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Jones AW, Makanjuola A, Bray N, Prior Y, Parker D, Nester C, Tang J, Jiang L. The efficacy of custom-made offloading devices for diabetic foot ulcer prevention: a systematic review. Diabetol Metab Syndr 2024; 16:172. [PMID: 39049069 PMCID: PMC11267867 DOI: 10.1186/s13098-024-01392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Therapeutic offloading devices, including insoles, shoes, and other orthoses, are some of the most commonly used interventions to treat or prevent diabetic foot ulceration. Custom-made offloading devices are increasingly used to offset the development of foot ulcers. However, whether these devices are more effective than prefabricated standard offloading devices is uncertain. Therefore, this systematic review collates and examines evidence on the efficacy of custom-made offloading devices in preventing foot ulcer incidence and recurrence in people diagnosed with diabetes. METHODS Five scientific databases were searched, covering 2011-2023. Initial searches and screening were carried out independently by two researchers. Studies meeting the inclusion criteria were further examined through additional screenings, and critical appraisal. Data relevant to the review aims were extracted and analysed within a narrative synthesis. RESULTS Of the 1,715 articles found in the initial searches, nine papers were found to meet inclusion criteria and were included in the review. The evidence shows that custom-made offloading devices are likely to be more effective for reducing or preventing diabetic foot ulcers than standard offloading devices. However, due to a lack of data it remains uncertain whether custom-made offloading devices are more cost-effective for preventing ulceration compared to standard insoles. Likewise, due to measurement heterogeneity between studies and lack of data, it is unclear whether adherence is higher in users of custom-made offloading devices, and whether such devices deliver significantly greater reductions in peak pressure as compared to standard offloading devices. CONCLUSION Custom-made offloading devices are more effective than standard devices for preventing diabetic foot ulceration, and we recommended their use when feasible; however, there remains uncertainty regarding their cost-effectiveness compared to standard insoles and offloading devices.
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Affiliation(s)
- Aled Wyn Jones
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
| | - Abraham Makanjuola
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK
- Faculty of Life Sciences and Education, University of South Wales, Cardiff, UK
| | - Nathan Bray
- Academy for Health Equity, Prevention and Wellbeing, Bangor University, Bangor, UK.
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Daniel Parker
- Centre for Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Hellstrand Tang U, Smith F, Karilampi UL, Gremyr A. Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool. JMIR Hum Factors 2024; 11:e50889. [PMID: 38669076 PMCID: PMC11087855 DOI: 10.2196/50889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Frida Smith
- Regional Cancer Centre West, Gothenburg, Sweden
- Department of Technology Management and Economics, Collaborative Plattform for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Ulla Leyla Karilampi
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Bhar B, Ranta P, Samudrala PK, Mandal BB. Omentum Extracellular Matrix-Silk Fibroin Hydroscaffold Promotes Wound Healing through Vascularization and Tissue Remodeling in the Diabetic Rat Model. ACS Biomater Sci Eng 2024; 10:1090-1105. [PMID: 38275123 DOI: 10.1021/acsbiomaterials.3c01877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Nonhealing diabetic wounds are often associated with significant mortality and cause economic and clinical burdens to the healthcare system. Herein, a biomimetic hydroscaffold is developed using omentum tissue-derived decellularized-extracellular matrix (dECM) and silk fibroin (SF) proteins that associate the behavior of a collagenous fibrous scaffold and a hydrogel to reproduce all aspects of the provisional skin tissue matrix. The chemical cross-linker-free in situ gelation property of the two types of SF proteins from Bombyx mori and Antheraea assamensis ensures the adherence of dECM with surrounding tissue on the wound bed, circumventing further suturing. The physicochemical and mechanical properties of the composite hydroscaffold (SF-dECM) were thoroughly evaluated. The hydroscaffolds were found to support the growth and proliferation of human dermal fibroblasts and influence the angiogenic potential of endothelial cells under in vitro conditions. Furthermore, the healing efficacy of the composites was evaluated by generating full-thickness wounds on a streptozotocin-induced diabetic rat model. The presence of dECM components in the composite facilitated the rate of wound closure, granulation tissue formation, and re-epithelialization by providing intrinsic cues to advance the inflammatory stage and stimulating angiogenesis. Collectively, as an off-the-shelf wound dressing requiring only a single topical administration, the SF-dECM hydroscaffold is a promising, cost-effective dressing for the management of chronic diabetic wounds.
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Affiliation(s)
- Bibrita Bhar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Priyanka Ranta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical and Educational Research Guwahati, Guwahati, Assam 781101, India
| | - Pavan Kumar Samudrala
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical and Educational Research Guwahati, Guwahati, Assam 781101, India
| | - Biman B Mandal
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Sanjeeviraj S, Subburaj A, Aluri S, Thakku Sekar BR, Jalan M, Joseph AG. A Cohort Study on the Outcome of Diabetic Foot Ulcers. Cureus 2023; 15:e48030. [PMID: 38034176 PMCID: PMC10687807 DOI: 10.7759/cureus.48030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) represent a significant and challenging complication of diabetes mellitus, often leading to serious morbidity and a substantial burden on healthcare systems. The study was conducted with the objectives of evaluating the outcomes of DFUs. MATERIALS AND METHODS A cohort study was conducted to evaluate the outcomes of DFUs from May 2019 to May 2020 at a tertiary care hospital located in Chennai. The study included patients aged 18 to 90 years who were diagnosed with DFUs. Individuals with diabetic foot lesions (skin lesions such as fissures, abscess, cellulites) other than ulcers or those without diabetes were excluded. The data was collected from a total of 100 diabetic patients using systematic random sampling technique. RESULTS The mean (SD) age of the study participants was 54.68 (6.72) years with males constituting 56% of the study population. Among 100 participants, 65% experienced healing while 35% did not. Logistic regression analysis showed that glycated haemoglobin (HbA1c) levels, age, and diabetes duration had significant effect on patient outcome. Logistic regression analysis showed that HbA1c levels, age, and diabetes duration had significant effect on patient outcome. Out of 12 patients with major amputation, seven (58.3%) survived, while out of 19 patients with minor amputations, 18 (94.7%) showed remarkably higher survival rate. Meanwhile, 100% survival rate was observed in patients with no amputation. CONCLUSION The study's comprehensive assessment of risk factors and their associations with healing outcomes provides essential knowledge for clinical practice. The study findings collectively support the optimization of interventions and strategies to prevent and manage DFUs, ultimately improving patient care and enhancing their quality of life. The study highlights the significance of glycemic control and limb preservation in DFU management.
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Affiliation(s)
| | | | - Smriti Aluri
- Surgery, Kakatiya Medical College, Warangal, IND
| | | | - Manik Jalan
- Emergency Medicine, Tagore Hospital and Heart Care Centre, Jalandhar, IND
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DiLosa KL, Nguyen RK, Brown C, Waugh A, Humphries MD. Defining Vascular Deserts to Describe Access to Care and Identify Sites for Targeted Limb Preservation Outreach. Ann Vasc Surg 2023; 95:125-132. [PMID: 37247838 PMCID: PMC10529312 DOI: 10.1016/j.avsg.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Access to care plays a critical role in limb salvage in chronic limb-threatening ischemia (CLTI). A "medical desert" describes a community lacking access to medical necessities, resulting in increased morbidity and mortality. We sought to describe vascular deserts, which we defined as regions with decreased access to specialty care. METHODS All California providers performing vascular surgery procedures were identified through online provider and health care facility searches. Facility participation in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) lower extremity bypass (LEB) and peripheral vascular intervention (PVI) modules was also determined. Addresses were geocoded with a 30-mile surrounding buffer using ArcGIS (Geographic information systems), creating maps based on care type, including all providers performing vascular procedures, board-certified vascular surgeons, and facilities participating in VQI modules. Public census data overlayed on the maps demonstrated population composition in desert versus nondesert regions. Subsequently, data from the Healthy Places Index (HPI) was overlayed, providing data regarding 25 social factors, comprising an overall HPI score and percent, with lower scores corresponding to poorer health and outcomes. RESULTS Maps depicting care regions demonstrated decreased provider coverage with increasing specialty care, with the VQI provider map showing the most prominent "desert" regions. When comparing nondesert versus desert regions by care type, demographics including race, the percentage of the population 200% below the poverty line, and the rate of uninsured residents were described. Social determinants of health were then described for desert and nondesert regions by care type, including the HPI percentage and specific domain factors. The percentage of uninsured residents was significant only in the desert and nondesert areas served by board-certified vascular surgeons (19.6 vs. 16.8%, P < 0.001). The mean HPI percentile was significantly lower in board-certified provider and VQI facility deserts than nondeserts (50.48% vs. 40.65%, P < 0.001 and 52.68% vs. 43.12%, P < 0.001, respectively). The economic and education factor percentiles were significantly lower in all desert populations, while the housing, social, and pollution factors were significantly higher in nondesert regions. Health care access, transportation, and neighborhood factor percentiles were significantly lower in board-certified and VQI facility deserts than in the nondesert areas. CONCLUSIONS Access to vascular care plays a significant role in limb salvage. Through mapping vascular deserts, patient demographics, and social factors in desert regions are better understood, and areas that would benefit most from targeted outreach and limb preservation programs for CLTI are identified.
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Affiliation(s)
- Kathryn L DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA.
| | - Ryan Khoa Nguyen
- Division of Vascular Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
| | - Christina Brown
- Division of Vascular Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
| | - Aidan Waugh
- Division of Vascular Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
| | - Misty D Humphries
- Division of Vascular Surgery, Department of Surgery, University of California, Davis Health, Sacramento, CA
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Thanigaimani S, Jin H, Ahmad U, Anbalagan R, Golledge J. Comparative efficacy of growth factor therapy in healing diabetes-related foot ulcers: A network meta-analysis of randomized controlled trials. Diabetes Metab Res Rev 2023; 39:e3670. [PMID: 37277960 PMCID: PMC10909411 DOI: 10.1002/dmrr.3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION This study examined the relative efficacy of growth factor therapies in healing diabetes-related foot ulcers (DFU). METHODS PubMed and Cochrane databases were searched for randomized controlled trials testing growth factor therapies for treating DFU. The primary outcome was complete wound closure. Results were reported as relative risk (RR) ± 95% credible intervals (CrI). The risk of bias was assessed using Cochrane's RoB-2 tool. RESULTS A total of 31 RCTs involving 2174 participants were included. Only 13 of the trials (n = 924) reported on the aetiology of the ulcers (85.4% neuropathic and 14.6% ischaemic). Epidermal growth factor (RR 3.83; 95% CrI 1.81, 9.10), plasma-rich protein (PRP) (RR 3.36; 95% CrI 1.66, 8.03) and platelet-derived growth factor (PDGF) (RR 2.47; 95% CrI 1.23, 5.17) significantly improved the likelihood of complete ulcer healing compared to control. Sub-analyses suggested that PRP (3 trials - RR 9.69; 95% CrI 1.37, 103.37) and PDGF (6 trials - RR 2.22; 95% CrI 1.12, 5.19) significantly improved the likelihood of wound closure amongst trial mainly recruiting participants with neuropathic ulcers. Eleven trials had a low risk of bias, 9 had some concerns and 11 had a high risk of bias. Sub-analysis of trials with a low risk of bias suggested that none of the growth factors significantly improved ulcer healing compared with control. DISCUSSION This network meta-analysis found low-quality evidence that Epidermal growth factor, PRP and PDGF therapy improved DFU healing likelihood compared with control. Larger well-designed trials are needed.
