High Follow-up Rates Research Articles

Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study.

Prospective follow-up study. To identify indicators leading to compliance with yearly controls (YCs) and to describe the clinical and functional outcomes 2 years after traumatic spinal cord injury (SCI). The national SCI rehabilitation centre in Botswana. Included in the study were all people who were admitted with a traumatic SCI during a 2-year period and survived to be discharged (n=38). Data were collected at the YCs and included demographic characteristics and clinical and functional outcomes. Comparisons were made between those who did or did not attend YCs and between those who did or did not develop pressure ulcers (PUs). The follow-up rate was 71% (27/38) with higher attendance among those with complete injuries and those with secondary complications, especially pain. Age, gender, distance to the centre and education did not affect the follow-up rate. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Despite high rates of PUs (48%) and urinary tract infections (UTIs; 41%), no death had occurred during the follow-up period. Furthermore, one-third had resumed work. Despite high rates of UTIs and PUs developed in the home environment, this study showed a high survival rate 2 years after traumatic SCI, which might be explained by the establishment of a specialised SCI unit and the high follow-up rate. In addition, the continuing contact with the SCI staff might have facilitated the relatively high return-to-work rate. Long-term follow-up seems possible even in resource-constrained settings with clearly stated objectives, transport, dedicated staff and well-educated patients and families.

Association of severe placental inflammation with death prior to discharge and cerebral palsy in preterm infants.

The objective of our study was to identify placental patterns associated with death before discharge or cerebral palsy in a large cohort of preterm infants with a high follow-up rate at 2years of corrected age. Population-based monocentric study. Monocentric study in the maternity unit of the University Hospital of Angers, France between 24+0 and 33+6 weeks of gestation, between January 2008 and December 2011. All singleton infants born alive with a placental examination were eligible. Clinical data (obstetric and neonatal) were collected prospectively through the LIFT cohort. Placental data were collected retrospectively from medical records. The main outcome measure was death before discharge or cerebral palsy. We did not find any significant association between severe inflammatory lesions on the placenta and death [odds ratio (OR) 1.49; 95% CI 0.55-4.01; P=0.43] or cerebral palsy (OR 1.41; 95% CI 0.43-4.62; P=0.57). This lack of significant association persisted even after adjustment (aOR 0.9; 95% CI 0.20-2.30; P=0.54; aOR 0.98; 95% CI 0.27-3.58; P=0.97). Our results do not provide evidence for a significant association between severe inflammatory placental lesions and either death before discharge or cerebral palsy at 2years of corrected age in preterm infants born at <34weeks of gestational age. Further studies remain necessary to confirm this result. We found no significant association between inflammatory placental lesions and death or cerebral palsy.

Management of Toddler’s Fractures in the Pediatric Emergency Department

To evaluate current practice in treatment of toddler's fractures, as well as subsequent healthcare utilization and complications. Retrospective cohort study of children age 9 months to 3 years with a radiographically evident toddler's fracture diagnosed at a single academic pediatric emergency department (PED) from January 2008 to December 2012. Data collected included initial form of immobilization (if any), referral to orthopedic clinic, number of repeat radiographs obtained, presence of skin breakdown related to splinting or casting, and presence of other complications. Seventy-five patients were treated. Most patients were placed in splints or casts in the PED (66.7%) as opposed to controlled ankle motion (CAM) boot (24%) or no immobilization (9.3%). Splinted patients had a longer total duration of immobilization, higher rate of follow-up in orthopedic clinic, and greater number of repeat radiographs obtained than those in the CAM boot or no immobilization groups. Thirteen patients (17.3%) developed skin breakdown during their course of therapy; all of these patients had been placed in a splint or cast in the PED. No difference in PED return rates was observed between groups. There is wide variation in management of toddler's fractures within this single tertiary care PED. Given that these fractures are unlikely to displace and that complications of splinting and casting are not insignificant, this study suggests that immobilization may not be necessary for acute management of toddler's fractures.

