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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on patients with diabetic foot ulcers. J Adv Nurs 2024; 80:3395-3413. [PMID: 38156736 DOI: 10.1111/jan.16039] [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: 05/29/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
AIMS To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). DESIGN A non-randomized parallel controlled non-inferiority trial. METHODS Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. RESULTS Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. CONCLUSION The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. IMPACT This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. REPORTING METHOD We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Yadav JP, Verma A, Pathak P, Dwivedi AR, Singh AK, Kumar P, Khalilullah H, Jaremko M, Emwas AH, Patel DK. Phytoconstituents as modulators of NF-κB signalling: Investigating therapeutic potential for diabetic wound healing. Biomed Pharmacother 2024; 177:117058. [PMID: 38968797 DOI: 10.1016/j.biopha.2024.117058] [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: 04/15/2024] [Revised: 06/14/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
The NF-κB pathway plays a pivotal role in impeding the diabetic wound healing process, contributing to prolonged inflammation, diminished angiogenesis, and reduced proliferation. In contrast to modern synthetic therapies, naturally occurring phytoconstituents are well-studied inhibitors of the NF-κB pathway that are now attracting increased attention in the context of diabetic wound healing because of lower toxicity, better safety and efficacy, and cost-effectiveness. This study explores recent research on phytoconstituent-based therapies and delve into their action mechanisms targeting the NF-κB pathway and potential for assisting effective healing of diabetic wounds. For this purpose, we have carried out surveys of recent literature and analyzed studies from prominent databases such as Science Direct, Scopus, PubMed, Google Scholar, EMBASE, and Web of Science. The classification of phytoconstituents into various categorie such as: alkaloids, triterpenoids, phenolics, polyphenols, flavonoids, monoterpene glycosides, naphthoquinones and tocopherols. Noteworthy phytoconstituents, including Neferine, Plumbagin, Boswellic acid, Genistein, Luteolin, Kirenol, Rutin, Vicenin-2, Gamma-tocopherol, Icariin, Resveratrol, Mangiferin, Betulinic acid, Berberine, Syringic acid, Gallocatechin, Curcumin, Loureirin-A, Loureirin-B, Lupeol, Paeoniflorin, and Puerarin emerge from these studies as promising agents for diabetic wound healing through the inhibition of the NF-κB pathway. Extensive research on various phytoconstituents has revealed how they modulate signalling pathways, including NF-κB, studies that demonstrate the potential for development of therapeutic phytoconstituents to assist healing of chronic diabetic wounds.
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Affiliation(s)
- Jagat Pal Yadav
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; Pharmacology Research Laboratory, Faculty of Pharmaceutical Sciences, Rama University, Kanpur 209217, India; Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India.
| | - Amita Verma
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
| | - Prateek Pathak
- Department of Pharmaceutical Analysis, Quality Assurance and Pharmaceutical Chemistry, GITAM School of Pharmacy, GITAM (Deemed to be University), Hyderabad Campus, 502329, India
| | - Ashish R Dwivedi
- Department of Pharmaceutical Analysis, Quality Assurance and Pharmaceutical Chemistry, GITAM School of Pharmacy, GITAM (Deemed to be University), Hyderabad Campus, 502329, India
| | - Ankit Kumar Singh
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Ghudda, Bathinda 151401, India
| | - Pradeep Kumar
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Ghudda, Bathinda 151401, India
| | - Habibullah Khalilullah
- Department of Pharmaceutical Chemistry and Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Unayzah 51911, Saudi Arabia
| | - Mariusz Jaremko
- Smart-Health Initiative (SHI) and Red Sea Research Center (RSRC), Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, 23955-6900, Saudi Arabia
| | - Abdul-Hamid Emwas
- Core Labs, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955-6900, Saudi Arabia
| | - Dinesh Kumar Patel
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India.
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Flynn S, Kirwan E, MacGilchrist C, McIntosh C. The impact of COVID-19 on the care of diabetic foot ulcers: A scoping review. J Tissue Viability 2024:S0965-206X(24)00091-3. [PMID: 38981778 DOI: 10.1016/j.jtv.2024.06.016] [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: 10/03/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
AIM The aims and objectives of this scoping review were to conduct a systematic search of the literature to identify the nature and extent of the research evidence to which the COVID-19 pandemic impacted and disrupted the care of Diabetic Foot Ulcers (DFU) and the subsequent impact on patient outcomes. Secondly, to identify transformation in models of care and service delivery, adoption of innovative technologies and new models of service innovations, including modalities such as telehealth that were adopted during the pandemic. METHODS This systematic scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). RESULTS Nineteen papers were included. These studies explored aspects of care for DFUs during the COVID-19 pandemic. The focus of these studies ranged from exploring new modalities of care such as telehealth, reporting of clinical outcomes, development of triage systems and patient behaviors during COVID-19. CONCLUSION Ten of twelve studies reported on DFU outcomes and reported a worsening of outcomes compared to pre-pandemic times. Reduced DFU presentations, alongside an increase in urgent hospitalisations and amputation, were key themes that emerged from this review. More high-quality evidence is needed to establish any longer-lasting effects of the Covid-19 pandemic on people living with DFU. Further, there is a lack of evidence relating to the feasibility and success of telemedicine and limited data on changes to service delivery, including triage systems in this patient cohort.
