Abstract:
BACKGROUND:Colonoscopy is an effective screening modality for the early detection of colonic polyps and cancer, but screening rates are low particularly among minorities and the uninsured. In 2008, Capital Health obtained a clinical grant from the American Cancer Society to perform screening colonoscopies for patients without insurance who were established at the hospital's primary care clinic. The aim of this study is to evaluate the grant program with respect to endoscopic findings and changes in the demographics of patients undergoing colonoscopy. METHODS:A retrospective review was performed on all patients registered for colonoscopy at the endoscopy suite of Capital Health Regional Medical Center. A pre- and postimplementation analysis was designed to compare 3 groups: 1) all colonoscopies performed in the twenty four months prior to the program's start (pre-program group) 2) all screening colonoscopies performed on uninsured patients in the program during twenty four months period (program group) and 3) all other colonoscopies performed in the same suite during the time of the program (parallel group). A descriptive analysis of demographics, ethnicity and insurance status was performed. RESULTS:There were a total of 4004 colonoscopies performed during this 52month period, 53 (1.3%) were excluded because the data was incomplete. The pre-program group had 1892 colonoscopies of which 375 were screening colonoscopies, the program group had 363 screening colonoscopies, and the parallel group had 1750 colonoscopies of which 343 were screening colonoscopies. Implementation of the grant program resulted in nearly double the screening colonoscopies performed as compared to the pre-program period (375 vs 705). There was no change in the number of the reimbursed procedures performed in the same suite after initiation of the grant program. The proportion of minority patients undergoing a screening procedure in the program group was significantly increased compared to the other groups and this increase was largely accounted for by a higher proportion of Hispanic patients. The number of patients with polyps was higher in the program group compared with the preprogram and parallel group (42%, 36.8%, and 33.9%, respectively). CONCLUSIONS:A grant-funded program offering screening colonoscopies to uninsured patients demonstrated a high number of premalignant polyps that might otherwise have been undetected. Our experience suggests that targeting health care disparities by insurance status can increase access to preventive services and detect a high number of premalignant lesions.
journal_name
J Natl Med Assocjournal_title
Journal of the National Medical Associationauthors
Casadesus D,Penaloza O,Tewary AM,Moazami D,Simonian A,Goldsmith Ddoi
10.1016/S0027-9684(15)30024-9subject
Has Abstractpub_date
2015-06-01 00:00:00pages
46-50issue
2eissn
0027-9684issn
1943-4693pii
S0027-9684(15)30024-9journal_volume
107pub_type
杂志文章abstract:OBJECTIVE:Breast cancer mortality has declined, yet disease outcomes have not improved equally across populations. Disparities may initiate early in the continuum of care, in health behavior patterns, and screening practices. We examined variations in mammography, exercise, fruit and vegetable intake, alcohol consumpti...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/s0027-9684(15)30937-8
更新日期:2009-06-01 00:00:00
abstract::A survey of the nursing staff in an emergency service was completed by anonymous questionnaire. The results of the survey indicate satisfaction and confidence in the triaging group, a wish for more staff and specific inservice course content, good perception of emergency situations, misperception about restraint polic...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1983-04-01 00:00:00
abstract::Organizational barriers play a key role in colorectal cancer (CRC) screening disparities in low-income minorities. This is a prospective, randomized trial to determine whether a patient navigator (PN) can help overcome the organizational barriers low-income minorities face in trying to obtain screening colonoscopy. Pa...
