Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model
Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model
复制标题
DOI：
10.1016/j.compbiomed.2014.01.007
复制
发表时间：
2014-04-01
影响因子：
7.7
通讯作者：
Brugh, Ann
中科院分区：
文献类型：
--
作者：
Day, T. Eugene;Ravi, Nathan;Brugh, Ann
目的：在模拟的退伍军人糖尿病视网膜病变(DR)队列中，研究改变筛查间隔对视力丧失发生率的影响。这种模拟使我们能够检查潜在的干预措施，而不会将患者置于危险之中。方法：模拟随机对照试验。我们开发了一种基于代理/离散事件的混合模拟，它结合了模拟退伍军人群体和离散事件模拟(DES)眼科诊所，其中包括模拟退伍军人群体-使用从真实世界的糖尿病退伍军人队列中提取的数据-在离散事件模拟(DES)眼科诊所为医生寻求治疗。我们比较了不同筛查政策下的视力损失，在模拟人群中，每组进行了50次独立的十年模拟运行。结果：随着筛查间隔从一年延长到五年，糖尿病视网膜病变相关视力损失增加(P<；0.0001)。这一增长集中在筛查间隔的第三年(p<；0.01)。将筛查间隔从一年增加到两年，视力损失没有增加(p=0.98)。结论：对于尚未发展为糖尿病视网膜病变的糖尿病患者，将筛查间隔从一年增加到两年似乎是安全的，而将间隔增加到三年会增加视力丧失的风险。爱思唯尔有限公司出版。
Objective: 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. Published by Elsevier Ltd.