Clinical Screening Tool Research Articles

Performance of three screening tools to predict COVID-19 positivity in emergency department patients

BackgroundCOVID-19 symptoms vary widely. This retrospective study assessed which of three clinical screening tools—a nursing triage screen (NTS), an ED review of systems (ROS) performed by physicians and physician assistants...

Outcome of visuospatial dysfunction assessment in patients with Parkinson's disease using mobile application software.

Visuospatial dysfunction and cognitive impairment are common in Parkinson's disease (PD), which draw increasing attention in the current literature. But clinicians still lack rapid, effective and unified cognitive battery for visuospatial assessment. A new approach was studied to explore the feasibility of using mobile application software (APP) to evaluate visuospatial dysfunction in patients with PD and compared with traditional assessment tools. We aimed to verify the threshold score of the APP for early diagnosis. A total of 41 patients with PD underwent assessments using several test modules including Digit Symbol Test (DST), Visual Organization Test (VOT), Facial Recognition Test (FRT), Vocabulary Memory Test (VMT) of this APP, as well as Clock Drawing Test (CDT), Cube Copying Test (CCT) and the Mini-Mental State Examination (MMSE) for comparison. Among the 41 PD patients, 30 individuals were found to have visuospatial dysfunction based on CDT score < 5 and CCT score of<18 while the remaining 11 patients served as control. There were statistically significant differences in DST, VOT, and FRT scores (all p ≤ 0.001 for group comparisons). DST, VOT, and FRT-1 were significantly correlated with MMSE, CDT and CCT and the correlations were moderate or fairly strong. For visuospatial dysfunction diagnosis, all the areas under curves (AUC) of DST, VOT, and FRT-1 were statistically significant (p < 0.0001, p = 0.0002, and p = 0.0002, respectively). The estimates and 95% confidence intervals of AUC were 0.8303 (0.6868, 0.9739), 0.8045 (0.6423, 0.9668), and 0.7833 (0.6344, 0.9322), respectively. Their cut-off points for visuospatial dysfunction were 26, 17, and 19, respectively. After dichotomization by the cut-off points, DST had high sensitivity of 96.67% while VOT and FRT-1 had high specificity of 81.82 and 90.91%. This study demonstrated that visuospatial disorders was highly prevalent in PD patients, and the APP used in study could be a practical clinical screening tool for visuospatial ability assessment with high sensitivity and specificity.

Development and validation of an intensive care unit acquired weakness prediction model: A cohort study.

At present, intensive care unit acquired weakness (ICU-AW) has become an important health care issue. The aim of this study was to develop and validate an ICU-AW prediction model for adult patients in intensive care unit (ICU) to provide a practical tool for early clinical diagnosis. An observational cohort study was conducted including 400 adult patients admitted from September 2021 to June 2022 at an ICU with four ward at a medical university affiliated hospital in China. The Medical Research Council (MRC) scale was used to assess bedside muscle strength in ICU patients as a diagnostic basis for ICUAW. Patients were divided into the ICU-AW group and the no ICU-AW group and the clinical data of the two groups were statistically analyzed. A risk prediction model was then developed using binary logistic regression. Sensitivity, specificity, and the area under the curve (AUC) were used to evaluate the predictive ability of the model. The Hosmer-Lemeshow test was used to assess the model fit. The bootstrap method was used for internal verification of the model. In addition, the data of 120 patients in the validation group were selected for external validation of the model. The prediction model contained five risk factors: gender (OR: 4.31, 95% CI: 1.682-11.042), shock (OR: 3.473, 95% CI: 1.191-10.122), mechanical ventilation time (OR: 1.592, 95% CI: 1.317-1.925), length of ICU stay (OR: 1.085, 95% CI: 1.018-1.156) and age (OR: 1.075, 95% CI: 1.036-1.115). The AUC of this model was 0.904 (95% CI: 0.847-0.961), with sensitivity of 87.5%, specificity of 85.8%, and Youden index of 0.733. The AUC of the model after resampling is 0.889. The model verification results showed that the sensitivity, specificity and accuracy were 71.4, 92.9, and 92.9%, respectively. An accurate, and readily implementable, risk prediction model for ICU-AW has been developed. This model uses readily obtained variables to predict patient ICU-AW risk. This model provides a tool for early clinical screening for ICU-AW.

