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1.
JAMA Netw Open ; 2(7): e198090, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31365108

RESUMO

Importance: Recent evidence has shown that although the incidence of colorectal cancer (CRC) is decreasing among older adults, rates have increased in adults younger than 50 years. Given that younger adults are typically classified as at low risk for the disease, this epidemiologic shift is cause for concern. Objective: To analyze Canadian national cancer incidence registries to determine incidence trends for CRC among older and younger adults, updated to 2015. Design, Setting, and Participants: This cohort study determined the incidence of CRC using data from the National Cancer Incidence Reporting System (1969-1992) and the Canadian Cancer Registry (1992-2015). All Canadians diagnosed with CRC from January 1, 1969, through December 31, 2015, were included in this study. Trends among men and women were examined separately and by age category (>50 vs <50 years). Birth cohort models were fit using 5-year groups starting in 1886, with 1936 as the reference cohort. Data were analyzed from May 13, 2018 to May 16, 2018. Main Outcomes and Measures: Annualized percentage changes and incidence rate ratios of CRC. Results: From 1971 to 2015, 688 515 incident cases (52.9% women) of CRC were identified. Although the incidence of CRC has decreased in older men and women, rates among younger men and women have increased since 2006 and 2010, respectively. For women younger than 50 years, incidence has increased with a mean annual percentage change of 4.45% since 2010; for men younger than 50 years, a mean annual percentage change of 3.47% from 2006 through 2015. There was an association between CRC incidence and birth cohort, with more recent cohorts being at greater risk than those born earlier. For men, the risk of colorectal cancer in the youngest cohort is more than double that of the reference (incidence rate ratio, 2.57; 95% CI, 1.32-5.02). Incidence rate ratios were not significant for women (IRR, 2.12; 95% CI, 0.95-4.70) but increased in successively younger cohorts. Conclusions and Relevance: This study found increasing incidence of colorectal cancer diagnoses among Canadian men and women younger than 50 years of age. This increase in incidence among a low-risk population calls for additional research on possible risk factors that may be affecting these younger cohorts. It appears that primary prevention should be the highest priority to reduce the number of younger adults developing CRC in the future.

3.
CMAJ Open ; 6(4): E538-E543, 2018 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30404788

RESUMO

BACKGROUND: Cancer screening aims to detect malignant disease early in its natural history when interventions might improve patient outcomes. Such benefits are unclear when screening occurs for patients with an existing high risk of death. Our aim was to study the extent of routine cancer screening for a new primary cancer in patients with existing metastatic cancer. METHODS: We used administrative databases from Ontario to identify a retrospective cohort of adults of eligible screening age (≥ 50 yr) who had a diagnosis of stage IV (metastatic) colorectal, lung, breast or prostate cancer between 2007 and 2012. We calculated the cumulative incidence of cancer screening over time for colorectal and breast cancer. RESULTS: Among the 20 992 patients with metastatic lung, breast or prostate cancer, 2.9%, 6.3% and 13.3% of patients, respectively, underwent testing for colorectal cancer within 1 year of cancer diagnosis. Within 3 years of diagnosis, rates reached 4.1%, 12.3% and 27.5%, respectively (8.5% of all patients). Incidence of colorectal cancer testing was higher among patients who received their diagnoses more recently compared with patients with diagnoses from earlier time periods (p = 0.0143). Among the 10 034 women with metastatic lung or colorectal cancer, 8.7% and 8.0% of patients, respectively, underwent breast cancer screening within 1 year of cancer diagnosis. Within 3 years of diagnosis, screening rates reached 10.2% and 13.1%, respectively. INTERPRETATION: Our findings indicate excessive rates of cancer screening among patients with metastatic cancer who are unlikely to benefit. Further studies are warranted to identify predictors for screening, resource implications, potential and real harms borne by patients, and the impact of a recent Choosing Wisely statement recommending against the practice.

4.
Am J Gastroenterol ; 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30361625

RESUMO

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.

5.
Genet Med ; 2018 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-30349099

RESUMO

PURPOSE: Lynch syndrome (LS) is the most common inherited cause of colorectal cancer. Although testing all colorectal tumors for LS is recommended, the uptake of reflex-testing programs within health systems has been limited. This multipronged study describes the design of a provincial program for reflex testing in Ontario, Canada. METHODS: We recruited key stakeholders to participate in qualitative interviews to explore the barriers and facilitators to the implementation of a reflex-testing program. Data were analyzed in an iterative manner, key themes identified, and a framework for a proposed program developed. RESULTS: Twenty-six key informants participated in our interviews, and several themes were identified. These included providing education for stakeholders (patients, primary care providers, surgeons); challenges with sustaining various resources (laboratory costs, increased workload for pathologists); ensuring consistency of reporting test results; and developing a plan to measure program success. Using these themes, a framework for the reflex-testing program was developed. At a subsequent stakeholder meeting, the framework was refined, and recommendations were identified. CONCLUSIONS: This study identifies factors to ensure the effective implementation of a population-level program for reflex LS testing. The final product is a prototype that can be utilized in other jurisdictions, taking into account local environmental considerations.

