Comparison of Photographic Screening Methods for Diabetic Retinopathy - A Meta-analysis.

INTRODUCTION: Diabetic Retinopathy (DR) is a leading cause of irreversible visual impairment and blindness in both developed and developing countries. Although the merits of DR screening are well recognized, significant variations in screening practices including imaging modality still exists. PURPOSE: To evaluate and compare the sensitivity and specificity of mydriatic and non-mydriatic photographic screening methods using 7-Field fundus photography or dilated fundus examination (DFE) by an ophthalmologist as reference standard. METHODS: A systematic review using PRISMA Guidelines was conducted by online search of MEDLINE, Web of Science, and other repositories of all available studies from 1990 until 2019. A total of 62 studies were included in the meta-analysis from a total of 406 suitable abstracts screened and 95 articles reviewed in full. Data were collected using a standardized extraction form independently, with all authors masked to others' search results. RESULTS: For the detection of any DR (ADR), sensitivity ranged from 81% with single field to a maximum of 99% for 4-7 fields and wide-angle images. For detection of referable DR (RDR) sensitivity ranged from 76% for single field to 93% for wide-angle photography. Specificity was lowest at 91% for wide-angle images and greatest at 99% for three field photography. Study heterogeneity was noted to be significant, which was partly attributed to the range of DR classification between studies. CONCLUSIONS: The sensitivity and specificity of DR screening are positively associated with number of photographic fields. Pooled estimates suggest non-mydriatic two-field photography may be sufficient for screening detection of ADR and RDR.

Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis.

PURPOSE: To investigate wellbeing and work impacts in younger people with persistent shoulder pain. MATERIALS AND METHODS: People aged 20-55 years with shoulder pain of >6 weeks' duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire. RESULTS: Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI -0.38 to -0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work. CONCLUSIONS: The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation.Implications for rehabilitationPersistent shoulder pain in younger people (aged 20-55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts.As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age.Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions.Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.

Structured Feedback: Acceptability and Feasibility of a Strategy to Enhance the Role of a Clinical Quality Registry to Drive Change in Cardiac Surgical Practice.

BACKGROUND: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database collects and monitors preoperative, operative, and 30-day outcome data on patients undergoing cardiac surgery, and delivers regular performance feedback reports to key personnel with intent to drive quality improvement. The current feedback approach appears to be ineffective in driving change to minimise Unit performance variation. We sought to determine the acceptability and feasibility of providing structured feedback in addition. METHODS: Cardiac surgeons were surveyed to assess their evaluation of the current feedback reports and assist in developing the content of structured feedback. We then assessed acceptability and performance outcomes of control Units receiving current feedback reports via email, versus intervention Units that in addition received structured feedback. RESULTS: Survey respondents assessing the current feedback report agreed that the content is relevant (95%), key performance indicators (KPIs) are useful (85%), and that it would be beneficial to compare surgeons' KPIs (75%). Survey respondents rating method of feedback, requested structured feedback sessions one to two times annually (67%; control Units), and future structured feedback (83%; intervention Units). With combined report and structured feedback, improved performance was noted for an under-performing Unit. Limitations of feedback in driving quality improvement was high performance of Units at baseline, low surgeon participation, and scheduling challenges for structured feedback. CONCLUSIONS: In this pilot study, compared to the control method, structured feedback did not significantly improve communication. To maximise quality improvement efforts, a collaborative feedback approach that fosters a climate of continuous performance improvement, is recommended.

Exploring the personal burden of shoulder pain among younger people in Australia: protocol for a multicentre cohort study.

INTRODUCTION: Persistent musculoskeletal conditions can impact profoundly on younger people's quality of life, psychological distress and capacity to work, as shown by previous research involving younger people with osteoarthritis. The personal impacts, in particular, work and parenting impacts, of other musculoskeletal conditions (such as persistent shoulder pain) on younger patient groups remain poorly understood. Furthermore, the personal financial burden associated with managing musculoskeletal conditions is rarely documented. This study aims to investigate well-being, work participation and productivity, shoulder-related parenting disability and out-of-pocket healthcare expenditure among younger people with shoulder pain and evaluate changes over 12 months. METHODS AND ANALYSIS: One hundred and fifty people aged 20-55 years with shoulder pain of more than 6 weeks' duration (excluding those with recent history of fracture or dislocation) will be recruited for this cohort study. Participants will be recruited from three major public hospitals in Victoria, Australia, following screening of orthopaedic outpatient clinics lists and referrals. Participants will be asked to complete a baseline questionnaire and 2-week healthcare costs diary, with follow-up data collected at 12 months. Patient-reported outcomes will be collected, including health-related quality of life (HRQoL), shoulder pain and function, psychological distress, shoulder-related parenting disability and work productivity. Information on sociodemographics, employment, health services utilisation and shoulder-related healthcare expenditure will also be collected. Descriptive analysis of baseline data will provide a comprehensive snapshot of the personal burden of shoulder pain. Baseline HRQoL and psychological distress data will be compared with Australian population norms to provide context around well-being. Associations between sociodemographic factors and patient-reported outcomes will be evaluated using univariate and multivariate analyses. Changes in patient-reported outcomes from baseline to 12 months will be analysed using paired t-tests. ETHICS AND DISSEMINATION: Ethics approval has been obtained. The study findings will be submitted to peer-reviewed journals and presented at relevant scientific meetings.

