Clinical Health Settings Research Articles

A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

A Comparative Case Study of the Implementation of a Digital App-Based Platform Aimed at Reducing Sexual Risk in Adolescents and Young Adults

Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use.

Complexities and benefits of adopting next-generation sequencing-based tuberculosis diagnostics: a qualitative study among stakeholders in low and high-income countries

ObjectivesTo clarify perceived benefits, barriers and facilitators of Mycobacterium tuberculosis next-generation sequencing implementation in Madagascar and Canada, towards informing implementation of this diagnostic technology in public health agencies and clinical...

Effects of simulation-based cardiopulmonary and respiratory case training experiences on interprofessional teamwork: A systematic review.

Simulation exercises are meant to provide an opportunity for health care workers to improve teamwork and develop clinical skills, among other goals. The objective of this systematic review was to determine whether simulated interdisciplinary activities in the health care or clinical setting improve interprofessional collaboration within health care teams that include respiratory therapists. A systematic literature search of PubMed, EMBASE and CINAHL was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline to find relevant articles using both MeSH terms and free text. Filters were applied to include English-language studies; studies published within the last 10 years (2011-2021), and studies involving human participants. Studies were excluded if they did not assess the effects of simulation on aspects of teamwork, if participants were students, if teams did not include respiratory therapists, or if the training did not involve a simulated experience in a clinical setting. The search identified 312 articles, 75 of which were advanced to full-text review. Of those 75 articles, 62 were eliminated for not measuring teamwork in their outcomes. Two articles were excluded for being published before 2011, and one was eliminated for poor methodological quality. A risk of bias assessment using standardized qualitative and quantitative appraisal checklists was conducted on each of the remaining 10 studies selected for inclusion. A total of 10 studies met the inclusion criteria for this review (eight prospective, pre/post-test studies and two prospective observational studies). Randomization and participant/researcher blinding were not present in the majority of the studies and reporting bias was also found to be a concern throughout the literature. However, all of the studies noted increased teamwork scores post-intervention, though they differed in the tools used to evaluate this outcome. Collectively, the studies included in this review demonstrate that interprofessional simulation experiences including respiratory therapists enhance teamwork. The various tools used to assess change in teamwork had evidence of validity; however, studies varied in their outcomes measured, making quantitative analysis inappropriate. There are challenges involved in creating and assessing these simulations, particularly when performed within a clinical environment, which make it difficult to fully remove bias from the study design. It is unclear if the teamwork improvement can strictly be attributed to the simulation intervention or in part due to the general development of team members' competencies throughout the research period. Additionally, the permanency of the effects cannot be evaluated based on the studies included and could be an area for future research. Despite the limited number and methodological precision of studies included in this review along with the differing outcome evaluation methods, the authors conclude that positive teamwork improvement results are generalizable and agree with the broader base of research of the effectiveness of simulation on teambuilding.

Socioeconomic determinants of asthma health.

The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism. Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes. Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.

Challenges and opportunities for medical referrals at a mobile community health clinic serving sexual and gender minorities in rural South Carolina: a qualitative approach

BackgroundSexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics.Aims and objectivesThe purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States.MethodsWe recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved.ResultsThe findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers’ knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources.ConclusionThe findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.

Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study

Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder

BackgroundImproving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment. The current study explores the dynamic temporal associations between theory-driven cognitive and behavioural mechanisms of symptom change both during and following group CBT. MethodsA randomized controlled trial of imagery-enhanced CBT (n = 51) versus traditional verbal CBT (n = 54) for social anxiety was completed in a community mental health clinic setting. This study included data collected from 12-weekly sessions and a 1-month follow-up session. Mixed models were used to assess magnitude of change over the course of treatment. Cross-lagged panel models were fit to the data to examine temporal relationships between mechanisms (social-evaluative beliefs, safety behaviours) and social interaction anxiety symptoms. ResultsParticipants in both CBT groups experienced significant improvements across all cognitive, behavioural, and symptom measures, with no significant differences in the magnitude of changes between treatments. During treatment, greater social-evaluative beliefs (fear of negative evaluation, negative self-portrayals) at one time point (T) were predictive of more severe SAD symptoms and safety behaviours at T+1. Social-evaluative beliefs (fear of negative evaluation, probability and cost of social failure) and safety behaviours measured at post-treatment were positively associated with SAD symptoms at the 1-month follow-up. ConclusionsThe current study identifies social-evaluative beliefs that may be important targets for symptom and avoidance reduction during and following CBT. Assessment of these social-evaluative beliefs throughout treatment may be useful for predicting future SAD symptoms and avoidance, and for adapting treatment to promote optimal change for patients.

