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Mafusi LG, Egenasi CK, Steinberg WJ, Benedict MO, Habib T, Harmse M, Van Rooyen C. Knowledge, attitudes and practices on diabetic foot care among nurses in Kimberley, South Africa. S Afr Fam Pract (2004) 2024; 66:e1-e10. [PMID: 38949451 PMCID: PMC11219695 DOI: 10.4102/safp.v66i1.5935] [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: 02/19/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Diabetic foot is a dangerous complication of diabetes and can lead to high morbidity and mortality. As essential team members of the healthcare system, nurses play an important role in diabetic foot management and are indispensable in patients' education to prevent diabetic foot. The study assessed nurses' knowledge, attitudes and practices regarding diabetic foot care in Sol Plaatje primary health care centres in the Northern Cape: Sol Plaatje's 14 district municipality clinics, Kimberley, Northern Cape. METHODS This was a descriptive cross-sectional analytical study. A questionnaire assessed nurses' knowledge, practices and attitudes towards diabetic foot care in the above setting. RESULTS A total of 128 professionals, enrolled and auxiliary nurses who are providing primary care to patients within the 14 clinics in the Sol-Plaatje sub-district were recruited for the study. Hundred and five participants completed the self-administered questionnaires. The majority (95%) were females and 58.1% knew that South African Diabetic Foot Guidelines existed, while 57.7% had read them. About 57% did not know about the 60-s diabetic foot screening tool, and 67% did not know the 10 g monofilament test. Approximately 29.8% had never attended a class on diabetic foot care and 85.6% required training on diabetic foot care. CONCLUSION This study revealed that the majority of nurses working in the Sol-Plaatje sub-district primary health care centres are knowledgeable of the diabetic foot guidelines for primary care. However, there is a need for ongoing education on diabetic foot care.Contribution: The study results will help improve nurses' awareness of the importance of diabetic foot care.
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Affiliation(s)
- Labala G Mafusi
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; and, Department of Family Medicine, Robert Mangaliso Sobukwe Hospital, Kimberley.
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Sibbald RG, Dalgarno N, Hastings-Truelove A, Soleas E, Jaimangal R, Elliott J, Coderre-Ball AM, Hill S, van Wylick R, Smith K. COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp. Adv Skin Wound Care 2024; 37:76-84. [PMID: 38241450 DOI: 10.1097/asw.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.
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Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, FRCPC (Med, Derm), FAAD, MAPWCA, JM, is Professor of Public Health and Medicine, University of Toronto, Dalla Lana School of Public Health and Dept. of Medicine, Faculty of Medicine, University of Toronto, Canada. Nancy Dalgarno, HBOR, BEd, MEd, PhD, OCT, is Director of Education Scholarship, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Canada. Also at Queen's University, Amber Hastings-Truelove, MA, PhD, is Health Education Researcher and Consultant, Office of Professional Development and Educational Scholarship; and Eleftherios Soleas, MEd, PhD, OCT, is Director of Continuing Professional Development, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences. Reneeka Jaimangal, MD, MScCH, is Project Manager, WoundPedia Project ECHO Ontario, Ontario Skin and Wound, Mississauga, Canada. James Elliott, MSc, is Director of Operations, Woundpedia, Mississauga. Also at Queen's University, Angela M. Coderre-Ball, MSc, PhD, is Research Associate, Department of Family Medicine; Shannon Hill, MEd, OCT, is PhD Candidate, School of Rehabilitation Therapy; Richard van Wylick, MD, FRCPC, is Associate Dean, Professional Development, Faculty of Health Sciences; and Karen Smith, MD, FRCPC, FAAPMR, FABEM, is Professor, Department of Physical Medicine and Rehabilitation
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Lv J, Li R, Yuan L, Huang FM, Wang Y, He T, Ye ZW. Development and Validation of a Risk Prediction Model for Foot Ulcers in Diabetic Patients. J Diabetes Res 2023; 2023:1199885. [PMID: 36846514 PMCID: PMC9949944 DOI: 10.1155/2023/1199885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The current study analyzed the status and the factors of foot ulcers in diabetic patients and developed a nomogram and web calculator for the risk prediction model of diabetic foot ulcers. METHODS This was a prospective cohort study that used cluster sampling to enroll diabetic patients in the Department of Endocrinology and Metabolism in a tertiary hospital in Chengdu from July 2015 to February 2020. The risk factors for diabetic foot ulcers were obtained by logistic regression analysis. Nomogram and web calculator for the risk prediction model were constructed by R software. RESULTS The incidence of foot ulcers was 12.4% (302/2432). Logistic stepwise regression analysis showed that BMI (OR: 1.059; 95% CI 1.021-1.099), abnormal foot skin color (OR: 1.450; 95% CI 1.011-2.080), foot arterial pulse (OR: 1.488; 95% CI: 1.242-1.778), callus (OR: 2.924; 95%: CI 2.133-4.001), and history of ulcer (OR: 3.648; 95% CI: 2.133-5.191) were risk factors for foot ulcers. The nomogram and web calculator model were developed according to risk predictors. The performance of the model was tested, and the testing data were as follows: AUC (area under curve) of the primary cohort was 0.741 (95% CI: 0.7022-0.7799), and AUC of the validation cohort was 0.787 (95% CI: 0.7342-0.8407); the Brier score of the primary cohort was 0.098, and the Brier score of the validation cohort was 0.087. CONCLUSIONS The incidence of diabetic foot ulcers was high, especially in diabetic patients with a history of foot ulcers. This study presented a nomogram and web calculator that incorporates BMI, abnormal foot skin color, foot arterial pulse, callus, and history of foot ulcers, which can be conveniently used to facilitate the individualized prediction of diabetic foot ulcers.
