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Primary eye care

Yao Liu, Nicholas J Zupan, Rebecca Swearingen, Nora Jacobson, Julia N Carlson, Jane E Mahoney, Ronald Klein, Timothy D Bjelland, Maureen A Smith
OBJECTIVE: Teleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. We sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use. DESIGN: We conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use...
February 18, 2019: BMJ Open
Claire Nollett, Barbara Ryan, Nathan Bray, Catey Bunce, Robin Casten, Rhiannon Tudor Edwards, David Gillespie, Daniel J Smith, Miles Stanford, Tom H Margrain
OBJECTIVE: To identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future. DESIGN: A cross-sectional study using baseline data from a pragmatic randomised controlled trial. SETTING AND PARTICIPANTS: 990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London...
January 17, 2019: BMJ Open
Louis Vernacchio, Emily K Trudell, Sarah R McLaughlin, Vijeta Bhambhani
Recently, several professional groups have recommended a change from chart-based to instrument-based screening for preschool-age children, but the effect of this change on health care utilization is unknown. We performed a secondary analysis of a site-randomized quality improvement project on transitioning from chart-based to instrument-based vision screening for 3- to 5-year-old children in primary care. We analyzed visit rates to ophthalmologists and optometrists and costs of such care before and after implementation of instrument-based vision screening with comparison to nonparticipating practices...
February 19, 2019: Clinical Pediatrics
Federico Paoli, Ingrid Schmidt, Olivia Wigzell, Andrzej Ryś
EU countries have recently joined forces to carry out common work on health systems performance assessment (HSPA). After the signature of the Tallinn Charter in 2008, a small group of countries brought the issue of HSPA on the EU agenda; this led the European commission and member states to set up an expert group on HSPA in 2014. This group started by facilitating the exchange of best practices and lessons learnt, with an eye to avoiding duplications with activities of international organisations. While progressing on its work, the group broadened its scope: it stepped into concrete work on policy priorities such as the assessment of quality of care, integrated care and primary care...
February 12, 2019: Health Policy
Lisa A Hark, Jonathan S Myers, Andrew Ines, Alicia Jiang, Kamran Rahmatnejad, Tingting Zhan, Benjamin E Leiby, Sarah Hegarty, Scott J Fudemberg, Anand V Mantravadi, Michael Waisbourd, Jeffrey D Henderer, Christine Burns, Meskerem Divers, Jeanne Molineaux, Laura T Pizzi, Ann P Murchison, Jinan Saaddine, Louis R Pasquale, Julia A Haller, L Jay Katz
AIMS: To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS: A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes...
February 15, 2019: British Journal of Ophthalmology
G Alden Holmes, Janna M Vassantachart, Brittanya A Limone, Michael Zumwalt, Jane Hirokane, Sharon E Jacob
Use of dermoscopy and detection algorithms by primary care physicians can enhance assessment of clinically suspicious lesions compared with that of naked eye examinations.
May 2018: Federal Practitioner: for the Health Care Professionals of the VA, DoD, and PHS
Noemi Lois, Evie Gardner, Norman Waugh, Augusto Azuara-Blanco, Hema Mistry, Danny McAuley, Nachiketa Acharya, Tariq M Aslam, Clare Bailey, Victor Chong, Louise Downey, Haralabos Eleftheriadis, Samia Fatum, Sheena George, Faruque Ghanchi, Markus Groppe, Robin Hamilton, Geeta Menon, Ahmed Saad, Sobha Sivaprasad, Marianne Shiew, David H Steel, James Stephen Talks, Catherine Adams, Christina Campbell, Matthew Mills, Mike Clarke
BACKGROUND: In the UK, macular laser is the treatment of choice for people with diabetic macular oedema with central retinal subfield thickness (CST) < 400 μm, as per National Institute for Health and Care Excellence guidelines. It remains unclear whether subthreshold micropulse laser is superior and should replace standard threshold laser for the treatment of eligible patients. METHODS: DIAMONDS is a pragmatic, multicentre, allocation-concealed, randomised, equivalence, double-masked clinical trial that aims to determine the clinical effectiveness and cost-effectiveness of subthreshold micropulse laser compared with standard threshold laser, for the treatment of diabetic macular oedema with CST < 400 μm...
