3 research outputs found
Prevalence of visual impairment and severity of diabetic retinopathy in various ethnic groups in the UK
No full textDiabetic Retinopathy (DR) is a leading cause of visual impairment (VI) in the working population. Minor ethnic groups are at increased risk of diabetes. Diabetic Retinopathy In Various Ethnic groups in the United Kingdom (DRIVE UK) is a cross-sectional study to estimate the prevalence of DR, VI and associated risk factors for sight threatening diabetic retinopathy (STDR) in Afro-Caribbeans (AC) and South Asians (SA) compared to Caucasians. People with diabetes in two regions in the United Kingdom who were screened and/or treated for DR from September 2008 to September 2009 were included in this study. VI and severe visual impairment (SVI) were defined as Snellen visual acuity of ≤ 6/18 and ≤ 6/60 respectively. DR was graded according to National Screening Committee (NSC) for diabetes guidelines UK.
There were 57,144 people on the diabetic register, of which retinopathy data was available from 50,285 (88.1%) subjects (type 1 n=3,323, type 2 n=46,962). In type 1 and type 2 diabetes, any DR was detected in 53.1%, 39.5%, diabetic maculopathy in 13.1%, 8.4% and STDR in 9.91%, 4.0% of people respectively. STDR was significantly more prevalent in the SA (10.3%) and AC (11.5%) populations compared to Caucasians (5.5%). Overall VI was significantly higher in the ethnic minority population. A total of 7.5% (95% CI 7.3, 7.8) people with diabetes were not eligible for driving based on their visual acuity, 3.4% (95% CI 3.2, 3.5) were classified as VI and 0.4% (95% CI 0.33, 0.44) as SVI. Risk factors for STDR were found to include longer duration of diabetes and higher mean HbA1c.
This study provides information that could be used to help develop future service frameworks and guidelines for local health bodies responsible for delivery of end userservices. The study also supports the need to explore the role of inflammatory, genetic and epigenetic factors as markers for ethnic differences in DR and potential treatment avenues for diabetic retinopathy
Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries
No full textIntroductionTelemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries.MethodA multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics.ResultsPatients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935).ConclusionSSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings
Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis
No full textBackground: The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation. Methods: This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model. Results: In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever). Conclusion: This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways
