Differences In Completion Rates Research Articles

Comparison of morning versus afternoon cecal intubation rates

BackgroundMany factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.MethodsRetrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow.Results6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon.ConclusionUncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies.

Randomized Control Trial of Magnetic Positioning Device Assisted Pediatric Colonoscopy: A Pilot and Feasibility Study

Background and Aims: Complete colonoscopy with intubation of the terminal ileum is critical for the evaluation of many pediatric gastrointestinal diseases. A colonoscope that incorporates magnetic coils has been developed to help determine the shape and position of the colonoscope in real time without the use of x-rays (ScopeGuide®, Olympus Imagining America, Inc). In adult colonoscopy, magnetic positioning device assisted colonoscopy has been shown to improve navigation of colonic loops, detection of pathologic findings, and total procedure time. The use of magnetic positioning colonoscopy has not been studied in the pediatric patient population. The aim of this study was to investigate the feasibility of magnetic positioning device for pediatric colonoscopy and to compare completion rate and procedure time with and without the device. Methods: Prospective randomized pilot trial of standard colonoscopy (SC) compared to magnetic positioning (MP) device assisted colonoscopy in children and adolescents ages 7-20 years was performed. Four experienced endoscopists participated in the trial. In addition to demographic data, rates of successful colonoscopy to the cecum and procedure times were recorded. We used nonparametric Wilcoxon rank-sum for statistical analysis. Results: There were a total of 40 patients enrolled in the trial, 22 in the MP arm (59% female, median age 14 years) and 18 in the SC arm (56% female, median age 14.5 years). Two patients (both MP group) were excluded from the analysis due to incomplete preparation or failed sedation. Of the remaining 38 patients, interim intention to treat analysis showed that the proportion of successfully completed colonoscopies were 19/20 (95%) in the MP arm versus 17/18 (94.4%) in the SC arm, p = NS. The median time to complete colonoscopy to the cecum was 16.5 minutes (range 6-52 minutes) in the MP arm and 12 minutes (range 6-33 minutes) in the SC arm, p = NS. Conclusions: Our preliminary data suggest that the use of magnetic positioning device for colonoscopy is feasible in pediatric patients. However, there were no differences in completion rates or colonoscopy times between the MP and the SC arms. The use of magnetic positioning device may not be of benefit for experienced endoscopists who achieved very high colonoscopy completion rates. Further studies are needed to determine its role in pediatric colonoscopy since this device may be of more benefit for physicians in training.

Psychiatric Diagnosis and Clinical Trial Completion Rates: Analysis of the FDA SBA Reports

Completion rates may affect the safety and efficacy evaluations of psychotropics. We assessed completion rates in clinical trials evaluating psychotropics for five psychiatric disorders. We also examined differences in completion rates between psychotropics and placebo in each diagnostic category. We reviewed clinical data in the Food and Drug Administration summary basis of approval reports for 20 psychotropics evaluated for the treatment of depression, schizophrenia, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), or panic disorder, consisting of 19 710 patients. Patients with OCD had the highest completion rates (78.0%), followed by patients with panic disorder (74.4%), GAD (69.2%), depression (64.7%) and schizophrenia (49.0%). Patients assigned to placebo had significantly lower completion rates in antipsychotic clinical trials. Patients assigned to psychotropics in OCD trials had significantly lower completion rates compared to the placebo group. A greater number of early terminations relating to a lack of efficacy was seen among patients assigned to placebo (17.4%) compared with patients assigned to psychotropics (12.2%). A greater number of early terminations relating to adverse events was seen among patients assigned to psychotropics (10.4%) compared with patients assigned to placebo (4.8%). Our findings suggest that psychiatric diagnosis and treatment assignment (placebo vs psychotropic) were associated with completion rates in clinical trials. These findings may help in the design of future psychopharmacology clinical trials.

Completing an Advance Directive in the Primary Care Setting: What Do We Need for Success?

