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Article: Impact of Epic Smartlist and Lumens Software in Improving OP-29 Compliance at a Tertiary Health Care Network.

Prenatt, Zarian / Liaquat, Hammad / Lovett, Troy / Evans, Joseph / Srivilli, Manasa / Marzotto, Nicholas / Martins, Noel

Cureus

2023 Volume 15, Issue 6, Page(s) e40193

Abstract: Background OP-29 is a Centers for Medicaid and Medicare Services (CMS) measure to ensure that endoscopists recommend appropriate follow-up intervals after normal colonoscopy in average risk patients. Failure to report OP-29 compliance can adversely ... ...

Abstract	Background OP-29 is a Centers for Medicaid and Medicare Services (CMS) measure to ensure that endoscopists recommend appropriate follow-up intervals after normal colonoscopy in average risk patients. Failure to report OP-29 compliance can adversely affect hospital quality star rating as well as reimbursement for health care. The aim of our quality improvement project was to improve OP-29 compliance to the top decile over three years. Methodology Our sample included patients between 50-75 years of age who received average risk screening colonoscopies with normal findings. We provided intensive education to endoscopists about the importance of OP-29 compliance, developed an Epic Smartlist that directs our endoscopists to list an appropriate reason for colonoscopy intervals other than 10 years, and monitored OP-29 compliance monthly. We became the first health network in the United States to implement the Lumens endoscopy report writing software (Epic Systems Corporation, Verona, USA) and added the OP-29-related Epic Smartlist to the Lumens colonoscopy note template. All statistical analyses were conducted in SPSS version 26 (IBM Corp., Armonk, USA) to compute the means and frequencies of outcomes. Results Our sample included 2,171 patients with a mean age of 60.5 years of whom the majority were female (57.2%) and Caucasians (90%). Our OP-29 score increased from 87.47% to 100% over the course of three years, and this steady improvement was seen broadly across our network. We compared our network score averages to our state and national averages and consistently demonstrated higher compliance rates while reaching the top decile by 2020. Conclusion We believe our improved OP-29 compliance has reduced colonoscopy overutilization, improved health care quality, and reduced health care costs for our patients and health network. To our knowledge, this is the first reported project towards improving OP-29 compliance utilizing the Epic Lumens software. Epic Lumens (Epic Systems Corporation, Verona, USA) added this Smartlist as quick buttons in the standard colonoscopy procedure note templates they built for other organizations to improve health care quality and cost nationally.
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.40193
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Association of Metabolic Syndrome Components and Colonic Diverticulosis in the Very Elderly: A Tertiary Health Network Study.

Liaquat, Hammad / Harmouch, Farah / Patel, Nishit / Prenatt, Zarian / Stoltzfus, Jill / Geme, Berhanu / Martins, Noel / Chaput, Kimberly

Cureus

2024 Volume 16, Issue 1, Page(s) e51610

Abstract: Introduction There is scarce data about the association of metabolic syndrome (MetS) or its components with the development of colonic diverticulosis (CD) in the elderly. We aim to determine the association of MetS and its components with CD in the ... ...

Abstract	Introduction There is scarce data about the association of metabolic syndrome (MetS) or its components with the development of colonic diverticulosis (CD) in the elderly. We aim to determine the association of MetS and its components with CD in the elderly aged ≥75 years. Methods We conducted a retrospective chart review at St. Luke's University Health Network to identify patients who underwent a colonoscopy between 2011 and 2020. We collected data on patient demographics, comorbidities, and colonoscopy findings. Statistical analyses were conducted to compute means and frequencies of patient characteristics and rates of CD, as well as to test for associations between potential risk factors and the presence of CD. Results A total of 1239 patients were included with a median age of 80 years, 57.6% females, 89.5% Caucasians, 72.9% with CD, and 66.7% having a left-sided disease. On bivariate analysis, the older age group (p=0.02), Caucasian ethnicity (p=0.01), and hypertension (p=0.04) were found to be significant risk factors for developing CD. Multivariate regression analysis showed older age group and hypertension (OR=1.47, 95% CI: 1.66-2.02, p=0.02) were major risk factors. A significant proportion of patients with left-sided disease had Caucasian ethnicity (p<0.001), while female gender, obesity, and iron deficiency anemia were also seen more frequently, although without statistical significance. Conclusion In the elderly (>75 years old), our study found hypertension to be associated with an increased risk of CD, while impaired fasting glucose (IFG) was protective. Most patients exhibited isolated left-sided diverticulosis, with pan-diverticulosis associated with higher proportions of adverse health indicators, including American Society of Anesthesiologists (ASA) score ≥3, IFG, hypertriglyceridemia, hypertension, and hypothyroidism. Further research with larger sample sizes in similar age groups is needed to expand upon these findings.
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.51610
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Article: Effect of Using Personal Protective Equipment during the COVID-19 Pandemic on the Quality Indicators of Screening Colonoscopies.

