Evaluation of patient-focused interventions to promote colorectal cancer screening among new york state medicaid managed care patients

BACKGROUND

The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population.

METHODS

Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized.

RESULTS

In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region.

CONCLUSIONS

Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

Chemotherapy screening assay using 3-dimensional cell culture

A new alginate culture method (ACM) was used to test the effects of vincristine and 5-fluorouracil (5-FU) on the commonly used human colon carcinoma cell line HT-29. Colorimetric analysis of viability following treatment with physiologically tolerated levels of vincristine showed significant reduction of the surviving cell population. Hematoxylin and eosin staining of sections of treated organoid growths corroborated the colorimetric analyses. The ACM is inexpensive, rapid and extremely versatile. Many alginate beads containing "mini-tissue" growths of many cell lines can be used simultaneously to evaluate numerous chemotherapeutic agents in an "in vivo-like" environment.

Use of polysulphated glycosaminoglycan in equine lameness

Four cases of equine lameness were treated with intra-articular polysulphated glycosaminoglycan. Two, two-year-old flat racers were treated conservatively after traumatic injury. They subsequently became lame owing to the formation of new bone and osteophytes. Two older steeplechasers were lame owing to degenerative joint disease. The four horses were treated with intra-articular injections of polysulphated glycosaminoglycans and, after three or four injections, they became clinically sound and were able to continue racing with varying degrees of success.

Ultrastructural variations in the sweat glands of anhidrotic horses

The ultrastructure of sweat glands from the skin of free sweating horses was compared with that of glands from anhidrotic cases. Evidence of atrophied and abnormal sweat glands in the anhidrotic horses indicates that the condition involves progressive failure of the glandular mechanism of sweat production.

Breed and species comparison of amino acid transport variation in equine erythrocytes

The amino acid permeability of red blood cells from Equus caballus (thoroughbred, Arab, shire and pony), E przewalskii (Przewalski's horse), E asinus (donkey and mule) and E burchelli (common or plains zebra) was measured. Individual animals exhibited stable but widely differing rates of L-[U-14C]alanine uptake in the range 5 to 1554 mumol (litre cells)-1 h-1 (0.2 mM extracellular L-alanine, 37 degrees C). Of the thoroughbreds tested, 30 per cent had red blood cells which were essentially impermeable to L-alanine (5 to 10 mumol (litre cells)-1 h-1, giving transport rates similar to those found previously in amino acid transport-deficient sheep erythrocytes. In contrast, only 3 per cent of the ponies tested had red blood cells impermeable to L-alanine. No cases of erythrocyte amino acid transport deficiency were found in the other horse breeds and species tested.

Case of angiosarcoma of the nasal passage of the horse--ultrastructure and differential diagnosis from progressive haematoma

An angiosarcoma involving the right frontal and maxillary sinuses in a nine-year-old Thoroughbred mare was studied post mortem by light and electron microscopy. Important diagnostic features included malignant endothelial cells lining ill-defined vascular spaces, supported by other vasoformative elements. Rhabdomyoblasts were also found. The tumour is apparently rarely seen in the nasal passages of the horse.

Effect of bedding on the incidence of exercise induced pulmonary haemorrhage in racehorses in Hong Kong

An investigation into the incidence of exercise induced pulmonary haemorrhage (EIPH) in thoroughbreds in Hong Kong was carried out between the 1981 and 1983 racing seasons. A total of 1039 post race endoscopic examinations were performed in 1982-1983 and the results indicated that 46.8 per cent of runners had EIPH. This was not statistically different from the percentage of horses showing EIPH during 1981-82 (46.9 per cent). As it had been postulated that dust, especially from straw, could be implicated in lung haemorrhage a proportion of horses were bedded on paper in the 1982-83 season. No significant differences could be demonstrated in the incidence of EIPH resulting from the use of paper bedding in preference to straw.