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Retinopathy Screening (retinopathy + screening)
Kinds of Retinopathy Screening Terms modified by Retinopathy Screening Selected AbstractsDiabetic retinopathy screening: a systematic review of the economic evidenceDIABETIC MEDICINE, Issue 3 2010S. Jones Diabet. Med. 27, 249,256 (2010) Abstract This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were ,diabetic retinopathy', ,screening', ,economic' and ,cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost,utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients. [source] A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathyDIABETIC MEDICINE, Issue 7 2003J. A. Olson Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source] Training evaluation of a course in diabetic retinopathy screeningEUROPEAN DIABETES NURSING, Issue 2 2005R Pauli PhD Senior Lecturer Abstract The success and effectiveness of diabetic screening programmes are dependent on the availability of appropriately trained image graders. This study was designed to evaluate graders enrolled on a locally devised, formal training course by means of a performance-based measure. The course consisted of four days of classroom-based tuition followed by three months of practice-based learning in the workplace. The aim was to establish whether trainees showed an improvement in their ability to grade images, and secondly whether test sets of images are useful in measuring training outcome. Thirteen trainees were required to grade a test set of 24 single images both before and after training. A significant improvement in sensitivity (from 35% before training to 45% after training) was observed as a result of training but at a cost of a decline in specificity. Trainees' confidence ratings measured on a five-point scale increased from an average of 2.4 to 4.1 (p<0.01). We concluded that the course needs to focus more on trainees' ability to discriminate between normal and abnormal images as well as improving grading accuracy in line with increased grading confidence. Test-based course evaluation can be seen to be a valuable instrument in establishing a quality standard for stated learning outcomes. In this research it has clearly indicated weaknesses of the training programme in its current form. Copyright © 2005 FEND. [source] Measuring the Quality of Diabetes Care Using Administrative Data: Is There Bias?HEALTH SERVICES RESEARCH, Issue 6p1 2003Nancy L. Keating Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients. Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans. Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data. Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data. Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients <45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent CI 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent CI 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected. Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives. [source] Risk factors for visual impairment registration due to diabetic retinopathy in Leeds, 2002,2005PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2009Diabetes & Endocrinology, H Hayat Specialist Registrar Abstract We undertook a retrospective study of case notes of those patients registered blind or partially sighted due to diabetic retinopathy in the Leeds metropolitan area in the years 2002 and 2005. Both the incidence of visual impairment due to diabetic retinopathy and the relative contribution to total registrations are similar to those observed in other local and national studies. The main risk factors for registered visual impairment were poor glycaemic control prior to ophthalmic review, no prior retinopathy screening, late presentation with symptomatic visual loss, non-compliance with planned review and laser treatment failure. Most of these risk factors are avoidable. Nearly two-thirds of patients diagnosed with diabetes mellitus were being screened for diabetic retinopathy. These figures would suggest that the National Service Framework for Diabetes' proposed coverage of 80% by 2006 and 100% by the end of 2007 is achievable. The duration of diagnosed diabetes mellitus at the time of registration was an average of 16 years in this study. This reflects the slow development of sight-threatening retinopathy and visual loss observed previously. Conventional therapy for diabetic retinopathy with laser photocoagulation reduces the risk of visual loss more effectively than it improves visual function. Despite the increased risk of early worsening of retinopathy seen with intensive glycaemic control in the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study, improved control closer to the time of diagnosis of diabetes mellitus would have helped to provide a sustained reduction in the risk of retinopathy developing or progressing. Both laser treatment failure and non-attendance may limit the benefits of improved screening coverage. Copyright © 2009 John Wiley & Sons. [source] | ||||||||||