Barriers to the Uptake of Cataract Surgery and Eye Care After Community Outreach Screening in Takeo Province, Cambodia.

PURPOSE: To assess the barriers influencing eye healthcare seeking behavior after community outreach screening. DESIGN: A concurrent mixed methods study. METHODS: A total of 469 patients screened during the previous 12 months were followed up, of which 354 (75%) from 5 districts were interviewed in person, using a semi-structured questionnaire, in-depth interviews (n = 11), and 16 focus groups (n = 71). SPSS and NVivo were used to analyze response frequency and identify themes. RESULTS: Of the respondents, 98% (350/354) reported they were told they had an eye problem, with 295 individuals (83%) told to attend CARITAS Takeo Eye Hospital (CTEH) and 55 to have their eyes checked at Kiri Vong Vision Centre. Of those 68.9% (244/354) who reported seeking treatment, only 7.4% (18/244) reported they attended CTEH, 54% (n = 132) attended a "local pharmacy," 31.6% (n = 77) "self-treated at home," 11% (n = 27) reported "using steam from boiling rice," and 10.7% (n = 26) attended a "traditional healer." Of those who reported reasons for "not attending," responses included "no time" (47.8%, 86/180), "no one to accompany" (21.7%, n = 39), "fear of losing sight" (17.8%, n = 32), "cannot afford to travel" (16.1%, n = 29), and "eye problem is not serious enough" (15.6%, n = 28). Follow-up of patient records identified that 128 individuals (79 females) attended eye care services. CONCLUSIONS: Socioeconomic factors, personal concerns, and the use of local cultural remedies were reasons for not seeking eye hospital treatment. An integrated community approach to improve awareness and uptake of appropriate treatment is recommended.

Disparities in access to anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration.

BACKGROUND: Late neovascular age-related macular degeneration (nvAMD) is very common and causes irreversible severe visual loss unless treated swiftly with vascular endothelial growth factor (VEGF) inhibitors. Although publicly subsidized access to treatment may be inequitable, which is why we assessed treatment provision across Australia. DESIGN: Secondary analysis of Australian data. PARTICIPANTS: All Pharmaceutical Benefits Scheme (including Repatriation PBS) beneficiaries. METHODS: Treatment and incidence data were obtained from Medicare Australia, the Royal Australian and New Zealand College of Ophthalmologists, Optometry Australia, the Blue Mountains Eye Study and the Australian Bureau of Statistics. Data were mapped using geographical information software, and factors associated with treatment provision were assessed using multiple linear regression models. MAIN OUTCOME MEASURE: Unmet need (%) for anti-VEGF treatment for nvAMD. RESULTS: On average, we estimated 7316 incident cases of nvAMD not to be treated per year from 2010 to 2014 (50.1% of total). Number of ophthalmologists and optometrists (per 1000, ß = -0.024; 95% confidence interval [CI] -0.041, -0.007) and being located in remote regions (ß = 0.186; 95% CI 0.110, 0.262) were associated with percentage of untreated cases. A higher proportion of the population speaking a language other than English at home was associated in univariate analyses only (ß = 0.0015; 95% CI -0.0004, 0.0027; P = 0.007). CONCLUSION: A large proportion of incident nvAMD is not treated with anti-VEGF. Not receiving treatment is more likely in regional or remote areas and areas with fewer service providers. Not speaking English at home may further limit access. Service delivery models for more equitable service provision are needed.

Cataract Surgical Rate and Socioeconomics: A Global Study.