February 12, 2019: Trials
Eileen L Mayro, Laura T Pizzi, Lisa A Hark, Ann P Murchison, Douglas Wisner, Anish Koka, Benjamin E Leiby, Nooreen Dabbish, Adedoyin Okulate, Alexa Dessy, Caitlin Green, Robert Bailey
Background: Cataracts are the leading cause of preventable blindness globally. As a result, competence in cataract surgery is an important component of ophthalmology residency training. Residency programs must optimize the number of cataract surgery cases to train proficient physicians. However, the rate of cataract surgery cancellations is high, and some are canceled because of preventable causes. Objective: To evaluate the effect of mandatory on-site preadmission testing, including having a physical examination, on resident-performed cataract surgery cancellation rates...
December 2018: American Health & Drug Benefits
Johann S de Bono, Nicole Concin, David S Hong, Fiona C Thistlethwaite, Jean-Pascal Machiels, Hendrik-Tobias Arkenau, Ruth Plummer, Robert Hugh Jones, Dorte Nielsen, Kristian Windfeld, Srinivas Ghatta, Brian M Slomovitz, James F Spicer, Jeffrey Yachnin, Joo Ern Ang, Paul Morten Mau-Sørensen, Martin David Forster, Dearbhaile Collins, Emma Dean, Reshma A Rangwala, Ulrik Lassen
BACKGROUND: Tisotumab vedotin is a first-in-human antibody-drug conjugate directed against tissue factor, which is expressed across multiple solid tumour types and is associated with poor clinical outcomes. We aimed to establish the safety, tolerability, pharmacokinetic profile, and antitumour activity of tisotumab vedotin in a mixed population of patients with locally advanced or metastatic (or both) solid tumours known to express tissue factor. METHODS: InnovaTV 201 is a phase 1-2, open-label, dose-escalation and dose-expansion study done at 21 centres in the USA and Europe...
February 7, 2019: Lancet Oncology
Suneeta Dubey, Kanika Jain, Saptarishi Mukherjee, Neha Sharma, Julie Pegu, Monica Gandhi, Madhu Bhoot
PURPOSE: To study the current profile of secondary glaucoma in all age groups of patients presenting to a tertiary eye care hospital in Northern India Materials and methods: In this retrospective study, files of 5725 patients who were newly diagnosed to have glaucoma in our tertiary eye care centre from January 2014 to December 2016 were reviewed. Detailed data were collected from patient's records, including history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy findings, gonioscopy, and fundus findings...
February 4, 2019: Ophthalmic Epidemiology
Duangnate Rojanaporn, Ekachat Chanthanaphak, Rawi Boonyaopas, Tharikarn Sujirakul, Suradej Hongeng, Sirintara Singhara Na Ayudhaya
PURPOSE: To study the safety and efficacy of intra-arterial chemotherapy (IAC) as a treatment for intraocular retinoblastoma in Thailand. DESIGN: Retrospective, interventional case series. METHODS: In this study, IAC was performed as primary or secondary treatment for patients with intraocular retinoblastoma using melphalan with or without additional topotecan or carboplatin. Survival rate, globe salvage rate, and treatment complications were recorded and analyzed...
February 4, 2019: Asia-Pacific Journal of Ophthalmology
Josep Vidal-Alaball, Dídac Royo Fibla, Miguel A Zapata, Francesc X Marin-Gomez, Oscar Solans Fernandez
BACKGROUND: Diabetic retinopathy (DR) is one of the most important causes of blindness worldwide, especially in developed countries. In diabetic patients, periodic examination of the back of the eye using a nonmydriatic camera has been widely demonstrated to be an effective system to control and prevent the onset of DR. Convolutional neural networks have been used to detect DR, achieving very high sensitivities and specificities. OBJECTIVE: The objective of this is paper was to develop an artificial intelligence (AI) algorithm for the detection of signs of DR in diabetic patients and to scientifically validate the algorithm to be used as a screening tool in primary care...
February 1, 2019: JMIR Research Protocols
Diane M Gibson
Importance: Prior studies found that screening for diabetic retinopathy (DR) in primary care settings using telemedicine increased screening rates among individuals with diabetes. This finding has led to interest in expanding the use of primary care-based screening for DR. Objective: To estimate the percentages of US adults with diabetes and high-risk US adults with diabetes who have regular contact with primary care physicians and therefore could potentially receive timely screening for DR in primary care settings...
January 31, 2019: JAMA Ophthalmology
Clare Villalba, Deborah Askew, Anjali Jaiprakash, Jared Donovan, Jonathan Roberts, Anthony Russell, Ross Crawford, Noel Hayman
This research applies a mixed-method approach to retrospectively study the history of diabetic retinopathy (DR) screening in an urban Aboriginal and Torres Strait Islander general practice. Data from administrative practice software and publications were extracted and presented as a timeline data visualisation to staff, in six focus groups. Eighteen key staff from the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (CoE) were purposively recruited. The main outcome measures were retrospective administrative practice data, publications and staff interpretations regarding DR screening at the CoE...
