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Objectives In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). Background Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. Methods Out of 1,061 consecutive patients who underwent a non-emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1-year. Results The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one-year outcomes. Conclusions Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one-year outcomes after PCI compared to the SYNTAX score.

People living in Australia on temporary student or work visas are excluded from Medicare access and can face barriers to adequate healthcare, even if they are privately insured. This analysis aimed to quantify this issue in relation to people living with chronic hepatitis B, the majority of whom in Australia were born overseas. The data suggest that an estimated 25 000 people living with chronic hepatitis B in Australia are ineligible for Medicare, 10% of the total number affected, with considerable potential impact in access to effective healthcare and prevention of adverse outcomes.

Objectives Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). Methods A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Results Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P

Based on interviews and fieldwork in a migrant farmworking community in California's Central Valley, this article examines the phenomenon of “identity masking” and its implications for workers’ labor conditions. It shows that labor supervisors often take advantage of unauthorized migrants’ and minors’ legal ineligibility for employment by making their employment contingent upon working a set of loaned identity documents. In doing so, employers render these groups “ghost workers”—that is, they simultaneously obscure their presence from the state and federal governments while benefitting from the wage deductions associated with such prohibited workers’ labor. By calling attention to on-the-ground practices of document circulation, this article thus critiques the charges of “identity theft” often levied against unauthorized migrants during worksite raids. Yet the common practice of “identity masking” not only directly benefits supervisors as individuals, but also makes injured “ghost workers” disappear. As employers wield the threat of implicating such workers in “identity theft” to suppress their workers’ compensation claims, this article illustrates the implications of the trend towards “governing immigration through crime” (Dowling and Inda 2013) on the migrant labor force.

Aim To describe difficulties experienced with recruitment of frail, malnourished inpatients aged 65+ years to a 12-week multidisciplinary home-based nutrition and physical activity intervention (SUSTAIN) and to identify factors associated with non-participation. Methods A multidisciplinary team approach to recruitment involved monthly team meetings, weekly clinician case conferences and strategic planning to accommodate patient needs (provision of transport, easy access to facilities, appropriate written/verbal information). Intensive recruitment occurred in eligible inpatients from a major acute tertiary and rehabilitation hospitals in a local health district over seven months. Results Of the 124 patients screened, 88 were not eligible, 32 declined, and 4 consented. Neither socio-demographic nor clinical characteristics (age, gender, clinical diagnosis, birthplace, cognitive function, length of stay or nutritional status) explained non-participation or ineligibility or refusals rates. Conclusions The advanced age and poor overall health status of this population necessitates alternative recruitment strategies to improve participation in clinical trials and improve generalisability for clinical practice.

The article describes the documentary vicissitudes of young Gambian men of Soninke ethnicity. Normally the most mobile subjects in a milieu where international migration is central to subsistence and prosperity, these young men often fail to secure entry visas to the West and other desirable destinations owing to restrictive admission policies. Would-be travellers cope with high rejection rates, but also struggle to secure financial and logistical support from relatives in order to meet the demanding requirements of visa applications. Since kinship mediates access to travel documents, the article suggests that visa ineligibility is a product of both state-based and societal practices of certification. It shows how the visa regime plays into the kinship reciprocities and affects that produce, discipline, and select prospective migrants, thereby transferring and concealing the arbitrariness and uncertainty of legal-political structures of mobility.

Objective To estimate the accuracy of self-screening for contraindications to combined oral contraceptive pills (COCs) and to estimate the proportion of women with contraindications to hormonal methods among those using drug shops in Tanzania. Methods Trained nurses interviewed 1651 women aged 18–39 years who self-screened for contraindications to COCs with the help of a poster at drug shops in Tanzania. Nurse assessment of the women served as the gold standard for comparison with self-assessment. Blood pressure was also measured onsite. Results Nurses reported that 437 (26.5%) women were not eligible to use COCs, compared with 485 (29.4%) according to self-report. Overall, 133 (8.1%) women who said that they were eligible were deemed ineligible by nurses. The rate of ineligibility was artificially high owing to participant and nurse assessments that were incorrectly based on adverse effects of pill use and cultural reasons, and because of the sampling procedure, which intercepted women regardless of their reasons for visiting the drug shop. Adjusted rates of ineligibility were 8.6% and 12.7%, respectively, according to nurse and participant assessment. Both nurses and women underestimated the prevalence of hypertension in the present group. Conclusion Self-screening among women in rural and peri-urban Tanzania with regard to contraindications to COC use was comparable to assessment by trained nurses.

