Surveillance

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Lewis B Morgenstern - One of the best experts on this subject based on the ideXlab platform.

  • comparison of active and passive Surveillance for cerebrovascular disease the brain attack Surveillance in corpus christi basic project
    American Journal of Epidemiology, 2002
    Co-Authors: Paisith Piriyawat, Miriam Smajsova, Melinda A Smith, Sanjay Pallegar, Areej Alwabil, Nelda M Garcia, Jan M H Risser, Lemuel A Moye, Lewis B Morgenstern
    Abstract:

    To provide a scientific rationale for choosing an optimal stroke Surveillance method, the authors compared active Surveillance with passive Surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive Surveillance, 802 were validated to be cerebrovascular events. When passive Surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active Surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active Surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive Surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active Surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive Surveillance for cerebrovascular disease. More uniform Surveillance methods would allow comparisons across studies and communities. cerebral hemorrhage; cerebrovascular accident; cerebrovascular disorders; epidemiologic methods; population Surveillance

  • comparison of active and passive Surveillance for cerebrovascular disease the brain attack Surveillance in corpus christi basic project
    American Journal of Epidemiology, 2002
    Co-Authors: Paisith Piriyawat, Miriam Smajsova, Melinda A Smith, Sanjay Pallegar, Areej Alwabil, Nelda M Garcia, Jan M H Risser, Lemuel A Moye, Lewis B Morgenstern
    Abstract:

    To provide a scientific rationale for choosing an optimal stroke Surveillance method, the authors compared active Surveillance with passive Surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive Surveillance, 802 were validated to be cerebrovascular events. When passive Surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active Surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active Surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive Surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active Surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive Surveillance for cerebrovascular disease. More uniform Surveillance methods would allow comparisons across studies and communities.

Ronald C Chen - One of the best experts on this subject based on the ideXlab platform.

  • receipt of guideline recommended Surveillance in a population based cohort of active Surveillance prostate cancer patients
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Ronald C Chen, Sabrina G Prime, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Deborah S Usinger, Aaron J Katz
    Abstract:

    ABSTRACT Prospective clinical trials have demonstrated the safety and efficacy of active Surveillance for men with localized prostate cancer, but also suggested that inadequate Surveillance may risk missing an opportunity for cure. We used data from a population-based cohort of active Surveillance patients to examine the rigor of Surveillance monitoring in the general population. Among 1,419 patients enrolled from 2011–2013 throughout the State of XXXXX in collaboration with the state cancer registry and followed prospectively, 346 pursued active Surveillance. Only 13% received all guideline-recommended Surveillance testing (including prostate specific antigen, digital rectal exam, and prostate biopsy) within the first two years. Further, adherence was

  • receipt of guideline recommended Surveillance in a population based cohort of active Surveillance prostate cancer patients
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Ronald C Chen, Sabrina G Prime, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Deborah S Usinger, Aaron J Katz
    Abstract:

    Prospective clinical trials have demonstrated the safety and efficacy of active Surveillance for men with localized prostate cancer, but also suggested that inadequate Surveillance may risk missing an opportunity for cure. We used data from a population-based cohort of active Surveillance patients to examine the rigor of Surveillance monitoring in the general population. Among 1,419 patients enrolled from 2011-2013 throughout the State of XXXXX in collaboration with the state cancer registry and followed prospectively, 346 pursued active Surveillance. Only 13% received all guideline-recommended Surveillance testing (including prostate specific antigen, digital rectal exam, and prostate biopsy) within the first two years. Further, adherence was <20% in all patient subgroups. These findings suggest that "active Surveillance" as implemented in the general population may not represent the rigorous monitoring regimens used in the studies that demonstrated the safety of this management approach. More real-world studies on active Surveillance are needed.

Amit G. Singal - One of the best experts on this subject based on the ideXlab platform.

  • use of hepatocellular carcinoma Surveillance in patients with cirrhosis a systematic review and meta analysis
    Hepatology, 2021
    Co-Authors: Erin Wolf, Nicole E Rich, Neehar D. Parikh, Jorge A Marrero, Amit G. Singal
    Abstract:

    BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) Surveillance is associated with early tumor detection and improved survival; however, it is often underused in clinical practice. We aimed to characterize Surveillance use among patients with cirrhosis and the efficacy of interventions to increase Surveillance. APPROACH AND RESULTS We performed a systematic literature review using the MEDLINE database from January 2010 through August 2018 to identify cohort studies evaluating HCC Surveillance receipt or interventions to increase Surveillance in patients with cirrhosis. A pooled estimate for Surveillance receipt with 95% confidence intervals was calculated. Correlates of Surveillance use were defined from each study and prespecified subgroup analyses. Twenty-nine studies, with a total of 118,799 patients, met inclusion criteria, with a pooled estimate for Surveillance use of 24.0% (95% confidence interval, 18.4-30.1). In subgroup analyses, the highest Surveillance receipt was reported in studies with patients enrolled from subspecialty gastroenterology/hepatology clinics and lowest in studies characterizing Surveillance in population-based cohorts (73.7% versus 8.8%, P < 0.001). Commonly reported correlates of Surveillance included higher receipt among patients followed by subspecialists and lower receipt among those with alcohol-associated or nonalcoholic steatohepatitis (NASH)-related cirrhosis. All eight studies (n = 5,229) evaluating interventions including patient/provider education, inreach (e.g., reminder and recall systems), and population health outreach strategies reported significant increases (range 9.4%-63.6%) in Surveillance receipt. CONCLUSIONS HCC Surveillance remains underused in clinical practice, particularly among patients with alcohol-associated or NASH-related cirrhosis and those not followed in subspecialty gastroenterology clinics. Interventions such as provider education, inreach including reminder systems, and population health outreach efforts can significantly increase HCC Surveillance.

  • Surveillance for hepatocellular carcinoma current best practice and future direction
    Gastroenterology, 2019
    Co-Authors: Fasiha Kanwal, Amit G. Singal
    Abstract:

    Hepatocellular cancer (HCC) is the fourth leading cause of cancer-related deaths worldwide and the fastest growing cause of cancer deaths in the United States. The overall prognosis of HCC remains dismal, except for the subset of patients who are diagnosed at early stage and receive potentially curative therapies, such as surgical resection and liver transplantation. Given this, expert society guidelines recommend HCC Surveillance every 6 months in at-risk individuals. Despite these recommendations, the effectiveness of HCC Surveillance remains a subject of debate. We discuss current best practices for HCC Surveillance and the evidence that support these recommendations. We also describe several initiatives that are underway to improve HCC Surveillance and outline areas that may serve as high-yield targets for future research. Overall, we believe these efforts will help the field move toward precision Surveillance, where Surveillance tests and intervals are tailored to individual HCC risk. Doing so can maximize Surveillance benefits, minimize Surveillance harms, and optimize overall value for all patients.

  • racial social and clinical determinants of hepatocellular carcinoma Surveillance
    The American Journal of Medicine, 2015
    Co-Authors: Amit G. Singal, Mahendra Nehra, Jasmin A Tiro, Pragathi Kandunoori, Beverley Adamshuet, Adam C Yopp
    Abstract:

    Abstract Objectives Less than 1 in 5 patients receive hepatocellular carcinoma Surveillance; however, most studies were performed in racially and socioeconomically homogenous populations, and few used guideline-based definitions for Surveillance. The study objective was to characterize guideline-consistent hepatocellular carcinoma Surveillance rates and identify determinants of hepatocellular carcinoma Surveillance among a racially and socioeconomically diverse cohort of cirrhotic patients. Methods We retrospectively characterized hepatocellular carcinoma Surveillance among cirrhotic patients followed between July 2008 and July 2011 at an urban safety-net hospital. Inconsistent Surveillance was defined as at least 1 screening ultrasound during the 3-year period, annual Surveillance was defined as screening ultrasounds every 12 months, and biannual Surveillance was defined as screening ultrasounds every 6 months. Univariate and multivariate analyses were conducted to identify predictors of Surveillance. Results Of 904 cirrhotic patients, 603 (67%) underwent inconsistent Surveillance. Failure to recognize cirrhosis was a significant barrier to Surveillance use ( P Conclusions Only 13% of patients with cirrhosis receive annual Surveillance, and less than 2% of patients receive biannual Surveillance. There are racial and socioeconomic disparities, with lower rates of hepatocellular carcinoma Surveillance among African Americans and underinsured patients.

  • failure rates in the hepatocellular carcinoma Surveillance process
    Cancer Prevention Research, 2012
    Co-Authors: Amit G. Singal, Samir Gupta, Jorge A Marrero, Adam C Yopp, Celette Sugg Skinner, Ethan A Halm, Eucharia Okolo, Mahendra Nehra, William M Lee, Jasmin A Tiro
    Abstract:

