Download a study to assess the knowledge, attitude and practice

A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICE
REGARDING DIABETIC RETINOPATHY AMONG DIABETIC
MELLITUS TYPE II PATIENTS IN SELECTED HOSPITALS AT
BANGALORE
M.Sc NURSING DISSERTATION PROTOCOL SUBMITTED TO
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
BY
Mr. MANESSH KUMAR,
MSc NURSING 1ST YEAR 2011 TO 2013
Under the Gudiance of
HOD, DEPARTMENT OF MEDICAL SURGICAL NURSING
Nightingale College of Nursing
GURUVANNA DEVARA MUTT
MAGADI ROAD
Bangalore-23
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE Mr. MANESSH KUMAR,
(IN BLOCK LETTERS)
MSc NURSING 1ST YEAR
2.
NAME OF THE INSTITUTION
NIGHTINAGLE COLLEGE OF
NURSING
GURUVANNA DEVARA MUTT
MAGADI ROAD
BANGALORE-23
3.
COURSE OF THE STUDY AND M.SC., NURSING IN MEDICAL
SURGICAL NURSING
SUBJECT
4.
DATE
OF
COURSE
5.
TITLE OF THE STUDY
ADMISSION 04/05/2011
A Study To Assess The Knowledge,
Attitude And Practice Regarding Diabetic
Retinopathy Among Diabetic Mellitus
Type Ii Patients In Selected Hospitals At
Bangalore”.
6.
BRIEF RESUME OF INTENDED WORK:
2
6.1 INTRODUCTION
“Diseases can rarely be eliminated through early diagnosis or good
treatment, but prevention can eliminate diseases”.
Denis Burkitt
Eye is the ‘window of brain’ and organ of sight, which is the most precious
sense organ and many people fear blindness more than any disability. As per ‘WHO’
diabetic retinopathy is the 5th leading cause of blindness all over the world.1
Diabetic retinopathy is the micro vascular complication of Diabetes Mellitus
that damages the tiny blood vessels of retina that can lead to blindness. It is estimated
that about 40% of people with diabetes will have at least mild retinopathy.
It is an embarrassing truth that India is the leading nation which has the highest
incidence of Diabetes Mellitus. More than 5.6 million people are affected by Diabetic
Retinopathy in India. Since most of these victims represent low educational and
economical status; this background creates a great burden which leads to ineffective
prevention of blindness due to Diabetic Retinopathy. Most of the Indian population are
ignorant about the prevention and management of Diabetic Retinopathy.2
Information, Education & Communication (I E C) activities are the vital
interventions to rule out the darkness of public ignorance. Proper education should be
given to the diabetic clients
to make them vigilant towards the ophthalmic
3
complications of Diabetes Mellitus. Regular eye checkups, control over diabetes,
control over Hypertension etc... can prevent the occurrence of Diabetic Retinopathy.
6.2 NEED FOR THE STUDY
“Life is not over because you have Diabetes. Make the most of what you have, be
grateful.”
Dale Evans Rogers
As per WHO 2.5 million people experience vision loss due to Diabetic
Retinopathy worldwide. The diabetic retinopathy was the 17th cause of blindness some
decade ago now it is the 5th. It is also estimated that about 40% of people with diabetes
will have at least mild retinopathy. WHO predicts that over 54 million people in the
world will be suffering from diabetes by 2025.3
India can be called as the ‘Diabetic capital of the world’. The world’s largest
cases of Diabetes are reported in Ahmadabad. In the year of 1970 the prevalence of
diabetes among urban Indians was reported to be 2.1% and now has risen to 12.1%.
Presently there are more than 31.7 million diabetic individuals in India, among that
around 17.6% have Diabetic Retinopathy. This would translate to more than 5.6 million
subjects with Diabetic Retinopathy. Furthermore the number of diabetic subjects is
expected to increase to 74.4 million by 2030.4
The socio economic burden resulting from visual impairment or blindness
particularly in working group is a serious concern. People with Diabetes should never
4
ignore visual problems because it could be a more serious problem. Early diagnosis and
treatment can prevent Diabetic Retinopathy.
