The effect evaluation of continuous nursing intervention in patients with type 2 diabetic retinopathy.

INTRODUCTION: To evaluate the application effect of continuous nursing intervention in type 2 diabetic retinopathy (DR). METHODS: Patients with type 2 DR were selected and divided into intervention group and control group by random. The control group received routine nursing intervention, and the intervention group received continuous nursing intervention on the basis of the control group. The clinical effects of the two groups were compared. RESULTS: After 1 and 2 years of intervention, the intervention group compared to the control group. The rate of visual acuity decrease was significantly lower (p < 0.05). Fasting blood glucose, 2 h postprandial blood glucose, and glycosylated hemoglobin were significantly lower (p < 0.05). The self-management ability and satisfaction were significantly higher, and the readmission rate was significantly lower (p < 0.05). CONCLUSION: The continuous nursing intervention model has a good clinical effect on the visual acuity of patients with type 2 DR.

Diabetes mellitus in the Tamil Nadu State-Noncommunicable diseases nurse model in diabetic retinopathy screening.

Tamil Nadu is one of the states in India, where the diabetic retinopathy (DR) project was implemented in the Tirunelveli District. Aravind Eye Hospital, Tirunelveli was the mentoring institution and ophthalmology department of Tirunelveli Medical College and Hospital (TVMCH) was the implementing partner. The objective of the project was to develop a district level model for building capacity at the government health system for effective screening, diagnosis and management (primary to tertiary) of diabetic retinopathy. The DR screening, counseling, referral and follow-up tasks were included in the scope of Non- Communicable Disease (NCD) nurses at the respective Community Health Centres and Primary Health Centres using the tele-medicine platform. During the project period (December 2016 to June 2019), 8,574 people with diabetes were registered at the 18 CHCs/PHCs. 6,462 (75.4% of those registered) were screened by NCD staff. The government has agreed to scale up services in 3 more districts.

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples.

Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.

Cribado de retinopatía diabética mediante retinografía no midriática: concordancia de médicos de familia, enfermeras y oftalmólogos / Retinopathy diabetic screening by non-mydriatic retinography: concordance between primary care physicians, nurses and ophthalmologists

Objetivo: Comparar la evaluación de las retinografías para el cribado de retinopatía diabética (RD) realizadas por la enfermera de teleoftalmología y los médicos de atención primaria (MAP) con un oftalmólogo del hospital de referencia (estándar de oro). Métodos: Estudio transversal en una muestra aleatoria de 337 pacientes del programa de teleoftalmología desde enero de 2010 a enero de 2015. Analizamos la valoración diagnóstica (si presentaba hallazgos de RD o no) y la valoración terapéutica (si precisaba derivación al Servicio de Oftalmología o no) que realizaron de manera independiente sobre las retinografías de la muestra los MAP, una enfermera y un oftalmólogo (patrón de oro). Se comprobó la fiabilidad y concordancia de los MAP y la enfermera con el patrón de oro, apoyando los análisis estadísticos con SPSS v.23.00 y calculadoras de fiabilidad de pruebas diagnósticas (EPIDAT 4.1). Resultados: En el diagnóstico de RD, la enfermera presentó: sensibilidad (S): 0,96; especificidad (E): 0,89; VPP: 0,58; VPN: 0,99; índice Kappa: 0,67 y el MAP: S: 0,98; E: 0,99; VPP: 0,96; VPN: 0,99; índice Kappa: 0,96. En la derivación a Oftalmología valorado por la enfermera: S: 0,83; E: 0,83; VPP: 0,51; VPN: 0,96; índice Kappa: 0,53 y el MAP: S: 0,62. E: 0,76; VPP: 0,36; VPN: 0,90; índice Kappa: 0,29. Conclusiones: La enfermera del programa de teleoftalmología podría realizar el cribado poblacional de RD con la misma calidad que los MAP. Esto permitiría incrementar la cobertura, además de proporcionar un mejor aprovechamiento de los recursos al evitar citaciones intermedias de los pacientes a través del MAP y un mayor ahorro sanitario (AU)

