Detection and Diagnosis of Retinoblastoma: Can Mobile Devices Be the Next Step Toward Early Intervention?

Retinoblastoma (RB) is a common intraocular cancer in pediatric patients worldwide, and screening is routinely performed throughout the first few years of life. The diagnosis is often made clinically; however, the diagnosis can be delayed due to undetectable leukocoria because of small tumor size at the time of examination, missed appointments, non-compliance with eye examinations, or failure to perform the exam. As mobile devices continue to gain in both popularity and functionality, their use via applications and smartphone attachments for ocular examination introduces a new avenue for screening, detection, and staging of RB both inside and outside the clinical setting. Currently, research regarding mobile device use is still in its infancy, and further research is required to determine whether mobile devices could play a significant role in assisting with the diagnosis of RB. The purpose of this systematic review was to determine whether the existing literature supports the use of mobile devices by healthcare providers, specifically ophthalmologists and non-ophthalmologists, as well as by parents for the early detection of RB. A comprehensive literature search was conducted via PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science with a total of 10 studies included in the final analysis.

The pediatric rheumatology objective structured clinical examination: progressing from a homegrown effort toward a reliable and valid national formative assessment.

BACKGROUND: Of 37 pediatric rheumatology fellowship training programs in the United States, many have three or fewer fellows at a given time, making large-scale assessment of fellow performance difficult. An objective structured clinical examination (OSCE) is a scenario-based simulation method that assesses individual performance, thus indirectly measuring training program effectiveness. This study describes the development and implementation of two national pediatric rheumatology OSCEs and methods used for programmatic improvement. METHODS: OSCEs for pediatric rheumatology fellows were held in 2009 and 2011 during national rheumatology meetings using scenarios and assessment forms originally developed by a fellowship program director. The seven scenarios tested medical knowledge, physical exam and interpersonal skills. Pediatric rheumatologist evaluators assessed fellows' performance using checklists and gave immediate feedback. Program directors were sent summaries of their fellows' performances. Fellows evaluated the OSCE, providing organizational and scenario improvement suggestions. Programmatic changes to the 2011 OSCE were based on 2009 performance data and program evaluation feedback. RESULTS: Twenty-two fellows participated in 2009 and 19 in 2011. Performance scores in similar scenarios did not change considerably over the two iterations. In 2009, 85.7% of participants reported desire to change clinical behavior. Assessors' 2009 program evaluation data prompted changes in rating scales and removal of invalid or unreliable assessments. Negative evaluation data about individual stations decreased from 60% in 2009 to 15.4% in 2011. Fellows' ratings of the experience's overall value were similar in 2009 and 2011. The average experience ratings were lower among fellows who proposed scenario-specific improvements and higher among those who recommended organizational improvements. CONCLUSIONS: The 2011 examination exhibited programmatic improvement via reduction in fellows' scenario-specific negative feedback. Fellows' overall satisfaction did not change. Further work in scenario selection, assessment validation and inter-rater reliability will improve future pediatric rheumatology OSCEs.