A cross sectional study was conducted in South India to assess the awareness
of Diabetic Retinopathy among non medical persons. The study found that almost half
of the persons were not aware of the risk factors of Diabetic Retinopathy. Only onetenth of the persons were aware that Uncontrolled Diabetes was a risk factor of
Retinopathy. Over 75% of the responders were not aware of either Laser or Surgery as
an intervention for Retinopathy. The study concluded that considerable efforts are
required to motivate the public about Diabetic Retinopathy.5
A study conducted in the centres for disease control and prevention, Atlanta to
assess the patient’s adherence to guidelines for Diabetes eye care. The study followed
by 569 people with Diabetes. The study found that only 35% of the subjects underwent
dilated eye examinations before entering the programme. The study concluded that a
lack knowledge about the disease & limited finance were primary reasons for non
adherence. The eye care providers & health care staffs must strive to eliminate these
educational and financial barriers.6
Researcher had a personal experience with relative who had chronic history of Diabetes
Mellitus along with mild visual impairment. The client and family had a wrong
conception that the visual problem was due to some neurological defects. The client
underwent Fundus photography as per the direction of an Ophthalmologist. It was
found that the client had severe Proliferative Diabetic Retinopathy. From the
5
experience researcher realized that the diabetic clients have inadequate knowledge
regarding the prevention and management of Diabetic Retinopathy. So the researcher
thought of taking the task of assessing the knowledge of diabetic clients and help them
to effectively manage the Diabetic Retinopathy
6.3 REVIEW OF LITERATURE.
Researchers almost never conduct a study in an intellectual vacuum; their
studies are usually undertaken within the context of an existing knowledge base. A
literature review helps to lay the foundation for the study and can also inspire new
research ideas.
A population based study was conducted in the Indian state Andhra Pradesh
to assess the prevalence and potential risk factors for Diabetic Retinopathy. Participants
from 94 clusters in one urban and 3 rural areas. They underwent a detailed interview
and a comprehensive dilated ocular evaluation by trained professionals. Among them,
Diabetic Retinopathy was present in 39 of the 5586 subjects. Multi variable analysis
shown that increasing age, middle and upper socio economic group, Hypertension and
duration of Diabetes were significantly associated with increasing risk of Diabetic
Retinopathy.7
A cross sectional study was conducted in Tamil Nadu, India, to estimate the
prevalence and risk factors for presence and severity of Diabetic Retinopathy. A total
of 26,519 participants attended, all the participants underwent dilated eye examination.
The results have shown that, the prevalence of Diabetic Retinopathy was 17.6% among
self reported rural population with diabetes. The prevalence of sight threatening
Retinopathy was 5.3%. Risk factors associated with development of Diabetic
6
Retinopathy were male gender, longer duration of diabetes, lean body mass index,
higher systolic pressure and insulin treatment. The results suggested that there was a
need for formulating effective preventive strategies to minimize avoidable blindness
due to Diabetes in rural area.8
A population based study was conducted in Chennai City, South India to
assess the prevalence of Diabetic Retinopathy in type 2 Diabetic subjects in urban
India. Individuals with more than of 20 years of age were screened for diabetes, 1382
known diabetic subjects participated in the study. All the subjects underwent four –
field colour photography. The results have shown that the overall prevalence of
Diabetic Retinopathy was significantly higher in men than women. Logical regression
analysis showed that for every five years increase in the duration of Diabetes, the risk
increased 1.89 fold. The study concluded that Diabetic Retinopathy is likely to pose a
public health burden in India; hence routine retinal examination is mandatory to detect
this case in the early stages.9
A cross sectional study was conducted on awareness of Diabetic
Retinopathy among non–medical persons in South India. In this study, trained social
workers conducted face to face interview. The results have shown that over half of the
respondents were not aware of risk factors of Diabetic Retinopathy .Only one tenth of
the persons from community were aware that uncontrolled diabetes was a risk factor of
Retinopathy. Over 75% of respondents were not aware of either Laser or Surgery as an
intervention of Retinopathy. Only 43.5% respondents had ever visited an
Ophthalmologist. Nearly three-fourth of the respondents did not have any material