A Screening Tool to Quickly Identify Movement Disorders in Patients with Inborn Errors of Metabolism.

Movement disorders are frequent in patients with inborn errors of metabolism (IEMs) but poorly recognized, particularly by nonmovement disorder specialists. We propose an easy-to-use clinical screening tool to help recognize movement disorders. The aim is to develop a user-friendly rapid screening tool for nonmovement disorder specialists to detect moderate and severe movement disorders in patients aged ≥4 years with IEMs. Videos of 55 patients with different IEMs were scored by experienced movement disorder specialists (n=12). Inter-rater agreements were determined on the presence and subtype of the movement disorder. Based on ranking and consensus, items were chosen to be incorporated into the screening tool. A movement disorder was rated as present in 80% of the patients, with a moderate inter-rater agreement (κ =0.420, P< 0.001) on the presence of a movement disorder. When considering only moderate and severe movement disorders, the inter-rater agreement increased to almost perfect (κ=0.900, P< 0.001). Dystonia was most frequently scored (27.3%) as the dominant phenotype. Treatment was mainly suggested for patients with moderate or severe movement disorders. Walking, observations of the arms, and drawing a spiral were found to be the most informative tasks and were included in the screening tool. We designed a screening tool to recognize movement disorders in patients with IEMs. We propose that this screening tool can contribute to select patients who should be referred to a movement disorder specialist for further evaluation and, if necessary, treatment of the movement disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Opportunities and challenges in lung cancer screening implementation: a narrative review

: The U.S. Preventive Services Task Force and the Centers for Medicare and Medicaid Services (CMS) recommend lung cancer screening (LCS) for high risk current and former smokers. Developing a comprehensive LCS program requires coordinated planning from program conception through implementation and maintenance that address both pragmatic and regulatory matters. In this review article, we discuss the available evidence, guideline recommendations, and practical considerations for implementing a high-quality LCS program. Key factors in the initial planning phase include engagement of stakeholders with a particular focus on support from providers, patients and healthcare organizations. Additionally, it is important to consider the infrastructure and program design that will best serve local needs, and implement mandatory components such as a data registry and smoking cessation. We also discuss the implementation phase including strategies for optimizing the eligible patient population to be screened as well as the processes of shared decision making (SDM), standardization of screening results and communication of findings to patients. Once patients have been screened, maintenance of a successful LCS program requires iterative multidisciplinary reviews of key quality metrics and establishing systematic mechanisms to track evaluation, minimizing loss to follow-up. We also review other recommended components that contribute to maintaining a high-quality screening program such as a clinical screening coordinator, patient navigator, and tools to improve the uptake of and adherence to LCS.

Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study.

The one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk. Data from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60-64. Number of falls in the past year was self-reported at ages 53, 60-64 and 68; recurrent falls (0-1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60-64; age 53 → 68; age 60-64 → 68; age 53 & 60-64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points. Median eyes open balance time was 30 s at ages 53 and 60-64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577-0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604-0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using "optimal" cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42-0.47), poor sensitivity (0.38-0.61) and poor specificity (0.23-0.56). Despite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.

The effectiveness and cost-effectiveness of clinical fracture-risk assessment tools in reducing future osteoporotic fractures among older adults: a structured scoping review.

