RJ, Pontifex D, Webbink V, Rees C, Brown C, Whetter DH, Kelsey SG, Hilsden RJ. Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc 2013; 77:255-61. [PMID: 23317691 DOI: 10.1016/j.gie.2012.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/03/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comfort during colonoscopy is a critical component of safety and quality. OBJECTIVE To develop and validate the Nurse-Assessed Patient Comfort Score (NAPCOMS). DESIGN Prospective scale validation. SETTING Colorectal cancer screening centers in the United Kingdom and Canada. PATIENTS A total of 300 consecutive patients undergoing colonoscopy at participating colorectal cancer screening centers. INTERVENTION The NAPCOMS was developed by using a modified Delphi process. During colonoscopy, two endoscopy room nurses independently observed and rated patient comfort and tolerability by using NAPCOMS. In addition, endoscopists reported global comfort scores and patients' reported global comfort by using visual 4-point Likert and National Health Service-United Kingdom Global Rating Scales. MAIN OUTCOME MEASUREMENTS Reliability and validity of NAPCOMS was measured by using intraclass correlations (ICC) between nurse ratings of colonoscopies and between NAPCOMS, endoscopist ratings, and patient ratings of global comfort. RESULTS The ICC for the overall NAPCOMS was 0.84 (95% confidence interval [CI], 0.80-0.87). There was high agreement between the NAPCOMS and endoscopist ratings of comfort (ICC = 0.77; 95% CI, 0.72-0.81), moderate agreement between the NAPCOMS and patient ratings (ICC = 0.61; 95% CI, 0.53-0.67), and moderate agreement between the endoscopist and patient ratings (ICC = 0.52; 95% CI, 0.43-0.60). LIMITATIONS NAPCOMS was validated in outpatients who received colonoscopy with minimal to moderate sedation as part of a screening and surveillance program, so performance among inpatients or those requiring deep sedation was not tested. CONCLUSION NAPCOMS is a reliable and valid tool for assessing patient comfort in the setting of outpatient colonoscopy performed with minimal to moderate sedation.
Collapse
Affiliation(s)
- Alaa Rostom
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
MacIntosh D, Dubé C, Hollingworth R, van Zanten SV, Daniels S, Ghattas G. The endoscopy Global Rating Scale-Canada: development and implementation of a quality improvement tool. Can J Gastroenterol 2013; 27:74-82. [PMID: 23472242 PMCID: PMC3731117 DOI: 10.1155/2013/165804] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/10/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer. OBJECTIVE To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided. METHODS Based on feedback from 22 sites across Canada that completed the UK endoscopy GRS, and integrating results of the Canadian consensus on safety and quality indicators in endoscopy and other Canadian consensus reports, a working group of endoscopists experienced with the GRS developed the GRS-Canada (GRS-C). RESULTS The GRS-C mirrors the two dimensions (clinical quality and quality of the patient experience) and 12 patient-centred items of the UK-GRS, but was modified to apply to Canadian health care infrastructure, language and current practice. Each item is assessed by a yes⁄no response to eight to 12 statements that are divided into levels graded D (basic) through A (advanced). A core team consisting of a booking clerk, charge nurse and the physician responsible for the unit is recommended to complete the GRS-C twice yearly. CONCLUSION The GRS-C is intended to improve endoscopic services in Canada by providing endoscopy units with a straightforward process to review the quality of the service they provide.
Collapse
Affiliation(s)
- Donald MacIntosh
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia
| | - Catherine Dubé
- Division of Gastroenterology, University of Calgary, Calgary, Alberta
| | - Roger Hollingworth
- Division of Gastroenterology, The Credit Valley Hospital, Mississauga, Ontario
| | | | - Sandra Daniels
- Canadian Association of Gastroenterology, Oakville, Ontario
| | - George Ghattas
- Division of Gastroenterology, McGill University, Montreal, Quebec
| |
Collapse
|
40
|
Sewitch MJ, Dubé C, Brien S, Jiang M, Hilsden RJ, Barkun AN, Armstrong D. Patient-identified quality indicators for colonoscopy services. Can J Gastroenterol 2013; 27:25-32. [PMID: 23378980 PMCID: PMC3545623 DOI: 10.1155/2013/574956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/04/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current quality improvement tools for endoscopy services, such as the Global Rating Scale (GRS), emphasize the need for patient-centred care. However, there are no studies that have investigated patient expectations and/or perceptions of quality indicators in endoscopy services. OBJECTIVES To identify quality indicators for colonoscopy services from the patient perspective; to rate indicators of importance; to determine factors that influence indicator ratings; and to compare the identified indicators with those of the GRS. METHODS A two-phase mixed methods study was undertaken in Montreal (Quebec), Calgary (Alberta) and Hamilton (Ontario) among patients ≥18 years of age who spoke and read English or French. In phase 1, focus group participants identified quality indicators that were then used to construct a survey questionnaire. In phase 2, survey questionnaires, which were completed immediately after colonoscopy, prompted respondents to rate the 20 focus group-derived indicators according to their level of importance (low, medium, high) and to list up to nine additional items. Multiple logistic regression analysis was used to determine the factors that influenced focus group-derived indicator ratings. Patient-identified indicators were compared with those used in the GRS to identify novel indicators. RESULTS Three quality indicator themes were identified by 66 participants in 12 focus groups: communication, comfort and service environment. Of the 828 surveys distributed, 402 (48.6%) were returned and 65% of focus group-derived indicators were rated highly important by at least 55% of survey respondents. Indicator ratings differed according to age, sex, site and perceived colorectal cancer risk. Of the 29 patient-identified indicators, 17 (58.6%) were novel. CONCLUSIONS Patients identified 17 novel quality indicators, suggesting that patients and health professionals differ in their perspectives with respect to quality in colonoscopy services.