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Affiliation(s)
- Sinead Flynn
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Ellen Kirwan
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland
| | - Claire MacGilchrist
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
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Goyal G, Majumdar S, Biswas Bose U, Shrivastava MR, Mukherjee JJ, Banka SP, Kapoor S, Jude E. The effect of the different waves of COVID-19 pandemic on the outcome of diabetic foot ulcers. INT J LOW EXTR WOUND 2024:15347346241237284. [PMID: 38659365 DOI: 10.1177/15347346241237284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
AIMS COVID-19 pandemic has massively impacted human health. We studied the effect of COVID-19 on outcome of Diabetic foot ulcers (DFUs). OBJECTIVES AND METHODS We recruited 483 people with DFUs from June 2020 to April 2022 (pandemic) together with a matched group of 226 people with DFU from March 2019 to March 2020 (pre-pandemic). Primary endpoint was outcome of ulcers-healed or amputation (major/minor). It was sub-analysed into 3 waves of COVID-19. Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data included site and type of ulcer (ischemic or neuropathic), duration, presence or absence of infection and Wagner's grading of DFUs was collected for all patients. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ankle brachial index (ABI). Standardized treatment protocol was provided. All patients were monitored for 6 months. RESULTS In the pandemic group 323 (66.9%) patients in whom ulcers healed, 70 (14.5%) underwent minor amputation, 11 (2.2%) major amputation, 29 (6%) were lost to follow up, 22 (4.6%) were not healed. Rate of healing of DFU was higher (66.9% vs 53.5%) and rate of amputation was lower (16.7% vs 23.4%) in the pandemic group than in the pre-pandemic group (P = 0.001 and 0.037 respectively). Rate of healing in first, second and third wave was 65.4%, 75.2%, 58.3% respectively (P = 0.001). Neuropathic ulcers though less prevalent (49.8% vs 57.8%) in the first two waves than in the third wave, healing was better (79.3% vs 75.6%) in the first two waves than in the third wave (P = 0.085 and 0.488 respectively). Similarly, amputation rates in ischemic and neuro-ischemic ulcers were greater in the third wave than first two waves (46.7% vs 15.7%, P = 0.049). CONCLUSION During the COVID-19 pandemic, healing of neuropathic ulcers was better, especially in the first and second waves and travel restriction may have accounted for this. However, worsening of ischemic and neuro-ischemic ulcers was observed with more amputation in these two groups. Conversely, in the third wave withdrawal of lockdown led to worsening of DFUs resulting in less healing and more amputation.
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Affiliation(s)
| | | | | | | | | | - S P Banka
- ILS Hospital, Saltlake, Kolkata, India
| | - S Kapoor
- ILS Hospital, Saltlake, Kolkata, India
| | - Edward Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton under Lyne, UK
- University of Manchester, Manchester, UK
- Manchester Metropolitan University, Manchester, UK
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5
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Chen H, Lu S, Wang Q, Li M, Chen X, Pan B. Application of hyperbaric oxygen therapy in diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14621. [PMID: 38531355 PMCID: PMC10965274 DOI: 10.1111/iwj.14621] [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: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 03/28/2024] Open
Abstract
Hyperbaric oxygen therapy (HBOT) has been used in patients with diabetic foot ulcers (DFU) for many years, but its clinical efficacy is still controversial. Therefore, this study explored the efficacy of HBOT applied to DFU by means of meta-analysis. PubMed, Cochrane Library, Embase, CNKI and Wanfang databases were searched, from database inception to October 2023, and published randomised controlled trials (RCTs) of HBOT in DFU were collected. Two investigators independently screened the collected literature, extracted relevant data and assessed the quality of the literature. Review Manager 5.4 software was applied for data analysis. Twenty-nine RCTs with 1764 patients were included. According to the combined results, when compared with conventional treatment, HBOT significantly increased the complete healing rate of DFUs (46.76% vs. 24.46%, odds ratio [OR]: 2.83, 95% CI: 2.29-3.51, p < 0.00001) and decreased the amputation rate (26.03% vs. 45.00%, OR: 0.41, 95% CI: 0.18-0.95, p = 0.04), but the incidence of adverse events was significantly higher in patients (17.37% vs. 8.27%, OR: 2.49, 95% CI: 1.35-4.57, p = 0.003), whereas there was no significant difference in the mortality (6.96% vs. 12.71%, OR: 0.52, 95% CI: 0.21-1.28, p = 0.16). Our results suggest that HBOT is effective in increasing the complete healing rate and decreasing the amputation rate in patients with DFUs, but increases the incidence of adverse events, while it has no significant effect on mortality.