Seven Benefits of Employing Dynamic Health in Clinical Settings

Dynamic Health™, from EBSCO Information Services, is an evidence-based clinical decision support resource designed for quick retrieval of diagnosis and treatment information at the point of patient care.

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

Devices for the transport and microbiological detection of Neisseria gonorrhoeae in sexual health clinic samples: a prospective comparative study.

Propagation and microbiological detection of N. gonorrhoeae can be challenging due to the fastidious nature of the bacterium outside the human host environment. Different sample transport options were evaluated in order to address this issue. Symptomatic and high-risk patients consented to take part. Standard practice in clinics involve using a guanine and cytosine selective (GC) plate for transport and incubation. Other devices were assessed in two different studies. MWE's Sigma VCM™-a transport device for use between clinic and laboratory-was used in one study (n = 166). In the other, (n = 102), Biomed's Intray™ plates were used, which can be used for both initial transport and incubation at the destination laboratory. In the Sigma VCM™ study, positive results were obtained for 14% (Sigma VCM™), 21% (GC plates); the distribution of outcomes did not significantly differ between the two microbiological sampling methods (p-value 0.09, Chi-squared test). Concerning the InTray™ sub-study, N. gonorrhoeae was detected in 9% (InTray™), 13% (GC plating) of cases respectively, with again no significant difference between the microbiological sampling methods (p-value 0.25). Regression analysis identified a significant association between N. gonorrhoeae detection and male patients, absence of dysuria and previous gonorrhoea infection. No significant difference in rate of microbiological detection of N. gonorrhoeae could be detected between different transport devices in a sexual health clinic setting. Performance appraisal of transport devices for bacterial sexually transmitted infection can inform practitioners' options regarding said devices.

Study protocol: Evaluation of the ‘real-world’ Farmers Have Hearts – Cardiovascular Health Program

Premature cardiovascular disease (CVD) mortality among men represents a public health concern worldwide. In Ireland, male farmers are a ‘high-risk’ group for CVD mortality compared to normative values for Irish males. Despite this, they are perceived to be a ‘hard-to-reach’ (HTR) group to engage with health interventions. Primary prevention measures, including health screening and health behavior change interventions, are key strategies in addressing CVD yet often do not reach HTR groups such as male farmers.The Farmers Have Hearts – Cardiovascular Health Program (FHH-CHP) is a unique large-scale (n = 868) workplace health intervention specifically targeted at Irish male livestock farmers. It included a baseline and Week 52 health check and a health behavior change intervention with three delivery methods: ‘health coach by phone’ and/or mobile (M)-health by text message. The program adopted gender-specific and strengths-based methods to maximize participant engagement. It integrated a multi-actor approach and was trialed in a ‘real world’ practice outside of confined health care settings. Data collection comprised health check results (baseline, Week 52) and self-report measures (baseline, Week 26, Week 52).The FHH-CHP is the first targeted health intervention adopting gender-specific methods to reach and engage male livestock farmers in their cardiovascular health. Documenting the FHH-CHP study protocol is important therefore and will benefit practitioners attempting to apply gender-specific approaches to engage at-risk and HTR groups of men with targeted health interventions. Meeting men outside of clinical health settings and adopting gender competency standards are needed to address inequities in health outcomes experienced by men.

46.1 Early Childhood Mental Health Care in Traditional Child Mental Health Clinic Settings: A Case Example of the Importance of a Family Systems Approach

The goal of this presentation is to explore the basic concepts of early childhood mental health work and how this intricately connects to addressing issues in the family, in particular in families where multiple generations and/or extended family members need to be involved as part of treatment.

Alternative interventions in clinical mental health settings: A survey of mental health professionals' perceptions

• Three religious/spiritual (R/S) practices – chanting, pranayama and yoga may be used as supplementary mental health interventions. • Mental health professionals expressed the need for training to use considered R/S practices as mental health interventions. • The need for a guideline regarding using R/S practices in mental health was identified. • Findings of the survey may inform possible integration of these R/S practices in mental health clinical settings in Australia.

Building the 2022 Diabetes Technology Practice Competencies Using Modified Delphi Methodology.

