Utilization of Video-Based Education through the Patient Portal to Improve Adherence to Colorectal Cancer Screening

Principal Investigator: Rajesh N. Keswani, MD Screening colonoscopies have been credited with turning the tide against colorectal cancer—the second leading cause of death in the United States—with early prevention and treatment. Yet barriers, from patient fears to cultural influences, keep many Americans from undergoing the potentially lifesaving procedure. Even when screening colonoscopies are scheduled, no shows and cancellations are common. Some 10 percent of Northwestern Medicine’s scheduled patients change their minds at the last minute and never make it to their appointments. Not only do patients miss out on this effective preventive health screening but they also contribute to wasted healthcare resources due to unfilled endoscopy appointments. Patient education remains critical to convincing individuals of the importance of colon cancer screening. In most busy clinical practices, though, healthcare practitioners often can’t devote the necessary time to the topic. Given the constraints of the current patient-primary care provider relationship, novel methods for delivering this vital information are needed to improve screening rates across the nation. Patient portals have fast become a standard feature of many electronic health records (EHRs) systems.  Allowing patients to schedule appointments, access test results and communicate with their doctors, EHRs can present an alternative channel for patient education materials. Northwestern Medicine investigators have already shown that the use of patient portals for educating patients on the importance of pneumonia vaccinations works. Patients who viewed a video on the subject were significantly more likely, than those who didn’t, to agree to being vaccinated. Thanks to a grant from the Digestive Health Foundation, researchers led by Rajesh N. Keswani, MD, Director of Quality for the Digestive Health Center,...

Video Case Series with 3D Animation for Endoscopic Submucosal Endoscopy (ESD) Strategies

Principal Investigator: A. Aziz Aadam, MD From development to implementation, new medical advancements often don’t enter into mainstream usage without education and training. Introduced in the 1990s in Japan, minimally-invasive endoscopic submucosal dissection (ESD) has become the standard of care for not only treating but also, most importantly, curing early gastrointestinal cancers. While widely accepted practice in Japan and Eastern countries, ESD hasn’t yet gain a foothold in western countries—mainly due to lack of available training from specialists skilled in performing ESD. Medical centers with the highest volumes of GI procedures typically provide the best ESD training experiences. At the moment, most of those centers operate outside of the United States. Endoscopists with an interest in learning the leading-edge technique must travel abroad and even with the instruction they receive, usually require more education and guidance to shorten the learning curve. Interest in developing ESD programs in this country has grown: Northwestern Medicine launched its ESD program in January 2016, joining the 15 to 20 centers in the country performing ESD. Supported by a grant from the Digestive Health Foundation, investigators led by A. Aziz Aadam, MD, in Northwestern Medicine’s Division of Gastroenterology and Hepatology, plan to bring much-needed ESD training closer to home. By creating an original video series, they intend to develop a premier educational tool for endoscopists from Western countries. Dr. Aadam and his co-investigators, including two Japanese endoscopic experts, will produce six 3D animated videos based on real-world examples. The videos will illustrate in detail the best strategies for treating the most commonly encountered lesions in the GI tract, focusing on those found in the...

Semen Quality in Males with Inflammatory Bowel Disease: Influence of Methotrexate Treatment

Principal Investigator: Anne Grosen, MD Immunosuppressive drugs have made living with inflammatory bowel disease (IBD) easier. But these powerful medications have their drawbacks, especially when it comes to potentially affecting future fertility. Complicating matters, IBD often strikes people during their key reproductive years. Patients’ fertility fears may dissuade them from taking effective medication that could help them to better manage their disease. Methotrexate (MTX) is a commonly prescribed drug treatment for IBD. Linked to birth defects, though, it is not recommended for pregnant women. How the drug affects a man’s ability to start a family remains a mystery. Funded by a Digestive Health Foundation grant, Northwestern Medicine researchers led by visiting scholar Anne Grosen, MD, from Aarhus University Hospital in Denmark, plan to shed light on the effects of this potent drug by examining several markers of male fertility, including sperm quality and reproductive hormones.   Dr. Grosen’s research team, which includes GI and fertility and reproductive medicine specialists, will focus on adult males (ages 18 to 45) who have been diagnosed with Crohn’s disease or ulcerative colitis. Seen by the IBD team at Northwestern Medicine, these individuals are either planning to start MTX treatment or are currently taking the drug for their disease. A healthy control group will participate in a separate study in Denmark and be used for comparative purposes. By analyzing MTX metabolites and other biomarkers in blood and semen samples, the investigators hope to determine if MTX makes a clinically relevant impact on male fertility. Study findings of this trans-Atlantic collaboration have the potential to improve future patient care by allaying concerns about drug safety...

