scholarly journals P009 Service evaluation to optimise ophthalmological services for hydroxychloroquine retinal screening

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Chan Ning Lee ◽  
Mrinalini Dey ◽  
Mooikhin Hng ◽  
Simon Peterson ◽  
Imna Rahiman ◽  
...  
Keyword(s):  
Patient Education ◽  
Service Evaluation ◽  
Continuous Treatment ◽  
Fundus Photography ◽  
Baseline Risk ◽  
Service Development ◽  
Cross Sectional ◽  
Retinal Pathology ◽  
Retinal Screening ◽  
Sd Oct

Abstract Background/Aims  Hydroxychloroquine (HCQ), a frequently-used therapy in rheumatology, can be associated with retinal toxicity. More stringent screening and monitoring guidelines for HCQ-related retinopathy were published by the Royal College of Ophthalmologists (RCOphth) in 2018. Recommendations include: 1) baseline retinal screening within six-twelve months of commencing HCQ; 2) subsequent annual monitoring for at-risk patients, specifically: concurrent tamoxifen-use, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, HCQ dose >5mg/kg/day; 3) annual monitoring for all other patients after five years continuous treatment; 4) patient education on HCQ retinopathy. We quantified the rheumatology HCQ exposure and estimated burden on ophthalmology, to inform the development of HCQ retinal screening services. Methods  Cross-sectional data were extracted for patients established on HCQ between 1995-2020 including: weight; eGFR; concomitant retino-toxic medication; concomitant retinal pathology; HCQ dose and duration; documentation of patient education on retinal side-effects. Documentation of relevant ophthalmic testing at baseline (i.e. at time of starting HCQ) were recorded, specifically colour fundus photography, spectral domain optical coherence tomography (SD-OCT) and 10-2 Humphrey visual field (HVF) testing as necessary. Subsequent monitoring with 10-2 HVFs, SD-OCT, autofluorescence (AF) and electrodiagnostic tests (EDTs) as appropriate annually from baseline and from 5 years was recorded. Results  150 patients were included, 84% female, with a mean baseline age of 50.7 years (SD 14.8) and mean weight of 76.4kg (SD 17.6). 63% were on HCQ >5 years (mean duration 7.0 years, SD 5.1). At time of auditing, 50% (75/150) patients had permanently ceased HCQ (62% due to treatment >5 years). 60% patients had documented evidence of education regarding HCQ retinopathy. Of the 150 patients, 39% had baseline risks for retinopathy. 6% had a baseline eGFR <60ml/min/1.73m2. 32% were commenced on HCQ dose greater than 5mg/kg/day. No patients were on concomitant tamoxifen; one patient was on a known retino-toxic drug (quinine). 4% of patients had pre-existing retinal pathology. Of the 75 patients still taking HCQ at time of auditing, 27 (36%) had baseline risk factors warranting yearly retinal screening and 44 (58%) had been on treatment >5years. Most ophthalmology reviews were put on hold until a screening service was established. Of the small number (5.3%) that had baseline ophthalmic screening, 12.5% had colour photography and 75% had SD-OCT. No patients required HVF testing or EDTs. Annual screening revealed 50% of patients had 10-2 HVFs; 75% had SD-OCT; 75% had AF. Only one patient developed maculopathy, not attributed to HCQ. Conclusion  Our results demonstrate the need for service development to facilitate adherence to RCOphth guidance. Up to 40% of patients started on HCQ have baseline risks for retinopathy, most due to dosing >5mg/kg/day warranting yearly screening. Our findings will inform development of a rheumatology HCQ retinal screening pathway and services, to ensure safe long-term use of HCQ. Disclosure  C. Lee*: None. M. Dey*: None. M. Hng: None. S. Peterson: None. I. Rahiman: None. M. Elshafei: None. C. Estrach: None. N.J. Goodson: None.

scholarly journals Diabetic maculopathy: multicolour and SD-OCT versus fundus photography

2021 ◽  
Vol 6 (1) ◽  
pp. e000514
Author(s):  
Obaid Kousha ◽  
Martina Maria Delle Fave ◽  
Mariano Cozzi ◽  
Elisa Carini ◽  
Sergio Pagliarini
Keyword(s):  
Macular Oedema ◽  
Cross Sectional Study ◽  
Fundus Photography ◽  
Diabetic Maculopathy ◽  
Perfect Agreement ◽  
Cross Sectional ◽  
Clinically Significant ◽  
Fundus Photographs ◽  
Diabetic Eye Screening ◽  
Sd Oct

