Follow-up Compliance Rate Research Articles

Follow-up compliance in patients undergoing abdominal aortic aneurysm repair at Veterans Affairs hospitals

ObjectiveThe Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well-established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals. MethodsWe queried the VA Surgical Quality Improvement Program database for elective infrarenal AAA repairs, EVAR and OSR, then merged in follow-up imaging and mortality information. Mortality rate over time was derived using Kaplan-Meier estimation. Generalized estimating equation with a logit link and a sandwich standard error estimate was performed to compare the probability of having annual follow-up imaging over time between procedure types and to identify variables associated with follow-up imaging for EVAR patients. ResultsOur analysis included 11,668 patients who underwent EVAR and 4507 patients who underwent OSR at VA hospitals between the years 2000 and 2019. The 30-day mortality rate for EVAR and OSR was 0.37% and 0.82%, respectively. OSR was associated with lower long-term mortality after adjusting age, sex, American Society of Anesthesiologists classification and preoperative renal failure with an adjusted hazard ratio of 0.88 (95% confidence interval, 0.84-0.92; P < .01). Of surviving patients, the follow-up imaging rate was 69.1% by 1 year post-EVAR. The follow-up rate after 5 years was 45.6% post-EVAR compared with 63.6% post-OSR of surviving patients. A history of smoking or drinking, baseline hypertension, and known cardiac disease were independently associated with poor follow-up after EVAR. ConclusionsPatients undergoing elective open AAA repair in the VA hospital system had lower long-term mortality compared with patients who underwent endovascular repair. Compliance with post-EVAR imaging is low. Patient factors associated with poor post-EVAR imaging surveillance were smoking within the last year, excess alcohol consumption, and cardiac risk factors including hypertension, prior myocardial infarction, and congestive heart failure.

Five-year outcomes of endosuture aneurysm repair in patients with short neck abdominal aortic aneurysm from the ANCHOR registry

ObjectiveHostile aortic neck anatomies such as proximal short necks are known to put patients at an increased risk for type IA endoleaks, migration, and need for reinterventions. The Heli-FX EndoAnchor System was designed to improve seal of aortic stent grafts. Endosuture aneurysm repair (ESAR) using EndoAnchors with the Endurant stent graft has been shown to be safe and effective for the treatment of patients with short necks through one year. This study reports the 5-year patient outcomes of the Aneurysm Treatment using the Heli-FX EndoAnchor System Global Registry (ANCHOR) short neck regulatory cohort. MethodsThe 70 patients from the ANCHOR Registry were cohort submitted to regulators for approval of the Endurant short neck indication. Patients had an infrarenal neck length of ≥ 4 mm and <10 mm. At 5 years, this short neck cohort had clinical and imaging follow-up compliance rates of 85% (28/33) and 70% (23/33), respectively. ResultsThe short neck cohort had a mean age of 71.3±8.1 years and was 27.1% (19/70) female. Kaplan Meier freedom from all-cause mortality was 68.5 ± 6.2%, freedom from aneurysm-related mortality was 90.1 ± 4.5%, freedom from any endovascular or surgical secondary procedure was 76.9 ± 7.2%, and freedom from rupture was 95.6 ± 3.2%. Eight patients had a total of nine type IA endoleaks detected through 5 years, of which three resolved spontaneously by the next follow-up visit. There were two patients with renal complications who did not undergo reintervention and there were no device migrations reported through 5 years. After 5 years, 68.2% of patients (15/22) had sac regression, 13.6% (3/22) had stable sacs, and 18.2% (4/22) had increased sac diameter as compared with their 1-month measurements. ConclusionsAfter ESAR treatment using Heli-FX EndoAnchors with Endurant, the 5-year outcomes of the short neck cohort from the ANCHOR registry had encouraging results with regards to proximal neck-related complications, secondary procedures, and sac regression. This review of ESAR in patients with short proximal necks showed positive outcomes through 5 years although follow-up of a larger cohort is necessary.

