Background & Aims Colorectal cancer (CRC) screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing CRC screening whose largest polyp is 9mm or less. Methods Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi-square and Fisher’s Exact tests. Results 13,992 asymptomatic patients had screening with colonoscopy; 6360 patients (45%) had polyps, with complete histology available in 5977 (94%). The proportion with advanced histology was 1.7% in the 1–5mm group; 6.6% in the 6–9mm group; 30.6% in the greater than 10mm group; 72.1% in the tumor group. Distal location was associated with advanced histology in the 6–9mm group (p =0.04) and the greater than 10mm group (p = 0.002). Conclusions One in 15 asymptomatic patients whose largest polyp is 6 to 9mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Since histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine if patients whose largest polyp is 1–5mm, can be safely followed without polypectomy.

Background & Aims-The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and to identify potential risk factors for complications.

Although the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30% to 0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by hearing loss or other otologic diseases.

Results indicate that the PROMIS short 29-item form may be useful for the study of patients with chronic musculoskeletal pain. Our findings also support use of the novel “impact score” recommended by the National Institutes of Health (NIH) Task Force on Research Standards for Chronic Low Back Pain.

C-TraIn did not reduce 30-day inpatient readmissions or ED use; however, it improved transitional care quality.

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Background: Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. Methods: The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. Results: After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales ( p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. Conclusions: Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.

Although the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30-0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by the presence of hearing loss or other otological diseases.