BackgroundAt present, there is no national population-based retinopathy screening programme for people in Ireland who have diabetes, such as those operating in the UK for over a decade. AimTo evaluate a community-based initiative that utilised existing resources in general practice and community optometry/ophthalmology services to provide screening for diabetic retinopathy. Design and settingCross-sectional study using electronic ophthalmic patient screening records in community optometry clinics in Cork, Ireland. MethodA purposive sample of 32 practices was recruited from Diabetes in General Practice, a general practice-led initiative in the South of Ireland. Practices invited all adult patients registered with diabetes to participate in free retinopathy screening (n = 3598), provided by 15 community optometry practices and two community ophthalmologists. Data were recorded on an electronic database used by optometrists and the performance was benchmarked against proposed national standards for retinopathy screening. ResultsIn total, 30 practices participated (94%). After 6 months, 49% of patients (n = 1763) had been screened, following one invitation letter and no reminder. Forty-three per cent of those invited consented to their data being used in the study and subsequent analyses are based on that sample (n = 1542). The mean age of the patients screened was 65 years (standard deviation = 13.0 years), 57% were male (n = 884), and 86% had type 2 diabetes (n = 1320). In total, 26% had some level of retinopathy detected (n = 395); 21% had background retinopathy (n = 331), 3% had preproliferative retinopathy (n = 53), and 0.7% had proliferative retinopathy (n = 11). ConclusionThe detection of retinopathy among 26% of those screened highlights the need for a national retinopathy screening programme in Ireland. Significant learning, derived from the implementation of this initiative, will inform the national programme.
Objectives & BackgroundMany emergency medicine clinical trials have struggled to recruit to ‘time and target’ with investigators having to make a large additional effort or extend the time for recruitment. This study was performed to describe our experience in the use of a computer ‘app’ to facilitate the process of research subject identification and communication between the ED staff and the research team. Key questions were:1) Does the introduction of an iPad ‘app’ result in a greater rate of patient notification to the research team?2) Which type of notification method was most used?MethodsAn observational ‘before and after' study was performed where ED staff had the choice of using a telephone ‘research hotline', verbal notification, a sticky label on the clinical notes or an iPad app (in the second phase of the study). A ‘gold standard' was provided by a manual search of the notes of every patient who presented to the ED. We developed the specification for an ‘app’ that presented the trial entry criteria coupled with an easy embedded method of emailing the research team using only three ‘clicks'. The iPads were secured to walls in key locations (such as triage areas) and ED staff simply entered the patient's identification number and pressed ‘send' for a message to be emailed. We reviewed the method of patient notification for 3 months before and after the introduction of the iPad system.ResultsThere was a significant (Fisher's Exact Test. p<0.0001) increase in ‘real time' notification of patients to the research team from 18% to 33% after the introduction of the iPad app. The mode of notification also changed–with no use of the ‘research hotline' telephone number after the app system was introduced. The use of sticky labels and the number of verbal notifications was also greatly reduced (See table 1).ConclusionThere was a significant increase in the immediacy of communication after the introduction of the iPad app. This occurred without a large amount of input from the research team, and seemed to be due to the staff knowing a specific location for the system and the ease of use, with the whole process taking less than 20 seconds. ED staff seemed to prefer using the ‘app', as after it was introduced there was very little use of the well publicised ‘research hotline' phone number. Information and communications technology can aid in the timely identification of potential research subjects in emergency care.
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