Predictors of follow-up non-compliance after definitive radiotherapy for locally advanced cervical cancer at a community cancer center

IntroductionNon-compliance to post-treatment cancer surveillance can lead to late detection of recurrence. This study aims to identify patients at high risk for loss of follow-up after radiotherapy for locally advanced cervical cancer. MethodsConsecutive patients with locally advanced cervical cancer treated with definitive chemoradiotherapy (2013–2020) at a community cancer center were retrospectively reviewed. The main outcome was overall follow-up compliance rate over time. Additionally, specialist-specific follow-up times, reasons for discontinuation and predictors of loss of follow-up events were evaluated. ResultsThe median age of the 154 patients included was 46.5 years (range: 26–84). The 6-month, 1-, 3-, and 5-year overall loss of follow-up rates were: 5.3%, 15.3%, 33.6%, and 48.2%, respectively. After a median overall follow-up time of 21.0 months, the median specialist-specific surveillance times were 17 months and 6 months with gynecologic and radiation oncologists, respectively (p < 0.01). Overall, the most common reasons for loss of follow-up were financial (21.7%) and relocation to another city (28.3%). By specialty, the most common reasons were relocation of care (56.5%, gynecologic oncologist) and disease progression (31.3%, radiation oncologist). In the multivariable analysis, older age (continuous, OR: 0.96; p < 0.01) and Hispanic ethnicity (OR: 0.39; p < 0.01) were protective against loss of follow-up, while increased number of gestations (continuous, OR: 1.23, p = 0.01) and living farther from the cancer center (continuous, OR: 1.002; p = 0.03) increased the chance of loss of follow-up. ConclusionYounger, non-Hispanic, multiparous women that live far from the community cancer center have an increased chance of follow-up discontinuity, which are attributed to financial reasons in more than 20% of the cases.

Implementation of SEEK in a Children’s Advocacy Center: A Process Improvement Initiative

Introduction:Risk factors for child maltreatment are well-described, but clinicians may overlook these risk factors. The Safe Environment for Every Kid (SEEK) model is an evidence-based approach to identifying psychosocial risk factors for child maltreatment. This article describes a quality improvement initiative to implement the SEEK model in a unique pediatric setting, a Children’s Advocacy Center.Methods:The objectives were to (1) describe the identification of psychosocial risk factors for child maltreatment by implementing the SEEK screening tool with each new family, (2) achieve and sustain a SEEK completion rate of greater than 85%, and (3) achieve and sustain a SEEK follow-up compliance rate of greater than 75%. Structured quality improvement methods, including several plan-do-study-act cycles, were used to implement interventions.Results:The percentage of caregivers who completed the SEEK questionnaire increased from a baseline of 76% to 86%, which was sustained for more than 2 years, resulting in a better understanding and support of families’ needs. Caregivers completed 3,606 SEEK Parent Questionnaire-R. Mental health concerns and food insecurity were among the most commonly endorsed items. Follow-up compliance increased from 47% to 90%, a level that has been maintained.Conclusions:While Children’s Advocacy Centers evaluate children with suspected abuse, identifying current stressors in the home and linking families with resources to address their immediate psychosocial concerns can improve short- and long-term outcomes. This initiative demonstrates the feasibility of incorporating consistent screening for psychosocial risk factors for child maltreatment in this busy environment.