related to diabetes for health education. The study concluded that considerable effort is
7
required to improve awareness of the public regarding Diabetic Retinopathy.10
A cross sectional study was conducted in South India to determine the
risk factor for Diabetic Retinopathy in an Urban South Indian Type-2 Diabetic
population. A total of 1736 Type-2 Diabetic subjects were recruited for this study,
which included 1382 known Diabetic subjects
(90.4 % response rate) and 354 randomly selected. All the subjects underwent four –
field stereo retinal colour photography. The study revealed that male gender, duration
of Diabetes Mellitus, glycated haemoglobin [Hb A (1c)], macro albuminurea and
insulin therapy were significantly associated with severity of Diabetic Retinopathy.11
A study was conducted in Chennai Urban Rural Epidemiology Eye
Study (CURES), India. The study found that Diabetic Retinopathy is associated with
increased Intima-Media thickness and arterial stiffness in Type-2 diabetic Indian
subjects suggesting that common pathogenic mechanism might predispose to Diabetic
micro angiopathy. Visual disability from diabetic retinopathy is largely preventable; if
managed by timely intervention by Laser. It has been clearly demonstrated that among
Type -2 diabetic Indian clients with Proliferative Diabetic Retinopathy who underwent
Pan Retinal Photo Coagulation regained good eye health. The study concluded that
annual retinal examination and early detection of Diabetic Retinopathy can
considerably reduce the risk of visual loss in diabetic individuals.12
A cohort study was conducted in Sana’s University, Yemen, to identify
the association between the regularity in visits to a diabetes clinic with the presence of
Diabetic Retinopathy and visual disabilities. The cohort consisted of 228 clients (114 in
each group), one that attended Diabetes clinics regularly [Group A] and one that had
8
irregular attendance [Group B]. Diabetic retinopathy was found in (41.2%) 47 and
(61.4%) 68 clients respectively. The risk of Diabetic Retinopathy was significantly
higher in those with irregular attendance. The study concluded that the severity of
Diabetic Retinopathy was positively associated with irregularity in clinic visits. The
regularity of medical visit is an indicator of better primary prevention of eye
complications of Diabetes Mellitus.13
A comparative study was conducted to compare the efficacy of usual
diabetic care to an intervention emphasizing patient education in Nova South Eastern
University, USA. 90 clients were selected to usual care or to the intervention. All the
clients received a comprehensive eye health, vision examination, diabetic eye health
pre test and post test administered at 1 week and 3 months. The assessment of patient’s
knowledge at baseline revealed misconception about diabetic eye disease. Most clients
incorrectly reported that Diabetic eye diseases usually have early warning signals. The
study concluded that clients who participated in the educational intervention
demonstrated an increase in knowledge across the time. Patient may benefit from
education emphasizing the importance of dilated eye examinations in the absence of
ocular symptoms.14
A study was conducted by Sansum Diabetes Research Institute, USA, to
test whether intensive Diabetes case management could prevent or delay Diabetic
Retinopathy in clients with Type-2 Diabetes. Subject with at least two retinal
photographs, 149 subjects were included in this analysis to assess the intervention on
development or progression of Diabetic Retinopathy. The result shown that a relatively
9
short duration of case management before the onset of clinically identifiable
retinopathy diminishes its development in clients with Type-2 diabetes. The study
concluded that the Diabetic Retinopathy can be improved by good blood glucose
control.15
A study was conducted in Complex unit of Diabetology, Italy, suggested
that Diabetic Retinopathy in the way of Proliferative Diabetic Retinopathy and macular
oedema is the most common cause of new cases of legal blindness in Europe as well as
in North America in the age group 30 to 70 years. Detection of earliest sign of Diabetic
Retinopathy is an essential requirement of Diabetes care. Blood glucose control and
strict control of Hypertension have a clear effect on the development of micro vascular
complications of Diabetes like Diabetic Retinopathy. Treatment options of severe Non
Proliferative and Proliferative forms of Diabetic Retinopathy are limited to Laser photo
coagulation and Vitrectomy.16
A study was conducted in the University of California, USA, to assess
the contribution of systemic factors in the severity and progression of Diabetic
Retinopathy. The study suggested that; intensive glucose and blood pressure control
has been shown to delay both the onset and progression of Diabetic Retinopathy.