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Affiliation(s)
- Jing Lv
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Rao Li
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Li Yuan
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Feng-Mei Huang
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Yi Wang
- West China School of Nursing, West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu 610041, China
| | - Ting He
- West China School of Nursing, West China Hospital Endocrinology and Metabolism Department, Sichuan University, Chengdu 610041, China
| | - Zi-Wei Ye
- West China Hospital Endocrinology and Metabolism Department, West China School of Nursing, Sichuan University, Chengdu 610041, China
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Lee EJ, Jeong IS, Kim IJ, Cho YH, Kim YJ. Risk assessment and classification for foot ulceration among patients with type 2 diabetes in South Korea. Int J Nurs Pract 2021; 28:e13012. [PMID: 34545667 DOI: 10.1111/ijn.13012] [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: 08/13/2018] [Revised: 07/01/2021] [Accepted: 08/14/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the distribution of foot conditions, the risk of foot ulceration and its associated factors in patients with diabetes. Few studies have focused on the risk of foot ulceration in patients with diabetes. METHODS A total of 267 patients with diabetes who attended outpatient clinics in two tertiary referral hospitals were recruited from June to September 2016. The risk of foot ulceration was classified using the American Diabetes Association (ADA), International Working Group on the Diabetic Foot (IWGDF) and Scottish Intercollegiate Guidelines Network (SIGN) classification systems. The risk categories of each system were reclassified into high- (categories of 2 and 3 for the ADA and IWGDF systems and high for the SIGN system) and low-risk. RESULTS Foot deformity was the most prevalent condition (38.2%). Among 261 patients without active ulcers, between 17.6% to 35.2% were classified in the high-risk group and overall agreement among systems ranged from .42 to .56 of the kappa statistic. Insulin treatment was consistently associated with a high-risk of foot ulceration. CONCLUSIONS As the risk varies between systems, nurses should select a suitable classification system through validation studies and assess the risk in patients with diabetes, particularly, those receiving insulin treatment.
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Affiliation(s)
- Eun Joo Lee
- Department of Nursing, Dong-Eui University, Busan, Republic of Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Republic of Korea
| | - In Ju Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University Yangsan Hospital & Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Affiliation(s)
- Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Gary Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Lee EJ, Jeong IS, Woo SH, Jung HJ, Han EJ, Kang CW, Hyun S. [Development of a Diabetic Foot Ulceration Prediction Model and Nomogram]. J Korean Acad Nurs 2021; 51:280-293. [PMID: 34215707 DOI: 10.4040/jkan.20257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). METHODS This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients' electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow-Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. RESULTS The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. CONCLUSION The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.
