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Lepetit-Aimon G, Playout C, Boucher MC, Duval R, Brent MH, Cheriet F. MAPLES-DR: MESSIDOR Anatomical and Pathological Labels for Explainable Screening of Diabetic Retinopathy. Sci Data 2024; 11:914. [PMID: 39179588 PMCID: PMC11343847 DOI: 10.1038/s41597-024-03739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 08/05/2024] [Indexed: 08/26/2024] Open
Abstract
Reliable automatic diagnosis of Diabetic Retinopathy (DR) and Macular Edema (ME) is an invaluable asset in improving the rate of monitored patients among at-risk populations and in enabling earlier treatments before the pathology progresses and threatens vision. However, the explainability of screening models is still an open question, and specifically designed datasets are required to support the research. We present MAPLES-DR (MESSIDOR Anatomical and Pathological Labels for Explainable Screening of Diabetic Retinopathy), which contains, for 198 images of the MESSIDOR public fundus dataset, new diagnoses for DR and ME as well as new pixel-wise segmentation maps for 10 anatomical and pathological biomarkers related to DR. This paper documents the design choices and the annotation procedure that produced MAPLES-DR, discusses the interobserver variability and the overall quality of the annotations, and provides guidelines on using the dataset in a machine learning context.
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Affiliation(s)
- Gabriel Lepetit-Aimon
- Department of Computer and Software Engineering, Polytechnique Montréal, Montréal, QC, Canada.
| | - Clément Playout
- Department of Ophthalmology, Université de Montréal, Montréal, Canada
- Centre Universitaire d'Ophtalmologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Université de Montréal, Montréal, Canada
- Centre Universitaire d'Ophtalmologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Renaud Duval
- Department of Ophthalmology, Université de Montréal, Montréal, Canada
- Centre Universitaire d'Ophtalmologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Canada
| | - Farida Cheriet
- Department of Computer and Software Engineering, Polytechnique Montréal, Montréal, QC, Canada
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Omar A, Williams RG, Whelan J, Noble J, Brent MH, Giunta M, Olivier S, Lhor M. Diabetic Disease of the Eye in Canada: Consensus Statements from a Retina Specialist Working Group. Ophthalmol Ther 2024; 13:1071-1102. [PMID: 38526804 DOI: 10.1007/s40123-024-00923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
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Affiliation(s)
- Amer Omar
- Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
| | - R Geoff Williams
- Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada
| | - James Whelan
- Faculty of Medicine, Memorial University, St. John's, NF, Canada
| | - Jason Noble
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michel Giunta
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Olivier
- Centre Universitaire d'ophtalmologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mustapha Lhor
- Medical and Scientific Affairs Ophthalmology, Bayer Inc., Mississauga, ON, Canada
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Li HD, Li MX, Zhang WH, Zhang SW, Gong YB. Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy: A systematic review and network meta-analysis of randomized clinical trials. World J Diabetes 2023; 14:1422-1449. [PMID: 37771328 PMCID: PMC10523233 DOI: 10.4239/wjd.v14.i9.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/14/2023] [Accepted: 07/29/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness. Commonly used clinical approaches include etiological control, microvascular improvement, and surgical intervention, but they are ineffective and have many side effects. Oral Chinese medicine (OCM) has been used for thousands of years to treat DR and is still widely used today, but it is unclear which OCM is more effective for DR. AIM To estimate relative effectiveness and safety profiles for different classes of OCMs for DR, and provide rankings of the available OCMs. METHODS The search time frame was from the creation of the database to January 2023. RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses (NMA). RESULTS A total of 107 studies and 9710 patients were included, including 4767 cases in the test group and 4973 cases in the control group. Based on previous studies and clinical reports, and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR, 9 OCMs were finally included in this study, namely Compound Xueshuantong Capsules, Qiming Granules, Compound Danshen Dripping Pills, Hexue Mingmu Tablets (HXMM), Qiju Dihuang Pills (QJDH), Shuangdan Mingmu Capsules (SDMM), Danggui Buxue Decoction (DGBX), Xuefu Zhuyu Decoction and Buyang Huanwu Decoction. When these nine OCMs were analyzed in combination with conventional western medicine treatment (CT) compared with CT alone, the NMA results showed that HXMM + CT has better intervention effect on the overall efficacy of DR patients, HXMM + CT has better effect on improving patients' visual acuity, SDMM + CT has better effect on inhibiting vascular endothelial growth factor, DGBX + CT has better effect on reducing fundus hemorrhage area, HXMM + CT has better effect on reducing fasting blood glucose, and QJDH + CT has better effect on reducing glycated hemoglobin. When there are not enough clinical indicators for reference, SDMM + CT or HXMM + CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy. CONCLUSION This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone. Based on the findings, we highly recommend the use of SDMM or HXMM for the treatment of DR. These two OCMs have demonstrated outstanding efficacy across multiple indicators.