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Affiliation(s)
- Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- The Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
| | - Harry Jin
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Usama Ahmad
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Raghuveeran Anbalagan
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- The Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- The Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- The Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
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Tan ST, Aisyah PB, Firmansyah Y, Nathasia N, Budi E, Hendrawan S. Effectiveness of Secretome from Human Umbilical Cord Mesenchymal Stem Cells in Gel (10% SM-hUCMSC Gel) for Chronic Wounds (Diabetic and Trophic Ulcer) - Phase 2 Clinical Trial. J Multidiscip Healthc 2023; 16:1763-1777. [PMID: 37383529 PMCID: PMC10295509 DOI: 10.2147/jmdh.s408162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Background Chronic wounds carry financial burdens and increase morbidity and mortality, especially in diabetic ulcers and Hansen's Morbus. More than 50% of chronic ulcers are difficult to heal with regular treatment and require new types of therapy such as the use of secretome of human umbilical cord mesenchymal stem cells (SM-hUCMSC). Methods This experimental study was carried out to see the effectiveness of using SM-hUCMSC in diabetic ulcers and Hansen's Morbus in four medical facilities (multicentre). The level of active secretion has been measured by default in 10% SM-hUCMSC gel, used as a treatment intervention. The primary outcome is wound healing in terms of the length, width, and extent of the wound. The secondary is the side effects of treatment 2 weeks after administration. Follow-up visits will be scheduled at 1 and 2 weeks post-treatment. Results Forty-one chronic ulcers successfully followed the study until the end. In patients with chronic ulcers, the mean ulcer length, width, and area were 1.60 (0,50-13,0), 1.3 (0,5-6,0), and 2.21 (0,25-78) cm square, respectively, before interventions and 1 (0-12), 0,8 (0-6,0), and 1 (0-72) square cm after interventions at the second follow-up. The change between the beginning and end of the intervention was significant (p-value <0.05). Conclusion The use of 10% SM-hUCMSC gel topically has been proven effective in accelerating the process of wound healing, especially chronic ulcers with side effects that are not present in this study.
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Affiliation(s)
- Sukmawati Tansil Tan
- Department of Dermatology and Venereology, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
| | | | | | | | - Erwin Budi
- Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
| | - Siufui Hendrawan
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
- Tarumanagara Human Cell Technology Laboratory, Tarumanagara University, Jakarta, Indonesia
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Lo ZJ, Tan E, Chandrasekar S, Ooi D, Liew H, Ang G, Yong E, Hong Q, Chew T, Muhammad Farhan MF, Zhu X, Ang P, Law C, Raman N, Park D, Tavintharan S, Hoi WH, Lin J, Koo HY, Choo J, Low KQ, Low R, Venkataraman K, Car J, Chew DEK. Diabetic foot in primary and tertiary (DEFINITE) Care: A health services innovation in coordination of diabetic foot ulcer (DFU) Care within a healthcare cluster - 18-month results from an observational population health cohort study. Int Wound J 2023; 20:1609-1621. [PMID: 36372913 PMCID: PMC10088846 DOI: 10.1111/iwj.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional and multi-disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster - an integrated network of seven primary care polyclinics and two acute care tertiary hospitals (1700-bed and 800-bed) with a total catchment population of 2.2 million residents. Results from prospective DEFINITE Care is referenced against a retrospective 2013-2017 cohort, which was previously published. Cardiovascular profile of the study population is compared against the same population's profile in the preceding 12 months. Between June 2020 and December 2021, there were 3475 unique patients with DFU with mean age at 65.9 years, 61.2% male, mean baseline HbA1c at 8.3% with mean diabetes duration at 13.3 years, mean diabetes complication severity index (DCSI) at 5.6 and mean Charlson Comorbidity Index (CCI) at 6.8. In the 12-months preceding enrolment to DEFINITE Care, 35.5% had surgical foot debridement, 21.2% had minor lower extremity amputation (LEA), 7.5% had major LEA whilst 16.8% had revascularisation procedures. At 18-months after the implementation of DEFINITE Care programme, the absolute minor and major amputation rates were 8.7% (n = 302) and 5.1% (n = 176), respectively, equating to a minor and major LEA per 100000 population at 13.7 and 8.0, respectively. This represents an 80% reduction in minor amputation rates (P < .001) and a 35% reduction in major amputation rates (P = .005) when referenced against a retrospective 2013-2017 cohort, which had minor and major LEA per 100000 population at 68.9 and 12.4, respectively. As compared to the preceding 12 months, there was also a significant improvement in cardiovascular profile (glycemic and lipid control) within the DEFINITE population, with improved mean HbAc1 (7.9% from 8.4%, P < .001), low-density lipoprotein (LDL) levels (2.1 mmol/L from 2.2, P < .001), total cholesterol (3.9 mmol/L from 4.1, P < .001) and triglycerides levels (1.6 mmol/L from 1.8, P = .002). Multivariate analysis revealed a history of minor amputation in the preceding 12 months to be an independent predictor for major and minor amputation within the study period of 18 months (Hazard Ratio 3.4 and 1.8, respectively, P < .001). In conclusion, within DEFINITE care, 18-month data showed a significant reduction of minor and major LEA rates, with improved medical optimisation and cardiovascular profile within the study population.
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Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of SurgeryWoodlands HealthSingaporeSingapore
- Centre for Population Health Sciences. Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Elaine Tan
- Toa Payoh PolyclinicNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Desmond Ooi
- Vascular Surgery Service, Department of General SurgeryKhoo Teck Puat HospitalSingaporeSingapore
| | - Huiling Liew
- Department of EndocrinologyTan Tock Seng HospitalSingaporeSingapore
| | - Gary Ang
- Health Services and Outcomes ResearchNational Healthcare GroupSingaporeSingapore
| | - Enming Yong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Tiffany Chew
- Department of PodiatryTan Tock Seng HospitalSingaporeSingapore
| | | | - Xiaoli Zhu
- Nursing ServiceNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Pauline Ang
- Podiatry ServiceNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Chelsea Law
- Department of PodiatryKhoo Teck Puat HospitalSingaporeSingapore
| | - Nadiah Raman
- Department of PodiatryKhoo Teck Puat HospitalSingaporeSingapore
| | - Derek Park
- Department of OrthopaedicsKhoo Teck Puat HospitalSingaporeSingapore
| | | | - Wai Han Hoi
- Department of EndocrinologyWoodlands HealthSingaporeSingapore
| | - Jaime Lin
- Department of EndocrinologyWoodlands HealthSingaporeSingapore
| | - Hui Yan Koo
- Group Integrated CareNational Healthcare GroupSingaporeSingapore
| | - Julia Choo
- Group Integrated CareNational Healthcare GroupSingaporeSingapore
| | - Kai Qiang Low
- Group Integrated CareNational Healthcare GroupSingaporeSingapore
| | - Rose Low
- Group Integrated CareNational Healthcare GroupSingaporeSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Josip Car
- Centre for Population Health Sciences. Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- School of Public HealthImperial College LondonLondonUK
| | - Daniel EK Chew
- Department of EndocrinologyTan Tock Seng HospitalSingaporeSingapore
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Alsheikh S, AlGhofili H, Alageel R, Ababtain O, Alarify G, Alwehaibi N, Altoijry A. Diabetic Foot Care: A Screening on Primary Care Providers' Attitude and Practice in Riyadh, Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010064. [PMID: 36676687 PMCID: PMC9861771 DOI: 10.3390/medicina59010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.
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Affiliation(s)
- Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Correspondence: ; Tel./Fax: +966-114671585
| | - Hesham AlGhofili
- Department of Vascular Surgery, King Salman Heart Center, King Fahad Medical City, Riyadh 12231, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON 11525, Canada
| | - Reema Alageel
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Omar Ababtain
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Ghadah Alarify
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Nasser Alwehaibi
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Department of Surgery, King Fahad Specialist Hospital, Buraidah 52366, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
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10
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Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A. Health economics of diabetic foot ulcer and recent trends to accelerate treatment. Foot (Edinb) 2022; 52:101909. [PMID: 36049265 DOI: 10.1016/j.foot.2022.101909] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Diabetic foot ulcer is a preventable complication of diabetes that imposes a significant burden on the community. It leads to amputation and increased disability if left untreated and thus bears profound implications on the individual, the community and the health system at large. Diabetic foot (DF) is an area of research interest where interdisciplinary researchers are trying to elucidate the best strategy to halt the progression of chronic diabetic wounds. It is an area where tissue engineering research is making a strong impact through the use of scaffolds and skin substitutes for diabetic wound healing. This review aims at discussing the geographical health economics, its impact on healing and factors influencing financial costs of DFU. The upcoming economic and clinical impacts due to disease outbreak such as the 2020 COVID-19 has also been discussed. Finally, it will discuss novel therapy available with emphasis on skin tissue engineering scaffolds with a cost-benefit analysis. The review aims at promoting better management of people with diabetes with emphasis on emerging treatments and technologies.
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Affiliation(s)
- Abha Jodheea-Jutton
- Department of Medicine, University of Mauritius, 80837 Réduit, Mauritius; Biomaterials, Drug Delivery and Nanotechnology Unit, Center for Biomedical and Biomaterials Research, University of Mauritius, 80837 Réduit, Mauritius
| | - Sandip Hindocha
- Department of Plastic and Reconstructive Surgery, Bedford Hospital NHS Trust, Kempston Road, Bedford, MK42 FDJ, United Kingdom
| | - Archana Bhaw-Luximon
- Biomaterials, Drug Delivery and Nanotechnology Unit, Center for Biomedical and Biomaterials Research, University of Mauritius, 80837 Réduit, Mauritius.
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11
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Nazeha N, Meng L, Ho P, Ng YZ, Graves N. The burden of costs on health services by patients with neuro-ischaemic ulcers in Singapore. Int Wound J 2022; 20:669-677. [PMID: 35948440 PMCID: PMC9927887 DOI: 10.1111/iwj.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/01/2022] Open
Abstract
The economic burden of neuro-ischaemic ulcers (NIU) is expected to increase because of rising prevalence of comorbidities in an aging population. We aim to estimate healthcare resources consumed by NIU patients, and to quantify the extent to which factors explain variation in cost-related outcomes. We analysed retrospective patient-level cohort data for NIU patients from a tertiary hospital registry in Singapore, from 2013 to 2017, using generalised linear regression models. The outcome variables were the length of stay per admission; inpatient and outpatient bill per admission; and, if they had an Emergency Department visit. Cost outcomes were reported in Singapore dollars (S$). A total of 1682 patients were included, and the mean age was 69.9 years (±13.0). An average patient incurred a length of stay of 38.7 days, 7.9 inpatient dressing sessions, an inpatient bill of S$33 096, 11.3 outpatient dressing sessions, and an outpatient bill of S$8780. Inpatient services per patient cost 73.5% higher than outpatient services. NIU patients with multiple (>3) comorbid conditions, peripheral artery disease, or chronic kidney disease incurred longer hospitalisation and higher inpatient bill. Patients with diabetes mellitus and coronary artery disease had higher odds of incurring an ED visit. Patients with coronary artery disease, hyperlipidaemia, kidney complications, or obesity incurred higher outpatient bills. NIU treatment imposes a significant economic burden, especially with inpatient services.
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Affiliation(s)
- Nuraini Nazeha
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - Lingyan Meng
- Department of SurgeryYong Loo Lin School of Medicine, National University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Pei Ho
- Department of SurgeryYong Loo Lin School of Medicine, National University of SingaporeSingapore,Department of Cardiac, Thoracic and Vascular SurgeryNational University Health SystemSingapore
| | - Yi Zhen Ng
- Wound Care Innovation for the Tropics ProgrammeSkin Research Institute of Singapore (A*STAR)Singapore
| | - Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
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12
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Bandarian F, Qorbani M, Nasli-Esfahani E, Sanjari M, Rambod C, Larijani B. Epidemiology of Diabetes Foot Amputation and its Risk Factors in the Middle East Region: A Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022:15347346221109057. [PMID: 35730157 DOI: 10.1177/15347346221109057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. The estimated rate of foot amputation in diabetes patients and those with DFUs in the Middle East region is approximately high, which may indicate low quality of preventive foot care, low socioeconomics and low patients awareness or education in countries with high amputation rate.
