bluuebunny/crossref_metadata_2025_split huggingface dataset:
294 A False Positive MT-DNA Stool Test—What Is Next?
Authors: Mubder Mohamad I. , Mashiana Harmeet , Dhaliwal Amaninder , Cross Chad , Dhindsa Banreet , Chandan Saurabh , Jayaraj Mahendran , Ohning Gordon 
Published: October 2019

INTRODUCTION:
Stool DNA testing for colorectal screening is a noninvasive and convenient method. Multiple studies have shown a wide range of false positive (FP) results. It is unclear if a patient with FP results are at increased long-term risk of adverse effect and currently there are no specific recommendations to guide the follow up in this cohort of patients. We aimed at finding the exact FP rate that can help design future studies.

METHODS:
A systematic literature search of multiple databases for studies in colorectal screening using MT-DNA test and reporting the FP results up to December 2018 identifying a total of 8 studies were included in our meta-analysis.

RESULTS:
The studies reported a total of 16921 patients who underwent MT-DNA screening test. A total of 789 FP results was reported with an estimated pooled rate of 10%. The estimates were calculated using the random effect model. There was a significant heterogenicity of the results reported with (I2 = 95%, Q-140.5, P < 0.001). The analysis was done using metaXL (v 5.3).

CONCLUSION:
In our meta-analysis, the FP rate was 10% which represent a significant number of patients with undetermined long-term complications especially colorectal cancer event rates in the follow-up period. More randomized controlled trials and prospective studies are needed to evaluate the possible complications and to establish possible additional follow up screening guidelines for FP test results. More randomized controlled trials and prospective studies are needed to evaluate the possible complications and to establish possible additional follow up screening guidelines for FP test results.
302 Increasing Appropriate Referrals to Genetic Counseling at the Time of Endoscopy
Authors: Feuille Colin , Avila Patrick , Ko Myung S. , Goldberg Dena , Rudrapatna Vivek A. , Singh Aparajita 
Published: October 2019

INTRODUCTION:
The ACG recommends an initial assessment of family history of cancer and premalignant conditions be performed for all patients evaluated in gastroenterology practices to develop a preliminary determination of risk of familial cancer predisposition. Due to the fast-paced nature of practice and a knowledge gap, providers often miss referring high-risk patients for genetic counseling. For example, less than 2% of the projected 830,000 Lynch syndrome patients in the US are aware of their mutation status. In this quality improvement project, we implemented a one-page, patient-administered survey to identify those at high risk of common hereditary cancer syndromes and facilitate appropriate referral to genetic counseling.

METHODS:
We created a four-question survey based on National Comprehensive Cancer Network (NCCN) guidelines for genetic testing for several hereditary cancer syndromes, including Lynch syndrome and Hereditary Breast and Ovarian Cancer syndrome. It was provided to all English-speaking patients presenting for outpatient endoscopy, who voluntarily completed the survey in the waiting area. Completed surveys were assessed for meeting criteria for referral for genetic testing. The survey was implemented on April 1, 2019, and we assessed its initial impact by comparing the number of positive surveys (i.e. meeting NCCN guidelines for referral to genetic counseling) over two months post-implementation (Apr-May 2019) with the number of genetic counseling referrals by gastroenterology providers at our institution over two months pre-implementation (Feb-Mar 2019).

RESULTS:
In February-March 2019, 13 genetic counseling referrals were made by gastroenterology providers at our institution. In April-May 2019, 874 surveys were completed. 330 surveys (37.8%) had responses meeting NCCN guidelines for referral for genetic counseling and a high risk of familial cancer predisposition. 481 (55%) did not meet criteria for high-risk family history, and 63 (7.2%) had indeterminate responses, requiring additional evaluation to determine risk.

CONCLUSION:
We created a simple, self-administered survey that identified a far larger number of endoscopy patients meeting NCCN criteria for genetic counseling referral than the number of referrals placed over a comparable timeframe prior to implementation. To address the large gap in appropriate genetic counseling referrals, we aim to create a sustainable workflow for referral from endoscopy, and plan to assess patient follow-through on these referrals.
303 Early-Onset Colorectal Cancer Trends and Survival
Authors: Wood Sarah J. , Webb Leigh-Ann J. , Freedy Elan 
Published: October 2019

INTRODUCTION:
In the United States, colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and third most common cancer. While incidence rates of colorectal cancer in the older population continues to decline, incidence rates in adults aged less than 50 years have been on the rise since the 1990s. The increase of CRC in this younger population is almost solely confined to the Caucasian race. In the younger population, key symptoms often go unrecognized and misdiagnoses often precede the suspicion for malignancy. Our large, retrospective study aimed to better understand the outcomes and survival horizons of young patients with CRC.