6.
JMIR Hum Factors ; 5(3): e25, 2018 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-30181108

RESUMO

BACKGROUND: Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback tools can only be effective if the targeted health professionals access and actively review their data. Email is used by Cancer Care Ontario, a provincial cancer agency, to promote access to a Web-based audit and feedback tool called the Screening Activity Report (SAR); however, current emails that lack behavior change content have been ineffective at encouraging log-in to the SAR. OBJECTIVE: The objective of our study was to describe the process and experience of developing email content that incorporates user input and behavior change techniques (BCTs) to promote the use of the SAR among Ontario primary care providers. METHODS: Our interdisciplinary research team first identified BCTs shown to be effective in other settings that could be adapted to promote use of the SAR. We then developed draft BCT-informed email content. Next, we conducted cocreation workshops with physicians who had logged in to the SAR more than once over the past year. Participants provided reactions to researcher-developed BCT-informed content and helped to develop an email that they believed would prompt their colleagues to use the SAR. Content from cocreation workshops was brought to focus groups with physicians who had not used the SAR in the past year. We analyzed notes from the cocreation workshops and focus groups to inform decisions about content. Finally, 8 emails were created to test BCT-informed content in a 2×2×2 factorial randomized experiment. RESULTS: We identified 3 key tensions during the development of the email that required us to balance user input with scientific evidence, organizational policies, and our scientific objectives, which are as follows: conflict between user preference and scientific evidence, privacy constraints around personalizing unencrypted emails with performance data, and using cocreation methods in a study with the objective of developing an email that featured BCT-informed content. CONCLUSIONS: Teams tasked with developing content to promote health professional engagement with audit and feedback or other quality improvement tools might consider cocreation processes for developing communications that are informed by both users and BCTs. Teams should be cautious about making decisions solely based on user reactions because what users seem to prefer is not always the same as what works. Furthermore, implementing user recommendations may not always be feasible. Teams may face challenges when using cocreation methods to develop a product with the simultaneous goal of having clearly defined variables to test in later studies. The expected role of users, evidence, and the implementation context all warrant consideration to determine whether and how cocreation methods could help to achieve design and scientific objectives.

7.
Gastroenterology ; 155(5): 1325-1347.e3, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30121253

RESUMO

BACKGROUND & AIMS: A family history (FH) of colorectal cancer (CRC) increases the risk of developing CRC. These consensus recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on screening these high-risk individuals. METHODS: Multiple parallel systematic review streams, informed by 10 literature searches, assembled evidence on 5 principal questions around the effect of an FH of CRC or adenomas on the risk of CRC, the age to initiate screening, and the optimal tests and testing intervals. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was used to develop the recommendations. RESULTS: Based on the evidence, the Consensus Group was able to strongly recommend CRC screening for all individuals with an FH of CRC or documented adenoma. However, because most of the evidence was very-low quality, the majority of the remaining statements were conditional ("we suggest"). Colonoscopy is suggested (recommended in individuals with ≥2 first-degree relatives [FDRs]), with fecal immunochemical test as an alternative. The elevated risk associated with an FH of ≥1 FDRs with CRC or documented advanced adenoma suggests initiating screening at a younger age (eg, 40-50 years or 10 years younger than age of diagnosis of FDR). In addition, a shorter interval of every 5 years between screening tests was suggested for individuals with ≥2 FDRs, and every 5-10 years for those with FH of 1 FDR with CRC or documented advanced adenoma compared to average-risk individuals. Choosing screening parameters for an individual patient should consider the age of the affected FDR and local resources. It is suggested that individuals with an FH of ≥1 second-degree relatives only, or of nonadvanced adenoma or polyp of unknown histology, be screened according to average-risk guidelines. CONCLUSIONS: The increased risk of CRC associated with an FH of CRC or advanced adenoma warrants more intense screening for CRC. Well-designed prospective studies are needed in order to make definitive evidence-based recommendations about the age to commence screening and appropriate interval between screening tests.