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Affiliation(s)
- Hong-Dian Li
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Ming-Xuan Li
- Capital Medical University, Beijing Hospital of Traditional Chinese Medicine, Beijing 100010, China
| | - Wen-Hua Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shu-Wen Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yan-Bing Gong
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol. Pilot Feasibility Stud 2023; 9:158. [PMID: 37689724 PMCID: PMC10492373 DOI: 10.1186/s40814-023-01372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. METHODS We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50-150 patients and 5-10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. DISCUSSION This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
- VITAM, Centre for Research On Sustainable Health, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- School of Psychology, University of Ottawa, Ottawa, Canada.
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Liu SL, Gonder JR, Owrangi E, Klar NS, Hramiak IM, Uvarov A, Mahon JL. Effectiveness of Nonmydriatic Ultra-Widefield Retinal Imaging to Screen for Diabetic Eye Disease: A Randomized Controlled Trial (Clearsight). Diabetes Care 2023; 46:399-407. [PMID: 36469332 DOI: 10.2337/dc22-0713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/06/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Suboptimal diabetic eye disease screening is a major cause of preventable vision loss. Screening barriers include mydriasis and the need for dedicated screening appointments. The Clearsight trial assessed whether nonmydriatic ultra-widefield (NM UWF) screening on the day of a diabetes clinic visit improved detection of clinically important eye disease versus usual screening. RESEARCH DESIGN AND METHODS This single-center, randomized, parallel-group controlled trial was conducted at St. Joseph's Health Care, London, Ontario, Canada. Adults with diabetes due for screening were randomized to same-day, on-site screening (NM UWF imaging) on the day of a scheduled diabetes clinic visit or usual screening (encouraged to arrange optometrist screening). The primary outcome was detection of actionable eye disease (AED), defined as the need for an ophthalmology referral or increased ocular surveillance. The primary analysis (modified intention-to-screen) compared the proportions of AED between groups within 1 year of enrollment. RESULTS Of 740 participants randomized between 7 March 2016 and 17 April 2019, 335 on-site screening and 323 usual screening participants met criteria for the primary analysis. More AED was detected in the on-site screening group than in the usual screening group (50 of 335 [14.9%] vs. 22 of 323 [6.8%]; adjusted odds ratio 2.51; 95% CI 1.49-4.36). The number needed to screen by on-site screening in order to detect 1 additional patient with AED was 13 (95% CI 8-29). CONCLUSIONS Same-day, on-site screening by NM UWF imaging increased the detection of clinically important diabetic eye disease versus usual screening. Integration of NM UWF imaging into routine diabetes clinic visits improved screening adherence and has the potential to prevent vision loss.
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Affiliation(s)
- Selina L Liu
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - John R Gonder
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ehsan Owrangi
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Neil S Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Irene M Hramiak
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Artem Uvarov
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jeffrey L Mahon
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Stamenova V, Nguyen M, Onabajo N, Merritt R, Sutakovic O, Mossman K, Wong I, Ives-Baine L, Bhatia RS, Brent MH, Bhattacharyya O. Mailed Letter Versus Phone Call to Increase Diabetic-Related Retinopathy Screening Engagement by Patients in a Team-Based Primary Care Practice: Prospective, Single-Masked, Randomized Trial. J Med Internet Res 2023; 25:e37867. [PMID: 36630160 PMCID: PMC9878360 DOI: 10.2196/37867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Vision loss from diabetic-related retinopathy (DR) is preventable through regular screening. OBJECTIVE The purpose of this study was to test different patient engagement approaches to expand a teleophthalmology program at a primary care clinic in the city of Toronto, Canada. METHODS A teleophthalmology program was set up in a large, urban, academic, team-based primary care practice. Patients older than 18 years with type 1 or type 2 diabetes were randomized to one of the following 4 engagement strategies: phone call, mail, mail plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for DR screening. RESULTS A total of 23 patients in the phone, 28 in the mail, 32 in the mail plus phone call, and 27 in the control (usual care) group were included in the analysis. After the intervention and after excluding patients who said they were screened, 88% (15/17) of patients in the phone, 11% (2/18) in the mail, and 100% (21/21) in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% (0/12) in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (P<.001), whereas mailing a letter had no effect. CONCLUSIONS Patient engagement to book DR screening via teleophthalmology in an urban, academic, team-based primary care practice using telephone calls was much more effective than patient engagement using letters or usual care. Practices that have access to a local DR screening program and have resources for such engagement strategies should consider using them as a means to improve their DR screening rates. TRIAL REGISTRATION ClinicalTrials.gov NCT03927859; https://clinicaltrials.gov/ct2/show/NCT03927859.