Dislipidemia is associated with macular exudates and vision loss.
Angiotensin
Converting Enzyme inhibitors were found effective in further reducing the progression
of Diabetic Retinopathy by hypertensive control. Pregnancy induced hyperglycaemia
may induce Diabetic Retinopathy if serum glucose levels are not well monitored and
controlled prior to and during pregnancy.17
10
A study was conducted in the University of Melbourne and Royal
Victorian Eye and Ear Hospital to review the best evidence for primary and secondary
intervention. The study concluded that tight glucose control and blood pressure control
reduces the incidence of moderate and severe visual loss by 50% in clients with
Diabetic Retinopathy. Focal Laser photo coagulation reduces the risk of moderate
visual loss by 50% to 70% in eyes with macular oedema. Early vitrectomy improves
visual recovery in clients with Proliferative Retinopathy and severe vitreous
haemorrhage. Intravitreal injections of steroids may be considered in eyes with
persistent loss of vision when conventional treatment has failed. Tight glucose and
blood pressure control remains the corner stone in primary prevention of Diabetic
Retinopathy.18
A study was conducted in Pennsylvania USA suggested that
Proliferative Diabetic Retinopathy may cause severe visual loss. Tighter control over
the blood glucose levels and lower blood pressure reduce the risk of progression of
diabetic retinopathy. Regular dilated eye examinations and appropriate interventions
with Laser or Vitrectomy surgery help to preserve vision in clients with established
macular oedema or Proliferative Retinopathy.19
A study was conducted by the University Of Pittsburgh, USA, to assess
ophthalmic knowledge and believes among women with diabetes. In this study 150 sub
urban, low income women with Diabetes were interviewed using a structured
telephonic questionnaire that included subscales of ophthalmic knowledge and beliefs
regarding barrier, benefits, concerns and self efficacy related to receiving
recommended ophthalmic screening. The data revealed significant gap in knowledge
11
about Diabetes related eye complications. More than half of the subjects did not know
that eye complications may be asymptomatic and there are ways to lower the risk of
eye problems and 17% did not know that annual eye exams were recommended.
Subjects were concerned about eye complications associated with Diabetes. The study
concluded that the diabetic clients should gain an awareness of the benefits of eye
exams and control over the Diabetes.20
A study was conducted in Atlanta, at the centres for disease control and
prevention, to assess the patient’s adherence to guidelines to Diabetes eye care. The
study followed 569 people with Diabetes participating in Blindness Prevention
Programmes during 1985 through 1987; it was found that 35% of the subjects received
dilated eye examinations before entering in to the programme in comparison with 60%
afterwards and about 85% of the participants referred for Proliferative Retinopathy
treatment began such treatment. The study concluded that a lack of knowledge about
disease and limited finances were primary reason for non adherence. To improve the
effectiveness of prevention programmes eye care providers and programme staffs must
strive to eliminate this educational and financial barrier.21
A study was conducted in Dublin, Ireland, to assess whether clients
were receiving regular Diabetic Retinopathy screening and to examine factors
influencing screening uptake questionnaire covering demographics, diabetic medical
history, knowledge, and attitudes to Diabetic Retinopathy was administered to all
adults. Results shown that out of the 209 people who completed the questionnaire, only
81% of the people (169) underwent dilated fundal examination. The main barrier of
receiving adequate screening was the lack of knowledge regarding the need for ocular
12
examination. The study concluded that the clients should get complete awareness about
the need for regular eye examinations.22
6.4. STATEMENT OF PROBLEM :
A
STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICE
REGARDING DIABETIC RETINOPATHY AMONG DIABETIC MELLITUS TYPE II
PATIENTS IN SELECTED HOSPITALS AT BANGALORE
6.5. OBJECTIVES :
1. To assess the knowledge of type
II diabetes clients regarding diabetic
retinopathy.
