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Full-Text Articles in Medicine and Health Sciences
Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper
Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper
Evidence-Based Practice Project Reports
Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography …
A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold
A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold
Evidence-Based Practice Project Reports
Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …
A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser
A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser
Evidence-Based Practice Project Reports
In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …
You're Not Forgotten: Effects Of Screening For Postpartum Depression Within A Pediatric Setting, Marrisa S. Culver
You're Not Forgotten: Effects Of Screening For Postpartum Depression Within A Pediatric Setting, Marrisa S. Culver
Evidence-Based Practice Project Reports
Postpartum depression (PPD) is depression that occurs in women following childbirth occurring during the postpartum period and affects 1 in 7 women (The United States Preventive Services Task Force, 2019). The American Academy of Pediatrics [AAP] (2019), recommends that pediatric healthcare providers utilize their position to screen for PPD. The purpose of this evidence-based practice (EBP) project was to implement a PPD screening intervention within a pediatric healthcare setting using the Edinburgh Postnatal Depression Scale (EPDS). The Academic Center for Evidence-Based (ACE) Practice Star Model guided this EBP project with evidence-based interventions developed after a comprehensive literature search. Implementation of …
Take A Shot: The Effect Of A Multicomponent Strategy To Increase Meningitis B Vaccination Rates, Valerie Cline
Take A Shot: The Effect Of A Multicomponent Strategy To Increase Meningitis B Vaccination Rates, Valerie Cline
Evidence-Based Practice Project Reports
Neisseria meningitidis is the major cause of invasive meningococcal disease (IMD) (Peterson et al, 2018). Approximately 10-15 percent of IMD cases result in debility including neurological impairment, amputation, and death (Peterson et al, 2018). Outbreaks of IMD are sporadic and unpredictable. The incidence of IMD varies geographically, but serogroup B has become more prevalent in recent years. Meningitis-B (Men-B) has been the cause of several university outbreaks on different US college campuses since 2013.The purpose of this project was to implement an intervention at a midwestern university student health center to help students understand the risk of the disease and …
Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger
Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger
Evidence-Based Practice Project Reports
Adolescent alcohol consumption is a serious health problem in the United States. Alcohol is the most widely used substance, and it continues to be the drug of choice for adolescents (CDC, 2018). Over 7 million adolescents and approximately 30 percent of high school students in the U.S. that admit to drinking more than a few sips of alcohol in the past 30 days (NIAAA, n.d.). Underage alcohol use can lead to many complications such as social, school, and legal problems, and when initiated early in life is associated with the development of alcohol use disorder (NIAAA, n.d.). The purpose of …
The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong
The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong
Evidence-Based Practice Project Reports
Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …
Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn
Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn
Evidence-Based Practice Project Reports
Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …
Impact Of A Protocol Implementation On Identification And Referral Of Women At-Risk For Hereditary Breast Cancer, Chrysanthemum Davis Lawson
Impact Of A Protocol Implementation On Identification And Referral Of Women At-Risk For Hereditary Breast Cancer, Chrysanthemum Davis Lawson
Evidence-Based Practice Project Reports
Breast cancer is the foremost new cancer diagnosis and the second highest cause of cancer death in American women (American Cancer Society, 2019). Hereditary breast cancer is most commonly caused by a mutation within the breast cancer susceptibility genes, BRCA 1 or 2, which increases women’s risk for breast cancer by five to ten-fold the average population (Mayo Clinic, 2019). The U.S. Preventive Services Task Force has assigned a Grade B recommendation advising health care providers to use a risk assessment tool, such as the Breast Cancer Genetics Referral Screening Tool (B-RST™), to recognize and provide medical management recommendations for …
Living Sweet: A Multi-Functional Mobile-Phone Application Strategy For Adults With Uncontrolled Type 2 Diabetes Mellitus, Chantel K. Anderson
