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Alyna T Chien - One of the best experts on this subject based on the ideXlab platform.
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Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.
Journal of General Internal Medicine, 2019Co-Authors: Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Sanja Percac-lima, Alyna T ChienAbstract:Inadequate diagnostic evaluations of breast lumps and Rectal Bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of Rectal Bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. To examine processes undertaken for diagnostic evaluations of breast lumps and Rectal Bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. A retrospective cohort study using explicit chart abstraction methods. Three hundred women aged 30–80 presenting with breast lumps and 300 men and women aged 40–80 years presenting with Rectal Bleeding to 15 academically affiliated primary care practices, 2012–2016. Rates and timing of test ordering and completion and patterns of visits and communications. At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with Rectal Bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p
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comparing diagnostic evaluations for Rectal Bleeding and breast lumps in primary care a retrospective cohort study
Journal of General Internal Medicine, 2019Co-Authors: Sanja Percaclima, Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T ChienAbstract:Inadequate diagnostic evaluations of breast lumps and Rectal Bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of Rectal Bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. To examine processes undertaken for diagnostic evaluations of breast lumps and Rectal Bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. A retrospective cohort study using explicit chart abstraction methods. Three hundred women aged 30–80 presenting with breast lumps and 300 men and women aged 40–80 years presenting with Rectal Bleeding to 15 academically affiliated primary care practices, 2012–2016. Rates and timing of test ordering and completion and patterns of visits and communications. At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with Rectal Bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p < 0.01). Most (90%) patients with breast lumps completed recommended diagnostic testing within 1 month, versus 31% of patients with Rectal Bleeding (p < 0.01). By 1 year, 7% of patients with breast lumps had not completed indicated imaging, versus 27% of those with Rectal Bleeding. Patients with breast lumps had fewer subsequent primary care visits related or unrelated to their symptom and had fewer related communications with specialists. The study relied on documented care, and findings may be most generalizable to academically affiliated institutions. Diagnostic processes for Rectal Bleeding were less frequently guideline-concordant and timely than those for breast lumps. The largest discrepancies occurred in initial ordering of indicated tests and the timeliness of test completion.
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diagnostic evaluation of patients presenting to primary care with Rectal Bleeding
Journal of General Internal Medicine, 2018Co-Authors: Sanja Percaclima, Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T ChienAbstract:Background Rectal Bleeding is a common, frequently benign problem that can also be an early sign of coloRectal cancer. Diagnostic evaluation for Rectal Bleeding is complex, and clinical practice may deviate from available guidelines.
Brent Dubeshter - One of the best experts on this subject based on the ideXlab platform.
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Interstitial pregnancy complicated by Rectal Bleeding
American Journal of Obstetrics and Gynecology, 1996Co-Authors: David P. Warshal, Giuseppe Del Priore, Patrick J. Fultz, Andrea E. Dawson, Brent DubeshterAbstract:An interstitial pregnancy complicated by Rectal Bleeding is described. Despite modern imaging modalities, confounding features made preoperative diagnosis difficult. The pregnancy ruptured into the ileum. Ossified fetal skull bones and degenerated placental tissue were the only remains from the pregnancy. (Am J Obstet Gynecol 1996;175:1373-5.)
Lydia E Pace - One of the best experts on this subject based on the ideXlab platform.
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Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.