journal_title:Journal of the National Medical Association
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0027-9684(15)31240-2
更新日期:2008-03-01 00:00:00
abstract::Relaxation therapy is one of the new modalities in the area of behavioral medicine which physicians may wish to use for tense patients as adjunctive to purely medical treatment. Efficacy of the specific therapy and patient compliance may be improved by use of relaxation therapy. This paper gives details on how to prov...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1983-02-01 00:00:00
abstract::Perineural and endoneural tumor spread is a form of metastatic disease in which the primary tumors spread along neural pathways and gain access to noncontiguous regions. Although rare, this type of skip metastasis into the cranial cavity occurs from tumors of the parotid gland and facial skin. Recognition of this proc...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Climatic conditions may trigger subclinical disease in predisposed individuals and also exacerbate eczematous symptoms resulting in persistence or increased frequency of atopic dermatitis (AD) flares. The aim of this study is to assess the impact of tropical weather conditions on the frequency at which atopi...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/j.jnma.2018.06.005
更新日期:2019-02-01 00:00:00
abstract::A Nigerian school boy with the syndrome of multiple jaw cysts, skeletal anomalies, and basal cell nevi is described and discussed. To the authors' knowledge, this is the first report of this syndrome in a black African. ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1980-03-01 00:00:00
abstract::Forty-two patients with renal cell carcinoma were evaluated with computerized tomography (CT) followed by surgical exploration, extirpative surgery, or autopsy to determine the accuracy of the CT scan in assessing the extension of the disease. There was an overall accuracy of 95 percent (40/42 patients). The two stagi...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1986-06-01 00:00:00
abstract::Jails and prison populations are unique in the incidence of deliberate self-harm, but the phenomenon is not well understood. One of the few generally accepted findings about suicidal behavior among the incarcerated is that white prisoners are overrepresented among both completed and attempted suicides, whereas black p...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1989-04-01 00:00:00
abstract::Adynamic ileus due to invasion of the myenteric plexus of the small and large intestine was a significant symptom in a patient with a peritoneal mesothelioma. A record of this unusual complication was not found in the medical literature surveyed. ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1987-07-01 00:00:00
abstract::There are significant health disparities between African Americans and whites in the United States. While colon cancer screening aids in decreasing the morbidity and mortality from colon cancer in African Americans, other health risks may also be identified during gastroenterology consultations. This study evaluated w...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2007-05-01 00:00:00
abstract::Endomyocardial fibrosis (EMF), an idiopathic cardiac disorder, occurs predominantly in the tropical and subtropical regions of the world. We present herein a report of EMF in a young man from the savannah belt of Nigeria. He was a 19-year-old young man who presented with recent onset of palpitation and dyspnea and was...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/s0027-9684(15)30756-2
更新日期:2010-12-01 00:00:00
abstract::A 65-year-old man underwent coronary artery bypass graft surgery at our tertiary care hospital. Perioperatively, he was transfused with four units of nonirradiated whole blood from first-degree relatives and discharged from the hospital at postoperative day seven. He presented six days later with fever, skin rash, ele...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2005-03-01 00:00:00
abstract::Carcinoma of the colorectum should be suspected and diagnosed early and treated adequately. Principles of surgical therapy are discussed. Meticulous follow-up is essential and re-exploration to remove recurrent disease is necessary. ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00
abstract:OBJECTIVES:Recurrent abdominal pain (RAP) is a common presenting symptom in children with sickle cell disease (SCD). This may be as a result of complications of the disease, surgical problems, or Helicobacter pylori gastritis. The prevalence of H pylori infection in SCD children is not known. This study aimed to determ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/s0027-9684(15)30738-0
更新日期:2010-11-01 00:00:00
abstract::The incidence of ADHD appears to be similar in African Americans and white populations. However, fewer African-American than white children are diagnosed and treated for ADHD. Reasons for this disparity have not been fully elucidated; causes are most likely complex. Whereas certain barriers to treatment are driven by ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS:We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured int...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/s0027-9684(15)30176-0
更新日期:2012-07-01 00:00:00
