Structured Phone Interview Research Articles

Development and Psychometric Properties of the Arabic Parent Nutritional Assessment Scale (A-PNAS) for Children with Developmental Disabilities

Aims: To describe the development of the Arabic-Parent Nutritional Assessment Scale (A-PNAS), and to examine construct and known-group discriminant validity, internal consistency, and test-retest reliability of the A-PNAS. Methods: A cross-sectional design was used. Participants were 130-children with CP (mean age = 4.26 ± 3.29 years) who were registered in the national CP registry of Jordan with a matching group of 130-children with typical development (mean age = 4.65 ± 3.54 years). Parents completed the developed A-PNAS through a structured phone interview. Parents of children with CP confirmed their child’s level of gross motor function classification system. Results: Exploratory factor analysis identified three subscales in the A-PNAS: Food Intake Problems, Health Problems, and Behavioral Problems which explained 31.6% of the variance in nutritional problems of children with CP. Cronbach’s alpha indicated acceptable internal consistency for Food Intake (α = 0.61) and Health Problems (α = 0.67)subscales. Parents of children with CP reported that their children had more food intake, health, and behavioral problems compared to children with typical development (p<.001). Test-retest reliability was excellent for the subscales of the A-PNAS (ICCs = 0.96, 0.98, 0.96). Conclusions: The findings provide support for the face validity, construct validity, internal consistency, Known-Groups discriminant validity, and test-retest reliability of the A-PNAS.

Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness.

Objective: To explore whether the presence of an event-related potential (ERP) “global effect” (GE+)—that corresponds to a correlate of conscious processing in the local–global auditory task—predicts behaviorally overt consciousness recovery in a large cohort of patients suffering from disorders of consciousness (DOC).Methods: We conducted a prospective study on all DOC patients evaluated during the 2009–2018 period. Behavioral examination included Coma Recovery Scale-Revised (CRS-R) scores and bedside high-density EEG recordings. Consciousness recovery was evaluated at 6 months by a structured phone interview. The predictive value of a GE+ was calculated both on survivors and on all patients.Results: A total of 236 patients with a documented outcome and technically valid EEG recordings could be included. Among them, 66 patients had a GE+ status (28%). Presence of GE+ predicted behaviorally overt consciousness recovery in survivors with high specificity (Sp = 84%) and high positive predictive value (PPV = 80%) but with low sensitivity (Se = 35%) and low negative predictive value (NPV = 42%). Positive likelihood ratio (LR+) of GE+ was superior to LR+ of initial clinical status and of ERP effect indexing unconscious auditory processing [local effect (LE)].Interpretation: Our results demonstrate that the presence of a bedside ERP GE+ is highly predictive of behaviorally overt consciousness recovery in DOC patients, regardless of the delay, of behavioral status, and of the etiology of brain dysfunction. However, the absence of this effect is not a reliable predictor of negative outcome. This study provides Class III evidence that the presence of an ERP “global effect” predicts consciousness recovery in DOC patients.

Effects of COVID-19 lockdown on a bariatric surgery waiting list cohort and its influence in surgical risk perception.

PurposeThe COVID-19 outbreak has forced a 2-month lockdown (LD) in Spain. We aimed to assess how that had affected our cohort of bariatric patients waiting for surgery.MethodsA review of electronic records and a structured phone interview with each patient were conducted. Changes in severity of obesity were analyzed using the Obesity Surgery Score (OSS) and changes in health-related quality of life (HRQoL) using the validated EQ-5D questionnaire. Other miscellaneous questions about behavior modifications and surgical risk perception were also analyzed.ResultsAll 51 patients fully answered the questionnaires. Mean age was 47 years and mean time on waiting list 91 days. Mean BMI increased during LD (42.7 vs 43.2; p < 0.001). Both OSS (2.84 vs 3; p = 0.011) and EQ-5D (69 vs 64; p < 0.001) mildly worsened during LD, mainly due to psychosocial issues. Twenty-seven patients (53%) thought that perioperative risks were higher under the current circumstances but they were as willing to undergo surgery as those who believed that the risks had not increased (74% vs 87%, p = 0.2).ConclusionsCOVID-19 LD had a significant but mild effect on our cohort of bariatric surgery waiting list patients. Although perioperative risk perception had increased, patients were still willing to undergo their planned surgeries.