Journal of General Internal Medicine, 2019Co-Authors: Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Sanja Percac-lima, Alyna T ChienAbstract:Inadequate diagnostic evaluations of breast lumps and Rectal Bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of Rectal Bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. To examine processes undertaken for diagnostic evaluations of breast lumps and Rectal Bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. A retrospective cohort study using explicit chart abstraction methods. Three hundred women aged 30–80 presenting with breast lumps and 300 men and women aged 40–80 years presenting with Rectal Bleeding to 15 academically affiliated primary care practices, 2012–2016. Rates and timing of test ordering and completion and patterns of visits and communications. At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with Rectal Bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p
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comparing diagnostic evaluations for Rectal Bleeding and breast lumps in primary care a retrospective cohort study
Journal of General Internal Medicine, 2019Co-Authors: Sanja Percaclima, Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T ChienAbstract:Inadequate diagnostic evaluations of breast lumps and Rectal Bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of Rectal Bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. To examine processes undertaken for diagnostic evaluations of breast lumps and Rectal Bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. A retrospective cohort study using explicit chart abstraction methods. Three hundred women aged 30–80 presenting with breast lumps and 300 men and women aged 40–80 years presenting with Rectal Bleeding to 15 academically affiliated primary care practices, 2012–2016. Rates and timing of test ordering and completion and patterns of visits and communications. At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with Rectal Bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p < 0.01). Most (90%) patients with breast lumps completed recommended diagnostic testing within 1 month, versus 31% of patients with Rectal Bleeding (p < 0.01). By 1 year, 7% of patients with breast lumps had not completed indicated imaging, versus 27% of those with Rectal Bleeding. Patients with breast lumps had fewer subsequent primary care visits related or unrelated to their symptom and had fewer related communications with specialists. The study relied on documented care, and findings may be most generalizable to academically affiliated institutions. Diagnostic processes for Rectal Bleeding were less frequently guideline-concordant and timely than those for breast lumps. The largest discrepancies occurred in initial ordering of indicated tests and the timeliness of test completion.
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diagnostic evaluation of patients presenting to primary care with Rectal Bleeding
Journal of General Internal Medicine, 2018Co-Authors: Sanja Percaclima, Lydia E Pace, Kevin H Nguyen, Charis Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T ChienAbstract:Background Rectal Bleeding is a common, frequently benign problem that can also be an early sign of coloRectal cancer. Diagnostic evaluation for Rectal Bleeding is complex, and clinical practice may deviate from available guidelines.
Deborah A Kuban - One of the best experts on this subject based on the ideXlab platform.
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comparison of Rectal dose wall histogram versus dose volume histogram for modeling the incidence of late Rectal Bleeding after radiotherapy
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Susan L Tucker, Rex Cheung, Lei Dong, Helen H Liu, Howard D Thames, Eugene H Huang, Radhe Mohan, Jennifer L Johnson, Deborah A KubanAbstract:Purpose To compare the fits of normal-tissue complication probability (NTCP) models based on Rectal dose–wall histograms (DWHs) vs. dose–volume histograms (DVHs) when the two are used to analyze a common set of late Rectal toxicity data. Methods and materials Data were analyzed from 128 prostate cancer patients treated with 3-dimensional conformal radiotherapy (3D-CRT) at The University of Texas M.D. Anderson Cancer Center (UTMDACC). The DVH for total Rectal volume, including contents, was obtained for each patient from the treatment-planning system. A DWH was also computed, using the outer Rectal contour plus an autogenerated inner contour that corresponds to an assumed 3-mm Rectal wall thickness. The endpoint for analysis was Grade 2 or higher late Rectal Bleeding within 2 years of treatment; all patients had at least 2 years of follow-up. Four different NTCP models were fitted to the response data by using either the DVH or the DWH to describe the dose distribution to rectum or Rectal wall, respectively. The 4 models considered were the Lyman model, the mean dose model, the parallel-architecture model, and a model based on the volume of a organ receiving more than a specified dose (the “cutoff-dose” model). Results For each of the models, the fit to the late Rectal Bleeding data was slightly improved when the analysis was based on the Rectal DWH instead of on the DVH. In addition, the results of the cutoff dose and parallel architecture models were consistent with one another for the DWH data but not for the DVH data. For the DWH data, both models predict a 50% or higher incidence of Grade 2 or worse late Rectal Bleeding within 2 years if 80% or more of the Rectal wall is exposed to doses greater than 32 Gy. A 50% or higher incidence of Rectal Bleeding is also predicted if the mean dose to Rectal wall exceeds 53.2 Gy. Conclusions A consistent, although modest, improvement occurs in the fits of NTCP models to the UTMDACC 2-year late Rectal Bleeding data when the fit is based on the Rectal dose–wall histogram instead of on the dose–volume histogram for entire rectum, including contents.