To systematically review studies designed to increase advance directive completion in the primary care setting and employ meta-analytic techniques to quantify their effects. Extensive bibliographic searches of English-language literature published from January 1991 through July 2005 were conducted. Investigators abstracted prespecified information (e.g., design, study duration, types of interventions employed) and advance directive completion rates for intervention and control arms in each investigation and calculated absolute rate differences (i.e., difference in completion rates between the two groups) for each study. Individual study and pooled-effect sizes were also calculated, along with 95% confidence intervals (CIs). Literature review. Eighteen studies were retained in the final sample. Most studies employed multimodal interventions. The most common approach consisted of educational materials directed at patients (through mailing or at visit) coupled with a patient-healthcare provider interaction in a group or individual setting (n=7). Absolute differences in completion rates varied from a high of 44% (favors intervention) to a low of -2% (favors control). Effect sizes could be calculated for 15 of the 18 studies. The pooled effect size was 0.50 (95% CI=0.17-0.83), indicating a moderate overall effect in favor of the intervention. The majority of studies demonstrated statistically significant effects associated with the advance directive intervention. The most successful interventions incorporated direct patient-healthcare professional interactions over multiple visits. Passive education of patients using written materials (without direct counseling) was a relatively ineffective method for increasing advance directive completion rates in the primary care setting.

Best laid plans: Gender and the MBA completion rates of GMAT registrants

Evidence suggests that while women are more likely to go to college than men, they are less likely to go to graduate school. Moreover, in fields like science and engineering, women who do pursue advanced degrees are less likely than men to complete them. This paper compares MBA completion rates for women and men who registered to take the Graduate Management Admission Test (GMAT). We find that female test registrants are about 30% less likely than men to complete the MBA. This difference in completion rates seems only partly due to gender disparity in family responsibilities.

Randomised Controlled Trial of Sedation for Colonoscopy: Entonox Versus Intravenous Sedation

Introduction: Intravenous sedation for colonoscopy is associated with cardio-respiratory complications, delayed recovery and prolonged drowsiness. We aimed to determine whether inhaled Entonox (50% nitrous oxide: 50% oxygen) provides adequate analgesia compared to Midazolam/Fentanyl and its impact on psychomotor recovery and patient satisfaction. Methods: All patients undergoing elective colonoscopy except those with history of colon resection were included. Ethics committee approval was obtained. Randomisation was stratified by endoscopist grade with adequate allocation concealment. The entonox group inhaled for 60 seconds before procedure and continued till the caecum was reached. In intravenous group, Fentanyl was followed by Midazolam and colonoscope was inserted 5 minutes thereafter. Patients completed anxiety score (HAD questionnaire), baseline letter-cancellation test and pain score on visual analogue scale (VAS) before procedure. Patients then completed letter-cancellation tests and marked pain assessment on VAS immediately after procedure and at discharge. All patients completed satisfaction survey at discharge and 24-hours post-procedure, when they also marked pain assessment. Secondary end-points measured were completion rates, nurse and endoscopist satisfaction and complication rates. Results: 120 patients were randomised to receive Entonox (n = 60) or Midazolam/Fentanyl (n = 60). None of entonox patients needed conversion to intravenous medication. Entonox patients reported significantly lesser pain (mean score 25 versus 40, p < 0.003; Mann Whitney U Test) with similar pre-procedure anxiety scores (p = 0.1). Pre-colonoscopy letter cancellation scores were similar, Entonox group patients scored significantly better than the intravenous group (p = 0.001) both immediate post-procedure and at discharge. Discharge time was significantly lesser for entonox patients (mean 26 minutes) than intravenous group (mean 44 minutes; p = 0.004). There was no significant difference in completion rates between two groups (96% versus 94%; p = 0.5). Patient satisfaction was higher in entonox group (mean 98 versus 80; p = 0.001). Conclusion: Entonox is more effective than midazolam/fentanyl for colonoscopy, provides greater patient satisfaction and facilitates early discharge. These findings have enormous socio-economic impact as faster psychomotor recovery implies patients do not need carer, can be allowed to drive home and are able to join work next day. The health service benefits with obvious lower costs and faster turnover.

