Improve Completion Rates Research Articles

Su1254 FACTORS PREDICTING INCOMPLETE SMALL BOWEL CAPSULE ENDOSCOPY

Although small bowel capsule endoscopy (SBCE) is an important diagnostic tool, rates of incomplete examination of the small intestine (i.e. the capsule cannot reach the caecum during recording) have been reported in up to 30% of the procedures. In a retrospective analysis of consecutive SBCE procedures we aimed to identify predictive factors associated with incomplete SBCE. Consecutive patients undergoing SBCE in a tertiary referral center were included in the study. Pillcam SB2 and SB3 capsules were employed and the standard international protocol for small bowel preparation was applied. Each examination was evaluated independently by two physicians experienced with the method. Logistic regression analysis was applied to identify independent factors associated with incomplete SBCE. SBCE from 1021 consecutive patients [mean age (SD) 55.0±19.1 years, males 51.9%] performed between 1st January 2011 and 31st October 2017 were assessed. Overall 62.7% of the SBCE were performed using the Pillcam SB2 capsule. Of the patients, 184 (18.0%) were inpatients and 84 (8.2%) had a prior abdominal surgery. The most common indications for SBCE were obscure gastrointestinal bleeding (41.8%), suspected Crohn’s disease (CD) (11.9%), assessment of known CD (11.3%), and chronic unexplained diarrhea (11.3%). Bowel preparation was poor in 5% of the examinations. The mean gastric transit time (GTT) was 44.4 min. Incomplete SBCE was recorded in 121 (11.9%) patients. The most common findings were ulcerations (18.6%) and angiodysplasias (14.6%). Multiple logistic regression revealed several predictive factors for incomplete SBCE shown in Table 1. ROC curve (Figure 1) showed that the optimal cut-off of GTT for the prediction of incompletion was 30 min (sensitivity 63%, specificity 67%). We identified several factors predictive of incomplete SBCE, such as being inpatient, use of the SB2 capsule, finding erosions or blood in the lumen, prior abdominal surgery, and prolonged GTT. These results may guide appropriate use of SBCE, improve completion rates and the diagnostic yield of the test in future procedures.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Presidential Leadership: Improving Completion Rates of Latino Male Students at Texas Community Colleges

Enrollment rates for Latino male students continue to increase at community colleges; unfortunately, compared to their other racial and/or ethnic male counterparts they are less likely to earn a college credential or degree. This qualitative study explores the narratives of six presidents at Texas community colleges designated as Hispanic-Serving Institutions. We asked these presidents to describe their perceptions of their institution’s awareness and commitment to improve degree completion outcomes of Latino male students. We utilized cultural and social-cognition theories to help understand how these presidents may change or shift their institution’s efforts to address this pressing issue. Based on the findings, three key themes emerged that described how these leaders perceived their respective institution. Our findings suggest these presidents are concerned with the low completion rates for Latino male students; however, their institutions need to better align their institution's core values, mission, and culture to support educational outcomes of Latino male students. Lastly, we highlight how other community college presidents could enhance their institution’s commitment to improve degree completion rates of Latino male students.

Adjuvant and Neoadjuvant Therapy for Pancreatic Adenocarcinoma

Despite decades of advancement and research into the multimodal care of pancreatic cancer, mortality after the diagnosis of pancreatic ductal adenocarcinoma remains grim. The role of adjuvant therapy following surgical resection has been well established in the literature. However, adjuvant therapy is imperfect, and outside of a clinical trial, there are high rates of omission or delayed initiation of therapy. Neoadjuvant treatment strategies continue to be explored in the management of resectable, borderline-resectable, and locally advanced unresectable pancreatic adenocarcinoma. With improved resection rates and the possibility for tumor downstaging, neoadjuvant therapy has become standard for patients with borderline-resectable and locally advanced unresectable tumors. Additional benefits of neoadjuvant therapy in the treatment of resectable tumors include improved completion rates of systemic therapy and R0 resection rates. Future clinical trials, including the use of novel treatment agents and combination treatment strategies in both neoadjuvant and adjuvant regimens, will add value to the treatment of pancreatic adenocarcinoma. Key words: adjuvant therapy, borderline-resectable pancreatic cancer, locally advanced pancreatic cancer, neoadjuvant therapy, pancreatic adenocarcinoma, resectable disease