METHODS:
A population dataset for CRC cases from 2003-2015 was acquired from the NCI SEER database. Data extracted from SEER includes all CRC cancer diagnoses from 2003-2015 for patients aged less than 50 years old. There were 48,506 cases in total.The data was cleaned and merged, and subsequently analyzed by various modalities including Kaplan-Meier Survival Estimators, Cox Proportional Hazard Ratio, and Logistic Regression.

RESULTS:
From 2003-2015, 75% of all individuals diagnosed with early-onset CRC were of Caucasian race. The majority of patients at time of diagnosis were found to have high tumor burden, no metastatic disease, and moderate (grade 3) differentiation. Approximately half of the initial diagnoses were T3. Despite large tumor burden, over 70% of young adult patients were M0 and 46.8% were N0 at time of diagnosis. Collectively, 70% of tumors were either poorly or moderately differentiated. Kaplan-Meier analysis showed overall 10-year survival of those with early onset CRC a mere 57%. Unsurprisingly, hazards ratio showed that the presence and degree of metastasis, tumor burden (stage T4), poor differentiation, and elevated CEA have the highest impact on decreasing survival.

CONCLUSION:
Our retrospective study showed that most patients diagnosed with early onset CRC had high tumor burden, no metastatic disease, and moderate to poor differentiation. Despite that 70% of patients were M0 at time of diagnosis, 10-year survival is only 57%. The escalating rates of CRC in the younger population is a serious public health concern that highlights the need for appropriate, timely follow-up of symptoms. Recently, both the ACS and ACP, have amended CRC screening guidelines to those of average risk to start at age 45, which will enable earlier detection and likely better survival outcomes for those with early-onset CRC.
306 Multicenter Success Increasing Colorectal Cancer Screening at Federally Qualified Healthcare Centers (FQHCs)
Authors: Desai Koosh , Vega Kenneth J. 
Published: October 2019

INTRODUCTION:
Colon cancer is the second leading cause of cancer-related death in Georgia with 1,400 annual deaths. Colon cancer incidence and mortality decreases by 61% when patients are appropriately screened using American College of Gastroenterology recommendations. While the national screening rate is 71% and the statewide rate is 68%, at Georgia’s Federally Qualified Healthcare Centers (FQHCs), which serve 494,464 underserved patients yearly, the screening rate was only 32% in 2017.

METHODS:
Between April 2018 to July 2018, two physicians with an interest in colon cancer conducted quality improvement at four FQHCs around the state in an attempt to bridge that gap in screening. The team provided educational lectures about colon cancer to providers, reviewed screening processes to identify gaps and used ACG guideline recommendations to help clinics develop a screening policy to help ensure eligible patients get screened. They also provided patient education materials such as brochures, posters, and postcards. As a federal grant requirement, FQHCs are required to report colon cancer screening rates using a federal government system called electronic Clinical Quality Improvement. Screening rates are calculated by dividing all eligible patients who have received screening by total patients eligible for screening. These rates were collected to track quality improvements.

RESULTS:
Screening rates increased at all sites 3 months post-intervention. Site 1: 41% to 48.4%; site 2: 31.6% to 37.8%, site 3: 30.5% to 38.2%, site 4: 43.9% to 46.8%.

