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Ong EKM, Murray C, Hillier S, Charlton K, Causby R. Decision-making processes for non-emergency diabetes-related lower extremity amputations: A scoping review. Diabetes Res Clin Pract 2023; 206:111015. [PMID: 37981124 DOI: 10.1016/j.diabres.2023.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
Living with a diabetes-related foot ulcer has significant lifestyle impacts. Whilst often considered a last resort, amputation can overcome the burden of ulcer management, for an improved quality of life. However, limited research has been conducted to understand how the decision to amputate is made for people with a chronic ulcer when amputation is not required as a medical emergency. Therefore, the aim was to identify and map key concepts in the literature which describe the decision-making for diabetes-related amputations. This review followed Arksey and O'Malley's PRISMA scoping review framework. Five electronic databases and grey literature were searched for papers which described clinical reasoning and/or decision-making processes for diabetes-related amputation. Data were extracted and mapped to corresponding domains of the World Health Organisation's International Classification of functioning, Disability and Health (ICF) framework. Ninety-four papers were included. Personal factors including emotional wellbeing, quality of life, and treatment goals are key considerations for an elective amputation. It is important to consider an individual's lifestyle and personal circumstances, as well as the pathology when deciding between amputation or conservative management. This highlights the importance of a holistic and shared decision-making process for amputation which includes assessment of a person's lifestyle and function.
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Affiliation(s)
- Emilee Kim Ming Ong
- GPO Box 2471, Adelaide, South Australia 5001, Australia; Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Carolyn Murray
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Susan Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Kimberly Charlton
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, South Australia, Australia.
| | - Ryan Causby
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
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Sherlock C, Linehan C, Madigan C, Downes M. ‘A Rollercoaster of Emotions’: Reflections on Growing Up with Epilepsy in Ireland. Seizure 2023; 108:60-65. [PMID: 37088056 DOI: 10.1016/j.seizure.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE Childhood epilepsy can have lasting effects which extend beyond those attributed to seizures. Previous studies have explored the lived experience of childhood epilepsy, but to our knowledge, no study has afforded adults with a diagnosis of childhood epilepsy the opportunity to reflect on their experiences. In comparison with children, adult respondents have the benefit of ample time having lapsed in order to process their experiences and have greater linguistic competencies. The aim of this study was to retrospectively capture, via interview, adults' perceptions of the impact of epilepsy during their childhood. METHODS A semi-structured interview schedule was developed in collaboration with patient experts to investigate participants' experiences of growing up with epilepsy in Ireland. Thirteen Irish adults aged between 18 and 35 years, who had their first seizure before the age of 16, were interviewed. Data was analysed using Big Q reflective thematic analysis. RESULTS Three main themes and 14 subthemes were generated from the data. The main themes comprised (1) disenfranchised grief, (2) need to belong and (3) walking in my shoes. CONCLUSION All three themes demonstrated a common need for patient care that is cognisant of the child's developmental stage and psychosocial health, and the myriad of factors that contribute to both. Information, resources and clinical engagement with children with epilepsy require the input of patients with current or past experience of childhood epilepsy to guide development. A co-production approach is needed to address some of the disenfranchised and isolating experiences recollected by our participants.
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Affiliation(s)
- Clara Sherlock
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland.