Adjuvant and Neoadjuvant Therapy for Pancreatic Adenocarcinoma

Despite decades of advancement and research into the multimodal care of pancreatic cancer, mortality after the diagnosis of pancreatic ductal adenocarcinoma remains grim. The role of adjuvant therapy following surgical resection has been well established in the literature. However, adjuvant therapy is imperfect, and outside of a clinical trial, there are high rates of omission or delayed initiation of therapy. Neoadjuvant treatment strategies continue to be explored in the management of resectable, borderline-resectable, and locally advanced unresectable pancreatic adenocarcinoma. With improved resection rates and the possibility for tumor downstaging, neoadjuvant therapy has become standard for patients with borderline-resectable and locally advanced unresectable tumors. Additional benefits of neoadjuvant therapy in the treatment of resectable tumors include improved completion rates of systemic therapy and R0 resection rates. Future clinical trials, including the use of novel treatment agents and combination treatment strategies in both neoadjuvant and adjuvant regimens, will add value to the treatment of pancreatic adenocarcinoma. Key words: adjuvant therapy, borderline-resectable pancreatic cancer, locally advanced pancreatic cancer, neoadjuvant therapy, pancreatic adenocarcinoma, resectable disease

Boost student completion as a student‐centered institution

“I like to say that I have the heart of an advisor and the brain of an academic,” said Lynn Mahoney, Ph.D., provost and vice president for academic affairs at California State University, Los Angeles. That mentality, born out of Mahoney's background as both a lecturer and academic advisor, has been at the forefront of Mahoney's work to improve time to degree and completion rates on campus. “[Throughout my career] I've been consumed with the inadvertent obstacles we place in students' way as they attempt to achieve their degrees,” Mahoney said. She shared strategies and changes the Cal State LA campus is making to improve completion rates.

Boost student completion as a student‐centered institution

“I like to say that I have the heart of an advisor and the brain of an academic,” said Lynn Mahoney, Ph.D., provost and vice president for academic affairs at California State University, Los Angeles. That mentality, born out of Mahoney's background as both a lecturer and academic advisor, has been at the forefront of Mahoney's work to improve time‐to‐degree and completion rates on campus. “[Throughout my career] I've been consumed with the inadvertent obstacles we place in students' way as they attempt to achieve their degrees,” Mahoney said. She shared strategies and changes the Cal State LA campus is making to improve completion rates.

Boost student completion as a student‐centered institution

“I like to say that I have the heart of an advisor and the brain of an academic,” said Lynn Mahoney, Ph.D., provost and vice president for academic affairs at California State University, Los Angeles. That mentality, born out of Mahoney's background as both a lecturer and academic advisor, has been at the forefront of Mahoney's work to improve time‐to‐degree and completion rates on campus. “[Throughout my career] I've been consumed with the inadvertent obstacles we place in students' way as they attempt to achieve their degrees,” Mahoney said. She shared strategies and changes the Cal State LA campus is making to improve completion rates.

Improving completion rates of students in biomedical PhD programs: an interventional study

BackgroundAnalysis of graduation success at the University of Split School of Medicine PhD programs conducted in 2011 revealed that only 11% of students who enrolled and completed their graduate coursework between 1999 and 2011 earned a doctoral degree. In this prospective cohort study we evaluated and compared three PhD programs within the same medical school, where the newest program, called Translational Research in Biomedicine (TRIBE), established in the academic year 2010/11, aimed to increase the graduation rate through an innovative approach.MethodsThe intervention in the new program was related to three domains: redefined recruitment strategy, strict study regulations, and changes to the curriculum. We compared performance of PhD students between the new and existing programs and analyzed their current status, time to obtain a degree (from enrolment to doctorate), age at doctorate, number of publications on which the thesis was based and the impact factor of journals in which these were published.ResultsThese improvement strategies were associated with higher thesis completion rate and reduced time to degree for students enrolled in the TRIBE program. There was no change in the impact factor or number of publications that were the basis for the doctoral theses.ConclusionOur study describes good practices which proved useful in the design or reform of the PhD training program.

