RESUMEN
The use of Electronic Nicotine Delivery Systems (ENDS) increased dramatically over the past decade, making them the most common tobacco product used among youth. While physicians often screen for the use of tobacco, very few screen for vaping product usage. This quality improvement project aimed to increase the screening rate of ENDS use among adolescents to 85% to match the Healthy People 2020 screening target of 83.3% for smoking. METHOD: We collected data from weekly chart reviews of all adolescent visits with a primary care provider by using keywords such as "vapor," "e-cigs," and "vaping" to document screening for ENDS use. The project consisted of 4 PDSA cycles: (1) education of the Adolescent Clinic staff about screening; (2) the addition of the specific question for e-cigarette use in the facility's Electronic Health Record; (3) house staff lecture about the importance of screening; and (4) reinforcement about screening to adolescent physicians. RESULTS: The percentage of screening for traditional tobacco use was consistently higher than ENDS use in all months. ENDS use assessment increased since the first intervention, going from 0% at baseline to 90% at the end. The addition of a specific question for ENDS use in EPIC was the most significant intervention and increased the screening percentage to 78%. CONCLUSIONS: To adequately assess for the use of ENDS, the nonspecific question, "do you smoke?" is not sufficient. A direct approach is necessary. A specific question in the EHR is the most significant way to increase screening for ENDS use.
RESUMEN
BACKGROUND: More remains to be known about polycystic ovary syndrome (PCOS) among overweight/obese adolescents across different ethnicities especially in regards to mental illness as an associated comorbidity. OBJECTIVE: To determine the prevalence of PCOS among overweight and obese adolescents and to evaluate known risk factors for PCOS in a diverse population. METHODS: Charts of patients at an Adolescent Clinic between April 1, 2016 and July 30, 2018 were filtered using: obese, overweight and body mass index (BMI) >85%. Charts were reviewed to identify the presence of PCOS using National Institutes of Health (NIH) criteria, race/ethnicity and known risk factors for PCOS [lipid, BMI, glycated hemoglobin (HA1c), blood pressure (BP)] and mental health conditions associated with PCOS (anxiety/depression and self-harm/suicidal ideation). RESULTS: Patients with PCOS were more likely to have elevated lipids (19.6% vs. 9.9%, p = 0.05), be obese (67.4% vs. 50.9%, p = 0.03), and have acanthosis nigricans (68.9% vs. 28.2%, p =< 0.001). PCOS was more common among non-Hispanic patients (77.9%) vs. Hispanic patients (57.8%). There was no difference in the prevalence of depression/anxiety (37% vs. 33%, respectively, p = 0.590) or self - harm/suicidal ideation (17% vs. 17%, p = 0.96) in patients with and without PCOS. In a logistic regression model, after adjusting for all demographics and clinical features, ethnicity, acanthosis nigricans and BMI were significant risk factors for PCOS. CONCLUSION: Patients with PCOS are more likely to be obese, hyperlipidemic, have acanthosis nigricans and be of non-Hispanic ethnicity. However, there was no difference in the prevalence of depression/anxiety and self-harm/suicidal ideation among adolescents with or without PCOS.