ResearchPad - 1718 https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Patient-centred and economic effectiveness of a decision aid for patients with age-related cataract in China: study protocol of a randomised controlled trial]]> https://www.researchpad.co/article/elastic_article_12527 The need for cataract surgery is on the rise due to our ageing population and high demands for greater visual functioning. Although the majority of patients want to participate in a shared decision-making process, no decision aid has been available to improve the quality of decision. The present study aims to determine whether a decision aid increases informed decision about cataract surgery.Methods and analysisA parallel randomised controlled trial (772 participants) will be conducted. The decision aid will be implemented among patients with any age-related cataract in Yuexiu District, which is socioeconomically representative of a major metropolitan region in Southern China. Participants will be randomly assigned to receive either a patient decision aid or a traditional booklet, and they will complete three surveys: (1) baseline assessment before the intervention (time point (T)1), 2 weeks (T2) and 1 year (T3) after the intervention. The control group receives a traditional booklet with standard general information developed by the National Eye Institute to help patients understand cataract, whereas the intervention group receives a patient decision aid that includes not only the standard general information, but also the quantitative risk information on the possible outcomes of cataract surgery as well as value clarification exercise. The primary study outcome is the informed decision, the percentage of patients who have adequate knowledge and demonstrate consistency between attitudes and intentions. Secondary outcomes include perceived importance of cataract surgery benefits/harms, decision conflict and confidence, anticipated regret and booklet utilisation and acceptability at 2 weeks, and surgical rates and a cost–utility estimate of the decision aid at 1 year.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Zhongshan Ophthalmic Center (reference number: 2019KYPJ090). Results will be published in peer-reviewed journals and presented at scientific meetings for academic audiences.Trial registration numberNCT03992807. ]]> <![CDATA[Global eye health and the sustainable development goals: protocol for a scoping review]]> https://www.researchpad.co/article/elastic_article_9130 In 2015, most governments of the world committed to achieving 17 sustainable development goals (SDGs) by the year 2030. Efforts to improve eye health contribute to the advancement of several SDGs, including those not exclusively health-related. This scoping review will summarise the nature and extent of the published literature that demonstrates a link between improved eye health and advancement of the SDGs.Methods and analysisSearches will be conducted in MEDLINE, Embase and Global Health for published, peer-reviewed manuscripts, with no time period, language or geographic limits. All intervention and observational studies will be included if they report a link between a change in eye health and (1) an outcome related to one of the SDGs or (2) an element on a pathway between eye health and an SDG (eg, productivity). Two investigators will independently screen titles and abstracts, followed by full-text screening of potentially relevant articles. Reference lists of all included articles will be examined to identify further potentially relevant studies. Conflicts between the two independent investigators will be discussed and resolved with a third investigator. For included articles, data regarding publication characteristics, study details and SDG-related outcomes will be extracted. Results will be synthesised by mapping the extracted data to a logic model, which will be refined through an iterative process during data synthesis.Ethics and disseminationAs this scoping review will only include published data, ethics approval will not be sought. The findings of the review will be published in an open-access, peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health. ]]> <![CDATA[Validity and feasibility of a self-administered home vision examination in Yueqing, China: a cross-sectional study]]> https://www.researchpad.co/article/N4fc4c4ee-3b31-463e-9978-203d18c8fe36 To investigate the validity and feasibility of a self-administered home vision examination programme in China.DesignCross-sectional study.SettingYueqing, China.ParticipantsA two-stage convenience sampling procedure was used to randomly select 600 households from 30 communities participating in the Yueqing Eye Study (YES). The aim of YES is to encourage home-based vision screening, reporting of visual acuity (VA) annually through social media and encouraging people to attend follow-up clinic appointments as a way to improve eye care access for adults with VA ≤+0.5 log of the minimum angle of resolution (logMAR).InterventionsHousehold screeners (one per household) who tested other family members’ VA completed a questionnaire on family structure, demographic information and knowledge about screening procedures. Other family members then underwent confirmatory VA testing by researchers.Outcome measuresThe completion rate of home-based VA screening, its sensitivity and specificity were used to evaluate validity. Factors that determined whether families participated in the self-VA screening were used to evaluate feasibility.Results345 (66%) of the 523 (87.2%) households with valid data form their home-based vision examinations also were retested by researchers. There was no statistically significant difference in scores on the family-administerd or researcher-administerd VA test (VA≤+0.5 logMAR, p=0.607; VA >+0.5 logMAR, p=0.612). The sensitivity and specificity of home-based vision screening were 80.5% (95% CI 70.2% to 86.9%) and 95.1% (95% CI 92.6% to 96.8%), respectively. 14.7% (77/523) of tested respondents had VA ≤+0.5 logMAR. Predictors of performing home screening for VA remaining in regression models included higher economic status (‘fair and above’ vs ‘poor’: OR 1.74; 95% CI 1.08 to 2.76; p=0.022), age (<45 years vs ≥45 years: OR 0.46; 95% CI 0.25 to 0.85; p=0.014) and living in a nuclear (OR 5.17; 95% CI 2.86 to 9.36; p<0.001) or extended family (OR 8.37; 95% CI 4.93 to 14.20; p<0.001).ConclusionSelf-administered home vision screening is reliable and highly accepted by Chinese adults. ]]> <![CDATA[What hinders congenital ectopia lentis patients’ follow-up visits? A qualitative study]]> https://www.researchpad.co/article/N47b32eb9-1666-4515-86ed-4a05b68c606e