We aim to provide a synopsis of the evidence about the use of clinical fracture-risk assessment tools to influence health outcomes, including reducing future osteoporotic fractures and their cost-effectiveness. We followed the guidelines of Arksey and O'Malleyand their modifications. A comprehensive search strategy was created to search CINAHL, Medline, and Embase databases until June 29, 2021, with no restrictions. We critically appraised the quality of all included studies. Fourteen studies were included in the review after screening 2484 titles and 68 full-text articles. Four randomized controlled trials investigated the effectiveness of clinical fracture-risk assessment tools in reducing all fractures among older women. Using those assessment tools did not show a statistically significant reduction in osteoporotic fracture risk compared to usual care; however, additional analyses of two of these trials showed a trend toward reducing hip fractures, and the results might be clinically significant. Four studies tested the impact of screening programs on other health outcomes, and participants reported positive results. Eight simulation studies estimated the cost-effectiveness of using these tools to screen for fractures, with the majority showing significant potential savings. According to the available evidenceto date, using clinical fracture-risk assessment screening tools was not more effective than usual care in preventing all osteoporosis-related fractures. However, using those screening tools positively influenced women's perspectives on osteoporosis, may have reduced hip fracture risk, and could potentially be cost-effective. This is a relatively new research area where additional studies are needed.

Utility and impact of early diagnostic assessment of sepsis on mortality in an emergency department of a tertiary hospital in Lagos, Nigeria.

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria. The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital. Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria. Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ2 = 14.83, P = 0.002). This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.

Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension

Purpose Chemical adherence testing is a reliable method to assess adherence to antihypertensive drugs. However, it is expensive and has limited availability in clinical practice. To reduce the number and costs of chemical adherence tests, we aimed to develop and validate a clinical screening tool to identify patients with a low probability of non-adherence in patients with uncontrolled hypertension. Materials and Methods In 495 patients with uncontrolled hypertension referred to the University Medical Centre Utrecht (UMCU), the Netherlands, a penalised logistic regression model including seven pre-specified easy-to-measure clinical variables was derived to estimate the probability of non-adherence. Non-adherence was defined as not detecting at least one of the prescribed antihypertensive drugs in plasma or urine. Model performance and test characteristics were evaluated in 240 patients with uncontrolled hypertension referred to the Heartlands Hospital, United Kingdom. Results Prevalence of non-adherence to antihypertensive drugs was 19% in the UMCU and 44% in the Heartlands Hospital population. After recalibration of the model’s intercept, predicted probabilities agreed well with observed frequencies. The c-statistic of the model was 0.63 (95%CI 0.53–0.72). Predicted probability cut-off values of 15%–22.5% prevented testing in 5%–15% of the patients, carrying sensitivities between 97% (64–100) and 90% (80–95), and negative predictive values between 74% (10–99) and 70% (50–85). Conclusion The combination of seven clinical variables is not sufficient to reliably discriminate adherent from non-adherent individuals to safely reduce the number of chemical adherence tests. This emphasises the complex nature of non-adherence behaviour and thus the need for objective chemical adherence tests in patients with uncontrolled hypertension.

A new test (Sacco Manni test 3) of congenital dysplasia of the HIP: A Cross Sectional and Analytic Study

Purpose Or Objective: Without a prompt diagnosis, congenital dysplasia of the hip in newborns can lead severe sequelae. Current screening strategies emphatize the use of ORTOLANI AND BARLOW tests, yet they exhibit low sensibility. The purpose of this study is to evaluate for a new test as a screening tool for congenital dysplasia of the hip. Methods: to evaluate the new test, a cross sectional and analytic study was performed with a non-probabilistic sampling method. Patients with either a positive ORTOLANI AND BARLOW TESTS were evaluated with the new test (Sacco Manni test 3) and hip ultrasounds. Controls were infants With negative ORTOLANI AND BARLOW and SACCOMANNI TESTs and also had an ultrasound performed. Results: CONGENITAL dysplasia of the hip was confirmed in 83 to 130 cases (64%), and 2 of 130 controls (2%). The new test had a sensitivity of 76% AND A specificity of 94% as compared to the ORTOLANI AND BARLOW TESTS (sensitivity 31 to 32 %, specificity 93 to 100% (p inferior to 0,05). Conclusion: this new test could serve as another clinical tool for the initial screening of congenital dysplasia of the hip in in fans or newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with congenital dysplasia of hip.

