Electronic messages reminding patients that they're overdue for colorectal cancer screenings can lead them to schedule appointments, but don't discount the value of a letter in the mail, according to 2 studies appearing in the Archives of Internal Medicine.

One of the studies used electronic medical records to contact patients who had missed their appointed screening dates. For the study, researchers at Brigham and Women's Hospital, Harvard Medical School and Harvard Vanguard Medical Associates in Boston observed 1,103 patients of a single group practice.

Half were randomly selected to receive an electronic message if they were overdue for a screening appointment. They also received a link to a website that allowed them to calculate their risk for colorectal cancer. The other half were not electronically reminded.

Four weeks later, the screening rate was 8.3% for the electronic message group and 0.2% for the non-message group. Researchers also saw a boost in scheduling among the patients who said they visited the website. Four months later, however, researchers note the difference was not as significant (15.8% for the electronic group, 13.1% for the others), owing to other reminders such as letters and phone calls.

In the other study, researchers from Northwestern University in Chicago examined 638 patients who were overdue for screenings. Half were mailed a reminder letter, brochure and educational DVD. The other half received no reminders until the study concluded.

By the end of the study, 9.9% of the reminded patients had undergone screenings, as compared to 3.2% of those who weren't reminded. Six months after that, the screening rates were 18.2% for the reminder group and 12.1% for the others.

Follow-up calls to about one-third of the reminded group determined that while almost all of them read the letter and brochure, only 30% watched the DVD, leading researchers to question the effectiveness of its inclusion in the mailing.

David Bernard

Mayo Clinic researchers have designed an assessment tool that takes the subjectivity out of determining whether trainees are competent to perform colonoscopies on their own.

In an article in the December issue of the journal Gastrointestinal Endoscopy, the researchers describe the tool, how it was validated and how well endoscopy fellows improved as they performed more colonoscopies. The article defines 11 core colonoscopy skills and includes a form that can be used to rate a trainee's performance.

One of researchers' goals in developing the assessment tool was to objectively determine trainee competency through their motor and cognitive skills, rather than just the number of colonoscopies they've performed. Training guidelines suggest a trainee can be assessed after 140 supervised colonoscopies, while various studies report that some trainees may need to perform as many as 500 procedures before they can be assessed for competency.

Acquiring a skill is more than simply having repeated an action a number of times; instead, a trainee's progress must be measured in a qualitative manner, says co-author Robert E. Sedlack, MD, MHPE. "Such a tool would allow continuous monitoring of a trainee's ongoing progress and the establishment of normal learning curves for trainees."

Kent Steinriede

Physicians who post personal information on websites could jeopardize their professional relationships with patients who view the information, according to a French study.

Out of 202 physicians surveyed by researchers at the Rouen University Hospital, 147 had a Facebook profile. Nearly all the physicians with profiles displayed their actual names and birthdates, according to the study. The researchers report that 91% of the physicians who used Facebook posted personal photographs, 59% noted the university they attended and 55% listed their professional title.

Only 61% of the physicians changed Facebook's default privacy settings, which control who can see profiles and post information on them, who can see a user's contact information and who can access profiles through Facebook and search engines. Users registered longer than 1 year were more likely to have changed the privacy settings than newer users, notes the study, which appears in the Dec. 15 issue of the Journal of Medical Ethics.

Eighty-five percent of the respondents said they would automatically decline Facebook "friend" requests from patients, while 26% would decide whether to accept the requests on a case-by-case basis. Four of the 8 physicians who had received friend requests from patients accepted them.

The study's authors say the blurring of doctors' and patients' private lives on Facebook raises ethical dilemmas. Should a doctor who sees pictures of a patient smoking, even though the patient claims to have quit, use that information to provide better care? Will a patient who sees evidence of a doctor drinking to excess at an after-hours party lose confidence in the care he can provide during his workday?

For these reasons, physician-users of Facebook should not engage in online activities with patients that are not related to direct patient care, say the study's authors, who tell doctors to decline all friend requests from patients, avoid revealing personal information that is typically not shared in face-to-face interactions and be aware that comments and pictures posted online may be misinterpreted outside of their original context.

"We advise doctors to use caution and restraint in displaying online material, keeping in mind that they cannot control the potential consequences of public knowledge on their professional practice," the researchers note, adding that doctors should read Facebook's privacy settings, understand how they may be customized, monitor Facebook's regular updates of those polices and adjust their data protection accordingly.

Daniel Cook

Did your staff find a little something extra in their December paychecks this year, or did the down economy take the holiday bonus down with it? See how your response compares to your colleagues' when you answer this week's InstaPoll, and check back next week for the results.

Insects in the OR have been enough of a problem for 61% of the 80 facility managers who took last week's online poll that they've called in an exterminator. Another 20% reported some infestations, but have handled the problem themsleves. The other 19% said insects weren't a problem in their ORs. Use these results to reinforce your no-food-in-the-OR policy.

Dan O'Connor