Publications by authors named "David S Weinberg"

74 Publications

Colorectal Cancer Screening in Young Adults: About Carcinoid Tumors and Cancer.

Ann Intern Med 2021 02 15;174(2):263-264. Epub 2020 Dec 15.

Fox Chase Cancer Center Philadelphia, Pennsylvania.

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http://dx.doi.org/10.7326/M20-7244DOI Listing
February 2021

Cost-effectiveness of surveillance with CT colonography after resection of colorectal cancer.

BMJ Open Gastroenterol 2020 09;7(1)

Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

Objective: Surveillance following colorectal cancer (CRC) resection uses optical colonoscopy (OC) to detect intraluminal disease and CT to detect extracolonic recurrence. CT colonography (CTC) might be an efficient use of resources in this situation because it allows for intraluminal and extraluminal evaluations with one test.

Design: We developed a simulation model to compare lifetime costs and benefits for a cohort of patients with resected CRC. Standard of care involved annual CT for 3 years and OC for years 1, 4 and every 5 years thereafter. For the CTC-based strategy, we replace CT+OC at year 1 with CTC. Patients with lesions greater than 6 mm detected by CTC underwent OC. Detection of an adenoma 10 mm or larger was followed by OC at 1 year, then every 3 years thereafter. Test characteristics and costs for CTC were derived from a clinical study. Medicare costs were used for cancer care costs as well as alternative test costs. We discounted costs and effects at 3% per year.

Results: For persons with resected stage III CRC, the standard-of-care strategy was more costly (US$293) and effective (2.6 averted CRC cases and 1.1 averted cancer deaths per 1000) than the CTC-based strategy, with an incremental cost-effectiveness ratio of US$55 500 per quality-adjusted life-year gained. Our analysis was most sensitive to the sensitivity of CTC for detecting polyps 10 mm or larger and assumptions about disease progression.

Conclusion: In a simulation model, we found that replacing the standard-of-care approach to postdiagnostic surveillance with a CTC-based strategy is not an efficient use of resources in most situations.
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http://dx.doi.org/10.1136/bmjgast-2020-000450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493100PMC
September 2020

Comparing the clinical impact of pancreatic cyst surveillance programs: A trial of the ECOG-ACRIN cancer research group (EA2185).

Contemp Clin Trials 2020 10 10;97:106144. Epub 2020 Sep 10.

University of Pennsylvania-Abramson Cancer Center, Philadelphia, PA, United States of America.

Background: The optimal surveillance strategy for pancreatic cysts, which occur in up to 20% of the adult population, is ill defined. The risk of malignant degeneration of these cysts is low, however the morbidity and mortality associated with pancreatic cancer are high. Two clinical surveillance guidelines are in regular use. Both the Fukuoka and American Gastroenterological Association (AGA) guidelines rely on radiographic and endoscopic imaging. They differ primarily in their recommended frequencies of interval surveillance imaging. While evidence driven clinical guidelines should promote higher quality care, competing guidelines on the same topic may provide discordant recommendations and potential reduction in the quality and/or value of care.

Objectives: The primary objective is to compare the clinical effectiveness of the two surveillance guidelines to identify patients most likely to benefit from pancreatic resection. Secondary objectives include comparison of resource utilization, patient reported outcomes, incidental findings are other clinical outcomes.

Methods: 4606 asymptomatic patients with newly identified pancreatic cysts ≥1 cm in diameter will be randomized 1:1 to high intensity (Fukuoka) or low intensity (AGA) surveillance. All participants will be followed prospectively for 5 years.

Conclusion: Differing guidelines confuse providers, patients and policymakers. This large, prospective, randomized trial will compare the clinical effectiveness and resource allocation requirements of two guidelines addressing a common clinical entity. CLINICALTRIALS.

Gov Identifier: NCT04239573.
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http://dx.doi.org/10.1016/j.cct.2020.106144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686040PMC
October 2020

A War on Two Fronts: Cancer Care in the Time of COVID-19.

Ann Intern Med 2020 06 27;172(11):756-758. Epub 2020 Mar 27.

Fox Chase Cancer Center, Philadelphia, Pennsylvania (A.K., D.S.W., M.J.E., E.M.H., R.G.U., R.I.F.).

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http://dx.doi.org/10.7326/M20-1133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133056PMC
June 2020

Preneoplastic Colorectal Polyps: "I Found Them and Removed Them-Now What?"

