Deborah Fisher

Overview:

As Associate Director for Gastroenterology Research at the Duke Clinical Research Institute I am building on the success of the Hepatology research program at DCRI GI and expanding the research portfolio to GI medical devices and GI luminal (e.g., upper GI, colorectal) research. My own research focus is colorectal cancer prevention, detection, and surveillance.  My research, advocacy, and clinical work are connected by the goal to improve the quality, efficiency, and effectiveness of medical care and in particular colorectal cancer screening and surveillance programs.  My work has been recognized by several awards and I am funded by NIH and VA.  I have served on national committees including chairing the National VA GI Field Advisory Committee and am currently a member of the American Gastroenterology Association (AGA) Publications Committee and the American Society for Gastrointestinal Endoscopy (ASGE) Quality in Endoscopy committee. My current educational work includes clinical teaching in medicine, clinical gastroenterology and endoscopy, directing the Department of Medicine MENTORS program for clinical research fellows and research mentoring individual fellows and residents.  I am faculty of the GI Division T32 training grant and of the Duke Clinical Research Training Program. Finally, I am the Director of Social and Digital Media for the GI Division.

Positions:

Associate Professor of Medicine

Medicine, Gastroenterology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Education:

M.D. 1996

Vanderbilt University

Medical Resident, Medicine

University of Virginia

Fellow in Gastroenterology, Medicine

Duke University

Grants:

H9X-MC-GBGL

Administered By
Duke Clinical Research Institute
Role
Principal Investigator
Start Date
End Date

CATNIP - Subcontract with Weill Cornell

Administered By
Duke Clinical Research Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Correction to: Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease.

The original version of this article unfortunately contained a mistake. The shared first authorship information was missing in the published article. It has been given below. The first authorship is shared between Dr. Shai Posner and Kurren Mehta.
Authors
Posner, S; Mehta, K; Parish, A; Niedzwiecki, D; Gupta, RT; Fisher, DA; Leiman, DA
MLA Citation
Posner, Shai, et al. “Correction to: Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease.Dysphagia, May 2020. Pubmed, doi:10.1007/s00455-020-10122-1.
URI
https://scholars.duke.edu/individual/pub1441519
PMID
32388772
Source
pubmed
Published In
Dysphagia
Published Date
DOI
10.1007/s00455-020-10122-1

Comparison of survival of stage I-III colon cancer by travel distance and hospital volume.

BACKGROUND: Previous studies have demonstrated improved outcomes at high-volume colorectal surgery centers; however, the benefit for patients who live far from such centers has not been assessed relative to local, low-volume facilities. METHODS: The 2010-2015 National Cancer Database (NCDB) was queried for patients with stage I-III colon adenocarcinoma undergoing treatment at a single center. A 'local, low-volume' cohort was constructed of 12,768 patients in the bottom quartile of travel distance at the bottom quartile of institution surgical volume and a 'travel, high-volume' cohort of 11,349 patients in the top quartile of travel distance at the top quartile of institution surgical volume. RESULTS: In unadjusted analysis, patients in the travel cohort had improved rates of positive resection margins (3.7% vs. 5.5%, p < 0.001), adequate lymph-node harvests (92% vs. 83.6%, p < 0.001), and 30- (2.2% vs. 3.9%, p < 0.001) and 90-day mortality (3.7% vs. 6.4%, p < 0.001). On multivariable logistic regression analysis adjusting for patient demographic, tumor, and facility characteristics, the cohorts demonstrated equivalent overall survival (HR: 0.972, p = 0.39), with improved secondary outcomes in the 'travel' cohort of adequate lymph-node harvesting (OR: 0.57, p < 0.001), and 30- (OR 0.79, p = 0.019) and 90-day mortality (OR 0.80, p = 0.004). CONCLUSIONS: For patients with stage I-III colon cancer, traveling to high-volume institutions compared to local, low-volume centers does not convey an overall survival benefit. However, given advantages including 30- and 90-day mortality and adequate lymph-node harvest, nuanced patient recommendations should consider both these differences and the unquantified benefits to local care, including cost, travel time, and support systems.
Authors
Turner, MC; Jawitz, O; Adam, MA; Srinivasan, E; Niedzwiecki, D; Migaly, J; Fisher, DA; Mantyh, CR
MLA Citation
Turner, M. C., et al. “Comparison of survival of stage I-III colon cancer by travel distance and hospital volume.Tech Coloproctol, Apr. 2020. Pubmed, doi:10.1007/s10151-020-02207-8.
URI
https://scholars.duke.edu/individual/pub1438114
PMID
32281019
Source
pubmed
Published In
Tech Coloproctol
Published Date
DOI
10.1007/s10151-020-02207-8

Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease.

Gastroesophageal reflux disease and esophageal dysmotility are common in patients with advanced lung disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p < 0.01). There were 7 (26%) patients with abnormal barium tablet passage who had normal HRM. The sensitivity (35%) and specificity (77%) for detecting pathologic reflux with BaS was poor. Inducibility of reflux and barium column height were not associated with pH-metry results. No clinically significant luminal irregularities were identified. In conclusion, while BaS can non-invasively assess esophageal mucosa, its findings are not associated with EFTs in patients with ALD.
Authors
Posner, S; Mehta, K; Parish, A; Niedzwiecki, D; Gupta, RT; Fisher, DA; Leiman, DA
MLA Citation
Posner, Shai, et al. “Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease.Dysphagia, Apr. 2020. Pubmed, doi:10.1007/s00455-020-10113-2.
URI
https://scholars.duke.edu/individual/pub1436979
PMID
32277290
Source
pubmed
Published In
Dysphagia
Published Date
DOI
10.1007/s00455-020-10113-2

Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.

