Screening and identifying diabetes in optometric practice: a prospective study

Background: Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. Aim: The study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Design and setting: Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. Results: Of 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. Conclusion: Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings

Diagnosis of Esophagitis Based on Face Recognition Techniques

Face recognition technology has evolved over years with the Principal Component Analysis (PCA) method being the benchmark for recognition efficiency. The face recognition techniques take care of variation of illumination, pose and other features of the face in the image. We envisage an application of these face recognition techniques for classification of medical images. The motivating factor being, given a condition of an organ it is represented by some typical features. In this paper we report the use of the face recognition techniques to classify the type of Esophagitis, a condition of inflammation of the esophagus. The image of the esophagus is captured in the process of endoscopy. We test PCA, Fisher Face method and Independent Component Analysis techniques to classify the images of the esophagus. Esophagitis is classified into four categories. The results of classification for each method are reported and the results are compared

Treatments for irritable bowel syndrome: patients' attitudes and acceptability

<p>Abstract</p> <p>Background</p> <p>Irritable Bowel Syndrome, a highly prevalent chronic disorder, places significant burden on the health service and the individual. Symptomatic distress and reduced quality of life are compounded by few efficacious treatments available. As researchers continue to demonstrate the clinical efficacy of alternative therapies, it would be useful to gain a patient-perspective of treatment acceptability and identify patient's attitudes towards those modalities considered not acceptable.</p> <p>Methods</p> <p>Six hundred and forty-five participants identified from an earlier IBS-prevalence study received a postal questionnaire to evaluate preferences and acceptability of nine forms of treatment. Proportions accepting each form of treatment were calculated and thematic analysis of qualitative data undertaken.</p> <p>Results</p> <p>A total of 256 (39.7%) of 645 potential respondents completed the questionnaire (mean age 55.9 years, 73% female). Tablets were most acceptable (84%), followed by lifestyle changes (diet (82%), yoga (77%)). Acupuncture (59%) and suppositories (57%) were less acceptable.</p> <p>When explaining lack of acceptability, patient views fell into four broad categories: dislike treatment modality, do not perceive benefit, general barriers and insufficient knowledge. Scepticism, lack of scientific rationale and fear of CAM were mentioned, although others expressed a dislike of conventional medical treatments. Past experiences, age and health concerns, and need for proof of efficacy were reported.</p> <p>Conclusion</p> <p>Most patients were willing to accept various forms of treatment. However, the reservations expressed by this patient-population must be recognised with particular focus directed towards allaying fears and misconceptions, seeking further evidence base for certain therapies and incorporating physician support and advice.</p

Illness perceptions mediate the relationship between bowel symptom severity and health-related quality of life in IBS patients

PURPOSE: Irritable bowel syndrome (IBS) is a functional bowel disorder with a large negative impact on HRQOL. The present study examines whether severity of bowel symptoms is directly related to HRQOL, and/or indirectly, mediated by the patients’ illness perceptions. METHODS: Patients were recruited from an IBS support group (N = 123), and data were collected online. HRQOL was measured with the Quality of Life Measure for Persons with IBS and illness perceptions with the brief Illness Perception Questionnaire. Mediation models were tested using the bootstrapping procedure developed by Hayes. RESULTS: Irritable bowel syndrome symptom severity is directly related to total HRQOL and its subscales; after entering the mediator variables (i.e. the patients’ illness perceptions) into the model, this direct association remained only significant for total HRQOL. The relationship between bowel symptom severity and total HRQOL was partially mediated by illness perceptions, and its relationship with each of the HRQOL subscales was fully mediated by the patients’ illness perceptions. Perceived consequences were a mediator of the relationship between bowel symptom severity, total HRQOL as well as its subscales, with the exception of Sexuality. CONCLUSIONS: Bowel symptom severity not only has a direct relationship with HRQOL, but also an indirect relationship via the patients’ cognitive and emotional representations of their illness. In order to better understand this relationship, future research should not only include illness perceptions but also assess cognitive and behavioural coping responses. Clinicians wanting to improve patients’ HRQOL should not only focus on the patients’ symptoms, but also on their illness beliefs and coping responses

Do gastrointestinal complaints increase the risk for subsequent medically certified long-term sickness absence? The HUSK study