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Affiliation(s)
- Eun Joo Lee
- College of Nursing, Healthcare Sciences & Human Ecology, Dong-Eui University, Busan, Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Seung Hun Woo
- Department of Orthopedics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyuk Jae Jung
- Endovascular and Vascular and Transplantation Division, Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Eun Jin Han
- Division of Nursing, Severance Hospital, Seoul, Korea
| | - Chang Wan Kang
- IT Convergence College of Components and Materials Engineering, Dong-Eui University, Busan, Korea
| | - Sookyung Hyun
- College of Nursing, Pusan National University, Yangsan, Korea
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From Bedsores to Global Health Care: Insights from Nightingale’s Notes on Nursing. Adv Skin Wound Care 2020; 33:237-238. [DOI: 10.1097/01.asw.0000658604.86284.f2] [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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Validated 60-Second General Foot Screen: A Pilot Trial and Guide to Diagnoses and Treatment. Adv Skin Wound Care 2020; 32:490-501. [PMID: 31625965 DOI: 10.1097/01.asw.0000582624.75772.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To provide information on a 60-second General Foot Screen to assist in the prevention and/or identification and management of common foot problems. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Use the 60-second General Foot Screen to assist healthcare professionals in the recognition of common foot problems.2. Identify risk factors, causes, and treatment of selected foot problems. ABSTRACT Foot health is important to overall patient health. Early diagnosis and treatment of diabetes, neuropathy, fungal foot infections, foot deformity, and vascular disease/lower leg edema can improve patient quality of life. One way to achieve this is effective screening. To this end, researchers piloted a validated 10-item screening tool to assess foot health on 120 patients; 74.17% had at least one positive abnormality, demonstrating the critical importance of these early findings. Only 25.83% of individuals had completely low-risk feet. This easy-to-use tool can assist healthcare professionals in the recognition and treatment of common foot problems. The article also outlines the early signs of disease by screening item and provides a guide to treatment to enable effective prevention and quality care.
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Banik PC, Barua L, Moniruzzaman M, Mondal R, Zaman F, Ali L. Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study. BMJ Open 2020; 10:e034058. [PMID: 32114471 PMCID: PMC7050319 DOI: 10.1136/bmjopen-2019-034058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/14/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh. PRIMARY AND SECONDARY OUTCOME MEASURES Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately. RESULTS Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy. CONCLUSION A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.
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Affiliation(s)
- Palash Chandra Banik
- Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
- Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Lingkan Barua
- Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | | | - Rajib Mondal
- Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Farhana Zaman
- Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
| | - Liaquat Ali
- Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
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Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria. ENFERMERIA CLINICA 2019; 30:72-81. [PMID: 31500959 DOI: 10.1016/j.enfcli.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/19/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems. METHOD Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. RESULTS 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). CONCLUSIONS All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.
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Determining Root Causes and Designing Change Ideas in a Quality Improvement Project. Can J Diabetes 2019; 43:241-248. [DOI: 10.1016/j.jcjd.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 11/19/2022]
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Peripheral Neuropathy and the Insensate Foot: More Than Diabetes. Adv Skin Wound Care 2019; 32:149. [DOI: 10.1097/01.asw.0000554390.18232.bd] [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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Rickards T, Cornish T. Reaching out to diabetic soles: Outreach foot care pilot project. SAGE Open Med 2018; 6:2050312118820030. [PMID: 30574310 PMCID: PMC6299298 DOI: 10.1177/2050312118820030] [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: 08/02/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: To assess the effectiveness of outreach foot care services as a tool for engagement with isolated vulnerable seniors. To improve foot health of diabetic seniors, thus avoiding expensive and potentially life-threatening diabetic complications. Methods: Four validated tools are used to gather data: InLow 60-second Diabetic Foot Screen©, Short Diabetes Knowledge Instrument for Older and Minority Adults, Brief Healthcare Questionnaire (Patient Health Questionnaire-9), and the Health-Related Quality of Life Questionnaire. Results: Five monthly visits to 20 participants resulted in multiple co-morbidities being identified, improvements in foot status and diabetic knowledge realized, and determinants of health addressed. Seniors needed support and resources to engage in diabetes self-management. Conclusion: The importance of regular foot care as a key element of any self-management plan for diabetes cannot be understated, nor can increasing social services spending to include coverage for foot care thereby avoiding expensive healthcare. Using foot care as a tool for engagement conferred access to vulnerable seniors who ultimately benefited from healthcare and social interactions with a provider.