Ann Intern Med 2019 11 24;171(9):667-668. Epub 2019 Sep 24.

University of Pittsburgh, Pittsburgh, Pennsylvania (R.E.S.).

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http://dx.doi.org/10.7326/M19-2795DOI Listing
November 2019

Post-operative colorectal cancer surveillance: preference for optical colonoscopy over computerized tomographic colonography.

Cancer Causes Control 2019 Nov 17;30(11):1269-1273. Epub 2019 Sep 17.

Fox Chase Cancer Center, Philadelphia, PA, USA.

Purpose: Post-operative surveillance strategies for colorectal cancer (CRC) include periodic optical colonoscopy (OC) and abdominal-pelvic CT scan. Adherence with these recommendations is limited. For CRC screening, CT colonography (CTC) identifies larger adenomas and cancers nearly as well as OC. Most screening studies demonstrate that patients prefer CTC. However, CTC has never been compared to OC in the post-operative surveillance setting.

Methods: We hypothesized that CTC might represent an attractive substitute for the standard OC/CT scan combination. Here, 223 patients underwent CTC followed by same day OC 1 year after curative CRC resection.

Results: Of the 144/223 (64.6%) participants with a preference, 65.9% (95/144) preferred OC. This preference was more pronounced in women and in patients with polyps detected. No additional patient level factors significantly altered this primary result.

Conclusions: In contrast to CRC screening, this first study in CRC post-operative surveillance patients demonstrates a preference for OC. Assuming patient preference is an important determinant, introduction of CTC as a method to increase patient adherence with CRC surveillance is unlikely to be effective.

Trial Registration: Clinical Trials.gov registration number: NCT02143115.
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http://dx.doi.org/10.1007/s10552-019-01231-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534185PMC
November 2019

From Colorectal Cancer Screening Guidelines to Headlines: Beware!

Ann Intern Med 2019 05;170(10):734

Fox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.).

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http://dx.doi.org/10.7326/L19-0086DOI Listing
May 2019

Adherence to postresection colorectal cancer surveillance at National Cancer Institute-designated Comprehensive Cancer Centers.

Cancer Med 2018 11 18;7(11):5351-5358. Epub 2018 Oct 18.

Fox Chase Cancer Center, Philadelphia, Pennsylvania.

Guidelines recommend surveillance after resection of colorectal cancer (CRC), but rates of adherence to surveillance are variable and have not been studied at National Cancer Institute (NCI)-designated Comprehensive Cancer Centers. The aim of this study was to determine rates of adherence to standard postresection CRC surveillance recommendations including physician visits, carcinoembryonic antigen (CEA), computed tomography (CT), and colonoscopy after CRC resection at three NCI-designated centers. Data on patients with resected CRC from 2010 to 2017 were reviewed. Adherence to physician visits was defined as having at least two visits within 14 months after surgical resection. CEA adherence was defined as having at least four CEA levels drawn within 14 months. CT and colonoscopy adherence were defined as completing each between 10 and 14 months from surgical resection. Chi-square test and logistic regression analyses were performed for overall adherence and adherence to individual components. A total of 241 CRC patients were included. Overall adherence was 23%. While adherence to physician visits was over 98%, adherence to CEA levels, CT, and colonoscopy were each less than 50%. Center was an independent predictor of adherence to CEA, CT, and/or colonoscopy. Stage III disease predicted CT adherence, while distance traveled of 40 miles or less predicted colonoscopy adherence. Overall adherence to postresection CRC guideline-recommended care is low at NCI-designated centers. Adherence rates to surveillance vary by center, stage, and distance traveled for care. Understanding factors associated with adherence is critical to ensure CRC patients benefit from postresection surveillance.
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http://dx.doi.org/10.1002/cam4.1678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247039PMC
November 2018

From Colorectal Cancer Screening Guidelines to Headlines: Beware!

Ann Intern Med 2018 09 10;169(6):405-406. Epub 2018 Jul 10.

Fox Chase Cancer Center, Philadelphia, Pennsylvania (D.S.W.).

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http://dx.doi.org/10.7326/M18-1720DOI Listing
September 2018

Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery.

Gastroenterology 2018 03 22;154(4):927-934.e4. Epub 2017 Nov 22.