Kianda MN, Wissing KM, Broeders NE, Lemy A, Ghisdal L, Hoang AD, Mikhalski D, Donckier V, Vereerstraeten P, Abramowicz D. Ineligibility for renal transplantation: prevalence, causes and survival in a consecutive cohort of 445 patients. Clin Transplant 2011: 25: 576–583. © 2010 John Wiley & Sons A/S. Abstract: Little is known about the proportion of renal transplant candidates who are considered ineligible by the transplant center, the reasons of their ineligibility and their survival during dialysis. In this retrospective, single-center study of 445 adult patients referred between 2001 and 2006, 36 (8%) were deemed ineligible for medical contraindications. The leading reason was cardiovascular (CV) (75%), specifically aorto-iliac, and/or limb vessels atheromatosis or calcifications; ischemic heart disease; or a combination thereof. Nine patients had other contraindications that were absolute for three of them; six patients displayed a combination of relative contraindications. When compared to eligible patients (N = 409), those ineligible were significantly older (60 yr vs. 48), more often diabetics (50% vs. 15%), obese (39% vs. 17%) suffering from coronary artery disease (53% vs. 11%) and peripheral arterial disease (86% vs. 11%). Their primary nephropathy was more often diabetic and/or hypertensive/nephroangiosclerosis (61% vs. 23%), and their median dialysis vintage prior to evaluation was longer (29 months vs. 10, p

Issues. The aim of this study is to examine the extent to which drug-dependent patients are ineligible for or unwilling to participate in randomised clinical trials. This is important because unrepresentative sample selection is a potentially important problem for randomised trials in the drug dependence field and little is known about the magnitude of the problem. Approach. A total of 98 clinical trials were drawn for analysis from a systematic review of the drug dependence treatment literature. Key Findings. The trials reviewed excluded an average of 29% of potential subjects as ineligible; a further 29% of the eligible subjects were unwilling to participate. Trials comparing widely different treatments had a higher proportion of ineligible and unwilling subjects than did studies comparing more similar treatments. Experiments with large samples enrolled a smaller proportion of patients from their sampling pool than did experiments with small samples. Implications. Drug-dependent trial subjects are a minority of all drug patients seen in real-world clinical practice. It is necessary to improve the reporting of these potential problems in randomised trials. Systematic reviews of the literature ought to use this information to distinguish reliable from less reliable findings. Conclusion. Unrepresentative sample selection is a serious problem for randomised trials in the drug dependence field.[Melberg HO, Humphreys K. Ineligibility and refusal to participate in randomised trials of treatments for drug dependence. Drug Alcohol Rev 2009]

We consider the link between apprenticeship and large employers in Britain, in terms of the contribution of apprenticeship to intermediate skills and the contribution of large employers to the Advanced Apprenticeship (AA) programme. Evidence is taken from interviews with managers in 28 organizations. We find that apprenticeship functions to only a limited extent outside AA, and then primarily because of the ineligibility of particular categories of trainee. The use that employers make of apprenticeship varies considerably, in association with its cost‐effectiveness relative to recruitment and upgrade training within human resource management strategy, and with employers’ evaluations of the technical content of AA qualifications. The prospects for increased sponsorship of apprenticeship by large organizations are curbed by the greater appeal of recruitment and upgrade training in various contexts.

Objective. To examine factors contributing to the loss of potential minority participants in a study of medication adherence among rheumatoid arthritis patients. Methods. Chi-square statistics were used to test for differences in refusal/ineligibility by race and site at 4 screening points (initial eligibility review, initial patient contact, adherence screening, and informed consent). Differences in criteria-specific risks for exclusion at initial eligibility review were examined across 4 sites by race. Odds ratios (95% confidence intervals) were estimated if differences were significant. Multivariate logistic regression was used to examine sociodemographic factors associated with the probability for ineligibility at the initial eligibility review. Stated reasons for refusal were qualitatively quantified. Results. A greater percentage of African Americans were lost at every screening point when compared with whites, but only the difference at the initial eligibility review was statistically significant. Conclusion. Factors associated with attrition included selection of area medical sites, research design issues, comorbid conditions, alcohol abuse, and being younger, unmarried, African American, and male.