abstract::Loss of integrity of the thoracic duct will produce a chylous thoracic effusion. latrogenic chylothorax occurring during an intrathoracic surgical procedure in the vicinity of the thoracic duct is an omnipresent reality. The fluid is characteristically milky in appearance, sterile, and high in fat content.There seems ...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1986-11-01 00:00:00
abstract::The rare association of protease inhibitor deficiency (Pi(zz) genotype) in a black American with chronic, obstructive pulmonary disease due to asthmatic bronchitis, rather than basal pan lobular emphysema, is presented. The late onset of symptoms, despite environmental exposures, is also unusual in this homozygote, as...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1978-02-01 00:00:00
abstract::Sixteen normal individuals and 100 hospital patients, all black, were tested for abnormal carcinoembryonic antigen (CEA) levels. Male and female subjects (smokers and non-smokers) were tested. The results of the tests are discussed. For normal subjects, the CEA values ranged from 0.0 ng/ml to 2.6 ng/ml. Among hospital...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To determine if African American and European American children with asthma admitted to an intensive care unit (ICU) had different characteristics, we conducted a retrospective chart review of asthma admissions to the region's only pediatric ICU. PATIENTS AND METHODS:A chart review was performed on 125 patie...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:10.1016/s0027-9684(15)31107-x
更新日期:2009-11-01 00:00:00
abstract:OBJECTIVE:To determine whether any associations exist between cultural (racial/ethnic, spiritual/religious) competence and end-of-life treatment decisions in hospitalized patients and the potential impact of those associations on hospitalists' provision of care. DATA SOURCES AND METHODS:MEDLINE, PubMed, Embase, Psychl...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章,评审
doi:10.1016/s0027-9684(15)31040-3
更新日期:2009-09-01 00:00:00
abstract::Circumcision is one of the most common surgical procedures performed on males in the United States. Ethical considerations of the procedure have been considered for many years and, recently, research on the topic has shed more light on the debate. The purpose of this study was to review the history and emergence, curr...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章,评审
doi:10.1016/s0027-9684(15)30200-5
更新日期:2012-09-01 00:00:00
abstract::We sought to evaluate the economic impact and diagnostic utility of magnetic resonance imaging (MRI) in the management of patients with headache and nonfocal physical examinations. Computerized medical records were retrospectively reviewed of 1,233 patients presenting for MRI of headache at our institution over a 3-ye...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2000-12-01 00:00:00
abstract::Although mortality from cardiovascular diseases (CVDs) has been declining, it remains the leading cause of death among urban U.S. blacks. McCord and Freeman reported CVD as the major contributor to excess mortality in Central Harlem. However the disease-specific CVD mortality was not assessed. Thus, it was unclear wha...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2003-12-01 00:00:00
abstract::We report a case of a Hispanic male presenting with acute onset of bilateral lower extremity weakness, without any antecedent viral or bacterial illness, dietary changes, infiltrative orbitopathy, diffuse goiter, infiltrative dermopathy, and family history of periodic paralysis, who was later found to have Graves' dis...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:2002-05-01 00:00:00
abstract::Adverse drug reactions are defined and examples are given. Four areas of concern are addressed, namely, defining drug reactions, identifying some of the factors contributing to the adverse drug reactions, implications of adverse drug reactions for health-care providers, and preventive measures which impact on the occu...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1978-10-01 00:00:00
abstract::Arsine gas exposure is a rare occupational event and can be completely prevented with the use of appropriate protective gear. Exposure often occurs when arsine gas is generated while arsenic-containing crude ores or metals are treated with acid. Cases of toxicity require an index of suspicion and a good history. In pa...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章,评审
doi:
更新日期:2006-12-01 00:00:00
abstract::There are few reports in the medical literature of treatment of compression of the spinal cord by the use of radiation therapy alone. Laminectomy has been the standard procedure to relieve compression of the spinal cord and should be performed within 48 hours of initial symptoms. In this patient, radiation therapy was...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1979-03-01 00:00:00
abstract::Pneumococcal and mycoplasma infection of the lung or pleura, infarction of lung or pleura, local abscess below the diaphragm, and heart, kidney, or pancreas involvement are among the many causes of pleural effusion. Several of these have an increased likelihood of occurrence in sickle cell disease as a direct conseque...
journal_title:Journal of the National Medical Association
pub_type: 杂志文章
doi:
更新日期:1977-08-01 00:00:00