Chirayath, Subin / Bahirwani, Janak / Kaur, Parampreet / Martins, Noel / Modi, Ronak

Gastroenterology research and practice

2021 Volume 2021, Page(s) 8910004

Abstract: Background: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies.: Aims: Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by ... ...

Abstract	Background: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Aims: Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as the cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT), and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT, and ADR from outpatient, nonemergent procedures conducted at 3 endoscopy suites of St. Luke's University Health Network. All inpatient and emergent procedures were excluded. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 and 2020 (318 in 2019 vs. 157 in 2020, Conclusion: Our study showed that quality indices for screening colonoscopies like CIR, CIT, and SWT were negatively impacted during the COVID-19 time period. ADR, however, was similar. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopy's clinical benefit.
Language	English
Publishing date	2021-07-27
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2435460-0
ISSN	1687-630X ; 1687-6121
ISSN (online)	1687-630X
ISSN	1687-6121
DOI	10.1155/2021/8910004
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Article ; Online: Effect of using personal protective equipment during the COVID-19 pandemic on the quality indicators of screening colonoscopies.

Chirayath, Subin G / Bahirwani, Janak / Kaur, Parampreet / Martins, Noel / Modi, Ronak

medRxiv

Abstract: Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by ... ...

Abstract	Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT) and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT and ADR from outpatient, non-emergent procedures conducted at 3 endoscopy suites of St Lukes University Health Network. All inpatient and emergent procedures were excluded. Data was obtained by performing chart review on EPIC electronic health record. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 to 2020 (318 in 2019 vs 157 in 2020, p= 0.005). CIT (320+/-105 seconds in 2019 vs 392+/-107 seconds in 2020, p=0.001) and SWT (706+/-232 seconds in 2019 vs 830+/-241 seconds in 2020, p=0.001) were increased while CIR (98.2% in 2019 vs 96.6% in 2020, p=0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs 38.18(16.66-66.00) in 2020, p=0.8). Conclusion: Our study showed that quality indices for screening colonoscopies like cecal intubation rate, cecal intubation time and scope withdrawal time were negatively impacted during the initial COVID time period compared to pre-COVID time. The study also displayed that though there was a significant decline in both screening and diagnostic colonoscopies during pandemic, adenoma detection rates were comparable. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopies clinical benefits.
Keywords	covid19
Language	English
Publishing date	2021-05-10
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.05.07.21256743
Database	COVID19

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Article: Octreotide as an adjunct in the management of arterial gastrointestinal bleeding: Should it be considered in refractory cases of obscure origin?

Martins, Noel B / Chaput, Kimberly J / Stawicki, Stanislaw P / Modi, Ronak

International journal of critical illness and injury science

2017 Volume 7, Issue 1, Page(s) 8–11

Language	English
Publishing date	2017-03-10
Publishing country	India
Document type	Journal Article
ZDB-ID	2638865-0
ISSN	2231-5004 ; 2229-5151
ISSN (online)	2231-5004
ISSN	2229-5151
DOI	10.4103/IJCIIS.IJCIIS_14_17
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Article ; Online: Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis.

Duarte-Chavez, Rodrigo / Stoltzfus, Jill / Yellapu, Vikas / Martins, Noel / Nanda, Sudip / Longo, Santo / Geme, Berhanu / Schneider, Yecheskel

International journal of colorectal disease

2020 Volume 36, Issue 1, Page(s) 83–91

Abstract: Purpose: Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are ... ...