2. To assess the attitude of type II diabetes clients regarding diabetic retinopathy.
3. To assess the practice of type II diabetes clients regarding diabetic retinopathy.
4. To find out the correlation between the knowledge, attitude and practice of type
II diabetes clients regarding regarding diabetic retinopathy.
5. To find out the association between the knowledge, attitude and practice of type
II diabetes clients regarding regarding diabetic retinopathy with their selected
demographic variable.
.
13
6.6. HYPOTHESIS :
H1. There will be statistically significant corrleation between knowledge, attitude and
practice regarding diabetic retinopathy among diabetic mellitus type ii patients in selected
hospitals.
H2. There will be statistically significant association between knowledge, attitude and
practice regarding diabetic retinopathy among diabetic mellitus type ii patients in selected
hospitals with their selected demographic variables.
6.7. OPERATIONAL DEFINITIONS :
1) Assess- Assess refers to the critical analysis and valuation or judgement of the
status or quality of a particular condition or situation.
2) Knowledge- In this study it refers to the awareness, response to the etructured
interview schedule regarding diabetic retinopathy.
3) Attitude – It refers to the view, opinion, state of mind regarding prevention of
regarding diabetic retinopathy.
4) Practice: It refers the control measures, habits, behaviour followed by type II
diabetes clients regarding regarding diabetic retinopathy.
5) Diabetic Retinopathy – Diabetic Retinopathy refers to a micro-vascular
complication of Diabetes mellitus in which haemorrhaging or exudation may
occur, either from damaged blood vessels in to retina or from new abnormal
vessels in to vitreous humour.
6) Type II diabetes Mellitus –A group of metabolic diseases characterised by
elevated levels of glucose in the blood; resulting from defects in insulin
14
secretion, insulin action or both.
6.8. ASSUMPTION:
1. Diabetic clients possess some knowledge attitude and practice regarding the
prevention and management of diabetic Retinopathy.
2. Diabetic client’s knowledge, attitude and practice regarding the prevention and
management of diabetic Retinopathy can be measured by using a structured
questionnaire.
6.9. DELIMITATION OF THE STUDY:
1. The study is limited to type II diabetic clients admitted in selected hospitals in
Bangalore
2. The study is limited to persons who are having at least 5 years of history of type
II diabetic clients.
3. The study is limited to type II diabetic clients between the age group of 35 – 60
years.
7.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA
The data will be collected from Diabetic clients admitted in selected hospitals in
Bangalore.
7.1.1 RESEARCH DESIGN
Non experimental descriptive study
15
7.1.2 RESEARCH APPROACH
Non experimental approach
7.1.3 RESEARCH VARIABLES
A concept which can take on different quantitative values is called a variable.

Dependent variable – Knowledge attitude and practice of the type II diabetes
clients regarding diabetic retinopathy.

Independent variables - Age, Gender, Food habits, Exercise pattern,
Educational status, Occupation, Body Mass Index, Duration of diabetes
Mellitus, History of visual impairment, Frequency of eye examination, Blood
pressure, Blood glucose level, Duration of treatment.
7.1.4 SETTING OF THE STUDY
The study will be conducted at selected hospitals in Bangalore, among the diabetic
clients who meet the inclusion criteria.
7.1.4 POPULATION
All type II diabetic clients admitted in selected hospitals in Bangalore
7.2 METHOD OF COLLECTION OF DATA
The data collection procedure will be carried out for a period of one
month. This study will be conducted after obtaining permission from the concerned
authorities. The data will be collected by using a structured questionnaire.