January 30, 2019: Australian Journal of Primary Health
Jialiang Zhao, Silvio Paolo Mariotti, Serge Resnikoff, Yuqin Wang, Shicheng Yu, Mingguang He, Yingchuan Fan, Haidong Zou, Wenfang Zhang, Yading Jia, Lihua Wang, Huaijin Guan, Xiao Xu, Leilei Zhan, Lei An, Quanfu Ye, Ningli Wang
BACKGROUND: China used to be among the countries with a high prevalence of trachoma. At the launch of The Global Elimination of Trachoma (GET) 2020 campaign by the World Health Organization (WHO) in 1996, China was placed on the list of countries endemic for trachoma based on historical data. However, empirical observation and routinely collected eye care data were suggesting that trachoma was no longer a public health problem. To determine whether the GET 2020 goals had been met in P...
January 28, 2019: PLoS Neglected Tropical Diseases
Harathy Selvan, Dewang Angmo, Ankit S Tomar, Suresh Yadav, Arpit Sharma, Tanuj Dada
PURPOSE: To study the change in intraocular pressure (IOP) and angle status after phacoemulsification in a cohort of primary angle closure hypertension (PACHT) patients. SETTING: Tertiary Eye Care, India. DESIGN: Prospective interventional case-series. METHODS: Case-series of 18 eyes of 18 patients. Preoperative biometry including axial length, anterior chamber depth (ACD), lens thickness, and central corneal thickness were studied...
February 2019: Journal of Glaucoma
Isaac Siegfried, Jennifer Jacobs, Robert P Olympia
BACKGROUND: Although urgent care centers (UCCs) can often evaluate and treat minor injuries/illnesses, patients may present with life threatening conditions that require immediate recognition, stabilization, and transfer to a higher level of care, beyond the capabilities of most UCCs. OBJECTIVE: To describe adult ED referrals from UCCs and to determine the percentage of referrals considered critical, complex, and simple. METHODS: A prospective study was conducted between 8/2016-8/2017 on patients >18 years referred directly to our ED from surrounding UCCs...
January 17, 2019: American Journal of Emergency Medicine
Cheuk Ni Kan, Liwen Zhang, Ching-Yu Cheng, Tien Yin Wong, Narayanaswamy Venketasubramanian, Christopher Li-Hsian Chen, Xin Xu
OBJECTIVES: The informant-AD8 (i-AD8) was found to be reliable in detecting cognitive impairment and dementia in tertiary and primary health care settings. We evaluated the discriminability of the i-AD8, as compared to other brief cognitive measures, and its combination with the 5-minute Montreal Cognitive Assessment (MoCA) and Mini-Cog in detecting very mild dementia in an Asian older cohort. DESIGN: The Epidemiology of Dementia in Singapore (EDIS) study recruited participants from a population-based eye disease study who were of Chinese, Malay, and Indian ethnicities...
January 17, 2019: Journal of the American Medical Directors Association
Iwona M Kicinger, Alison Cuellar, Lorens A Helmchen, Gilbert Gimm, Jay Want, Bradley J Kells, Len M Nichols
Despite their value, comprehensive diabetes care and screening for common cancers remain underutilized. We examined the association between participation in a patient-centered medical home (PCMH) program with strong financial incentives and receipt of preventive care in the first 5 years after program launch. Using multivariate regression analysis, we compared outcomes for adults under the care of participating primary care providers (PCPs) with adults under the care of nonparticipating PCPs. Outcomes were breast, cervical and colorectal cancer screenings, and elements of diabetes care...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Megan Quist, Debra Chopp, Camille M Wilson, Jenny Radesky
Charles is a 10-year-old African-American male who presents to the Developmental Behavioral Pediatrics Clinic for evaluation of his learning. His primary care provider (PCP) was concerned that his developmental delays were negatively affecting his ability to engage in his homeschooling curriculum and also that his mother seemed unaware of the severity of his delays. Neuropsychological evaluation had been recommended by the PCP several times in the past, but the family declined. At one point, the PCP had considered potential child protective services (CPS) referral for medical neglect because of missed appointments and lack of follow-through on recommendations, which motivated the parent to bring him to this appointment...
January 14, 2019: Journal of Developmental and Behavioral Pediatrics: JDBP
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