Living Sweet: A Multi-Functional Mobile-Phone Application Strategy For Adults With Uncontrolled Type 2 Diabetes Mellitus, Chantel K. Anderson
Evidence-Based Practice Project Reports
Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases, is increasing worldwide, and once diagnosed, lifetime self-management is critical to maintain glycemic control (Vermeire et al., 2005; American Diabetes Association (ADA), 2018). Management of T2DM has been acknowledged as challenging due to the need for strict lifestyle adaptations. From a public health perspective, uncontrolled diabetes leads to increased healthcare costs, secondary complications, and ultimately severe disabilities (ADA, 2018). The purpose of this evidencebased practice (EBP) project was to evaluate the effectiveness of a diabetes-specific mobile health application (MHA) on glycated-hemoglobin (HbA1C), self-care perception (SCP), and self-care behaviors …
Increasing Chlamydia Trachomatis And Neisseria Gonorrhea Screening Among Women 15 To 24 Years Old Using A Multifaceted Approach, Mackenzie Shireman
Increasing Chlamydia Trachomatis And Neisseria Gonorrhea Screening Among Women 15 To 24 Years Old Using A Multifaceted Approach, Mackenzie Shireman
Evidence-Based Practice Project Reports
The Centers for Disease Control and Prevention (CDC) (2017a) estimates that one-quarter of sexually active people are between 15 and 24 years old, but account for half of 20 million sexually transmitted diseases (STD) reported annually in the United States. Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) are the most common reportable STDs (CDC, 2018). The purpose of this project was to increase CT/NG screening rates among sexually active, nonpregnant women 15 to 24 years old within the primary care setting through colleague education, routine sexual history taking, and indicated testing. A 30-minute colleague in-service was provided to educate clinical …
The Effects Of A Mobile Fitness Application On Weight Management And Physical Acticity Amongst University Students, Erica Deenihan
The Effects Of A Mobile Fitness Application On Weight Management And Physical Acticity Amongst University Students, Erica Deenihan
Evidence-Based Practice Project Reports
The prevalence of obesity, and obesity related diseases throughout America, specifically in regard to the college student population has steadily climbed over the course of the last forty years, due largely in part to the increase in sedentary lifestyle behaviors, amongst other factors (Swanson, 2016). Physical activity has been widely recognized as a valid means of combatting obesity and weight gain while promoting health related quality of life (Swanson, 2016). Therefore, implementing strategies aimed at increasing physical fitness in attempt to control weight management is imperative to promoting improved health outcomes. The purpose of this evidence-based project was to examine …
Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif
Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif
Evidence-Based Practice Project Reports
The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …
Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice
Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice
Evidence-Based Practice Project Reports
The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project …
The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava
Evidence-Based Practice Project Reports
The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, …
A Multifaceted Approach To Antibiotic Stewardship In The Outpatient Clinical Setting For Bronchitis, Elizabeth A. Weaver
A Multifaceted Approach To Antibiotic Stewardship In The Outpatient Clinical Setting For Bronchitis, Elizabeth A. Weaver
Evidence-Based Practice Project Reports
Antimicrobial resistance is a world-wide health crisis (Infectious Disease Society of America [IDSA], 2016; World Health Organization [WHO], 2017) expedited by the overuse/inappropriate use of antibiotics. In the outpatient setting it has been determined that approximately 60% of antibiotic therapies are prescribed (Centers for Disease Control and Prevention [CDC], 2016). Antibiotic stewardship is the coordinated effort to improve the use of antibiotic therapies, minimize misdiagnosis and delayed diagnosis and select appropriate antibiotic drug regimens (IDSA, 2016). The purpose of this evidence-based practice project was to evaluate the effects of an antibiotic stewardship program (presentation, survey collection, bimonthly e-mail reminders, patient …
Use Of Smartphone Application To Facilitate Weight Loss And Promote Accountability In Obese And Overweight Patients, Angela M. Turner
Use Of Smartphone Application To Facilitate Weight Loss And Promote Accountability In Obese And Overweight Patients, Angela M. Turner
Evidence-Based Practice Project Reports