Abstract 340: Analysis of Post Cardiac Arrest Recovery Services

Introduction: Cardiac arrest survivors may suffer sustained functional, psychiatric and cognitive impairments . Survivors’ perspectives on outpatient services necessary for recovery are unknown. Hypothesis: Survivors rate the usefulness of certain outpatient services more highly than others. Methods: We performed a structured phone interview of patients treated from 2010 to 2018 at a single center after cardiac arrest who survived at least one year. We asked survivors or their proxies about their experiences with physician, rehabilitation and care coordination services. Survivors rated usefulness of each resource on a Likert scale (1 “not useful” to 4 “essential”) and identified the single most useful resource. Results: We interviewed 25 survivors. All received outpatient physician services (24 primary care (PCP); 19 cardiologist, 7 neurologist, and 7 other). Subjects identified PCP (12/25, 48%) and cardiologist (12/25, 48%) services most useful. Seventeen (68%) subjects received outpatient rehabilitation (13 physical therapy; 9 occupational therapy; 8 speech therapy; 8 cardiac rehab; and 1 pulmonary rehab). Subjects considered physical therapy (9/17, 53%) and cardiac rehab (6/17, 35%) most useful. Nine (36%) subjects received care coordination (5 psychological; 4 case management; 3 home nursing). Median rating of usefulness for all services was 3. Only three subjects rated either cardiologist, physical therapy or psychological services as non-useful. Conclusion: Cardiac arrest survivors may require multiple and varied outpatient services. The most beneficial services include PCP, cardiologist and physical therapy. Survivors vary in their needs, and care should be tailored to the individual.

Multiple Measures of Student Learning: A Case Study Examination of Completer Impact

ABSTRACT Evaluating the impact of new teachers on student learning is a requirement for accredited teacher preparation programs. This article shares findings from a mixed methods, multiple case study investigating P-12 student learning in the classrooms of six graduates two-three years after completing a teacher preparation program. Data collection included student engagement surveys, de-identified student growth percentile scores, teacher selected pre-post assessment data, and structured phone interviews with each graduate. Results indicated a majority of students from participants’ classrooms demonstrated learning growth, and participants viewed their teaching as effective. Implications for programs include pre-service opportunities to identify and respond to authentic student engagement and opportunities to build collective teacher efficacy. Additional insights describe pre-service teacher training to measure student progress and measure impact based on classroom assessments. The investigation provides a replicable case study design for teacher educators to examine relationships between teacher preparation, program graduates, and P-12 student outcomes.

Identifying metrics of success for transitional care practices in childhood cancer survivorship: a qualitative interview study of survivors

BackgroundAdolescent and young adult (AYA) childhood cancer survivors (CCS) should be empowered to continue their survivor-focused care as they transition into adult medicine. However, the majority of AYA-aged survivors become lost to follow up around the age of typical transition to adulthood. The purpose of this study was to identify, from the patient’s perspective, key factors that facilitate successful transitions to adult-centered survivorship care.MethodsA qualitative study was conducted with AYA CCS (n = 29) from the survivorship clinic of a single institution as key informants. Data were collected through a series of structured phone interviews and subjected to thematic content analysis.ResultsFour major themes with multiple subthemes were identified: (1) transition practices need to be flexible and individually tailored; (2) effective communication is critical to a successful transition; (3) continuity in providers is needed during the transition; and (4) comprehensive care means care that also addresses psycho-social well-being.ConclusionsFrom the perspective of AYA CCS, the ideal model of transitional survivorship care could include a patient navigator who promotes provider flexibility, consistent communication, and pro-active comprehensive care that encompasses both medical and psycho-social well-being. Models of care for CCS should be built to provide, or seamlessly facilitate, continuous survivor-focused care across the age continuum. A longitudinal relationship with a survivor-focused provider can help promote the values that CCS’ report as important in transitioning care from pediatric- to adult-centered care.

