Chemoprevention of Colorectal Cancer

Chemoprevention of Colorectal Cancer

Although colorectal cancer (CRC) screening has reduced the incidence of and mortality from CRC, chemoprevention strategies have the potential to further reduce CRC incidence and mortality. Chemoprevention agents might be used for average-risk as well as high-risk groups, and to prevent CRC recurrence after therapy. CRC chemoprevention agents that have been studied include aspirin, nonaspirin nonsteroidal anti-inflammatory drugs, statins, agents that target metabolic pathways, and vitamins and minerals.

In this article, HIP Investigator Dr. Jennifer Weiss along with Dr. Bryson Katona reviewed the prospect of chemoprevention of colorectal cancer, results from preclinical and human studies, challenges, and future directions.

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Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Pelvic floor muscle exercises are a mainstay in the treatment of pelvic floor disorders such as urinary incontinence, overactive bladder, pelvic organ prolapse, and fecal incontinence. Women are more likely to report improvement in incontinence symptoms when they participate in directly supervised pelvic floor physical therapy (PFPT) as opposed to performing recommended exercises without supervision. However, < 50% of women referred for PFPT complete their prescribed program. HIP Investigator, Dr. Heidi Brown et al. sought to determine whether consultation with PFPT at the time of initial urogynecologic evaluation increases adherence to PFPT and to identify factors associated with PFPT attendance and completion.

The authors were also interested in exploring the relationship between the rate of surgical management of patients seen in multidisciplinary clinic versus those seen in a traditional clinic and those who attended PFPT versus those who did not. They hypothesized that rates of PFPT adherence would be higher when the patient met with a physical therapist at her initial urogynecology consultation as opposed to meeting with the urogynecologist alone.

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Association of Cardiovascular and Alzheimer’s Disease Risk Factors with Intracranial Arterial Blood Flow in Whites and African Americans

Association of Cardiovascular and Alzheimer’s Disease Risk Factors with Intracranial Arterial Blood Flow in Whites and African Americans

Alzheimer’s disease (AD) is the most common cause of dementia among older adults (≥60 years old), affecting more than 5.3 million people in the United States. AD has a higher prevalence among African Americans. Targeting cardiovascular and metabolic risk factors may be potential mechanisms to modify AD risk and address racial/ethnic disparities in AD dementia. HIP Investigator, Dr. Heather Johnson et al. investigated relationships among cardiovascular and metabolic risk factors, APOE genotype, AD biomarkers, and intracranial arterial blood flow in Whites and African Americans enriched for AD risk.

Authors found that elevated fasting glucose and triglycerides were associated with lower intracranial arterial flow; these relationships were more prominent in African Americans. Targeting metabolic risk factors may impact intracranial arterial health. Additional research is needed to determine if this will impact disparities in dementia prevalence.

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A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers

A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers

Nearly 2 million Americans develop a diabetic foot ulcer each year; within 5 years of ulceration, 5% will undergo major amputation and 50% to 70% will die. Experts have recommended a multidisciplinary team approach to optimally address certain comorbidities in a coordinated manner and to reduce major amputations. Authors including HIP Investigators Dr. Meghan Brennan and Dr. Christie Bartels described multidisciplinary team composition and function using a systems engineering conceptual model and summarized the impact of multidisciplinary teams on major amputations. They hypothesized that multidisciplinary teams are associated with a reduced risk of major amputation.

The group found that multidisciplinary team composition was variable but reduced major amputations in 94% of studies.

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Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial

Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial

More than 60% of older U.S. women suffer from urinary incontinence, bowel incontinence, or both, the annual cost of which exceeds $30 billion. In addition to significant negative effect on quality of life and depression,2 incontinence increases risk for institutionalization. HIP Investigator, Dr. Heidi Brown et al. evaluated the effects of Mind Over Matter: Healthy Bowels, Healthy Bladder, a small-group intervention, on urinary and bowel incontinence symptoms among older women with incontinence.

The authors found that participation in a small-group intervention improves symptoms of both urinary and bowel incontinence in older women. Mind Over Matter is a feasible model with potential to bring effective behavioral solutions to the community.

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Learn more about Mind Over Matter

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Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department

Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department

Falls among older adults are both a common reason for presentation to the emergency department, and a major source of morbidity and mortality. It is critical to identify fall patients quickly and reliably during, and immediately after, emergency department encounters in order to deliver appropriate care and referrals. Unfortunately, falls are difficult to identify without manual chart review, a time intensive process infeasible for many applications including surveillance and quality reporting. HIP Investigator, Dr. Brian Patterson described and validated a pragmatic, rules-based Natural Language Processing approach for identification of fall patients in the emergency department.

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HIP Model

A practical model for research with learning health systems: Building and implementing effective complex case management

A practical model for research with learning health systems: Building and implementing effective complex case management

For researchers to contribute meaningfully to the creation of learning health systems, practical tools are required to operationalize existing conceptual frameworks. A team of authors including HIP Investigators, Dr. Maureen Smith and Dr. Menggang Yu describe a model currently in use by the University of Wisconsin Health Innovation Program (HIP). The HIP model consolidates and enhances existing learning health system frameworks by defining specific steps needed to create sustainable change based on research conducted within the health system.

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View the HIP Model and Tools for Research with Learning Health Systems

View the Case Management Case Management Benefit Scoring System Toolkit

Eye doctor

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. While teleophthalmology has become increasingly accepted for diabetic eye screening in primary care settings, the availability of adequately trained, qualified readers may limit its widespread implementation. HIP Investigator, Dr. Yao Liu et al. assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.

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Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Despite the many uncertainties in the current health care delivery environment, payers and providers continue to demonstrate considerable interest in alternative payment models, including Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). HIP Investigator, Dr. Maureen Smith et al. believe that there is an alternative explanation for hospital-based ACOs’ seemingly poorer financial performance. Specifically, as Medicare beneficiaries develop new and more complex diseases, the increased utilization they require leads them to facilities that have more specialized care, which may more likely be part of a hospital-based ACO than a physician-led one.

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Eye appointment

Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic

Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic

Teleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. HIP Investigator, Dr. Yao Liu et al. sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use. The team of authors conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use.

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