OBJECTIVEThis meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends.RESEARCH DESIGN AND METHODSThis systematic literature review and meta-analysis of prospective studies assesses progression of retinopathy among diabetic patients without treatment for retinopathy at baseline. Studies published between 1975 to February 2008 were identified. Outcomes of interest were rates of progression to PDR and/or SVL. Pooled baseline characteristics and outcome measures were summarized using weighted averages of counts and means. Baseline characteristics and outcomes were compared between two periods: 1975–1985 and 1986–2008.RESULTSA total of 28 studies comprising 27,120 diabetic patients (mean age 49.8 years) were included. After 4 years, pooled incidence rates for PDR and SVL were 11.0 and 7.2%, respectively. Rates were lower among participants in 1986–2008 than in 1975–1985. After 10 years, similar patterns were observed. Participants in 1986–2008 studies had lower proportions of PDR and non-PDR at all time points than participants in 1975–1985 studies.CONCLUSIONSSince 1985, diabetic patients have lower rates of progression to PDR and SVL. These findings may reflect an increased awareness of retinopathy risk factors; earlier identification and initiation of care for patients with retinopathy; and improved medical management of glucose, blood pressure, and serum lipids. Differences in baseline characteristics, particularly in the prevalence and severity of retinopathy, could also have contributed to these temporal differences.

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Assessment of clinically meaningful change is useful for treatment planning, monitoring progress, and evaluating treatment response. Outcome studies often assess statistically significant change, which may not be clinically meaningful. Study objectives are to: (1) evaluate responsiveness of the BASIS-24 using three methods for determining clinically meaningful change: reliable change index (RCI), effect size (ES), and standard error of measurement (SEM); and (2) determine which method provides an estimate of clinically meaningful change most concordant with other change measures. BASIS-24 assessments were obtained at two time points for 1,397 inpatients and 850 outpatients. The proportion showing clinically meaningful change using each method was compared to the proportion showing change in global mental health, retrospectively reported change, and clinician-assessed change. BASIS-24 demonstrated responsiveness at both aggregate and individual levels. Regarding clinically meaningful improvement and decline, SEM was most concordant with all three outcome measures; regarding no change, RCI was most concordant with all three measures.

Increasing racial and ethnic diversity calls for mental health assessment instruments that are appropriate, reliable, and valid for the wide range of cultures that comprise the current US population. However, most assessment instruments have not been tested on diverse samples. This study assessed psychometric properties and sensitivity to change of the revised Behavior and Symptom Identification Scale (BASIS-24) among the three largest race/ethnicity groups in the USA: Whites, African-Americans, and Latinos. BASIS-24 assessments were obtained for 2436 inpatients and 2975 outpatients treated at one of 27 mental health and/or substance abuse programs. Confirmatory factor analysis and several psychometric tests supported the factor structure, reliability, concurrent validity, and sensitivity of the instrument within each race/ethnicity group, although discriminant validity may be weaker for African-Americans and Latinos than for Whites. Further research is needed to test and validate assessment instruments with other race/ethnicity groups.

Although the majority of participants were concordant for PTSD status, over 25% of EMR diagnoses differed from those obtained in the diagnostic interview, with varying proportions of false positives and false negatives. Overall, those individuals with the most and least severe symptom presentations in the diagnostic interview were more likely to be accurately classified.