Short-term effects of improvisational music therapy for children with autism spectrum disorder: findings from the TIME-A randomised trial

Background: Previous meta-analysis provided some evidence that music therapy (MT) is more effective than standard care for improving social interaction, non-verbal and verbal communication, initiating behaviour, social-emotional reciprocity, social adaptation and parent–child relationships.Methods: Children (4;0–6;11 years) with autism spectrum disorders were randomly assigned to one of three conditions: low-intensity MT (once per week), high-intensity MT (three times per week) or standard care over a period of five months. The effect of MT was measured using Autism Diagnostic Observation Schedule, Social Responsiveness Scale and visual analogue scales for quality of life at baseline, 2, 5 and 12 months. Analysis was done by intention-to-treat.Results: About 364 children with autism spectrum disorders were recruited in nine countries (Australia, Austria, Brazil, Israel, Italy, Korea, Norway, UK and USA). MT was well accepted by the participants, as indicated by high follow-up rates. Effects of MT on autis...

Comparative study of late rectal toxicity in prostate cancer patients treated with low-dose-rate brachytherapy: With or without supplemental external beam radiotherapy

PurposeSupplemental external beam radiation therapy (sEBRT) is often prescribed in men undergoing low-dose-rate (LDR) brachytherapy. A population of patients was analyzed to assess the effect of sEBRT on late rectal toxicity. It was hypothesized that sEBRT + LDR would be associated with a higher risk of late rectal toxicity. Methods and MaterialsThis retrospective cohort study examined LDR brachytherapy patients, treated with or without sEBRT, with a minimum of 5-year followup. Longitudinal assessments were evaluated using the computerized patient record system. The Kaplan–Meier method was used for analysis. ResultsMedian followup was 7.5 years for 245 patients from 2004 to 2007. sEBRT was administered to 33.5%. Followup beyond 5 years was available for 89%. Overall rates of Grade ≥2 and ≥3 rectal toxicities were 6.9% and 2.9%, respectively. The risk of Grade ≥2 rectal toxicity was 2.8-fold higher for patients receiving sEBRT (95% confidence interval: 1.1–7.2; p = 0.02). The risk of Grade ≥3 rectal toxicity was 11.9-fold higher for patients who received sEBRT (1.5–97.4, 95% confidence interval; p = 0.003). Six of seven patients with a Grade ≥3 rectal toxicity received sEBRT, including one who required an abdominoperineal resection. Median post-LDR D90, V150, V200, and R100 values were 103.3%, 59.4%, 30.1%, and 0.5 cc. ConclusionsIn a cohort of LDR brachytherapy patients with high rates of followup, sEBRT + LDR was associated with significantly higher risk of Grade ≥2 and ≥3 late rectal toxicity. This analysis supports previous findings and maintains concern about the supplemental use of external beam radiation therapy with LDR brachytherapy while its benefit for tumor control has yet to be prospectively validated.

Improving access to bariatric surgery: early surgical and patient-focused outcomes of a rural obesity clinic

BackgroundBariatric surgery is typically offered in larger health care centers, forcing patients to travel long distances to access care. An adult obesity program was established in Whitehorse, Yukon based on the multidisciplinary adult bariatric clinic in Edmonton, to alleviate long-distance care difficulties. This study analyzes patient/health care staff satisfaction and surgical outcomes for this program. MethodsA survey was administered to patients and health care staff at Edmonton and Whitehorse. Patient charts were reviewed. A multivariate linear regression predicted the main effect of travel distance and other clinical covariates on follow-up compliance. ResultsPostoperative body mass index, complications, and satisfaction scores were similar. Whitehorse patients had higher rates of follow-up (85.6% vs 71.1%, P = .002). ConclusionsThe Whitehorse Bariatric Program provides perioperative obesity care comparable to a larger center. Patient follow-up and satisfaction suggest a highly successful program. This may serve as a model for improving access to obesity services across Canada.

