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OBJECTIVE To develop a disease-specific questionnaire for identifying domains having the greatest impact on the quality of life (QOL) of patients with neuroendocrine tumors (NETS). METHODS Patient responses to clinical interviews provided an 80-item initial pool for the development of the QOL-NET. The Delphi panel reviewed the items for content validity; the patient focus group reviewed the items for content/readability. Domains were derived from analysis of224 questionnaire responses. After principal components analysis, a scree plot suggested 7 domains. Exploratory factor analysis with forced 7-factor varimax rotation determined an ideal structure. Reliability/reproducibility was determined by test/retest 4 to 6 weeks apart. Logistic regression determined each domain score. RESULTS All 7 domains exhibited strong internal consistency (Cronbach alpha = 0.86-0.97). Physical functioning contributed 40% of the total QOL score, followed by flushing, gastrointestinal symptoms, respiratory, cardiovascular, depression, and attitude domains. Most items loaded 0.40 or higher. No significant differences in test and retest scores. The mean values for the total QOL and 4 of 7 factor scores were significantly higher (P < 0.05) for NETS than controls: sensitivity was 71.4% and specificity was 69.6% to discriminate the NETS from the controls. CONCLUSIONS We developed a 7-domain tool to determine QOL in NETS. Strong internal consistency exists within each domain of the QOL-NET. The QOL-NET is reliable and reproducible but weakly identifies NETS. Physical functioning is a greatest contributor to QOL impairment in NETS.

We report a surveillance method for influenza that is based on automated hospital laboratory and pharmacy data. During the 2009 H1N1 influenza pandemic, this method was objective, easy to perform, and utilized readily available automated hospital data. This surveillance method produced results that correlated strongly with influenza-like illness surveillance data.

CONTEXT The Advisory Committee on Immunization Practices (ACIP) publishes annual recommendations for the prevention and control of seasonal influenza. Between 2011 and 2013, the ACIP recommended 2 approaches that providers could use to determine how many influenza vaccine doses children aged 6 months through 8 years should receive. One did not consider doses received prior to the 2010-2011 season; the other considered complete influenza immunization history, such as that available in immunization information system (IIS). OBJECTIVES To use Michigan's IIS, the Michigan Care Improvement Registry (MCIR), to compare the number of children recommended to receive 2 doses of influenza vaccine under each ACIP approach, and to determine the potential for overimmunization of Michigan children with influenza vaccine if providers do not use the data in MCIR. DESIGN Cross-sectional analysis in the 2011-2012 to 2013-2014 influenza seasons. SETTING We used the seasonal influenza and 2009 H1N1 monovalent vaccine doses in MCIR to determine the number of influenza vaccine doses children should receive using both ACIP approaches each season. PARTICIPANTS We analyzed data for more than 900 000 children aged 6 months through 8 years in each influenza season. MAIN OUTCOME MEASURE Number of children recommended 2 doses of influenza vaccine using each ACIP approach in each influenza season. RESULTS Our evaluation showed that using MCIR could prevent the overimmunization with a second influenza vaccine dose for 70 323 children during the 2011-2012 influenza season, 126 076 children during the 2012-2013 season, and 81 635 children during the 2013-2014 season. CONCLUSIONS This is the first study to use an IIS to quantify the difference between ACIP's approaches for 2-dose influenza vaccine recommendations. The immunization history and 2-dose forecasting algorithm available through MCIR minimizes overimmunization and has potential cost-saving implications. Our study illustrates the value of a centralized repository provided by IISs to immunization providers, public health, and caregivers.

Background Influenza vaccination for all children aged 6 months to 18 years has been recommended since 2008 to prevent flu-related morbidity and mortality. However, 2010–2011 influenza vaccine coverage estimates show under-vaccination in children of all ages. We examined predictors of influenza vaccination in Michigan during the 2010–2011 influenza season. Purpose To determine whether immunization provider type was associated with a child's influenza vaccination in Michigan and assess whether county-level factors were confounders of the association. Methods Influenza vaccinations reported to the Michigan Care Improvement Registry from the 2010–2011 influenza season were analyzed in 2012 to estimate ORs for the association between immunization provider type and influenza vaccination. Results Among 2,373,826 Michigan children aged 6 months through 17 years, 17% were vaccinated against influenza and lower vaccination rates were observed for public compared to private providers (13% vs 18%). In the unadjusted model, public providers had lower odds of vaccinating children compared to private providers (OR=0.60, 95% CI=0.60, 0.61). County-level factors, including percentage of families living below the poverty line, median household income, and percentage black race, were not shown to confound the association. In the adjusted models, public providers had lower odds of vaccinating children compared to private providers (OR=0.87, 95% CI=0.86, 0.88). Conclusions Although a child's likelihood of influenza vaccination in Michigan varies by provider type, more effective strategies to improve influenza vaccination rates for all Michigan children are needed.

We determined the prevalence of mandatory influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination policies for staff in Michigan hospitals and factors affecting policy implementation. Forty-one percent of responders reported a mandatory influenza vaccination policy, and 11% reported a mandatory Tdap vaccination policy. The support of hospital leadership is critical to policy implementation and overcoming barriers.

Objective: Pertussis infections have risen exponentially in the United States with the highest incidence of morbidities and mortalities in infants less than one year of age. Although Center for Disease Control and Prevention recommendations have recently changed several times, current recommendations are to give tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine during each pregnancy to all gravidas between 27 and 36 weeks gestation or immediately postpartum. Vaccine “cocooning” of close contacts is also advocated to reduce transmission to newborns. This study was undertaken to determine Michigan birthing hospitals’ Tdap vaccination policies and practices. Methods: A telephone survey of Michigan birthing hospital administrators was conducted May-June 2012. Statistical analysis was by Fisher exact test for categorical variables. Results: Response rate was 83% of Michigan’s 84 birthing hospitals. Fifty-one (73%) reported a process in place to assess gravida Tdap vaccine status. Only 14 (20%) had a written policy. Vaccine cost was the most cited barrier (21%) to policy implementation. The majority (91%) of hospitals surveyed indicated that they offered Tdap. The minority (11%) evaluated antepartum-admitted gravidas or vaccinated household contacts (4%). All hospitals documented vaccination in hospital records; only 53% entered these data into the Michigan Care Improvement Registry (MCIR). Most (77%) documented vaccination refusal; few (6%) recorded this in MCIR. Hospitals affiliated with other hospitals and hospitals affiliated with an Obstetrics/Gynecology residency program were more likely to have written postpartum Tdap vaccination policies (P=0.03). Conclusions: Based on recall data, many Michigan birthing hospitals have not adequately addressed pertussis vaccine surveillance in an obstetrical patient population. Although most reported assessing postpartum patients for vaccine status, few had a written policy. Vaccine opportunities are being missed during the antepartum period and for other close contacts. Finally, suboptimal utilization of a robust statewide vaccine registry compromises the long-term care of these patients.