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Affiliation(s)
- Tracey Rickards
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
| | - Tammy Cornish
- Fredericton Downtown Community Health Centre, Fredericton, NB, Canada
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A Framework to Assist Providers in the Management of Patients with Chronic, Nonhealing Wounds. Adv Skin Wound Care 2018; 31:491-501. [DOI: 10.1097/01.asw.0000546117.86938.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
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Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Vogt EC, Øksnes M, Suleiman F, Juma BA, Thordarson HB, Ommedal O, Søfteland E. Assessment of diabetic polyneuropathy in Zanzibar: Comparison between traditional methods and an automated point-of-care nerve conduction device. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 10:9-14. [PMID: 29204366 PMCID: PMC5691212 DOI: 10.1016/j.jcte.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/19/2023]
Abstract
We screened for signs of neuropathy in a diabetes population in Zanzibar. Nerve conduction study by NC-stat DPNCheck found neuropathy in 45%. Monofilament results suggestive of neuropathy in 61%. Compared to nerve conduction study, monofilament had a 59% specificity. Hyperglycaemia and hypertension are highly prevalent risk factors in this population.
Aim Scant information is available about the prevalence of diabetic polyneuropathy, as well as the applicability of screening tools in sub-Saharan Africa. We aimed to investigate these issues in Zanzibar (Tanzania). Methods One hundred consecutive diabetes patients were included from the diabetes clinic at Mnazi Mmoja Hospital. Clinical characteristics were recorded. Further, we investigated: a) self-reported numbness of the lower limbs, b) ten-point monofilament test, c) the Sibbald 60-s Tool and d) nerve conduction studies (NCS, using an automated handheld point-of-care device, the NC-stat DPNCheck). Results Mean age was 54 years, 90% had type 2 diabetes, and with 9 year average disease duration. Mean HbA1c was 8.5% (69 mmol/mol), blood pressure 155/88 mmHg. Sixty-two% reported numbness, 61% had positive monofilament and 79% positive Sibbald tool. NCS defined neuropathy in 45% of the patients. Only the monofilament showed appreciable concordance with the NCS, Cohen’s κ 0.43. Conclusions The patient population was characterised by poor glycaemic control and hypertension. In line with this, neuropathy was rampant. The monofilament test tended to define more cases of probable neuropathy than the NCS, however specificity was rather low. Plantar skin thickening may have led to false positives in this population. Overall concordance was, however, appreciable, and could support continued use of monofilament as a neuropathy screening tool. The NC-stat DPNCheck could be useful in cases of diagnostic uncertainty or for research purposes in a low resource setting.
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Affiliation(s)
- Elinor C. Vogt
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Corresponding author at: Haukeland University Hospital, Department of Medicine, PO Box 1400, N-5021 Bergen, Norway.Haukeland University HospitalDepartment of MedicinePO Box 1400N-5021 BergenNorway
| | - Marianne Øksnes
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Faiza Suleiman
- Medical Department, Mnazi Mmoja Hospital, Stone Town, Zanzibar, Tanzania
| | - Buthayna Ali Juma
- Medical Department, Mnazi Mmoja Hospital, Stone Town, Zanzibar, Tanzania
| | | | - Ola Ommedal
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, 5021 Bergen, Norway
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17
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Woodbury MG. Diabetic foot risk assessment. Diabetes Metab Res Rev 2016; 32:376-8. [PMID: 26825436 DOI: 10.1002/dmrr.2784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/08/2022]
Abstract
Diabetes is a serious chronic disease that results in foot complications for many people world-wide. In 2014, the World Health Organization estimated the global prevalence of diabetes in adults to be 9%. To ascertain the risk that an individual patient might develop a diabetic foot ulcer that could lead to an amputation, clinicians are strongly encouraged to perform a risk assessment. Monteiro-Soares and Dinis-Ribeiro have presented a new DIAbetic FOot Risk Assessment with the acronym DIAFORA. It is different from other risk assessments in that it predicts the risk of developing both diabetic foot ulcers and amputation specifically. The risk variables were derived by regression analysis based on a data set of 293 patients from a high-risk setting, a Hospital Diabetic Foot Clinic, who had diabetes and a diabetic foot ulcers. Clear descriptions of the risk variables are provided as well as sensitivity, specificity, positive and negative predictive values for the risk categories. As an added benefit, likelihood ratios are provided that will help clinicians determine the risk of amputation for individual patients. Having a risk assessment form is important for clinician use and examples exist. A question is raised about the effectiveness of risk assessment and how effectiveness might be determined.