The Reliability of Turkish "Basic Life Support" and "Cardiac Massage" Videos Uploaded to Websites

In this study, the reliability of Turkish cardiac massage and Basic Life Support (BLS) videos, which have already been downloaded from three website such as YouTube, Google, Yahoo following the publication of 2010 cardiopulmonary resuscitation (CPR) guideline and their suitability to the same guideline were researched. The videos uploaded to the three web-site to search videos on internet were queried by using the keywords "cardiac massage" and "basic life support". Videos that had been uploaded between January 2011 and July 2014 were analyzed and scored by two experienced emergency specialists. A total of 1126 videos were obtained. 1029 of the videos (91.4%) were excluded by researchers. 97 videos were detected to accord with study criteria. Despite most of the videos were found on Google website by keywords, the enormous part of videos proper to criteria were sourced from YouTube website (n=65, 67.0%). One fourth of the videos (24.7%) were observed to not be suitable for 2010 CPR guideline. AED usage was mentioned slightly in the videos (14.4%). Median score of the videos is 5 (IQR: 4-6). The rate and scores of the videos uploaded by official institution or association were significantly higher than others (p=0.007 and 0.006, respectively). Moreover, scores of the videos compatible with guidelines uploaded by official institution or association and medical personal were also found higher (p=0.001). Eventually, all the data obtained in this study support that Turkish videos were not reliable on the subject of BLS and cardiac massage. It is promising that videos with high follow-up rates also have been scored higher.

Abstract 141: Depression and Cardiovascular Disease: Improving Patient Care

Background: Depression affects up to 20% of patients with coronary artery disease (CAD), diabetes mellitus (DM), and congestive heart failure (CHF); and is associated with poorer health outcomes. HEDIS Depression Care Measure Set includes the utilization of PHQ-9 survey to monitor depression and appropriate treatment and follow-up. The goal of this program is to design, implement, and measure the success of a quality improvement (QI) initiative addressing HEDIS depression measures in the cardiovascular (CV) population. Methods: First an analysis of current practice and HEDIS compliance was conducted; 2. A plan was developed to address gaps in care; 3. A QI program was executed in the cardiac catheter lab; and 4. Outcome measures and methods to determine program success were designed. Results: Current practice analysis of the catheter lab revealed that depression screening, monitoring, and follow-up were not routinely conducted. Further, it was identified that the PHQ-9 screener was available in the EMR system but not being utilized. Therefore, a QI program was designed with the following components: 1. Patients &gt; 18 years old receive the PHQ-9 upon discharge from the catheter lab; 2. If a patient scores &gt; 10 on the PHQ-9 they receive education and are scheduled for follow-up; 3. A clinical database collects information on Framingham risk scores, CV risks, PHQ-9 scores, medical history, and biometric data. These data are then used to provide customized CV care plans including depression education; 4. A shared medical appointment (SMA) format provides additional depression education and follow-up. This program was executed in January 2014. The outcomes plan evaluates the impact of this QI program on HEDIS goal attainment and CV care. A control group receives screening, initial education, and standard of care. The intervention group receives screening, initial education, entry into the disease management database, customized education, therapeutic lifestyle counselling, and participation in the SMA focusing on depression. Currently 39 patients are enrolled in each arm. Interim analysis reveals 100% depression screening in both groups and high rates of follow-up in the intervention group (2 initial components of the HEDIS goals). Conclusions: Implementing a multi-faceted depression screening and follow-up QI program addresses HEDIS goals and has shown initial success in closing identified gaps in care. Future implications include a comparative analysis of the QI program to standard of care on composite HEDIS depression measures and CV goal attainment.

Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.

ObjectivesTo examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians.MethodsWe conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010.ResultsA total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05–1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12–1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23–1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71–0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07–1.48) than those cared for by physicians.ConclusionsCompared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and APPs.