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Affiliation(s)
- Fatemeh Bandarian
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular- Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rambod
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
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13
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Lo ZJ, Chandrasekar S, Yong E, Hong Q, Zhang L, Chong LRC, Tan G, Chan YM, Koo HY, Chew T, Sani NF, Cheong KY, Cheng LRQ, Tan AHM, Muthuveerappa S, Lai TP, Goh CC, Ang GY, Zhu Z, Hoi WH, Lin JHX, Chew DEK, Lim B, Yeo PS, Liew H. Clinical and economic outcomes of a multidisciplinary team approach in a lower extremity amputation prevention programme for diabetic foot ulcer care in an Asian population: A case-control study. Int Wound J 2022; 19:765-773. [PMID: 34363329 PMCID: PMC9013583 DOI: 10.1111/iwj.13672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022] Open
Abstract
Present guidelines recommend a multidisciplinary team (MDT) approach to diabetic foot ulcer (DFU) care, but relevant data from Asia are lacking. We aim to evaluate the clinical and economic outcomes of an MDT approach in a lower extremity amputation prevention programme (LEAPP) for DFU care in an Asian population. We performed a case-control study of 84 patients with DFU between January 2017 and October 2017 (retrospective control) vs 117 patients with DFU between December 2017 and July 2018 (prospective LEAPP cohort). Comparing the clinical outcomes between the retrospective cohort and the LEAPP cohort, there was a significant decrease in mean time from referral to index clinic visit (38.6 vs 9.5 days, P < .001), increase in outpatient podiatry follow-up (33% vs 76%, P < .001), decrease in 1-year minor amputation rate (14% vs 3%, P = .007), and decrease in 1-year major amputation rate (9% vs 3%, P = .05). Simulation of cost avoidance demonstrated an annualised cost avoidance of USD $1.86m (SGD $2.5m) for patients within the LEAPP cohort. In conclusion, similar to the data from Western societies, an MDT approach in an Asian population, via a LEAPP for patients with DFU, demonstrated a significant reduction in minor and major amputation rates, with annualised cost avoidance of USD $1.86m.
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Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
- Lee Kong Chian School of Medicine Centre for Population Health SciencesNayang Technological UniversitySingapore
- Skin Research Institute of SingaporeAgency for Science, Technology and ResearchSingapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Enming Yong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Li Zhang
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | | | - Glenn Tan
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Yam Meng Chan
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Hui Yan Koo
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Tiffany Chew
- Department of PodiatryTan Tock Seng HospitalSingapore
| | | | | | | | | | | | - Tina Peiting Lai
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingapore
| | - Gary Y. Ang
- Health Services and Outcomes ResearchNational Healthcare GroupSingapore
| | - Zhecheng Zhu
- Health Services and Outcomes ResearchNational Healthcare GroupSingapore
| | - Wai Han Hoi
- Department of EndocrinologyWoodlands Health CampusSingapore
| | | | | | - Brenda Lim
- Department of EndocrinologyTan Tock Seng HospitalSingapore
| | - Pei Shan Yeo
- Department of EndocrinologyTan Tock Seng HospitalSingapore
| | - Huiling Liew
- Department of EndocrinologyTan Tock Seng HospitalSingapore
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14
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Antimicrobial TiN-Ag Coatings in Leather Insole for Diabetic Foot. MATERIALS 2022; 15:ma15062009. [PMID: 35329463 PMCID: PMC8955427 DOI: 10.3390/ma15062009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 12/27/2022]
Abstract
This work reports on TiN-Ag antimicrobial coatings deposited by d.c. magnetron sputtering on leather used for insoles on the footwear industry, studies involving the antimicrobial properties of Ag-based functionalized leathers by sputtering techniques are shown. The X-ray diffraction (XRD) results suggested the presence of crystalline fcc-TiN phase for the sample without silver, and also a fcc-Ag phase in the samples containing silver. According to the Scanning Electron Microscopy (SEM) analysis, the coatings were homogeneous and dispersed Ag clusters were detected on the surface of samples with silver content above 8 at. %. The Inductively coupled plasma-optical emission spectrometry (ICP-OES) analysis showed that the ionization of silver over time depends on the morphology of the coatings. The samples did not present cytotoxicity and only samples with incorporated silver presented antibacterial and antifungal activity, highlighting the potential of the TiN-Ag insole coatings for diseases such as diabetic foot.
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15
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Bhadauria SS, Malviya R. Advancement in Nanoformulations for the Management of Diabetic Wound Healing. Endocr Metab Immune Disord Drug Targets 2022; 22:911-926. [PMID: 35249512 DOI: 10.2174/1871530322666220304214106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/01/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
People with diabetes have a very slow tendency for wound healing. Wound healing is a vast process where several factors inhibit the sequence of healing. Nano formulation plays a major role during acute and chronic wound healing. The present manuscript aims to discuss the role of nanoformulation in the treatment of diabetic wound healing. Diabetes is a common disease that has harmful consequences which lead to bad health. During the literature survey, it was observed that nanotechnology has significant advantages in the treatment of diabetic wound healing. The present manuscript summarized the role of nanomaterials in wound healing, challenges in diabetic wound healing, physiology of wound healing, a limitation that comes during wound repair, and treatments available for wound healing. After a comprehensive literature survey, it can be concluded that health worker needs more focus on the area of wound healing in diabetic patients. Medical practitioners, pharmaceutical and biomedical researchers need more attention towards the utilization of nanoformulations for the treatment of wound healing, specifically in the case of diabetes.
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Affiliation(s)
- Shailendra Singh Bhadauria
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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16
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Salawu AI, Ajani GO, Soje MO, Ojo OD, Olabinri EO, Obajolowo OO, Babalola OF, Ipinnimo TM, Oguntade HB, Adediran OO. Diabetes mellitus foot ulcer and associated factors among Type 2 diabetes patients in a Tertiary Institution in Southwest Nigeria. Ann Afr Med 2022; 21:339-347. [PMID: 36412332 PMCID: PMC9850882 DOI: 10.4103/aam.aam_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim This study aims to assess the proportion of diabetic foot ulcer (DMFU) and associated factors among patients with type 2 diabetes in a tertiary hospital in Southwest Nigeria. Methods A pretested semi-structured interviewer-administered questionnaire adapted from the STEPwise Approach to Surveillance of Noncommunicable Disease Risk Factors of WHO.14 was used for data collection from a sample of 181 patients with type 2 diabetes mellitus. Sociodemographic, behavioral, clinical, and laboratory variables were collated from the participants. Chi-square test and logistic regression were used to identify the predictors of DMFU. Results A total of 166 patients had their questionnaires completed. The mean age (standard deviation) of the respondents was 62.6 (14.3) years. The proportion of DMFU was 18.7%. More than two-third (71.1%) of our respondents had clinical symptoms suggestive of peripheral neuropathy while 34.3% of the patients seen in the study had evidence of peripheral vascular disease on duplex Doppler ultrasound. Male patients were about five times more likely to have DMFU than female patients (adjusted odds ratio [AOR] =5.27; 95% confidence interval [CI] = 1.001-27.841). Those with duration of diabetes ≥10 years were more likely to have DMFU than those with disease duration <10 years (AOR = 15.47; 95% CI = 1.201-199.314). Patients with fasting blood glucose (FBG) of ≥ 7.2 mmol/L were about four times more likely to have DMFU than those with FBG of <7.2 mmol/L (AOR = 4.19; 95% CI = 1.618-18.463). Conclusions The proportion of DMFU was 18.7%, and the predictors identified included sex, duration of disease, and FBG level.
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Affiliation(s)
- Adedayo Idris Salawu
- Department of Surgery, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria,Address for correspondence: Dr. Adedayo Idris Salawu, Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria. E-mail:
| | - Gbadebo Oladimeji Ajani
- Department of Medicine, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Michael Osisiogu Soje
- Department of Medicine, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Owolabi Dele Ojo
- Department of Surgery, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Orthopaedic and Trauma, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Eunice Oluremi Olabinri
- Department of Radiology, College of Health Sciences, Afe Babalola University, Ekiti State, Nigeria,Department of Radiology, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Omotola Olawale Obajolowo
- Department of Medicine, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Olakunle Fatai Babalola
- Department of Surgery, College of Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria,Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | - Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
| | | | - Olufemi Olusola Adediran
- Department of Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
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17
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Kuang B, Pena G, Cowled P, Fitridge R, Greenwood J, Wagstaff M, Dawson J. Use of Biodegradable Temporising Matrix (BTM) in the reconstruction of diabetic foot wounds: A pilot study. Scars Burn Heal 2022; 8:20595131221122272. [PMID: 36157311 PMCID: PMC9500262 DOI: 10.1177/20595131221122272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Complex diabetes-related foot wounds are at high risk of infection and subsequent major amputation unless healed expediently. Biodegradable Temporising Matrix (BTM) is a synthetic matrix that facilitates the organisation of the extracellular matrix, resulting in a neodermis layer over these difficult-to-heal areas. The aim of this study was to evaluate the efficacy of using BTM in the reconstruction of challenging diabetic foot wounds. Methods Eighteen patients with complex diabetic foot wounds (exposed tendon, fascia, joint, bone), or chronic ulcers at high shear stress locations had BTM applied. Indications for BTM application were high shear stress location (66.6%), exposed bone (16.6%), exposed fascia (5.6%), exposed tendon (5.6%) and chronic non-healing wound (5.6%). The time to complete healing, infection rate and incidence of subsequent wound breakdown was analysed. Discussion Thirteen of 18 patients completed the BTM treatment regime with all these patients achieving complete wound healing at a median time of 13 weeks. One patient had partial treatment with BTM and four patients were withdrawn from the study following BTM application. The rate of infection and re-ulceration were both 15.4%. Conclusion This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic diabetic foot wounds with exposed deep structures and chronic wounds subject to high shear stress. The re-ulceration and infection rates were relatively low for this high-risk population. BTM may also offer promise as an alternative to free flaps. Lay Summary The prevalence of diabetes and its complications, including foot ulcers and wounds, have significantly increased worldwide over the last 40 years. Increasingly patients are admitted to hospital for antibiotics, debridements and subsequent amputations from these wounds. Complex diabetes-associated wounds are those at highest risk of these complications or necessitating more extensive, complex operations such as free flaps. These wounds may have exposed deep structures, be at risk of high shear stress or be chronic non-healing wounds. Temporisers are a type of material which integrates into the wound and promotes in-growth of tissue, ideal for healing over these difficult to heal areas. Biodegradable Temporising Matrix (BTM) is a synthetic temporising matrix which has demonstrated positive outcomes in facilitating healing in burns and plastics wounds, but its effectiveness in diabetic foot wounds has not yet been proven. This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic complex diabetic foot wounds and potentially avoiding more complex operations.