Prospectively collected data on screening of 166 patients for a placebo controlled double blind clinical trial of a putative anti-psychotic drug was analyzed to establish the rate of recruitment of patients in an academic centre known for its interest in schizophrenia and its associated hospitals. Screening of patients was carried out intensively. A descriptive analysis was carried out on why otherwise eligible patients did not consent to enter the trial, and on why patients were not eligible to be entered, either because of physical or psychiatric morbidity. Social demography and morbidity were compared between the subgroups of consenting and non consenting eligible patients. No differences were detected between the demography and morbidity level of the consenters and non-consenters. Nearly 60 per cent of patients screened were ineligible to enter the trial. Reasons for ineligibility are discussed. Of patients eligible 66 per cent were not willing or able to give their consent. This meant that overall, about 1 in 7 of all patients screened were able to be entered into the trial.

Reasons for patient non-entry in randomized clinical trials (RCTs) assessing oncologic treatment modalities are not well documented in the literature. We have prospectively recorded reasons for RCT non-entry in breast cancer patients at St. Michael's Hospital, Toronto. From September 1984 to November 1989, 592 consecutive patients were evaluated through the clinical trials office. One hundred six out of the 592 patients were placed into a RCT (17.9%). Protocol ineligibilities accounted for 273 non-entries (46.1%) and protocol eligible but not entered patients accounted for 213 (36.0%) non-entries. The most common reason for protocol ineligibility was advanced age (94 patients). The most common reason for protocol eligible but not entered patients was patient refusal (148 patients). A total of 272 patients in both non-entered groups were identified as having reasons for non-entry that were potentially correctable. In summary, protocol ineligibilities account for the majority of non-entered patients, but patient refusal accounted for the single largest group of potentially correctable non-entries. More dissemination about the merit of RCTs in the lay press and amongst primary care physicians must take place if we are to expediently and efficiently answer important oncologic questions. © 1992 Wiley-Liss, Inc.

Central pathology review for quality assurance in cooperative clinical cancer trials has been an accepted practice for over a decade. However, the actual value of such pathology review has never been statistically evaluated or the need defined in a comprehensive manner. Pathology exclusions in 35 completed and ongoing Eastern Cooperative Oncology Group (ECOG) trials were analyzed. Ineligibility rates ranged from 0% to 16.9%. The lowest ineligibility rates occurred in breast cancer, small cell and non-small cell lung cancer, squamous cell carcinoma of head and neck, and gastrointestinal carcinoma protocols. The highest rates occurred in rare cancers such as malignant thymoma, endocrine carcinomas, and in the sarcoma-mesothelioma area. Simulated prototypical trials involving an aggressive and an indolent cancer were examined to evaluate the precision with which treatment differences would be measured when pathologically ineligible cases were included. Analysis of these models indicated that in trials in which the pathology exclusion rate is greater than 10%, slide review is prudent. When the exclusion rate is 5% to 10%, the necessity for pathology confirmation depends on the scientific objective of the trial. If less than 5% pathology exclusions characterize a clinical trial, routine pathology review is not justified. Routine histopathologic review for quality assurance in cooperative groups is not always necessary and may be eliminated in studies of the more common cancers. The practical value of reallocating limited pathology resources for investigative studies in cooperative groups is significant.

Recruitment of patients to clinical trials is a multi-stage process. To participate in a protocol, a patient must meet all the eligibility requirements; the physicians managing the patient must be amenable to enrolling the patient on protocol; and finally, the patient must consent to participate. In 1979, 64 clinical trials were open to patient accrual in the Division of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri. A total of 1103 cases were reviewed. Two hundred sixty-three patients were eligible for one of the protocols, of whom 124 were successfully recruited. The reasons for ineligibility and nonparticipation are discussed.