Facilitators and barriers to colorectal cancer screening in an outpatient setting

BACKGROUND Colorectal cancer(CRC)is the third most common cancer and the second leading cause of cancer-related deaths in the United States.Still,1 in 3 adults aged 50 years to 75 years have not been screened for CRC.Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality.AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina.The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening.METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic.Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year,Cologuard in the past three years,flexible sigmoidoscopy/virtual colonoscopy in the past five years,or colonoscopy in the past ten years.Data on patient socioeconomic status,comorbid conditions,and other determinants of health compliance were included as covariates.RESULTS Age[odds ratio(OR)=1.058;P=0.017],no-show rate percent(OR=0.962;P<0.05),patient history of obstructive sleep apnea(OR=1.875;P=0.025),compliance with flu vaccinations(OR=1.673;P<0.05),compliance with screening mammograms(OR=2.130;P<0.05),and compliance with screening pap smears(OR=2.708;P<0.05)were important factors in determining whether a patient will receive CRC screening.Race,gender,insurance or employment status,use of blood thinners,family history of CRC,or other comorbid conditions including diabetes,hypertension,congestive heart failure,chronic obstructive pulmonary disease,and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening.CONCLUSION Patient age,history of sleep apnea,and compliance with other health maintenance tests were significant facilitators to CRC screening,while no-show rate percent was a significant barrier in our patient population.This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

Disseminated herpes simplex infection induced hepatitis during pregnancy mimicking HELLP syndrome,a diagnostic challenge

The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms and potential overlap with other conditions.Pregnancy is a risk factor as it conforms to a partially immunocompro-mised state.Dissemination to the brain could be devastating,and the treatment requires intravenous antivirals like acyclovir.Fetal outcomes are variable based on previous case reports.We present a case of young female gravida 1 para 1 who presented with disseminated HSV infection mimicking HELLP(Hemolysis,Elevated Liver enzymes,and Low Platelets)syndrome.She responded well to intravenous acyclovir,and the fetus had a viable outcome at the 26th week of gestation.Early diagnosis can prevent progression to fulminant liver failure and the need for a liver transplant.