A screening checklist to minimize the adverse effects of cosmetic dermatological procedures; a short paper (Preprint)

BACKGROUND Cosmetic dermatological procedures which are aimed at enhancing the external appearance have troublesome yet preventable adverse effects. At present, there is a lack of a comprehensive screening guideline to detect patients with risk factors for such adverse effects. OBJECTIVE To introduce a comprehensive screening checklist to pick up the patients’ risk factors in advance, in order to prevent or minimize adverse effects from cosmetic dermatological procedures. METHODS The checklist was administered to 1150 patients attending an outpatient dermatology clinic for cosmetic dermatological procedures. Checklist composed of 30 ‘yes/no’ type questions and 7 other components in the pre-procedure workup. RESULTS Except for two risk factors (being pregnant and having a pacemaker inserted), all other assessed possible risk factors were present in one or more patients who attended for procedures. The most prevalent risk factor was the current use of medications in 226 (19.65%) patients. The other commonly found risk factors were: lack of full understanding of the procedure (14.52%) and phobia/fear of injections (9.30%). CONCLUSIONS The screening checklist that we used is a simple yet comprehensive tool for minimizing the possible adverse effects of cosmetic dermatological procedures. We were able to postpone, take remedial actions or alter the cosmetic dermatological procedures after going through the checklist and increase patient satisfaction and improve the safety of the doctor as well. CLINICALTRIAL Not applicable

Compliance of Professional Nurses at Primary Health Care Facilities to the South African Cervical Cancer Screening Guidelines

Despite the availability of the South African cervical cancer screening guidelines at clinics, women still present in district hospitals of Thulamela Municipality with no cervical cancer screening results. Thus, many cervical cancer screenings done at the hospitals often come back positive for cervical cancer at advanced stages. This study was conducted to investigate the compliance of professional nurses at primary health care facilities (PHCs) in Thulamela Municipality to the South African cervical cancer screening guidelines. The study adopted a qualitative approach. Purposive, non-probability sampling method was used to select PHCs and recruit eligible participants. Sample size was determined by data saturation. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. This study established that clinic professional nurses are non-compliant to the South African cervical cancer screening guidelines owing to several challenges they face, such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources, shortage of staff and patients’ factors. We recommend a strengthening of the South African cervical cancer screening guideline, in-service trainings and workshops on cervical cancer and cervical cancer screening guideline as well as improvement on patients’ education.

Improving physician compliance with mammography screening by implementing a breast cancer screening guideline at a hospital in Bahrain

BackgroundFrom a health and safety perspective, it is critical to use adequate, evidence-based breast screening guidelines. The aim of this quality improvement project was to improve physicians’ compliance with breast cancer screening guidelines to enhance the mammography screening rate among eligible women; this was achieved through the implementation of multifaceted changes to the hospital’s processes and the improvement of physicians’ attitudes towards the guidelines.MethodsThe project used the Plan-Do-Study-Act method to implement the changes. This was a pre-post evaluation study. The data were collected from patients’ charts. The primary outcome of interest was the rate of physician compliance with mammography screening guidelines before and after the implementation of the process changes. A literature review was conducted to determine which women should be identified as eligible for mammography screening.InterventionThe interventions targeted physician knowledge and hospital processes. Improving doctors’ expertise was achieved by implementing the US Preventive Service Task Force recommendation for mammography screening every 2 years for women aged 50–74 years. The process modifications included the establishment of a system that would be effective in identifying at-risk patients and reminding physicians at the point of care.ResultsOver the course of this study, 825 patients met the criteria for breast cancer screening. The rate of physician compliance with the breast cancer screening guideline increased from 2% to 69% after 23 weeks, and the control charts demonstrated a reliable process.ConclusionThis project examined the relationship between different interventions (identification of the eligible patient, reminder alerts and physician knowledge) and physician compliance with mammography screening guidelines. The results suggest a positive link between the study variables and physicians’ compliance with mammography screening guidelines.

