Comput. Biol. Med. - Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model.

Tópicos

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Resumo

JECTIVE: To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk.METHODS: Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans--using abstracted data from a retrospective cohort of real-world diabetic Veterans--with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group.RESULTS: Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98).CONCLUSIONS: Increasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.

Resumo Limpo

jectiv examin effect chang screen interv incid vision loss simul cohort veteran diabet retinopathi dr simul allow us examin potenti intervent without put patient riskmethod simul random control trial develop hybrid agentbaseddiscret event simul incorpor popul simul veteransus abstract data retrospect cohort realworld diabet veteranswith discret event simul des eye clinic seek treatment dr compar vision loss vari screen polici simul popul veteran independ tenyear simul run groupresult diabet retinopathi associ vision loss increas screen interv extend one five year p increas concentr third year screen interv p increas vision loss associ increas screen interv one year two year pconclus increas screen interv diabet patient yet develop diabet retinopathi year appear safe increas interv year heighten risk vision loss

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