7.2.1 SAMPLING TECHNIQUE
Sampling technique adopted for the selection of sample is Non- probability
convenience sampling.
16
7.2.2 SAMPLE SIZE
The sample consists of 60 Diabetic clients at selected hospitals in Bangalore.
SAMPLING CRITERIA
7.2.3
INCLUSION CRITERIA
1. Diabetic clients admitted at selected hospitals in Bangalore.
2. Diabetic clients who are willing to participate in the study.
3. Diabetic clients who are having at least 5 years of history of Diabetes Mellitus.
4. Diabetic clients who are able to read Kannada and English.
5. Diabetic clients between the age group of 35 – 60 years.
7.2.4
EXCLUSION CRITERIA
1
Diabetic clients who are not admitted in hospitals
2
Diabetic clients who are not available at the time of study
3
Diabetic clients who are not willing to participate in the study
4
Diabetic clients who are having less than 5 years of Diabetes history.
5
Diabetic clients who are selected for pilot study.
7.2.5
TOOL FOR DATA COLLECTION
A structured questionnaire will be used to collect the data from the Diabetic
patients.
Section A: Demographic data
Section B: Questions to assess the level of knowledge of the type II diabetes clients
regarding diabetic retinopathy.
17
Section C: Likert scale will be used to assess the level of attitude of the type II
diabetes clients regarding diabetic retinopathy
Section D: Questions to assess the level of practice of the type II diabetes clients
regarding diabetic retinopathy
7.2.6
DATA ANALYSIS METHOD
The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics: Frequency and percentage for analysis of demographic
data and mean, mean percentage and standard deviation will be used for
assessing the level of knowledge.

Inferential statistics: Inferential statistics will be done using
karl pearon
correlation and Chi square test to find out the association between knowledge
7.3
and demographic variables.
Does the study require any investigation or interventions to be
conducted on patients
or other human & animals? If so please
describe briefly.
-NO-
7.4
Has ethical clearance been obtained from your institution in case of above?
The main study will be conducted after the approval of research committee of the
college. Permission will be obtained from the head of the institution. The purpose and
details of the study will be explained to the study subjects and assurance will be given
8.
regarding the confidentiality of the data collected.
18
REFERENCES
1. K Viswanath. Diabetic Retinopathy: Clinical findings and management. Journal of
Community Eye Health. 2003; 16(46): 21–24. Available from
URL: http://
www.cehjournal.org
2. M Rema. Diabetic Retinopathy: An Indian perspective. Indian journal of medical
research. 2007 March; 297 – 310. Available from URL: http://www.icmr.nic.in
3.
WHO definition of Diabetic Retinopathy. Articles related to Prevention of
blindness and visual impairment. Available from URL: http://www.who.int
4. R. Raman, P. Rani, S. Reddi Rachepalle, P. Gnanamoorthy, S. Uthra, G.
Kumaramanickavel, T. Sharma. Prevalence of Diabetic Retinopathy in India.
2008;
116(2):
311-318.
Available
from
URL:
http://
www.linkinghub.elsevier.com.
5.
Namperumalsamy P, Kim R, Kaliaperumal K, Sekar A, Karthika A, Nirmalan
PK. A pilot study on awareness of diabetic retinopathy among non-medical
persons in South India. Indian journal of ophthalmology 2004 Sep;52(3):247-51.
Available from URL: http:// www.pubmed.com.
6. Will JC, German RR, Schuman E, Michael S, Kurth DM, Deeb L. Patient
adherence to guidelines for diabetes eye care: results from the diabetic eye disease
follow-up study. American journal of public health 1994 Oct;84(10):1669-71.
Available from URL: http:// www.pubmed.com.
7. Krishnaiah S, Das T, Nirmalan PK, Shamanna BR, Nutheti R, Rao GN, Thomas
R. Risk factors for diabetic retinopathy: Findings from The Andhra Pradesh Eye
Disease Study. Clinical Ophthalmology. 2007 Dec;1(4):475-82. Available from
19
URL: http:// www.pubmed.com.