Stereotactic fractionated radiotherapy of the resection cavity in patients with one to three brain metastases

ObjectivesThe goal of this study is to evaluate the role of stereotactic fractionated radiotherapy (SFRT) in patients with one to three brain metastases after surgical resection. Methods and materialsWe performed a retrospective single-institutional study in patients undergoing SFRT of surgical cavity after resection of ≤3 brain metastases. 60 patients with newly diagnosed brain metastases treated with SFRT following resection were included. The total irradiation dose was 30Gy (5Gy/d, BED 45Gy) after complete macroscopical resection and 35Gy (5Gy/d, BED 52.5Gy) in patients with macroscopic residual tumour after surgery. Macroscopic residual tumour was defined as contrast enhancement next to the resection cavity on the postoperative T1-MRI. The gross tumour volume (GTV) encompassing the residual tumour was delineated on the T1-MRI, the clinical target volume (CTV) encompassed the surgical cavity plus 1mm and the planning target volume (PTV) the CTV plus 2mm. ResultsEight of 60 patients had no imaging follow-up due to morbidity/mortality. Two of 52 (3.8%) patients experienced local failures only, 25 of 52 (48.1%) patients experienced distant intracranial failures only and 4 (7.7%) patients experienced both local and distant intracranial failures. In summary, there were 6 (11.5%) local failures and 29 (55.8%) distant failures. Age was significant for local control in the Cox regression test (p=0.046). Thirty-seven of 60 (61.7%) patients died during follow-up. Median follow-up was 8 months. Median overall survival was 15 months. Cox regression for survival was significant for KPS score ≤70% and size of PTV. No severe side effects were seen. Patients undergoing whole brain radiation therapy (WBRT) as salvage therapy in case of progression had no severe side effects either. ConclusionIn the light of encouraging local control rates, SFRT could be an alternative to WBRT after surgical resection of ≤3 brain metastases. Due to the high rate of distant intracranial failure regular follow-up with MRI is mandatory.

Comparative study of late rectal toxicity in veterans undergoing low-dose rate prostate brachytherapy treated with or without supplemental external beam radiotherapy.

112 Background: Supplemental external beam radiation therapy (sEBRT) is often prescribed in men undergoing low dose rate (LDR) brachytherapy for prostate cancer. A population of patients was analyzed to assess the effect of sEBRT on late rectal toxicity. It was hypothesized that sEBRT+LDR would be associated with a higher risk of late rectal toxicity, compared to LDR brachytherapy alone. Methods: This retrospective cohort study examined LDR brachytherapy patients, treated with or without sEBRT, with a minimum of 5 years follow-up. All were treated at a credentialed Veterans Affairs medical center that enrolled many of these patients on RTOG 0234. Longitudinal assessments were evaluated using the Computerized Patient Record System, and toxicities were coded using the CTCAE v4.0. The Kaplan-Meier method was used for analysis. Results: Median follow-up was 7.5 years for 245 consecutive patients from 2004 and 2007. sEBRT was administered to 33.5%. Follow-up beyond 5 years was available for 89%. Overall rates of grade ≥ 2 and ≥ 3 rectal toxicities were 6.9% and 2.9%, respectively. The risk of grade ≥ 2 rectal toxicity was 2.8-fold higher for patients receiving sEBRT (1.1 - 7.2, 95% CI, p = 0.02). The risk of grade ≥ 3 rectal toxicity was 11.9-fold higher for patients who received sEBRT (1.5 - 97.4, 95% CI, p = 0.003). Six out of 7 patients with a grade ≥ 3 rectal toxicity received sEBRT, including one who required an abdominoperineal resection due to radiation proctopathy. The median post-LDR D90, V150, V200, and R100 values were 103.3%, 59.4%, 30.1%, and 0.5 cc. The minimum R100 associated with a grade ≥ 2 toxicity was 0.2 cc, and the minimum R100 for a grade ≥ 3 toxicity was 0.4 cc. Grade ≥ 2 rectal toxicity was seen in 3% vs 13% of patients who had post-implant dosimetry of R100 &lt; 1 cc vs R100≥ 1 cc, respectively. Conclusions: In a cohort of LDR brachytherapy patients with high rates of follow-up, sEBRT+LDR was associated with significantly higher risk of grade ≥ 2 and ≥ 3 late rectal toxicity. This analysis supports previous findings and maintains concern about the supplemental use of EBRT with LDR brachytherapy while its benefit for tumor control has yet to be prospectively validated.

