免散瞳眼底照相在糖尿病视网膜病变筛查中的临床观察

目的 探讨免散瞳眼底彩色照相在糖尿病视网膜病变(DR)筛查中的应用价值.方法 对我院内分泌科收治的318例患者的636只眼,采用免散瞳眼底彩色数码照相机行眼底检查后,进行分析评估.结果 318例患者中正常眼底109例,占筛查总人数的34.27%;非增生性DR 164例,占结果阳性患者的78.47%;增生性DR 45例,占结果阳性者的21.53%.结论 免散瞳眼底照相法是DR筛查工作中一项有效的方法.     

免散瞳眼底拍照对糖尿病视网膜病变筛查效果的评价

目的 评价免散瞳眼底拍照诊断糖尿病视网膜病变(DR)的效果.方法 104例高血糖患者均行免散瞳眼底拍照(NMFCS)和散瞳后7个标准视野眼底彩照(SSSCFP)检查.结果 发现任何程度的DR,NMFCS与SSSCFP间有高度一致性(к=0.75±0.03);发现需推荐眼科诊治的DR患者,二者间也有极好的一致性(к=0.85±0.05).结论 NMFCS适用于高血糖人群的DR筛查,对DR的分诊和治疗有指导意义.     

Diabetic retinopathy and pancreas transplantation: a 3-year follow-up

The effect of simultaneous pancreas and kidney transplantation on diabetic retinopathy was studied in a prospective study with 30 patients (57 eyes) and 15 control subjects (26 eyes), patients who lost the pancreas, but preserved kidney function. There was no significant difference between the groups after a mean observation time of more than 35 months (a range of 12 to 96 months). Both populations had a stable retinopathy during follow-up. This seems to be a consequence of the far advanced retinopathy (mean duration of type 1 diabetes was 22 years) and the high percentage of coagulated eyes (81% and 85%, respectively), but is not related to the organ transplantation. A closer look at the few patients who did not receive laser coagulation (14 patient and 6 control eyes), produced a different result. Four control eyes experienced a significant deterioration of the retinopathy which had been stable before rejection. It is the most important and so far never mentioned aspect of this study, that periods of destabilisation are a definite threat for the retinopathy. Nevertheless, it seems questionable whether we will ever be able to make a definite statement on the pancreas-eye relation, as long as the transplantation must be restricted to carefully selected late-stage diabetic subjects.     

MICROALB study: screening for microalbuminuria in type 2 diabetic hypertensive patients by general practitioners in France

OBJECTIVE: To determine the prevalence of microalbuminuria (MAU) detected by a specific urinary strip in type 2 diabetic hypertensive patients in metropolitan France. METHOD: Screening for MAU with a semi-quantitative strip measuring the albumin/creatinine ratio was performed by general practitioners (GPs) in 6 type 2 diabetic hypertensive patients. This screening method was considered reliable if a preliminary search for proteinuria was performed with a usual strip and the quality of the MAU reading was good. RESULTS: 3347 GPs screened 19,714 patients (60% M, average age 64 +/- 10 years): 43.3% had MAU. MAU screening was considered reliable for 6679 patients (61.8% M, average age 65 +/- 10 years): 48.5% had MAU (alb/creat ratio between 30 and 300 mg/g), and 10.7% had manifest MAU (alb/creat ratio >300 mg/g). In all cases, the prevalence of MAU increased with the severity of hypertension. In the population with a reliable MAU screen, the analysis of risk factors according to the level of MAU yielded the following results: [table: see text]. In the MAU+ group, the need for multiple antidiabetic (including insulin) and antihypertensive drugs was more frequent. In contrast to current guidelines, only a minority of patients received an antiplatelet agent (approximately 33%). CONCLUSION: Despite recommendations, screening for proteinuria in type 2 diabetic hypertensive patients is seldom performed. However, the prevalence of MAU was high in this patient population. The prevalence of comorbidities and risk factors was significantly higher in the MAU+ group, with less frequent BP control despite a more aggressive antihypertensive treatment.     

