Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System.

BACKGROUND & AIMS: Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adherence to guidelines for repeat colonoscopy screening and polyp surveillance intervals. METHODS: We performed a multi-center, retrospective, observational study using administrative claims, physician databases, and electronic medical records (EMR) from 1455 patients (50-64 y old) who underwent colonoscopy in the Veterans Affairs healthcare system in fiscal year 2008. Patients had no prior diagnosis of CRC or inflammatory bowel disease, and had not undergone colonoscopy examinations in the previous 10 years. We compared EMR-documented, endoscopist-recommended intervals for colonoscopies with intervals recommended by the 2008 Multi-Society Task Force guidelines. RESULTS: The overall rate of non-adherence to guideline recommendations was 36% and ranged from 3% to 80% among facilities. Non-adherence was 28% for patients who underwent normal colonoscopies, but 45%-52% after colonoscopies that identified hyperplastic or adenomatous polyps. Most of all recommendations that were not followed recommended a shorter surveillance interval. In adjusted analyses, non-adherence was significantly higher for patients whose colonoscopies identified hyperplastic (odds ratio [OR] = 3.1; 95% CI, 1.7-5.5) or high-risk adenomatous polyps (OR = 3.0; 95% CI, 1.2-8.0), compared to patients with normal colonoscopy examinations, but not for patients with low-risk adenomatous polyps (OR = 1.8; 95% CI, 0.9-3.7). Nonadherence was also associated with bowel preparation quality, geographic region, Charlson comorbidity score, and colonoscopy indication. CONCLUSIONS: In a managed care setting with salaried physicians, endoscopists recommend repeat colonoscopy sooner than guidelines for more than one third of patients. Factors associated with non-adherence to guideline recommendations were colonoscopy findings, quality of bowel preparation, and geographic region. Targeting endoscopist about non-adherence to colonoscopy guidelines could reduce overuse of colonoscopy and associated healthcare costs.

An assessment of survey measures used across key epidemiologic studies of United States Gulf War I Era veterans.

Over the past two decades, 12 large epidemiologic studies and 2 registries have focused on U.S. veterans of the 1990-1991 Gulf War Era. We conducted a review of these studies' research tools to identify existing gaps and overlaps of efforts to date, and to advance development of the next generation of Gulf War Era survey tools. Overall, we found that many of the studies used similar instruments. Questions regarding exposures were more similar across studies than other domains, while neurocognitive and psychological tools were the most variable. Many studies focused on self-reported survey results, with a range of validation practices. However, physical exams, biomedical assessments, and specimen storage were not common. This review suggests that while research may be able to pool data from past surveys, future surveys need to consider how their design can yield data comparable with previous surveys. Additionally, data that incorporate recent technologies in specimen and genetic analyses would greatly enhance such survey data. When combined with existing data on deployment-related exposures and post-deployment health conditions, longitudinal follow-up of existing studies within this collaborative framework could represent an important step toward improving the health of veterans.

Proteomic differentiation between murine retinal and brain-derived progenitor cells.

Previous studies have transplanted a variety of neural stem cells (NSCs) to the eye in hopes of developing a therapy to replace retinal neurons lost to disease. Successful integration, survival, and differentiation of the cell types has been variably successful. At the moment, little is known about the fundamental biological differences between stem cell or progenitor cell types. Characterization of these differences will not only increase our general understanding of this broadly characterized group of cells, but also lead to development of criteria for sorting cells, evaluating their differentiation, and predicting their suitability for transplantation. We have used two-dimensional gel electrophoresis protein expression profiles to characterize the molecular differences between two populations of murine progenitor cells-retinal progenitor cells (RPCs) and brain progenitor cells (BPCs) isolated from mice of the same age and same genetic background. Our protein expression profiling identified 22 proteins that are differentially expressed in RPCs when compared to BPCs. Four of the differentially expressed proteins correspond to proteins known to be involved in a cellular response to stress, and analysis of potential transcription factor binding sites in the promoter regions of their genes suggests these proteins could be co-regulated at the transcriptional level. On the basis of this discovery, we tested the hypothesis that the addition of the antioxidant vitamin E would decrease the expression of the stress-response proteins and influence differentiation of RPCs. Further investigation of differences between multiple populations of RPCs and BPCs during their maintenance and differentiation will further identify fundamental differences that define 'retinal-like' characteristics and provide tools to assay the success of efforts to influence many populations of stem cells to adapt a retinal cell fate.