Rapid In Situ Hydrogel LAMP for On-Site Large-Scale Parallel Single-Cell HPV Detection.

Rapid human papillomavirus (HPV) screening is urgently needed for preventing and early diagnosis of cervical cancer in rural areas. To date, no HPV nucleic acid test (NAT) can be implemented within a single patient visit starting from clinical samples. Here, we develop a hydrogel loop-mediated isothermal amplification (LAMP) method in a fashion of large-scale parallel (about 1000 cells) in situ HPV DNA detection in clinical cervical exfoliated cells at the single-cell level. It can be used with a hotplate and smartphone to obtain HPV NAT results in less than 30 min, which is especially suitable for the on-site scenario. We apply this rapid HPV NAT on 40 clinical cervical exfoliated cell samples and compare the results to a clinical gold standard quantitative polymerase chain reaction (qPCR) method [area under curve (AUC), 1.00]. Meanwhile, our assay can provide HPV infection information for large-scale parallel single clinical cervical exfoliated cells, which cannot be received from traditional NAT methods. Our findings suggest the potential of in situ hydrogel LAMP as a powerful tool for clinical HPV screening and fundamental research.

Presentation of the septic patient to the emergency department with respect to age and sex – a retrospective cross-sectional study

ObjectiveIt is challenging to identify sepsis in the emergency department, in part due to the non-specific presentation of septic patients. Current clinical sepsis screening tools rely on vital signs but many patients present with near normal vital signs and are therefore not identified as septic. This suggests that variables, e.g. signs and symptoms, need to be included to improve sepsis detection in the emergency department. Our hypothesis was that the presentation of sepsis differs based age and sex. The potential differences in presentation could be used to apply to future sepsis screening tools. The aim was to analyze the prevalence of keywords reflecting the presentation of septic patients in the emergency department in relation to age and sex.MethodRetrospective cross-sectional study. Keywords reflecting sepsis presentation to the emergency department were quantified and compared between age categories and the sex. 479 patients admitted to the emergency department of Södersjukhuset, Stockholm during 2013 and discharged with an ICD-10 code consistent with sepsis were included. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons.Result“Pain” and “risk factors for sepsis” were significantly more common among patients younger than 65 years as compared with those 75 years and older: (n = 87/137; 63.5% vs n = 99/240; 41.3%, P-value < 0.000) and (n = 74/137; 54.0% vs 55/240; 22.9%, P-value < 0.000) respectively. “Risk factors for sepsis” was also significantly more common among patients between 65 and 74 years as compared with those 75 years and older: (n = 43/102; 42.2% vs 55/240; 22.9%, P-value < 0.000). “Pain” and “gastrointestinal symptoms” were significantly more common among women as compared with men: (n = 128/224; 57.1% vs n = 102/255; 40.0%, P-value < 0.000) and (n = 82/244; 36.6% vs n = 55/255; 21.6%, P-value < 0.000) respectively.ConclusionThe keywords “pain” and “risk factors for sepsis” were more common among younger patients and “pain” and “gastrointestinal symptoms” were more common among women. However, most keywords had a similar prevalence irrespective of age and sex. The results could potentially be used to augment sepsis screening tools or clinical decision tools.

A New Screening Tool for Rapid Diagnosis of Functional and Environmental Factors Influencing Adults with Intellectual Disabilities.

The dynamic nature of intellectual disability (ID) and its many comorbidities necessitate repeated screening and functional diagnosis. However, the existing scales are lengthy and expensive and cannot be implemented at all levels of ID. During phase one of this study (September 2019-September 2020), the functional screening tool (FST-ID) was validated for adults with ID and then used as a clinical tool to collect data for 76 participants from their direct service providers (DSP). Their age ranged from 21 to 71 years (mean = 37.63, SD ± 14.61), and they were diagnosed with severe/profound (N = 16) and moderate (N = 29), and mild (N = 31) levels of ID. The scale was found to hold high psychometric values. During phase two (September 2020-June 2022), the scale was found to be reliable as a continuous, clinical on-going screening tool, enabling the screening of functional and environmental changes experienced by adults with ID during acute times of the pandemic and regular times alike. All 76 adults experienced changes at the senior's daycare center mostly. The new scale may also help in the future to determine whether those changes only relate to post COVID-19 symptoms or other comorbidities as well.

