Morphological Features of Dysplastic Progression in Epithelium: Quantification of Cytological, Microendoscopic, and Second Harmonic Generation Images

Advances in imaging technology have led to a variety of available clinical and investigational systems. In this collection of studies, we tested the relevance of morphological image feature quantification on several imaging systems and epithelial tissues. Quantification carries the benefit of creating numerical baselines and thresholds of healthy and abnormal tissues, to potentially aid clinicians in determining a diagnosis, as well as providing researchers with standardized, unbiased results for future dissemination and comparison. Morphological image features in proflavine stained oral cells were compared qualitatively to traditional Giemsa stained cells, and then we quantified the nuclear to cytoplasm ratio. We determined that quantification of proflavine stained cells matched our hypothesis, as the nuclei in oral carcinoma cells were significantly larger than healthy oral cells. Proflavine has been used in conjunction with translational fluorescence microendoscopy of the gastrointestinal tract, and we demonstrated the ability of our custom algorithm to accurately (up to 85% sensitivity) extract colorectal crypt area and circularity data, which could minimize the burden of training on clinicians. In addition, we proposed fluorescein as an alternative fluorescent dye, providing comparable crypt area and circularity information. In order to investigate the morphological changes of crypts via the supporting collagen structures, we adapted our quantification algorithm to analyze crypt area, circularity, and an additional shape parameter in second harmonic generation images of label-free freshly resected murine epithelium. Murine models of colorectal cancer (CRC) were imaged at early and late stages of tumor progression, and we noted significant differences between the Control groups and the late cancer stages, with some differences between early and late stages of CRC progression

Investigating socioeconomic disparities in cancer survival using geographic area-based measures

Many studies in developed countries around the world have reported variations in cancer survival associated with socioeconomic status. Understanding the causes of survival disparities is of continued interest to inform interventions targeting disparities, and monitoring survival trends over time to evaluate the effectiveness of such interventions. Cancer survival is a useful measure in evaluating cancer control efforts, giving a quantifiable measure of the effectiveness of diagnostic and treatment services, and the management of cancer care. Ecologic analyses are widely used for evaluating the effectiveness of a population intervention. Increased socioeconomic variability within geographic area-units makes it difficult to isolate the discrete effect of socioeconomic status on cancer survival, particularly when using few, or large, geographic units. Despite recent research interest in socioeconomic disparities in cancer outcomes, NSW cancer-registry data has not been used to track temporal trends in survival disparities for many years. Furthermore, no study in NSW has investigated how the geographic area-level at which SES is measured impacts the survival disparities detected. This thesis analyses trends in socioeconomic survival disparities over time for ten major cancers in New South Wales, demonstrating that recent health and social policies in NSW have accompanied an increase in cancer survival overall, but they have not been associated with a reduction in socioeconomic inequalities. This thesis also compares two different area-units for measuring socioeconomic disparities in cancer survival in NSW, showing that while patient SES classification differed between area-units, the impact on cancer survival disparities of SES misclassification when using the larger area-unit was relatively small and inconsistent. Overall, this thesis emphasizes the importance of assessing progress toward eliminating cancer survival inequalities and has important implications for predicting and planning for the future needs of cancer care services in NSW. This thesis also contributes to the field of epidemiology by improving our understanding of the impact of using area-based measures of differing geographical precision when investigating socioeconomic inequalities in health outcomes

Implementation Of Cervical Cancer Screening Protocol (CCSP): A Quality Improvement Project

