Aims/background-A hospital based prevalence study was undertaken to estimate the prevalence of diabetic retinopathy (DR) in patients diagnosed as having diabetes mellitus after the age of 70 years. The prevalence of visually threatening retinopathy at the time of diagnosis of diabetes was also determined. The association between prevalence of DR and duration of diabetes mellitus, mode of treatment, HbA 1c levels, presence of hypertension, and sex of patient was examined and a comparison was drawn between this study and earlier prevalence studies of DR in older type II diabetics. Methods-Using data on the Irish Diabetic Retinopathy Register located in the Mater Misericordiae Hospital, Dublin, all patients who were diagnosed as having type II diabetes mellitus after the age of 70 years were invited to attend for ophthalmic review. Medical records were examined to determine the duration of diabetes mellitus, mode of treatment, recent HbA 1c levels, and the presence of systemic hypertension. Results-Of the 150 patients examined, 21 (14%) had some form of DR and 10 of these patients (6.6%) had visually threatening retinopathy or previously treated visually threatening retinopathy. Five patients (3.3%) presented with visually threatening retinopathy at the time of diagnosis of diabetes. Those patients with DR had a significantly higher median duration of diabetes (5.0 years) compared with those patients without DR (3.5 years). A significantly higher proportion of patients with DR required treatment with insulin and a correspondingly lower proportion of patients without DR were controlled on diet alone. There was no significant association between prevalence of DR and HbA 1c levels, systemic hypertension, or sex of patient. There was a lower overall prevalence of DR in comparison with earlier studies. Conclusions-The prevalence of DR in these elderly type II diabetics is lower than that previously reported in patients with type II disease but a small percentage of patients had visually threatening retinopathy at presentation. Longer duration of diabetes and insulin use were associated with a significantly increased prevalence of DR. All elderly type II diabetic patients require thorough ophthalmic examination near to the time of first presentation and thereafter at regular intervals. (Br J Ophthalmol 1997;81:218-222) Diabetic eye complications and, in particular, diabetic retinopathy are a leading cause of blindness in industrialised countries.

Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients’ specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provision were evaluated including treatment of pain and other symptoms, communication and decision making at end-of-life and level of involvement of the palliative care team. Physical symptoms were managed with relatively low doses of end-of-life medications. High levels of patient and family anxiety, however, highlight the complexity of death from a stigmatised disease. Prompt acknowledgement of the vulnerability of advanced cancer patients with COVID-19 can facilitate proactive symptom management, anticipatory communication and enhance family support.

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BackgroundRoyal Trinity Hospice supports around 2500 patients a year, 80% of whom live in the community. Feedback from patients and carers was that it was difficult to get to grips with changing symptoms and medications, and to understand the support available at the hospice, particularly in the early days after being referred.AimsThe Royal Trinity Hospice app is designed to provide patients and carers living at home with the support and information they need, in a timely and accessible way.MethodsThe content of the app was developed through collaboration between a multi-disciplinary team of staff at the hospice incorporating feedback from patients and carers. The app includes:• Easy to understand information on medications and common symptoms.• Advance care planning prompts which can be shared via email with relatives or hospice staff.• A function to manage attendance at hospice outpatients groups and contact key hospice teams directly.• Bereavement content for carers.Challenges during the development process included a lack of skills and experience in digital product development, capacity challenges around generating content and securing buy-in among hospice staff.ResultsThe app was launched on iTunes in April 2017 and was downloaded 83 times in the first two months. Patients commented that it confirmed that they were receiving the best possible care. Carers commented that the information on symptoms was good to refer back to. Both patients and carers felt it would be of most benefit when they were first referred to the hospice.ConclusionsThe app is still in its pilot phase. A full evaluation will be undertaken to disseminate learning, to understand the full impact on patient and carer outcomes and to determine whether the app merits further investment. However initial findings would indicate there is scope for hospices to enhance face-to-face care with digital tools.