OBJECTIVES: A history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. We sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrhage. METHODS: We analyzed key efficacy and safety outcomes in patients with prior GIB in ARISTOTLE. Centrally adjudicated outcomes according to GIB history were analyzed using Cox proportional hazards models adjusted for randomized treatment and established risk factors. RESULTS: A total of 784 (4.3%) patients had prior GIB events (321 [41%] lower, 463 [59%] upper); 215 (27%) occurred <1 year before study enrollment. Patients with prior GIB were older, had more comorbidities, and higher CHADS2 and HAS-BLED scores than those with no GIB. Major GIB occurred more frequently in those with prior GIB (lower: aHR 1.72, 95% CI 0.86-3.42; upper: aHR 3.13, 95% CI 1.97-4.96). This association with major GIB was more pronounced in patients with GIB <1 year before randomization versus no recent GIB (recent lower: aHR 2.58, 95% CI 0.95-7.01; recent upper: aHR 5.16, 95% CI 2.66-10.0). There was no association between prior GIB and risk of stroke/systemic embolism or all-cause death. In those with prior GIB, the apixaban versus warfarin relative risks for stroke/systemic embolism, hemorrhagic stroke, death, or major bleeding were consistent with the results of the overall trial. CONCLUSIONS: In patients with AF on oral anticoagulants, prior GIB was associated with an increased risk of subsequent major GIB but not stroke, intracranial bleeding, or all-cause mortality. For the key outcomes of stroke, hemorrhagic stroke, death, and major bleeding, we found no evidence that the treatment effect (apixaban vs. warfarin) was modified by a history of GIB.
Authors
Garcia, DA; Fisher, DA; Mulder, H; Wruck, L; De Caterina, R; Halvorsen, S; Granger, CB; Held, C; Wallentin, L; Alexander, JH; Lopes, RD
URI
https://scholars.duke.edu/individual/pub1425666
PMID
31896036
Source
pubmed
Published In
American Heart Journal
Volume
221
Published Date
Start Page
1
End Page
8
DOI
10.1016/j.ahj.2019.10.013

Methods of extraction of optical properties from diffuse reflectance measurements of ex-vivo human colon tissue using thin film silicon photodetector arrays.

Spatially resolved diffuse reflectance spectroscopy (SRDRS) is a promising technique for characterization of colon tissue. Herein, two methods for extracting the reduced scattering and absorption coefficients ( μ s ' ( λ ) and μ a ( λ ) ) from SRDRS data using lookup tables of simulated diffuse reflectance are reported. Experimental measurements of liquid tissue phantoms performed with a custom multi-pixel silicon SRDRS sensor spanning the 450 - 750 nm wavelength range were used to evaluate the extraction methods, demonstrating that the combined use of spatial and spectral data reduces extraction error compared to use of spectral data alone. Additionally, SRDRS measurements of normal and tumor ex-vivo human colon tissue are presented along with μ s ' ( λ ) and μ a ( λ ) extracted from these measurements.
Authors
LaRiviere, B; Ferguson, NL; Garman, KS; Fisher, DA; Jokerst, NM
MLA Citation
LaRiviere, Ben, et al. “Methods of extraction of optical properties from diffuse reflectance measurements of ex-vivo human colon tissue using thin film silicon photodetector arrays.Biomed Opt Express, vol. 10, no. 11, Nov. 2019, pp. 5703–15. Pubmed, doi:10.1364/BOE.10.005703.
URI
https://scholars.duke.edu/individual/pub1421764
PMID
31799041
Source
pubmed
Published In
Biomedical Optics Express
Volume
10
Published Date
Start Page
5703
End Page
5715
DOI
10.1364/BOE.10.005703

Research Areas:

Activities of Daily Living
Adaptation, Psychological
Adolescent
Adult
Algorithms
Ambulatory Care Facilities
Attitude of Health Personnel
Barrett Esophagus
Blood
Chi-Square Distribution
Colonoscopy
Community Health Services
Constriction, Pathologic
Continental Population Groups
Data Mining
Databases as Topic
Decision Support Techniques
Diet
Dilatation
Early Detection of Cancer
Early Diagnosis
Endoscopy, Digestive System
Epidemiologic Methods
Feces
Gastrointestinal Diseases
Gastrointestinal Hemorrhage
Guideline Adherence
Health Behavior
Health Care Costs
Health Resources
Health Services Accessibility
Health Services Misuse
Health Services Research
Health Status
Healthcare Disparities
Hemostasis, Endoscopic
Humans
Hypopharynx
Intubation, Gastrointestinal
Liver
Lower Gastrointestinal Tract
Mass Screening
Melena
Mental Health
Needs Assessment
Neoplasm Recurrence, Local
Neoplasm Staging
Occult Blood
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient Selection
Physical Examination
Preventive Health Services
Prognosis
Quality Assurance, Health Care
Quality Indicators, Health Care
Quality of Health Care
Quality of Life
Questionnaires
Reproducibility of Results
Research Design
Risk Reduction Behavior
Sensitivity and Specificity
Social Class
Socioeconomic Factors
Standard of Care
Stents
Surveys and Questionnaires
Survivors
Time Factors
Treatment Outcome
Upper Gastrointestinal Tract
Veterans