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Affiliation(s)
- Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca Merritt
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, ON, Canada
| | - Kathryn Mossman
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Ivy Wong
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
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Nguyen M, Stamenova V, Onabajo N, Merritt R, Sutakovic O, Mossman K, Wong I, Ives-Baine L, Bhatia RS, Brent MH, Bhattacharyya O. Perceptions of a Teleophthalmology Screening Program for Diabetic Retinopathy in Adults With Type 1 and Type 2 Diabetes in Urban Primary Care Settings. Can J Diabetes 2022; 46:S1499-2671(22)00043-0. [PMID: 35985924 DOI: 10.1016/j.jcjd.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 01/24/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Teleophthalmology has improved diabetic retinopathy screening, and should be expanded in urban areas, where most unscreened individuals reside. In this study we explored facilitators and barriers of teleophthalmology in primary care settings in Toronto, Canada. METHODS Semistructured interviews were conducted with 7 health-care providers and 7 individuals with diabetes to explore their perspectives of teleophthalmology in urban primary care settings. Interview data were analyzed using interpretive thematic analysis to generate themes. RESULTS Six themes were identified. Facilitators included patient-centred implementation, access to teleophthalmology at primary care sites and patients' trust in their providers' recommendations. Barriers included patients' lack of understanding of diabetic retinopathy and the health-care system, providers' lack of interest and the need to streamline administrative processes. CONCLUSIONS Although teleophthalmology was well-received by patients, there was limited interest from primary care providers. Strategies for increasing uptake include increasing primary care providers' awareness of teleophthalmology's value in urban centres, improving administrative processes and centralizing patient recruitment.
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Affiliation(s)
- Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
| | - Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Rebecca Merritt
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Ontario, Canada
| | - Kathryn Mossman
- Research and Strategy, Throughline Strategy, Toronto, Ontario, Canada
| | - Ivy Wong
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Lori Ives-Baine
- Patient Partner, Diabetes Action Canada, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
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8
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Rosenberg D, Noble J, Chaudhary V. Recours au télédépistage pour la rétinopathie diabétique. CMAJ 2021; 193:E1408-E1409. [PMID: 34493572 PMCID: PMC8443290 DOI: 10.1503/cmaj.202141-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel Rosenberg
- École de médecine Michael G. DeGroote (Rosenberg), Université McMaster, Hamilton, Ont.; Département d'ophtalmologie et des sciences de la vision (Noble); Centre des sciences de la santé Sunnybrook (Noble), Toronto, Ont.; Département de chirurgie, Division d'ophtalmologie (Chaudhary); Département des méthodes, des données et de l'incidence de la recherche en santé (Chaudhary), Université McMaster; Centre de soins de santé St. Joseph's de Hamilton (Chaudhary), Hamilton, Ont
| | - Jason Noble
- École de médecine Michael G. DeGroote (Rosenberg), Université McMaster, Hamilton, Ont.; Département d'ophtalmologie et des sciences de la vision (Noble); Centre des sciences de la santé Sunnybrook (Noble), Toronto, Ont.; Département de chirurgie, Division d'ophtalmologie (Chaudhary); Département des méthodes, des données et de l'incidence de la recherche en santé (Chaudhary), Université McMaster; Centre de soins de santé St. Joseph's de Hamilton (Chaudhary), Hamilton, Ont
| | - Varun Chaudhary
- École de médecine Michael G. DeGroote (Rosenberg), Université McMaster, Hamilton, Ont.; Département d'ophtalmologie et des sciences de la vision (Noble); Centre des sciences de la santé Sunnybrook (Noble), Toronto, Ont.; Département de chirurgie, Division d'ophtalmologie (Chaudhary); Département des méthodes, des données et de l'incidence de la recherche en santé (Chaudhary), Université McMaster; Centre de soins de santé St. Joseph's de Hamilton (Chaudhary), Hamilton, Ont.