The purpose of this study was to construct professional competencies for diabetes technology use in various care settings reflecting the mission of the Association of Diabetes Care & Education Specialists (ADCES). ADCES convened a core team of nationally representative diabetes technology experts to develop professional competencies specifically related to diabetes technology use. A modified Delphi methodology, which comprised 4 rounds, was used for consensus development among these experts. First, experts developed and arrived at a consensus on the initial draft of competencies. They also identified health care professionals and staff essential for effective technology integration in various diabetes care settings. A survey was completed by diabetes technology experts that are members of ADCES. Next, a multidisciplinary focus group was conducted to gain feedback. Finally, the edited competencies were distributed via survey for feedback by diabetes technology experts from various disciplines. One hundred four diabetes technology experts in the United States participated in the final survey, representing various health care professions and clinical settings. A final set of 94 competencies across 7 domains was determined. Modified Delphi methodology is an effective way to utilize multidisciplinary expertise to develop diabetes technology-related competencies for diabetes care professionals and staff in a variety of settings. These competencies align with the mission of ADCES to empower diabetes care and education specialists to expand the horizons of innovative education, management, and support.

Screening for depression among the general adult population and in women during pregnancy or the first-year postpartum: two systematic reviews to inform a guideline of the Canadian Task Force on Preventive Health Care

BackgroundDepression affects an individual’s physical health and mental well-being and, in pregnant and postpartum women, has specific adverse short- and long-term effects on maternal, child, and family health. The aim of these two systematic reviews is to identify evidence on the benefits and harms of screening for depression compared to no screening in the general adult and pregnant and postpartum populations in primary care or non-mental health clinic settings. These reviews will inform recommendations by the Canadian Task Force on Preventive Health Care.MethodsWe searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library using a randomized controlled trial filter, where applicable, October 4, 2018, and updated to May 11, 2020. We also searched for gray literature (e.g., websites of organizations of health professionals and patients). Study selection for depression screening trials was performed first on title and abstract, followed by full-text screening. Data extraction, assessment of the risk of bias using the Cochrane risk of bias tool, and application of Grading of Recommendations Assessment, Development and Evaluation were performed by one reviewer and validated by a second reviewer.ResultsA total of three trials were included. All three trials were included in the general adult review, while one of the three trials was included in the pregnant and postpartum review. We did not pool results due to substantial differences between studies and high risk of bias. In the general adult review, the first trial (n = 1001) evaluated whether screening for depression in adults with acute coronary syndrome compared to usual care improves health-related quality of life, depression symptoms, or harms of screening at 6, 12, and 18 months. There were little to no differences between the groups at 18 months for the outcomes. The second trial included adults (n = 1412) undergoing initial consultation for osteoarthritis, evaluated for depression and general health (mental and physical) after initial consultation and at 3, 6, and 12 months. The physical component score was statistically significantly lower (worse health) in the screened group at 6 months; however, this difference was not significant at 3 or at 12 months. There were no clinically important or statistically significant differences for other outcomes between groups at any time. The third trial (included in both reviews) reported on 462 postpartum women. At 6 months postpartum, fewer women in the screening group were identified as possibly depressed compared to the control group (RR 0.59, 95% confidence interval (CI) 0.39 to 0.89) and mean EPDS scores were also statistically significantly lower in the screened group (standardized mean difference 0.34 lower (95% CI 0.15 to 0.52 lower)). All other outcomes did not differ between groups at follow-up. There were serious concerns about the cut-offs used for the questionnaire used to screen, diagnostic confirmation, selective outcome reporting, and the reported magnitude of effects.DiscussionThere are limitations of the evidence included in the reviews. There was moderate certainty in the evidence from one trial that screening for depression in the general adult population in primary care or non-mental health clinic settings likely results in little to no difference on reported outcomes; however, the evidence was uncertain from the other two included trials. The evidence is very uncertain about the effect of screening for depression in pregnant or postpartum women in primary care or non-mental health clinic settings. Well-conducted and better-reported trials are needed that meet the screening trial criteria used in this review.Systematic review registrationBoth protocols have been registered in the International Prospective Registry of Systematic Reviews (PROSPERO) [adult: CRD42018099690; pregnancy and postpartum: CRD42018099689] and published (https://systematicreviewsjournal.biomedcentral.com/track/pdf/10.1186/s13643-018-0930-3).

Simulation as an Alternative to Women's Health Clinical Rotations for Ultra-Orthodox Men: A Pilot Study of Cultural Adjustment

BackgroundDue to the cultural needs of male Jewish Ultra-Orthodox nursing students, the entire women's health clinical rotation in our nursing program was replaced with simulation training. This study sought to determine student and teacher satisfaction and student knowledge and skill acquisition during a pilot of an alternative method of instruction. MethodsParticipants, a total of 96 Ultra-Orthodox male students from four student cohorts. Six clinical settings were created, with 32 hybrid scenarios, covering 47 clinical situations. The program's evaluation was based on student and instructor feedback and pre-post knowledge exams. ResultsStudents and instructors reported that the training improved students' skills and readiness to practice. Students significantly improved their post-course knowledge score and were comfortable taking care of female standardized patients in common women's health clinical settings. ConclusionsSimulation was found to be an effective and feasible way to meet curriculum requirements while also addressing the cultural needs of male Ultra-Orthodox nursing students.

