Skin of Colour Dermatoses Self-Learning Module: Assessing Student Comprehension.

BACKGROUND: Dermatology for diverse skin types is a globally growing area of medicine, but the inclusion of skin of color dermatology has not yet been formally included across all Canadian undergraduate medical education curricula. There is also a paucity of representation of diverse skin types in most medical textbooks, research, and clinical trials. OBJECTIVES: The main objective was to develop a concise, Skin of Colour Dermatoses Self-Learning Module (SOCSLM) that could be implemented at an undergraduate medical education level. The secondary objective was to analyze participant responses to improve and add to learning module content. METHODS: From March to May 2022, second-year medical students at the University of Ottawa completed pre- and post-SOCSLM questionnaires which were available in French and English through their online student learning portals. The pre-test consisted of five multiple choice questions relating to images of dermatoses seen in diverse skin types. The post-test repeated the same five questions, rearranged, with an additional five new ones, and responses were analyzed. RESULTS: Twenty-five participants completed the surveys, and twenty responses were included. Percent correct answers increased between pre- and post-test, 51% vs 87%. In the post-test, questions repeated from the pre-test had a mean score of 95% while the new post-test questions had a mean score of 80%. Interest in dermatology did not have an impact on correct response rates. CONCLUSIONS: Skin of color dermatology self-learning modules may be an effective way to integrate skin of color dermatology into undergraduate medical curricula.

Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation.

Importance: Frailty is associated with severe morbidity and mortality among people with chronic obstructive pulmonary disease (COPD). Interventions such as pulmonary rehabilitation can treat and reverse frailty, yet frailty is not routinely measured in pulmonary clinical practice. It is unclear how population-based administrative data tools to screen for frailty compare with standard bedside assessments in this population. Objective: To determine the agreement between the Hospital Frailty Risk Score (HFRS) and the Clinical Frailty Scale (CFS) among hospitalized individuals with COPD and to determine the sensitivity and specificity of the HFRS (vs CFS) to detect frailty. Design, Setting, and Participants: A cross-sectional study was conducted among hospitalized patients with COPD exacerbation. The study was conducted in the respiratory ward of a single tertiary care academic hospital (The Ottawa Hospital, Ottawa, Ontario, Canada). Participants included consenting adult inpatients who were admitted with a diagnosis of acute COPD exacerbation from December 2016 to June 2019 and who used a clinical care pathway for COPD. There were no specific exclusion criteria. Data analysis was performed in March 2022. Exposure: Degree of frailty measured by the CFS. Main Outcomes and Measures: The HFRS was calculated using hospital administrative data. Primary outcomes were the sensitivity and specificity of the HFRS to detect frail and nonfrail individuals according to CFS assessments of frailty, and the secondary outcome was the optimal probability threshold of the HFRS to discriminate frail and nonfrail individuals. Results: Among 99 patients with COPD exacerbation (mean [SD] age, 70.6 [9.5] years; 56 women [57%]), 14 (14%) were not frail, 33 (33%) were vulnerable, 18 (18%) were mildly frail, and 34 (34%) were moderately to severely frail by the CFS. The HFRS (vs CFS) had a sensitivity of 27% and specificity of 93% to detect frail vs nonfrail individuals. The optimal probability threshold for the HFRS was 1.4 points or higher. The corresponding sensitivity to detect frailty was 69%, and the specificity was 57%. Conclusions and Relevance: In this cross-sectional study, using the population-based HFRS to screen for frailty yielded poor detection of frailty among hospitalized patients with COPD compared with the bedside CFS. These findings suggest that use of the HFRS in this population may result in important missed opportunities to identify and provide early intervention for frailty, such as pulmonary rehabilitation.

Scoping review of evidence for managing postnatal hypoglycaemia.

OBJECTIVES: To identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia. DESIGN: Scoping review that applied a preregistered protocol based on established frameworks. DATA SOURCES: Medline and Embase, up to 12 May 2020. STUDY SELECTION: Comparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns. DATA GATHERING: Article selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines. RESULTS: 12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies. CONCLUSIONS: The primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.