Abstract PO-259: The impact of genetic ancestry and lifestyle factors on the risk of colorectal adenoma and adenocarcinoma in a Brazilian screening population

Abstract Background: Colorectal cancer (CRC) is the second most common cancer in Brazil. The Barretos Cancer Hospital (BCH) implemented a Fecal immunochemical test-based (FIT)-CRC screening program. Risk factors of the screening population and the prevalence of baseline colorectal neoplasia are important features for guiding a CRC screening strategy. This study aims to measure screening outcomes of the BCH program and associate with sociodemographic risk factors and genetic ancestry. Methods: This cross-sectional analysis included consecutive subjects between 50 and 65 years from the BCH (first round) CRC screening program. A REDCap database was built to track participants and measure clinical outcomes (adenoma, advanced adenoma (AA), and cancer). The ancestry components were analyzed using a multiplex PCR of 46 ancestry informative markers, based on insertion-deletion polymorphisms. A binary logistic regression model was used to examine the associations between sociodemographic factors and screening outcomes. Results: From Nov 2017 to Mar 2020, 2946 asymptomatic individuals were enrolled, being 83.0% females with a mean age of 57.1 ± 4.5 years, mainly from São Paulo State (79.1%). Self-reported skin color revealed 56.8% white, 36.6% brown, 5.8% black, and 0.7% yellow, and 69.9% had less than a high school diploma. The genetic ancestry revealed a mean proportion of 67.9% for European ancestry, 17.0% for African, 7.3% for East Asian, and 7.8% for Native American. A significant association was found between genetic ancestry proportions and self-reported skin colors (p&amp;lt;0.001). Current and former smokers comprised 41.9% of participants, 31.2% were alcohol drinkers, 73.3% reported exercise &amp;lt; 3x/week, and 71.9% had a BMI &amp;gt; 25kg/m². Of the 2946 participants, 80.7% completed and returned FIT kits. The inadequate FIT rate was 2.0%, and the positivity rate was 6.2%. The follow-up colonoscopy compliance rate was 90.5%, and the cecal intubation was successful in 99.0%. The PPV was 64.1% (86/134) for adenoma 20.1% (27/134) for AA, and 3.7% (5/134) for CRC. The five cancer patients had stage I (40.0%) or II (60.0%). The male gender (OR=2.94, 95% CI 1.06-8.17), BMI &amp;gt; 25kg/m² ≤ 30kg/m² (OR=5.40, 95% CI 1.42-20.52), alcohol consumption (OR=3.86, 95% CI 1.38-10.78), fried foods' consumption (OR=2.82, 95% CI 1.02-7.78) were associated to AA. Non-white skin color (OR=2.83, 95% CI 1.11-7.17), BMI &amp;gt; 25kg/m² ≤ 30kg/m² (OR=3.54, 95% CI 1.21-10.30), and eggs/milk consumption (OR=5.25, 95% CI 1.32-20.80) were associated to early adenoma. No association was found between genetic ancestry and screening outcomes. Conclusions: CRC detected in early stages corroborates the role of screening programs to increase the rate of early diagnosis. Further, lifestyle risk factors linked to colorectal cancer were significantly associated with the presence of a high and low-risk colorectal precursor lesion. Overall, our results in an admixed population can contribute to delineating preventive strategies and a targeted CRC screening program to improve CRC prevention and control in Brazil. Citation Format: Jun Porto, Adeylson G. Ribeiro, Lucas Henrique Viza, Laura W. Musselwhite, Thais Talarico, Maraisa Costa, Denise C. Rocha, Marco Antonio Oliveira, Jose Humberto T.G. Fregnani, Edmundo Mauad, Rui M. Reis, Dawn Provenzale, Denise P. Guimaraes. The impact of genetic ancestry and lifestyle factors on the risk of colorectal adenoma and adenocarcinoma in a Brazilian screening population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-259.

Utilizing the SEIPS model to guide hand hygiene interventions at a tertiary hospital in Ethiopia.

We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.

Compliance to kangaroo mother care best practice: an evidence-based implementation project.