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms.</p> <p>Method</p> <p>Health data on 13 880 40-45 year olds from the Hordaland Health Study (1997-99) were linked to national registries on sickness absence. As part of a wider health screening, gastrointestinal complaints were ascertained. Participant's anxiety and depression, and the presence of other somatic symptoms were evaluated. In Cox regression models, we predicted sickness absences over an average 5.4 years follow-up, with adjustment for confounders, anxiety and depression and other somatic symptoms.</p> <p>Results</p> <p>After adjusting for gender, level of education and smoking, those reporting GI complaints had higher risk for later sickness absence (HR = 1.42, 95% CI 1.34-1.51). GI complaints were associated with both anxiety (OR = 3.66, 95% CI 3.31-4.04) and depression (OR = 3.28, 95% CI 2.89-3.72), and a high level of other somatic symptoms (OR = 8.50, 95% CI 7.69-9.40). The association of GI complaints was still independently associated with future sickness absence (HR = 1.17, 95% CI 1.10-1.16) adjusting for mental illness and other somatic symptoms.</p> <p>Discussion</p> <p>Sickness absence is a complex behavioural outcome, but our results suggest GI complaints contribute by increasing the risk of long term sickness absence independently of comorbid mental illness and presence of other somatic symptoms. Occupational consequences of illness are important, and should also be addressed clinically with patients presenting with GI complaints.</p

Patients with poorly controlled diabetes in primary care: health care clinicians’ beliefs and attitudes

Objective: To determine doctors’ and nurses’ attitudes and beliefs about treating patients with type 2 diabetes with less than ideal glycaemic control while receiving maximal oral treatment in primary care. Design: Focus groups. Setting: Primary care. Participants: Four focus groups of 23 GPs and practice nurses. Results: General practice was thought to be the best setting for managing all patients with type 2 diabetes but there were concerns about a lack of resources and unfamiliarity with starting insulin. Issues around compliance were extensively discussed; the "failing diabetic" had dual meanings of failing glycaemic control and failing compliance and effort by both patient and doctor. Although views about insulin therapy differed, patients were understood to be resistant to starting insulin, representing for them a more serious stage of diabetes, with fears of needles and hypoglycaemia. Conclusion: The role of diabetes specialist nurses working in primary care will be crucial in managing such patients to improve knowledge, for extra resources, for their experience of insulin use, and to change attitudes

Screening for diabetes in unconventional locations: resource implications and economics of screening in optometry practices

Objectives: Unconventional locations outwith general medical practice may prove opportunities for screening. The aim was to determine the resource implications and economics of a screening service using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in the 'at risk' population attending high street optometry practices. Method: A screening service was implemented in optometry practices in North East England: the cost of the service and the implication of different screening strategies was estimated. Results: The cost of a screening test was £5.53–£11.20, depending on the screening strategy employed and who carried out the testing. Refining the screening strategy to target those ≥40years with BMI of ≥25kg/m2 and/or family history of diabetes resulted in a cost per case referred to the GP of £14.38–£26.36. Implementing this strategy in half of optometric practices in England would have the potential to identify up to 150,000 new cases of diabetes and prediabetes a year. Conclusions: Optometry practices provide an effective way of identifying people who would benefit from further investigation for diabetes. Effectiveness could be improved further by improving cooperation and communication between optometrists and medical practitioners

Screening and diagnosing diabetes in optometrists’ practices: an evaluation of perceptions, attitudes and beliefs

In the UK, optometrists examine 17 million people yearly, many of whom will not have consulted a doctor and may have undiagnosed diabetes. Selective testing in optometry practices presents a new detection strategy. The purpose of this research was to ascertain optometrists' perceptions, attitudes and beliefs towards diabetes and screening, prior to evaluating a pilot service. Focus groups and interviews were conducted with 21 optometrists in Northern England. Analysis was based on grounded theory. Four themes emerged: varying awareness of diabetes and its early diagnosis, a reluctance in accepting a screening role, organisational barriers in implementing such a service, and controversies around the changing roles of optometrists. Although optometrists' awareness of diabetes was varied, all had seen patients they suspected of having diabetes and felt that the public under‐estimated risks of diabetes. Some felt that diagnosis of asymptomatic diabetes was unnecessary, although most felt that early diagnosis would be beneficial. Optometrists believed that the public and doctors had mixed attitudes to their possible involvement in screening. Specific barriers included additional cost, time, remuneration and litigation fears. However, optometrists felt that their professional role has evolved and that a greater, extended clinical involvement would be positive. In conclusion, optometrists are willing to carry out capillary blood glucose tests, provided that the scheme is simple, is supported by other health care professionals and is properly funded. There is a clear advantage in identifying undiagnosed diabetes in people attending optometry practices who are not accessing other health care providers