In 2015, the U.S. Department of Health and Human Services published a National Health and Nutrition Survey (NHANES) on obesity from 2011 through 2014. From the survey, it was determined that the prevalence of obesity in the U.S. was 36% in adults and 17% in young adults/children (Ogden et al., 2015). Lifestyle modifications including moderation of caloric intake and increased exercise have been shown to be effective for both prevention and treatment of obesity. The purpose of this evidence-based practice (EBP) project involved the design, administration, and evaluation of a technology-assisted weight loss intervention to address the health problem of …
Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean
Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean
Evidence-Based Practice Project Reports
Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …
A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough
A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough
Evidence-Based Practice Project Reports
As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …
Pain Management For Intrauterine Device Insertion And Endometrial Biopsy, Michelle Lipton-Carroll
Pain Management For Intrauterine Device Insertion And Endometrial Biopsy, Michelle Lipton-Carroll
Evidence-Based Practice Project Reports
Intrauterine device (IUD) insertions and endometrial biopsies (EMB) can be painful in office gynecological procedures. In the clinical setting used for this evidence-based project (EBP) it was noted there was no consistent pain management being used for these procedures. For this EBP project a protocol for pain management during IUD insertions and EMBs was developed and implemented into this clinical setting. The protocol was created from an exhaustive literature search, which yielded six pieces of high-level evidence of good quality. The evidence supported the use of a 1% lidocaine paracervical block prior to IUD insertion and a 2% lidocaine intrauterine …
The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer
The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer
Evidence-Based Practice Project Reports
Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …
Application Of Beers Criteria And A Brown Bag Event To Increase Prescribing Safety In Older Adults, Kristen Garza
Application Of Beers Criteria And A Brown Bag Event To Increase Prescribing Safety In Older Adults, Kristen Garza
Evidence-Based Practice Project Reports
With older adults making up about 14.5% of the U.S. population, polypharmacy may be an unintended consequence of adhering to clinical practice guidelines (Kim & Luck Parish, 2017). Effective polypharmacy interventions are needed in the primary care setting to increase prescribing safety and lower the risk of adverse drug events among older adults. The application of the Beers criteria, in conjunction with a brown bag medication reconciliation event, was initiated as focused interventions for a private primary practice without electronic health records. Outcomes included medication reduction, identification of possible inappropriate medication, decrease of medication dosages, and identification of duplicate medication. …
A Multi-Faceted Intervention To Improve Diagnosis And Treatment Rates Of Overweight And Obesity By Nurse Practitioners In Primary Care, Susan Disser
Evidence-Based Practice Project Reports
The United States is amid an obesity epidemic (Institute of Medicine, 2012). Indiana ranks as the tenth most overweight state. (America’s Health Rankings, 2018). Despite guidelines outlining the treatment of obesity, primary care providers seldom use these guidelines (Hayes et al., 2017). In a 2010 study, only 28.9% of obese patients received a diagnosis of obesity and less than 25% of these patients received counseling on diet, exercise, or weight loss (Bleich, Pickett-Blackely, & Cooper, 2011). The purpose of this evidence-based practice (EBP) project is to determine if a multi-faceted intervention consisting of academic detailing, reminders, audit with feedback, and …
Sun Prevention Fun (Spf): A Multicomponent Sun Prevention Program For Children In Kindergarten And First Grade, Sarah Gouker
Sun Prevention Fun (Spf): A Multicomponent Sun Prevention Program For Children In Kindergarten And First Grade, Sarah Gouker
Evidence-Based Practice Project Reports
Skin cancer is an important topic in the United States due to the recent increase in cost and mortality. The purpose of this evidence-based practice (EBP) project was to determine if the early implementation of a multicomponent sun prevention program positively impacted kindergarten and first grade students’ knowledge and behavioral intentions to practice safe sun techniques after a one week period. Kotter’s Model of Change and the ACE Star model were utilized to guide this EBP project. An exhaustive review of the literature yielded 12 articles which were used to develop best practices for education on sun safety. The quality …