| | - Cathy Madigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
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Cach G, Rogers AE, Spoer DL, Sayyed AA, Deldar R, Attinger CE, Evans KK. Amputation Acceptance: A Survey of Factors Influencing the Decision to Undergo Lower Extremity Amputation. J Foot Ankle Surg 2023; 62:548-552. [PMID: 36813633 DOI: 10.1053/j.jfas.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
Accepting to undergo amputation is an arduous process often fraught with confusion, fear, and uncertainty. To assess how to best facilitate discussions with at-risk patients, we surveyed lower extremity amputees about their experiences surrounding this decision-making process. Patients who underwent lower extremity amputation at our institution from October 2020 to October 2021 were asked to complete a 5-item telephone survey assessing their decision to undergo amputation and postoperative satisfaction. Retrospective chart review of respondent demographics, comorbidities, operative details, and complications was conducted. Of 89 lower extremity amputees identified, 41 (46.07%) responded to the survey, with the majority undergoing below-knee amputations (n = 34, 82.93%). At a mean follow-up of 5.90 ± 3.45 months, 20 patients (48.78%) were ambulatory. Surveys were completed at a mean of 7.74 ± 4.03 months since amputation. Factors that helped patients decide to undergo amputation included discussions with doctors (n = 32, 78.05%) and concern for worsening health (n = 19, 46.34%). Deteriorating ability to walk (n = 18, 45.00%) was the most common concern prior to surgery. Recommendations by survey respondents to ease the decision-making process included speaking with amputees (n = 9. 22.50%), more discussions with doctors (n = 8, 20.00%), and access to mental health and social services (n = 2, 5.00%); however, many had no recommendations (n = 19, 47.50%), and most were pleased with their decision to undergo amputation (n = 38, 92.68%). Despite most patients primarily citing satisfaction with their decision to undergo lower extremity amputation, it is critical to consider factors that affect patient decisions and recommendations to improve this decision-making process.
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Affiliation(s)
- Gina Cach
- Georgetown University School of Medicine, Washington, DC
| | - Ashley E Rogers
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Daisy L Spoer
- Georgetown University School of Medicine, Washington, DC
| | - Adaah A Sayyed
- Georgetown University School of Medicine, Washington, DC
| | - Romina Deldar
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
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Canbolat Seyman C, Uzar Ozcetin YS. "I Wish I Could Have My Leg": A Qualitative Study on the Experiences of Individuals With Lower Limb Amputation. Clin Nurs Res 2021; 31:509-518. [PMID: 34612075 DOI: 10.1177/10547738211047711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Amputation is commonly regarded as a lifesaving procedure. However, the loss of a body part can lead to permanent disability that can impact patients physically, psychologically, and socially. The aim of this study was to describe and understand the perspectives of patients with lower limb amputation (LLA) about their condition. The study uses a descriptive phenomenological design. Data were collected from 12 patients. The researchers conducted interviews using semi-structured questions. MAXQDA was used for qualitative software support in managing the interview data. Data were transcribed. The participants were aged 61.3 ± 10.8 years. Three themes emerged from the qualitative data: (i) losing control over one's own life, (ii) dreams versus the realities of life, and (iii) future perceptions. Most of the participants emphasized that they face undesirable experiences in their post-amputation lives. The findings of the present study provide novel insight into how individuals subjectively experience life after LLA.
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Subrata SA. Implementation of spiritual care in patients with diabetic foot ulcers: a literature review. ACTA ACUST UNITED AC 2020; 29:S24-S32. [PMID: 32790549 DOI: 10.12968/bjon.2020.29.15.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.
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Affiliation(s)
- Sumarno Adi Subrata
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand, Nursing Lecturer at the Department of Nursing and Wound Research Centre, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
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Bereavement, Grief and Adult Type 1 Diabetes: Living With Diabetes Today. Can J Diabetes 2020; 44:545-548. [PMID: 32653156 DOI: 10.1016/j.jcjd.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/13/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
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Herring B, Paraskeva N, Tollow P, Harcourt D. Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: A qualitative study. Psychooncology 2019; 28:2076-2082. [PMID: 31386237 DOI: 10.1002/pon.5196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/03/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Beth Herring
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Nicole Paraskeva
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Philippa Tollow
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
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Abstract
BACKGROUND Alongside physical impairment, psychosocial health issues may arise after amputation, impacting quality of life. Traditional psychosocial care models provide services in a linear fashion, with limited supports upon discharge. A novel program entitled Amputees Unanimous is a 12-step program provided for amputees by amputees. OBJECTIVE To shape the final content of Amputees Unanimous by identifying personal beliefs and opinions of healthcare professionals and amputees. STUDY DESIGN Qualitative design utilizing a phenomenological approach. METHOD Five focus groups were held: four with amputees and one with healthcare providers. A phenomenological approach shaped the inquiry of the lived experience of limb loss in relation to the content of Amputees Unanimous. RESULTS Three themes emerged: (1) accepting limb loss, (2) peer inspiration, and (3) regaining prior level of function. CONCLUSION Limb loss may alter one's self-image, both physically and psychologically, having a profound effect on how an individual copes throughout his or her lifetime. The content and delivery format of Amputees Unanimous could be tested for effectiveness as a program tailored to facilitate coping after limb loss and to provide encouragement, support, and hope for the future of amputees. CLINICAL RELEVANCE A dynamic, amputee-led, mutual help program may provide individuals with limb loss a place for encouragement, support, and optimism for the future.
