المؤلفون: Amer Omar, R. Geoff Williams, James Whelan, Jason Noble, Michael H. Brent, Michel Giunta, Sébastien Olivier, Mustapha Lhor

المصدر: Ophthalmology and Therapy, Vol 13, Iss 5, Pp 1071-1102 (2024)

مصطلحات موضوعية: Diabetes complications, Diabetic disease of the eye, Diabetic retinopathy, Macular edema, Therapeutics, Ophthalmology, RE1-994

الوصف: Abstract Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2193-8245Test; https://doaj.org/toc/2193-6528Test

الوصول الحر: https://doaj.org/article/5267c885da0b4abda55dc11f02f6a42aTest

المؤلفون: Valerie Umaefulam, Mackenzie Wilson, Marie Carole Boucher, Michael H. Brent, Maman Joyce Dogba, Olivia Drescher, Jeremy M. Grimshaw, Noah M. Ivers, John G. Lawrenson, Fabiana Lorencatto, David Maberley, Nicola McCleary, Sheena McHugh, Olivera Sutakovic, Kednapa Thavorn, Holly O. Witteman, Catherine Yu, Hao Cheng, Wei Han, Yu Hong, Balkissa Idrissa, Tina Leech, Joffré Malette, Isabelle Mongeon, Zawadi Mugisho, Marlyse Mbakop Nguebou, Sara Pabla, Siffan Rahman, Azaratou Samandoulougou, Hasina Visram, Richard You, Junqiang Zhao, Justin Presseau

المصدر: Pilot and Feasibility Studies, Vol 9, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Diabetic retinopathy, Screening, Tele-retinopathy, Immigrants, Protocol, Fidelity, Medicine (General), R5-920

الوصف: Abstract Background Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. Methods We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50–150 patients and 5–10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. Discussion This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2055-5784Test

الوصول الحر: https://doaj.org/article/97ef7dc61e7746f8b807e8e225dd38a4Test

المؤلفون: Valerie Umaefulam, Mackenzie Wilson, Marie Carole Boucher, Michael H. Brent, Maman Joyce Dogba, Olivia Drescher, Jeremy M. Grimshaw, Noah M. Ivers, John G. Lawrenson, Fabiana Lorencatto, David Maberley, Nicola McCleary, Sheena McHugh, Olivera Sutakovic, Kednapa Thavorn, Holly O. Witteman, Catherine Yu, Hao Cheng, Wei Han, Yu Hong, Balkissa Idrissa, Tina Leech, Joffré Malette, Isabelle Mongeon, Zawadi Mugisho, Marlyse Mbakop Nguebou, Sara Pabla, Siffan Rahman, Azaratou Samandoulougou, Hasina Visram, Richard You, Junqiang Zhao, Justin Presseau

المصدر: BMC Health Services Research, Vol 23, Iss 1, Pp 1-19 (2023)

مصطلحات موضوعية: Diabetic Retinopathy, Retinal Screening, Tele-retinopathy, Health services, Intervention development, Theoretical Domains Framework, Public aspects of medicine, RA1-1270

الوصف: Abstract Background Diabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries. Methods Following an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers. Results We carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels. Conclusion Working with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1472-6963Test

الوصول الحر: https://doaj.org/article/333b5051937447a7bcf7d9c75bb0a53dTest

المؤلفون: Daniel Scarr, Petter Bjornstad, Leif E. Lovblom, Julie A. Lovshin, Genevieve Boulet, Yuliya Lytvyn, Mohammed A. Farooqi, Vesta Lai, Andrej Orszag, Alanna Weisman, Hillary A. Keenan, Michael H. Brent, Narinder Paul, Vera Bril, David Z.I. Cherney, Bruce A. Perkins

المصدر: Kidney International Reports, Vol 4, Iss 6, Pp 786-796 (2019)

مصطلحات موضوعية: Diseases of the genitourinary system. Urology, RC870-923

الوصف: Introduction: Glomerular filtration rate (GFR) is routinely used for clinical assessment of kidney function. However, the accuracy of estimating equations in older adults is uncertain. Methods: In 66 adults with ≥50 years type 1 diabetes (T1D) duration and 73 nondiabetic controls from age/sex-matched subgroups (65 ± 8 years old and 77[55%] were women) we evaluated the performance of estimated GFR (eGFR) by creatinine (Modification of Diet and Renal Disease [MDRD], Chronic Kidney Disease–Epidemiology [CKD-EPI]cr), cystatin C (CKD-EPIcys, CKD-EPIcr-cys), and β2-microglobulin (β2M) compared with measured GFR by inulin clearance (mGFR). Performance was evaluated using metrics of bias (mean difference), precision (SD), and accuracy (proportion of eGFR that differed by >20% of mGFR). Results: Mean mGFR was 104 ± 18 ml/min per 1.73 m2 (range: 70–154 ml/min per 1.73 m2) and was not different between T1D and controls (103 ± 17 vs. 105 ± 19 ml/min per 1.73 m2, P = 0.39). All equations significantly underestimated mGFR (bias: −15 to −30 ml/min per 1.73 m2, P < 0.001 for all comparisons) except for β2M, which had bias of 1.9 ml/min per 1.73 m2 (P = 0.61). Bias was greatest in cystatin C–based equations. Precision was lowest for β2M (SD: 43.5 ml/min per 1.73 m2, P < 0.001 for each comparison). Accuracy was lowest for CKD-EPIcysC (69.1%, P < 0.001 for each comparison). Cystatin C–based equations demonstrated greater bias and lower accuracy in older age subgroups (