Longitudinal Relations among Adolescent Risk Behavior, Family Cohesion, Violence Exposure, and Mental Health in a National Sample.

Violence is a public health concern linked with mental health problems among adolescents, and risk behavior increases the likelihood of violence exposure. Family cohesion may attenuate the negative effects of risk behavior. The purpose of this study was to examine family cohesion as a moderator in the relation between risk behavior (substance use and delinquency) and violence exposure, and to explore longitudinal associations among cohesion, violence exposure, and subsequent mental health outcomes (PTSD and depression). Data were drawn from the National Survey of Adolescents-Replication, a nationally representative sample of 3604 adolescents, with data collected via structured phone interviews at three waves spanning a two-year period. Hypotheses were tested using longitudinal structural equation modeling. Findings revealed that high family cohesion attenuated the relation between risk behavior and subsequent violence exposure. Wave 2 violence exposure was associated with more Wave 3 mental health problems, but high family cohesion was related to fewer subsequent symptoms. Follow-up analyses revealed that family cohesion moderated the relation between risk behavior and experiencing, but not witnessing, violence. Several demographic associations were observed. Although risk behavior increases exposure to violence, and in turn, mental health problems, family cohesion may serve as a protective factor, attenuating the link between risk behavior and subsequent negative consequences. This effect emerged even when accounting for demographic and socioeconomic covariates. Interventions with adolescents should target family relationships as a protective factor to reduce risk of violence exposure and mental health problems, particularly for adolescents who are engaging in high-risk behaviors.

Provider perspectives on implementing a student health and counseling center intervention for sexual violence

Objective To describe provider experiences with implementation of the GIFTSS (Giving Information for Trauma Support and Safety) intervention. Participants: Health and counseling center staff from participating campuses attended trainings between August 2015 and August 2016. Interviews were conducted between May and August 2017. Methods: Providers (n = 230) completed surveys prior to and six months following a 3-hour training on the intervention. Structured phone interviews were conducted with a purposively selected subset of 14 providers. Results: Overall, staff found the intervention acceptable. Implementation barriers noted were time and competing patient priorities. Providers noted variation based on patient and visit characteristics. Clinic commitment, particularly in adopting strategies for universal dissemination of the GIFTSS card, was seen as helpful. Conclusion: Implementation of a brief trauma-informed intervention in campus health and counseling centers was feasible and acceptable to most providers. Opportunities to change organizational culture regarding ensuring adequate time and safety for patients are discussed.

Reflections of Hospice Staff Members About Educating Hospice Family Caregivers Through Telenovela.

Hospice family caregivers are seeking additional information related to patient care, pain and symptom management, and self-care. This study interviewed hospice staff about the potential dissemination of bilingual telenovelas to address these caregiver needs. Qualitative structured phone interviews were conducted with 22 hospice professionals from 17 different hospice organizations in 3 different Midwest states. The interviews were conducted from October to December 2019. Hospice staff volunteers were recruited from conferences, then individual interviews were audio-recorded, transcribed, and thematic analysis was conducted to gain an in-depth understanding of how to best implement telenovela video education into hospice care. Most participants were hospice nurses (36%) located primarily in Missouri (91%), with a mean of 9 years of experience. Three discrete themes emerged, the educational resources currently provided to patient/families, perceptions of the usefulness of telenovelas for education, and practical suggestions regarding the dissemination of telenovelas. The development of 4 telenovela videos covering different topics is described. Hospice staff responded favorably to the concept of telenovelas and identified important keys for dissemination.

