Cargando…
Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study
OBJECTIVES: To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess t...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472142/ https://www.ncbi.nlm.nih.gov/pubmed/36691192 http://dx.doi.org/10.1136/bmjopen-2021-059205 |
_version_ | 1784789243519827968 |
---|---|
author | Curran, Katie Congdon, Nathan Hoang, Tung Thanh Lohfeld, Lynne Nguyen, Van Thu Nguyen, Hue Thi Nguyen, Quan Nhu Dardis, Catherine Virgili, Gianni Piyasena, Prabhath Tran, Huong Salongcay, Recivall Pascual Tung, Mai Quoc Peto, Tunde |
author_facet | Curran, Katie Congdon, Nathan Hoang, Tung Thanh Lohfeld, Lynne Nguyen, Van Thu Nguyen, Hue Thi Nguyen, Quan Nhu Dardis, Catherine Virgili, Gianni Piyasena, Prabhath Tran, Huong Salongcay, Recivall Pascual Tung, Mai Quoc Peto, Tunde |
author_sort | Curran, Katie |
collection | PubMed |
description | OBJECTIVES: To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess the impact of supplementary targeted grader training. DESIGN: Diagnostic test accuracy study. SETTING: Secondary care hospitals in Southern Vietnam. PARTICIPANTS: DR training was delivered to Vietnamese graders in February 2018 by National Health Service (NHS) UK graders. Two-field retinal images (412 patient images) were graded by 14 trained graders in Vietnam between August and October 2018 and then regraded retrospectively by an NHS-certified reference standard UK optometrist (phase I). Further DR training based on phase I results was delivered to graders in November 2019. After training, a randomised subset of images from January to October 2020 (115 patient images) was graded by six of the original cohort (phase II). The reference grader regraded all images from phase I and II retrospectively in masked fashion. PRIMARY AND SECONDARY OUTCOME MEASURES: Sensitivity was calculated at the two different time points, and χ(2) was used to test significance. RESULTS: In phase I, the sensitivity for detecting any DR for all grader groups in Vietnam was low (41.8–42.2%) and improved in phase II after additional training was delivered (51.3–87.2%). The greatest improvement was seen among level 1 graders (p<0.001), and the lowest improvement was observed among level 3 graders (p=0.326). There was a statistically significant improvement in sensitivity for detecting referable DR and referable diabetic macular oedema between all grader levels. The post-training values ranged from 40.0 to 61.5% (including ungradable images) and 55.6%–90.0% (excluding ungradable images). CONCLUSIONS: This study demonstrates that targeted training interventions can improve accuracy of DR grading. These findings have important implications for improving service delivery in DR screening programmes in low-resource settings. |
format | Online Article Text |
id | pubmed-9472142 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-94721422022-09-15 Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study Curran, Katie Congdon, Nathan Hoang, Tung Thanh Lohfeld, Lynne Nguyen, Van Thu Nguyen, Hue Thi Nguyen, Quan Nhu Dardis, Catherine Virgili, Gianni Piyasena, Prabhath Tran, Huong Salongcay, Recivall Pascual Tung, Mai Quoc Peto, Tunde BMJ Open Ophthalmology OBJECTIVES: To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess the impact of supplementary targeted grader training. DESIGN: Diagnostic test accuracy study. SETTING: Secondary care hospitals in Southern Vietnam. PARTICIPANTS: DR training was delivered to Vietnamese graders in February 2018 by National Health Service (NHS) UK graders. Two-field retinal images (412 patient images) were graded by 14 trained graders in Vietnam between August and October 2018 and then regraded retrospectively by an NHS-certified reference standard UK optometrist (phase I). Further DR training based on phase I results was delivered to graders in November 2019. After training, a randomised subset of images from January to October 2020 (115 patient images) was graded by six of the original cohort (phase II). The reference grader regraded all images from phase I and II retrospectively in masked fashion. PRIMARY AND SECONDARY OUTCOME MEASURES: Sensitivity was calculated at the two different time points, and χ(2) was used to test significance. RESULTS: In phase I, the sensitivity for detecting any DR for all grader groups in Vietnam was low (41.8–42.2%) and improved in phase II after additional training was delivered (51.3–87.2%). The greatest improvement was seen among level 1 graders (p<0.001), and the lowest improvement was observed among level 3 graders (p=0.326). There was a statistically significant improvement in sensitivity for detecting referable DR and referable diabetic macular oedema between all grader levels. The post-training values ranged from 40.0 to 61.5% (including ungradable images) and 55.6%–90.0% (excluding ungradable images). CONCLUSIONS: This study demonstrates that targeted training interventions can improve accuracy of DR grading. These findings have important implications for improving service delivery in DR screening programmes in low-resource settings. BMJ Publishing Group 2022-09-09 /pmc/articles/PMC9472142/ /pubmed/36691192 http://dx.doi.org/10.1136/bmjopen-2021-059205 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Ophthalmology Curran, Katie Congdon, Nathan Hoang, Tung Thanh Lohfeld, Lynne Nguyen, Van Thu Nguyen, Hue Thi Nguyen, Quan Nhu Dardis, Catherine Virgili, Gianni Piyasena, Prabhath Tran, Huong Salongcay, Recivall Pascual Tung, Mai Quoc Peto, Tunde Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title | Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title_full | Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title_fullStr | Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title_full_unstemmed | Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title_short | Impact of targeted diabetic retinopathy training for graders in Vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
title_sort | impact of targeted diabetic retinopathy training for graders in vietnam and the implications for future diabetic retinopathy screening programmes: a diagnostic test accuracy study |
topic | Ophthalmology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9472142/ https://www.ncbi.nlm.nih.gov/pubmed/36691192 http://dx.doi.org/10.1136/bmjopen-2021-059205 |
work_keys_str_mv | AT currankatie impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT congdonnathan impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT hoangtungthanh impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT lohfeldlynne impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT nguyenvanthu impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT nguyenhuethi impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT nguyenquannhu impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT dardiscatherine impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT virgiligianni impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT piyasenaprabhath impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT tranhuong impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT salongcayrecivallpascual impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT tungmaiquoc impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy AT petotunde impactoftargeteddiabeticretinopathytrainingforgradersinvietnamandtheimplicationsforfuturediabeticretinopathyscreeningprogrammesadiagnostictestaccuracystudy |