CONCLUSION:
We demonstrate success of a physician driven program to increase colon cancer screening rates at four federally funded clinics for the underserved in Georgia. A total of 10,933 unscreened patients were at the clinics prior to the project and screening increased from a range of 2.9% to 7.7%. A multifaceted approach included the following: 1-direct provider education sessions, emphasizing ACG tier 1 screening, especially FIT tests 2- technical expertise in making process improvements 3- providing patient education resources. These low cost strategies increased screening rates. Based on the results of this study, this program should be scaled to FQHCs around the country and would be expected to improve colon cancer mortality for the nation's underserved patients.
307 Transgelin Regulates Colon Cancer Cell Invasion by Interacting With PARP1 and Activating Rho Signaling Pathway: A Bioinformatics Analysis
Authors: Lin Ying , Lew Zhen-Xian 
Published: October 2019

INTRODUCTION:
Our previous studies found that Transgelin was up-regulated in node-positive colorectal cancer versus in node-negative disease. Transgelin, an actin-binding protein, is associated with the remodeling of cytoskeleton in the cytoplasm. However, we found that Transgelin had nuclear localization in colon cancer cells and gene expression profiling identified that TAGLN over-expression affected the expression of 256 downstream genes closely related to cell morphology, migration and invasion. In addition, we found that Transgelin could interact with 297 proteins by immunoprecipitation and liquid chromatography -mass spectrometry. Thus, we speculate that Transgelin may play different roles in the nucleus and the cytoplasm, which collaboratively participate in the invasion and metastasis of colon cancer cells.

METHODS:
256 downstream genes regulated by Transgelin were analyzed by bioinformatics analysis. Transgelin has been found to regulate colon cancer metastasis through specific key genes and signaling pathways. Then, by analyzing the promoter regions of these key genes, a protein has been predicted to be the transcription factor of these genes. Further, by comparing the 297 proteins that have been previously detected to potentially interact with Transgelin, we found that the predicted transcription factor fell in this pool. Finally, we verified the interaction between Transgelin and this transcription factor by immunoprecipitation and Western blotting.

RESULTS:
Over-expression of TAGLN could lead to differential expression of 184 downstream genes. By constructing the network of gene-encoded proteins, we conducted network topology analysis and identified the key genes, including CALM1, MYO1F, NCKIPSD, PLK4, RAC1, WAS and WIPF1 (Figure 1). They are mainly involved in the Rho signaling pathway which is related to oncogenesis and tumor metastasis. In addition, bioinformatics analysis (GCBI tools) showed that all of the promoter regions of the key genes had binding sites with PARP1 protein. And PARP1 also fell in the 297 proteins that have been previously detected to interact with Transgelin. Thus, PARP1 protein was selected as a potential transcription factor. Immunoprecipitation validated that PARP1 interacted with Transgelin in RKO human colon cancer cells.

CONCLUSION:
Bioinformatics analysis revealed that Transgelin may activate the Rho signaling pathway in promoting colon cancer metastasis by interacting with PARP1.
309 Changing Characteristics and Survival in Early Onset Colorectal Cancer in an Asian American County Population From 1990 to 2016
Authors: Yik Barnabas , Ho Andrew 
Published: October 2019

INTRODUCTION:
The incidence of early onset colorectal cancer has been rising, but we have limited understanding of this pattern. Some groups have noticed racial disparities in survival rates, but we still have little data on ethnic differences. We sought to analyze the characteristics of early onset colorectal cancer in a county population and discovered changes in staging and survival in the Asian subgroup over time.

METHODS:
We performed a retrospective study involving all patients less than 50 years old that were newly diagnosed with colorectal cancer at a county hospital. We collected data from the hospital’s electronic medical system and existing databases from 1991 to 2016, and analyzed the demographics, staging, survival and follow up rates for patients of Asian descent. We divided the time frame into 2 equal periods (1991-2003 and 2004-2016) and performed chi-square analysis to assess for changes in colorectal cancer diagnoses between these two groups.

RESULTS:
A total of 182 patients under the age of 50 years old were diagnosed with colorectal cancer during this 26 year period. 69 patients were diagnosed from 1991-2003, of which 17 were of Asian descent. 113 patients were diagnosed from 2004-2016, of which 36 were of Asian descent. Among the Asian population, there was 1 case of Stage 2 (6%), and 16 cases of Stage III and IV (94%) in 1991-2003. Meanwhile, there were 15 cases of Stage 1 and 2 (42%), and 21 cases of Stage 3 and 4 (58%) in 2004-2016. Chi-square analysis of early (Stage 1 and 2) vs late (Stage 3 and 4) staging revealed a significantly higher proportion of early stage colorectal cancer in 2004-2016 compared to 1991-2003 (P-val 0.02). This coincides with a significantly higher 3 year-survival and follow up in 2004-2016 than in 1991-2003 (58% vs 24%, P-val 0.038). There were no significant differences in staging or survival for the non-asian population between these time periods.