Colorectal cancer screening: a survey of French general practitioners

AIM: To determine knowledge, beliefs, self-reported practices and wishes of French general practitioners regarding colorectal cancer screening before the start of an organized screening program. METHODS: A postal survey of the 600 general practitioners of the Haut-Rhin area was made in 2002. RESULTS: Response rate was 62%. Eighty-five% asked routinely their patients about their family history of colorectal cancer. Colorectal cancer screening was routinely proposed by 92% of practitioners to individuals with a family history (86% with colonoscopy) and by 20% to individuals without family history (69% with faecal occult blood test). Seventy-five% did not know French consensus conference guidelines on colorectal cancer screening. Fifty-three% ordered routinely faecal occult blood testing, mostly for the screening of individuals with family history and for the evaluation of symptoms, mainly iron-deficiency anemia and weight loss. Seventy-seven% would explore with colonoscopy subjects with positive faecal occult blood test. Fifty-four% had personally undergone screening. Fifty-six% considered that mass screening could reduce a lot colorectal cancer mortality and most of them agreed with the forthcoming organized colorectal cancer mass screening program. CONCLUSIONS: Screening for colorectal cancer is ordered less often than screening for female cancers. General practitioners are unaware of current guidelines. Beliefs and practices vary considerably and faecal occult blood testing is often inappropriately prescribed. Medical education concerning screening is needed. Colorectal cancer screening guidelines and policy should be clarified in France.     

High prevalence of retinal vascular changes in never-treated essential hypertensives: an inter- and intra-observer reproducibility study with non-mydriatic retinography

BACKGROUND: The clinical significance of stratifying cardiovascular risk in hypertensive patients on the basis of retinal changes such as arteriolar narrowing or arterio-venous crossing has been criticized. AIM: Objectives of the study were: (i) to compare the prevalence of retinal abnormalities detected by non-mydriatic retinography with that of other quantitative markers of target organ damage (TOD), such as echocardiographically determined left ventricular hypertrophy (LVH), carotid structural abnormalities and microalbuminuria in recently diagnosed and never treated hypertensives; (ii) to assess the inter- and intra-observer reproducibility in evaluating retinal microvascular changes. METHODS: One hundred ninety-seven grade 1 (73%) and grade 2 essential hypertensives (119 males; mean age 46.8 +/- 12.0 years, duration of hypertension: 2.3 +/- 1.8 years) referred for the first time to our outpatient hypertension hospital clinic were subjected to the following procedures: (i) repeated clinic blood pressure (BP) measurements; (ii) electrocardiogram; (iii) routine blood chemistry and urinalysis; (iv) 24-h urine collection for microalbuminuria; (v) 24-h ambulatory BP monitoring; (vi) non-mydriatic retinography; (vii) echocardiogram; (viii) carotid ultrasonography. Retinal changes were evaluated according to a modified Keith, Wagener and Barker (KWB) classification by two physicians, who had no knowledge of the patients' characteristics. These following markers of TOD were considered: (i) left ventricular mass index > or = 125 g/m2 in men and > or = 110 g/m2 in women; (ii) at least one carotid plaque (focal thickening > 1.3 mm) or diffuse common carotid thickening (> or = 0.9 mm); (iii) microalbuminuria (urinary albumin excretion > or = 30 and < 300 mg/24 h). RESULTS: The prevalence rates of LVH, carotid structural alterations and microalbuminuria were 12.9, 26.0 and 8.6% respectively; while the distribution of patients in the different degrees of hypertensive retinopathy made by two independent readers (1 and 2) was: 0 = 15.2, I = 25.4, II = 58.9, III = 0.5% (1); 0 = 14.7, I = 27.9, II = 56.8, III = 0.5% (2), p = NS. The overall prevalence of retinal changes was 84.3% and 84.7%, respectively, and the inter- and intra-observer reproducibility 89.1, 91.6 (1) and 90.2% (2), respectively. CONCLUSIONS: Our data indicate that: (i) the prevalence of initial retinal changes is far higher than that of other prognostically validated quantitative markers of cardiac and extracardiac TOD; (ii) the inter- and intra-observer reproducibility between two skilled readers in detecting these abnormalities with non-mydriatic retinography is excellent; (iii) the high prevalence of retinal changes in untreated subjects with mild hypertension offers a new piece of evidence that they cannot be considered a proof of TOD.     

Assessment of diabetes screening by general practitioners in France: the EPIDIA Study.

AIM: To audit Type 2 diabetes screening in general practice in France and to determine the frequency of undiagnosed diabetes in patients at high risk, after systematic screening and diagnosis. METHODS: For this study, 288 general practitioners volunteered to include all consecutive non-diabetic patients aged < 65 years who had at least two risk factors for diabetes, whatever the reason for consultation. If a plasma glucose had not been recorded in the previous 12 months, a fasting plasma glucose (FPG) was performed, with a second test if FPG >or= 7.0 mmol/l. RESULTS: There were 5950 patients included. The most frequent diabetes risk factors were: age >or= 40 years, 92%; overweight [body mass index (BMI) >or= 27 kg/m2], 59%; treated hypertension, 48%; treated dyslipidaemia, 37%; family history of diabetes, 24%. Of these subjects at high risk for diabetes, 88% had a FPG measurement in their medical record (75% measured during the preceding 12 months). In the 1499 patients in whom FPG was measured, diabetes was diagnosed in 40 patients (2.7% 95% CI 1.9-3.5) and 22% had impaired fasting glucose (IFG). Thus, the frequency of undiagnosed diabetes in the 5950 high-risk patients was 0.67% (0.46-0.88). CONCLUSION: Screening for diabetes by general practitioners in France appears to be adequate and undiagnosed diabetes is rare in patients with risk factors for diabetes, at least in those consulting the general practitioners studied.     