Worldwide about 13 million babies are born prematurely every year. Kangaroo mother care (KMC) is a proven, acceptable and feasible method to decrease the mortality rate of premature infants. Reviewing current KMC practices, implementing in the context and auditing the compliance would benefit the promotion evidence-based practice (EBP), which was not well known in the study area. The main objective of the study was to increase awareness of EBP for KMC in the neonatal care unit of a public hospital through identifying local barriers and facilitators, and to measure compliance with best practice recommendations. The current KMC best practice quality improvement project was conducted between March and May 2018. The project team was established for this implementation project. Six KMC best practice audit criteria were used to evaluate the compliance at baseline and endline using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. All (20) clinical staff who were working in the neonatal care unit were included in the study. Based on the baseline audit result, gaps and barriers were identified and discussed, and implementation strategies specific to the local setting were developed to mitigate the gaps. Baseline results were compared with the final follow-up audit result to measure change in compliance. Again, these data were compared with other studies to identify the sustainability of the project in a clinical setting. A total of 80 cases (baseline 20 and implementation 60) were observed demonstrating KMC procedures. Study found that follow-up compliance rates for all criteria improved compared with baseline audit; for example, criterion 5 (assessment of infant's condition) improved from 20% during baseline to 90% during follow-up and criterion 3 (parent/family received counselling) improved from 30 to 95%. The current study demonstrated that EBP training and frequent supportive supervision translated in improved compliance to best available evidence to KMC in a resource-limited setting.

Tele Otology in India: Last 10 Years-A Scopic Review.

Hearing loss is the commonest sensory deficit among humans, affecting 466 million people worldwide. Early detection is the key to hearing rehabilitation, as speech and language develops early in the childhood. Scarcity of human resources and infrastructure in developing countries like India leads to difficulty in implementation of hearing screening programmes. Tele otology is very fruitful methodology in providing health care facility from distant site to the doorsteps of needy individuals. The action initiated in the field of tele otology in India was reviewed at electronic databases: Pubmed, Google scholar, Medline, Cochrane library, science direct and author mapper using the keywords ‘tele otology’ and ‘tele audiometry’ in January 2021. Eligible studies were those related to tele otology and tele audiometry in India. A total of 16 articles were shortlisted for the present study. Tele hearing testing was satisfactory for the parents in regard to accessibility, testing process and counselling. Tele audiometry surveillance shows better overall follow-up compliance rate then in-person audiological surveillance. During covid 19 pandemic virtual approach to the patient through video calling and telephone calls proved handy approach, ensuring safety profile of both health care professionals and patients. Even Tele ABR conducted in tele van shows similar results as in face-to-face mode ABR. Tele otology should be considered by the service providers and policy makers while planning for hearing screening programmes for both new-born and school going children in view of its reliability, low-cost, non-invasive and portability. The village health workers (VHWs) should be well trained in assisting tele practice and internet connectivity should be well established. Tele otology looks very promising in providing health services through the ever-expanding reach of global connectivity.

Health-related quality of life in patients with multiple myeloma participating in a multidisciplinary rehabilitation program.

Patients with multiple myeloma (MM) report high symptom burden and functional disabilities resulting in impaired health-related quality of life (HRQoL). Effective evidence-based rehabilitation guidelines are needed for patients with MM to improve HRQoL. The primary aim of this study was to investigate HRQoL in patients with rehabilitation needs living their everyday life. Patients with MM in remission attended a 12-week multidisciplinary rehabilitation program including a 5-day residential course, home-based exercise and a 2-day follow-up course. The patients were referred by the treating haematologist and completed a booklet of validated HRQoL questionnaires at baseline and before arriving for the 2-day follow-up course. The proportion of participants with moderate to severe symptoms and functional problems were assessed at the two time points and multivariate logistic regression was used to investigate explaining factors of impaired HRQoL at baseline. Ninety-two patients participated with a follow-up compliance rate of 90%. Median age was 67years and median time since diagnosis was 26months (ranged 5months to 15.6years). The most frequently reported symptoms were global quality of life, role functioning, fatigue, pain, peripheral neuropathy and physical functioning. Pain and fatigue were both highly coherent with impairment in physical functioning and those two symptoms explained most HRQoL impairments. Overall, the participants reported no change in HRQoL after the 12-week rehabilitation program. The study supports the need for an evidence-based guideline for rehabilitation and palliative care to patients with MM in remission living their everyday life.