Aim: To compare the evaluation of retinographies by a teleophthalmology nurse and primary care physicians (PCP) with an ophthalmologist referral hospital (gold standard). Methods: Cross-sectional study on a random sample of 337 patients on the teleophthalmology programme from January 2010 to January 2015. We analyzed the diagnostic evaluation (whether or not it presented findings of RD) and the therapeutic assessment (whether or not referral to the opthalmology department was needed) which were conducted independently on the sample retinographies by the PCP, a nurse and an ophthalmologist (gold standard). Reliability and concordance between the gold standard and the PCP and the nurse were checked and the statistical analyses were supported using SPSSv.23.00 software and diagnostic test reliability calculators (EPIDAT 4.1). Results: In the diagnosis of RD, the nurse presented: sensitivity (S): 0.96; specificity (Sp): 0.89; PPV: 0.58; NPV: 0.99; Kappa index: 0.67 and PCP: S: 0.98; Sp: 0.99; PPV: 0.96; NPV: 0.99; Kappa index: 0.96. In the referral to ophthalmology assessed by the nurse: S: 0.83; Sp: 0.83; PPV: 0.51; NPV: 0.96; Kappa Index: 0.53 and PCP: S: 0.62; Sp: 0.76; PPV: 0.36; NPV: 0.90; Kappa index: 0.29. Conclusions: A nursing teleophthalmology programme could perform population screening for RD with the same quality as PCP. This would increase coverage, in addition to providing better use of resources by avoiding intermediate patient appointments through PCP and increased health savings (AU)

Tratamiento del síndrome de tracción vitreomacular con plasmina autógena / Treatment of vitreomacular traction syndrome with autologous plasmin enzyme

OBJETIVO: Analizar si la inyección intravítrea de plasmina autógena es eficaz en el síndrome de tracción vítreo-macular (STVM), mejorando la agudeza visual y restaurando la morfología macular. MÉTODOS: Estudio prospectivo de 11 pacientes consecutivos diagnosticados de STVM en nuestro Servicio de Oftalmología de enero a mayo de 2011. CRITERIOS DE INCLUSIÓN: mejor agudeza visual corregida (MAVC) inferior a 0,5 y adhesión vítreo-macular foveal, ocasionando aumento del grosor macular central (GMC) > 250 μ diagnosticado mediante tomografía de coherencia óptica (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Alemania). Criterios de exclusión: retinopatía diabética proliferante activa, miopía axial > 26 mm, vitrectomía previa, glaucoma, intravítreas previas y antecedentes de desprendimiento de retina. Se realizaron hasta 3 inyecciones mensuales de 0,2 ml de plasmina autógena, evaluándose a las 3 semanas de cada inyección el despegamiento de la adhesión vítreo-macular (AVM), MAVC, GMC y la recuperación de morfología macular en la OCT, interrumpiendo el tratamiento en caso de éxito. Análisis estadístico con test de Wilcoxon. Resultados De 12 ojos de 11 pacientes se consiguió despegamiento de AVM en 4 (33%), 2 con una inyección y 2 con 3 inyecciones. La mejoría de la MAVC (p = 0,017) y la disminución del GMC (p = 0,016) fueron estadísticamente significativas, mejorando la morfología macular en todos los casos con despegamiento de la AVM. La única complicación fue un caso de hipertensión intraocular tras la inyección, que cedió repitiendo la paracentesis. CONCLUSIONES: La inyección de plasmina autógena evitó la vitrectomía del STVM en uno de cada 3 pacientes

PURPOSE: To determine whether intravitreal injection of autologous plasmin enzyme (APE) is effective in vitreomacular traction syndrome (VMTS) by improving visual acuity and restoring macular morphology. METHODS: A prospective study of 11 consecutive patients diagnosed with VMTS in the Ophthalmology Department from January to May, 2011. Inclusion criteria: best corrected visual acuity (BCVA) less than 0.5, and vitreomacular attachment in foveal area resulting in macular thickness > 250 microns diagnosed by optical coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Germany). Exclusion criteria: active proliferative diabetic retinopathy, axial myopia > 26 mm, vitrectomy, glaucoma, previous intravitreal injections and previous rhegmatogenous detachment. One to 3 monthly intravitreal injections of 0.2 ml of APE were applied, interrupting if posterior vitreous detachment was attained. Wilcoxon's test was used for statistical analysis. RESULTS: A total of 12 eyes of 11 patients were treated. A complete posterior vitreous detachment was achieved in 4 (33%) eyes at the end of the study, 2 of them with one injection, and 2 with 3 monthly injections. Improvement of BCVA was statistically significant (P=.017) and the decrease in central macular thickness also was statistically significant (P=.016). There was only one complication: intraocular hypertension after injection that subsided with a new paracentesis. CONCLUSIONS: Intravitreal APE injections avoided vitrectomy in VMTS in one in every 3 patients

Coordination skills during vitrectomy in treatment of proliferative diabetic retinopathy.