Objectives

The aim of our study is to give insight into congenital ectopia lentis (CEL) patients’ care-seeking behaviour and explore the factors affecting their follow-up visits.

Design

Cross-sectional study; in-depth and face-to-face semistructured interview.

Setting

A large-scale ophthalmology hospital in China.

Participants

35 patients with CEL and their parents from May 2017 to August 2017.

Main outcome measures

Themes and categories. The interviews were audio-recorded, transcribed verbatim, coded and analysed using grounded theory. Data collection was closed when new themes did not emerge in subsequent dialogues.

Results

The factors affecting the timely visits included insufficient awareness of CEL, shame on hereditary disease, lack of effective doctor–patient communication, lack of reliable information online and daily stressors.

Conclusion

Continuing medical education of severe and rare disease, reforming the pattern of medical education, constructing an interactive platform of the disease on the internet and improving healthcare policy are effective ways to improve the diagnosis and treatment status of CEL in China.

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<![CDATA[Pattern of corneal astigmatism induced by primary pterygium in patients with cataract in a secondary hospital in Southern China: a cross-sectional study]]> https://www.researchpad.co/article/Nad1a70ee-b646-4dfa-85fc-f675d3fef821

Objectives

To review the pattern of primary pterygium-induced corneal astigmatism in patients with cataract in a southern Chinese population.

Design

Clinic-based cross-sectional retrospective study.

Setting

A secondary hospital at southern China.

Participants

A group of 1689 eyes with primary pterygium (PT group) and the other group of 4062 eyes without pterygium (NPT group) were included.

Main outcome measures

Corneal power was measured by an autokeratorefractometer. Corneal astigmatism was calculated as the difference in corneal power between the steepest and flattest meridians. Distribution of corneal astigmatism was compared between eyes with pterygium and eyes without pterygium.