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Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Guilherme Pena
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
| | - John Greenwood
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marcus Wagstaff
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joseph Dawson
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia.,Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Woodville South, SA, Australia
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18
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Haridass SA, Bodansky J, Santhakumar A. Adverse outcomes in people with swimming pool associated diabetic foot infection: a case series. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sabari Anand Haridass
- Huddersfield Royal Infirmary, Huddersfield, UK 2St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Ponkilainen VT, Vuorlaakso M, Kaartinen I, Kiiski J, Saarinen E, Huttunen TT, Paloneva J, Mattila VM. The Development of Lower Limb Amputations in Finland from 1997 to 2018: A Nationwide Retrospective Registry Study. Eur J Vasc Endovasc Surg 2021; 63:138-146. [PMID: 34774371 DOI: 10.1016/j.ejvs.2021.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the rates of transfemoral, transtibial foot and toe amputations, and lower limb revascularisations in Finland between 1997 and 2018. METHODS Retrospective observational cohort study. Data from the Finnish National Hospital Discharge Register for the period 1997 - 2018 were used. The study population covered all patients 20 years and older who underwent lower limb revascularisations or amputations in private and public hospitals during the study period. All (outpatient and inpatient) amputations and revascularisations were included. The age adjusted incidence rates were based on the annual mid populations, which were obtained from the Official Statistics of Finland. Continuous variables were presented as median with interquartile range (IQR) or as mean with standard deviation. The 95% confidence intervals (CI) for the incidence rates were calculated using the Poisson exact method. All changes in incidence were calculated as relative change (%). RESULTS A total of 75 230 patients underwent 149 492 lower limb revascularisations and amputations between 1997 and 2018 in Finland. The median (IQR) age of the patients was 73 (65, 80) and 60% of the patients were men. The incidence of all endovascular lower limb revascularisations increased by 159% while the incidence of lower limb amputations increased by 25%. The most notable increase occurred in toe (84%) and foot (107%) amputations, while the incidence of transfemoral amputations remained steady and transtibial amputations decreased by 53%. The first minor-major amputation ratio (CI) increased from 1.13 (1.03 - 1.24) to 1.49 (1.36 to 1.62) during the study period. CONCLUSION The findings of this nationwide cohort study suggest that the incidence of both lower limb revascularisations and amputations is increasing. More specifically, revascularisations are more often performed endovascularly, and the incidence of transtibial amputations is declining, whereas the incidence of toe and foot amputations is increasing.
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Affiliation(s)
| | - Miska Vuorlaakso
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Ilkka Kaartinen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Juha Kiiski
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Eva Saarinen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland; The Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Juha Paloneva
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland; COXA Hospital for Joint Replacement, Tampere, Finland
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20
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Akturk A, van Netten JJ, Vermeer M, Kruse RR, Schaper NC, van Gemert-Pijnen LJEWC, van Baal JG. Improved outcomes in patients with diabetic foot ulcers despite of differences in baseline characteristics. Wound Repair Regen 2021; 29:912-919. [PMID: 34665904 DOI: 10.1111/wrr.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/11/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
The incidence of diabetes is increasing worldwide with concomitant raising number of patients with diabetic foot disease. Diabetic foot disease treatment has received more attention in the past decades, culminating in the creation of multidisciplinary outpatient clinics, but at the same time, complexity of patients seems to have increased. The aim of this article is to study differences in patient characteristics and outcomes (ulcer healing and ulcer-free survival days) in patients with a diabetic foot ulcer in two prospective cohorts with 15 years in between. Prospective cohort study of all patients in one diabetic foot centre of expertise in 2003-2004 and 2014-2018. Clinical outcomes were determined after a follow-up period of 12 months. Outcomes were differences in baseline characteristics and comorbidities, and differences in ulcer-related outcomes between both cohorts. We included all consecutive diabetic foot ulcer patients from our centre for the period 2003-2004 (n = 79) and 2014-2018 (n = 271). Age (67.0 ± 14.3 vs. 71.6 ± 11.5, p = 0.003) and prevalence of end-stage renal disease (1.3% vs. 7.7%, p = 0.036) were significantly higher in the more recent population. The more recent population had higher healing rate (53.2% vs. 76.4%, p < 0.001), higher median ulcer-free survival days once an ulcer had healed [173 days (IQR 85.3-295.5) vs. 257.0 (IQR 157.0-318.0), p = 0.026], and fewer minor amputations (20.3% vs. 8.1%, p = 0.002). People with diabetic foot ulcers treated in 2014-2018 were older and more frequently diagnosed with ESRD, compared to this population in 2003-2004, while other characteristics were similar; ulcer-related outcomes were better.
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Affiliation(s)
- Afram Akturk
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands
| | - Jaap J van Netten
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands.,Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands
| | - Rombout R Kruse
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands
| | - Nicolaas C Schaper
- Division of Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, The Netherlands
| | | | - Jeff G van Baal
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands.,ZGT Academy, Ziekenhuisgroep Twente (ZGT), Almelo and Hengelo, The Netherlands.,University of Cardiff, Cardiff, UK
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21
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High-intensity Hospital Utilization Among Adults with Diabetic Foot Ulcers: A Population-Based Study. Can J Diabetes 2021; 46:330-336.e7. [DOI: 10.1016/j.jcjd.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/04/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
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22
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Moayedi M, Arshi AR, Salehi M, Akrami M, Naemi R. Associations between changes in loading pattern, deformity, and internal stresses at the foot with hammer toe during walking; a finite element approach. Comput Biol Med 2021; 135:104598. [PMID: 34346320 DOI: 10.1016/j.compbiomed.2021.104598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Over the past decade, Finite Element (FE) modelling has been used as a method to understand the internal stresses within the diabetic foot. Foot deformities such as hammer toe have been associated with increased risk of foot ulcers in diabetic patients. Hence the aim of this study is to investigate the influence of hammer toe deformity on internal stresses during walking. A 3D finite element model of the human foot was constructed based on capturing Magnetic Resonance Imaging (MRI) of a diabetic neuropathic volunteer exhibiting hammer toe. 3D gait measurements and a multi-body musculoskeletal model for the same participant were used to define muscle forces. FE simulations were run at five different instances during the stance phase of gait. Peak plantar pressure and pressure distribution results calculated from the model showed a good agreement with the experimental measurement having less than 11% errors. Maximum von Mises internal stresses in the forefoot hard tissue were observed at the 3rd and 5th metatarsals and 4th proximal phalanx. Moreover, presence of hammer toe deformity was found to shift the location of maximum internal stresses on the soft tissue to the forefoot by changing the location of centre of pressure with internal stress 1.64 times greater than plantar pressure. Hammer toe deformity also showed to reduce the involvement of the first phalanx in internal/external load-bearing during walking. The findings of this study support the association between changes in loading pattern, deformity, and internal stresses in the soft tissue that lead to foot ulceration.
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Affiliation(s)
- M Moayedi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - A R Arshi
- Biomechanics and Sports Engineering Groups, Biomedical Engineering Department, Amirkabir University of Technology, Iran.
| | - M Salehi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - M Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, UK.
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK.
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23
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Greene T, Hasenstein T, Choi ET, Meyr AJ. Level of Agreement Between Systematic Doppler Examination of the Lower Extremity and Diagnostic Angiography in the Setting of Peripheral Arterial Disease. J Am Podiatr Med Assoc 2021; 111:466696. [PMID: 34144576 DOI: 10.7547/18-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this investigation was to determine the level of agreement between a systematic clinical Doppler examination of the foot and ankle and diagnostic peripheral angiography. METHODS The described Doppler examination technique attempted to determine the patency, quality, and direction of the flow through the dorsalis pedis artery, posterior tibial artery, terminal branches of the peroneal artery, and vascular arch of the foot. These results were then compared with angiographic distal run-off images as interpreted by a blinded vascular surgeon. RESULTS Levels of agreement with respect to artery patency/quality ranged from 64.0% to 84.0%. Sensitivity ranged from 53.8% to 84.2%, and specificity ranged from 64.7% to 91.7%. Agreement with respect to arterial flow direction ranged from 73.3% to 90.5%. CONCLUSIONS We interpret these results to indicate that this comprehensive physical examination technique of the arterial flow to the foot and ankle with a Doppler device might serve as a reasonable initial surrogate to diagnostic angiography in some patients with peripheral arterial disease.
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24
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Albright RH, Fleischer AE. Association of select preventative services and hospitalization in people with diabetes. J Diabetes Complications 2021; 35:107903. [PMID: 33691987 DOI: 10.1016/j.jdiacomp.2021.107903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess the utilization rates and trends of preventative outpatient visits to providers in a population of people with diabetes, and evaluate which preventative services may offer protection against poor outcomes (i.e. all-cause hospitalization). METHODS The National Health and Nutrition Examination Survey (NHANES) was used to examine the relationship between select outpatient services and risk of all-cause hospitalization in people with diabetes. NHANES data from 2011 to 2016 were included. We assessed five outpatient services commonly recommended to prevent future complications in patients with diabetes: (1) routine examination from a physician (2) assessment of hemoglobin A1C (3) eye exam with pupil dilation (4) foot exam and (5) assessment from a diabetes specialist. Logistic regression models were performed to assess the independent association of outpatient services used in the past 1 year, and hospitalization within that same year. RESULTS The prevalence of diabetes within the NHANES population was 10.5% (n = 3054). Hospitalization was significantly more common among diabetics who were older, had lower income levels (i.e. under $20,000) and those who considered themselves in 'fair' or 'poor health'. After adjustment for important covariates, patients who received a preventative foot exam within the last year (i.e. 1-4 times per year) were 33% less likely to be hospitalized within that year (OR 0.67, 95%CI 0.46, 0.96). Those visiting a diabetes specialist were 44% less likely to be hospitalized that year (OR 0.56, 95%CI 0.39, 0.82) if the visit was preventative in nature (i.e. occurred more than one year before the hospitalized event). No other outpatient services displayed an independent association with hospitalization. CONCLUSION Outpatient Services were consistently being used annually by the diabetic population. Receiving a preventative foot exam and visiting a diabetes specialist were associated with protection against hospitalization, resulting in a 33% and 44% decreased risk, respectively. RESEARCH IN CONTEXT Evidence before this study: Current guidelines focus on preventative care measures to avert diabetes complications. In a 2018 national database study of approximately one-third of the Italian population, guidelines for prevention were not consistently being met among the diabetes population, however, patients who regularly received all the recommended preventative measures experienced a 20% risk reduction in hospitalization. The study's preventative measures included periodic lab monitoring including glycated hemoglobin and lipid profiles and dilated eye exams. Added value of this study: In our study, we used a national database representing the United States' non-institutionalized population to identify the prevalence of prevention measures being utilized in adults with diabetes and further examine their relationship with all-cause hospitalization. Logistic regression analysis identified two preventative measures with inconsistent utilization, however, when these measures were used according to guidelines, they contributed to a risk reduction in all-cause hospitalization. Implications of all the available evidence: Current preventative guidelines can contribute to a risk reduction in hospitalization among adults with diabetes. National guidelines and quality improvement initiatives should be aimed at improving the utilization of foot exams as a preventative measure and referral to a diabetes specialist before complications incur.
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Affiliation(s)
- Rachel H Albright
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, 1 Rope Ferry Rd., Hanover, NH 03755, USA.
| | - Adam E Fleischer
- Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
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25
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Mahmoodi H, Abdi K, Navarro-Flores E, Karimi Z, Sharif Nia H, Gheshlagh RG. Psychometric evaluation of the Persian version of the diabetic foot self-care questionnaire in Iranian patients with diabetes. BMC Endocr Disord 2021; 21:72. [PMID: 33865367 PMCID: PMC8052781 DOI: 10.1186/s12902-021-00734-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetic foot self-care refers to a group of self-management behaviors that can reduce the incidence of foot ulcers and amputations. It is necessary to have a valid and reliable standard tool to measure foot self-care in diabetic patients. This study aimed to evaluate the psychometric properties of the Persian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ-UMA) in Iran. METHODS This cross-sectional study was conducted with 407 diabetic patients who were selected using a convenient sampling method. Construct validity was assessed by exploratory (with 207 patients) and confirmatory (with 200 patients) factor analyses. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients. RESULTS In the exploratory factor analysis, three factors with eigenvalues of 3.84, 2.41, and 2.26 were extracted that together explained 56.74% of the total variance of diabetic foot self-care. A Cronbach's alpha of 0.865 was found for the total instrument. CONCLUSIONS The Persian version of the DFSQ-UMA has good validity and reliability, and given its good psychometric properties, it can be used in future studies.