Fox Chase Cancer Center, Philadelphia, Pennsylvania.

Background & Aims: Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance.

Methods: Our study enrolled 231 patients with resected stage 0-III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard.

Results: Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2-57.8) and 93.4% specificity (95% CI, 89.7-97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0-99.8) and 89.0% specificity (95% CI, 84.8-93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7-94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0-100).

Conclusions: In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.
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http://dx.doi.org/10.1053/j.gastro.2017.11.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847443PMC
March 2018

Prospective Trial Evaluating the Surgical Anastomosis at One-Year Colorectal Cancer Surveillance: CT Colonography Versus Optical Colonoscopy and Implications for Patient Care.

Dis Colon Rectum 2017 Nov;60(11):1162-1167

1 University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin 2 Fox Chase Cancer Center, Philadelphia, Pennsylvania 3 Mayo Clinic, Rochester, Minnesota 4 Memorial Sloan-Kettering Cancer Center, New York, New York 5 University of Chicago Medical Center, Chicago, Illinois.

Objective: The aim of this study was to compare the accuracy of CT colonography versus optical colonoscopy for neoplastic involvement at the surgical anastomosis 1 year after curative-intent colorectal cancer resection.

Design, Setting, Patients, And Interventions: Two hundred one patients (mean age, 58.6 years; 117 men, 84 women) underwent same-day contrast-enhanced CT colonography and colonoscopy approximately 1 year (mean, 12.1 months; median, 11.9 months) after colorectal cancer resection as part of a prospective, multicenter trial. All patients enrolled were without clinical evidence of disease and considered low risk for recurrence (stage I-III).

Main Outcome Measures: Suspected neoplastic lesions within 5 cm of the colonic anastomosis were recorded at CT colonography, with subsequent colonoscopy performed for the same, with segmental unblinding of colonography findings. Anastomotic region biopsy or polypectomy was performed at the endoscopist's discretion.

Results: None of the 201 patients had intraluminal anastomotic cancer recurrence or advanced neoplasia (or metachronous cancers). CT colonography detected extramural perianastomotic recurrence in 2 patients (1.0%); neither was detected at colonoscopy. Only 2 patients (1.0%; 2/201) were called positive at CT colonography for intraluminal anastomotic nondiminutive lesions (7- to 8-mm polyps), which were confirmed at colonoscopy but nonneoplastic at histopathology. At optical colonoscopy, the anastomosis was deemed abnormal and/or biopsied in 10.0% (20/201), yielding only 1 nondiminutive benign neoplasm (7-mm tubular adenoma).

Limitations: The lack of luminal cancer recurrence in our lower-risk cohort precludes assessment of sensitivity for detection, rendering the study underpowered in this regard. Potential cost savings of combined CT/CT colonography over the standard CT/colonoscopy approach were not assessed.

Conclusions: Relevant intraluminal anastomotic pathology appears to be very uncommon 1 year after colorectal cancer resection in lower-risk cohorts. Unlike colonoscopy, diagnostic contrast-enhanced CT colonography effectively evaluates both the intra- and extraluminal aspects of the anastomosis. See Video Abstract at http://links.lww.com/DCR/A471.
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http://dx.doi.org/10.1097/DCR.0000000000000845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635837PMC
November 2017

Bioactivity of Oral Linaclotide in Human Colorectum for Cancer Chemoprevention.

Cancer Prev Res (Phila) 2017 Jun 10;10(6):345-354. Epub 2017 Apr 10.

Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.

Guanylate cyclase C (GUCY2C) is a tumor-suppressing receptor silenced by loss of expression of its luminocrine hormones guanylin and uroguanylin early in colorectal carcinogenesis. This observation suggests oral replacement with a GUCY2C agonist may be an effective targeted chemoprevention agent. Linaclotide is an FDA-approved oral GUCY2C agonist formulated for gastric release, inducing fluid secretion into the small bowel to treat chronic idiopathic constipation. The ability of oral linaclotide to induce a pharmacodynamic response in epithelial cells of the colorectum in humans remains undefined. Here, we demonstrate that administration of 0.87 mg of oral linaclotide daily for 7 days to healthy volunteers, after oral colon preparation with polyethylene glycol solution (MoviPrep), activates GUCY2C, resulting in accumulation of its product cyclic (c)GMP in epithelial cells of the cecum, transverse colon, and distal rectum. GUCY2C activation by oral linaclotide was associated with homeostatic signaling, including phosphorylation of vasodilator-stimulated phosphoprotein and inhibition of proliferation quantified by reduced Ki67-positive epithelial cells. In the absence of the complete oral colonoscopy preparation, linaclotide did not alter cGMP production in epithelial cells of the colorectum, demonstrating that there was an effect related to the laxative preparation. These data show that the current FDA-approved formulation of oral linaclotide developed for small-bowel delivery to treat chronic idiopathic constipation is inadequate for reliably regulating GUCY2C in the colorectum to prevent tumorigenesis. The study results highlight the importance of developing a novel GUCY2C agonist formulated for release and activity targeted to the large intestine for colorectal cancer prevention. .
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http://dx.doi.org/10.1158/1940-6207.CAPR-16-0286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758862PMC
June 2017