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2468024919300713Test; https://doaj.org/toc/2468-0249Test

الوصول الحر: https://doaj.org/article/c292c75b1ebd4628986a5c56d7f5c87fTest

المؤلفون: Nigar Sekercioglu, Leif Erik Lovblom, Petter Bjornstad, Julie A. Lovshin, Yuliya Lytvyn, Geneviève Boulet, Mohammed A. Farooqi, Andrej Orszag, Vesta Lai, Josephine Tse, Leslie Cham, Hillary A. Keenan, Michael H. Brent, Narinder Paul, Vera Bril, Bruce A. Perkins, David Z. I. Cherney

المصدر: Renal Failure, Vol 41, Iss 1, Pp 427-433 (2019)

مصطلحات موضوعية: type 1 diabetes, diabetic kidney disease, diabetic neuropathy, diabetic retinopathy, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Objectives: Diabetic kidney disease (DKD) is an independent predictor of cardiovascular morbidity and mortality in type 1 diabetes (T1D). We aimed to explore clinical and biochemical factors, including the achievement of American Diabetes Association (ADA) recommended targets associated with DKD in people living with T1D for ≥50 years. Methods: This was a post hoc analysis of a cross-sectional study of 75 participants enrolled in the Canadian Study of Longevity in T1D. We explored diabetes-related complications, including neuropathy, retinopathy, cardiovascular disease, and DKD. Study participants were dichotomized based on the achievement of ADA recommended targets as the low-target group (achieving ≤4 targets, n = 31) and high-target group (achieving >4 targets, n = 44). The outcome of interest was DKD defined by estimated glomerular filtration rate (eGFR) values 30 mg. Multivariable logistic regression models were employed to estimate odds ratios (ORs) for DKD with 95% confidence intervals (CIs). Results: Of the 75 participants with prolonged T1D duration (45% male, mean age 66 years), 25 participants had DKD and 50 did not. There was no statistical difference between the high- and low-target groups in terms of age and body mass index. eGFR was significantly higher and the prevalence of diabetic retinopathy was significantly lower in the high-target group. Older age at diagnosis of T1D and lower frequency component to high-frequency component ratio increased the odds of having DKD. Conclusions: In adults with prolonged T1D duration, older age at diagnosis and lower heart rate variability may be associated with DKD.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/0886-022XTest; https://doaj.org/toc/1525-6049Test

الوصول الحر: https://doaj.org/article/e5474eaf563e403b8c103cc886b356e5Test

المؤلفون: Saba Samet, Esther G. González, Mark S. Mandelcorn, Michael H. Brent, Luminita Tarita-Nistor

المصدر: Vision, Vol 2, Iss 4, p 40 (2018)

مصطلحات موضوعية: central vision loss, age-related macular degeneration, fixation stability, worse eye, preferred retinal locus, fixation duration, Biology (General), QH301-705.5

الوصف: The purpose of this study was to examine changes in fixation stability over time during binocular and monocular viewing in patients with age-related macular degeneration (AMD). Seventeen patients with AMD and 17 controls were enrolled. Using an EyeLink eyetracker (SR Research Ltd., Mississauga, Ontario, Canada), fixation stability was recorded binocularly and monocularly with each eye for a duration of 15 s while the fellow eye was covered. Fixation stability was analyzed over 3 s intervals for each condition using a 68% bivariate contour ellipse area. Fixation stability did not change with time during binocular viewing for both groups, both monocular conditions for the control group, and monocular viewing with the better eye for the AMD group. However, during monocular viewing with the worse eye, the test of within-subject contrasts showed linear improvement in fixation stability with time (p = 0.016). In conclusion, in patients with AMD, monocular fixational control with the worse eye is poor, but improves with time.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2411-5150/2/4/40Test; https://doaj.org/toc/2411-5150Test

الوصول الحر: https://doaj.org/article/fa5e1ee4c589412c84934d3584910bd7Test

المؤلفون: Olena Puzyeyeva, Wai Ching Lam, John G. Flanagan, Michael H. Brent, Robert G. Devenyi, Mark S. Mandelcorn, Tien Wong, Christopher Hudson

المصدر: Journal of Ophthalmology, Vol 2011 (2011)

مصطلحات موضوعية: Ophthalmology, RE1-994

الوصف: Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2090-004XTest; https://doaj.org/toc/2090-0058Test