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Affiliation(s)
- Catrinna Amorelli
- 1 Specialty Care Services, Vilseck Army Health Clinic, Vilseck, Germany
| | - Kathleen Yancosek
- 2 Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ruth Morris
- 3 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Exploring the needs and challenges of parents and their children in childhood epilepsy care: A qualitative study. Epilepsy Behav 2018; 88:268-276. [PMID: 30321756 DOI: 10.1016/j.yebeh.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/15/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
Because of the nature of epilepsy, and the unpredictability of seizure recurrence, epilepsy requires long-term treatment with medications. As a consequence, epilepsy has a negative pervasive impact in children with epilepsy (CWE), and their parents. Hence, our aim was to explore the needs and challenges of parents and their CWE. In-depth interviews (IDIs) were conducted with 15 families (12 mothers and 3 fathers) and 15 CWE (aged 8-18 years). Data were transcribed verbatim and thematically analyzed using the descriptive phenomenology approach. The experiences of parents and their CWE could be divided into two time frames: "experiences during a child's first seizure" and "experiences whilst growing up with epilepsy". Parents' main concerns and worries were regarding their child's physical health, psychological and emotional wellbeing, academic achievement, and future. The children's main concerns were restrictions imposed, their interpersonal relationship with peers, and being independent in the future. Parents reported that they needed epilepsy-related information, continuity of care, and a parental support group, while CWE reported that their main needs were independence and autonomy. The views of parents and their child with epilepsy were similar in physical functioning and academic achievement. However, parents and children had different views on how epilepsy impacted on the child emotionally, as well as behavioral and interpersonal relationship with peers.
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Limb loss: The unspoken psychological aspect. JOURNAL OF VASCULAR NURSING 2016; 34:128-130. [DOI: 10.1016/j.jvn.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/18/2022]
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Murphy G, Peters K, Wilkes LM, Jackson D. Adult Children of Parents with Mental Illness: Losing Oneself. Who am I? Issues Ment Health Nurs 2016; 37:668-673. [PMID: 27192113 DOI: 10.1080/01612840.2016.1178359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a limited body of research that focuses on experiences of families of people with mental illness. While the body of knowledge concerning children of parents with mental illness is increasing, there remains limited discourse surrounding the experiences of adults who have lived with childhood parental mental illness. This paper examined one major theme of a study focusing on parenting narratives of adults who had experienced childhood parental mental illness. The narrative study from a metropolitan area of Australia reflects adult children's experiences of being overwhelmed with parental mental illness. They felt unsure of their own emotions and felt they had lost a sense of who they were as individual people. Adult children felt confused about their sense of reality, particularly for those whose parent had a diagnosis of schizophrenia or psychosis. Their experiences of loss were closely associated with changing self identity. Furthermore, many of the narratives demonstrated experiences of grief for adult children. Greater understanding of adult children's perceptions of being parented by a person with mental illness, alongside their experiences of loss, has the potential to help health and social care professionals to facilitate greater resilience for families who are living with parental mental illness.
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Affiliation(s)
- Gillian Murphy
- a Western Sydney University , School of Nursing and Midwifery , Penrith South DC, New South Wales , Australia
| | - Kathleen Peters
- a Western Sydney University , School of Nursing and Midwifery , Penrith South DC, New South Wales , Australia
| | - Lesley M Wilkes
- a Western Sydney University , School of Nursing and Midwifery , Penrith South DC, New South Wales , Australia
| | - Debra Jackson
- b Oxford Brookes University , Faculty of Health & Life Sciences , Oxford University Hospitals NHS Trust, Oxford , United Kingdom ; University of New England , School of Health, Armidale , New South Wales , Australia
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Affiliation(s)
- Anne Phillips
- Senior lecturer in diabetes care, Alcuin C College, Department of Health Sciences, University of York, Heslington, York YO10 5DD
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