Real-World Results from Combined Screening for Monogenic Genomic Health Risks and Reproductive Risks in 300 Adults.

New methods and demonstrations of feasibility guide future implementation of genomic population health screening programs. This is the first report of genomic population screening in a primary care, non-research setting using existing large carrier and health risk gene sequencing panels combined into one 432-gene test that is offered to adults of any health status. This report summarizes basic demographic data and analyses patterns of pathogenic and likely pathogenic genetic findings for the first 300 individuals tested in this real-world scenario. We devised a classification system for gene results to facilitate clear message development for our Genomic Medicine Action Plan messaging tool used to summarize and activate results for patients and primary care providers. Potential genetic health risks of various magnitudes for a broad range of disorders were identified in 16% to 34% of tested individuals. The frequency depends on criteria used for the type and penetrance of risk. 86% of individuals are carriers for one or more recessive diseases. Detecting, reporting, and guiding response to diverse genetic health risks and recessive carrier states in a single primary care genomic screening test appears feasible and effective. This is an important step toward exploring an exome or genome sequence as a multi-purpose clinical screening tool.

Reduced Steroid Metabolites Identify Infection-Prone Children in Two Independent Pre-Birth Cohorts.

Recurrent respiratory infections are a leading cause of morbidity and mortality in early life, but there is no broadly accepted means to identify infection-prone children during this highly vulnerable period. In this study, we investigated associations between steroid metabolites and incident respiratory infections in two pre-birth cohorts to identify novel metabolomic signatures of early infection proneness. Children from the Vitamin D Antenatal Asthma Reduction Trial and the Copenhagen Prospective Studies on Asthma in Childhood were included, and profiling was performed on plasma samples collected at ages 1 and 6 years. Both cohorts recorded incidence of lower respiratory infections, upper respiratory infections, ear infections, and colds. Poisson regression analysis assessed the associations between 18 steroid metabolites and the total number of respiratory infections that occurred in offspring during follow-up. We found that steroid metabolites across androgenic, corticosteroid, pregnenolone, and progestin classes were reduced in children that suffered more infections, and these patterns persisted at age 6 years, generally reflecting consistency in direction of effect and significance. Our analysis suggested steroid metabolite measurement may be useful in screening for infection proneness during this critical developmental period. Future studies should clinically evaluate their potential utility as a clinical screening tool.

A Videogame as a Tool for Clinical Screening of Possible Vulnerability to Impulsivity and Attention Disturbances in Children.

An attention disturbance is a problem that affects many school-aged children. The assessment in children is usually report-based, and as a result, controversy surrounds the diagnosis. To solve this issue, the aim of this study was to develop a new tool to detect possible attention-related problems and impulsive behavior in 4- and 5-year-old children. This tool was developed as an Android app and could be used to provide an early indicator of possible future development problems. A sample of 103 children (48 girls and 55 boys) was randomly selected from primary schools and assessed by Pinky-Piggy, a videogame application based on a classical paradigm in experimental psychology. Data from this app were compared with a Child Neuropsychological Maturity Questionnaire. The subjects displayed different patterns of response to play a very simple game called Pinky-Piggy. The application discriminated between high-responders and low responders. The results showed a relationship between these two profiles and the levels of attention and neurodevelopment in each group. The tool could identify different types of profiles and demonstrated its potential to evaluate endophenotypes to predict attentional problems related to impulsive behavior. Additionally, it required less time and fewer tests to identify possible at-risk populations, thus assisting in clinical diagnosis.