PURPOSE: To discuss effective nursing and coordination skills for vitrectomy in the treatment of diabetic retinopathy. METHODS: Fifty patients (51 eyes) with diabetic retinopathy required vitrectomy were enrolled in this study. Individual nursing service was delivered by strengthening preoperative preparation, providing psychological nursing, and intraoperative observation of the severity of diseases by circulating nurses; meticulous nursing was given postoperatively. RESULTS: All 50 patients underwent surgery successfully. Intraoperatively, patients had stable physical signs. Five patients had postoperative visual acuity < 0.05, 14 with 0.05 to 0.1, 20 with 0.1 to 0.3 and 16 with > 0.3. No complicated infection was seen. CONCLUSION: For patients diagnosed with proliferative diabetic retinopathy requiring vitrectomy, full preparations should be made and psychological nursing should be delivered preoperatively, the severity of diseases and clinical reactions should be closely observed intraoperatively, and proper processing and nursing measures should be taken postoperatively, which collectively enhance surgical success rate, decrease surgical complications, and attain favorable treatment efficacy.

Ações preventivas de enfermagem ao cliente portador de retinopatia diabética: uma revisão integrativa da literatura / Acción preventiva de cliente de enfermería de la retinopatía diabética: una revisión de la literatura de integración / Preventive action of nursing customer of diabetic retinopathy: an integrative literature review

Identificar através de uma revisão integrativa as ações preventivas de enfermagem ao cliente portador de Retinopatia Diabética. Método: Revisão integrativa da literatura. Esse método de pesquisa tem seis fases distintas, a saber: identificação do tema ou questionamento da revisão integrativa; amostragem ou busca na literatura; categorização dos estudos; avaliação dos estudos incluídos na revisão integrativa; interpretação dos resultados; e síntese do conhecimento evidenciado nos artigos analisados ou apresentação da revisão integrativa. Resultados: O levantamento visou à identificação das fontes bibliográficas, sendo realizado por meio do sistema informatizado: SCIELO, LILACS e BDENF. Dos seis artigos selecionados por ter correlação com a temática, apenas um artigo, da base de dados LILACS, tem correlação ao objeto de estudo. Conclusão: Foi possível identificar, por meio das produções científicas na área da enfermagem relacionada a Retinopatia Diabética, uma produção pouco expressiva para direcionar e planejar as ações preventivas de enfermagem ao cliente portador de RD.

Identificar a través de una revisión integral de la enfermería acciones preventivas para el cliente de la retinopatía diabética. Método: Revisión de la literatura de integración. Este método de investigación consta de seisfases, a saber: identificación del tema o la pregunta de la revisión integradora de muestreo, o buscar en la literatura, la categorización de los estudios, la evaluación de los estudios incluidos en la revisión de integración, interpretación de resultados y síntesis del conocimiento se evidencia en los artículos análisis o la presentación de la revisión integradora. Resultados: El estudio tuvo como objetivo identificar las fuentes bibliográficas, que se realiza a través del sistema informático: SCIELO, LILACS y BDENF. De los seis artículos seleccionados que se correlaciona con el tema, sólo un artículo, la base de datos LILACS, se correlaciona con el objeto de estudio. Conclusión: No se identificaron por medio de la producción científica de enfermería relacionados con la retinopatía diabética, una producción muy expresivo para dirigir y planificar la prevención de los clientes de enfermería RD portador.

Objective: To identify through an integrative review of nursing preventive actions to the customer of diabetic retinopathy. Method: integrative literature review. This research method has six distinct phases, namely: identification of the topic or question the integrative review, sampling or literature search, categorization of studies, assessment of studies included in the integrative review, interpretation of results and synthesis of knowledge evidenced in Articles analysis or presentation of the integrative review. Results: The survey aimed to identify the bibliographic sources, being done through the computerized system: SCIELO, LILACS and BDENF. Of the six selected articles to be correlated with the theme, only one article, the LILACS database, correlates to the object of study. Conclusion: There were identified by means of scientific production in nursing related to diabetic retinopathy, a very expressive production to direct and plan the preventive nursing customer carrier RD.

Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives.