Assuntos
Adenoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Guias de Prática Clínica como Assunto , Adenoma/genética , Colonoscopia , Neoplasias Colorretais/genética , Consenso , Gastroenterologia , Humanos , Sangue Oculto
8.
CMAJ Open ; 6(3): E330-E338, 2018 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30104417

RESUMO

BACKGROUND: Colonoscopy is used widely, but its quality is highly variable, which may adversely affect patients. Research and quality-improvement initiatives in a variety of jurisdictions have sought to address this issue, often supported by the use of health administrative data. As these data are generally not collected for these purposes, it is critical to measure their validity before use. The aim of this study was to validate health administrative data definitions for 5 key colonoscopy elements through comparison to the clinical record. METHODS: In a cross-sectional study, we randomly sampled 1968 colonoscopy and noncolonoscopy procedures performed at 23 hospitals and 5 nonhospital endoscopy clinics between April 2008 and March 2009 in Ontario. We compared definitions for 5 key colonoscopy elements (colonoscopy case, colonoscopy setting, colonoscopy completeness, anesthesiologist assistance and polypectomy) derived from the health administrative data to the clinical record. We calculated weighted and unweighted sensitivity, specificity and positive predictive value, adjusted for clustering of patients within physicians, for each definition relative to the reference standard. RESULTS: We abstracted 1845 records; in 1282 cases (69.5%), colonoscopy was intended or performed. The weighted sensitivity and specificity of colonoscopy case, nonhospital colonoscopy setting and anesthesiologist assistance exceeded 95%. The weighted sensitivity for colonoscopy completeness and polypectomy exceeded 95%, but specificity was less than 90%. INTERPRETATION: Ontario health administrative data definitions for 5 key colonoscopy data elements performed well, with sensitivity and specificity values acceptable for use in research and quality-improvement initiatives. In jurisdictions where health administrative data are similarly used for research or quality improvement, similar studies could be considered.

10.
Gastroenterology ; 155(3): 909-925.e3, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29958856

RESUMO

BACKGROUND & AIMS: Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term is too restrictive, so the term post-colonoscopy colorectal cancer (PCCRC) was created in 2010. However, PCCRC definitions and methods for calculating rates vary among studies, making it impossible to compare results. We aimed to standardize the terminology, identification, analysis, and reporting of PCCRCs and CRCs detected after other whole-colon imaging evaluations (post-imaging colorectal cancers [PICRCs]). METHODS: A 20-member international team of gastroenterologists, pathologists, and epidemiologists; a radiologist; and a non-medical professional met to formulate a series of recommendations, standardize definitions and categories (to align with interval cancer terminology), develop an algorithm to determine most-plausible etiologies, and develop standardized methodology to calculate rates of PCCRC and PICRC. The team followed the Appraisal of Guidelines for Research and Evaluation II tool. A literature review provided 401 articles to support proposed statements; evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The statements were voted on anonymously by team members, using a modified Delphi approach. RESULTS: The team produced 21 statements that provide comprehensive guidance on PCCRCs and PICRCs. The statements present standardized definitions and terms, as well as methods for qualitative review, determination of etiology, calculation of PCCRC rates, and non-colonoscopic imaging of the colon. CONCLUSIONS: A 20-member international team has provided standardized methods for analysis of etiologies of PCCRCs and PICRCs and defines its use as a quality indicator. The team provides recommendations for clinicians, organizations, researchers, policy makers, and patients.


Assuntos
Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Guias de Prática Clínica como Assunto/normas , Colo/diagnóstico por imagem , Colonoscopia/métodos , Consenso , Detecção Precoce de Câncer/métodos , Humanos , Fatores de Risco , Fatores de Tempo
11.
Gastroenterology ; 154(8): 2279-2280, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29750910
12.
Prev Med ; 111: 180-189, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29548788