Attitudes and factors contributing to attrition in Canadian surgical specialty residency programs.

We recently studied attrition in Canadian general surgical programs; however, there are no data on whether residents enrolled in other surgical residencies harbour the same intents as their general surgical peers. We sought to determine how many residents in surgical disciplines in Canada consider leaving their programs and why. An anonymous survey was administered to all residents in 9 surgical disciplines in Canada. Significance of association was determined using the Pearson χ2 test. The Canadian Post-MD Education Registry (CAPER) website was used to calculate the response rate. We received 523 responses (27.6% response rate). Of these respondents, 140 (26.8%) were either "somewhat" or "seriously" considering leaving their program. Residents wanting to pursue additional fellowship training and those aspiring to an academic career were significantly less likely to be considering changing specialties (p = 0.003 and p = 0.005, respectively). Poor work-life balance and fear of unemployment/underemployment were the top reasons why residents would change specialty (55.5% and 40.8%, respectively), although the reasons cited were not significantly different between those considering changing and those who were not (p = 0.64). Residents who were considering changing programs were significantly less likely to enjoy their work and more likely to cite having already invested too much time to change as a reason for continuing (p < 0.001). More than one-quarter of residents in surgical training programs in Canada harbour desires to abandon their surgical careers, primarily because of unsatisfactory work-life balance and limited employment prospects. Efforts to educate prospective residents about the reality of the surgical lifestyle and to optimize employment prospects may improve completion rates.

Real-Time Assessment of Patient Reported Outcomes in Heart Failure Clinic

Introduction: Patient-reported outcomes (PROs) are commonly used in clinical trials to assess patient health-related quality of life (hrQoL), but PRO implementation in daily practice is rare. We sought to develop a novel approach to integrate PROs within routine clinical practice at a heart failure (HF) clinic. Methods and Results Technical implementation of PRO capture was facilitated by the University of Utah mEVAL Personal Health Assessment team. We deployed a computer program on portable computers (iPad) to collect PRO instruments of interest—Kansas City Cardiomyopathy Questionnaire & physical function, depression, fatigue, and satisfaction with social roles domains of Patient-Reported Outcomes Measurement Information System—PROMIS. We initiated an automated algorithm through which patients are identified at registration for clinic, provided with iPAD and asked to complete the PROs (Fig. 1A). Through secure data transfer, PROs are scored and made immediately available in the electronic health record (EHR) (Fig. 1B). We also conducted provider training in PRO score interpretation. In 2016, serial PRO assessments were done in 685 patients (age 60.1 ± 16.3 yrs, 66% male, average completion time 6.7 min), which represented a 58% completion rate among eligible patients. PRO results indicated marked reduction in hrQoL in a large number of the patients—Table 1. The original design was to collect PROs at 3 month intervals; early experience indicated that it was more useful to collect these at each visit and share the results with patients. This is expected to improve completion rates. Conclusion PRO capture during routine clinical care with real-time EHR uploads is feasible in a large HF outpatient population. Ongoing efforts will better determine how best to share this information with patients and will provide data regarding the utility of routine PRO use in clinical care. While PROs are being proposed as required metrics of quality of health care delivery, our approach intends to make these measures actionable in real-time clinical care.Table 1Scores of completed patient-reported outcome assessmentsInstrument NameSample SizeMedian Score25th Percentile75th PercentileKCCQ-12804573974PROMIS-Depression714504557PROMIS-Fatigue788554861PROMIS-Physical Function719413547PROMIS-Satisfaction Roles Activities791453951 Open table in a new tab