The impact of second hip fracture on rehospitalization and mortality in older adults

PurposeAlthough a second hip fracture is not uncommon in the older population, the extent to which such an event may affect health-related outcomes has not been fully clarified. We aimed to evaluate the risk of new falls, functional decline, rehospitalization, institutionalization and mortality in older patients admitted for a second vs. a first hip fracture. MethodsThe sample consisted of 288 older patients admitted to the Orthogeriatric Unit of Bolzano Hospital (northern Italy) and surgically treated for a hip fracture from June 2016 to June 2017. Socio-demographic data and hospitalization-related information were collected and a multidimensional assessment was made upon admission and during the hospital stay. Fifteen months after discharge, data on mobility level, functional status, institutionalization, and new falls were obtained from personal or structured phone interviews. Information on rehospitalization and mortality was obtained from local hospital registers. ResultsOne out of six patients (14.6 %) admitted was suffering a second hip fracture, of which only 16.7 % were on antiresorptive therapies. At the 15-month follow-up, individuals who had been treated for a second hip fracture were more likely than those treated for their first to have low mobility levels (OR = 4.13, 95 %CI:1.23−13.84), to be rehospitalized (OR = 2.57, 95 %CI:1.12−5.90), and to have a higher mortality (HR = 1.81, 95 %CI:1.05–3.12). ConclusionsThe occurrence of a second hip fracture may further affect the clinical vulnerability and mortality of older adults. These results highlight the need to implement preventive action to minimize the risk of re-fracture after the first event.

Real world application of ocrelizumab in multiple sclerosis: Single-center experience of 128 patients

BackgroundPivotal trials showed good clinical efficiency of the monoclonal antibody ocrelizumab while being well tolerated and manageable in multiple sclerosis (MS). However, data on adverse events in everyday practice are scarce. Hence, our study aims at investigating short-term tolerability of ocrelizumab in a “real-world” setting. MethodsIn this retrospective cohort study, data of 128 (86 relapsing-remitting, 42 progressive) MS patients at initiation of ocrelizumab were analyzed at the MS center of the University of Erlangen, Germany. Additionally, follow-up data of 68 patients at 6-months retreatment were analyzed. Structured phone interviews were applied after ocrelizumab initiation to report undocumented side effects. ResultsPatients predominantly switched from monoclonal antibodies (46%), orals (20%), injectables (10%), steroids or immunosuppressants (each 8%), with a mean interval of 9.0 months after the last application of the previous immunotherapy. Applying a combined premedication with steroids, antihistamines and antipyretics for >90% of patients, ocrelizumab treatment was well tolerated and mainly comprised mild (n = 59/128 at initiation, n = 5/68 at 6 months retreatment) and rarely moderate (n = 7/128 at initiation, n = 2/68 at 6 months) side effects. Predominantly mild infusion related reactions (IRR) were reported with a declining percentage over the follow-up applications. Infections occurred rarely. No severe side effects were observed. Secondary, treatment appeared efficient when looking at clinical surrogates of stable disease. DiscussionOur study delineates good short-term tolerability of ocrelizumab in a miscellaneous “real-world” MS cohort. Additional studies are warranted to confirm these beneficial findings and to reveal safety concerns in the longer-term follow-up.

Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?

BackgroundProximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated.MethodsThis retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone.ResultsBaseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573).ConclusionWe found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.

Telemedicine Online Visits in Urology During the COVID-19 Pandemic—Potential, Risk Factors, and Patients’ Perspective

The current coronavirus disease 2019 (COVID-19) pandemic has placed considerable strain on hospital resources. We explored whether telemedicine (defined as a videoconference) might help. We undertook prospective structured phone interviews of urological patients (n = 399). We evaluated their suitability for telemedicine (judged by a panel of four physicians) and their risks from COVID-19 (10 factors for a poor outcome), and collected willingness for telemedicine and demographic data. Risk factors for an adverse outcome from COVID-19 infection were common (94.5% had one or more) and most patients (63.2%) were judged suitable for telemedicine. When asked, 84.7% of patients wished for a telemedical rather than a face-to-face consultation. Those favouring telemedicine were younger (68 [58–75] vs 76 [70–79.2] yr, p < 0.001). There was no difference in preference with oncological (mean 86%) or benign diagnoses (mean 85%), or with COVID-19 risks factors. In subgroup analysis, men with prostate cancer preferred telemedicine (odds ratio: 2.93 [1.07–8.03], p = 0.037). We concluded that many urological patients have risk factors for a poor outcome from COVID-19 and most preferred telemedicine consultations at this time. This appears to be a solution to offer contact-free continuity of care. Patient summaryRisk factors for a severe course of coronavirus disease 2019 are common (94.5%) in urology patients. Most patients wished for a telemedical consultation (84.7%). This appears to be a solution to offer contact-free continuity of care.

