Improving Fecal Immunochemical Test Collection for Colorectal Cancer Screening During the COVID-19 Pandemic.

Background: Colonoscopy is a first-line method for colorectal cancer (CRC) screening. However, cost-effective noninvasive tests, such as high-sensitivity guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT), are also used. The COVID-19 pandemic had a substantial negative impact on CRC screening rates. The James A. Haley Veterans Affairs Hospital (JAHVAH) continued socially distant CRC screening using FITs, but encountered inefficiencies due to high rates of incorrectly collected FIT samples. A quality improvement (QI) project was conducted to increase correctly collected and testable FIT kits upon initial laboratory submission. Observations: The ambulatory QI project sought out root causes for incorrectly returned FITs and proposed Plan-Do-Study-Act (PDSA) cycles based on a series of approved action plans. A multidisciplinary team of laboratory, nursing, administrative, and primary care staff worked together to discover 6 major root causes. Our multipronged PDSA cycle attempted to set up redundant patient reminders, centralize the FIT dispersal process, and make the patient-FIT interface more user-friendly. All PDSA solutions were implemented over 4 months. Lack of collection date was the most common reason for incorrectly returned FIT kits and the focus of PDSA improvements. The rate of FITs with missing collection dates dropped from 24% prior to PDSA to 14% in April 2021. The rate of correctly returned FIT kits rose from 38% before the project to 72% afterwards, surpassing the 20% improvement goal. Conclusions: FIT is a useful method for CRC screening that can be particularly helpful when in-person visits are limited, as seen during the COVID-19 pandemic. The increase in demand for FITs during the pandemic revealed process deficiencies and gave JAHVAH an opportunity to improve workflow.

A Common Symptom With an Uncommon Diagnosis: A Case of Primary Esophageal Diffuse Large B-cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. Although it can have gastrointestinal involvement, there are limited recorded cases that show primary esophageal DLBCL. This report discusses the case of an 85-year-old female who initially presented with weight loss associated with dysphagia and was later diagnosed with an esophageal mass by endoscopy. Pathology showed large, atypical lymphocytes, and the final morphologic, immunohistochemical, and molecular findings were most consistent with a diagnosis of primary esophageal DLBCL.

From the Outside Looking in: Psoriasiform Dermatitis Presenting as a Paraneoplastic Syndrome for Pancreatic Adenocarcinoma.

Paraneoplastic syndromes exist for a number of malignancies and their presentations are diverse. Some of them are self-limited, while others can be life-threatening but regardless of the outcome, understanding the presentation is vital to picking up on the diagnosis for further treatment. The case that is presented here is a rare paraneoplastic skin process called Bazex syndrome that was associated with pancreatic adenocarcinoma.