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9
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Rosenberg D, Noble J, Chaudhary V. Teleretina screening for diabetic retinopathy. CMAJ 2021; 193:E1006. [PMID: 34226264 PMCID: PMC8248575 DOI: 10.1503/cmaj.202141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Daniel Rosenberg
- Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph's Healthcare Hamilton (Chaudhary), Hamilton, Ont
| | - Jason Noble
- Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph's Healthcare Hamilton (Chaudhary), Hamilton, Ont
| | - Varun Chaudhary
- Michael G. DeGroote School of Medicine (Rosenberg), McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences (Noble); Sunnybrook Health Sciences Centre (Noble), Toronto, Ont.; Department of Surgery, Division of Ophthalmology (Chaudhary); Department of Health Research Methods, Evidence and Impact (Chaudhary), McMaster University; St. Joseph's Healthcare Hamilton (Chaudhary), Hamilton, Ont.
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Diabetic Retinopathy Screening: A Systematic Review of Qualitative Literature. Can J Diabetes 2021; 45:725-733.e12. [PMID: 33814308 DOI: 10.1016/j.jcjd.2021.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Our aim was to understand facilitators and barriers influencing diabetic retinopathy screening attendance and to examine factors that promote program success. METHODS MEDLINE, Embase, PsycINFO and CINAHL from inception until September 23, 2019 were used for data collection. Studies were included if they were original qualitative research articles, included adults >18 years of age and assessed diabetic retinopathy screening programs or retinopathy screening as a component of a general diabetes care program. A "best-fit" framework synthesis methodology was used for this analysis. RESULTS Twenty-nine articles involving 1,433 participants were identified. Six themes of barriers to, and facilitators of, diabetic retinopathy screening were identified, including access to screening, knowledge and information sharing, training and skills competency, service delivery, cultural competency and psychological factors. Cost and competing interests were common barriers to access; lack of knowledge about screening services was also a frequently reported barrier. Both patients and providers identified the need for improved service delivery, especially the referral and follow-up process. Providers recognized the need for additional training, patients enumerated several psychological barriers to screening uptake and cultural considerations were believed to be important, particularly among indigenous communities. CONCLUSIONS To improve screening uptake, the identified challenges must be addressed while also reinforcing the facilitators. Furthermore, program administrators could model new and unsuccessful screening programs after the successful ones while also considering local peculiarities.
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Morein J, Uvarov A, Spaic T, Mahon JL, Hramiak I, Liu SL. Low prevalence of fibrate use in adults with type 1 and type 2 diabetes and established diabetic retinopathy. Can J Ophthalmol 2021; 56:394-395. [PMID: 33524315 DOI: 10.1016/j.jcjo.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Justin Morein
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada
| | - Artem Uvarov
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada
| | - Tamara Spaic
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada; St. Joseph's Health Care London, London, Ont., Canada
| | - Jeffrey L Mahon
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada; St. Joseph's Health Care London, London, Ont., Canada
| | - Irene Hramiak
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada; St. Joseph's Health Care London, London, Ont., Canada
| | - Selina L Liu
- Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada; St. Joseph's Health Care London, London, Ont., Canada.