Abstract	Purpose: Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are to clarify this association using a larger patient population and to identify risk factors in general to develop diverticular disease. Methods: The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the population with ADPKD compared with the general population without ADPKD. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease in the general population. Results: The prevalence of diverticulosis, diverticulitis, and diverticular bleeding were considerably increased in patients with ADPKD compared with the general population without ADPKD. The prevalence of colonic surgery was less in ADPKD patients with diverticulitis. In patients with kidney transplant, the prevalence of diverticulitis was increased in the ADPKD group, but colonic surgery was not significantly different between both groups. The prevalence of diverticular bleeding was slightly elevated in patients with ADPKD, but colonic surgery was significantly increased in patients with ADPKD. NSAID use, hypertension, constipation, and ADPKD had increased odds ratios for diverticular disease during multivariate analysis. Conclusion: There is an increased prevalence of colonic diverticular disease in the population with ADPKD.
MeSH term(s)	Diverticular Diseases/complications ; Diverticular Diseases/epidemiology ; Diverticulitis/complications ; Diverticulitis/epidemiology ; Diverticulosis, Colonic ; Humans ; Kidney Transplantation ; Polycystic Kidney, Autosomal Dominant/complications ; Polycystic Kidney, Autosomal Dominant/epidemiology ; Risk Factors
Language	English
Publishing date	2020-09-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-020-03736-2
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Article: Upper gastrointestinal bleeding.

Martins, Noel B / Wassef, Wahid

Current opinion in gastroenterology

2006 Volume 22, Issue 6, Page(s) 612–619

Abstract: Purpose of review: This review provides an update on the management of upper gastrointestinal bleeding with special attention to patient preparation, sedation, hemostatic techniques, and postprocedure care.: Recent findings: In a large multicenter ... ...

Abstract	Purpose of review: This review provides an update on the management of upper gastrointestinal bleeding with special attention to patient preparation, sedation, hemostatic techniques, and postprocedure care. Recent findings: In a large multicenter clinical trial, nurse-administered propofol sedation had a complication rate of less than 0.2%. The optimal management for an ulcer with adherent clot was confirmed by a meta-analysis to be clot removal and endoscopic treatment of the underlying lesion. A number of prospective studies have demonstrated that capsule endoscopy is the most sensitive imaging modality for identifying lesions in the small bowel and that double-balloon enteroscopy is the least invasive modality available for the management of these lesions. Summary: This update describes many recent advances in the diagnosis and management of upper gastrointestinal bleeding. However, clearly, much work needs to be done in this field. Since propofol is not available for use in all endoscopy units, is there a better alternative for deep sedation? Rebleeding occurs in 20% of patients after endoscopic therapy, and so can we provide better outcomes with newer technologies (endoscopic suturing devices)? Finally, what is the best management for Helicobacter pylori-negative, nonsteroidal antiinflammatory drug-negative ulcer patients?
MeSH term(s)	Capsule Endoscopy ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/surgery ; Hemostasis, Surgical/methods ; Humans ; Postoperative Care/methods ; Preoperative Care/methods ; Prognosis
Language	English
Publishing date	2006-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632571-3
ISSN	1531-7056 ; 0267-1379
ISSN (online)	1531-7056
ISSN	0267-1379
DOI	10.1097/01.mog.0000245542.95408.5d
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Article: Inflammatory bowel disease.

Martins, Noel B / Peppercorn, Mark A

The American journal of managed care

2004 Volume 10, Issue 8, Page(s) 544–552

Abstract: Inflammatory bowel disease is a complicated condition, including Crohn's disease, ulcerative colitis, microscopic colitis, and indeterminate colitis, that affects the intestine and several extraintestinal sites. There has been much debate regarding ... ...