Collapse
Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec.
| | | | | | | | | | | | | |
Collapse
|
41
|
Dubé C, Sanchez J, Reeves A. Adapting existing models of highly contagious diseases to countries other than their country of origin. REV SCI TECH OIE 2012; 30:581-9. [PMID: 21961228 DOI: 10.20506/rst.30.2.2061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many countries do not have the resources to develop epidemiological models of animal diseases. As a result, it is tempting to use models developed in other countries. However, an existing model may need to be adapted in order for it to be appropriately applied in a country, region, or situation other than that for which it was originally developed. The process of adapting a model has a number of benefits for both model builders and model users. For model builders, it provides insight into the applicability of their model and potentially the opportunity to obtain data for operational validation of components of their model. For users, it is a chance to think about the infection transmission process in detail, to review the data available for modelling, and to learn the principles of epidemiological modelling. Various issues must be addressed when considering adapting a model. Most critically, the assumptions and purpose behind the model must be thoroughly understood, so that new users can determine its suitability for their situation. The process of adapting a model might simply involve changing existing model parameter values (for example, to better represent livestock demographics in a country or region), or might require more substantial (and more labour-intensive) changes to the model code and conceptual model. Adapting a model is easier if the model has a user-friendly interface and easy-to-read user documentation. In addition, models built as frameworks within which disease processes and livestock demographics and contacts are flexible are good candidates for technology transfer projects, which lead to long-term collaborations.
Collapse
Affiliation(s)
- C Dubé
- Animal Health and Production Division, Canadian Food inspection Agency, 59 Camelot, Ottawa, Ontario, K1A 0Y9, Canada
| | | | | |
Collapse
|
42
|
Willeberg P, Grubbe T, Weber S, Forde-Folle K, Dubé C. The World Organisation for Animal Health and epidemiological modelling: background and objectives. REV SCI TECH OIE 2012; 30:391-405. [PMID: 21961212 DOI: 10.20506/rst.30.2.2046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The papers in this issue of the Scientific and Technical Review (the Review) examine uses of modelling as a tool to supportthe formulation of disease control policy and applications of models for various aspects of animal disease management. Different issues in model development and several types of models are described. The experience with modelling during the 2001 foot and mouth disease outbreak in the United Kingdom underlines how models might be appropriately applied by decision-makers when preparing for and dealing with animal health emergencies. This paper outlines the involvement of the World Organisation for Animal Health (OIE) in epidemiological modelling since 2005, with emphasis on the outcome of the 2007 questionnaire survey of model usage among Member Countries, the subsequent OIE General Session resolution and the 2008 epidemiological modelling workshop at the Centers for Epidemiology and Animal Health in the United States. Many of the workshop presentations were developed into the papers that are presented in this issue of the Review.
Collapse
Affiliation(s)
- P Willeberg
- Center for Animal Disease Modeling and Surveillance, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | | | | | | | | |
Collapse
|
43
|
Dubé C. Tackling colorectal cancer as a public health issue: what can the gastroenterologist do? Can J Gastroenterol 2012; 26:417-8. [PMID: 22803014 PMCID: PMC3395440 DOI: 10.1155/2012/507989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 12/18/2022]
Affiliation(s)
- Catherine Dubé
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta
| |
Collapse
|
44
|
McNab B, Dubé C, Alves D. Using simplified models to communicate the importance of prevention, detection and preparedness before a disease outbreak. REV SCI TECH OIE 2011; 30:591-602. [PMID: 21961229 DOI: 10.20506/rst.30.2.2060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Frontline farm workers and veterinary-policy-makers are arguably in the best positions to influence prevention, detection, and preparedness-for-control of farm animal diseases. It is important that such individuals make biologically sound decisions concerning the daily management and regulation of the health of animals. Such decisions should be based on a good understanding of key principles of disease spread and control. This paper summarises these principles, as described in previous publications, into simple models. These models may be used to communicate concepts to readers who may not have time to study more complex models. These models illustrate the relationship between the development of new disease cases (from existing cases, i.e., the reproductive ratio R) and (i) the duration of the period during which existing cases are available as infectious, (ii) contact rates, (iii) transmission rates and (iv) susceptibility. Understanding these concepts through models has great utility, facilitating better decisions for disease prevention, detection and preparedness-for-control, before an outbreak becomes unmanageable. These basic concepts apply to all animal species, including humans.