RESUMO

Though colorectal cancer (CRC) screening rates have increased over time in Ontario, Canada, immigrants continue to have lower rates of screening. This study examines the association between non-adherence to CRC screening and immigration, socio-demographic, healthcare utilization, and primary care physician characteristics among immigrants to Ontario. This is a population-based retrospective cross-sectional study that uses healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences. Our cohort comprised immigrants aged 60 to 74 years who lived in Ontario on March 31, 2015 and who had been eligible for the Ontario Health Insurance Plan for at least 10 years. The outcome was lack of adherence to CRC screening with any modality (fecal occult blood test, flexible sigmoidoscopy, colonoscopy) on March 31, 2015. Our cohort contained 182,949 immigrants. Overall 70,134 (38%) individuals were not adherent to screening. Risk of non-adherence to CRC screening was higher among immigrants who were from low (adjusted relative risk [ARR] 1.35, 95%CI 1.28-1.42) or low-middle (ARR 1.27, 95%CI 1.24-1.30, population-attributable risk [PAR] 9.8%) income countries and refugees (ARR 1.09, 95%CI 1.06-1.11). Compared to those from the United States, Australia, and New Zealand, immigrants from most other world regions, particularly Eastern Europe and Central Asia (ARR 1.28, 95%CI 1.21-1.37), had higher risks of non-adherence. Non-immigration factors such as low healthcare use and lack of primary care enrolment also increased the risk of non-adherence to screening. These findings can be used to inform future efforts to improve uptake of CRC screening among immigrant groups.

13.
JMIR Res Protoc ; 7(2): e11, 2018 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-29453190

RESUMO

BACKGROUND: Cancer Care Ontario's Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada, identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report. OBJECTIVE: The goal of the study is to determine whether rewritten emails result in increased log-ins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested and how a process evaluation will explore why and how any effects observed were (or were not) achieved. METHODS: A user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing 3 behavior change techniques: anticipated regret, material incentive (behavior), and problem solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimization strategy will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the emails may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semistructured interviews using convenience and snowball sampling. RESULTS: As of April 2017, 5576 primary care physicians across the province of Ontario, Canada, had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May to August 2017 participants received the redesigned monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses. CONCLUSIONS: This study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report. TRIAL REGISTRATION: ClinicalTrials.gov NCT03124316; https://clinicaltrials.gov/ct2/show/NCT03124316 (Archived by WebCite at http://www.webcitation.org/6w2MqDWGu).

14.
Gastrointest Endosc ; 87(5): 1324-1334.e4, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29317271

RESUMO

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.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/epidemiologia , Idoso , Estudos de Coortes , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Ontário/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
15.
J Med Screen ; 25(3): 141-148, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28862521

RESUMO

OBJECTIVE: To evaluate the association between repeated faecal occult blood testing and advanced colorectal cancer risk at population level in Canada. METHODS: A retrospective cohort study of all Ontario residents aged 56-74 diagnosed with colorectal cancer from 1 April 2007 to 31 March 2010, identified using health administrative data. The primary outcome was stage IV colorectal cancer, and primary exposure was faecal occult blood testing use within five years prior to colorectal cancer diagnosis. Patients were categorized into four mutually exclusive groups based on their exposure to faecal occult blood testing in the five years prior to colorectal cancer diagnosis: none, pre-diagnostic, repeated, and sporadic. Logistic regression was utilized to adjust for confounders. RESULTS: Of 7753 patients (median age 66, interquartile range 61-70, 62% male) identified, 1694 (22%) presented with stage I, 2056 (27%) with stage II, 2428 (31%) with stage III, and 1575 (20%) with stage IV colorectal cancer. There were 4092 (53%) with no record of prior faecal occult blood testing, 1485 (19%) classified as pre-diagnostic, 1693 (22%) as sporadic, and 483 (6%) as repeated faecal occult blood testing. After adjusting for confounders, patients who had repeated faecal occult blood testing were significantly less likely to present with stage IV colorectal cancer at diagnosis (Odds ratio 0.46, 95% Confidence Interval 0.34-0.62) than those with no prior faecal occult blood testing. CONCLUSIONS: Repeated faecal occult blood testing is associated with a decreased risk of advanced colorectal cancer. Our findings support the use of organized screening programmes that employ repeated faecal occult blood testing to improve colorectal cancer outcomes at population level.

16.
Gastroenterology ; 154(1): 77-85.e3, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28865733

RESUMO

BACKGROUND & AIMS: The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury. METHODS: In a population-based cohort study using administrative databases, we studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012. Patient, endoscopist, institution, and procedure factors were derived. The primary outcome was bowel perforation, defined using a validated algorithm. Secondary outcomes were splenic injury and aspiration pneumonia. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression models under a generalized estimating equations approach to explore the relationship between AA and outcomes. RESULTS: Data from 3,059,045 outpatient colonoscopies were analyzed; 862,817 of these included AA. After propensity matching, a cohort of 793,073 patients who had AA and 793,073 without AA was retained for analysis (51% female; 78% were age 50 years or older). Use of AA did not significantly increase risk of perforation (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.84-1.16) or splenic injury (OR, 1.09; 95% CI, 0.62-1.90]. Use of AA was associated with an increased risk of aspiration pneumonia (OR, 1.63; 95% CI, 1.11-2.37). CONCLUSIONS: In a population-based cohort study, AA for outpatient colonoscopy was associated with a significantly increased risk of aspiration pneumonia, but not bowel perforation or splenic injury. Endoscopists should warn patients, especially those with respiratory compromise, of this risk.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia/efeitos adversos , Colonoscopia/efeitos adversos , Sedação Profunda/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Intravenosos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Perfuração Intestinal/epidemiologia , Masculino , Pessoa de Meia-Idade , Ontário , Pneumonia Aspirativa/epidemiologia , Propofol/uso terapêutico , Baço/lesões , Adulto Jovem
17.
Arch Pathol Lab Med ; 142(1): 75-82, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28967803