Abstract Background and significance: Cervical cancer is the fourth most commonly occurring cancer in women and the eighth most commonly occurring cancer overall (WCRF, 2020). Papanicolaou (Pap) testing is the primary screening for cervical cancer. In the past 40 years the number of cases and deaths from cervical cancer has decreased significantly, resulting from cervical cancer screenings (CDC, 2021). Healthy People 2030 reports to increase the proportion of females ages 21-65 who receive a cervical cancer screening based on the most recent guidelines. The 2030 target is 84.3%. Human papillomavirus (HPV) is a virus that is transmitted through sexual contact and is the leading cause of cervical cancer. Purpose: The purpose of this quality improvement (QI) project is to support the implementation of the Women’s Health Cervical Cancer Screening Protocol (CCSP) in Primary Care Practices within a federal qualified health center (FQHC) serving the underserved residents in Southwestern PA. The goal of the CCSP is to review the current pap workflow in comparison to the ASCCP guidelines, HPV vaccine, and correct documentation. Methods: This project utilized the Model of Improvement and the PDSA approach in the implementation of the CCSP in a selected primary care clinic. A program charter was developed with the FQHC stakeholders that guided the CCSP implementation and evaluation. After training sessions with the staff and providers the CCSP workflow processes was implemented, Audits of the EHR documentation reviewing compliance with ASCCP guidelines and HPV vaccine guidelines. Results: After completion of CCSP, EHR documentation audits compliance with the CCSP improved by 75% as compared to pre-implementation EHR documentation. The CCSP workflow was adopted with the recommendation that the NextGen Clinical Care Guidelines module to be implemented to support compliance and monitoring of the CCSP process. This will result in improved UDS cervical cancer screening performance measures. Keywords: cervical cancer screening, cervical cancer guidelines, HPV, cervical cancer tracking, EHR, HIT, HIT/cance

An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers

Indiana University-Purdue University Indianapolis (IUPUI)A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations

J Registry Manag

Background:Cancer incidence and death rates in the United States are often published at the county or state-levels; examining cancer statistics at the congressional district (CD) level allows decision makers to better understand how cancer is impacting the specific populations they represent.Methods:Cancer incidence data were obtained from the Centers for Disease Control and Prevention\u2019s National Program of Cancer Registries and the National Cancer Institute\u2019s Surveillance, Epidemiology, and End Results Program. Mortality data were obtained from the National Center for Health Statistics. CD rates were estimated by assigning the county-level age-adjusted rates to the census block and weighting those by the block population proportion of the CD. Those weighted rates were then aggregated over the blocks within the CD to estimate the district rate. Incidence rate estimates for 406 CDs and death rate estimates for 436 CDs were reported according to the boundaries for the 115th Congress of the United States. Maps showing rate estimates for all cancers combined, lung/bronchus, colorectal, female breast, cervical, and prostate cancer are presented by sex and race/ethnicity.Results:The distribution of cancer incidence and death rates by CDs show similar patterns to those that have been observed at the county and state levels, with the highest cancer incidence and death rates observed in CDs in the South and Eastern regions.Conclusion:This examination of cancer rates at the CD-level provides data that can be used to inform cancer control strategies at the local and national levels. Displaying the data with the Data Visualizations tool makes it easily accessible to the public and decision makers.20202022-04-04T00:00:00ZCC999999/ImCDC/Intramural CDC HHSUnited States/35363673PMC89785381119

Impact of Report Recommendation on Follow-Up Ultrasound Studies in the Work-Up of Incidental Thyroid Nodules

The primary objective of this study was to determine the impact of report recommendation on follow-up ultrasound studies in the work-up of incidental thyroid nodules. Secondary objective was to determine the rate of cost savings, number of missed thyroid cancers avoided, and number of negative fine needle aspirations/biopsies avoided. This study utilized de-identified data of RadPartners (RP) from 102 hospitals and 180 outpatient centers, 1936 CT scans pre-intervention and 2121 CT scans post-intervention were analyzed. Secondary analysis was performed utilizing Medicare cost data from a 5 percent sample data set from the Comparative Effectiveness and Data Analysis Resource (CEDAR). Results demonstrate a cost savings of $23,057,207 in the Medicare population with 7,592 negative fine needle aspirations/biopsies and 750 additional thyroid cancers detected. Using a clinical decision tree model and economic modeling, best practice development for the reporting of incidental thyroid nodules will lead to improvement in value of care. This model can be applied in future studies of other common incidentaloma management and associated Medicare cost analysis

Identifying eligible patients for Human Immunodeficiency Virus (HIV) testing in UK primary care setting: derivation and internal validation of HIV risk score using a retrospective cohort study and investigation of issues in implementation.