Compliance to immediate newborn care practice among midwives working in maternity wards: a best practice implementation project.

The WHO has a series of comprehensive care instructions to improve the health of newborns from prior to conception, throughout pregnancy, soon after birth and in the postnatal period. The objective of this best practice implementation project was to promote evidence-based best practice of immediate newborn care practice among midwives working in the maternity ward. Baseline and postimplementation audits were conducted using the JBI Practical Application of Evidence System using nine audit criteria for immediate newborn care. The gaps and barriers were analyzed using Getting Research into Practice strategies based on the baseline audit result. Discussion was conducted on the identified gaps and the implementation strategies. A total of 94 cases were observed for both a baseline and follow-up audit. We found that follow-up compliance rates for all criteria were improved compared with the baseline audit. For instance, criterion 5 improved from 26% during baseline to 96% during follow-up audit, and the overall average compliance at baseline was 58% and for the postimplementation audit was 96%. The current project revealed that training of the health professionals and presenting evidence summaries to them were strategies that resulted in improved compliance to best available evidence to immediate newborn care.

Current Status of Electroconvulsive Therapy: Practices of a Training and Research Hospital in Ankara

Amaç: Kliniğimiz tıbbi kayıtlarına dayanan bu çalışmada Türkiye’de elektrokonvülsif tedavi (EKT) kullanım sıklığını, endikasyonlarını ve takip süreci hasta uyum oranlarını incelemek amaçlanmıştır. Gereç ve Yöntemler: İki yıllık Ocak 2014—Aralık 2015 döneminde Ankara Numune Eğitim ve Araştırma Hastanesi Psikiyatri Kliniği’ne yatırılan ve EKT gören 105 hastanın tedavi ve müteakip bir yıllık takip kayıtları retrospektif olarak incelenmiştir.Bulgular: Hastaların %9,95’ine EKT uygulanmıştı. En yaygın endikasyon şizofreni olup bunu bipolar bozukluk (manik epizot) izlemekteydi. Ortalama EKT seansı sayısı 7,60±2,58 idi. Tedavide en yaygın görülen komplikasyonlar uzamış konfüzyon ve kardiyovasküler sistem yan etkisi idi. EKT en sık tedavi direnci ve oral alım reddi nedenlerinden ötürü tercih edilmişti. Bir yıllık takip sürecinde hastaların %89,5’i takip protokolüne uymuş olup %9,5’i nüks nedeniyle yeniden hastaneye yatırılmıştı. Mükerrer EKT hastaların sadece %1,9’unda görüldü. Tartışma ve Sonuç: EKT güvenli ve etkili bir tedavi seçeneği olmayı sürdürmektedir. EKT’nin güncel tedaviler arasındaki yerinin daha iyi anlaşılabilmesi için geniş örneklemli, prospektif çalışmalar yapılması yararlı olabilir.

Surveillance Colonoscopy after Appendicectomy in Patients over the Age of 40: Targeted Audit of Outcomes and Variability in Practice.

Introduction: Recent evidence suggests the need to proceed with a surveillance colonoscopy in patients above the age of 40 years who undergo appendicectomy for acute appendicitis, given the higher risk of an underlying colonic tumor. After anecdotally observing a substantial variability in terms of adaptation of these recommendations by the on-call surgical teams, we performed a clinical audit regarding our relevant endoscopic follow-up compliance rates to identify areas for improvement of our practise. Materials Methods: We performed a retrospective review of the electronic records of all patients above 40 years who had appendicectomy for acute appendicitis within a 3-year period in our institution, assessing as primary outcome the actual performance of a follow-up colonoscopy and the detected endoscopic findings. Results: Our results demonstrated that more than 80% of our patients did not have an endoscopic follow-up, as suggested by the current evidence. In addition, with respect to the subspecialisation of the parent surgical team, it seems that non-colorectal teams had lower compliance regarding the arrangement of endoscopic surveillance, when compared to specialist colorectal team. Conclusions: Emergency surgical teams need to be further educated with respect to the current practise recommendations concerning the appropriate endoscopic follow-up after the performance of appendicectomy for acute appendicitis. Establishment of dedicated bundles of postoperative care, as well as clear relevant guidance from the gastrointestinal/emergency surgery societies would be of great value in this direction.