ObjectiveThe English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening.Methods and analysisThis cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.ResultsIntergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema.ConclusionMulticolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.

scholarly journals Characterizing right-angled vessel in macular telangiectasia type 2 with structural optical coherence tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo-Ri Chung ◽  
Young Ho Kim ◽  
Jaeryung Oh ◽  
Seong-Woo Kim ◽  
Christopher Seungkyu Lee ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Cross Sectional Study ◽  
Fundus Photography ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Macular Telangiectasia ◽  
Advanced Phase ◽  
Tertiary Hospitals ◽  
Sd Oct

AbstractWe investigated the structural findings on spectral-domain optical coherence tomography (SD-OCT) related to the presence of right-angled vessels (RAV) in patients with macular telangiectasia (MacTel) type 2 with severity 3 in Korea. A retrospective multicenter cross-sectional study was conducted in six tertiary hospitals in Korea; the study included 116 MacTel type 2 eyes with severity 3. The SD-OCT findings were compared between eyes with RAV on fundus photography or fluorescein angiography and those without RAV. Logistic regression was performed to determine factors associated with the presence of RAV. Fifty eyes presented with RAV and 61 eyes without RAV. More eyes presented with only inner retinal (IR) cavities on SD-OCT among eyes without RAV than among those with RAV (P < 0.001). However, eyes with RAV presented with IR disorganization, outer retinal (OR) cavity, and ellipsoid zone (EZ) disruption more frequently than eyes without RAV did (all P < 0.001). These SD-OCT findings were significantly associated with the presence of RAV. The presence of RAV was closely related to IR disorganization, OR cavities, and EZ disruption on SD-OCT. These findings suggest an advanced phase of MacTel type 2.

scholarly journals Long-Term Natural Outcomes of Simple Hemorrhage Associated with Lacquer Crack in High Myopia: A Risk Factor for Myopic CNV?

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Bing Liu ◽  
Xiongze Zhang ◽  
Lan Mi ◽  
Ling Chen ◽  
Feng Wen
Keyword(s):  
Risk Factor ◽  
High Myopia ◽  
Fundus Photography ◽  
Fundus Fluorescein Angiography ◽  
Cross Sectional ◽  
Ellipsoid Zone ◽  
Significant Difference ◽  
Sd Oct ◽  
Myopic Cnv ◽  
Central Fovea

Purpose. To investigate the relationship between simple hemorrhage (SH) associated with lacquer crack (LC) and myopic choroidal neovascularization (CNV) in high myopia.Methods. A cross-sectional evaluation including best-corrected visual acuity (BCVA), axial length, refractive error, color fundus photography, and spectral domain optical coherence tomography (SD-OCT) was performed in patients diagnosed with high myopia and SH. Fundus fluorescein angiography and indocyanine green angiography were performed if the eye was suspected with CNV.Results. Thirty-three eyes of 27 patients with SH were enrolled in the study. None of the eyes developed CNV at final examination following the occurrence of hemorrhage. Recurrent hemorrhage was observed in 36.5% of the eyes. Compared with the initial BCVA, the final BCVA was significantly improved (P<0.001) and correlated with the integrity of the ellipsoid zone in SD-OCT. There was no significant difference in the final BCVA between group 1 (LC crossed the central fovea) and group 2 (no LC crossed the central fovea) (P=0.299).Conclusions. SH associated with LC is not a risk factor for the development of myopic CNV in patients with high myopia. LCs have little influence on the final BCVA unless the integrity of the ellipsoid zone in the central fovea is disrupted.