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Affiliation(s)
- Hai‐Rong Chen
- Department of General Practice MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
| | - Shi‐Juan Lu
- Department of Cardiovascular MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
| | - Qi Wang
- Department of General Practice MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
| | - Ming‐Lan Li
- Department of General Practice MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
| | - Xun‐Chun Chen
- Department of General Practice MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
| | - Bi‐Yun Pan
- Department of General Practice MedicineAffiliated Haikou Hospital of Xiangya Medical College of Central South UniversityHaikouChina
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [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] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Anthony L, Gillies M, Iyer V, Goh D. The Indirect Impact of COVID-19 Pandemic on Lower Extremity Amputations - An Australian Study. Vasc Health Risk Manag 2023; 19:797-803. [PMID: 38108023 PMCID: PMC10724556 DOI: 10.2147/vhrm.s426434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The COVID-19 pandemic has had indirect and deleterious effects on patient health due to interruptions to routine provision of healthcare. This is particularly true for patients with chronic conditions like peripheral vascular disease (PVD). This study aims to evaluate the impact of the pandemic on patients with PVD in Australia by analysing rates of amputation, indications for amputation and urgency of surgery in the pre-pandemic and pandemic periods. Methods The Australian Vascular Audit was used to capture lower extremity amputation data in Victoria, Australia, in the 22 months before and after the start of the pandemic. Results The number of total amputations increased from 1770 pre-pandemic to 1850 during the pandemic, a 4.3% increase. This was largely driven by a statistically significant, 19% increase in major amputations. The number of minor amputations remained relatively similar in the two time periods. Amputations due to tissue loss secondary to arterial insufficiency increased from 474 to 526, an 11% increase, potentially indicating disruptions to revascularisation procedures contributing to the rise in amputations. Elective and emergency surgeries fell by 14% and 18%, respectively, while semi-urgent amputations increased by 32%. Conclusion This study found an increase in the number of amputations overall and a significant increase in major amputations during the pandemic compared to pre-pandemic times. Tissue loss secondary to arterial insufficiency was an increasingly common indication for amputation that was observed in the pandemic group, indicating that disruption to revascularisation likely contributed to this increase in amputations. These findings can inform and direct future vascular surgery service delivery to prepare for the post-pandemic recovery. Additionally, this study further confirms that patients with chronic diseases are often disproportionately disadvantaged when global crises affect routine provision of healthcare and calls for better systems to be developed that can be used in such crises in the future.
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Affiliation(s)
- Lakmali Anthony
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| | - Madeline Gillies
- Department of Surgery, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Vikram Iyer
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| | - David Goh
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
- Department of Vascular Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Moya-Salazar J, Chamana JM, Porras-Rivera D, Goicochea-Palomino EA, Salazar CR, Contreras-Pulache H. Increase in antibiotic resistance in diabetic foot infections among peruvian patients: a single-center cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1267699. [PMID: 38116313 PMCID: PMC10728874 DOI: 10.3389/fendo.2023.1267699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Background Diabetic foot is one of the most significant complications in individuals with diabetes and is closely associated with lower limb amputation. The antibiotic susceptibility patterns of these bacterial isolates play a critical role in guiding effective treatment strategies We aimed to determine the most common bacterial agents causing diabetic foot infections in a tertiary-care hospital in Peru. Methods Clinical and microbiological data were collected from 181 patients diagnosed with diabetic foot infections and positive microbiological culture results. All the samples were analyzed with the Vitek 2 compact system and the cut-off points were defined with the CLSI M100 guide. The data were segregated based on mono-microbial or poly-microbial cultures, bacterial types, and antibiotic susceptibility profiles. Results A total of 32 bacterial species were identified, predominantly Gram-negative (63%). The most frequent bacterial agents isolated were Staphylococcus aureus (19.9%), Escherichia coli (12.2%), Pseudomonas aeruginosa (8.3%), and Proteus vulgaris (6.6%). These bacteria commonly exhibited resistance to Ampicillin, Ciprofloxacin, Levofloxacin, Trimethoprim-sulfamethoxazole, and Cefuroxime. E. coli showed the highest antibiotic resistance (19 antibiotics), while Gentamicin, Tobramycin, and Levofloxacin demonstrated the highest sensitivity against the most prevalent bacteria. Gram-negative bacteria also exhibited notable antibiotic-susceptibility to Meropenem, Piperacillin/tazobactam, and Amikacin. Regarding the presence of Extended-Spectrum Beta-Lactamase, 54 isolates tested positive, with 35 (64.8%) and 14 (42.4%) of these being S. aureus and E. coli. Conclusions Bacterial agents causing diabetic foot infections pose a constant concern, particularly due to the increasing antibiotic resistance observed. This difficulty in treating the condition contributes to a higher risk of amputation and mortality. Further research on bacterial susceptibility is necessary to determine appropriate dosages for pharmacological treatment and to prevent the overuse of antibiotics.