Colorectal Cancer Screening in the United States: What Is the Best FIT?

Ann Intern Med 2017 Feb 25;166(4):297-298. Epub 2016 Oct 25.

From Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas.

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http://dx.doi.org/10.7326/M16-2341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573882PMC
February 2017

Biomarkers in Colorectal Cancer Screening.

J Natl Compr Canc Netw 2016 08;14(8):1033-40

From Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania.

Colorectal cancer (CRC) is the third most common cause of cancer death in men and women in the United States. The main goals of screening are to prevent carcinogenesis (via adenoma detection and removal) and detect cancer at an early, curable stage. CRC mortality is steadily dropping in the United States, partly because of greater screening utilization. However, nearly 1 in 3 average-risk people are not up to date with standard CRC screening recommendations. This review surveys a wide range of CRC biomarkers in various stages of development, which may offer attractive risk stratification tools; a few have reached the commercial stage. If widely accepted, these tools may contribute to shift CRC screening practices away from 1-step colonoscopy to a 2-step risk stratification process of predictive biomarker measurements followed by colonoscopy for lower-risk patients with a positive result. Such strategies could potentially increase the rate of CRC screening.
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http://dx.doi.org/10.6004/jnccn.2016.0109DOI Listing
August 2016

AGA Clinical Practice Guidelines: Robust, Evidence-Based Tools for Guiding Clinical Care Decisions.

Gastroenterology 2015 Aug 29;149(2):493-5. Epub 2015 Jun 29.

Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1053/j.gastro.2015.06.040DOI Listing
August 2015

BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia.

Am J Gastroenterol 2015 May 14;110(5):662-82; quiz 683. Epub 2015 Apr 14.

Oregon Health and Science University, Portland, Oregon, USA.

Objectives: Barrett's esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD).

Methods: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations.

Results: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients.

Conclusions: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.
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http://dx.doi.org/10.1038/ajg.2015.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436697PMC
May 2015

Effects of genetic and environmental risk assessment feedback on colorectal cancer screening adherence.

J Behav Med 2015 Oct 18;38(5):777-86. Epub 2015 Mar 18.

Fox Chase Cancer Center, Philadelphia, PA, USA.

Little is known about the impact of genetic and environmental risk assessment (GERA) feedback on colorectal cancer (CRC) screening. In a recently completed randomized trial, primary care patients received GERA feedback based on a blood test for genetic polymorphisms and serum folate level (GERA Group) versus usual care (Control Group). Subsequently, participants were offered CRC screening. Among participants who received GERA feedback, being at elevated risk was negatively associated with prospective CRC screening adherence. Secondary analyses of data from this study were performed to identify independent predictors of adherence among participants who received GERA feedback. We obtained baseline survey, follow-up survey, and endpoint medical records data on sociodemographic background, knowledge, psychosocial characteristics, risk status, and adherence for 285 GERA Group participants. Univariate and multivariable analyses were performed to identify predictors of CRC screening adherence. Following a 6-month outcomes observation period, we also conducted two focus groups with GERA Group participants to assess their perceptions of GERA risk feedback and screening. Content analyses of focus group data were evaluated to gain insights into participant response to risk feedback. Overall, half of GERA Group participants adhered to screening within 6 months after randomization. Multivariable analyses showed a statistically significant interaction between race and GERA feedback status relative to screening adherence (p = 0.043). Among participants who received average risk feedback, adherence was comparable among whites (49.7 %) and nonwhites (54.1 %); however, among those at elevated risk, adherence was substantially higher among whites (66.7 %) compared to nonwhites (33.3 %). Focus group findings suggest that whites were more likely than nonwhites to view elevated risk feedback as a prompt to screen. In response to receiving elevated risk feedback, nonwhites were more likely than whites to report feeling anxiety about the likelihood of being diagnosed with CRC. Further research is needed to explore race-related CRC screening differences in response to GERA feedback.
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http://dx.doi.org/10.1007/s10865-015-9626-5DOI Listing
October 2015

Management of pancreatic cysts in an evidence-based world.