Oscillation between identities and Subjective psychological health objectives among an informed audience in therapeutic patient education

2018 ◽  
Vol 10 (1) ◽  
pp. 10202
Author(s):  
Sandrine Roussel ◽  
Alain Deccache ◽  
Mariane Frenay
Keyword(s):  
Patient Education ◽  
Psychological Health ◽  
Healthcare Professionals ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Therapeutic Patient Education ◽  
French Speaking ◽  
Health Objectives ◽  
Self Administered Questionnaire

Introduction: The implementation of Therapeutic Patient Education (TPE) remains a challenge. An exploratory study highlighted two tendencies among practitioners of TPE, which could hamper this implementation: an oscillation between identities (as caregivers versus as educators) and an inclination towards subjective psychological health objectives. Objectives: To verify whether these tendencies can be observed among an informed audience in TPE. Next, to explore the variables associated with one or other of these tendencies. Method: A quantitative cross-sectional survey by a self-administered questionnaire was carried out among 90 French-speaking healthcare professionals. Statistical analyses (chi-square, logistic regression) were then conducted. Results: Sixty percent of respondents displayed identity oscillation, which was found to be linked to task oscillation, patient curability, scepticism towards medicine and practising in France. Fifty-six percent pursued subjective psychological health objectives, which was found to be associated with health behaviour objectives and a locus of power in the healthcare relationship distinct from those seen in the pre-existing health models (biomedical, global). This tendency seems to constitute an alternative model of TPE. Discussion & conclusion: Identity oscillation and subjective psychological health objectives can be both observed. This study stresses the need to deliberate on the form(s) of TPE that is/are desired.

scholarly journals 41 From Ward to Classroom: Service Evaluation of Education to Increase Awareness of Frailty and Resilience and Encourage Greater Physical Activity

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65 ◽  
Author(s):  
John Travers ◽  
Roman Romero-Ortuno ◽  
Declan Lyons ◽  
Marie-Therese Cooney
Keyword(s):  
Physical Activity ◽  
Patient Education ◽  
Health Education ◽  
Group Discussion ◽  
Service Evaluation ◽  
Old Patients ◽  
Strength Exercises ◽  
Local Quality ◽  
Key Aspects ◽  
Weekly Group

Abstract Background Our hospital routinely offers a weekly group discussion session for inpatients on aspects of ageing as part of an ‘evergreen programme’ (EP) of health education. Topics are varied and facilitated by a doctor in an informal, open forum. Feedback from nurses, doctors and patients suggested that the EP was lacking in emphasis on the benefits of exercise to improve the levels of physical activity among inpatients. As part of a local quality improvement (QI) initiative, the EP set out to incorporate the provision of patient education on the reported benefits of strength exercises in delaying and reversing frailty. Here we describe the development of this QI initiative and its evaluation. Methods New health education content was added to an EP group discussion to address four key aspects of frailty, namely: definition, risks, screening and interventions. The Socratic health education method was used in the next weekly group discussion (e.g., what does frailty mean to you? What are the consequences? How would you measure frailty? What if it could be delayed or reversed?). An exercise leaflet was provided and strength exercises were demonstrated. Results 18 of 27 over-65-year-old patients attended the group discussion, mean age 75, 11 female (61%). 2 participants were interested in doing strength exercises at the start of the session (11%, 0 female) when asked. Most participants had not been aware that strength exercises can delay and reverse frailty. 14 participants (78%, 8 female) declared interest in doing strength exercises at the end. Interested participants used the exercise leaflet for independent exercise in hospital and brought it home on discharge. Conclusion The EP at our hospital has been improved to include greater emphasis on the benefits of strength exercises in delaying and reversing frailty. QI initiatives can allow translation of research evidence into patient education.

scholarly journals Implications of Lifestyle and Occupational Factors on the Risk of Breast Cancer in Shiftwork Nurses

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 649
Author(s):  
Javier Fagundo-Rivera ◽  
Regina Allande-Cussó ◽  
Mónica Ortega-Moreno ◽  
Juan Jesús García-Iglesias ◽  
Adolfo Romero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Shift Work ◽  
Regression Tree ◽  
Night Work ◽  
Circadian Disruption ◽  
Classification And Regression Tree ◽  
Baseline Risk ◽  
Unhealthy Lifestyle ◽  
Cross Sectional ◽  
Occupational Factors