    Hepatocellular carcinoma (HCC) Surveillance is underutilized among patients with cirrhosis. Understanding which steps in the Surveillance process are not being conducted is essential for designing effective interventions to improve Surveillance rates. The aim of our study was to characterize reasons for failure in the HCC Surveillance process among a cohort of cirrhotic patients with HCC. We conducted a retrospective cohort study of cirrhotic patients diagnosed with HCC at a large urban safety-net hospital between 2005 and 2011. Patients were characterized by receipt of HCC Surveillance over a two-year period before HCC diagnosis. Among patients without HCC Surveillance, we classified reasons for failure into four categories: failure to recognize liver disease, failure to recognize cirrhosis, failure to order Surveillance, and failure to complete Surveillance despite orders. Univariate and multivariate analyses were conducted to identify predictors of failures. We identified 178 patients with HCC, of whom 20% had undergone Surveillance. There were multiple points of failure-20% had unrecognized liver disease, 19% had unrecognized cirrhosis, 38% lacked Surveillance orders, and 3% failed to complete Surveillance despite orders. Surveillance was more likely among patients seen by hepatologists [OR, 6.11; 95% confidence interval (CI), 2.5-14.8] and less likely in those with alcohol abuse (OR, 0.14; 95% CI, 0.03-0.65). Although a retrospective analysis in a safety-net hospital, our data suggest that only one in five patients received Surveillance before HCC diagnosis. There are multiple points of failure in the Surveillance process, with the most common being failure to order Surveillance in patients with known cirrhosis. Future interventions must target multiple failure points in the Surveillance process to be highly effective.

Aaron J Katz - One of the best experts on this subject based on the ideXlab platform.

  • receipt of guideline recommended Surveillance in a population based cohort of active Surveillance prostate cancer patients
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Ronald C Chen, Sabrina G Prime, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Deborah S Usinger, Aaron J Katz
    Abstract:

    ABSTRACT Prospective clinical trials have demonstrated the safety and efficacy of active Surveillance for men with localized prostate cancer, but also suggested that inadequate Surveillance may risk missing an opportunity for cure. We used data from a population-based cohort of active Surveillance patients to examine the rigor of Surveillance monitoring in the general population. Among 1,419 patients enrolled from 2011–2013 throughout the State of XXXXX in collaboration with the state cancer registry and followed prospectively, 346 pursued active Surveillance. Only 13% received all guideline-recommended Surveillance testing (including prostate specific antigen, digital rectal exam, and prostate biopsy) within the first two years. Further, adherence was

  • receipt of guideline recommended Surveillance in a population based cohort of active Surveillance prostate cancer patients
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Ronald C Chen, Sabrina G Prime, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Deborah S Usinger, Aaron J Katz
    Abstract:

    Prospective clinical trials have demonstrated the safety and efficacy of active Surveillance for men with localized prostate cancer, but also suggested that inadequate Surveillance may risk missing an opportunity for cure. We used data from a population-based cohort of active Surveillance patients to examine the rigor of Surveillance monitoring in the general population. Among 1,419 patients enrolled from 2011-2013 throughout the State of XXXXX in collaboration with the state cancer registry and followed prospectively, 346 pursued active Surveillance. Only 13% received all guideline-recommended Surveillance testing (including prostate specific antigen, digital rectal exam, and prostate biopsy) within the first two years. Further, adherence was <20% in all patient subgroups. These findings suggest that "active Surveillance" as implemented in the general population may not represent the rigorous monitoring regimens used in the studies that demonstrated the safety of this management approach. More real-world studies on active Surveillance are needed.

Paisith Piriyawat - One of the best experts on this subject based on the ideXlab platform.

  • comparison of active and passive Surveillance for cerebrovascular disease the brain attack Surveillance in corpus christi basic project
    American Journal of Epidemiology, 2002
    Co-Authors: Paisith Piriyawat, Miriam Smajsova, Melinda A Smith, Sanjay Pallegar, Areej Alwabil, Nelda M Garcia, Jan M H Risser, Lemuel A Moye, Lewis B Morgenstern
    Abstract:

    To provide a scientific rationale for choosing an optimal stroke Surveillance method, the authors compared active Surveillance with passive Surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive Surveillance, 802 were validated to be cerebrovascular events. When passive Surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active Surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active Surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive Surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active Surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive Surveillance for cerebrovascular disease. More uniform Surveillance methods would allow comparisons across studies and communities. cerebral hemorrhage; cerebrovascular accident; cerebrovascular disorders; epidemiologic methods; population Surveillance

  • comparison of active and passive Surveillance for cerebrovascular disease the brain attack Surveillance in corpus christi basic project
    American Journal of Epidemiology, 2002
    Co-Authors: Paisith Piriyawat, Miriam Smajsova, Melinda A Smith, Sanjay Pallegar, Areej Alwabil, Nelda M Garcia, Jan M H Risser, Lemuel A Moye, Lewis B Morgenstern
    Abstract:

    To provide a scientific rationale for choosing an optimal stroke Surveillance method, the authors compared active Surveillance with passive Surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive Surveillance, 802 were validated to be cerebrovascular events. When passive Surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active Surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active Surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive Surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active Surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive Surveillance for cerebrovascular disease. More uniform Surveillance methods would allow comparisons across studies and communities.