Diagnostic challenges for the distinction of high-grade prostatic adenocarcinoma and high-grade urothelial carcinoma of simultaneous occurrences - A literature review

Abstract: Two of the most prevalent types of cancer in men are prostate adenocarcinoma and urothelial carcinoma. Both can appear separately in the prostate and bladder, simultaneously as separate tumors affecting either organ or sporadically as a collision tumor. Distinguishing these tumors by the pathologist can be challenging, especially when the high-grade, poorly differentiated forms infiltrate the surrounding organs. The correct approach by the pathologist is important due to the different treatment modalities for these two entities. This review of the literature gives a comprehensive overview, our succinct understanding of the significance of correctly differentiating between these two tumors, the challenges involved in doing so, and the best collection of crucial and useful immunohistochemical markers for better diagnostic performance.The scientific papers used in this review were retrieved from the PubMed and Google Scholar databases. All the studies in this review have recently been peer-reviewed and published in academic journals. The literature was sifted through to find the most relevant and up-to-date information for medical professionals, specifically pathologists. The review concluded that: 1) Prostatic and urothelial markers such as NKX3.1, p63, thrombomodulin, and GATA3 are very useful for distinguishing prostatic adenocarcinoma from urothelial carcinoma. 2) Prostate Specific Antigen (PSA) is a good (clinical) screening tool, but because of its inverse relationship with tumor grade (the higher the grade, the lower the sensitivity of PSA staining), it is not recommended for high-grade tumor differentiation. 3) HMWCK (34βe12) and p63 are said to be more effective than thrombomodulin and S100p in detecting urothelial cancer. 4) Thrombomodulin is only moderately sensitive to urothelial carcinoma. 5) Cytokeratins 7 and 20 can be positive in both urothelial carcinoma and prostatic adenocarcinoma, therefore their use is restricted. The optimal combination of these markers may improve the ability to distinguish these tumors.

The Relationship between the Functional Movement Screen and the Star Excursion Balance Test in Non-Professional Soccer Players

Soccer is a very popular sport with a high incidence of injuries. Clinical screening tools are an important component of injury prevention. The aim of this study was to investigate the relationship between two screening tools, the Functional Movement Screen (FMS) and Star Excursion Balance Test (SEBT), and whether there are differences regarding SEBT scores, injuries, and painful symptoms in participants below and above the FMS cutoff score of ≤14. The research was performed as a secondary analysis of a longitudinal cohort study and included 42 non-professional soccer players from Eastern Croatia (age 25.5±6 years, training experience 15.8±6.6 years). Participants were surveyed regarding their sociodemographic data, soccer playing, and FMS and SEBT tests were performed. They were followed for 3.5 months when an additional set of data regarding injuries and painful symptoms was obtained. Moderate to good correlation was found between FMS total score and posterolateral reach of dominant and non-dominant legs (r=0.503, p=0.001; r=0.525, p&lt;0.001). Significant correlations were found between FMS total score and SEBT composite scores for dominant and non-dominant legs (r=0.486, p=0.001; r=0.453, p=0.003). Numerous significant correlations were found between individual items of FMS and SEBT. Participants with FMS score ≤14 had a higher occurrence of injuries and painful symptoms (p=0.018; p=0.034) and lower results of SEBT composite scores for dominant and non-dominant legs (p=0.010; p=0.001). There is a significant relationship between FMS and SEBT scores. Players with FMS scores ≤14 are more prone to injuries and painful symptoms and they have lower SEBT scores.

Implementation of EHR medication-adherence screening tool in breast cancer clinic.