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Affiliation(s)
- Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kamel Abdi
- Nursing Department, Faculty of Medicine, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region Iraq
| | - Emmanuel Navarro-Flores
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Málaga, Spain
| | - Zaniar Karimi
- Faculty of Nursing, Kurdistan University of Medical Sciences, Sananda, Iran
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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26
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Macauley M, Adams G, Mackenny P, Kubelka I, Scott E, Buckworth R, Biddiscombe C, Aitkins C, Lake H, Matthews V, Ashraff S, Ashwell S. Microbiological evaluation of resection margins of the infected diabetic foot ulcer. Diabet Med 2021; 38:e14440. [PMID: 33113230 DOI: 10.1111/dme.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
AIM To evaluate the impact of surgical debridement on the microbiology of resection margins of an infected diabetic foot ulcer and to compare the use of marginal sampling as a guide for antimicrobial therapy. METHODS Forty consecutive participants were studied. Tissue samples from infected diabetic foot ulcers were obtained at first contact by podiatrists. After surgical debridement to macroscopically healthy tissue, multiple samples were obtained from the margins of the residuum and also from excised non-viable tissue. Debridement was done by a single surgeon. Bacterial species were classified according to pathogenic potential a priori into Red Group-Definite pathogen causing infection, Yellow Group-Likely to be causing infection if present in more than one specimen and Green Group -Commensals, not causing infection. RESULTS There was a relative reduction of 49% (p = 0.002) in bacteria in the most pathogenic (red) group, and 59% (p = 0.002) in the yellow group in podiatry samples compared with resection specimen. Positive cultures from margins of the residuum were observed in 75% of cases. There was a relative reduction of 67% (p = 0.0001) in bacteria in the red and 48% (p = 0.06) in the yellow group in marginal samples from the residuum compared with podiatry samples. CONCLUSIONS After surgical debridement to healthy tissue, positive cultures from marginal tissue samples provided vital information on the presence of pathogenic bacteria. This allowed antibiotics to be individualised post-surgical debridement.
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Affiliation(s)
- Mavin Macauley
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - George Adams
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Paul Mackenny
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
- Orthopaedic Department Hartlepool, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Igor Kubelka
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Emma Scott
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Rebecca Buckworth
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Claire Biddiscombe
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Christopher Aitkins
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Hannah Lake
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Vicky Matthews
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Suhel Ashraff
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
| | - Simon Ashwell
- Diabetes and Endocrinology, South Tees Hospitals NHS Trust, Middlesbrough, Teesside, UK
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27
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Lo ZJ, Surendra NK, Saxena A, Car J. Clinical and economic burden of diabetic foot ulcers: A 5-year longitudinal multi-ethnic cohort study from the tropics. Int Wound J 2021; 18:375-386. [PMID: 33497545 PMCID: PMC8244009 DOI: 10.1111/iwj.13540] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcers (DFUs) present a substantial clinical and economic burden to healthcare systems around the world, with significant reductions in quality of life for those affected. We aimed to analyse the clinical and economic burden of DFU via a 5-year longitudinal multi-ethnic cohort study. A longitudinal analysis of inpatient and outpatient DFUs data over 5 years from a university tertiary hospital in Singapore was performed. Data included baseline characteristics, clinical outcomes, hospitalisation, and outpatient details. Descriptive statistics, Kaplan-Meier survival analyses, and Cox proportional hazard models were performed. Patients treated for DFUs (n = 1729, mean patient age of 63·4 years) were assessed. The cohort consists of Chinese (61.4%), Malay (13.5%), and Indian (18.4%) patients. Common comorbidities included peripheral arterial disease (74.8%), peripheral neuropathy (14.5%), and a median haemoglobin A1c of 9.9%. Patients underwent toe(s) amputation (36.4%), transmetatarsal amputations (16.9%), or major amputations (6·5%). The mean length of inpatient stay for ulcer-only, minor amputation, and major amputation was 13.3, 20.5, and 59.6 days, respectively. Mean cost per patient-year was US $3368 (ulcer-only), US $10468 (minor amputation), and US $30131 (major amputation). Minor amputation-free survival was 80.9% at 1 year and 56.9% at 5 years, while major amputation-free survival was 97.4% at 1 year and 91.0% at 5 years. In conclusion, within our multi-ethnic cohort of patients from the tropics, there was significant clinical and economic burden of DFUs, with a high wound per patient ratio and escalating healthcare costs corresponding to more proximal amputation levels.
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Affiliation(s)
- Zhiwen Joseph Lo
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Akshar Saxena
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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28
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Shah H, Shah R, Sanghani H, Lakhani N. Health related quality of life (HRQoL) and its associated surgical factors in diabetes foot ulcer patients. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.2/83.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim. To evaluate the health-related quality of life (HRQOL) in DFU patients and its association with different surgical parameters in a tertiary care teaching hospital. Methodology. A total of 70 DFU patients from surgery department were enrolled and their demographic details, surgical examination and treatment related parameter were recorded. HRQOL was evaluated using Cardiff Wound Impact Questionnaire. Association of different surgical parameters as predictors of HRQOL was statistically evaluated. Results. Mean age of the study patients was 53.92 ± 9.27 with male preponderance and male: female ratio of 1.5:1. All the patients in the study suffered from type 2 diabetes and mean duration of the diabetes was 8.0±1.4 year. Mean BMI of the study patients was 23.36 ±1.4. All patients of DFU showed deteriorated HRQOL with mean score of 42.2±15.13 in social domain, 17.12±7.43 in wellbeing, 75.33±27.06 in physical domain and total score of 146.56±45.46. Increasing age, female gender, increased BMI, alcohol addiction found to be significantly associated with the deteriorated quality of life with respect to all four major domains which include Social life (P<0.001), wellbeing (P<0.07), physical symptoms (P<0.001) and Overall Quality of life (P<0.001). Surgical parameters like treatment for ulcer, regular follow up, larger size of ulcer, more than one ulcer, and ulcer on planter surface and chronic and recurrent ulcer significantly affect social domain, wellbeing and physical symptoms and total score (p<0.05). Control of blood sugar levels with non-pharmacological measures, OHA or insulin significantly improve Qol (p<0.05). Conclusions. Surgical parameters like site, size, number and duration of ulcer, treatment and blood sugar control significantly affect Qol. Multidisciplinary approach with holistic view is required for management of DFU patients for better quality of life.
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29
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Alshammary S, Othman SA, Alshammari E, Alarfaj MA, Lardhi HA, Amer NM, Elsaid AS, Alghamdi HM. Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study. Ann Saudi Med 2020; 40:425-435. [PMID: 33007171 PMCID: PMC7532050 DOI: 10.5144/0256-4947.2020.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are a critical complication of diabetes mellitus (DM) affecting life quality and significantly impacting healthcare resources. OBJECTIVE Determine the direct medical costs associated with treating DFU in King Fahad Hospital of the University and identify factors that could assist in developing resource management guidelines in Saudi Arabia. DESIGN Retrospective study. SETTING SETTING: King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. PATIENTS AND METHODS The study included diabetic patients admitted with foot ulcerations between 2007 and 2017 inclusive. We determined management costs including drug usage, wound dressings, surgical procedures, admissions, and basic investigation. MAIN OUTCOME MEASURES Factors affecting the direct perspective medical costs of managing DFU. SAMPLE SIZE 99 patients. RESULTS The overall cost of managing 99 patients with DFU was 6 618 043.3 SAR ($1 764 632.68 USD), which further translates to approximately 6684.9 SAR per patient/year ($1782.6 USD). The highest cost incurred was for admission expenditure (45.6%), followed by debridement (14.5%) and intensive care unit (ICU) admission (10.4%). CONCLUSION The overall healthcare expenditure in treating DFU is high, with hospital admissions and surgical procedures adding a significant increase to the total cost. Focused patient education on overall glycemic control and prevention of DFU may decrease complications and hence, the overall cost. LIMITATIONS Identified only the direct medical costs of DFU as the indirect costs were subjective and more difficult to quantify. CONFLICT OF INTEREST None.
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Affiliation(s)
- Shadi Alshammary
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sharifah A Othman
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Eiman Alshammari
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mosab A Alarfaj
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haitham Amer Lardhi
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nasser Mohamed Amer
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayman S Elsaid
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hanan M Alghamdi
- From Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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30
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An orthopaedist’s review of diabetic foot wounds and osteomyelitis. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing Osteomyelitis: A Histology Guide for Pathologists. J Foot Ankle Surg 2020; 59:75-85. [PMID: 31753572 DOI: 10.1053/j.jfas.2019.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 06/22/2019] [Indexed: 02/03/2023]
Abstract
Histopathologic examination of bone specimens coupled with bone culture is considered the gold standard for the diagnosis of osteomyelitis (OM). Despite this, studies have demonstrated interpathologist agreement in the diagnosis of OM as low as 30%, largely stemming from a lack of specific definitions and diagnostic criteria. Review of the literature has provided insight into the lifecycle of OM, illustrating the histologic progression of OM phases from acute to chronic, and provides support for defining subcategories of OM. Using an algorithmic histopathologic tool consisting of 15 criteria, each with an associated score, we defined 5 categories of OM: (1) acute OM, (2) acute and chronic OM, (3) chronic OM, (4) chronic active OM, and (5) chronic inactive OM. We reviewed 462 microscopic slides from 263 patients with suspected OM, and for each slide, we determined an algorithm-derived diagnosis, which was then used to calculate a total histopathologic load score (Jupiter score). Algorithm-derived diagnoses recapitulated original clinical diagnoses and diagnosed cases as OM that had not been originally diagnoses. These novel cases were more likely to have subsequent clinical complications. Finally, pathologic load scores were assessed for association with the category of OM.
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Affiliation(s)
- Amelia B Sybenga
- Clinical Fellow, Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community Health, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX
| | - V O Speights
- Professor, Department of Pathology and Laboratory Medicine, Scott & White Medical Center, Baylor Scott and White Health, Texas A&M Health Science Center, Temple, TX
| | - Arundhati Rao
- Professor, Department of Pathology and Laboratory Medicine, Scott & White Medical Center, Baylor Scott and White Health, Texas A&M Health Science Center, Temple, TX
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32
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Kalbaugh CA, Strassle PD, Paul NJ, McGinigle KL, Kibbe MR, Marston WA. Trends in Surgical Indications for Major Lower Limb Amputation in the USA from 2000 to 2016. Eur J Vasc Endovasc Surg 2020; 60:88-96. [DOI: 10.1016/j.ejvs.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 01/03/2023]
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33
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Lo ZJ, Lim X, Eng D, Car J, Hong Q, Yong E, Zhang L, Chandrasekar S, Tan GWL, Chan YM, Sim SC, Oei CW, Zhang X, Dharmawan A, Ng YZ, Harding K, Upton Z, Yap CW, Heng BH. Clinical and economic burden of wound care in the tropics: a 5-year institutional population health review. Int Wound J 2020; 17:790-803. [PMID: 32149471 PMCID: PMC7948834 DOI: 10.1111/iwj.13333] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this study is to evaluate the clinical and economic burden of wound care in the Tropics via a 5-year institutional population health review. Within our data analysis, wounds are broadly classified into neuro-ischaemic ulcers (NIUs), venous leg ulcers (VLUs), pressure injuries (PIs), and surgical site infections (SSIs). Between 2013 and 2017, there were a total of 56 583 wound-related inpatient admissions for 41 461 patients, with a 95.1% increase in wound episodes per 1000 inpatient admissions over this period (142 and 277 wound episodes per 1000 inpatient admissions in 2013 and 2017, respectively). In 2017, the average length of stay for each wound episode was 17.7 days, which was 2.4 times that of an average acute admission at our institution. The average gross charge per wound episode was USD $12 967. Among the 12 218 patients with 16 674 wound episodes in 2017, 71.5% were more than 65 years of age with an average Charlson Comorbidity Index (CCI) of 7.2. Half (51.9%) were moderately or severely frail, while 41.3% had two or more wound-related admission episodes. In 2017, within our healthcare cluster, the gross healthcare costs for all inpatient wound episodes stand at USD $216 million within hospital care and USD $596 000 within primary care. Most NIU patients (97.2%) had diabetes and they had the most comorbidities (average CCI 8.4) and were the frailest group of patients (44.9% severely frail). The majority of the VLU disease burden was at the specialist outpatient setting, with the average 1-year VLU recurrence rate at 52.5% and median time between healing and recurrence at 9.5 months. PI patients were the oldest (86.5% more than 65 years-old), constituted the largest cohort of patients with 3874 patients at an incidence of 64.6 per 1000 admissions in 2017, and have a 1-year all-cause mortality rate of 14.3%. For SSI patients, there was a 125% increase of 14.2 SSI wound episodes per 1000 inpatient admissions in 2013 to 32.0 in 2017, and a 413% increase in wound-related 30-day re-admissions, from 40 in 2013 (4.1% of all surgeries) to 205 (8.3% of all surgeries) in 2017. The estimated gross healthcare cost per patient ranges from USD $15789-17 761 across the wound categories. Similar to global data, there is a significant and rising trend in the clinical and economic burden of wound care in Tropics.