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Affiliation(s)
- M Gail Woodbury
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Burdette-Taylor MS. Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention. Healthcare (Basel) 2015; 3:586-92. [PMID: 27417781 PMCID: PMC4939567 DOI: 10.3390/healthcare3030586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 12/03/2022] Open
Abstract
Lower extremity wounds and falls are on the rise with the demographics and projected aging population. Diabetes and heart disease supersede cancer deaths. A basic foot exam—performed routinely on patients identified as high risk allows time for early intervention and prevention. A Certified Foot and Nail Care Nurse (CFCN) who evaluates clients on a regular basis, conducts a comprehensive lower extremity exam for loss of protective sensation (LOPS) and compromised peripheral blood flow is more likely to provide needed care in a timely manner. Why a nurse? Because nurses who have the level of education, expertise through acquired training, and are board certified are competent to assess, educate, provide intervention, and refer. Utilizing CFCNs is cost-effective and efficient. CFCN is utilized as a member of the multidisciplinary team. Nurses are educators and education is an effective method for prevention. Nurses, as the most trusted health care provider, communicate, establish rapport, and develop sustaining relationships. Utilizing the Wound Ostomy Continence Nurses’ Credentialing Board (WOCNCB) CFCN raises the standard of care substantially and reduces overall costs to life, limbs, and dollars. This innovation in practice improves outcomes, patient satisfaction, and safety while reducing hospital admissions.
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Affiliation(s)
- Michele Shelly Burdette-Taylor
- Health Science Building, College of Health, School of Nursing, University of Alaska Anchorage, #357, 3211 Providence Drive, Anchorage, AK 99508, USA.
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Lowe J, Sibbald RG, Taha NY, Lebovic G, Rambaran M, Martin C, Bhoj I, Ostrow B. The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country. Int J Endocrinol 2015; 2015:920124. [PMID: 26089901 PMCID: PMC4452302 DOI: 10.1155/2015/920124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P < 0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.
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Affiliation(s)
- Julia Lowe
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - R. Gary Sibbald
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Nashwah Y. Taha
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Gerald Lebovic
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - Madan Rambaran
- Institute of Health Science Education, University of Guyana, Georgetown, Guyana
| | - Carlos Martin
- Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Indira Bhoj
- Diabetic Foot Centre, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Brian Ostrow
- Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5
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Lowe J, Sibbald RG, Taha NY, Lebovic G, Martin C, Bhoj I, Kirton R, Ostrow B. The Guyana Diabetes and Foot Care Project: a complex quality improvement intervention to decrease diabetes-related major lower extremity amputations and improve diabetes care in a lower-middle-income country. PLoS Med 2015; 12:e1001814. [PMID: 25898312 PMCID: PMC4405371 DOI: 10.1371/journal.pmed.1001814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Julia Lowe and colleagues describe the Guyana Diabetes Foot Care Project, a quality improvement intervention for improving diabetes care in a low-income setting.
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Affiliation(s)
- Julia Lowe
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - R. Gary Sibbald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nashwah Y. Taha
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre (AHRC), St. Michael's Hospital University of Toronto, Toronto, Ontario, Canada
| | - Carlos Martin
- Georgetown Public Hospital Corporation, Ministry of Health Guyana, Georgetown, Guyana
| | - Indira Bhoj
- Georgetown Public Hospital Corporation, Ministry of Health Guyana, Georgetown, Guyana
| | - Rolinda Kirton
- Guyana Diabetes and Foot Care Project, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Brian Ostrow
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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21
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Kröger K, Moysidis T, Feghaly M, Schäfer E, Bufe A. Association of diabetic foot care and amputation rates in Germany. Int Wound J 2014; 13:686-91. [PMID: 25185970 DOI: 10.1111/iwj.12347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/29/2014] [Accepted: 07/05/2014] [Indexed: 11/26/2022] Open
Abstract
Podologists are nurses who care for the diabetic foot (orthotics, offloading devices, blisters, calluses, treatment of fungus infection and patient education). In contrast to podiatrists, they are not qualified to perform any surgical treatment or wound care. We analysed whether there is an association between the decrease in major amputations and the number of podologic foot care (PFC) visits prescribed in Germany. Detailed list of all major lower limb amputations (OPS 5-864) performed from 2007 to 2011 was provided by the Federal Statistical Office. Data were separated for the 16 federal states in Germany. Detailed lists of the number of PFC treatments for each of the 5 years were derived from the federal report of the statutory health insurance. The total numbers of hospitalised cases per year having diabetes mellitus documented as an additional diagnosis were used to adjust for the different rates of people with diabetes in each federal state. Within a 5-year time period, population-based major amputations per 100 000 people dropped from 21·7 in 2007 to 17·5 in 2011 (-18·5%); whereas the number of PFC treatments per 1000 insured increased from 22 in 2007 to 60 in 2011 (+172·7%). The total number of major amputations divided by the total number of hospitalised cases with the additional diagnosis of diabetes mellitus (DM) shows an inverse correlation with the number of PFC treatments per 1000 insured (Pearson's correlation factor is -0·52049). The five countries with the highest increase in PFC compared with the five countries with the lowest increase (35·6 versus 15·4 per 1000 insured) will have only small differences in the decrease in major amputation rates in this period (-5·1 versus -3·4 per 100.000). There is a strong association between increasing utilisation PFC and decreasing major amputations in Germany. Further study is required to document the cost-effectiveness of this service.