A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin
A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin
Evidence-Based Practice Project Reports
It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …
Influencing College Influenza Vaccination Through A Multi-Component Campaign, Heather Strickler
Influencing College Influenza Vaccination Through A Multi-Component Campaign, Heather Strickler
Evidence-Based Practice Project Reports
Multiple influenza strains exist and college aged students are the most affected population from the H1N1 strain. The H1N1 influenza pandemic had high attack rates reported on campuses from 25% to 73% (Benjamin et. al., 2016; Uddin et. al., 2009). Only 8% to 40% of college students are vaccinated against influenza despite a target goal of 50% set by the American Healthy Campus 2020 (Benjamin et. al., 2016; Poehling, et. al., 2012). The purpose of this evidence based project was after implementing a multi-component influenza vaccination campaign to determine changes in intent to receive the vaccine among college students. To …
Affecting Tdap Vaccination Rates Among Women: A Multifaceted Intervention, Soneka Wynter
Affecting Tdap Vaccination Rates Among Women: A Multifaceted Intervention, Soneka Wynter
Evidence-Based Practice Project Reports
Despite the availability of a preventive vaccine, the incidence of pertussis in the United States has continued to increase over the past two decades and it is now considered the most common preventable infectious illness. Highly contagious in nature, it is estimated that about 50 million people are infected each year, and approximately 300,000 deaths occur worldwide (Centers for Disease Control and Prevention [CDC], 2012). In 2013, Indiana reported 616 cases (Indiana State Department of Health [ISDH], 2014). In spite of CDC recommendations on strategies that can improve vaccine delivery, rates of immunization remain low nationwide (CDC, 2014). The purpose …
Effects Of Multimodal Fever Education On Parents Of Febrile Children, Teresa S. Parkhouse
Effects Of Multimodal Fever Education On Parents Of Febrile Children, Teresa S. Parkhouse
Evidence-Based Practice Project Reports
Insufficient knowledge regarding the physiology and appropriate management of fever in children often contributes to an increased parental anxiety, inappropriate antipyretic use, and overutilization of medical resources (Chang, Liu, & Huang, 2013; Crocetti, Moghbeli, & Serwint, 2001; Schmitt, 1980). Parental concerns regarding childhood fever can lead to an overuse of health care resources as febrile illness in children accounts for approximately 20% of emergency department visits, 30% of office visits, and over 50% of after-hour phone calls to private physicians (Zomorrodi & Attia, 2008). Research shows that multidimensional educational interventions are most effective in improving parental management of fever (Young …
The Effect Of An Antenatal Breastfeeding Intervention On Breastfeeding Self-Efficacy And Intention Among Inner City Adolescents, Jamie El Harit
The Effect Of An Antenatal Breastfeeding Intervention On Breastfeeding Self-Efficacy And Intention Among Inner City Adolescents, Jamie El Harit
Evidence-Based Practice Project Reports
According to Healthy People 2020, infants who are breastfed have improved nutritional, immunological, developmental, and social outcomes (USDHHS, 2014). Despite the benefits of breastfeeding and the focused international efforts to increase levels of breastfeeding, adolescents remain largely unaware and continue to have among the lowest levels of breastfeeding initiation (CDC, 2013; Spear, 2006). The purpose of this EBP project was to reduce the disparities of breastfeeding initiation by increasing breastfeeding self-efficacy and intention in an inner city specialty high school. Synthesis of the evidence demonstrated that needs-based, repeated antenatal education delivered by a lactation expert including breastfeeding peer counselor supports …
The Effect Of Patient Reminders On Osteoporosis Screenings, Billie-Ann Black
The Effect Of Patient Reminders On Osteoporosis Screenings, Billie-Ann Black
Evidence-Based Practice Project Reports
Osteoporosis is characterized by reduction of bone mass and compromised bone strength, resulting in an increased fracture risk. Since a reduction of bone mass has been shown to be predictive of future fracture risk, prevention strategies target screening those patients at risk for decreased bone mass by using bone mineral density (BMD) dual energy x-ray absorptiometry (DXA) scans. Current national guidelines recommend that all women 65 years and older undergo BMD testing using central DXA every two years. Despite these recommendations, women age 65 years and older still do not participate in this screening. Greater rates of osteoporosis screening could …