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Affiliation(s)
- Zhiwen J. Lo
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Xuxin Lim
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Diane Eng
- Nursing ServiceTan Tock Seng HospitalSingapore
| | - Josip Car
- Centre for Population Health SciencesNanyang Technological University Lee Kong Chian School of MedicineSingapore
| | - Qiantai Hong
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Enming Yong
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Li Zhang
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Sadhana Chandrasekar
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Glenn W. L. Tan
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Yam M. Chan
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Seow C. Sim
- Vascular Surgery ServiceDepartment of General Surgery, Tan Tock Seng HospitalSingapore
| | - Chien W. Oei
- Office of Clinical EpidemiologyAnalytics and Knowledge, Tan Tock Seng HospitalSingapore
| | - Xiaojin Zhang
- Office of Clinical EpidemiologyAnalytics and Knowledge, Tan Tock Seng HospitalSingapore
| | - Ayliana Dharmawan
- Office of Clinical EpidemiologyAnalytics and Knowledge, Tan Tock Seng HospitalSingapore
| | - Yi Z. Ng
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)Singapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)Singapore
| | - Zee Upton
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)Singapore
| | - Chun W. Yap
- Health Services and Outcomes ResearchNational Health GroupSingapore
| | - Bee H. Heng
- Health Services and Outcomes ResearchNational Health GroupSingapore
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Foong HF, Kyaw BM, Upton Z, Tudor Car L. Facilitators and barriers of using digital technology for the management of diabetic foot ulcers: A qualitative systematic review. Int Wound J 2020; 17:1266-1281. [PMID: 32390305 PMCID: PMC7948580 DOI: 10.1111/iwj.13396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023] Open
Abstract
The use of digital technology has been shown to be effective in managing chronic conditions. Telemedicine and mobile application are two common applications of digital technology in managing diabetic foot ulcers (DFU). The facilitators and barriers of using it for DFU management are yet to be explored. This is a qualitative systematic review. Five bibliography databases and grey literature sources were searched (2000‐2019). Two reviewers independently screened the citations, extracted the data, assessed the quality of the included studies, and performed thematic synthesis. Three studies on patients and five studies on healthcare practitioners (HCPs) were included. Two studies focused on the use of mobile applications and six on telemedicine. In studies on patients, four analytical themes were generated: the relationships with HCPs; the attitude towards the usage of digital technology; the role of wound image taking; and impact of digital technology on DFU care, encompassing 15 facilitators (eg, enabling community support, improving wound care knowledge) and 12 barriers (eg, lack of technological savviness, difficulty reading on smartphones). Three analytical themes were generated from studies on HCPs: the impact of digital technology on HCPs; the role of digital technology in DFU care; and organisation of DFU care delivery, encompassing 17 facilitators (eg, adequate wound care training, digital technology enables holistic care) and 16 barriers (eg, lack of multidisciplinary approach in caring for DFU, lack of direct contact in care provision). Patients and HCPs reported various barriers and facilitators relating to different aspects of using digital technology in DFU management. Our findings can help inform future research as well as the adoption of digital technology in DFU management.
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Affiliation(s)
- Hui Foh Foong
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Zee Upton
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Syed MH, Salata K, Hussain MA, Zamzam A, de Mestral C, Wheatcroft M, Harlock J, Awartani D, Aljabri B, Verma A, Razak F, Verma S, Al-Omran M. The economic burden of inpatient diabetic foot ulcers in Toronto, Canada. Vascular 2020; 28:520-529. [PMID: 32379584 DOI: 10.1177/1708538120923420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. METHODS We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. RESULTS Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14-1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17-1.34). Propensity-scored matched analyses confirmed these results. CONCLUSION Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
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Affiliation(s)
- Muzammil H Syed
- Faculty of Science, McMaster University, Hamilton, Canada.,Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada
| | - Konrad Salata
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Charles de Mestral
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada, Toronto, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - John Harlock
- Department of Surgery, Hamilton General Hospital, Hamilton, Canada.,Division of Vascular Surgery, Hamilton General Hospital, Hamilton, Canada
| | - Deana Awartani
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amol Verma
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Fahad Razak
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Subodh Verma
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada, Toronto, Canada.,Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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The Treatment of Impaired Wound Healing in Diabetes: Looking among Old Drugs. Pharmaceuticals (Basel) 2020; 13:ph13040060. [PMID: 32244718 PMCID: PMC7243111 DOI: 10.3390/ph13040060] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic wounds often occur in patients with diabetes mellitus due to the impairment of wound healing. This has negative consequences for both the patient and the medical system and considering the growing prevalence of diabetes, it will be a significant medical, social, and economic burden in the near future. Hence, the need for therapeutic alternatives to the current available treatments that, although various, do not guarantee a rapid and definite reparative process, appears necessary. We here analyzed current treatments for wound healing, but mainly focused the attention on few classes of drugs that are already in the market with different indications, but that have shown in preclinical and few clinical trials the potentiality to be used in the treatment of impaired wound healing. In particular, repurposing of the antiglycemic agents dipeptidylpeptidase 4 (DPP4) inhibitors and metformin, but also, statins and phenyotin have been analyzed. All show encouraging results in the treatment of chronic wounds, but additional, well designed studies are needed to allow these drugs access to the clinics in the therapy of impaired wound healing.
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37
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Effects of walking speeds and durations on plantar skin blood flow responses. Microvasc Res 2020; 128:103936. [DOI: 10.1016/j.mvr.2019.103936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022]
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Dissanayake A, Vandal AC, Boyle V, Park D, Milne B, Grech R, Ng A. Does intensive glycaemic control promote healing in diabetic foot ulcers? - a feasibility study. BMJ Open 2020; 10:e029009. [PMID: 31964660 PMCID: PMC7044945 DOI: 10.1136/bmjopen-2019-029009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION One in four diabetes patients will develop a foot ulcer over their lifetime. The role of glycaemic control in the healing of foot ulcers in diabetes patients is not supported by randomised controlled trial (RCT) data. OBJECTIVES To determine the feasibility of an RCT of glycaemic control with intensive insulin therapy in diabetic foot ulcer, by assessing: entry criteria, fasting capillary blood glucose (FCBG) medication satisfaction and sensitivity of different ulcer-healing endpoints to glycaemic control. DESIGN Two substudies: one cross-sectional and one single-arm prospective. SETTING Single-centre secondary care diabetic foot clinic in New Zealand. PARTICIPANTS Substudy 1: 78 participants consisting of all people ≥18 years with a diabetic foot ulcer presenting to the clinic over 35 weeks in 2015.Substudy 2: 15 participants from Substudy 1 consenting to intensive insulin therapy. INTERVENTION Substudy 1: None.Substudy 2: Intensive insulin therapy with standard podiatry care over 24 weeks. OUTCOME Substudy 1: Proportion of participants satisfying potential RCT entry criteria; medication satisfaction (Diabetes Medication Satisfaction).Substudy 2: FCBG, index ulcer healing time, index ulcer size, health-related quality of life (HRQoL; EuroQol 5 Dimensions 5 Levels and Diabetic Foot Ulcer Scale-Short Form). RESULTS Proportion in Substudy 1 satisfying all entry criteria was 31% (95% CI 21 to 42). FCBG values decreased between baseline and study end (difference -3.7 mmol/L, 95% CI -6.5 to -0.8); 83% (95% CI 44 to 95) of ulcers healed by 24 weeks. FCBG correlated negatively with medication satisfaction. Ulcer area logarithm was most sensitive to FCBG changes, displaying significant negative correlation with HRQoL outcomes. Detecting a 30% between-group difference in this outcome (80% power, α=5%) requires 220 participants per arm, achievable within 1 year with 15 centres similar to study setting. CONCLUSIONS An adequately powered RCT requires cooperation between a large number of centres. Ulcer area logarithm should be primary endpoint. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617001414303.
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Affiliation(s)
- Ajith Dissanayake
- Endocrinology and Diabetes, Counties Manukau District Health Board, Auckland, New Zealand
| | - Alain C Vandal
- Department of Statistics, University of Auckland, Auckland, New Zealand
- Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | - Veronica Boyle
- Endocrinology and Diabetes, Counties Manukau District Health Board, Auckland, New Zealand
| | - Diane Park
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie Milne
- Middlemore Clinical Trials, Auckland, New Zealand
| | - Roger Grech
- Podiatry, Counties Manukau Health, Auckland, New Zealand
| | - Anthony Ng
- Podiatry, Counties Manukau Health, Auckland, New Zealand
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Blanchette V, Belosinschi D, Lai TT, Cloutier L, Barnabé S. New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1304016. [PMID: 31998775 PMCID: PMC6973200 DOI: 10.1155/2020/1304016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/25/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
AIM To evaluate in vitro the antibacterial effect of a paper made of silver phosphate cellulose fibers (SPCF) on Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products. METHODS The antibacterial activity of SPCF samples was evaluated through time with cell counting on agar plates. SPCF samples were then compared with commercial wound care products currently in use in DFU treatments (Silvercel™, Acticoat 7, and Aquacel Ag ExtraTM) through time on agar plates (growth inhibition zones). RESULTS After 6 hours, there was no viable bacterial cell detected on either plate (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (. CONCLUSIONS These results have shown the efficiency of SPCF paper to eliminate Staphylococcus aureus in these conditions. SPCF papers are effective when compared with other common commercial products and could have an industrial potential in wound care. Infected DFU could benefit from the antibacterial effectiveness of SPCF, but more relevant experimentations related to foot ulcers are needed.Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products.