Adherence to oral anticoagulant treatment and risk factor assessment six months after DC-conversion of atrial fibrillation

Objective. We wanted to study the adherence of oral anticoagulant treatment in patients 6 months after elective DC-cardioversion and to observe possible increases in CHA2DS2-VASc scores and new adverse outcomes. Design. Consecutive patients admitted for elective DC-cardioversion at Haukeland University Hospital during the period from June 2017 to April 2018 were screened. Only patients who had a DC-cardioversion performed were included. Baseline information was collected from hospital records and follow up information was gathered through a structured phone interview and the prescription database. Results. Of the 125 patients screened, 38 were excluded as DC-cardioversion was not performed. The included patients were contacted 6 months later, out of whom 77 (84%) responded. Three patients had discontinued oral anticoagulation therapy, but only one patient had done so in violation of Guidelines. Two patients had continued oral anticoagulant treatment despite lack of indication. Of the responding patients 89% were compliant, estimated by a Proportion of Days Covered > 80%. Three patients experienced a thromboembolic event, despite being on anticoagulation. The mean CHA2DS2-VASc score increased from 3.0 ± 1.4 to 3.3 ± 1.5, (p < .001). Less than half maintained sinus rhythm, the remaining had either atrial fibrillation (n = 30, 40%) or were unsure of their current rhythm (n = 9, 12%). A third received new cardiac interventions during follow up. Conclusion. We found an excellent adherence to Guidelines recommended therapy amongst our patients. CHA2DS2-VASc scores increased significantly during the 6-month observation period. From this we conclude there is a need for structured follow up to assess new risk factors.

714 Adherence to Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention

Current cardiac guidelines recommend dual antiplatelet therapy (DAPT) for 12 months to prevent stent thrombosis after a percutaneous coronary intervention (PCI). Non-adherence to DAPT increases the risk of stent thrombosis, especially within 6 months post-PCI. To characterise non-adherence to DAPT in patients who underwent PCI for acute coronary syndrome. Local participants were identified from the Victorian Cardiac Outcomes Registry who had been using DAPT or triple therapy for 4-6 or 8-10 months (groups 1 and 2, respectively) post-PCI. A structured phone interview was conducted using validated adherence tools (MMAS-4). Non-responders were sent a paper questionnaire. Ethics approval was obtained. 149 participants were enrolled (n=66 in group 1; n=83 in group 2, mean (standard deviation) age 65.4±10.7 years; 75.8% male), from which 117 (78.5%) participants were still taking the DAPT they were discharged on. The remaining 32 participants had stopped the discharged DAPT. Most patients stopped due to switching to another antiplatelet therapy (nine). Only three patients stopped due to non-adherence, from which two claimed that DAPT had been stopped in hospital. Other reasons to stop included side effects, after cardiology or general practitioner review and unknown. Patient discontinuation of DAPT is low at 4-6 and 8-10 month in this patient cohort. Most patients who stopped or changed DAPT did this in consultation with their medical practitioner. Clarifying a patient’s understanding of DAPT at the point of discharge is an important consideration in reducing the risk of non-adherence and thus avoiding early stent thrombosis.

Retrospective Review and Prospective Follow-up of 85 Consecutive Patients Treated With a Novel Hepatic-derived Surgical Mesh for Hiatal Hernia Repair: Outcomes, Surgical Complications, and Revisions.

This study examined outcomes, surgical complications, and revisions in patients treated with laparoscopic Nissen fundoplication for hiatal hernia and substantial gastroesophageal reflux disease. In total, 85 consecutive patients who underwent hernia repair with MIROMESH Biologic Matrix, a novel hepatic-derived surgical mesh served as subjects. Subjects were contacted by phone, consented, and participated in an Institutional Review Board-approved structured phone interview. Responses were acquired from 73 of the 85 patients. The gastroesophageal reflux disease health-related quality of life showed significant improvement postoperatively. Subjects reported high satisfaction with the procedure. The use of proton pump inhibitors was significantly reduced. Three minor complications were reported; these were quickly resolved without further sequelae. There were no mesh-related complications. No subjects reported further surgery. Placement of the surgical mesh, during surgery, to reinforce the hiatal repair was easy and safe. Excellent outcomes and no revisions a mean of 1.3 years after surgery suggest that a durable repair had been achieved.

Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion

In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.

Educating Patients About Opioid Disposal: A Key Role for Perianesthesia Nurses

To examine opioid prescription practices, patient use of opioids after laparoscopic cholecystectomy, and patient knowledge about disposal of unused medication. Mixed methods design with a chart review and structured phone interview. Thirty-four patients were interviewed by phone and asked how many opioids were prescribed, how many excess pills they had 6 to 10days postoperatively, and if they knew how to dispose of them. Average number of excess pills ranged from 0 to 42 (mean=14; SD=11.7). Nearly half of patients (47%) perceived the prescribed quantity as "too many." Seventy-one percent of patients using opioids for 5 days or less and 88% did not recall any instruction about medication disposal. Patients often have excess prescribed opioids after laparoscopic cholecystectomy, and they do not understand proper disposal of unused medications. Education about proper disposal of unused opioids medications is a key role of perianesthesia.

Poor compliance despite equal access: Military experience with screening breast MRI in high risk women

BackgroundUsing the military as a model for an equal-access, no-cost healthcare system, we sought to (1) describe screening breast MRI compliance rates and (2) identify patient-perceived barriers to screening. MethodsIn this retrospective cohort study of a prospectively maintained database at a tertiary level center, we compared compliance among women at ≥20% risk of developing breast cancer (Tyrer-Cuzick) and conducted structured phone interviews with women at ≥30% risk. ResultsFrom 2015 to 2016, 1,052 women met criteria for screening MRI. Of these, only 251 (24%) underwent MRI screening. Compliance among women with a 20–24%, 25–29%, 30–39%, and ≥40% risk was 16%, 24%, 37%, and 51%, respectively (p < 0.02). 37 of 128 unique patients (29%) with ≥30% risk agreed to interview. 43% cited time/inconvenience as the key barrier to screening; 22% cited questions regarding screening recommendations; and only 3% cited fear/concerns as the key barrier. ConclusionsEven in an equal-access system, there is poor compliance in patients who are at high risk for developing breast cancer. Patients cited time/inconvenience and questions regarding screening as key barriers to screening.

Effectiveness of previous mumps vaccination during the 2014–2015 outbreak in Lebanon

Introduction: In Lebanon, MMR was introduced at 12 months and 4-5 years in 1996. In 2014, the 2nd MMR dose was shifted to 18 months. Despite a national MMR coverage estimated at 79%, a six-fold increase in mumps national incidence was observed in December 2014. The objective of this study is to determine mumps vaccine effectiveness (VE) among Lebanese population to guide immunization policies. Methods: Clinical and confirmed mumps cases reported to the Epidemiological Surveillance Program between 2014W46 and 2015W11 were eligible if they were Lebanese and aged 1.5 to 19 years-old. Controls were randomly selected controls using phonebook of the same area and matched 1:1 on age and locality. Information was collected by structured phone interviews. Mumps vaccination status was based on documented valid dates for MMR doses. Data were entered using Epidata 3 and analyzed using Stata13. VE ((1-OR) × 100) of one and two doses and ORs (95%CI) for acquiring mumps were estimated using conditional logistic regression. Results: 91 cases and 91 controls were included. Only 36% of cases had vaccination cards, compared to 71% of controls (p<0.001). 94% of cases were not vaccinated compared to 51% of controls (p<0.001). Vaccine effectiveness was estimated 60% (CI= -27%: 88%) for one dose and 88% (CI=60: 96%) for 2 doses. Conclusion: Two-doses of MMR vaccine were estimated as 88% effective against mumps, similar to results found in the literature. This outbreak can be explained by suboptimal MMR2 coverage. Efforts should focus on achieving high MMR coverage and raising population’s awareness about preserving documentation of vaccination.