CONCLUSION:
Our findings support that there is a rising incidence of early onset colorectal cancer in general, and within the Asian population. Interestingly, there is an increasing proportion of early stage colon cancer associated with a higher 3-year survival rate in the Asian population that was not found in other ethnicities. While our study is limited to one county population, our findings show the rising incidence is associated with ethnic disparities. Additional investigation into these disparities may help shed light on the driving factors behind the increasing incidence of early colon cancer.
313 1 L NER1006 Improves High-Quality Colon Cleansing and Mean Polyp Detection versus Oral Sulfate Solution and 2 L Polyethylene Glycol Plus Ascorbate
Authors: Epstein Michael S. , Halonen Juha , Amlani Bharat , Hassan Cesare 
Published: October 2019

INTRODUCTION:
Interval cancers may occur due to missed neoplasia during colonoscopy. ‘Adequate’ cleansing quality permits stool presence in the colon, however high-quality (stool-free) cleansing is now known to improve polyp detection. The 1 L polyethylene glycol (PEG) NER1006 improves high-quality colon cleansing, but whether it primarily reduces stool or liquid is unknown. We characterized the segmental high-quality cleansing with NER1006 versus two comparators, and its effect on mean polyp detection per patient.

METHODS:
A post hoc analysis of two similarly designed phase 3 clinical trials NOCT and MORA examined overnight split-dosing regimens. NER1006 was compared with oral sulfate solution (OSS; NOCT) and 2 L polyethylene glycol + ascorbate (2LPEG; MORA). Treatment-blinded central readers assessed colon cleansing quality using the Harefield Cleansing Scale (HCS) with segmental scores 0-1 (failures; irremovable stool), 2 (adequate; removable stool), 3 (high-quality; clear liquid) or 4 (high-quality; liquid-free). Site endoscopists detected polyps. Patients with full segmental scoring were included. The segmental scores distribution and mean number of polyps per patient (MPP; in patients with at least 1 to 10 polyps) were analysed per treatment group. MPP was also assessed in pooled NER1006 versus pooled OSS and 2LPEG. One-sided t-tests assessed potential differences between groups.

RESULTS:
Totally 1037/1103 patients were included (94% primary analysis set = 5185 segments). NER1006 attained more stool-free segments (HCS 3) than OSS (30% [388/1275] vs 25% [331/1300]; P = 0.002) [Figure 1] or 2LPEG (28% [368/1310] vs 15% [191/1300]; P< 0.001) [Figure 2]. NER1006 attained more liquid-free segments (HCS 4) than 2LPEG (22% [285/1310] vs 17% [220/1300]; P = 0.001), and less stool-containing segments (HCS 2) than OSS (48% [612/1275] vs 53% [687/1300]; P = 0.007 or 2LPEG (49% [641/1310] vs 66% [854/1300]; P < 0.001). Pooled NER1006 showed a higher MPP than pooled OSS and 2LPEG for at least 1 (2.8 vs 2.3; P = 0.036), 2 (4.4 vs 3.5; P = 0.020), 3 (5.7 vs 4.5; P = 0.033), 4 (7.3 vs 5.8; P = 0.049), 5 (9.7 vs 6.8; P = 0.017) and 6 polyps per patient (10.9 vs 7.5; P = 0.020) [Figure 3]. In all other patients NER1006 had a numerically higher MPP per trial and when pooled.

CONCLUSION:
Finding multiple polyps in a patient is difficult. NER1006 improves high-quality cleansing over OSS or 2LPEG primarily by delivering more stool-free segments. This improved high-quality cleansing enables detection of more polyps per patient.
318 “Go Before You Go”: Interim Analysis of a Quality Improvement Project to Improve Colorectal Cancer Screening in a Safety Net Primary Care Clinic
Authors: Haghighat Shida , Shen Helen M. , Yeh Jeffrey , Cheng Marsha R. , Idos Gregory , Rubino Barbara , Suh Joanne 
Published: October 2019

INTRODUCTION:
More effective strategies are needed to improve the rate of colorectal cancer (CRC) screening among safety-net populations. The Fecal Immunochemical Test (FIT), a low-cost screening tool, is the primary modality for CRC screening at our safety net hospital. Institutional data demonstrated a poor FIT return rate of 20% within 4-6 weeks. In a study assessing barriers to FIT completion, we found that survey respondents preferred completing the FIT on the same day as their clinic appointment. This key result informed the development of a same day FIT intervention of our current study. Here we present the interim results.

