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Health care screening for people with mental handicap living in the community.

OBJECTIVE: To determine what contact people with mental handicap had had with their general practitioner in the previous year; what prescribed drugs they were taking and whether these had been reviewed; when hearing and vision had last been screened; and what medical problems were found on examination. DESIGN: Case series. SETTING-Day centre for adults with mental handicap. SUBJECTS: A balanced sample of 75 of the 150 people attending the day centre. 10 Were excluded because consent was not given. RESULTS: The subjects did not consult their general practitioners more frequently than the general population but were more likely to be taking prescribed drugs, and 57% of these prescriptions had not been reviewed by a doctor. Thirty three people failed vision screening, including 13 who wore glasses. Twenty seven of the 62 who were testable had a hearing impairment. CONCLUSIONS: As only eight out of 65 people examined in the study did not have an appreciable problem brought to light, screening seems to be worth while. Whether such screening needs to be done by a medically qualified person needs further research.

Adult↗

[Personal computer used in visual function screening].

BACKGROUND: The number of medical screenings is increasing. This fact is specially pronounced in the field of occupational health. Due to restricted financial resources and limitations in time there is a need for rationalisation in medical screenings. MATERIALS AND METHODS: Possible uses of personal computers (PC) enabling organisational and financial benefits in medical screenings are suggested. By means of a test for colour-blindness it is shown how unfavourable technical conditions may be by-passed. RESULTS AND DISCUSSION: Rationalisation in medical screenings can be achieved when using the PC as a multi-functional screening-device as well as an expert system, measuring apparatus and as a communication-device. Due to a lack of literature it is difficult to discuss possible effects of technical differences between PC-based screenings of visual functions and screenings where "traditional". Reliability, sensitivity and validity is insufficiently investigated for many of the commercial available screening-devices based on a PC.

Color Perception Tests↗

Screening for refractive errors in children.

It is well known that refractive anomalies play a prominent role in the genesis of amblyopia. The current aim of early visual screening is to look for these refractive anomalies along with strabismus and media opacities. This update reviews the frequency of refractive anomalies in the preschool-aged population, their amblyogenic potential, and the different methods of refractive screening, including the required equipment, costs, and diagnostic performance.

Amblyopia↗

Community screening for eye disease by laypersons: the Hoffberger program.

PURPOSE: To describe the results of a community-based eye screening program in Baltimore. DESIGN: Cross-sectional study. METHODS: This was a retrospective study of the results of screening both eyes of 5352 persons who presented at multiple community sites. The screening examination had eight risk factor questions, visual acuity measurement, and a screening field test and was carried out by technicians and lay volunteers. Screened persons (screenees) received a definitive eye examination at no out-of-pocket cost, transportation was offered, and inexpensive eyeglasses were provided if needed. The main outcome measures were the rate of appointment keeping and the eye diseases identified. Telephone interviews were used to assess reasons for missing appointments and satisfaction with visits. RESULTS: Screenees had a median age of 45 years, were 71% black, 59% female, and had estimated median annual family income of 24,000 dollars. Among 1331 screenees who scheduled a definitive examination appointment, 552 (41%) completed the visit. Data on definitive diagnosis was available in 480 out of 552 persons (87%). Reasons given for failing to come for definitive examination were: no appointment given (26%), forgot (20%), lack of transportation (9%), and lack of insurance coverage (6%). Of those who accepted a second visit date after defaulting, only 25% (41/167) appeared. Of 17 persons identified with glaucoma at screening, 4 had previously been diagnosed, but had ceased active care. CONCLUSION: After community screening for eye disease, efforts to provide definitive ophthalmic examination were only modestly effective. Failure of screenees to come for examination and loss to follow up were identified as serious problems.

Aged↗

Grading and disease management in national screening for diabetic retinopathy in England and Wales.

AIMS: A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service. METHODS: Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications. PROPOSALS: Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no 'questionable' lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1). DISCUSSION: The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes.

Clinical Protocols↗

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.

Adult↗

Tonometry in question: can visual screening tests play a more decisive role in glaucoma diagnosis and management?

Chronic open-angle glaucoma is a disease in which characteristic changes occur in optic nerve morphology and in ganglion cell function. The utility of intraocular pressure readings in the diagnosis and ongoing management of glaucoma patients is pragmatically considered in the light of the availability of potentially more sensitive means of glaucoma monitoring. Conservative appraisal of the literature suggests that traditional clinical tonometry has low diagnostic sensitivity and specificity. The majority of new cases of glaucomatous visual field loss are most likely to arise from the normotensive population. Clinical studies to determine the correlation between intraocular pressure reduction and the preservation of visual function have repeatedly yielded a much weaker association between these two variables than is perhaps generally assumed. Newer psychophysical methods may have greater potential for rapidly identifying and subsequently monitoring glaucoma patients, but still require refinement and more widespread clinical evaluation. One prerequisite for the eventual adoption of such methods is that clinicians fully appreciate the limitations inherent in tonometry as a glaucoma screening and monitoring technique.

Glaucoma, Open-Angle↗