Risk Factors for Retinopathy of Prematurity in the Netherlands: A Comparison of Two Cohorts

<b><i>Introduction:</i></b> Retinopathy of prematurity (ROP) remains an important cause for preventable blindness. Aside from gestational age (GA) and birth weight, risk factor assessment can be important for determination of infants at risk of (severe) ROP. <b><i>Methods:</i></b> Prospective, multivariable risk-analysis study (NEDROP-2) was conducted, including all infants born in 2017 in the Netherlands considered eligible for ROP screening by pediatricians. Ophthalmologists provided data of screened infants, which were combined with risk factors from the national perinatal database (Perined). Clinical data and potential risk factors were compared to the first national ROP inventory (NEDROP-1, 2009). During the second period, more strict risk factor-based screening inclusion criteria were applied. <b><i>Results:</i></b> Of 1,287 eligible infants, 933 (72.5%) were screened for ROP and matched with the Perined data. Any ROP was found in 264 infants (28.3% of screened population, 2009: 21.9%) and severe ROP (sROP) (stage ≥3) in 41 infants (4.4%, 2009: 2.1%). The risk for any ROP is decreased with a higher GA (odds ratio [OR] 0.59 and 95% confidence interval [CI] 0.54–0.66) and increased for small for GA (SGA) (1.73, 1.11–2.62), mechanical ventilation &#x3e;7 days (2.13, 1.35–3.37) and postnatal corticosteroids (2.57, 1.44–4.66). For sROP, significant factors were GA (OR 0.37 and CI 0.27–0.50), SGA (OR 5.65 and CI 2.17–14.92), postnatal corticosteroids (OR 3.81 and CI 1.72–8.40), and perforated necrotizing enterocolitis (OR 7.55 and CI 2.29–24.48). <b><i>Conclusion:</i></b> In the Netherlands, sROP was diagnosed more frequently since 2009. No new risk factors for ROP were determined in the present study, apart from those already included in the current screening guideline.

Predicting youth diabetes risk using NHANES data and machine learning

Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06–0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10−5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.

Evaluation of Turner Syndrome International Consensus Guideline Compliance in Multiple Subspecialty Clinics Verses a Coordinated Multidisciplinary Clinic Format

Turner syndrome’s (TS) lifelong association with multi-organ system comorbidities necessitates the effective implementation of, and adherence to, screening guidelines. Our team evaluated the effectiveness in implementing the 2016 Cincinnati International Turner Syndrome consensus guidelines [1] in a single, coordinated, multidisciplinary clinic (MDC) day format compared to multiple separate subspecialty clinic visits. A retrospective analysis of patients with TS followed at our pediatric tertiary referral center between December 2016 and April 2020 was conducted. Exclusion criteria included patients that were not seen in our pediatric endocrine clinic for over 24 months, age over 22 years, and those without confirmed genetic diagnosis of TS. The population was separated into two groups; girls who attended at least 1 MDC day each year and girls who had at least 1 endocrinology clinic visit in the last 14 months, but who were not part of the MDC (non-MDC). Age appropriate screenings included TSH, hepatic function test, Vitamin D level, blood glucose and/or HgA1C, celiac screening panel, hearing/auditory screening, eye examination, electrocardiogram, and echocardiogram. A total of 112 girls met study criteria. Sixty-eight were managed in the MDC and 44 managed in non-MDC. Only 36.6% of all the girls met all the above age-appropriate screening recommendations, 75.6% of which were managed in MDC (p-value 0.014). MDC girls had higher screening compliance rates vs non-MDC girls for TSH (95% vs 76%, p-value 0.017), auditory evaluation (85% vs 50%, p-value &lt;0.001), HgA1c and/or serum blood glucose levels (97% vs 76%, p-value 0.017), and tissue transglutaminase levels (95% vs 83%, p-value 0.048). No statistically significant difference was found with overall screening guideline compliance and insurance status, race/ethnicity, or age at time of the patients last recorded clinic visit. In conclusion, the MDC day format showed superior screening guideline compliance, both overall and to multiple specific screening tests, compared to those seen in multiple uncoordinated, single-disciplinary individual provider clinics. Overall guideline adherence remained low (36.6%), highlighting the need for continued optimization and improvement in guideline compliance. Reference: [1] Gravholt, C.H., et al., Eur J Endocrinol, 2017. 177(3): p. G1-G70.