PURPOSE: Cataract is the leading cause of blindness and cataract surgical rate (CSR) is used as a proxy indicator of access to cataract services in a country. The aim of this study was to explore the associations between the CSR and the economic development of countries in terms of gross domestic product per capital (GDP/P) and gross national income per capita (GNI/P). METHODS: We systematically searched OVID (Medline and Embase), Pubmed, Embase.com, ISI Web of Science, and Cochrane Library databases, and retrieved additional data from unpublished reports. Cataract surgical rates and economic indicators (GDP/P, GNI/P) were collected for each country from 2005 to 2014. Complete data were used for the 50 largest countries according to World Health Organization (WHO) population estimates. Linear correlations between GDP/P and CSR were calculated. Cataract surgical rate data over two periods were used for analysis: 2005 to 2009 and 2010 to 2014 (CSR in 2009 or nearest year, CSR in 2014 or nearest year). RESULTS: Over the study period, CSR data were available for 152 countries across both time periods. Most of the CSR data were obtained from nongovernment organization (NGO) reports, including WHO reports. A good linear correlation between CSR and GDP/P was found overall, nearest to 2009 (ß = 0.162, Linear: y = 0.162x + 282.242; R2 = 0.665, P < 0.001). Regression analysis of CSR nearest to 2014 produced similar findings, with significant correlations between CSR and GDP/P (Linear: y = 0.208x + 94.008; R2 = 0.785, P < 0.001). When using GNI/P as an economic indicator, similarly excellent lines of fit were obtained. After adjusting for time and country, CSR was significantly associated with GDP/P (Coefficient = 0.147, R2 = 0.759, P < 0.001), and GNI/P (Coefficient = 0.152, R2 = 0.757, P < 0.001). Most countries had an increase in CSRs over time, with the greatest increases observed for Iran and Argentina. CONCLUSION: Cataract surgical rate and economic indicators are closely associated, indicating the strong influence of resource availability on healthcare delivery. Considering this relationship, it is important to be innovative in delivery of low-cost services and invest strategically in capacity development to meet cataract surgical need in low-resource settings.

Field-testing of the rapid assessment of disability questionnaire.

BACKGROUND: The Rapid Assessment of Disability (RAD) questionnaire measures the magnitude and impact of disability and aims to inform the design of disability inclusive development programs. This paper reports the psychometric evaluation of the RAD. METHODS: The initial version of the RAD comprised five sections: 1) demographics, 2) functioning, 3) rights awareness, 4) well-being, and 5) access to the community. Item functioning and construct validity were assessed in a population-based study in Bangladesh. Data were analysed using descriptive statistics (sections 2 and 5) and Rasch modelling (sections 3 and 4). A subsequent case-control study in Fiji tested the refined questionnaire in a cross-cultural setting and assessed the sensitivity and specificity of the RAD section 2 to identify people with disability. RESULTS: 2,057 adults took part in the study (1,855 in Bangladesh and 202 in Fiji). The prevalence of disability estimated using RAD section 2 in Bangladesh was 10.5% (95% CI 8.8-12.2), with satisfactory sensitivity and specificity (62.4% and 81.2%, respectively). Section 3 exhibited multidimensionality and poor differentiation between levels of rights awareness in both Bangladesh (person separation index [PSI] = 0.71) and Fiji (PSI = 0.0), and was unable to distinguish between people with and without disability (Bangladesh p = 0.786, Fiji p = 0.43). This section was subsequently removed from the questionnaire pending re-development. Section 4 had good ability to differentiate between levels of well-being (PSI = 0.82). In both countries, people with disability had significantly worse well-being scores than people without disability (p < 0.001) and also access to all sectors of community except legal assistance, drinking water and toilets (p < 0.001). CONCLUSIONS: Filed-testing in Bangladesh and Fiji confirmed the psychometric robustness of functioning, well-being, and community access sections of the RAD. Information from the questionnaire can be used to inform and evaluate disability inclusive development programs.

Trachoma surveillance annual report, 2008. A report by the National Trachoma Surveillance and Reporting Unit.

The National Trachoma Surveillance and Reporting Unit has reported data for trachoma endemic regions and communities in the Northern Territory, South Australia and Western Australia for 2006 to 2008. Aboriginal children aged 1-9 years were examined using the World Health Organization grading criteria. Screening in the Northern Territory was conducted by the primary health care staff from the Healthy School Age Kids program, the Australian Government Emergency Intervention and Aboriginal Community Controlled Health Services. Forty-three of 92 communities in 6 regions were screened and reported data (2,462 children). In South Australia, the Eye Health and Chronic Disease Specialist Support Program and a team of eye specialists visited 11 of 72 communities in regions serviced by 6 Aboriginal Community Controlled Health Services (365 children). In Western Australia, population health unit and primary health care staff screened and reported data for 67 of 123 communities in 4 regions (1,823 children). Prevalence rates of active trachoma varied between the regions with reported prevalence ranging from 4%-67% in the Northern Territory, 0%-13% in South Australia and 8%-25% in Western Australia. Statistical comparisons must be viewed with caution due to the year-to-year variation in the coverage of children examined and the small numbers. Comparisons of 2006, 2007 and 2008 regional prevalence of active trachoma showed that many communities had no change in prevalence, though there were a few statistically significant increases and decreases (P<0.05). The number of communities screened and the number of children examined has improved but still remains low for some regions. The implementation of the World Health Organization Surgery (for trichiasis), Antibiotics (with azithromycin), Facial cleanliness and Environmental improvement (SAFE) strategy has been variable. Few data continue to be reported for the surgery and environmental improvement components. In general, the availability of the community programs for surgery, antibiotic treatment, and facial cleanliness has improved. Reporting of antibiotic treatment has improved from 2006 to 2008. No significant changes were noted in bacterial resistance reported by pathology services from 2007 to 2008; these rates are comparable to national data collected by the Advisory Group on Antibiotic Resistance in 2005.