A large-scale, observational study to investigate the current status of diabetes complications and their prevention in Japan: research outline and baseline data for type 2 diabetes—JDCP study 1

The Japan Diabetes Complication and its Prevention prospective (JDCP) study is a large-scale observational study conducted to investigate the current status of the management of people with diabetes, and to clarify the risk factors for the onset and progression of diabetes complications. The study includes 6338 patients aged 40 to <75 years who had received regular outpatient treatment from 2007–2009 at medical facilities nationwide specializing in diabetes. The primary endpoints for the study include occurrence and/or progression of nephropathy, retinopathy, neuropathy, macroangiopathy, and periodontal disease; the secondary endpoints include occurrence of malignancy and mortality. This report gives an outline of the study and a summary of the baseline data for participating patients with type 2 diabetes (n = 5944). The baseline characteristics were: men, 60.1 %; mean age, 61.4 years; duration of diabetes, 10.8 years; family history of diabetes, 52.8 %; BMI, 24.5 kg/m2; HbA1c, 7.4 % (achievement of <7.0, 40.6 %); blood pressure, 129.8/74.8 mmHg; and non-HDL-C, 137.6 mg/dL. Treatments included: diet therapy alone, 10.4 %, oral hypoglycemic agents, 62.1 %; and insulin therapy, 27.5 %. The cohort is to be followed up for at least 5 years, with a high follow-up rate. The focus of the study is to develop a clinical registry that is reliable and versatile and to bring the research findings and insights to bear on the society’s Treatment Guide for Diabetes.

The Use of Technology in Participant Tracking and Study Retention: Lessons Learned From a Clinical Trials Network Study

ABSTRACTBackground: The growing use of newer communication and Internet technologies, even among low-income and transient populations, require research staff to update their outreach strategies to ensure high follow-up and participant retention rates. This paper presents the views of research assistants on the use of cell phones and the Internet to track participants in a multisite randomized trial of substance use disorder treatment. Methods: Preinterview questionnaires exploring tracking and other study-related activities were collected from 21 research staff across the 10 participating US sites. Data were then used to construct a semistructured interview guide that, in turn, was used to interview 12 of the same staff members. The questionnaires and interview data were entered in Atlas.ti and analyzed for emergent themes related to the use of technology for participant-tracking purposes. Results: Study staff reported that most participants had cell phones, despite having unstable physical addresses and landlines. The incoming call feature of most cell phones was useful for participants and research staff alike, and texting proved to have additional benefits. However, reliance on participants' cell phones also proved problematic. Even homeless participants were found to have access to the Internet through public libraries and could respond to study staff e-mails. Some study sites opened generic social media accounts, through which study staff sent private messages to participants. However, the institutional review board (IRB) approval process for tracking participants using social media at some sites was prohibitively lengthy. Internet searches through Google, national paid databases, obituaries, and judiciary Web sites were also helpful tools. Conclusions: Research staff perceive that cell phones, Internet searches, and social networking sites were effective tools to achieve high follow-up rates in drug abuse research. Studies should incorporate cell phone, texting, and social network Web site information on locator forms; obtain IRB approval for contacting participants using social networking Web sites; and include Web searches, texting, and the use of social media in staff training as standard operating procedures.

Limited Uptake of Planned Intrauterine Devices During the Postpartum Period.