Results

Distribution of corneal astigmatism was different between PT group (skewness=2.548, kurtosis=8.237) and NPT group (skewness=2.778, kurtosis=15.52). Mean corneal astigmatism was significantly higher in the PT group (1.62±1.49D) compared with the NPT group (1.17±0.89D, p<0.0001). The prevalence of corneal astigmatism >1D (PT 52.3%, NPT 40.9%, p<0.0001), >2D (PT 22.4%, NPT 10.6%, p<0.0001) or >3D (PT 10.5%, NPT 3.2%, p<0.0001) was significantly higher in the PT group compared with the NPT group. Eyes in the PT group had significantly higher corneal astigmatism than the NPT group in almost every age group (all p<0.05), with the exception of patients ≥90 years. Moreover, eyes in the PT group had significantly higher with-the-rule (PT 1.72±1.59D, NPT 1.19±0.88D, p<0.0001) and against-the-rule (PT 1.63±1.46D, NPT 1.18±0.88D, p<0.0001) but similar oblique astigmatism (PT 1.11±1.00D, NPT 0.99±0.89D, p=0.065) corneal astigmatism compared with the NPT group. Power vector analysis indicated that the axis of corneal astigmatism was not significantly different between the two groups (J0, PT −0.01±0.74D, NPT 0.01±0.52D, p=0.48; J45, PT −0.03±0.82D, NPT 0.00±0.52D, p=0.54).

Conclusions

Pattern of corneal astigmatism in eyes with cataract and coexisting primary pterygium was different from eyes without pterygium. Pterygium is associated with higher magnitude but not different axis of corneal astigmatism.

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<![CDATA[Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study]]> https://www.researchpad.co/article/Neba24601-3fe5-4cdf-8860-527f17a429c4

Objective

This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients.

Design

We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients.

Setting

This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom.

Participants

13 systemically unwell patients admitted to the critical care unit were purposively sampled to enable evaluation in patients with a range of clinical states.

Outcome measures

The primary outcome was the feasibility of acquiring clinically interpretable OCT scans on a consecutive series of patients. The standardised scanning protocol included macula-focused OCT, OCT optic nerve head (ONH), OCT angiography (OCTA) of the macula and ONH OCTA.

Results

OCT images from 13 patients were attempted. The success rates of each scan type are 84% for OCT macula, 76% for OCT ONH, 56% for OCTA macula and 36% for OCTA ONH. The overall mean success rate of scans per patient was 64% (95% CI 46% to 81%). Clinicians reported clinical value in 100% scans which were successfully obtained, including both ruling in and ruling out relevant ocular complications such as corneal thinning, macular oedema and optic disc swelling. The most common causes of failure to achieve clinically interpretable scans were inadequately sustained OCT alignment in delirious patients and a compromised ocular surface due to corneal exposure.

Conclusions

This prospective evaluation indicates the feasibility and potential clinical value of the SPECTRALIS FLEX OCT system on the critical care unit. Portable OCT systems have the potential to bring instrument-based ophthalmic assessment to critically ill patients, enabling detection and micron-level monitoring of ocular complications.

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<![CDATA[Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study]]> https://www.researchpad.co/article/5c9e564ed5eed0c48423dbfc

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. The Chronic Care Model was used as a framework for the development of the interview guide and for categorising implementation strategies to increase teleophthalmology use.

Setting

A rural, US multipayer primary care clinic with an established teleophthalmology programme for diabetic eye screening.

Participants

We conducted interviews with 29 participants (20 patients with diabetes and 9 PCPs).

Results

Major patient barriers to teleophthalmology use included being unfamiliar with teleophthalmology, misconceptions about diabetic eye screening and logistical challenges. Major patient facilitators included a recommendation from the patient’s PCP and factors related to convenience. Major PCP barriers to referring patients for teleophthalmology included difficulty identifying when patients are due for diabetic eye screening and being unfamiliar with teleophthalmology. Major PCP facilitators included the ease of the referral process and the communication of screening results. Based on our results, we developed a model that maps where these key patient and PCP barriers occur in the teleophthalmology referral process. Patients and PCPs also identified implementation strategies to directly address barriers and facilitators to teleophthalmology use.

Conclusions

Patients and PCPs have limited familiarity with teleophthalmology for diabetic eye screening. PCPs were expected to initiate teleophthalmology referrals, but reported significant difficulty identifying when patients are due for diabetic eye screening. System-based implementation strategies primarily targeting PCP barriers in conjunction with improved patient and provider education may increase teleophthalmology use in rural, US multipayer primary care clinics.

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