BACKGROUND: The aim of the present study was to assess the performance of three primary care-led initiatives providing structured care to patients with Type 2 diabetes in Ireland, a country with minimal incentives to promote the quality of care. METHODS: Data, from three primary care initiatives, were available for 3010 adult patients with Type 2 diabetes. Results were benchmarked against the national guidelines for the management of Type 2 diabetes in the community and results from the National Diabetes Audit (NDA) for England (2008/2009) and the Scottish Diabetes Survey (2009). RESULTS: The recording of clinical processes of care was similar to results in the UK however the recording of lifestyle factors was markedly lower. Recording of HbA1c, blood pressure and lipids exceeded 85%. Recording of retinopathy screening (71%) was also comparable to England (77%) and Scotland (90%). Only 63% of patients had smoking status recorded compared to 99% in Scotland while 70% had BMI recorded compared to 89% in England. A similar proportion of patients in this initiative and the UK achieved clinical targets. Thirty-five percent of patients achieved a target HbA1c of < 6.5% (< 48 mmol/mol) compared to 25% in England. Applying the NICE target for blood pressure (≤ 140/80 mmHg), 54% of patients reached this target comparable to 60% in England. Slightly less patients were categorised as obese (> 30 kg/m²) in Ireland (50%, n = 1060) compared to Scotland (54%). CONCLUSIONS: This study has demonstrated what can be achieved by proactive and interested health professionals in the absence of national infrastructure to support high quality diabetes care. The quality of primary care-led diabetes management in the three initiatives studied appears broadly consistent with results from the UK with the exception of recording lifestyle factors. The challenge facing health systems is to establish quality assurance a responsibility for all health care professionals rather than the subject of special interest for a few.

[Retinography and tonometry in primary care: techniques incorporated into routine nursing practice]. / Retinografía y tonometría en atención primaria: técnicas incorporadas a la práctica habitual de enfermería.

OBJECTIVES: To determine the frequency of eye fundus examinations during the study period compared to the previous year. To find out the prevalence of diabetic retinopathy and the level of agreement between the primary care doctor and the ophthalmologist in the interpration of retinographies performed. To determine the relationship of the different variables with the prevalence of retinopathy. To describe the problems detected in the handling of the digital retinograph. And finally to determine the prevalence of increased intraocular pressure (IOP) in diabetic patients. METHODS: In the wellness area S. Gormaz Esteban (Soria, Spain) we performed a descriptive observational study on patients with diabetes. The nurse conducted a visual screening that included retinography and tonometry. RESULTS: There was moderate agreement in interpretation of retinographs. The coverage of diabetes who have undergone eye screening has increased to 50% (133). Some degree of retinopathy was seen in 38% (44) of the patients studied and the quality of images obtained in 67% (88) was good. The type of diabetes and treatment, the presence of dyslipidemia and nephropathy and years of evolution and elevated glycated haemoglobin are statistically significant variables. The mean IOP was 14.66 mmHg, and 5% (6) had levels >21 mmHg. CONCLUSIONS: The implementation of comprehensive eye screening for diabetic patients should be consolidated as an intervention in primary care and referring only patients with specialized referral criteria, doubtful cases and technical failures.

A percepção visual de pacientes com retinopatia diabética, segundo o referencial de Merleau-Ponty / The visual perception of patients with diabetic retinopathy, according to Merleau-Ponty’s reference framework

A retinopatia diabética (RD) é uma das complicações crônicas do diabetes mellitus e constitui a principal causa de cegueira no mundo. Este estudo tem como objetivo compreender a percepção visual de pacientes diabéticos acometidos pela RD. Foram entrevistados 11 sujeitos diabéticos em um Centro de Pesquisa e Extensão Universitária do interior paulista, em 2007. Utilizou-se o referencial teórico-metodológico da fenomenologia e da percepção do corpo, à luz de Merleau-Ponty. A análise dos depoimentos possibilitou a elaboração de quatro categorias: a percepção visual de pacientes com RD como algo não refletido; a percepção visual de pacientes com RD como algo em movimento; a percepção da RD; e a experiência existencial do conviver com a RD. Os resultados confirmam a necessidade de mudança da atenção de saúde, do enfoque fragmentado e do corpo centrado na doença, em direção a uma dimensão humana em todas as suas vertentes.

Diabetic retinopathy (DR) is one of the chronic complications of diabetes mellitus and constitutes the main cause of blindness around the world. This study aims to understand the visual perception of diabetic patients affected by DR. Eleven diabetic patients were interviewed at a University Research and Community Service Centre in the interior of São Paulo State, Brazil, in 2007. The theoretical-methodological framework consisted of phenomenology and the perception of the body, in the light of Merleau-Ponty. Content analysis allowed the elaboration of four analysis categories: the visual perception of DR patients as something that is not reflected, the visual perception of patients with diabetic retinopathy as something moving, the perception of diabetic retinopathy and the existential experience of living with diabetic retinopathy. The results confirm the need to rethink care beyond the biological dimension and disease-centered fragmented focus on the body, towards a human dimension in all of its aspects.