The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned. We conducted a retrospective chart review of women who had at least one prenatal visit and delivered a viable pregnancy at our academic medical center. Methods of planned and established postpartum contraceptive methods were recorded, as well as demographic information and documented reasons for failure to initiate planned intrauterine contraception. A total of 110 women planned postpartum IUD placement. Of these women, 84 (76%) presented for at least one postpartum appointment. Only 22.6% (95% confidence interval 13.7-31.5) of those presenting for postpartum follow-up underwent IUD placement within 8 weeks of delivery. Women planning postpartum IUD insertion were just as likely as women with no planned postpartum contraceptive method to fail to establish contraception within 8 weeks (P = 0.55). Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.

Establishment of a Maternal Newborn Health Registry in the Belgaum District of Karnataka, India.

BackgroundPregnancy-related vital registration is important to inform policy to reduce maternal, fetal and newborn mortality, yet few systems for capturing accurate data are available in low-middle income countries where the majority of the mortality occurs. Furthermore, methods to effectively implement high-quality registration systems have not been described. The goal of creating the registry described in this paper was to inform public health policy makers about pregnancy outcomes in our district so that appropriate interventions to improve these outcomes could be undertaken and to position the district to be a leader in pregnancy-related public health research.MethodsWe created a prospective maternal and newborn health registry in Belgaum, Karnataka State, India. To initiate this registry, we worked with the Ministry of Health to first establish estimated birth rates and define the catchment areas of the clusters, working within the existing health system and primary health centers. We also undertook household surveys to identify women likely to become pregnant. We then implemented monitoring measures to ensure high quality and completeness of the maternal newborn health registry. All pregnant women in the catchment area were identified, consented and enrolled during pregnancy, with follow-up visits to ascertain pregnancy outcomes and mother/infant status at 42-days postpartum.ResultsFrom 2008 through 2014, we demonstrated continued improvements in both the coverage for enrollment and accuracy of reporting pregnancy outcomes within the defined catchment area in Belgaum, India. Nearly 100% of women enrolled had follow-up at birth and 99% had 42-day follow-up. Furthermore, we facilitated earlier enrollment of women during pregnancy while achieving more timely follow-up and decreased time of reporting from the date of the pregnancy event.ConclusionsWe created a pregnancy-related registry which includes demographic data, risk factors, and outcomes allowing for high rates of ascertainment and follow-up while working within the existing health system. Understanding the elements of the system used to create the registry is important to improve the quality of the results. Tracking of pregnancies and their outcomes is an important step toward reducing maternal and perinatal mortality.

PC190. A Quality Improvement Project to Improve IVC Filter Retrieval

Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up as common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. In May 2012, as a process improvement project for Accreditation Council for Graduate Medical Education (ACGME) requirements, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We reported the initial 6-month results for 28 patients at the 2013 Winter Meeting of the Vascular and Endovascular Surgery Society. Here we report the results after 32 months with a total of 115 patients. Patients receiving R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record (EHR). When there were no longer indications for R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon and then retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were calculated for filters placed between May 2012 and January 2015. A total of 115 R-IVCFs were placed between May 2012 and January 2015. Fifty filters were placed for therapeutic indications and 65 for prophylactic indications. Our follow-up rate improved to 95%. A total of 72 filters were retrieved (63% absolute retrieval rate). The average dwell time was 103 days (range, 7-460 days), and 62% were retrieved within 3 months of placement. Technical success for retrieval was 91%. There were two major complications from retrievals (2.5% of retrievals). The creation of R-IVCF registry promoted on-going follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 95%. These results emphasize the importance of repetitive follow-up for R-IVCF. Despite follow-up, nearly a third of R-IVCF are not retrieved.

Clinical Factors Associated With Lower Postpartum Follow-up Among Women With Severe Preeclampsia [75