8. Rani PK, Raman R, Chandrakantan A, Pal SS, Perumal GM, Sharma T. Risk
factors for diabetic retinopathy in self-reported rural population with diabetes.
Journal of post graduate medicine. 2009 Apr-Jun;55(2):92-6. Available from
URL: http:// www.pubmed.com.
9. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of
diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology
Study. Investigative Ophthalmology and visual science. 2005 Jul;46(7):2328-33.
Available from URL: http:// www.pubmed.com
10. Namperumalsamy P, Kim R, Kaliaperumal K, Sekar A, Karthika A, Nirmalan PK.
A pilot study on awareness of diabetic retinopathy among non-medical persons in
South India. Indian journal of ophthalmology 2004 Sep;52(3):247-51. Available
from URL: http:// www.pubmed.com
11. Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Risk factors for diabetic
retinopathy in a South Indian Type 2 diabetic population. Journal of British
Diabetic association. 2008 May;25(5):536-42. Available from
URL: http://
www.pubmed.com
12. Rema M, Pradeepa R. Diabetic retinopathy: an Indian perspective. Indian journal
of medical research. 2007 Mar;125(3):297-310. Available from
URL: http://
www.pubmed.com
13. Bamashmus MA, Gunaid AA, Khandekar R. Diabetic retinopathy-a hospitalbased historical cohort study in Yemen. Diabetic technology and therapeutics.
20
2009 Jan;11(1):45-50. Available from URL: http:// www.pubmed.com
14. Wagner H, Pizzimenti JJ, Daniel K, Pandya N, Hardigan PC. Eye on diabetes: a
multidisciplinary patient education intervention. The Diabetes educator. 2008 JanFeb;34(1):84-9. Available from URL: http:// www.pubmed.com
15. Pettitt DJ, Okada Wollitzer A, Jovanovic L, He G, Ipp E. Decreasing the risk of
diabetic retinopathy in a study of case management. Diabetes care. 2005
Dec;28(12):2819-22. Available from URL: http:// www.pubmed.com
16. Grassi G. Diabetic retinopathy. Minerva medica. 2003 Dec;94(6):419-35.
Available from URL: http:// www.pubmed.com
17. Jain A, Sarraf D, Fong D. Preventing diabetic retinopathy through control of
systemic factors. Current opinion on Ophthalmology. 2003 Dec;14(6):389-94.
Available from URL: http:// www.pubmed.com
18. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a
systematic review. Journal of American medical association. 2007 Aug
22;298(8):902-16. Available from URL: http:// www.pubmed.com
19. Neely KA, Quillen DA, Schachat AP, Gardner TW, Blankenship GW. Diabetic
retinopathy. Medical Clinics North America. 1998 Jul;82(4):847-76. Available
from URL: http:// www.pubmed.com
20. Pasagian-Macaulay A, Basch CE, Zybert P, Wylie-Rosett J. Ophthalmic
knowledge and beliefs among women with diabetes. The diabetes educator. 1997
Jul-Aug;23(4):433-7. Available from URL: http:// www.pubmed.com
21. Will JC, German RR, Schuman E, Michael S, Kurth DM, Deeb L. Patient
adherence to guidelines for diabetes eye care: results from the diabetic eye disease
21
follow-up study. American journal of public health 1994 Oct;84(10):1669-71.
Available from URL: http:// www.pubmed.com.
22. Dervan E, Lillis D, Flynn L, Staines A, O'Shea D. Factors that influence the
patient uptake of diabetic retinopathy screening. Irish journal of medical science.
Dec;177(4):303-8. Epub 2008 Jul 19. Available from
www.pubmed.com.
22
URL: http://
9.
Signature of the Candidate.
10.
Remarks of the Guide.
11.
Name and Designation of
11.1 Guide
11.2 Signature
11.3 Co- Guide
11.4 Signature
11.5 Head of the Department
11.6 Signature
12.
12.1 Remarks of the Principal.
12.2 Signature.
23