Treating sight-threatening diabetic retinopathy in Vietnam using laser or anti-VEGF injections: Patients’ perspectives
P1729: Comparing the Psychosocial Impacts of the COVID-19 Pandemic Between Haematological Cancer and Myeloma Patients: Findings from an Online Survey
HemaSphere, Jun 1, 2022
Strengthening Screening and Detection Services for Breast Cancer in Vietnam
Journal of Global Oncology, Oct 1, 2018
Background: The incidence of breast cancer has increased consistently in Vietnam over the past tw... more Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district,…
The Challenge of Developing a Regional Palliative Care Data System: A Tale of Two Cities
Journal of Palliative Care, Mar 1, 2002
This article reviews the purposes of health care databases and the findings from a literature rev... more This article reviews the purposes of health care databases and the findings from a literature review of the use of patient databases in palliative care. We present the history and goals of databases developed in two Canadian settings, Hamilton and Halifax. We present data on the strengths, limitations, and difficulties encountered in each setting. We review the types of data collected and the potential of these databases, and we offer practical recommendations for others looking to set up such systems.
Objectives: To assess health-related quality of life (HRQOL) by EQ-5D among glaucoma patients in ... more Objectives: To assess health-related quality of life (HRQOL) by EQ-5D among glaucoma patients in the Handan Eye Study (HES), as well as the factors that in uence the quality of life. Methods: A central clinic in the county hospital, a temporary clinic in the targeted villages, or at the participant's home. The Handan Eye Study (HES) is a population-based prevalence study of eye disease in rural Yongnian County, northern China. A total of 99 adults with glaucoma were enrolled for analysis, including 67 with primary open-angle glaucoma (POAG) and 32 with primary angle-closure glaucoma (PACG). And 256 selected people with better visual acuity and visual eld but Without Primary Glaucoma. Results of ophthalmic examinations and socio-economic information were recorded. HRQOL was measured using the EQ-5D, and visual function (VF) and vision-related quality of life (VRQOL) were evaluated using a Visual function-quality of life (VF-QOL) instrument. Primary and secondary outcome measures: EQ-5D and VF-QOL score. Results The mean ± standard deviation (SD) scores on the EQ-5D, VF, and VRQOL for the 99 glaucoma cases were 0.98±0.04, 87.9±15.2, and 95.5±12.8 respectively. Utility values were signi cantly lower among participants with glaucoma (0.98±0.04) compared to those without (0.99±0.02, P = 0.008), even after adjusting for age, gender, education level, family income, and comorbidity (P = 0.02). There was a signi cantly lower utility value (0.92±0.08) among patients with lower VRQOL total score (55.4 ± 11.5) compared to higher (0.99 ± 0.03, P = 0.036), even after adjustment for age and family income (P = 0.006). Conclusion: Patients with glaucoma, particularly those with poor VRQOL, exhibited lower HR-QOL than those without. Early diagnosis and prevention facilitated by government health insurance may enhance VF-QOL for glaucoma patients, especially for PACG.
ObjectivesTo compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, e... more ObjectivesTo 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.DesignDiagnostic test accuracy study.SettingSecondary care hospitals in Southern Vietnam.ParticipantsDR 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 origi...
IntroductionGlobally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged... more IntroductionGlobally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged adults. Early detection and treatment of DR is essential for preventing sight loss. Services must be available, accessible and acceptable to patients if we are to ensure they seek such care.ObjectivesTo understand patients’ knowledge and attitudes towards laser versus antivascular endothelial growth factor (VEGF) injections to treat DR in Vietnam, and to identify factors Vietnamese ophthalmologists consider when making treatment decisions.MethodsThis is a descriptive qualitative study based on semi-structured interviews with 18 patients (12 from Ho Chi Minh City and 6 from Hanoi) plus individual interviews with 24 ophthalmologists working in eye clinics in these cities. Thematic analysis was used to analyse the data.ResultsIn total, 10/24 (41.7%) ophthalmologists were female, and their median age was 41 years (range 29–69 years). The median age of patients was 56.5 years (range 28–72 ye...
ObjectivesTo describe the demographic characteristics and ocular needs of children attending four... more ObjectivesTo describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme.DesignRetrospective analysis of clinic records.SettingFour child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019.ParticipantsChildren who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community.Main outcome measuresChildren’s age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye.ResultsOf all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=82...
Background Diabetic eye screening programmes have been developed worldwide based on evidence that... more Background Diabetic eye screening programmes have been developed worldwide based on evidence that early detection and treatment of diabetic retinopathy are crucial to preventing sight loss. However, little is known about the decision-making processes and training needs of diabetic retinal graders, particularly in low- and middle-income countries. Objectives To provide data for improving evidence-based diabetic retinopathy training to help novice graders process fundus images more like experts. Subjects/methods This is a mixed-methods qualitative study conducted in southern Vietnam and Northern Ireland. Novice diabetic retinal graders in Vietnam (n = 18) and expert graders in Northern Ireland (n = 5) were selected through a purposive sampling technique. Data were collected from 21st February to 3rd September 2019. The interviewer used neutral prompts during think-aloud sessions to encourage participants to verbalise their thought processes while grading fundus images from anonymised ...
Background: Vietnam has experienced a rapid increase in cancer incidence with many cancers (70%) ... more Background: Vietnam has experienced a rapid increase in cancer incidence with many cancers (70%) being diagnosed at a late stage. The majority of physical and psychosocial care is provided by caregivers with minimal professional input. Due to limited resources in hospitals and social and cultural norms regarding caregiving in Vietnam, caregivers provide a range of supportive functions for family members diagnosed with cancer. Objectives: This study sought to provide empirical evidence on the self-identified unmet needs of caregivers of inpatients in national oncology hospitals in Vietnam. Methods: Focus groups and in-depth interviews were conducted with caregivers (n = 20) and health care providers (n = 22) in national oncology hospitals in Hanoi and Ho Chi Minh City. Data was collaboratively analysed using thematic analysis. Findings were validated through key stakeholder group discussions with both caregivers and healthcare providers across multiple regions in Vietnam. Results: Analysis demonstrated that the burden of informal care is high with many caregivers managing patient's severe and complex health needs with minimal support. Caregivers highlighted four main areas of critical need: (i) challenges in providing long term care, particularly in hospital and in-patient settings, such as accessing comfortable facilities, accommodation and finance; (ii) information needs about cancer, treatment, and nutrition; (iii) support for the emotional impact of cancer; and (iv) training about how to provide care to their family members during treatment and recovery phases. Conclusions: Caregivers provide invaluable support in supporting people with a cancer diagnosis, particularly given wider systemic challenges in delivering cancer services in Vietnam. Increasing visibility and formal support is likely to have both a positive impact upon the health and wellbeing of caregivers, as well as for cancer patients under their care. Given its absence, it is critical that comprehensive psychosocial care is developed for caregivers in Vietnam.
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Papers by Lynne Lohfeld