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Commentary to ‘Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement’

      Smaller subspecialties, such as Pediatric Urology, can be late to develop best practices due to limited clinical trials and patient numbers. At the heart of clinical research, however, we still need patient outcomes. Earnest Codman pioneered this concept in surgery [
      • Codman E.A.
      The registry of bone sarcoma as an example of the end-result idea in hospital organization.
      ]. While true clinical outcome measures were not assessed in this study (such as medical anxiety from repeated exams or patient/parent comprehension of surgical goals), Cheng and colleagues [
      • Cheng J.W.
      • Cain M.P.
      • Nicassio L.N.
      • Amies Oelschlager A.-M.E.
      • Fechner P.Y.
      • McCauley E.
      • et al.
      Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: a standardized protocol for quality improvement.
      ] present pioneering research showing that digital photography improves the perioperative care of female congenital adrenal hyperplasia (CAH) patients by reducing opportunity costs related to travel and the number of clinical exams, as well as providers performing them. These are process measures, which are one of three types of meaningful outcomes in quality improvement research (process, balancing, outcome measures). Further studies should aim to demonstrate improvement in medical anxiety and perhaps educational endpoints (for patients and trainees) between photographic and legacy examinations.
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      References

        • Codman E.A.
        The registry of bone sarcoma as an example of the end-result idea in hospital organization.
        Bull Am Coll Surg. 1924 Jan; 8: 34-38
        • Cheng J.W.
        • Cain M.P.
        • Nicassio L.N.
        • Amies Oelschlager A.-M.E.
        • Fechner P.Y.
        • McCauley E.
        • et al.
        Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: a standardized protocol for quality improvement.
        J Pediatr Urol. April 2022; (S1477-5131(22)00145-0)
        • Awad A.J.
        • Walker L.
        • Lew S.M.
        Radiological imaging transmission via smartphones by neurosurgery residents in the United States.
        World Neurosurg. 2021 Oct; 154: e437-e442
        • Chandawarkar R.
        • Nadkarni P.
        Safe clinical photography: best practice guidelines for risk management and mitigation.
        Arch Plast Surg. 2021; 48: 295-304

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