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Identifying gaps in patient access to diabetic screening eye examinations in Ontario: a provincially representative cross-sectional study. Can J Ophthalmol 2020; 56:223-230. [PMID: 33232680 DOI: 10.1016/j.jcjo.2020.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Diabetes is the leading cause of acquired blindness in Canadians under the age of 50 years, and diabetic retinopathy affects an estimated 500 000 Canadians. Early identification of retinopathy with screening eye examinations allows for secondary prevention. To understand the need for resource allotment in diabetic screening, we undertook a cross-sectional study of key demographics and geographics of screened and unscreened patients in Ontario. METHODS Ontario Health Insurance Plan (OHIP) records were derived from physician and optometry billing, matched with patients aged >19 years with prevalent diabetes between 2011 and 2013. Data were cross-correlated with demographic covariates, including age, sex, income quintile, immigrant status, as well as geographic covariates such as rurality and patient Local Health Integration Network (LHIN). RESULTS Of almost 1 146 000 patients included in the analysis, approximately 406 000 were unscreened. Of note, this included 234 000 adults aged 40-64 years. Approximately 818 000 patients with diabetes lived in large cities, and 301 000 (37%) were unscreened. When the City of Toronto was analyzed as an urban area with the highest density of unscreened prevalence, autocorrelation between the percentage of eye examinations among patients with diabetes aged >40 years and low-income revealed that large areas of Toronto Central correlated for low examination rates and low income. The majority (13/22) of Community Health Centres are present in these areas. CONCLUSIONS Large cross-sectional population statistics for diabetes prevalence and ophthalmic examinations provides a geographic and socioeconomic profile for populations of middle-aged adults in large urban areas at risk for developing diabetic retinopathy and who might benefit from interventions to improve the rates of screening eye examinations.
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Sun Y, Cai YT, Chen J, Gao Y, Xi J, Ge L, Cao Y, Zhang J, Tian J. An evidence map of clinical practice guideline recommendations and quality on diabetic retinopathy. Eye (Lond) 2020; 34:1989-2000. [PMID: 32581391 PMCID: PMC7784673 DOI: 10.1038/s41433-020-1010-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/12/2020] [Accepted: 05/27/2020] [Indexed: 11/09/2022] Open
Abstract
To present an evidence map for explicating research trends and gaps, we systematically review clinical practice guidelines (CPGs) on diabetic retinopathy (DR) and assess the quality of CPGs and consistency of recommendations. A literature search was performed in PubMed, Embase, Web of Science, CPG databases, and website of diabetes society to include the CPGs. The basic information, methodological quality, and reporting quality of CPGs, recommendations for DR were exacted by the Excel 2013. Methodological and reporting quality of DR CPGs were evaluated by AGREE II instrument and RIGHT checklist. The bubble plot format of evidence map was made by Excel 2013. Nineteen CPGs proved eligible, which included eight DR CPGs and 11 comprehensive diabetic CPGs. The identified CPGs were of mixed quality and they scored poorly in the rigor of development, applicability domains by AGREE II. Field two (background) had the highest reporting rate (86.31%) and field five (review and quality assurance) obtained the lowest reporting rate (31.58%) among the seven domains of RIGHT checklist. According to the recommendations of CPGs, there were three inconsistencies in the screening of DR, and CPGs recommendations for treatment were consistent on the whole. At the same time, recommendations for laser therapy were not accurate. Some recommendations were not specific and clear in some DR CPGs. This evidence map could collect and evaluate the characteristics of published CPGs, add to our knowledge and promote the development of trustworthy CPGs for DR.
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Affiliation(s)
- Yue Sun
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Yi-Tong Cai
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ji Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jiangbo Xi
- School of Geology Engineering and Geomatics, Chang'an University, Xian City, Shanxi Province, China
| | - Long Ge
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- School of Public Health, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yi Cao
- The First Affiliated Hospital of Xi'an Jiaotong University, Xian City, Shanxi Province, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, Gansu Province, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Elder K, Turner KA, Cosgrove L, Lexchin J, Shnier A, Moore A, Straus S, Thombs BD. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020; 192:E617-E625. [PMID: 32538799 PMCID: PMC7867217 DOI: 10.1503/cmaj.191737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest. METHODS For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018. Eligible guidelines had to have a national focus and either a first-line drug recommendation or a screening recommendation leading to drug treatment. One investigator reviewed all CPG titles to exclude those that were clearly ineligible. Two reviewers independently reviewed all remaining guidelines and extracted data. We analyzed the data descriptively. RESULTS We included 21 CPGs: 3 from government-sponsored organizations, 9 from disease or condition interest groups and 9 from medical professional societies. None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest. None of the guidelines described a plan to manage organizational financial conflicts of interest. INTERPRETATION Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members. The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts.
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Affiliation(s)
- Katharine Elder
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Lisa Cosgrove
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Joel Lexchin
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Adrienne Shnier
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Sharon Straus
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Brett D Thombs
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
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Felfeli T, Alon R, Merritt R, Brent MH. Toronto tele-retinal screening program for detection of diabetic retinopathy and macular edema. Can J Ophthalmol 2019; 54:203-211. [DOI: 10.1016/j.jcjo.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022]
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