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Affiliation(s)
- Virginie Blanchette
- Université du Québec à Trois-Rivières, Podiatric Medicine Program, 3351, Boul. des Forges, C.P.500, Trois-Rivières, Québec G8Z 4M3, Canada
| | - Dan Belosinschi
- Innofibre, Cégep de Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5E6, Canada
| | - Thanh Tung Lai
- Université du Québec à Trois-Rivières, Lignocellulosic Material Research Center, 3351, Boul. des Forges, C.P.500, Trois-Rivières, Québec G8Z 4M3, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Nursing Department, 3351, Boul. des Forges, C.P.500, Trois-Rivières, Québec G8Z 4M3, Canada
| | - Simon Barnabé
- Université du Québec à Trois-Rivières, Lignocellulosic Material Research Center, 3351, Boul. des Forges, C.P.500, Trois-Rivières, Québec G8Z 4M3, Canada
- Université du Québec à Trois-Rivières, Department of Biochemistry, Chemistry and Physics, 3351, Boul. des Forges, C.P.500, Trois-Rivières, Québec G8Z 4M3, Canada
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Zhou G, Han X, Wu Z, Shi Q, Bao X. Rosiglitazone accelerates wound healing by improving endothelial precursor cell function and angiogenesis in db/db mice. PeerJ 2019; 7:e7815. [PMID: 31637120 PMCID: PMC6800979 DOI: 10.7717/peerj.7815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/02/2019] [Indexed: 01/18/2023] Open
Abstract
Background & Aims Endothelial precursor cell (EPC) dysfunction is one of the risk factors for diabetes mellitus (DM) which results in delayed wound healing. Rosiglitazone (RSG) is a frequently prescribed oral glucose-lowering drug. Previous studies have shown the positive effects of RSG on ameliorating EPC dysfunction in diabetic patients. Interestingly, knowledge about RSG with regard to the wound healing process caused by DM is scarce. Therefore, in this study, we investigated the possible actions of RSG on wound healing and the related mechanisms involved in db/db diabetic mice. Methods Db/db mice with spontaneous glucose metabolic disorder were used as a type 2 DM model. RSG (20 mg/kg/d, i.g.,) was administered for 4 weeks before wound creation and bone marrow derived EPC (BM-EPC) isolation. Wound closure was assessed by wound area and CD31 staining. Tubule formation and migration assays were used to judge the function of the BM-EPCs. The level of vascular endothelial growth factor (VEGF), stromal cell derived factor-1α (SDF-1α) and insulin signaling was determined by ELISA. Cell viability of the BM-EPCs was measured by CCK-8 assay. Results RSG significantly accelerated wound healing and improved angiogenesis in db/db mice. Bioactivities of tube formation and migration were decreased in db/db mice but were elevated by RSG. Level of both VEGF and SDF-1α was increased by RSG in the BM-EPCs of db/db mice. Insulin signaling was elevated by RSG reflected in the phosphorylated-to-total AKT in the BM-EPCs. In vitro, RSG improved impaired cell viability and tube formation of BM-EPCs induced by high glucose, but this was prevented by the VEGF inhibitor avastin. Conclusion Our data demonstrates that RSG has benefits for wound healing and angiogenesis in diabetic mice, and was partially associated with improvement of EPC function through activation of VEGF and stimulation of SDF-1α in db/db mice.
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Affiliation(s)
- Guoliang Zhou
- Department of Pharmacy, School of Life and Health Sciences, Anhui Science and Technology University, Fengyang, Anhui, China
| | - Xue Han
- Laboratory Animal Center, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Zhiheng Wu
- School of Clinical Medicine, Wannan Medicial Colledge, Wuhu, Anhui, China
| | - Qiaojuan Shi
- Laboratory Animal Center, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Xiaogang Bao
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Bellazreg F, Guigua A, Ferjani A, Hattab Z, Boukadida J, Ach K, Letaief R, Hachfi W, Letaief A. Correlation between superficial and intra-operative specimens in diabetic foot infections: results of a cross-sectional Tunisian study. Afr Health Sci 2019; 19:2505-2514. [PMID: 32127823 PMCID: PMC7040269 DOI: 10.4314/ahs.v19i3.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the correlation between superficial, and intra-operative specimens in diabetic foot infections (DFIs). Methods We conducted a cross-sectional study in patients with DFIs hospitalized in a Tunisian teaching hospital. Superficial specimens were collected for all patients, and intra-operative specimens were collected in operated patients. The specimens were processed using standard microbiology techniques. Antimicrobial susceptibility testing was carried out according to the protocol established by the European Committee on Anti-microbial Susceptibility Testing. Intra-operative and superficial specimens were considered correlated if they isolated the same microorganism(s), or if they were both negative. Results One hundred twelve patients, 81 males and 31 females, mean age 56 years, were included. Superficial samples were positive in 77% of cases, and isolated 126 microorganisms. Among the positive samples, 71% were monomicrobial. The most frequently isolated microorganisms were Enterobacteriaceae (53%), followed by streptococci (21%) and Staphylococcus aureus (17%). Nine microorganisms (7%) were multi-drug resistant. Intra-operative samples were positive in 93% of cases. Superficial specimens were correlated to intra-operative specimens in 67% of cases. Initial antibiotic therapy was appropriate in 70% of cases. The lower-extremity amputation and the mortality rates were 41% and 1%, respectively. Conclusion In our study, DFIs were most frequently caused by Enterobacteriaceae and superficial specimens were correlated to intra-operative specimens in only two thirds of cases. Clinicians should emphasize on the systematic practice of intraoperative specimens in all patients with DFIs treated surgically, while well-performed superficial specimens could be useful for prescribing appropriate antibiotic therapy in other patients.
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Affiliation(s)
- Foued Bellazreg
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Ahmed Guigua
- Department of Internal Medicine, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Asma Ferjani
- Department of Microbiology, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Zouhour Hattab
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Jalel Boukadida
- Department of Microbiology, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Koussay Ach
- Department of Endocrinolgy, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Rached Letaief
- Department of General Surgery, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Wissem Hachfi
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Diseases, Farhat Hached hospital, 4000 Sousse, Tunisia
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Mairghani M, Jassim G, Elmusharaf K, Patton D, Eltahir O, Moore Z, Sorensen J. Methodological approaches for assessing the cost of diabetic foot ulcers: a systematic literature review. J Wound Care 2019; 28:261-266. [DOI: 10.12968/jowc.2019.28.5.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To evaluate the methodological approaches used to assess the cost consequences of diabetic foot ulcers (DFUs) in published scientific papers. Method: A systematic literature search was conducted in PubMed, Embase, Scopus, Web of Science and CINAHL. English language papers reporting on the cost of DFUs were identified. Additionally, bibliographies were inspected to identify other relevant cost studies. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective and data collection approach in each of the included studies. Results: Relatively few studies of the cost consequences of DFUs were found (n=27). Most studies were conducted in Western countries with only five studies from countries in Asia and Africa. The identified studies used different study designs, epidemiological approaches, data collection strategies, and data sources, which in turn made a systematic comparison of cost estimates difficult. Detailed descriptions of the applied costing method and other methodological aspects were often limited or absent. Many studies only reported costs from a health-care payer's perspective and disregarded the costs to patients, their families and wider society. Conclusion: The costs of DFUs have been assessed using a wide range of different methodological approaches often restricted to the healthcare payer's perspective. Therefore, the cost analyses may fail to consider the true societal costs of DFUs.
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Affiliation(s)
| | - Ghufran Jassim
- Senior Lecturer, Royal College of Surgeons in Ireland, Bahrain
| | - Khalifa Elmusharaf
- Senior Lecturer, Graduate Entry Medical School, University of Limerick, Limerick
| | - Declan Patton
- Director of Research, Senior Lecturer, Royal College of Surgeons in Ireland, Dublin
| | - Omer Eltahir
- Registrar, MCh Scholar, Royal College of Surgeons in Ireland, Dublin
| | - Zena Moore
- Professor of Nursing, Head of Department, Royal College of Surgeons in Ireland, Dublin
| | - Jan Sorensen
- Director of Healthcare Outcomes Research Centre, Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin
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Tan S, Horobin H, Tunprasert T. The lived experience of people with diabetes using off-the-shelf prescription footwear in Singapore: a qualitative study using interpretative phenomenological analysis. J Foot Ankle Res 2019; 12:19. [PMID: 30949242 PMCID: PMC6429698 DOI: 10.1186/s13047-019-0329-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetic foot ulceration (DFUs) is increasingly prevalent in Singapore. Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. Footwear prescription has been a part of clinical guidelines to manage DFUs. However, adherence to prescription footwear is typically poor amongst patients. Reasons for this have been explored in Northern American and Western European studies, but not in Singapore's context. As cultural and climate differences limit transferability of findings from existing studies to individuals in Singapore, this study aims to explore the lived experiences of participants with diabetes using prescription footwear in Singapore. METHODS This was a qualitative study using interpretative phenomenological analysis (IPA) to understand some people's personal experience of using off the shelf prescription footwear. A total of 8 people with diabetes who received prescription footwear as part of their diabetic foot management were recruited. All participants provided written consent and took part in a semi-structured interview lasting up to an hour. Interviews were digitally recorded, transcribed and analysed using an IPA approach. FINDINGS AND DISCUSSION The analysis identified the super-ordinate themes of 1) security and 2) acceptance with sub-themes of 1.1) risk and 1.2) protection and 2.1) personal and social acceptance and 2.2) social and cultural acceptance respectively that inter-related to influence how participants' made footwear decisions. This process of evaluation was portrayed to be a fluctuant one, making it difficult to predict yet necessary to understand. A modified seesaw model of adherence is suggested to explain this decision-making process. CONCLUSIONS The complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice. Furthermore, prescription footwear should be seen more holistically. Empowering patients with choice to select from a range of therapeutic yet normalised footwear could increase the level of security and acceptance they experience with its use.
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Affiliation(s)
- Sheena Tan
- Podiatry Department, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Hazel Horobin
- University of Brighton, School of Health Professions, 49 Darley Road, Eastbourne, BN20 7UR UK
| | - Thanaporn Tunprasert
- University of Brighton, School of Health Professions, 49 Darley Road, Eastbourne, BN20 7UR UK
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Sarmiento S, Pierre JA, Dellon AL, Frick KD. Tibial nerve decompression for the prevention of the diabetic foot: a cost-utility analysis using Markov model simulations. BMJ Open 2019; 9:e024816. [PMID: 30878982 PMCID: PMC6429851 DOI: 10.1136/bmjopen-2018-024816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine whether tibial neurolysis performed as a surgical intervention for patients with diabetic neuropathy and superimposed tibial nerve compression in the prevention of the diabetic foot is cost-effective when compared with the current prevention programme. DESIGN A baseline analysis was built on a 5-year model to determine the cumulative incidence of foot ulcers and amputations with each strategy. Subsequently, a cost-effectiveness analysis and cohort-level Markov simulations were conducted with a model composed of 20 6-month cycles. A sensitivity analysis was also performed. SETTING A Markov model was used to simulate the effects of standard prevention compared with tibial neurolysis on the long-term costs associated with foot ulcers and amputations. This model included eight health states. PARTICIPANTS Each cohort includes simulated patients with diabetic neuropathy at different levels of risk of developing foot ulcers and amputations. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the long-term trends concerning the development of ulcers and amputations with each strategy. The secondary outcome measures were quality adjusted life years (QALYs), incremental cost-effectiveness and net monetary benefits of the optimal strategy. RESULTS When compared with standard prevention, for a patient population of 10 000, surgery prevented a simulated total of 1447 ulcers and 409 amputations over a period of 5 years. In a subsequent analysis that consisted of 20 6-month cycles (10 years), the incremental cost of tibial neurolysis compared with current prevention was $12 772.28; the incremental effectiveness was 0.41 QALYs and the incremental cost-effectiveness ratio was $31 330.78. Survival was 73% for those receiving medical prevention compared with 95% for those undergoing surgery. CONCLUSION These results suggest that among patients with diabetic neuropathy and superimposed nerve compression, surgery is more effective at preventing serious comorbidities and is associated with a higher survival over time. It also generated greater long-term economic benefits.