The Impact of a Video Educational Tool on Perceived Cancer Risk in Patients with Barrett’s Esophagus

Principal Investigator: Amanda Guentner, MD No one wants to hear the “C” word. Even the slightest hint of a cancer risk is, understandably, frightening—even when all signs point to a positive outcome. Chronic regurgitation of stomach acid can damage the esophagus and eventually lead to a condition known as Barrett’s esophagus (BE). Patients with BE are at risk for esophageal adenocarcinoma (cancer of the esophagus), which strikes about 3 to 4 Americans out of 100,000 each year. While a variety of advanced treatments such as endoscopic eradication therapy (EET) help to prevent cancer well before it ever starts, many patients overestimate their cancer risk. Being referred for treatment appears to further ramp up their anxiety. Despite patient education prior to and after EET, individuals facing a series of treatments often forget what they may have been told about their diagnosis, cancer risk and/or short- and long-term prognosis. This perceived lack of information, which has been linked to overall patient satisfaction, often pushes them over the top. Supported by the Digestive Health Foundation, researchers in Northwestern Medicine’s Division of Gastroenterology and Hepatology are evaluating the use of multimedia to enhance the patient experience pre- and post-EET therapy. Recent studies have shown them to be successful with patients who’ve undergone general and orthopaedic surgical procedures. The investigators plan to create an educational video for patients undergoing EET for Barrett’s esophagus through Northwestern’s Digestive Health Center and measure its impact on reducing patient anxiety. Led by GI fellow Amanda Guentner, MD, the team will produce a short video to reinforce the information patients typically receive during face-to-face consultations with their gastroenterologist and/or...

HepQuant Liver Function Testing in the Prediction of Outcomes

Principal Investigator: Daniel R. Ganger, MD Many babies born with heart problems grow up and mature well into adulthood thanks to modern surgical advancements. In fact, one million adults currently live with some form of congenital heart disease in the United States alone. A rare congenital heart condition, single ventricle disease usually requires surgical intervention early on, with most children undergoing a common surgery known as the Fontan procedure. While it helps these young patients to overcome their heart problem, unfortunately the Fontan procedure can lead to liver problems—from cirrhosis and liver cancer to even liver failure—over time. Even with this knowledge, current hepatic laboratory testing, imaging tools, and/or liver biopsies are woefully inaccurate predictors of the development of serious liver disease. Awarded a grant from the Digestive Health Foundation, Northwestern Medicine investigators see a potential solution to providing effective screening and treatment for this chronically-ill population: the HepQuant-SHUNT test. Safe and non-invasive, the HepQuant-SHUNT test has shown promise by yielding easily reproducible and accurate measurements of liver function. In studies involving Hepatitis C patients, the novel test has begun demonstrating its strength for predicting important hepatic clinical outcomes, including liver-related death. Outdoing the results of the current gold standard of care, invasive liver biopsy, the HepQuant-SHUNT test may offer a more accurate as well as tolerable test for patients. GI and hepatology faculty member Daniel R. Granger, MD and chief medical resident Alexander Lemmer, MD, hope to determine if the HepQuant liver function test can accurately predict significant hepatic clinical outcomes in the post-Fontan population. Recruiting a total of 50 Fontan patients (ages 18-65) from Northwestern Memorial Hospital...