The Acquired Immuno-Deficiency Syndrome (AIDS) and its causative agent, Human Immunodeficiency Virus (HIV) were recognised in the early 1980s. HIV/AIDS is one of the highest contributors to morbidity and a leading cause of mortality, worldwide, making it a public health concern. Diagnosis with HIV during the 1980s and early 1990s was like a death penalty but the life expectancy of the HIV infected individuals has increased over the years and is approaching that for the general population. This is attributed to improvement in management and treatment of people living with HIV/AIDS, the effective use of antiretroviral therapies (ARTs) combined with early HIV diagnosis, because earlier treatment with ARTs is more effective. In addition to enabling individuals to get better health outcomes and optimise their quality of life, early diagnosis of HIV is also important in reducing onward transmission of the disease and reducing healthcare costs. In UK, an action plan was put in plan to eliminate HIV/AIDS by 2025 and this relies on increasing uptake of HIV testing in various settings including primary care, in order to increase early diagnosis. This thesis developed a prediction model which could be used in primary care to identify patients likely to be HIV positive and to prompt clinicians to offer them HIV testing. It also investigated issues in implementation of a point-of-care alert. A systematic review was conducted to identify candidate predictor variables to use in the prediction model. Qualitative research was undertaken to find out if GPs used euphemistic terms to record a diagnosis of HIV in primary care records. Using the results from the systematic review and the qualitative research, a cohort study was conducted to derive and internally validate a HIV prediction model. Finally, a systematic review was conducted to elicit clinicians’ views on barriers and facilitators of use of point-of-care alerts to ensure that they are considered in the development of a HIV point-of-care alert. Demographic, socio-economic, lifestyle/behavioural, and clinical and comorbid conditions that predict risk of HIV infection were identified in this research. The demographic and socio-economic predictors associated with a risk of HIV infection were female gender (HR, 1.19 (CI: 1.13-1.25)), 25-34 years age group (HR, 1.29 (CI: 1.21-1.39)), being of black, (HR 10.95 (CI: 10.08-11.89)) and mixed/other ethnicity, deprivation (HR ranging from 1.3 to 1.85, increasing with deprivation) and living in urban areas (HR, 1.12 (CI: 1-1.25)). Lifestyle predictors were current smoker or ex-smoker (HR, 1.01 (CI:1.01-1.02), drug misuse (HR, 2.25 (CI: 2.01-2.52)) and contact abroad (HR, 2.04 (CI: 1.76-2.36)). Clinical and comorbid conditions included Kaposi’s sarcoma (HR, 171.01 (CI: 89.06-328.37)), pneumocystis carinii (HR, 71.15 (CI: 10.09-501.98)), progressive multifocal leukoencephalopathy (HR, 55.89 (CI: 14.16-220.66)), syphilis (HR, 10.88 (CI: 6.86-17.27)), non-Hodgkin’s lymphoma (HR, 9.31 (CI: 7.04-12.33)), tuberculosis (HR, 2.29 (CI: 1.15-4.55)), cerebral toxoplasmosis abscess (HR, 7.88 (CI: 2.98-20.84)). The other clinical and comorbid predictors were anal cancer or anal intraepithelial dysplasia, aseptic meningitis/encephalitis, oral candidiasis, hepatitis B and C, blood dyscrasia, chronic liver disease, depression and current STI (excluding syphilis) or any previous STI. The C-statistic from the model was 0.74 the optimism adjusted C-slope was 0.990. The sensitivity at 0.25% cut-off was 37% and the specificity was 84%. The results from the model could develop a risk score to identify patients at high risk of HIV infection in primary care through a point-of-care alert. The identified patients could be offered HIV testing. Barriers and facilitators that affect the use of point-of-care alerts were identified. They fall under the intervention (characteristics of the alert), features pertaining to the setting (GP practice) and person (features related to the clinicians). This study identified demographic, socio-economic, lifestyle/behavioural, clinical and comorbid conditions that predict risk of HIV infection. These predictors could be used to identify patients at high risk of HIV infection in primary care through a point-of-care alert. The study identified the barriers and facilitators that should be considered to ensure utilisation of a pop-up alert in primary care