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Affiliation(s)
- Samuel Sarmiento
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James A Pierre
- Department of Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin D Frick
- Johns Hopkins University Carey Business School, Baltimore, Maryland, USA
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Blanchette V, Hains S, Cloutier L. Establishing a multidisciplinary partnership integrating podiatric care into the Quebec public health-care system to improve diabetic foot outcomes: A retrospective cohort. Foot (Edinb) 2019; 38:54-60. [PMID: 30639800 DOI: 10.1016/j.foot.2018.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 02/04/2023]
Abstract
Diabetic foot ulcers (DFUs) are one of the main complications of diabetes affecting many Canadians that need to be effectively managed. There is limited data concerning outcomes of Canadian patients with DFUs treated with a team approach in the public health system. Podiatrists are known to be key members of a multidisciplinary team approach to DFUs management, but in Quebec, Canada, they are only available in private practice. The aim of this study is to evaluate diabetic foot outcomes after integrating podiatric care into in-hospital wound care clinic settings. A 12-month retrospective cohort study was conducted into a new organization named the Pododiabetology University Center (PUC), which is described in this article. Healing rate and healing time were the outcomes measured. The analysis was performed by comparing data collected before and after the integration of the podiatrists. Preliminary results indicate that 73.2% of DFUs (n=52) healed in an average of 19.8 weeks (time to wound closure). Previous data collected on 15 individuals before the integration of podiatric care showed a 27.3% of DFUs resolved in 44.6 weeks. The findings suggest that a patient with DFUs who receives wound care from a multidisciplinary team that includes a podiatrist can improve both their healing rate and time. An integrated multidisciplinary approach including podiatrists for patients affected by acute DFU is highly suggested in the literature in order to reduce the number of hospitalizations, amputations and financial burden, which are variables that could be evaluated in further studies.
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Affiliation(s)
- Virginie Blanchette
- Université du Québec à Trois-Rivières, Podiatric Medicine Program, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Sébastien Hains
- Université du Québec à Trois-Rivières, Podiatric Medicine Program, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Nursing Department, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
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Alrub AA, Hyassat D, Khader YS, Bani-Mustafa R, Younes N, Ajlouni K. Factors Associated with Health-Related Quality of Life among Jordanian Patients with Diabetic Foot Ulcer. J Diabetes Res 2019; 2019:4706720. [PMID: 30800685 PMCID: PMC6360050 DOI: 10.1155/2019/4706720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study is aimed at determining factors associated with the quality of life among Jordanian diabetic patients with foot ulcers. METHODS 144 consecutive patients with diabetic foot ulcers aged ≥ 18 years who were attending the diabetic foot clinic at a diabetes-specialized center were included in this study. Health-related quality of life was assessed using two self-administered questionnaires: Diabetic Foot Scale-Short Form (DFS-SF) and Short Form-8 (SF-8). RESULTS Patients with diabetic foot ulcer had low mean DFS-SF score and low mean scores on physical and mental component summary scales (PCS8 and MCS8). Males had significantly higher DFS-SF score indicating better health-related quality of life than females (P value 0.038). A patient with stressful life events had significantly lower health-related quality of life using DFS-SF scale and SF-8 summary scales. Patients with peripheral vascular disease (PVD) and patients with obesity had lower DFS-SF and PCS8 quality of life. CONCLUSION Patients with diabetic foot ulcer had low quality of life. Female gender, obesity, presence of PVD, and stressful life events were the most important factors associated with lower quality of life in patients with diabetic foot ulcer.
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Affiliation(s)
- Ahmad Abu Alrub
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
| | - Dana Hyassat
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
| | | | | | - Nidal Younes
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
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Thattaruparambil Raveendran N, Mohandas A, Ramachandran Menon R, Somasekharan Menon A, Biswas R, Jayakumar R. Ciprofloxacin- and Fluconazole-Containing Fibrin-Nanoparticle-Incorporated Chitosan Bandages for the Treatment of Polymicrobial Wound Infections. ACS APPLIED BIO MATERIALS 2018; 2:243-254. [DOI: 10.1021/acsabm.8b00585] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Use of Cerium Oxide Nanoparticles Conjugated with MicroRNA-146a to Correct the Diabetic Wound Healing Impairment. J Am Coll Surg 2018; 228:107-115. [PMID: 30359833 DOI: 10.1016/j.jamcollsurg.2018.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/23/2018] [Accepted: 09/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diabetic wounds have become one of the most challenging public health issues of the 21st century, yet there is no effective treatment available. We have previously shown that the diabetic wound healing impairment is associated with increased inflammation and decreased expression of the regulatory microRNA miR-146a. We have conjugated miR-146a to cerium oxide nanoparticles (CNP-miR146a) to target reactive oxygen species (ROS) and inflammation. This study aimed to evaluate the consequences of CNP-miR146a treatment of diabetic wounds. STUDY DESIGN Eight-millimeter wounds were created on the dorsal skin of Db/Db mice and treated with PBS or differing concentrations of CNP-mir146a (1; 10; 100; or 1,000 ng) at the time of wounding. Rate of wound closure was measured until the wounds were fully healed. At 4 weeks post-healing, a dumbbell-shaped skin sample was collected, with the healed wound in the center, and an Instron 5942 testing unit was used to measure the maximum load and modulus. RESULTS Our data showed that diabetic wounds treated with PBS or 1 ng CNP-miR146a took 18 days to heal. Treatment with 10, 100, or 1,000 ng of CNP+miR-146a effectively enhanced healing, and wounds were fully closed at day 14 post-wounding. The healed skin from the CNP-miR146a-treated group showed a trend of improved biomechanical properties (increased maximum load and modulus), however it did not reach significance. CONCLUSIONS We found that a 100-ng dose of CNP-miR146a improved diabetic wound healing and did not impair the biomechanical properties of the skin post-healing. This nanotechnology-based therapy is promising, and future studies are warranted to transfer this therapy to clinical application.
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López-Goerne T, Ramírez P, Alvarez D, Rodríguez-Reinoso F, Silvestre-Albero AM, Gómez E, Rodríguez-Castellon E. Physicochemical properties and in vivo evaluation of Pt/TiO 2-SiO 2 nanopowders. Nanomedicine (Lond) 2018; 13:2171-2185. [PMID: 30277422 DOI: 10.2217/nnm-2018-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM Sol-gel is a suitable and advantageous method to synthesize mixed oxide nanomaterials with unique physicochemical and biological properties. MATERIALS & METHODS In this work, TiO2-SiO2 nanopowders cogeled with platinum acetylacetonate were developed and studied in the perspective of nanomedicine. The physicochemical properties of the Pt/TiO2-SiO2 nanopowders, named NanoRa2-Pt, were evaluated in detail by means of complementary spectroscopic and microscopic tools. The nanopowder's biocatalytic efficiency in wound healing was evaluated in a Type I diabetes animal model. RESULTS These are TiO2-SiO2 submicron mesoporous particles with variable size and shape containing ultra-small platinum nanoparticles with catalytic properties. CONCLUSION The use of NanoRa2-Pt catalyzes the natural healing processes with a faster remodeling stage. These sols, which we call nanobiocatalysts, belong to an emerging and very promising research field known as catalytic nanomedicine.
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Affiliation(s)
- Tessy López-Goerne
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Institute of Physics, UNAM, Circuito de la Investigación Científica Ciudad Universitaria, 04510 Mexico City, Mexico
| | - Paola Ramírez
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Laboratorios de Nanomedicina y Nanotecnología. Nano Tutt S.A. de C.V. México City, México
| | - Daniel Alvarez
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Laboratorios de Nanomedicina y Nanotecnología. Nano Tutt S.A. de C.V. México City, México
| | - Francisco Rodríguez-Reinoso
- Advanced Materials Laboratory, Departamento de Química Inorgánica, Universidad de Alicante, Apartado 99, 03080 Alicante, Spain
| | - Ana M Silvestre-Albero
- Advanced Materials Laboratory, Departamento de Química Inorgánica, Universidad de Alicante, Apartado 99, 03080 Alicante, Spain
| | - Esteban Gómez
- AG Nano Optik, Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, 12489 Berlin, Germany
| | - Enrique Rodríguez-Castellon
- Universidad de Málaga, Facultad de Ciencias, Departamento de Química Inorgánica, Cristalografía y Mineralogía, 29071 Málaga, Spain
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George J, Navale SM, Nageeb EM, Curtis GL, Klika AK, Barsoum WK, Mont MA, Higuera CA. Etiology of Above-knee Amputations in the United States: Is Periprosthetic Joint Infection an Emerging Cause? Clin Orthop Relat Res 2018; 476:1951-1960. [PMID: 30794239 PMCID: PMC6259848 DOI: 10.1007/s11999.0000000000000166] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Above-knee amputation (AKA) is a morbid procedure and is performed for a number of conditions. Although AKA is usually performed for dysvascular disease, trauma, and malignancy, AKA is also considered in patients who have failed multiple salvage attempts at treating periprosthetic joint infection (PJI) of TKA. Although aggressive measures are being taken to treat PJI, the huge volume of TKAs might result in a large number of AKAs being performed for PJI in the United States. However, the national trends in the incidence of AKAs from different etiologies and the relative contribution of different etiologies to AKA are yet to be studied. QUESTIONS/PURPOSES (1) What are the temporal trends in the incidence of AKAs (from all causes) in the US population from 1998 to 2013? (2) What are the temporal trends in the incidence of AKAs by etiology (dysvascular disease, trauma, malignancy, and PJI)? (3) What are the temporal trends in the relative contribution of different etiologies to AKA? METHODS Using the Nationwide Inpatient Sample (NIS) from 1998 to 2013, AKAs were identified using International Classification of Diseases, 9 Revision (ICD-9) procedure code 84.17. The NIS database is the largest all-payer database in the United States containing information on approximately 20% of all the hospital admissions in the country. As a result of its sampling design, it allows for estimation of procedural volumes at the national level. All AKAs were grouped into one of the following five etiologies in a sequential manner using ICD-9 diagnosis codes: malignancy, PJI, trauma, dysvascular disease (peripheral vascular disease, diabetic, or a combination), and others. All of the numbers were converted to national estimates using sampling weights provided by the NIS, and the national incidence of AKAs resulting from various etiologies was calculated using the US population as the denominator. Poisson and linear regression analyses were used to analyze the annual trends. RESULTS From 1998 to 2013, the incidence of AKAs decreased by 47% from 174 to 92 AKAs per 1 million adults (incidence rate ratio [IRR]; change in the number of AKAs per 1 million adults per year; 0.96; 95% confidence interval [CI], 0.96-0.96; p < 0.001). The incidence of AKAs resulting from PJI increased by 263% (IRR, 1.07; 95% CI, 1.06-1.07; p < 0.001). An increase was also observed for AKAs from malignancy (IRR, 1.01; 95% CI, 1.00-1.02; p = 0.007), although to a smaller extent. AKAs from dysvascular causes (IRR, 0.96; 95% CI, 0.95-0.96; p < 0.001) and other etiologies (IRR, 0.97; 95% CI, 0.96-0.97; p < 0.001) decreased. There was no change in the incidence of AKAs related to trauma (IRR, 1.00; 95% CI, 0.99-1.00; p = 0.088). The proportion of AKAs resulting from PJI increased by 589% from 1998 to 2013 (coefficient = 0.18; 95% CI, 0.15-0.22; p < 0.001). The proportion of AKAs resulting from dysvascular causes decreased (coefficient = 0.18; 95% CI, 0.15-0.22; p < 0.001), whereas that resulting from malignancy (coefficient = 0.04; 95% CI, 0.03-0.05; p < 0.001) and trauma (coefficient = 0.13; 95% CI, 0.09-0.18; p < 0.001) increased. CONCLUSIONS The incidence of AKAs has decreased in the United States. AKAs related to dysvascular disease and other etiologies such as trauma and malignancy have either substantially decreased or remained fairly constant, whereas that resulting from PJI more than tripled. Given the increased resource utilization associated with limb loss, the results of this study suggest that national efforts to reduce disability should prioritize PJI. Further studies are required to evaluate the risk factors for AKA from PJI and to formulate better strategies to manage PJI. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Jaiben George
- J. George, E. M. Nageeb, G. L. Curtis, A. K. Klika, W. K. Barsoum, M. A. Mont, C. A. Higuera, Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA S. M. Navale, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
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