La retinopatía diabética (RD) es una de las complicaciones crónicas de la diabetes mellitus y constituye la principal causa de ceguera en el mundo. Este estudio tiene como objetivo investigar la percepción visual de pacientes diabéticos acometidos por la RD. Fueron entrevistados 11 pacientes diabéticos en un Centro de Investigación y Extensión Universitario del interior del Estado de São Paulo-Brasil, en 2007. Se utilizó el referencial teórico-metodológico de la fenomenología y de la percepción del cuerpo según Merleau-Ponty. La organización de los datos permitió clasificar cuatro categorías: la percepción visual de pacientes con RD como algo no reflexionado; la percepción visual de pacientes con RD como algo en movimiento; la percepción de la RD; y, la experiencia existencial de convivir con la RD. Los resultados confirman la necesidad de repensar el cuidado, buscando más allá de la dimensión biológica y del enfoque fragmentado del cuerpo centrado en la enfermedad, en dirección a una dimensión humana en todas sus vertientes.

[The instruction of the patient educational method in clinical nursing training: the actual condition of a student guidance case about diabetic's nursing using the diabetes retinopathy model].

We taught fourth-year students in a university about patient education using the diabetes retinopathy model in adult nursing practice. We analyzed teacher's student guidance plans and the guidance process using a clinical training education analysis form from the viewpoint of qualitative interpretation. We evaluated the degree of achievement of the students' goal for practice and the training subject. Consequently, the teacher developed training guidance as a class.

Ophthalmic nurse practitioner led diabetic retinopathy screening. Results of a 3-month trial.

PURPOSE: To describe the design and implementation of a nurse led diabetic retinopathy screening clinic. To present the results of a 3-month trial period assessing the concordance of retinopathy grading between a nurse practitioner and an ophthalmologist. METHOD: Patients attending for annual diabetic eye review during an initial 3-month trial period were assessed in a dedicated diabetic eye clinic by an ophthalmic nurse practitioner and an ophthalmologist, with both grading the degree of diabetic retinopathy using to the Wisconsin grading system. Each was masked as to the other's findings. The concordance of retinopathy grading between ophthalmic nurse practitioner and ophthalmologist was assessed. RESULTS: A total of 95 patients (189 eyes) were assessed during the study period. A 92% concordance was achieved between the ophthalmologist and the ophthalmic nurse practitioner. In total, 72 eyes were graded as having some degree of retinopathy by the ophthalmologist. The sensitivity of the nurse practitioner for diagnosing the presence of diabetic retinopathy was 93%, and the specificity 91%. Nine eyes with severe nonproliferative diabetic retinopathy or worse, and four with clinically significant macular oedema were seen. All were correctly identified by the nurse practitioner. CONCLUSIONS: The structure and management protocols of the clinic are described. An excellent concordance between ophthalmologist and nurse practitioner was achieved in this group of patients with relatively less advanced retinopathy.

A nurse-led approach to diabetic retinal screening.

Diabetic retinopathy is the leading cause of blindness in people under the age of 60 in industrialised countries (NICE, 2002). This article discusses a nurse-led approach to diabetic retinal screening currently being undertaken at the Western Eye Hospital, London.

Retinal outcomes in proliferative diabetic retinopathy presenting during and after pregnancy.

BACKGROUND: The aim of this study was to determine retinal outcomes in patients with proliferative diabetic retinopathy (PDR) presenting during pregnancy or within the first year postpartum. METHODS: All patients with diabetes mellitus during pregnancy from 1992 through 2002 were included. Medical records were reviewed and data including obstetric history, pregnancy outcome, other medical complications, and course and management of retinal disease were analyzed. RESULTS: The study group comprised 6 women with a total of 7 pregnancies complicated by PDR during pregnancy or during the first year postpartum. Two of these pregnancies were in patients who had long-standing PDR and had received panretinal photocoagulation prior to pregnancy. Both of them had stable retinas during pregnancy and during the postpartum period. Three patients (4 eyes) who presented with high risk PDR during pregnancy required either repeated laser therapy (3 eyes) or vitrectomy (one eye) during the first year postpartum. Two patients (3 eyes) who did not have PDR at delivery developed PDR during the first year postpartum. After the second year postpartum, nine eyes which had developed PDR during or post pregnancy had stable retinas, two had developed phthisis, and one manifested end stage PDR. CONCLUSIONS: Because of the persistent adverse effects of pregnancy on the retinas of women with diabetes mellitus, meticulous retinal surveillance and appropriate therapy are important not only during pregnancy but also during the postnatal period.