Collapse
Affiliation(s)
- B McNab
- Animal Health and Welfare Branch, Ontario Ministry of Agriculture, Food and Rural Affairs, 1 Stone Rd, Guelph, Ontario, N1G 4Y2, Canada
| | | | | |
Collapse
|
45
|
Dubé C. Practical Plans for Difficult Conversations in Medicine: Strategies That Work in Breaking Bad News by Robert Buckman, MD, PhD. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827611398192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Catherine Dubé
- Brown University and The Miriam Hospital, Providence, Rhode Island
| |
Collapse
|
46
|
Lapane KL, Waring ME, Dubé C, Schneider KL. E-PRESCRIBING AND PATIENT SAFETY: RESULTS FROM A MIXED METHOD STUDY. Am J Pharm Benefits 2011; 3:e24-e34. [PMID: 24179595 PMCID: PMC3811029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe ambulatory care clinicians' perspectives on the effect of e-prescribing systems on patient safety outcomes. STUDY DESIGN We used a mixed-method study of clinicians and staff in 64 practices using one of six e-prescribing technologies in six U.S. states. METHODS We used clinician surveys (web-based and paper) and focus groups to obtain clinicians' perspectives on e-prescribing and patient safety. RESULTS Providers highly valued having medications prescribed by other providers on the medication list and the ability to access patients' medication lists remotely. Providers felt that there will always be prescription or medication errors and that the implementation of e-prescribing software changes rather than eliminates prescription or medication errors. New errors related to the dosing or scheduling of a medication, accidentally prescribing the wrong drug, or duplicate prescriptions. CONCLUSIONS Lessons from the ambulatory care trenches must be considered as technology moves forward so that the hypothesized patient safety gains will be realized.
Collapse
Affiliation(s)
- Kate L. Lapane
- Department of Epidemiology and Community Health, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia
- Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Molly E. Waring
- Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Catherine Dubé
- Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Karen L. Schneider
- Department of Community Health, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- John Snow International, Boston, Massachusetts
| |
Collapse
|
47
|
|
48
|
Lapane KL, Rosen RK, Dubé C. Perceptions of e-prescribing efficiencies and inefficiencies in ambulatory care. Int J Med Inform 2011; 80:39-46. [PMID: 21112243 PMCID: PMC3073364 DOI: 10.1016/j.ijmedinf.2010.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent studies have demonstrated that e-prescribing takes longer than handwriting. Additional studies documenting the perceived efficiencies realized from e-prescribing from those who have implemented electronic prescribing are warranted. METHODS We used a mixed method study design. We report on qualitative date from 64 focus groups with clinicians and office staff from six US states. Participants used one of six e-prescribing software packages. Qualitative data from the focus groups (276 participants) were coded and analyzed using NVivo software. Quantitative data regarding perceived efficiencies were extracted from a survey of 157 clinicians using e-prescribing. RESULTS Perceptions of e-prescribing included 64% reporting e-prescribing as very efficient. The next closest method was computer generated fax and prescriptions in which ∼25% rated the method as very efficient. Improvements in workflow and record keeping were noted. Perceived efficiencies were realized by decreased errors, availability of formularies at the point of prescribing and refill processing. Perceived inefficiencies noted included the need for dual systems owing to regulations preventing e-prescribing of scheduled medications as well as those introduced with incorrect information on formularies, pharmacy used, and warnings. DISCUSSION Overwhelmingly, clinicians and their staff confirmed the perceived efficiencies realized with the adoption of e-prescribing. Perceived efficiencies were realized in knowing formularies, processing refills, and decreasing errors. Opportunities to improve efficiencies could be realized by assuring correct information in the system.
Collapse
Affiliation(s)
- Kate L Lapane
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | | | | |
Collapse
|
49
|
Jobin G, Gagnon MP, Candas B, Dubé C, Ben Abdeljelil A, Grenier S. User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol. Implement Sci 2010; 5:85. [PMID: 21044332 PMCID: PMC2988067 DOI: 10.1186/1748-5908-5-85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/02/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada. METHODS First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions. DISCUSSION This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.
Collapse
Affiliation(s)
- Gilles Jobin
- Department of Medicine, Université de Montréal, Montréal, Canada
- Maisonneuve-Rosemont Hospital, Montréal, Canada
| | - Marie Pierre Gagnon
- Department of Nursing, Université Laval, Québec, Canada
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Bernard Candas
- Department of Medicine, Université Laval, Québec, Canada
- Canadian Partnership Against Cancer, Québec, Canada
| | | | - Anis Ben Abdeljelil
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Sonya Grenier
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| |
Collapse
|
50
|
Reeves A, Harvey N, Dubé C, Forde-Folle K, Case S, Corso B, Hill A, McNab W, Hupalo R, Reeves C, Rooney J, Sanchez J, Schwickerath A, Salman M. Building Capacity for Epidemiologic Modeling: Experiences of the NAADSM Development Team. Ann Epidemiol 2010. [DOI: 10.1016/j.annepidem.2010.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|