Abstract	Inflammatory bowel disease is a complicated condition, including Crohn's disease, ulcerative colitis, microscopic colitis, and indeterminate colitis, that affects the intestine and several extraintestinal sites. There has been much debate regarding whether Crohn's disease and ulcerative colitis are distinct entities or if they exist along a continuum of the same disease process. In this article, the pathogenic mechanisms and clinical manifestations of inflammatory bowel disease are reviewed, as well as treatment options. Because Crohn's disease and ulcerative colitis are chronic diseases, they have an important economic effect on our healthcare system and the United States as a whole. Some newer and more expensive treatment options may provide overall cost savings in select patient populations because of decreased use of healthcare resources.
MeSH term(s)	Humans ; Immunosuppressive Agents/therapeutic use ; Inflammatory Bowel Diseases/etiology ; Inflammatory Bowel Diseases/physiopathology ; Inflammatory Bowel Diseases/therapy ; Probiotics ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; United States
Chemical Substances	Immunosuppressive Agents ; Tumor Necrosis Factor-alpha
Language	English
Publishing date	2004-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
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Article: Reflections on the Ebola Public Health Emergency of International Concern, Part 1: Post-Ebola Syndrome: The Silent Outbreak.

Stawicki, Stanislaw P / Sharpe, Richard P / Galwankar, Sagar C / Sweeney, Joan / Martins, Noel / Papadimos, Thomas J / Jeanmonod, Donald / Firstenberg, Michael S / Paladino, Lorenzo / Hansoti, Bhakti / Garg, Manish

Journal of global infectious diseases

2017 Volume 9, Issue 2, Page(s) 41–44

Language	English
Publishing date	2017-03-31
Publishing country	India
Document type	Journal Article
ZDB-ID	2545454-7
ISSN	0974-8245 ; 0974-777X
ISSN (online)	0974-8245
ISSN	0974-777X
DOI	10.4103/jgid.jgid_20_17
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Article ; Online: Computed tomographic enterography and enteroclysis: pearls and pitfalls.

Dave-Verma, Hetal / Moore, Scott / Singh, Ajay / Martins, Noel / Zawacki, John

Current problems in diagnostic radiology

2008 Volume 37, Issue 6, Page(s) 279–287

Abstract: Computed tomographic (CT) enterography and enteroclysis improve visualization of the small bowel mucosa and wall in comparison with traditional CT and fluoroscopic studies by distending the small bowel through enteric hyperhydration with a negative ... ...

Abstract	Computed tomographic (CT) enterography and enteroclysis improve visualization of the small bowel mucosa and wall in comparison with traditional CT and fluoroscopic studies by distending the small bowel through enteric hyperhydration with a negative contrast agent. Although CT enterography is performed with oral hyperhydration, CT enteroclysis requires the placement of an enteroclysis tube, often in patients who are unable to orally consume the amount of liquid. When tolerated, CT enterography is often preferred due to its lack of invasiveness. Magnetic resonance enterography and enteroclysis are other modalities that are still being studied and show promise in the imaging of small bowel. Unlike small bowel follow-through, conventional enteroclysis, or capsule endoscopy, extraenteric findings are best assessed on CT enterography. These include findings in the surrounding mesentery, perienteric fat, and the adjacent solid organs that may be associated with the small bowel process and include fistulas or abscesses, mural hyperenhancement, prominent vasa recta, and other inflammatory changes. CT enterography has developed into the first-line modality in the imaging of Crohn's disease and is considered the most appropriate imaging modality in patients with suspected Crohn's disease. It is also increasingly being used in the assessment of small bowel infections, neoplasms, adhesions, and polyps.
MeSH term(s)	Adolescent ; Adult ; Aged ; Capsule Endoscopy/methods ; Contrast Media/pharmacology ; Crohn Disease/diagnostic imaging ; Crohn Disease/pathology ; Female ; Gastrointestinal Agents ; Humans ; Inflammatory Bowel Diseases/diagnostic imaging ; Inflammatory Bowel Diseases/pathology ; Intestinal Mucosa/diagnostic imaging ; Intestinal Mucosa/pathology ; Intestine, Small/diagnostic imaging ; Intestine, Small/pathology ; Male ; Middle Aged ; Radiographic Image Enhancement/methods ; Sensitivity and Specificity ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/methods
Chemical Substances	Contrast Media ; Gastrointestinal Agents
Language	English
Publishing date	2008-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	198954-6
ISSN	1535-6302 ; 0363-0188
ISSN (online)	1535-6302
ISSN	0363-0188
DOI	10.1067/j.cpradiol.2007.08.007
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