Pharmacists in clozapine clinics improving physical health monitoring.

IntroductionPeople living with schizophrenia have a higher rate of comorbid physical health diseases and compared with the general population die earlier due to these diseases. A pharmacist working in an outpatient mental health clinic setting could assist with the management of physical health disease for this population. The aim of this study was to investigate whether having a pharmacist in a community clozapine clinic would improve adherence to physical health monitoring and whether this would have a positive effect on these physical health outcomes.MethodsThis retrospective observational study compared patient data from 2 clozapine clinics; one where a pharmacist engaged in medication reviews and management of medication side effects, and another that did not have a pharmacist. The rates of physical health monitoring and the changes from baseline of physical health outcomes (weight, BMI, BP, HbA1c, and lipids) were compared after the first pharmacist intervention (medication review).ResultsThe pharmacist clinic had statistically higher rates of metabolic and ECG monitoring (glucose 48% vs 11%, P < .001; lipids 61% vs 7.1%, P < .001; ECG 15% vs 0%, P = .001). Positive trends in weight were identified in the pharmacist-group, although this failed to reach statistical significance.DiscussionThis study shows that pharmacists providing regular medication reviews improves physical health monitoring for patients receiving clozapine.

MP58-18 REAL WORLD APPLICATION AND EXPERIENCE OF A PROSTATE SPECIFIC ANTIGEN (PSA) MACHINE LEARNING MODEL IN A SCREENING POPULATION

You have accessJournal of UrologyCME1 May 2022MP58-18 REAL WORLD APPLICATION AND EXPERIENCE OF A PROSTATE SPECIFIC ANTIGEN (PSA) MACHINE LEARNING MODEL IN A SCREENING POPULATION Marlon Perera, Lewis Smith, Peter Swindle, Anthony Costello, and Elliot Smith Marlon PereraMarlon Perera More articles by this author , Lewis SmithLewis Smith More articles by this author , Peter SwindlePeter Swindle More articles by this author , Anthony CostelloAnthony Costello More articles by this author , and Elliot SmithElliot Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Machine learning algorithms may be beneficial in the setting of prostate cancer screening. Our group has developed one such algorithm based on PSA, age, free:PSA and other variables based on the data sets from the Prostate, Lung, Colorectal and Ovarian Cancer and PCPT trials. Limited data exists examining the effect of machine learning algorithms on prostate cancer diagnosis prospectively. We aimed to report our early experience using this algorithm in prostate cancer screening on an Australian cohort. METHODS: 1223 men without previous history of prostate cancer were tested using an AI clinical decision support tool in a digital health clinical setting. Clinicians assessed demographic factors as well as PSA, Free-PSA, Prostate Health Index and MRI results alongside an AI based clinical decision support tool. Men determined to be high risk were referred for urologic assessment and potential biopsy. When results were discordant with guidelines but flagged by AI the case was reviewed by a second clinician. The results of those men who underwent biopsy were collected and compared to statistics in a recent publication from the Australian Prostate Cancer Outcomes Registry. RESULTS: Of the 1223 men tested prospectively, 49 were referred to a urologist on the basis of their clinical parameters and AI risk score. These men underwent MRI which was then assessed. Of those that underwent MRI 26 continued to a prostate biopsy. Of the 26 biopsies completed 19 were found to have prostate cancer, 17 of the 19 (89%) cancers were found to be Gleason 7 or above on surgical histopathology. This is above a recently published rate of 74%. The median PSA at diagnosis was 2.3 µg/L, lower than the published median of 7.3 µg/L. No biopsied men were found to have metastatic disease compared to a published rate of 7%. Overall initial results show early detection of clinically significant disease with a reduced rate of biopsies in low risk men. CONCLUSIONS: Our machine learning model appears to reduce the need for biopsy and reduces the diagnosis of low-risk prostate cancer. Further, we highlight that PSA at the time of diagnosis was considerably lower than comparable screening cohorts. We provide a proof-of-principal highlighting the utility of machine-learning algorithms for prostate cancer screening in a real-world population. Source of Funding: MP is funded by a Fulbright scholarship through the Australian-America Fulbright Association © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e999 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marlon Perera More articles by this author Lewis Smith More articles by this author Peter Swindle More articles by this author Anthony Costello More articles by this author Elliot Smith More articles by this author Expand All Advertisement PDF DownloadLoading ...

Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review

Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health &amp; Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.