RESUMO

CONTEXT: - Although promising for colorectal cancer screening, hemoglobin (Hb) stability remains a concern with fecal immunochemical tests. This study implemented a novel, standardized method to compare Hb stability across various fecal immunochemical tests. The method can be used to inform decisions when selecting a kit for use in colorectal cancer screening. In so doing, this work addressed a critical need for standardization in this field. OBJECTIVE: - To compare the stability of Hb across 5 different immunochemical kits and one guaiac kit. DESIGN: - The stability of Hb was analyzed in collection devices inoculated with Hb-spiked feces and (1) stored at various temperatures (frozen, refrigerated, ambient, and elevated) for more than 60 days; (2) after undergoing 3 controlled, freeze-thaw cycles; and (3) after being transported by courier or postal services in uncontrolled temperature conditions from 3 locations in Ontario, Canada, to a central testing center. RESULTS: - The stability of Hb varied with time and temperature and by kit. Lower Hb recoveries occurred with increasing temperature and increasing time from sample collection to testing. Refrigeration provided the best stability, although results varied across kits (eg, from 4.2 days to >60 days before a prespecified threshold [<70% probability of the test results remaining positive] was reached). Freeze-thaw stability varied across kits and cycles (Hb recoveries: NS Plus [Alfresa Pharma, Chuo-ku, Osaka, Japan], 91.7% to 95.4%; OC Diana [Eiken Chemical, Taito-ku, Tokyo, Japan], 57.6% to 74.9%). Agreement regarding Hb levels before and after transportation varied across kits (from 57% to 100%). CONCLUSIONS: - Important differences in Hb stability were found across the included fecal immunochemical tests. These findings should inform practice-based and population-based colorectal cancer screening.


Assuntos
Neoplasias Colorretais/diagnóstico , Hemoglobinas/análise , Imunoquímica/métodos , Sangue Oculto , Detecção Precoce de Câncer/métodos , Fezes/química , Guaiaco , Humanos , Indicadores e Reagentes , Programas de Rastreamento/métodos , Estabilidade Proteica , Manejo de Espécimes/métodos , Temperatura Ambiente , Fatores de Tempo
19.
Am J Gastroenterol ; 112(12): 1790-1801, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29087393

RESUMO

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.


Assuntos
Adenoma/mortalidade , Adenoma/patologia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Colonoscopia , Humanos
20.
Can J Gastroenterol Hepatol ; 2017: 5917057, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29082224

RESUMO

BACKGROUND: The goal of this study is to examine utilization of early repeat colonoscopy ≤ 6 months after an index procedure. METHODS: We identified persons having repeat colonoscopy ≤ 6 months following outpatient colonoscopy without prior colonoscopy ≤ 5 years or prior diagnosis of colorectal cancer (CRC). We modeled repeat colonoscopy using a generalized estimating equation with an exchangeable correlation structure to account for clustering of patients by endoscopist. RESULTS: The population included 334,663 persons, 7,892 (2.36%) of whom had an early repeat colonoscopy within 6 months. Overall, endoscopist prior year colonoscopy volume was inversely related to repeat ≤ 6 months. Repeat colonoscopy ≤ 6 months varied by the clinical setting of the index colonoscopy (adjusted OR = 1.41 (95% CI 1.29-1.55)) at nonhospital facilities compared to teaching or community hospitals. Among those who had polypectomy or biopsy, the adjusted OR for early repeat ≤ 6 months was elevated among those whose index colonoscopy was at a nonhospital facility (OR 1.44, 95% CI 1.30-1.60), compared to those at a teaching hospital or community hospital. CONCLUSIONS: Repeat colonoscopy ≤ 6 months after an index procedure is associated with the clinical setting of the index colonoscopy.


Assuntos
Assistência Ambulatorial/métodos , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Idoso , Biópsia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário
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