Determining Follow-Up Imaging Study Using Radiology Reports.

Radiology reports often contain follow-up imaging recommendations. Failure to comply with these recommendations in a timely manner can lead to delayed treatment, poor patient outcomes, complications, unnecessary testing, lost revenue, and legal liability. The objective of this study was to develop a scalable approach to automatically identify the completion of a follow-up imaging study recommended by a radiologist in a preceding report. We selected imaging-reports containing 559 follow-up imaging recommendations and all subsequent reports from a multi-hospital academic practice. Three radiologists identified appropriate follow-up examinations among the subsequent reports for the same patient, if any, to establish a ground-truth dataset. We then trained an Extremely Randomized Trees that uses recommendation attributes, study meta-data and text similarity of the radiology reports to determine the most likely follow-up examination for a preceding recommendation. Pairwise inter-annotator F-score ranged from 0.853 to 0.868; the corresponding F-score of the classifier in identifying follow-up exams was 0.807. Our study describes a methodology to automatically determine the most likely follow-up exam after a follow-up imaging recommendation. The accuracy of the algorithm suggests that automated methods can be integrated into a follow-up management application to improve adherence to follow-up imaging recommendations. Radiology administrators could use such a system to monitor follow-up compliance rates and proactively send reminders to primary care providers and/or patients to improve adherence.

2505. A Novel Mobile Phone Application for Remote Research Data Collection is Effective in Monitoring Chronic Sequelae After Acute Viral Infections

BackgroundAlthough much is known about the presentation of acute viral infections such as dengue fever, the long-term sequelae has not been systematically studied. Anecdotal evidence suggests that many viral infections, particularly flaviviral infections, may have long-term sequelae. Prospective longitudinal studies to evaluate such chronic health outcomes, however, require subjects to comply with multiple follow-up clinic visits, making them costly to run and vulnerable to high dropout rates. Using acute dengue and other febrile illnesses (OFI) as test cases, we aimed to explore the utility of a mobile phone application to evaluate the long-term sequelae and self-reported health outcomes in a cohort of patients up to one year post infection.MethodsWe designed a Mobile-phone Application for Information extraction in Dengue (MAIDEN) to study the long-term health outcomes of acute dengue compared with OFI. Demographic and clinical information was collected from the study participants at enrollment. Participants were sent a link via e-mail to download MAIDEN onto their mobile phone. Except for the day 1 visit, participants were not required to attend the study site in-person, but instead used MAIDEN to remotely enter information on symptoms experienced at stipulated intervals.ResultsA total of 44 participants have been recruited to date. 4 participants had acute dengue infection and 40 had OFI. The overall study follow-up compliance rate was 89.2%. 23/44 patients have completed visits up till day 21. Of these 23 patients, 43% reported symptoms at day 7 and 39% at day 21. The table below shows the number of individual symptoms experienced by these participants.Dengue (n = 4)OFI (n = 19)Day 7Day 21Day 7Day 21Lack of energy1184Inability to concentrate1043Memory impairment1023Headache1033Myalgia1113Arthralgia1213Anorexia1012ConclusionChronic symptoms continue to persist in a significant proportion of patients with acute viral illnesses. Mobile applications such as MAIDEN can serve as useful tools to support remote research data collection, making longitudinal follow-up of such patients feasible.Disclosures All authors: No reported disclosures.

Effectiveness of the Multidisciplinary Team Model in Treating Colorectal Cancer.