Colonoscopy in Elderly People is a Safe Procedure with a High Diagnostic Yield: A Prospective Comparative Study of 2000 Patients

Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy. However, the data on its safety and effectiveness in the elderly population are limited and somewhat conflicting. We prospectively assessed whether there are differences in completion rates, diagnostic yield, complication rates and 30-day mortality between patients aged > or = 65 years and patients aged < 65 undergoing colonoscopy at our centre. Data were collected prospectively on 2000 colonoscopies performed over a 2-year period (January 2002 to January 2004). We compared 1000 consecutive colonoscopies in patients aged > or = 65 with 1000 consecutive colonoscopies in patients aged < 65 (control group). Data were collected on sedation; on completion rates, both crude and adjusted to discount failures due to obstructive disease; on diagnostic yield; complications, and on 30-day mortality. The median age was 75 years (51 % women) for the elderly group and 54 years (59 % women) for controls. The proportion of patients who received sedation was similar for both groups (59 % vs. 62 %, P = 0.97) but the mean dose of midazolam was lower in the elderly group (3.8 mg vs. 4.5 mg, P < 0.0001). The crude completion rate was lower for the elderly group (81.8 % vs. 86.5 %, P = 0.004), but the adjusted rate was similar for both groups (88.1 % elderly vs. 87.6 % control, P = 0.18). The overall diagnostic yield was higher in the elderly group (65 % vs. 45 %, P < 0.0001) with higher rates of carcinoma detected (7.1 % vs. 1.3 %, P < 0.0001). The complication rate was low (0.2 % per group). Colonoscopy in the elderly is safe and effective with a high diagnostic yield. Colonoscopy may now be the imaging modality of choice in the elderly population.

Hepatitis B vaccination of men who have sex with men: experience with an accelerated course of vaccination in a genitourinary medicine clinic

An accelerated course of hepatitis B vaccination was offered to men who had sex with men attending a genitourinary medicine clinic. The uptake and completion rates of the vaccine between 1 November 2002 and 28 February 2004 were compared with data for 1994. The uptake of vaccine was significantly higher during the former audit period than the latter (310 [98%] of 315 versus 146 [74%]). There was, however, no significant difference in completion rates between the two audit periods: 220 (73%) of the 302 men who initiated the accelerated schedule, compared with 118 (81%) of the 146 men who completed the standard course in 1994. Innovative means of ensuring completion of vaccination are needed.

High Rates of Advance Care Planning in New York City’s Elderly Population

Previous studies have demonstrated low rates of advance care planning (ACP), particularly among nonwhite populations, raising questions about the generalizability of this decision-making process. To explore factors that may influence patients' willingness to engage in ACP. Survey. Thirty-four randomly selected New York City senior centers. A total of 700 African American (n = 239), Hispanic (n = 237), and white (n = 224) adults 60 years and older. Participants were administered a 51-item survey that assessed attitudes, beliefs, and practices regarding ACP. Attitudes and beliefs about physicians' trustworthiness, fatalism, beliefs about surrogate decision making, and comfort discussing end-of-life medical care; factors associated with health care proxy completion; and health care proxy completion rates. More than one third of the participants had completed a health care proxy. There were no significant differences in completion rates across the 3 ethnic groups. Respondents who had a primary care physician (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-3.2), were more knowledgeable about advance directives (OR, 2.0; 95% CI, 1.4-2.9), or had seen a friend or family member use a mechanical ventilator (OR, 1.5; 95% CI, 1.02-2.1) were significantly more likely to have designated a health care proxy. Respondents who were only comfortable discussing ACP if the discussion was initiated by the physician (OR, 0.6; 95% CI, 0.0-0.8) were significantly less likely to have completed a health care proxy. African American, Hispanic, and white community-dwelling, older adults had similarly high rates of advance directive completion. The primary predictors of advance directive completion involved modifiable factors such as established primary care physicians, personal experience with mechanical ventilation, knowledge about the process of ACP, and physicians' willingness to effectively initiate such discussions. Some of the racial/ethnic differences in desire for collective family-based decision making that were observed in this study have implications for the evolution of ACP policy that respects and operationalizes these preferences.

