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A new screening tool can adequately detect risk of diabetic retinopathy in adults with diabetes in low-income communities in Mexico, according to a study published in the October issue of Preventing Chronic Disease. Kenny Mendoza-Herrera, from the National Institute of Public Health in Mexico, and colleagues analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico in order to develop a screening tool based on a predictive model for early detection of diabetic retinopathy. Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were risk factors included in the screening tool. The researchers found that the model had a mean area under the receiver operating characteristic curve (AUC ROC) of 0.78 in the validation data set. Using the optimized cut point that best represented the study population, the model had a sensitivity of 82.9 percent and a specificity of 61.9 percent. "We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico," the authors write. "Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases in mandatory."

Internal medicine patients are frequently prescribed potentially inappropriate medications (PIMs), but screening tools can detect clinically relevant PIMs, according to a study published online Oct. 8 in the Journal of Clinical Pharmacy and Therapeutics. Anne-Laure Blanc, Pharm.D., Ph.D., from Geneva University Hospitals in Switzerland, and colleagues compared two PIM-screening tools -- STOPP/START and PIM-Check -- in a general internal medicine ward. They also analyzed a random sample of 50 patients hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and 50 sex-and age-matched patients who were not readmitted. The researchers found that across the whole ward population, PIM-Check and STOPP/START detected 1,348 and 537 PIMs, respectively, which was the equivalent of 13.5 and 5.4 PIMs per patient. PIM-Check had a substantially shorter screening time versus STOPP/START (four versus 10 minutes). Of the PIMs detected using PIM-Check and STOPP/START, the clinical pharmacist found 45 percent and 42 percent, respectively, to be clinically relevant to individual patients' cases. There were no significant differences in the rates of detected and clinically relevant PIMs between readmitted and nonreadmitted patients.

For patients with unruptured intracranial aneurysms (UIAs) that are 3 mm or smaller, no preventive treatment or imaging follow-up is the most effective management strategy, according to a study published online Nov. 20 in JAMA Neurology. Ajay Malhotra, M.D., from the Yale School of Medicine in New Haven, Conn., and colleagues used inputs from the medical literature to conduct a decision-analytic model-based comparative effectiveness analysis. Five management strategies were assessed: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every five years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. In an analysis of 10,000 iterations simulating adult patients, the researchers found that the highest health benefit was seen for the management strategy of no treatment or preventive follow-up (mean quality-adjusted life-years, 19.40). MRA every five years was the best of the management strategies that incorporate follow-up imaging, with the next highest effectiveness (mean quality-adjusted life-years, 18.05). When the annual growth rate and risk of rupture of growing aneurysms are varied, no routine follow-up remains the optimal strategy. No follow-up is the optimal strategy when the annual risk of rupture of nongrowing UIAs is less than 1.7 percent; coiling should be performed directly if the annual risk of rupture is >1.7 percent.