The multidisciplinary team (MDT) model involves multiple medical professionals providing integrated medical care. Colorectal cancer (CRC) has the highest prevalence of cancer in Taiwan. This study examines and evaluates the survival rates of CRC patients treated under the MDT model. In this retrospective and prospective study, 651 CRC patients were recruited. They were divided into 2 groups: the MDT group and the traditional care (TC) group. The MDT group comprised 326 patients who received care from a MDT. The TC group comprised 325 patients who received care from a TC. The outcome variables were survival rates, follow-up appointment compliance, and 14-day readmission rates. Adopting the MDT model for CRC care increased patient follow-up appointment compliance rates at the first week, first month, and third month (p = .032, p = .007, p = .001, respectively). The model also effectively reduced patients' 14-day readmission rates. The results indicated that the survival rates of the MDT care were superior to those of TC. The adoption of the MDT model to treat CRC effectively enhanced clinical treatment adherence, increased survival rates, and reduced the 14-day readmission rate.

Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P &lt; 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

Level of Compliance in Orthokeratology.

To investigate the level of compliance with orthokeratology (ortho-k) guidelines and the main behaviors of poor compliance to guide clinical care. A questionnaire was sent to ortho-k patients in the Eye Hospital of Wenzhou Medical University (EHWMU) in Mainland China who were prescribed ortho-k lenses after January 2013 and have worn ortho-k lenses for more than 1 year to determine the compliance rate for eight wear and care behaviors. Follow-up visit compliance was then investigated among these patients using a retrospective survey. A total of 1,500 questionnaires were distributed, and 405 patients responded. The mean age of the patients was 13.1±3.9 years (range 9-22 years); 60.5% of the patients were female, and 98.3% were younger than 18 years. The full compliance rate was 14.1%, the compliance rate for wear and care behaviors was 18.5%, and the compliance rate for follow-up visits was 63.3%. The three highest noncompliance categories for wear and care behaviors were exposure to nonsterile solution, not removing lens depositions according to the eye care practitioners' (ECPs) recommendations and inadequate hand washing. No correlation was observed between the compliance for wear and care behaviors and age, sex, and wearing experience. The follow-up visit compliance rate significantly decreased from the third month to the ninth month. The common reasons for discontinuing follow-up were lack of time, no symptoms, and inconvenience. The level of compliance with ortho-k lens wear in Mainland China is not high, necessitating ECPs to stress to patients the details of wear and care behaviors, especially avoiding exposing lenses to nonsterile solution. Improving monitoring of follow-up visits, particularly within the first 9 months of wearing ortho-k lenses, is needed.

Twelve-Week Rifapentine Plus Isoniazid Versus 9-Month Isoniazid for the Treatment of Latent Tuberculosis in Renal Transplant Candidates

Renal transplant candidates (RTC) with latent tuberculosis infection (LTBI) are at significant risk for tuberculosis reactivation. Twelve-week rifapentine (RPT)/isoniazid (INH) is effective for LTBI but clinical experience in RTC is scarce. We conducted a retrospective study of RTC with LTBI treated with either 12-week RPT/INH or 9-month INH from March 1, 2012, through February 28, 2014. We evaluated both groups for differences in rates of treatment completion, monthly follow-up visit compliance, transaminase elevations, and adverse reactions leading to discontinuation of LTBI treatment. The utility of weekly reminders was also evaluated in the 12-week regimen. Direct observed therapy was not performed in our study. Of 153 patients, 43 (28%) and 110 (72%) were started on 12-week RPT/INH and 9-month INH, respectively. The treatment completion and monthly follow-up visit compliance rates were higher in the 12-week RPT/INH group (40 [93%] vs 52 [47%], P < 0.001) and (11/40 [28%] vs 13/104 [13%], P = 0.03), respectively. Transaminase elevations were not observed in the RPT/INH group, but occurred in 6 (5%) of the INH group. There were no differences in adverse reactions leading to discontinuation of LTBI treatment. Twelve-week RPT/INH appears to be an excellent choice for LTBI in RTC. It has a higher treatment completion rate and causes less transaminase elevations, and weekly reminders may be an alternative when direct observed therapy is not feasible.