Does questionnaire structure influence response in postal surveys?

This study tested the effect of questionnaire structure on response, speed of return, and content of answers in a postal survey. All 259 patients aged 30–59 years who consulted with back pain at four UK general practices from March to June 2001 were randomly allocated to receive either a traditionally or chronologically structured self-completion questionnaire. The response was higher and the returns quicker (P = .05) for the chronologic questionnaire. There were no statistically significant differences in completion rates or scores on the SF-36, Chronic Pain Grade, Hospital Anxiety and Depression Scale, or Roland-Morris Disability Questionnaire between the two types of questionnaire, and test-retest reliability was high for all scales. Changing questionnaire structure to make questions chronologic does not substantially affect the answers given, but may make a questionnaire more acceptable and easier to complete and speed up returns.

Colonoscope length and procedure efficiency

OBJECTIVE: We set out to compare the success of colonoscopy using long and intermediate length standard adult instruments. METHODS: An intermediate length (133 cm working length) and long (168 cm) videocolonoscope were used on an alternate patient basis during routine endoscopy lists. Completion rates, times, and the need for external abdominal pressure were documented, as were causes of failed cecal intubation. RESULTS: Among patients with no history of colon resection and with satisfactory bowel preparation, 173 procedures were performed with the intermediate and 167 with the long colonoscope. There was no significant difference in completion rates (96% for both, excluding patients with strictures), completion times (intermediate mean = 7.73 min, long = 8.11 min; p = 0.44), or need for external abdominal pressure. Similarly, no difference was observed for male and female patients analyzed separately. Though there was no significant difference in completion rates for males and females overall (99% vs 95% excluding patients with strictures, p = 0.08), the latter had significantly longer completion times (mean = 8.75 vs 6.76 min, p < 0.001) and were more likely to require external abdominal pressure. Intermediate colonoscope length was responsible for failure to reach the cecum in one patient only (0.6%). CONCLUSIONS: Although the length of the intermediate instrument rarely compromises colonoscopy, it offers no significant advantage over the long scope for routine procedures.

The impact of naloxone/lofexidine combination treatment on the opiate withdrawal syndrome.

Clinical studies in opiate-dependent patients suggest that detoxification treatment with opiate antagonists may accelerate the resolution of the opiate withdrawal syndrome, permitting early induction onto naltrexone maintenance treatment. The present open study compared the clinical efficacy of daily naloxone injections in conjunction with lofexidine, with conventional lofexidine monotherapy, in 49 polysubstance-misusing opiate-dependent patients. Overall, the addition of naloxone did not confer substantial benefit over lofexidine monotherapy, although area-under-the-curve analysis showed that withdrawal severity in the naloxone/lofexidine combination group was significantly less than in the lofexidine monotherapy group, who experienced more severe withdrawal symptoms on days 4, 7, 9 and 13 of treatment. There were no significant differences in rates of completion of detoxification. Blood pressure remained within normal limits in both groups. Naltrexone maintenance treatment acceptability was low; only four patients continued with treatment for 5 or more days. The modest benefit of adding naloxone to lofexidine compared to the findings of previous opiate antagonist detoxification treatment studies is discussed in the context of the hypothesis that a critical level of opiate receptor occupancy is required to accelerate resolution of opiate withdrawal; the neurochemical mechanisms which may promote this are discussed.

Accelerated lofexidine treatment regimen compared with conventional lofexidine and methadone treatment for in-patient opiate detoxification

This open study compares an accelerated 5-day lofexidine regimen with orthodox 10-day lofexidine and methadone regimens in the treatment of opiate withdrawal in 61 polysubstance abusing opiate addicts. Significant differences in levels of withdrawal symptoms were found on days 11, 13–15 and 17–20, symptoms resolving most rapidly in the 5-day lofexidine treatment group, whilst withdrawal responses in the 10-day lofexidine treatment group were intermediate between the 5-day lofexidine and standard methadone treatment conditions. When the two lofexidine regimens were separately compared with methadone the 5-day lofexidine treatment was significantly more effective on day 10, 11 and 13–20, whilst the 10-day lofexidine treatment was not significantly different from methadone. There were no significant differences in rates of completion of detoxification between the three treatments. Both the lofexidine treatment regimens had a similar effect on blood pressure. Five patients experienced side effects which resolved with dose reduction, all remaining in the study. An accelerated 5-day lofexidine regimen may attenuate opiate withdrawal symptoms more rapidly than conventional 10-day lofexidine or methadone treatment schedules without exacerbating hypotensive side effects.