Improved prosthetic hand control with concurrent use of myoelectric and inertial measurements

BackgroundMyoelectric pattern recognition systems can decode movement intention to drive upper-limb prostheses. Despite recent advances in academic research, the commercial adoption of such systems remains low. This limitation is mainly due to the lack of classification robustness and a simultaneous requirement for a large number of electromyogram (EMG) electrodes. We propose to address these two issues by using a multi-modal approach which combines surface electromyography (sEMG) with inertial measurements (IMs) and an appropriate training data collection paradigm. We demonstrate that this can significantly improve classification performance as compared to conventional techniques exclusively based on sEMG signals.MethodsWe collected and analyzed a large dataset comprising recordings with 20 able-bodied and two amputee participants executing 40 movements. Additionally, we conducted a novel real-time prosthetic hand control experiment with 11 able-bodied subjects and an amputee by using a state-of-the-art commercial prosthetic hand. A systematic performance comparison was carried out to investigate the potential benefit of incorporating IMs in prosthetic hand control.ResultsThe inclusion of IM data improved performance significantly, by increasing classification accuracy (CA) in the offline analysis and improving completion rates (CRs) in the real-time experiment. Our findings were consistent across able-bodied and amputee subjects. Integrating the sEMG electrodes and IM sensors within a single sensor package enabled us to achieve high-level performance by using on average 4-6 sensors.ConclusionsThe results from our experiments suggest that IMs can form an excellent complimentary source signal for upper-limb myoelectric prostheses. We trust that multi-modal control solutions have the potential of improving the usability of upper-extremity prostheses in real-life applications.

Improving distress screening completion rates: Does virtual robot animation make a difference?

e21672 Background: Distress screening is an important part of cancer patients’ care. Programs accredited by Commission on Cancer must implement distress screening programs, based on improved doctor-patient relationships and clinical outcomes. We are interested in evaluating the use of an anthropomorphic robotic interface to improve survey completion rates and the patient experience. Methods: A validated distress screening survey was scheduled for 74 patients in 2016 in an IRB-exempt survey study. Patients were randomly assigned to fill out the survey on iPAD (N = 33), or on iPAD with a virtual robot animation (“Betty”) introducing the survey (N = 41). Patients were then asked to fill out a validated 10 question Technology Acceptance Model questionnaire (TAM) asking about ease of iPAD use. A five point Likert scale was used. Finally, two yes/no questions were asked: 1) “Were you more interested in filling out the distress screening survey because of the “Betty” animation?”, and 2) “Did the animation make filling out the distress screening survey more enjoyable?” Results: The survey completion rate was 24/33 = 73% for control and 26/41 = 63% for intervention groups (p = 0.86). Forty five patients completed the TAM questionnaire, with completion rate 92% and 88%, respectively. Average iPAD TAM score was 4.3 in the control group and 4.0 in the intervention group (p = 0.12), and none of the 10 questions showed statistically significant difference in ease of use. The last two questions evaluating “Betty” directly were answered by 17/23 and 15/23 patients, respectively. 8/17 felt they were more interested in filling out the distress screening because of “Betty”, and 7/15 felt “Betty” made the distress screening more enjoyable. Conclusions: The presence of “Betty” as part of the survey process did not negatively impact the completion rates. There was no significant difference between the groups in perceived ease of use of the iPAD on which the survey was administered. Approximately half of the patients taking the distress survey with the “Betty” animation felt they were more interested in filling out the survey and the process was more enjoyable. We are currently evaluating whether a true robot may improve completion rates and patient experience.

Evaluation Of A Hospital-based Weight Loss Program Involving Exercise, Nutritional, And Behavior Change Modification.

