Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review
Bibliographic record
Abstract
BACKGROUND: Acne is a common, chronic, and burdensome disease. There is evidence of delayed and inequitable patient access to isotretinoin. Overuse of antibiotics in patients with acne raises antimicrobial stewardship concerns. AIM: To identify clinical practice guideline (CPG) and consensus statement recommendations regarding the clinical competencies required for prescribing oral isotretinoin for acne. DESIGN AND SETTING: This was a scoping review of acne CPGs and consensus statements, globally. METHOD: The Arksey and O'Malley framework informed design in conjunction with Joanna Briggs Institute guidance. The PRISMA extension for Scoping Reviews guided reporting. The search was conducted across six databases (Embase, Scopus, Web of Science, PubMed, CINAHL, PsycINFO), three guideline repositories (Scottish Intercollegiate Guidelines Network, Guidelines International Network, Trip), and grey literature. Two researchers independently screened titles and abstracts, and full-text papers. The AGREE II checklist appraised CPG quality. RESULTS: From the initial 2292 articles, eight CPGs were included after applying inclusion and exclusion criteria. Five were from Europe, with one each from the US, Canada, and Malaysia. The CPG guidance varied regarding 'Which doctor may prescribe isotretinoin?' All CPGs indicated dermatologists and four identified GPs as appropriate prescribers. The CPGs identify the clinical competencies to safely manage people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. CONCLUSION: This scoping review has identified the key clinical competencies that underpin safe management of people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. Resourcing and supporting GPs to incrementally adopt this role may promote safe, timely, and equitable patient access to isotretinoin, while enhancing antimicrobial stewardship.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.107 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.026 | 0.023 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".