Objectives: The objective of this K24 proposal is to enable the candidate to mentor young investigators to successfully integrate clinical, outcomes and health services research methods to optimize management strategies for gastrointestinal disease. Background: The candidate has a successful program of patient- oriented research in gastrointestinal disease. He has obtained independent NIH funding for his research, and has an established record of mentoring young investigators who have been successful in conducting patient- oriented research, publishing in peer-reviewed journals and obtaining NIH support in the form of K-awards. The candidate has been invited to teach patient-oriented research design to national and international audiences, and publish reviews of research techniques in leading journals. Methods: Mentoring plan: The candidate's environment allows young investigators to obtain formal training in clinical study design, epidemiology and biostatistics. Specific goals for the candidate include formal coursework in health economic theory and participation in the UCSF Clinical and Translational Science Institute Mentor Development Program. The candidate proposes to teach quantitative analysis in order to generate hypotheses, which can be tested through properly designed prospective clinical trials. Data derived from these studies can be integrated into revised decision models to identify the optimal competing strategies of management, which can then be prospectively tested. An example testing this hypothesis is presented as a research project, which uses the infrastructure established by the candidate's R01 project to recruit and follow subjects. Research plan: The effectiveness of strategies to screen for colorectal neoplasia depends heavily on the rate of adherence between screening tests. This study aims to identify factors associated with non-adherence to colorectal neoplasia screening in a vulnerable population at high-risk for poor health outcomes. We are conducting a prospective cohort study of patients at average risk for development of polyps in which subjects receive counseling about screening using fecal occult blood testing or colonoscopy or their choice of either test. This proposal adds a survey to identify factors based on the Health Belief Model, including sociodemographic variables that predict non-adherence to screening. Data Collection: 1. The primary outcome is identification of variables associated with non-adherence. Data Analysis: Chi-square testing of proportions and generalized linear models. Public health: This grant will support mentorship of young investigators interested in patient-oriented research in gastrointestinal disease.
We aim to identify important questions through quantitative analysis and then definitively answer these questions through prospective clinical trials. The research project will provide targets for intervention to increase screening adherence for pre-malignant colorectal neoplasia, focusing on vulnerable populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24DK080941-06
Application #
8336884
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
Project Start
2008-07-01
Project End
2014-06-30
Budget Start
2012-07-01
Budget End
2014-06-30
Support Year
6
Fiscal Year
2012
Total Cost
$188,700
Indirect Cost
$13,529
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
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Somsouk, Ma; To'o, Katherine; Ali, Mujtaba et al. (2014) Esophageal varices on computed tomography and subsequent variceal hemorrhage. Abdom Imaging 39:251-6
Rubenstein, Joel H; Morgenstern, Hal; Appelman, Henry et al. (2013) Prediction of Barrett's esophagus among men. Am J Gastroenterol 108:353-62
Ho, Chanda; Kornfield, Rachel; Vittinghoff, Eric et al. (2013) Late presentation of colorectal cancer in a vulnerable population. Am J Gastroenterol 108:466-70
Rubenstein, Joel H; Morgenstern, Hal; McConell, Daniel et al. (2013) Associations of diabetes mellitus, insulin, leptin, and ghrelin with gastroesophageal reflux and Barrett's esophagus. Gastroenterology 145:1237-44.e1-5
Inadomi, John M; Vijan, Sandeep; Janz, Nancy K et al. (2012) Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med 172:575-82
Matsuzaki, J; Suzuki, H; Asakura, K et al. (2012) Classification of functional dyspepsia based on concomitant bowel symptoms. Neurogastroenterol Motil 24:325-e164

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