Private Schooling and Public Achievement

There are two contending explanations for the apparent public/private differences in educational outcomes—the ‘quality education’ argument versus the ‘selective-socioeconomic-recruitment’ explanation. The quality education argument explains these differences in terms of between-system differences in the quality of the education offered. The selective-socioeconomic-recruitment explanation suggests that between-system differences in outcomes have more to do with what students bring to school than with what they find there. These competing propositions are examined by asking whether attendance at a Catholic or non-Catholic private school provides a net benefit with regard to educational achievement and attainment. The answers come from additive models which control for a variety of family, individual and school variables in order to examine the net effect of school sector. The evidence presented suggests that a good part of the observed between-sector differences in performance is attributable to between-sector differences in student attributes—but not all. In the case of schooling, small between-sector differences in achievement remain, along with sizeable between-sector differences in Year 12 graduation rates. For higher education, between-sector differences in participation rates favour the graduates of non-government schools but sectoral differences in completion rates are negligible. It is suggested, in conclusion, that parents who invest in their children's education in this way may be getting a return on their investment, though probably not as much as they think.

A Note on Determining Questionnaire Destination in Survey Research

R eliance upon survey techniques in the analysis of general social phenomena of academic interest (e.g., social mobility and patterns of psychiatric disorder) as well as those of more practical concern (e.g., voting or consumer product preferences) has become ,commonplace. Extant literature addressed to the design and implementation of either interview or questionnaire surveys tends to focus upon issues such as sample selection, question or format development, coding and data analysis techniques. In instances of survey questionnaires distributed through the mails, however, little attention has been devoted to evaluating the consequences of selecting particular locations at which to confront subjects with the general research effort and the specific data collection instrument. In the course of recent sui-vey research it became possible to determine the relative importance of questionnaire reception at either the home or employment sites of subjects for overall survey return rates, as well as question completion rates for items categorized as closed-ended (i.e., answers constrained by given response alternatives) and open-ended (i.e., responses structured solely by subject feelings). The research project in question was designed to ascertain the perceptions and preferences of civic activists (i.e., Chamber of Commerce members) in western New York State in respect to the structure and functioning of various universities. Random selection of Chamber members generated a pool of 700 male subjects between the ages of thirty-five and seventy and employed in professional or managerial occupations. Given the availability of dual addresses for each individual, 350 subjects received survey questionnaires at their place of residence and an equal number received questionnaires at work sites. Each questionnaire contained a total of 64 closedended questions and 26 open-ended items usually requesting amplifications upon responses to previous closed-ended questions. Overall return rates for subjects contacted at place of work or residence were identical, both in terms of the rate of response (i.e., time elapsed prior to questionnaire return) and the final number of questionnaires returned by subjects. Between-group differences in completion rates for the 64 closed-ended questions proved insignificant, as did an analysis of the actual attitudes (i.e., resporses to closed-ended items) of subjects when grouped according to reception location. In terms of open-ended items, however, subject reception of a questionnaire at place of employment resulted in significantly greater (beyond the .01 level) numbers of completions (X = 23.4, s =2.4) than did contact of an individual at place of residence (X 18.1, s=4.1). Subsequent interviews with subjects revealed that participation in survey research through questionnaires, whether at work or residence sites, necessitates overcoming barriers caused by inertia, disinterest or resentment of intrusion. Although this results in similar rates of questionnaire return and response to closedended items, the actual completion of time consuming open-ended questions by individuals while at work appears facilitated by (1) the evocation of work-centered achievement orientations, (2) the organizational appropriateness of writing activity as a task diversion, and (3) formal corporate acceptance of participa-