Weight loss can reduce health risks associated with obesity. Team-approach interventions that involve exercise, diet, and behavioral modification have been shown to result in successful weight loss. PURPOSE: The purpose of this project was to evaluate the effectiveness of a hospital-based team-approach physician-referred program that enrolls community members without use of incentives. METHODS: Participants included obese (BMI≥30) members of the community (COM, N=48) compared to employees of the local hospital (EMP, N=88). COM were referred to the program by a Physician while EMP were provided with incentives to participate. All participants were evaluated both pre- and post- a 16-week intervention period which included regular supervised exercise sessions and monthly consults with a Registered Dietitian (RD) and a Behavioral Health Specialist (BHS). Background information collected included, sex, initial weight (kg), BMI (kg/m2), percent fat (%) using Bioelectrical Impedance, and readiness for change (RTC) evaluation (modified Brownell LEARN RTC Questionnaire). Attendance at all sessions (RD, BHS, exercise) were recorded. If final weight was obtained, then the program was considered completed. Independent samples t-tests (p<0.05) were used to determine differences in physical characteristics between groups as well as in total weight loss. Association between consultation attendance (RD and BHS) and completion was determined by Chi-square test for independence with a Bonferroni adjustment. RESULTS: No significant differences were detected between participant initial characteristics. There was no significant difference in weight loss between groups (EMP=-12.29±12.56lbs vs COM=-15.58±8.08lbs, p=0.20). However, overall program completion was lower in the COM compared to EMP (58% vs. 85%, respectively). In the COM program a Chi-square test revealed a significant association only between attending BHS consultations and program completion (Χ2(1,n=48), Χ2=6.291, p=0.01, phi= 0.41). CONCLUSION: A team-approach weight loss program may be an effective intervention if the participants successfully complete the program. However, additional research is warranted to determine if adhering to BHS consultation visits could improve completion rates when other incentives are not offered.

Patient-Reported Barriers to the Prekidney Transplant Evaluation in an At-Risk Population in the United States.

Despite our knowledge of barriers to the early stages of the transplant process, we have limited insight into patient-reported barriers to the prekidney transplant medical evaluation in populations largely at-risk for evaluation failure. One-hundred consecutive adults were enrolled at an urban, Midwestern transplant center. Demographic, clinical, and quality of life data were collected prior to patients visit with a transplant surgeon/nephrologist (evaluation begins). Patient-reported barriers to evaluation completion were collected using the Subjective Barriers Questionnaire 90-days after the initial medical evaluation appointment (evaluation ends), our center targeted goal for transplant work-up completion. At 90 days, 40% of participants had not completed the transplant evaluation. Five barrier categories were created from the 85 responses to the Subjective Barriers Questionnaire. Patient-reported barriers included poor communication, physical health, socioeconomics, psychosocial influences, and access to care. In addition, determinants for successful evaluation completion included being of white race, higher income, free of dialysis, a lower comorbid burden, and reporting higher scores on the Kidney Disease Quality of Life subscale role-emotional. Poor communication between patients and providers, and among providers, was the most prominent patient-reported barrier identified. Barriers were more prominent in marginalized groups such as ethnic minorities and people with low income. Understanding the prevalence of patient-reported barriers may aid in the development of patient-centered interventions to improve completion rates.

E-mail reminders improve completion rates of patient-reported outcome measures

BackgroundPatient-reported outcome measures (PROMs) have become increasingly important in assessing clinical outcomes. However, acquisition of data at routine time intervals can be challenging. The ability of e-mail reminders to save follow-up intervals when office visits are missed is unknown.Materials and MethodsA retrospective review of a consecutive series of 186 shoulder surgical patients who underwent surgery between October 2, 2012, and July 2, 2013, was conducted. Simple Shoulder Test and 12-Item Short Form Health Survey scores were completed at preoperative visits using office-based tablet surveys. Patients were observed for completeness of PROMs at expected routine follow-up of 1 year and 2 years. When office visits were missed, e-mail reminders with links to online surveys were sent to patients without further incentives. Improvement in data acquisition achieved using e-mail reminders when patient follow-up was missed was assessed. The influence of the procedure performed was further analyzed to determine whether patients treated with different surgical procedures would be more compliant with PROM completion.ResultsUse of e-mail reminders significantly increased the number of patients for whom complete follow-up data were obtained. Compared with tablet surveys completed during office visits alone, the addition of e-mail reminders increased the collection of complete PROM data (both 1- and 2-year follow-up) by 25.8% (P < .001). Similar findings were observed for total shoulder arthroplasty and arthroscopic rotator cuff repair patients (increased by 25.7% and 34.4%, respectively; P < .001).ConclusionE-mail reminders serve as a mechanism to increase the completeness of follow-up data in the absence of in-office patient evaluation.

Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy.

Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. This study aimed to evaluate the effects of a programme of three transdiagnostic seminars (TDS) for patients with common mental disorders accessing cognitive behavioural therapy (CBT) in primary care. TDS included CBT psychoeducation and role induction. A random sample of patients (n = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared with matched controls (n = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison with usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions.

Sibling and gender effects on children’s chance to continue primary education in Rwanda

Rwanda has made a huge effort to arrive at universal primary education, but many children do not qualify to sit the leaving exam before they reach the age of 14. Using the Heckman probit model on data from the Integrated Household Living Conditions Surveys 2000 and 2011, this study explores the school careers of 12,539 children ages 13-17 who had the opportunity to continue primary education. The combination of extreme poverty and having younger siblings or being an orphan or foster child, still leads to very high dropout rates regardless of gender. To improve completion rate for primary education, Rwanda should put more emphasis on disadvantaged children from larger families.

Drug resistant TB: UK multicentre study (DRUMS): Treatment, management and outcomes in London and West Midlands 2008–2014

Detailed information regarding treatment practices and outcomes of MDR-TB treatment in the UK is required as a baseline for care improvements. 100 consecutive cases between 2008 and 2014 were reviewed retrospectively at 4 MDR-TB treatment centres in England to obtain information on drug treatment choices, hospital admission duration and outcomes for MDR-TB. Initial hospital admission was long, median 62.5 (IQR 20-106, n=92) days, and 13% (12/92) of patients lost their home during this period. Prolonged admission was associated with pulmonary cases, cavities on chest radiograph, a public health policy of waiting for sputum culture conversion (CC) and loss of the patient's home. Sputum CC occurred at a median of 33.5 (IQR 16-55, n=46) days. Treatment success was high (74%, 74/100) and mortality low (1%, 1/100). A significant proportion of the cohort had "neutral" results due to deportation and transfer overseas (12%, (12/100)). 14% (14/100) had negative outcomes for which poor adherence was the main reason (62%, 9/14). Successful outcome is common in recognised centres and limited by adherence rather than microbiological failure. Duration of hospital admission is influenced by lack of suitable housing and some variation in public health practice. Wider access to long-term assisted living facilities could improve completion rates.

Increasing Patient Awareness, Education, and Access to Improve Completion Rates of Colorectal Cancer Screenings in an Underserved Population

Increasing Patient Awareness, Education, and Access to Improve Completion Rates of Colorectal Cancer Screenings in an Underserved Population

Evaluating the Factors Associated With the Completion of a Community-Based Group Exercise Program Among Older Women.

Despite the well-known benefits of exercise, only 50% of U.S. women met recommended physical activity levels in 2014. To combat this issue, the Healthy Aging Regional Collaborative of South Florida has been offering the EnhanceFitness (EF) program in community-based settings since 2008. In the current study, we examined the factors associated with the program completion among older women (≥ 60 years). During the first 4 years, 3,829 older women attended EF sessions. Of these, 924 (24.2%) attended the recommended 32 sessions within first 4 months. Results revealed that women who lived in Miami-Dade County, were ≥ 80 years, and did not report depression and/or risk factors for chronic conditions were more likely to complete EF. Black women were less likely to complete the program. Recognition of these factors might help identify at-risk individuals. More efforts are needed to improve completion rates. Theory-based interventions would allow comprehensive understanding of all factors and, therefore, should be explored in the future.