METHODS:
We designed and implemented an early FIT return strategy called “Go Before You Go” within the primary care clinic. Our team met with stakeholders involved with CRC screening, including clinic leadership, nursing staff, and resident physicians. Patients were encouraged to complete the FIT in-office during their primary care visit. If patients were unable to provide their sample on the same day, then they were encouraged to return the test within one week of when the test was ordered. Resident physicians and nursing staff were counseled to encourage this policy via brief didactic sessions and reminded at daily huddles and through weekly text reminders. Television monitors in the clinic waiting room displayed ads for ”Go Before You Go.”

RESULTS:
We report the frequency of FIT completion before and after the intervention. Prior to the intervention, the total number of FITs ordered from January to March 2019 was 1444. The baseline same-day FIT return rate was 5.0% (n = 72), the 1-week return rate was 11.1% (n = 160), and the 4-week return rate was 20.6% (n = 297). Interim analysis of data one month after the introduction of the intervention demonstrated an overall improvement in the FIT return rate. A total of 488 FITs were ordered in April 2019. During the intervention period, the same-day FIT return rate increased to 12.7% (n = 62), the 1-week rate was 20.1% (n = 98) and the 4-week return rate was 29.9% (n = 146).

CONCLUSION:
Interim analysis from an ongoing “Go Before You Go” strategy resulted in an overall increase in the same-day, 1-week, and 4-week FIT completion rate in a safety net primary care clinic. This innovative approach to CRC screening shows promise; the intervention is thus ongoing and FIT return rates continue to be monitored for sustained improvement.
319 Barriers to Colorectal Cancer Screening With FIT in a Safety-Net Primary Care Clinic
Authors: Haghighat Shida , Yeh Jeffrey , Shen Helen M. , Cheng Marsha R. , Rubino Barbara , Suh Joanne , Idos Gregory 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) screening participation remains suboptimal, particularly among underserved populations. The Fecal Immunochemical Test (FIT) is the primary CRC screening test utilized in the primary care clinic at our large safety-net hospital. The clinic’s surveillance data shows that there is only a 20% FIT return rate within 4-6 weeks. To identify key barriers to FIT completion, we adopted a community-based participatory research (CBPR) approach to identify challenges to FIT completion in this safety net setting.

METHODS:
The CBPR approach included forming relationships with pertinent stakeholders including patients, resident physicians, nursing leadership, clinic directors and staff, and laboratory personnel. An eight-item survey assessing patient awareness of CRC screening and barriers to FIT completion was administered to randomly selected patients between the ages of 50-75 in the primary care clinic. A process map for FIT collection was subsequently devised after conducting interviews with the aforementioned stakeholders.

RESULTS:
The study population (n = 126) was comprised of a diverse population: 73% Hispanic (n = 93), 9% Black (n = 11), 9% White (n = 11), and 9% other races/ethnicities (n = 11). Among the cohort, 60.3% (n = 76) were up-to-date with FIT screening. 57% (n = 72) preferred Spanish when speaking to a healthcare provider. 22% (n = 27) reported not knowing the purpose of a FIT while 33% (n = 42) reported that their provider had not spoken to them about a FIT. We did not find a statistically significant difference among patients who completed and did not complete their FIT when analyzing for language barriers, lack of awareness, lack of provider communication, and understanding of instructions. When asked how the FIT could be made easier, 22% (n = 23) preferred to complete the FIT on the same day as their appointment. A discrepancy was found between the clinic-reported and patient-reported one-year FIT completion rates (60.3% vs. 76.7%, respectively). We found that the discordance was due to mislabeled/expired FITs which were discarded by the lab without notifying providers.

CONCLUSION:
By using CBPR grounded methods, the study identified potential areas of improvement to increase the FIT return rate, including proper handling of FITs and implementing a same-day FIT return policy. Interventions informed by this study are currently underway to increase same-day and same-week FIT return.