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Wrzesinski S.H.,Yale University | Wrzesinski S.H.,Comprehensive Cancer Center | Taddei T.H.,Yale University | Taddei T.H.,Hepatitis source Center | And 2 more authors.
Clinics in Liver Disease | Year: 2011

Many potential systemic therapies are being investigated for the treatment of hepatocellular carcinoma (HCC). The incidence of this malignancy is rising sharply and the vast majority of patients present at advanced stages. Although the earlier dismal results with cytotoxic chemotherapies made way for the development of locoregional therapies that provided improved overall survival, truly personalized therapy will require the selection of phenotypically similar stages of disease and populations, an understanding of the complex molecular and genetic pathways leading to HCC, and a keen understanding of the pathobiology of cirrhosis. Only then will we understand how to offer a particular patient at a specific stage of disease the appropriate therapy to truly prolong survival. © 2011 Elsevier Ltd.

Hagedorn H.J.,Substance Use Disorders Quality Enhancement Research Initiative | Hagedorn H.J.,University of Minnesota | Hagedorn H.J.,Hepatitis source Center | Heideman P.W.,Minneapolis Medical Center
Implementation Science | Year: 2010

Background: The Organizational Readiness to Change Assessment (ORCA) is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD) clinics.Methods: Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline.Results: Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4) versus low (n = 5)-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics.Conclusions: The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice recommendations at follow-up. This supports the use of the ORCA to describe factors related to implementing practice recommendations in clinical settings. Future research utilizing larger sample sizes will be essential to support these preliminary findings. © 2010 Hagedorn and Heideman; licensee BioMed Central Ltd.

Fuller B.E.,Portland Medical Center | Fuller B.E.,Oregon Health And Science University | Fuller B.E.,Hepatitis source Center | Rodriguez V.L.,Portland Medical Center | And 2 more authors.
Open Infectious Diseases Journal | Year: 2011

Objective: This retrospective study analyzed the testing rates of individuals enrolled in the Hepatitis C Clinical Case Registry for the Veterans Health Administration (VHA) in order to determine Human Immunodeficiency Virus (HIV) co-testing rates for veterans with hepatitis C (HCV). Design: A chart review of 247,006 veterans enrolled in the National HCV Clinical Case Registry was examined retrospectively. Regression analysis identified factors that increased the probability of being tested for HIV. Methods: Simple odds ratios and a complex regression were applied to this dataset to calculate testing incidence and prevalence of HIV. Results: Only approximately one third of veterans with HCV were tested for HIV and, of these, 13.2% were positive. Sixty eight percent of veterans with HCV were not co-tested for HIV and within this group there may be a significant number of unidentified cases of HIV. Veterans with severe mental illness, substance use disorders and marijuana abuse/dependence treatment were more likely to be tested for HIV. Antiviral therapy for HCV had no impact on likelihood of co-testing prior to treatment initiation. Conclusions: Most veterans with HCV are not co-tested for HIV despite common risk factors for HIV and HCV infection. Mandatory testing for HIV, at least among veterans with HCV, as well as identification and removal of barriers to HIV testing within the VHA would serve to facilitate disease management for veterans in the future. © Fuller et al.

Pocha C.,Hepatitis source Center | Pocha C.,University of Minnesota | Dieperink E.,Hepatitis source Center | Dieperink E.,University of Minnesota | And 7 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2013

Background Guidelines recommend screening for hepatocellular cancer (HCC) with ultrasonography. The performance of ultrasonography varies widely. Computed tomography (CT) is less operator dependent. Aim To compare the performance and cost of twice-a-year ultrasonography to once-a-year triple-phase-contrast CT for HCC screening in veterans. We hypothesised that CT detects smaller HCCs at lower overall cost. Method One hundred and sixty-three subjects with compensated cirrhosis were randomised to biannual ultrasonography or yearly CT. Twice-a-year alpha-feto protein testing was performed in all patients. Contingency table analysis using chi-squared tests was used to determine differences in sensitivity and specificity of screening arms, survival analysis with Kaplan-Meier method to determine cumulative cancer rates. Multivariate logistic regression models were used to examine predictive factors. Results Hepatocellular cancer incidence rate was 6.6% per year. Nine HCCs were detected by ultrasonography and eight by CT. Sensitivity and specificity were 71.4% and 97.5%, respectively, for ultrasonography vs. 66.7% and 94.4%, respectively, for CT. Although 58.8% of screen-detected HCC were early stage (Barcelona Clinic Liver Cancer stage A), only 23.5% received potentially curative treatment despite all treatment options being available. HCC-related and overall mortality were 70.5% and 82.3%, respectively, in patients with screen-detected tumour. Overall costs were less for biannual ultrasonography than annual CT. Conclusions Biannual ultrasonography was marginally more sensitive and less costly for detection of early HCC compared with annual CT. Despite early detection, HCC-related mortality was high. These data support the use of biannual ultrasonography for HCC surveillance in a US patient population (NCT01350167). © 2013 John Wiley & Sons Ltd.

Chapko M.K.,Hepatitis source Center | Chapko M.K.,University of Washington | Yee H.S.,Hepatitis source Center | Yee H.S.,University of California at San Francisco | And 4 more authors.
Vaccine | Year: 2010

The incidence of hepatitis A infection in the United States has decreased dramatically in recent years because of childhood immunization programs. A decision analysis of the cost-effectiveness of hepatitis A vaccination for adults with hepatitis C was conducted. No vaccination strategy is cost-effective for adults with hepatitis C using the recent lower anticipated hepatitis A incidence, private sector costs, and a cost-effectiveness criterion of $100,000/QALY. Vaccination is cost-effective only for individuals who have cleared the hepatitis C virus when Department of Veterans Affairs costs are used. The recommendation to vaccinate adults with hepatitis C against hepatitis A should be reconsidered.

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