الوصول الحر: https://doaj.org/article/e0dfdc6f01b6467c8b9902d1fe951180Test

المؤلفون: Vess Stamenova, Megan Nguyen, Nike Onabajo, Rebecca Merritt, Olivera Sutakovic, Kathryn Mossman, Ivy Wong, Lori Ives-Baine, R. Sacha Bhatia, Michael H. Brent, Onil Bhattacharyya

مصطلحات موضوعية: Research, science and technology policy, Canada, diabetes, diabetic-related retinopathy, patient, primary care, screening, teleophthalmology, vision loss

الوصف: Background: Vision loss from diabetic-related retinopathy (DR) is preventable through regular screening. Objective: The purpose of this study was to test different patient engagement approaches to expand a teleophthalmology program at a primary care clinic in the city of Toronto, Canada. Methods: A teleophthalmology program was set up in a large, urban, academic, team-based primary care practice. Patients older than 18 years with type 1 or type 2 diabetes were randomized to one of the following 4 engagement strategies: phone call, mail, mail plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for DR screening. Results: A total of 23 patients in the phone, 28 in the mail, 32 in the mail plus phone call, and 27 in the control (usual care) group were included in the analysis. After the intervention and after excluding patients who said they were screened, 88% (15/17) of patients in the phone, 11% (2/18) in the mail, and 100% (21/21) in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% (0/12) in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (P<.001), whereas mailing a letter had no effect. Conclusions: Patient engagement to book DR screening via teleophthalmology in an urban, academic, team-based primary care practice using telephone calls was much more effective than patient engagement using letters or usual care. Practices that have access to a local DR screening program and have resources for such engagement strategies should consider using them as a means to improve their DR screening rates.

العلاقة: https://figshare.com/articles/journal_contribution/Mailed_Letter_Versus_Phone_Call_to_Increase_Diabetic-Related_Retinopathy_Screening_Engagement_by_Patients_in_a_Team-Based_Primary_Care_Practice_Prospective_Single-Masked_Randomized_Trial/24191466Test

الإتاحة: https://doi.org/10.32920/24191466.v1Test
https://figshare.com/articles/journal_contribution/Mailed_Letter_Versus_Phone_Call_to_Increase_Diabetic-Related_Retinopathy_Screening_Engagement_by_Patients_in_a_Team-Based_Primary_Care_Practice_Prospective_Single-Masked_Randomized_Trial/24191466Test

المؤلفون: Tina Felfeli, Michael H Brent, Petros Pechlivanoglou, Beate Sander, Felicia Tai, Parsa Mehraban Far, Adeteju Ogunbameru, David T Wong

المصدر: BMJ Open Ophthalmology, Vol 7, Iss 1 (2022)

مصطلحات موضوعية: Ophthalmology, RE1-994

العلاقة: https://bmjophth.bmj.com/content/7/1/e000915.fullTest; https://doaj.org/toc/2397-3269Test; https://doaj.org/article/b9d96f7e2ac24a31a1048060104fa909Test

الإتاحة: https://doi.org/10.1136/bmjophth-2021-000915Test
https://doaj.org/article/b9d96f7e2ac24a31a1048060104fa909Test

المؤلفون: Michelle Lim, Tina Felfeli, Winnie Mangubat, Hamid Moghimi, Michael Grinton, Michael H. Brent

الوصف: BACKGROUND Mobility challenges, transportation, and finances may serve as barriers to diabetic retinopathy (DR) screening in the growing elderly population in Ontario. Screening of patients in their own nursing homes using teleophthalmology may improve accessibility to DR screening. OBJECTIVE To report the feasibility, results, and patient satisfaction of a pilot expansion of the Toronto Tele-Retinal Screening Program in an elderly long-term care home. METHODS A pilot project was initiated with a cohort of elderly patients with Type II diabetes mellitus (DM) in long-term care who were referred to the Toronto Tele-Retinal Screening Program for DR screening between April 1, 2022 and July 1, 2022. RESULTS A total of 28 patients were screened for DR. Half (14/28) of patients suffered from a fall within the last year and 35% (10/28) were fully dependent for mobility. Overall, 14.3% (4/28) of patients could not be successfully imaged. Of the patients imaged, 8.3% (2/24) were advised to arrange an urgent follow-up. Pathologies identified included uncontrolled glaucoma (4.1%, 1/24), non-proliferative DR (NPDR) (8.3%, 2/24), wet age-related macular degeneration (AMD) (8.3%, 2/24), and dry AMD (37.5%, 9/24). A total of 20.8% (5/24) patients could not undergo tabletop imaging due to mobility issues. Screening of 60% (3/5) of these patients were successful with the handheld camera. Overall, 90% (17/19) of patients rated their subjective screening experience as either “brilliant” or “really good.” CONCLUSIONS This pilot project demonstrated that the implementation of the Toronto Tele-Retinal Screening Program into elderly long-term care homes may mitigate common barriers to eye screening with a good subjective patient experience.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::63be2b4cdee9378d65cf9769aa6b8b69Test
https://doi.org/10.2196/preprints.49188Test