INTRODUCTION: Preeclampsia is associated with long-term adverse outcomes, and, therefore, postpartum follow-up is critical. Despite the importance, there continue to be poor postpartum follow-up rates. We aimed to determine factors that are associated with lower postpartum follow-up among women with severe preeclampsia. METHODS: This was a planned secondary analysis of a retrospective cohort of women with severe preeclampsia who delivered between July 2011 and February 2013. Charts were reviewed for data abstraction and to confirm diagnosis. Women were included if they were diagnosed with severe preeclampsia before active labor and were at greater than 34 weeks of gestation. χ2 test compared categorical variables; Student t-test compared parametric data. RESULTS: A total of 202 women were included. The 6-week postpartum follow-up rate was 52.0%. Of women with severe preeclampsia, 77.2% were African American; however, these women were less likely to follow-up than were Caucasian women (46.8 compared with 73.9%, P=.02). Women with more prenatal visits were more likely to follow-up (8.7±3.2 compared with 6.9±3.7, P<.001), as were older women (27.8±3.8 compared with 24.8±5.9, P=.002). Additionally, there was a higher rate of follow-up among those who had undergone cesarean delivery (66.7%) compared with those who had undergone vaginal delivery (44.4%, P=.003). The rate of follow-up was not associated with body mass index, parity, gestational age at diagnosis of severe preeclampsia, neonatal intensive care unit admission, or being discharged home on a blood pressure medicine. CONCLUSION: In this study, we found an association with lower rates of postpartum follow-up among women who are African American, younger, had fewer prenatal visits, and underwent vaginal delivery. Identifying these characteristics will help target at-risk populations to implement strategies for improving follow-up.

Newborn hearing screening: analysis and outcomes after 100,000 births in Upper-Normandy French region

ObjectivesNeonatal hearing impairment is a common disorder with a prevalence of 1 to 2‰ worldwide, with significant consequences on overall development when rehabilitated too late. New-born hearing screening has been implemented in the 1990s in most European countries and the USA. The Upper-Normandy region of France has been conducting a pilot program since 1999. The aim of this prospective study was to evaluate and critically analyse it. MethodsThe Upper-Normandy universal new-born hearing screening program is performed in two steps. Between 1999 and 2004, first, we administered a Transient Evoked Oto Acoustic Emission (TEOAE) test was administered a few days after birth for healthy newborns without risk factors. For newborns admitted to a neonatal intensive care unit (NICU) or presenting risk factors, was administered an automated auditory brainstem response (AABR) test prior to discharge. Second, newborns who failed the initial hearing screening were retested as outpatients using TEOAE. Since 2004, infants who failed the initial screen were tested with AABR 3 to 4 weeks later as outpatients, providing an opportunity to compare the two protocols. ResultsOverall screening coverage in the Upper-Normandy region is 99.8%. First step coverage is 99.58% in well-infant nurseries and 97.09% in the NICU. The test–retest procedure during the first step and the use of AABR for the second resulted in higher follow-up rates and lower false positive rates. ConclusionsThe Upper-Normandy region universal newborn hearing screening program facilitated diagnosis and rehabilitation of infants before age of 9 months, most notably when severe to profound hearing impairment was found.

Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial.

Follow-up after a positive colorectal cancer screening test is necessary for screening to be effective. We hypothesized that nurse navigation would increase the completion of colonoscopy after a positive screening test. This study was conducted between 2008 and 2012 at 21 primary care medical centers in western Washington State. Participants in the Systems of Support to Increase Colorectal Cancer Screening study who had a positive fecal occult blood test (FOBT) or flexible sigmoidoscopy needing follow-up were randomized to usual care (UC) or a nurse navigator (navigation). UC included an electronic health record-based positive FOBT registry and physician reminder system. Navigation included UC plus care coordination and patient self-management support from a registered nurse who tracked and assisted patients until they completed or refused colonoscopy. The primary outcome was completion of colonoscopy within 6 months. After 6 months, both groups received navigation. We randomized 147 participants with a positive FOBT or sigmoidoscopy. Completion of colonoscopy was higher in the intervention group at 6 months, but differences were not statistically significant (91.0% in navigation group vs 80.8% in UC group; adjusted difference, 10.1%; P = .10). Reasons for no or late colonoscopies included refusal, failure to schedule or missed appointments, concerns about risks or costs, and competing health concerns. Navigation did not lead to a statistically significant incremental benefit at 6 months. Follow-up rates after a positive colorectal cancer (CRC) screening test are high in a health care system where UC included a registry and physician reminders. Because of high follow-up rates in a health care system where UC included a registry and physician reminders, and small sample size, we cannot rule out incremental benefits of nurse navigation.