438 Background: Nonadherence to prescribed medications occurs frequently in patient with breast cancer (BC) and can affect BC outcomes as well as outcomes for comorbid conditions. We implemented a process to screen for medication adherence in the electronic health record (EHR) in an urban outpatient BC clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to implement a screening process for medication adherence for all patients seen in the outpatient breast oncology clinic. At check-in (via the patient portal or clinic based kiosks), patients were asked to complete an EHR adherence screener. Two PDSA cycles were completed. During cycle one (2/16/22-5/17/22), patients were asked if they received ≥1 prescribed medication; if yes they were asked to complete the questionnaire (y/n); if yes a 3-item questionnaire was used to screen for adherence to all medications over the prior 7 days. Adherence was defined as 3 of 3 responses “none of the time” to “I have missed my medicine;” “I have skipped a dose of my medicine;” and “I did not take a dose of my medicine.” During cycle two (5/17/22-6/5/22) the screener was simplified. Patients were no longer asked to complete the survey; and the survey was modified to 1-item “I did not take a dose of my medicine”, adherence was defined as response of “none of the time”. We evaluated response rate and self-reported non-adherence rate. Results: During PDSA cycle 1 (2/16/22-5/17/22), 2840 visits occurred and 722 (25%) responses were received; 80% noted prescription of ≥1 medication, 38% agreed to complete the survey; and 87% reported adherence to all prescribed medications while 13% reported non-adherence. During PDSA cycle 2 (5/17/22-6/5/22), 512 visits occurred and 172 (33%) responses were received. Of those, 73% reported prescription of ≥1 medication; of those 66%-reported adherence to all prescribed medications, 21% reported non-adherence, and 17% preferred not to answer. Conclusions: This EHR screener is a simple and scalable tool to rapidly screen for medication adherence. Up to a quarter of patients who completed screening reported non-adherence. Further tools are needed to assess adherence among patients who lack access to the patient portal or clinic kiosk, or are uncomfortable checking in with these mechanisms. Future interventions are necessary to further screen potentially non-adherent patients and for interventions to improve adherence once vulnerable patients are identified.

S9 Development of a Clinical Screening Tool for Exocrine Pancreatic Insufficiency in Patients With Chronic Pancreatitis

Introduction: No accurate diagnostic tests exist for exocrine pancreatic insufficiency (EPI). As a result, EPI is misdiagnosed, including in chronic pancreatitis (CP), and there is an unmet need for clinical tools to help clinicians evaluate patients with CP at risk for EPI. The aim of this study was to generate a simple clinical tool to predict EPI in patients with CP. Methods: 49 variables from medical records of CP patients with or without EPI were entered into a Classification and Regression Tree (CART) model using the unimputed full analysis set and 4 other models (Logistic Regression with Least Absolute Shrinkage and Selection Operator regularization, Support Vector Machine, Random Forest, and Gradient Boosting Machine) using imputed full analysis set. EPI misclassification rate (mRate) served as primary metric to train the 5 prediction models. Each model’s generalizability was assessed using 5-fold cross-validation and the model that was best suited for clinician use based on mRate and other characteristics was selected. Results: Records of 274 patients with CP from 6 pancreatitis centers across the US were included. Among the 160 (58%)/114 (42%) patients with EPI/without EPI, 48%/55% were female, mean age was 55/52 years, 76%/69% were white, 29%/52% were never smokers, and 39%/53% were never alcohol users. All 5 prediction models demonstrated similar EPI mRates. The CART model was selected. The final CART decision tree includes 10 variables (in order of importance): smoking, pancreatic atrophy, steatorrhea, alcohol use, hemoglobin, serum vitamin D, pancreatic duct contour change, serum albumin, pancreatic parenchymal calcifications, and use of opioid analgesics. The mRate without and with 5-fold cross-validation of the CART was 0.153 (training error) and 0.314 (prediction error), and the area under the receiver operating characteristic curve was 0.889 and 0.682, respectively (Figure 1). Sensitivity/specificity without/with 5-fold cross validation was 0.888/0.789 and 0.794/0.535, respectively. Conclusion: A parsimonious set of 10 variables associated with EPI in CP was identified. The CART decision tree demonstrated good prediction performance for EPI and was selected as the most practical screening tool to aid clinicians in the assessment of EPI in patients with CP. Further external validation of the EPI screening tool is planned.Figure 1.: AUC-ROC of the CART model trained on the full analysis set and after 5-fold cross-validation. AUC, area under the curve; CART, classification and regression tree; CV, cross-validation; ROC, receiver operating characteristic.