Colorectal Cancer Screening Practices among Obstetrician/Gynecologists and Nurse Practitioners

Abstract Objective: Obstetrician/gynecologists (Ob/Gyn) and nurse practitioners (NP) are essential providers of primary and preventive care for their female patients. Therefore, colorectal cancer (CRC) screening should be part of their routine preventive practices. The purpose of our study is to evaluate the CRC screening practices of these providers. Methods: A self-administered survey was mailed to a national sample of 1130 Ob/Gyns and NPs to assess providers' demographics, current CRC screening practices, and familiarity with CRC guidelines. Results: Three hundred thirty-six providers (29.7%) returned our survey (54% Ob/Gyns and 46% NPs). Three fourths of providers routinely performed screening for CRC, compared with 95% for breast and cervical cancer. Routine CRC screening was more common among Ob/Gyns (87.2%) than NPs (61.7%) (p10 years (p<0.01), practicing in a multispecialty group (2.62 times more likely), and having an older patient population (p<0.001). Conclusions: Ob/Gyns and NPs underuse CRC screening compared with breast and cervical cancer screening and lack knowledge about appropriate use of CRC screening modalities. Opportunities to further educate Ob/Gyns and NPs should be sought to improve compliance with current CRC screening guidelines.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78151/1/jwh.2008.1117.pd

Does colonoscopy cause increased ulcerative colitis symptoms?

Background: Ulcerative colitis (UC) patients often report symptom flares after colonoscopy. However, this has not been documented in the literature. Objectives: 1. Determine whether colonoscopy is associated with increased UC symptoms. 2. Determine whether there is a need for escalation of UC medications after colonoscopy. 3. Identify baseline variables associated with increased symptoms after colonoscopy. Methods: Firty-five outpatients with a history of UC, intact colon, and quiescent disease were enrolled in a prospective case-crossover study. Subjects were evaluated with the Simple Clinical Colitis Activity Index (SCCAI) before colonoscopy, 1 week and 4 weeks after colonoscopy. A mixed model analysis was used to accommodate nonindependence of repeated measurements on the same patients. Results: Fifty-one (91%) subjects completed the study. Six subjects had clinical relapse defined by a score of 5 or greater on the SCCAI during the week after colonoscopy. Five subjects increased their 5-aminosalicylic acid (5-ASA) medications immediately postcolonoscopy, two of whom had a SCCAI 5 or greater. Multivariate modeling demonstrated a clear association between the week immediately after colonoscopy preparation and increased disease activity, with the time period being predictive of increased SCCAI (week 1 vs. week 4, P = 0.0127). The baseline SCCAI ( P value < 0.0001) and prednisone use ( P = 0.0120) were predictive of increased SCCAI postcolonoscopy. Thiopurines ( P < 0.001) were protective against increased symptoms. Conclusions: In our study, 1 in 8 subjects had UC relapse by SCCAI immediately postcolonoscopy, and 1 in 10 subjects required an increase in their 5-ASA medications. Clinicians should be cognizant of this effect of colonoscopy in patients with UC. (Inflamm Bowel Dis 2007;13:12–18)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55905/1/20049_ftp.pd

A survey of ampullectomy practices

AIM: To investigate the endoscopic ampullectomy practices of expert biliary endoscopists

CT colonography: Friend or foe of practicing endoscopists

AIM: To investigate the perceived impact of computed tomographic colonography (CTC) on endoscopists’ current and future practice