Transition from an in-person to a telemedicine diabetic retinopathy screening program.

PURPOSE: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. METHODS: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. RESULTS: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). CONCLUSION: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings.

Transition from an in-person to a telemedicine diabetic retinopathy screening program

ABSTRACT Purpose: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. Methods: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. Results: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). Conclusion: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings.

Hiponatremia em pacientes internados / Hyponatremia in hospitalized patients

Objetivo: Avaliar a prevalência de hiponatremia em pacientes internados, determinando seu perfil epidemiológico. Métodos: Estudo prospectivo, observacional e longitudinal. Utilizou-se o banco de dados do hospital no período entre março e maio de 2017, com total de 320 indivíduos. A análise estatística foi rea- lizada por meio do Statistical Package for Social Science, versão 24.0. Resultados: Do total de 320 pacientes avaliados, 51,6% deles eram do sexo masculino. A idade média foi de 62,73 anos, e a maior parte era da cor parda. Desenvolveram hiponatremia no decorrer do estudo 135 (42,18%) pacientes. Diabéticos tiveram maior predisposição a desenvolver hiponatremia (57,7%). Outras comorbidades também foram frequentes, como hipertensão ar- terial sistêmica (61,9%) e doenças neurodegenerativas (23,3%). Conclusão: Houve maior prevalência de hiponatremia nos pa- cientes do sexo feminino, acima dos 60 anos e pardos. O diabetes mellitus foi considerado fator de risco para o desenvolvimento da hiponatremia. Os resultados visam ampliar a percepção a respeito desse distúrbio hidroeletrolítico tão encontrado na clínica médica e que, muitas vezes, não recebe a devida importância.

Objective: to evaluate the prevalence of hyponatremia in hos- pitalized patients, determining their epidemiological profile. Me- thods: This is a prospective, observational and longitudinal study. The hospital database was used from March to May 2017, with a total of 320 individuals. The statistical analysis was done by means of the Statistical Package for Social Science, version 24.0. Results: Of the 320 patients evaluated, 51.6% were male. The mean age was 62.73 years old, with most of them being brown-skinned. A total of 135 (42.18%) of the patients developed hyponatremia over the course of the study. Diabetics had greater predisposition to de- velop hyponatremia (57.7%). Other frequent comorbidities were systemic arterial hypertension (61.9%) and neurodegenerative diseases (23.3%). Conclusion: There was a higher prevalence in females, those above 60 years old, and brown-skinned. Diabetes mellitus was considered a risk factor for the development of hypo- natremia. The results aim to increase the perception regarding this hydroelectrolytic disorder frequently found in internal medi- cine practice, and that does not receive the proper importance.