Does Direct Radiologist-Patient Verbal Communication Affect Follow-Up Compliance of Probably Benign Assessments?

PurposeThe aim of this study was to determine whether direct verbal communication of results by a radiologist affected follow-up compliance rates for probably benign breast imaging findings. MethodsThis study was institutional review board approved and HIPAA compliant. A retrospective search identified all patients from January 1, 2010 to December 31, 2010 who had breast findings newly assessed as probably benign (BI-RADS category 3). Patients were categorized by whether the radiologist or the technologist verbally communicated the result and follow-up recommendation. Patient adherence to 6-, 12-, and 24-month follow-up imaging recommendations was recorded. ResultsCompliance data were available for 770 of 819 patients in the study. Overall compliance was 83.0% (639 of 770) for 6-month examinations, 68.1% (524 of 770) for 6- and 12-month examinations, and 57.4% (442 of 770) for 6-, 12-, and 24-month examinations. For patients who initially underwent diagnostic mammography alone, there was no significant difference in compliance between those who had and those who did not have radiologist-patient communication (6 months, 81.9% vs 80.8% [P = .83]; 6 and 12 months, 70.8% vs 67.3% [P = .58]; 6, 12, and 24 months, 54.2% vs 58.4% [P = .53]). For patients who initially underwent diagnostic mammography alone versus ultrasound with or without diagnostic mammography, there was no significant difference in compliance (6 months, 81.1% vs 84.3% [P = .24]; 6 and 12 months, 68.1% vs 68.0% [P = .96]; 6, 12, and 24 months, 57.4% vs 57.4% [P = .00]). ConclusionsHigh initial compliance was achieved by radiologist or technologist verbal communication of findings and recommendations. Direct communication by the radiologist did not increase compliance compared with communication by a technologist.

Frequency of Malignancy and Imaging Characteristics of Probably Benign Lesions Seen at Breast MRI.

The purposes of this study were to evaluate the frequency, follow-up compliance, and cancer rate of MRI BI-RADS category 3 lesions and to determine the cancer rate for individual BI-RADS descriptors. A retrospective review was conducted of breast MRI examinations with an assessment of probably benign (BI-RADS category 3) from among 4279 consecutive breast MRI examinations performed from January 2005 through December 2009. The review revealed 282 (6.6%) examinations with 332 lesions defined as BI-RADS 3. Pathologic results, 2 years of follow-up imaging findings, or both were reviewed. The frequency of BI-RADS 3 assessments, follow-up imaging compliance, and cancer yield were calculated. Three fellowship-trained breast imagers reevaluated all lesions and recorded descriptors from the MRI lexicon of the fifth edition of the BI-RADS atlas. The distribution and likelihood of malignancy for each descriptor were calculated. The follow-up compliance rate was 84.3% (280/332), and the malignancy rate was 4.3% (12/280). There were 50 (17.9%) individual foci, 61 (21.8%) multiple foci, 74 (26.4%) masses, and 95 (33.9%) nonmass enhancement lesions. Masses were most commonly oval (59.5% [44/74]), circumscribed (75.7% [56/74]), and homogeneously enhancing (43.2% [32/74]). Nonmass enhancement was most commonly focal (57.9% [55/95]) with heterogeneous enhancement (53.7% [51/95]) Most of the lesions had persistent kinetics (74.3% [208/280]). The background parenchymal enhancement was most commonly mild (51.1% [143/280]). MRI BI-RADS category 3 is not frequently used, and the levels of patient compliance with follow-up imaging are acceptable. The cancer yield for probably benign lesions is greater for MRI-detected than for mammographically detected lesions, especially for specific BI-RADS descriptors.