Shift work that involves circadian disruption has been highlighted as a likely carcinogenic factor for breast cancer in humans. Also, unhealthy lifestyle habits observed in night work nurses could be causally related to an increase in the incidence of estrogen-positive breast tumours in this population. Assessing baseline risk of breast cancer in nurses is essential. The objective of this study was to analyze the risk of breast cancer that nurses had in relation to their lifestyle and labour factors related to shift work. A cross-sectional descriptive study through a questionnaire about sociodemographic variables, self-perception of health, and working life was designed. The sample consisted of 966 nurses. The relationship between variables was tested. A binary logistic regression and a classification and regression tree were performed. The most significant labour variables in relation to the risk of breast cancer were the number of years worked (more than 16 years; p < 0.01; OR = 8.733, 95% CI = 2.811, 27.134) and the total years performing more than 3 nights per month (10 or more years; p < 0.05; OR = 2.294, 95% CI = 1.008, 5.220). Also, the nights worked throughout life (over 500; OR = 4.190, 95% CI = 2.118, 8.287) were significant in the analysis. Nurses who had or ever had breast cancer valued their self-perceived health more negatively (p < 0.001) and referred a lower quality of sleep (p < 0.001) than the non-cases nurses. The occupational factors derived from night work could have several impacts on nurses’ health and their family-work balance. Promoting healthy lifestyles, informing about shift work risks, and adjusting shift work schedules are critical methods to decrease the possible effects of circadian disruption in nurses.

scholarly journals Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alex F. Martin ◽  
Sarah Denford ◽  
Nicola Love ◽  
Derren Ready ◽  
Isabel Oliver ◽  
...  
Keyword(s):  
Pilot Study ◽  
Minority Groups ◽  
Service Evaluation ◽  
Future Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Group ◽  
Negative Test ◽  
The Impact ◽  
Close Contacts

Abstract Background In December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10–14 days. In this study, we evaluated engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results. Methods We conducted a service evaluation of the pilot study, examining survey responses from a subset of those who responded to an evaluation questionnaire. We used an online cross-sectional survey offered to adult contacts of confirmed COVID-19 cases who consented to daily testing. We used a comparison group of contacts who were not offered testing and instead self-isolated. Results Acceptability of daily testing was lower among survey respondents who were not offered the option of testing and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts. Conclusions Our data suggest that daily testing is potentially acceptable, may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, and restrictions on activity have been reduced.

scholarly journals 127. Improving Patient Foot Health Care Through Audit and Service Evaluation: One-Year Outcomes of Regional Service Development Programme

Rheumatology ◽  
2014 ◽  
Vol 53 (suppl_1) ◽  
pp. i107-i108
Author(s):  
Lindsey S. Cherry ◽  
Rachel Merriman ◽  
Penelope Barnard ◽  
Colin Beevor ◽  
Graham Bowen ◽  
...  
Keyword(s):  
Health Care ◽  
Service Evaluation ◽  
Development Programme ◽  
Service Development ◽  
Foot Health ◽  
Regional Service ◽  
One Year

scholarly journals Identification of Ocular and Auditory Manifestations of Congenital Rubella Syndrome in Mbingo

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Imran Jivraj ◽  
Chris J. Rudnisky ◽  
Emmanuel Tambe ◽  
Graham Tipple ◽  
Matthew T. S. Tennant
Keyword(s):  
Hearing Impairment ◽  
Cross Sectional Study ◽  
Normal Hearing ◽  
Congenital Rubella Syndrome ◽  
Congenital Glaucoma ◽  
Fundus Photography ◽  
Igg Antibody ◽  
Case Definitions ◽  
Cross Sectional ◽  
Congenital Rubella

Purpose. Congenital rubella syndrome (CRS) is a global cause of preventable hearing impairment, blindness, and intellectual impairment. The present study sought to identify ocular and auditory manifestations of CRS in school-aged children in Mbingo, Cameroon.Design. Cross sectional study.Subjects. Students at two schools, one for children with hearing impairment, were screened for cataract, congenital glaucoma, and pigmentary retinopathy.Methods. Students underwent seven-field digital fundus photography through a dilated pupil using a Topcon NW200 nonmydriatic camera. Images were assessed by retina specialists in Canada via teleophthalmology. Clinical evidence was integrated to form case definitions for CRS based on Center for Disease Control and Prevention guidelines. Serological evidence of rubella infection was obtained using standardized IgG antibody titers.Main Outcome Measure. Number of probable and suspicious cases of CRS.Results. Between September 2009 and May 2010, 320 students participated. There were 28 (10.2%) probable cases, 104 (37.8%) suspects, and 143 (52.0%) unaffected. Rubella IgG serology was positive in 79 (48.7%) of children with hearing impairment and 11 (7.4%) of children with normal hearing.Conclusions. The present study identified 28 probable cases of CRS. Furthermore, 92.6% of students with normal hearing did not possess rubella IgG antibodies making future cases of CRS likely without intervention.

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