Gastroenterology 2015 Apr 24;148(4):692-5. Epub 2015 Feb 24.

Case Western Reserve University School of Medicine, Cleveland, Ohio.

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http://dx.doi.org/10.1053/j.gastro.2015.02.035DOI Listing
April 2015

Genetic and environmental risk assessment and colorectal cancer screening in an average-risk population: a randomized trial.

Ann Intern Med 2014 Oct;161(8):537-45

Background: New methods are needed to improve health behaviors, such as adherence to colorectal cancer (CRC) screening. Personalized genetic information to guide medical decisions is increasingly available. Whether such information motivates behavioral change is unknown.

Objective: To determine whether individualized genetic and environmental risk assessment (GERA) of CRC susceptibility improves adherence to screening in average-risk persons.

Design: 2-group, randomized, controlled trial. (ClinicalTrials.gov: NCT0087360).

Setting: 4 medical school-affiliated primary care practices.

Participants: 783 participants at average risk for CRC who were not adherent to screening at study entry.

Intervention: Participants were randomly assigned to usual care or GERA, which evaluated methylenetetrahydrofolate reductase polymorphisms and serum folate levels. On the basis of prespecified combinations of polymorphisms and serum folate levels, GERA recipients were told that they were at elevated or average risk for CRC.

Measurements: The primary outcome was CRC screening within 6 months of study entry.

Results: Overall screening rates for CRC did not statistically significant differ between the usual care (35.7%) and GERA (33.1%) groups. After adjustment for baseline participant factors, the odds ratio for screening completion for GERA versus usual care was 0.88 (95% CI, 0.64 to 1.22). Within the GERA group, screening rates did not significantly differ between average-risk (38.1%) and elevated-risk (26.9%) participants. Odds ratios for elevated- versus average-risk participants remained nonsignificant after adjustment for covariates (odds ratio, 0.75 [CI, 0.39 to 1.42]).

Limitation: Only 1 personalized genetic and environmental interaction and 1 health behavior (CRC screening) were assessed.

Conclusion: In average-risk persons, CRC screening uptake was not positively associated with feedback from a single personalized GERA. Additional studies will be required to evaluate whether other approaches to providing GERA affect screening utilization differently. These findings raise concern about the effectiveness of moderately predictive assessment of genetic risk to promote favorable health care behavior.

Primary Funding Source: National Institutes of Health.
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http://dx.doi.org/10.7326/M14-0765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412019PMC
October 2014

American Gastroenterological Association Institute Guideline on the pharmacological management of irritable bowel syndrome.

Gastroenterology 2014 Nov 16;147(5):1146-8. Epub 2014 Sep 16.

Department of Veterans Affairs Medical Center, Gastroenterology Section, North Florida/South Georgia Veterans Health System, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida; Minneapolis Veterans Affairs Health System, University of Minnesota, Minneapolis, Minnesota.

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http://dx.doi.org/10.1053/j.gastro.2014.09.001DOI Listing
November 2014

Medicare physician payment data: is this transparency?

Ann Intern Med 2014 Aug;161(4):291-2

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http://dx.doi.org/10.7326/M14-0913DOI Listing
August 2014

How to recognize a good guideline.

Gastroenterology 2013 Dec;145(6):1179-81

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http://dx.doi.org/10.1053/j.gastro.2013.10.025DOI Listing
December 2013

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples.

Psychol Health 2013 9;28(9):1046-65. Epub 2013 Apr 9.

a Population Science , UMDNJ/The Cancer Institute of New Jersey , New Brunswick , NJ , USA .

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands' support of their wives' CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples' ability to view CRCS as having benefit for the marital relationship.
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http://dx.doi.org/10.1080/08870446.2013.781601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778151PMC
December 2013