Abstract 3245: Multivitamins and cancer in the Physicians’ Health Study II: Expanded analyses and insights

Abstract The Physicians’ Health Study (PHS) II, the only clinical trial testing a daily multivitamin, recently reported a significant 8% reduction in the primary endpoint of total cancer. We conducted expanded post hoc analyses to test the effects of a common multivitamin (daily Centrum Silver) on the risk of site-specific cancer in a randomized, double-blind, placebo-controlled trial of 14,641 U.S. male physicians initially aged ≥50 years, including 1,312 with cancer at randomization. Treatment and follow-up occurred from 1997 to 2011. Cancer endpoints were confirmed by an Endpoints Committee of physicians blinded to randomized treatment. PHS II maintained high rates of morbidity and mortality follow-up. Computing hazard ratios (HRs) and 95% confidence intervals (95% CIs), we examined the effect of a daily multivitamin on cancers grouped by anatomic site (defined by ICD9 codes) and by previously unreported cancer sites. During a median follow-up of 11.2 years among men with mean age of 64.3 y at baseline, men taking a daily multivitamin had consistent, non-significant reductions in cancers of the digestive organs and peritoneum (HR, 0.82; 95% CI, 0.67-1.00; P=.05) and respiratory and intrathoracic organs (HR, 0.81; 95% CI, 0.60-1.09; P=.17) (Table). Men with a history of cancer had a significant reduction in genitourinary cancers (HR, 0.56; 95% CI, 0.35-0.89; P=.01). For individual cancer sites, there were strong but nonsignificant reductions in brain, colon, esophageal, gallbladder, kidney, liver, myeloid myeloma, small intestine, stomach, and thyroid cancer, and nonsignificant increases in connective tissue, multiple myeloma, other lymphoid, and rectum cancer. These expanded trial data in middle-aged and older men indicate that daily multivitamin use may benefit digestive and respiratory cancers, and genitourinary cancer among men with a history of cancer. These results support the need to understand the mechanisms and long-term effects of daily multivitamin use. HRs (95% CIs) of randomized multivitamin assignment on risk of cancer by site of malignant neoplasmSite of malignant neoplasm (ICD9 code)Total No. of Events Overall (n=14641)*Primary Prevention (n=13329)Secondary Prevention (n=1312)Lip, oral cavity, and pharynx (140-149)501.27 (0.72-2.21)1.23 (0.69-2.19)1.96 (0.18-21.7)Digestive organs and peritoneum (150-159)3890.82 (0.67-1.00)0.85 (0.68-1.05)0.64 (0.36-1.11)Respiratory and intrathoracic organs (160-165)1760.81 (0.60-1.09)0.86 (0.63-1.18)0.48 (0.20-1.19)Bone, connective tissue, skin, and breast (170-175)2501.21 (0.94-1.55)1.18 (0.91-1.53)0.99 (0.53-1.83)Genitourinary organs (179-189)15220.96 (0.87-1.06)0.98 (0.89-1.09)0.56 (0.35-0.89)Other and unspecified sites (190-199)1130.79 (0.55-1.15)0.78 (0.52-1.16)0.82 (0.31-2.23)Lymphatic and hematopoietic tissue (200-208)2910.98 (0.78-1.23)0.94 (0.74-1.19)1.67 (0.73-3.83)* For the incidence of site-specific cancers, analyses wererestricted to men without that site-specific cancer at baseline. Citation Format: Howard D. Sesso, William G. Christen, Vadim Bubes, JoAnn E. Manson, Robert J. Glynn, Julie E. Buring, J. Michael Gaziano. Multivitamins and cancer in the Physicians’ Health Study II: Expanded analyses and insights. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3245. doi:10.1158/1538-7445.AM2014-3245