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Affiliation(s)
- Knut Kröger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany.
| | - Theodoros Moysidis
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Michel Feghaly
- Wound Clinic and Training Center, Saint George Hospital, University Medical Center, Beirut, Libanon
| | - Erika Schäfer
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Alexander Bufe
- Department of Cardiology, HELIOS Klinik Krefeld, Krefeld, Germany
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Karakas A, Arslan E, Cakmak T, Aydin I, Akgul EO, Demirbas S. Predictive Value of Soluble CD14, Interleukin-6 and Procalcitonin For Lower Extremity Amputation in People with Diabetes with Foot Ulcers: A Pilot Study. Pak J Med Sci 2014; 30:578-82. [PMID: 24948983 PMCID: PMC4048510 DOI: 10.12669/pjms.303.4575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/21/2014] [Accepted: 01/25/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this pilot study was to determine clinical and laboratory factors that predict amputation surgery and to evaluate the predictive value of soluble CD14 (sCD14), interleukin-6 (IL-6), and procalcitonin (PCT) in patients with diabetic foot ulcers (DFUs). METHODS Twenty-seven (20 males, 7 females) Diabetic Foot Ulcers (DFU) patients admitted to our department were consecutively enrolled. The patients' demographics and wound characteristics were noted. IL-6, PCT, and sCD14 were measured at admission. RESULTS Six of the 27 patients (22%) eventually underwent lower extremity amputation. Compared to the non-amputation group, a previous history of amputation (p=0.017), the presence of gangrene (p=0.044), the Wagner grade (p=0.011), the IL-6 concentration (p=0.018), the white blood cell count (WBC) (p=0.036), and the erythrocyte sedimentation rate (ESR) (p=0.042) were significantly high in the amputation group. However, the sCD14 and PCT concentration were not significantly different. CONCLUSION We have shown for the first time that IL-6 may have predictive value for lower extremity amputation in patients with DFU. Further studies are needed to confirm its predictive value in this patient group.
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Affiliation(s)
- Ahmet Karakas
- Ahmet Karakas, Assistant Professor, Department of Infectious Disease and Clinical Microbiology, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey
| | - Erol Arslan
- Dr. Erol Arslan, Assistant Professor, Department of Medicine, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey
| | - Tolga Cakmak
- Dr. Tolga Cakmak,Department of Aerospace Medicine, Military Hospital, Eskisehir, Turkey
| | - Ibrahim Aydin
- E.Ozgur Akgul, Associate Professor, Department of Biochemistry, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey
| | - E Ozgur Akgul
- Seref Demirbas, Assistant Professor, Department of Medicine, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey
| | - Seref Demirbas
- Senol Yildiz, Professor, Department of Undersea and Hyperbaric Medicinem Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey
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23
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Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, Woo K, Boeni T, Ayello EA, Kirsner RS. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014; 70:1.e1-18; quiz 19-20. [PMID: 24355275 DOI: 10.1016/j.jaad.2013.06.055] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.
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Affiliation(s)
- Afsaneh Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada.
| | - R Gary Sibbald
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Department of Medicine (Dermatology) and Public Health, University of Toronto, Toronto, Ontario, Canada; Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - Dieter Mayer
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | | | - Mariam Botros
- Wound Care Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - David G Armstrong
- Department of Surgery, the University of Arizona College of Medicine/SALSA, Tucson, Arizona
| | - Kevin Woo
- Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Thomas Boeni
- Department of Prosthetics and Orthotics, University of Zurich, Zurich, Switzerland
| | | | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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25
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Abstract
The 60-second tool (2012)© uses a cost-effective, simple, standardized approach to identifying, in a timely fashion, which individuals are at high risk for diabetic foot complications. Using this tool, occupational health nurses can screen for diabetic foot complications in varied clinical settings.
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26
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Weinsier ST. Diabetic Foot Examination. Workplace Health Saf 2013. [DOI: 10.3928/21650799-20130226-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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