Screening for diabetic retinopathy by non-mydriatic fundus camera in a Turkish population

To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a diabetic population in Turkey using a non-mydriatic fundus camera. Patients presenting to our diabetes screening center were evaluated by fundus photography using a non-mydriatic fundus camera. Patients’ age at presentation, diabetes duration, hemoglobin A1c (HbA1c) levels, and treatments used for diabetes were recorded. The data of 1797 female (55%) and 1470 male (45%) diabetes patients (total 3267) were analyzed. The prevalence of DR was 28.6%. DR stage was mild non-proliferative DR (NPDR) in 345 patients (12.9%), moderate NPDR in 300 (11.2%), severe NPDR in 108 (4%), and proliferative DR (PDR) in 12 patients (0.4%). Diabetic macular edema (DME) was detected 98 patients (3.7%). Fundus pictures were inadequate for assessment in 18% of cases (588 patient). Advanced age, longer diabetes duration, higher HbA1c level, and being treated for diabetes were found as risk factors for DR. In this study, we used a non-mydriatic fundus camera to determine the prevalence and risk factors of diabetic retinopathy in a Turkish population. In developing countries, the non-mydriatic fundus camera may be an appropriate way to detect DR in the early stages before it progresses to the proliferative stage.     

Falls in older persons in Australia: screening instruments for general practitioners

Falls are a relatively common problem in older people in Australia causing significant morbidity including restricted activities of daily living and increased mortality. Falls may initiate institutionalisation and will increase in significance with the rapidly ageing population profile. Falls in older people are attributed to multiple factors and are potentially preventable with early detection and intervention. General practitioners, as the primary community medical care providers, are in an ideal position to screen all older patients for falls risk. A detailed history to identify falls risk factors should be complemented by screening with a simple and easy to use screening instrument. The requirements of a reliable and validated falls screening instrument are explored along with a review of available instruments. Although the literature is inconclusive, a suitable falls screening instrument is identified for use by general practitioners.     

The Exeter Diabetic Project: an acceptable district-wide education programme for general practitioners.

The Health District is a logical administrative unit for planning health services, and therefore the feasibility of delivering education for general practitioners across one such area was studied. By providing a suitable educational programme at convenient locations, it was possible to involve 89% out of 180 principals in General Practice in the Exeter Health District. Two-thirds of these general practitioners attended educational sessions away from the District Postgraduate Centre. In a questionnaire answered by 81% of the involved general practitioners, 98% acknowledged responsibility for managing their diabetic patients, but 76% admitted to inadequate skills in retinal assessment. In a follow-up postal questionnaire answered by 64% of general practitioners involved in the project, 74% found that they learnt from the retinopathy screening clinic and 100% found the sessions on eye disease helpful. The education programme was designed to link with a District-wide retinopathy screening initiative.     

Fast alcohol consumption evaluation: a screening instrument adapted for French general practitioners

BACKGROUND: To meet the needs of French general practitioners (GPs), we created a short (5 questions) interview/screening test for alcohol-related problems that is similar to AUDIT in terms of (1) test values and (2) identification of 3 groups: (a) abstainers and low-risk drinkers; (b) heavy drinkers; and (c) alcohol abusers or showing dependence. METHOD: Nine questions (from AUDIT, CAGE, TWEAK, Five-shot Questionnaire) were given systematically to their patients (aged 18 or more) by 41 volunteer GPs. Before the consultation, patients confidentially completed the AUDIT questionnaire in the waiting room. After the consultation, an addiction specialist evaluated each patient's alcohol consumption and DSM-IV criteria for alcohol abuse and dependence and these were used as gold standards. RESULTS: The analysis included 564 patient records and used stepwise logistic regression to select 7 questions, from which a second selection resulted in a 5-item questionnaire. These questions are: AUDIT questions 1 (Frequency) and 2 (Usual quantity), CAGE questions 2 (Annoyed) and 4 (Eye-opener), and TWEAK question 5 (Black-out), with each question scored 0 to 4. High levels of sensitivity and specificity were obtained for each diagnosis (sensitivity 75%-87.8%; specificity 74%-95.8%). CONCLUSION: FACE is an appropriate screening method for French general practitioners.