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dose volume response analyses of late Rectal Bleeding after radiotherapy for prostate cancer
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Susan L Tucker, Rex Cheung, Lei Dong, Helen H Liu, Howard D Thames, Eugene H Huang, Deborah A Kuban, Radhe MohanAbstract:Abstract Purpose To compare the fits of various normal tissue complication probability (NTCP) models to a common set of late Rectal toxicity data, with the aim of identifying the best model for predicting late Rectal injury after irradiation. Methods and materials Late toxicity data from 128 prostate cancer patients treated on protocol with three-dimensional conformal radiotherapy at The University of Texas M.D. Anderson Cancer Center (UTMDACC) were analyzed. The dose–volume histogram for total Rectal volume, including contents, was obtained for each patient, and the presence or absence of Grade 2 or worse Rectal Bleeding within 2 years of treatment was scored. Five different NTCP models were fitted to the data using maximum likelihood analysis: the Lyman model, the mean dose model, a parallel architecture model, and models based on either a cutoff dose or a cutoff volume. Results All five of the NTCP models considered provided very similar fits to the UTMDACC Rectal Bleeding data. In particular, none of the more highly parameterized models (the four-parameter parallel model, three-parameter Lyman model, or three-parameter cutoff dose and volume models) provided a better fit than the simplest of the models, the two-parameter NTCP model describing Rectal Bleeding as a probit function of mean dose to rectum. Conclusion No dose–volume response model has yet been identified that provides a better description of the UTMDACC Rectal toxicity data than the mean dose model. Because this model has relatively low predictive accuracy, the need to identify a better model remains.
Nicholas J Talley - One of the best experts on this subject based on the ideXlab platform.
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Rectal Bleeding epidemiology associated risk factors and health care seeking behaviour a population based study
Colorectal Disease, 2009Co-Authors: Guy D Eslick, Jamshid S Kalantar, Nicholas J TalleyAbstract:Purpose Rectal Bleeding is considered an important sign of colonic disease, particularly coloRectal cancer. The epidemiology of Rectal Bleeding in the community is poorly understood. Moreover, there is little information as to whether individuals seek health care for this problem. This study aimed to determine the prevalence of Rectal Bleeding and levels of healthcare seeking amongst an Australian population. Method A community sample of adults aged above 18 years of Penrith (a Sydney suburb representative of the Australian population) selected randomly from the electoral roll. The survey consisted of a self-administered questionnaire sent out to 440 residents stratified for equal numbers of men and women. Results The response rate was 77% (n = 338; mean age 46 years; SD: 16; range: 18–90; 55% women). Blood in the stools in the previous 12 months was reported by 18% (95% CI: 14–23). Colour of the blood in bowel movements was reported as bright (72%), dark (7%), bright and dark (10%), 11% did not know. Only 31% (n = 21/68) of respondents with Rectal Bleeding had visited a physician primarily about the presence of blood in the bowel movement within the previous 12 months. The majority (90%) who consulted about the presence of blood were aged between 30 and 60 years. Blood in the stools was independently associated with younger age (OR = 0.97, 95% CI: 0.95–0.99, P = 0.01), feelings of incomplete Rectal evacuation (OR = 3.42, 95% CI: 1.66–7.08, P = 0.001), self-reported injury or tear (OR = 3.45, 95% CI: 1.53–7.69, P = 0.002), and surgery (OR = 2.70, 95% CI: 1.03–7.14, P = 0.04) to the perianal region. Conclusions Rectal Bleeding is common in the general population. Only one-third of those with Rectal Bleeding consults a physician about their condition. Rectal Bleeding occurs in younger individuals, those who suffer from incomplete evacuation and among individuals who have had an injury, tear or surgery to the anus.
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self reported Rectal Bleeding in a united states community prevalence risk factors and health care seeking
The American Journal of Gastroenterology, 1998Co-Authors: Nicholas J Talley, Michael P JonesAbstract:Self-reported Rectal Bleeding in a United States community: prevalence, risk factors, and health care seeking