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Affiliation(s)
- Jeel Moya-Salazar
- Faculties of Health Science, Universidad Privada del Norte, Lima, Peru
| | | | - Daniela Porras-Rivera
- School of Medicine, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
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Demirkoparan M, Vahabi A, Özbek B, Mert M, Yıldırım Şimşir I, Erdem HA, Öztürk AM, Çetinkalp Ş. Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates. Int Wound J 2023; 20:3955-3962. [PMID: 37340728 PMCID: PMC10681535 DOI: 10.1111/iwj.14283] [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: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.
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Affiliation(s)
- Mesut Demirkoparan
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Arman Vahabi
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Berker Özbek
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Merve Mert
- Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
| | - Ilgın Yıldırım Şimşir
- Department of Internal Medicine, Division of Endocrinology and Metabolism DisordersEge University School of MedicineIzmirTurkey
| | - Hüseyin Aytaç Erdem
- Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
| | - Anıl Murat Öztürk
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Şevki Çetinkalp
- Department of Internal Medicine, Division of Endocrinology and Metabolism DisordersEge University School of MedicineIzmirTurkey
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10
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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. J Tissue Viability 2023:S0965-206X(23)00107-9. [PMID: 37884436 DOI: 10.1016/j.jtv.2023.10.004] [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: 03/27/2023] [Revised: 09/03/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To explore the effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. MATERIALS AND METHODS Patients were grouped by the campuses they were hospitalized. One group received home wound care, and the other one received outpatient wound care after their discharge. Non-inferiority testing was performed to compare ulcer healing. Their Diabetes-related Foot Ulcer Self-Management Behavior Scale (DFUSMBS) scores and medical expenses were compared. RESULTS Between October 2021 and December 2022, fifty-five patients in the home wound care group and fifty-two in the outpatient wound care group completed the study. The home wound care was non-inferior concerning ulcer complete healing rate in total or stratified by Wagner grade or baseline ulcer area. Concerning wound healing time, the home wound care group was inferior for Wagner Grade Ⅲ ulcers (hazard ratio = 0.7772, 95 % CI = 0.2799-2.1581). In contrast, for ulcers with baseline area>5 cm2, the home care group was non-inferior and even can be superior, although the superiority was not statistically significant (Log-rank X2 = 0.257, p = 0.612). Moreover, the home wound care group showed significant improvement concerning timely wound treatment (t = 23.045, p < 0.001, Cohen's d = 4.460, Effect Size = 0.912) and wound care behavior (t = 33.410, p < 0.001, Cohen's d = 6.454, Effect Size = 0.955), while that of diabetes self-management was not statistically significant (t = -0.673, p = 0.502, Cohen's d = 0.128, Effect Size = 0.064). The medium direct medical expense per capita of the patients in the outpatient care group was statistically significantly heavier than that of the home wound care group (Z = -6.877, p < 0.001). CONCLUSION The home wound care practice did not compromise ulcer healing, enhanced timely wound treatment and wound care behavior of the patients, and saved their medical expenses, hopefully providing a feasible wound care alternative with economic benefits for the physically and economically devastated patients.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Pride L, Kabeil M, Alabi O, Minc SD, Fakorede FA, Ochoa LN, Wright AS, Wohlauer MV. A review of disparities in peripheral artery disease and diabetes-related amputations during the COVID-19 pandemic. Semin Vasc Surg 2023; 36:90-99. [PMID: 36958904 PMCID: PMC9780019 DOI: 10.1053/j.semvascsurg.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has profoundly affected health care delivery. In addition to the significant morbidity and mortality associated with acute illness from COVID-19, the indirect impact has been far-reaching, including substantial disruptions in chronic disease care. As a result of pandemic disruptions in health care, vulnerable and minority populations have faced health inequalities. The aim of this review was to investigate how the COVID-19 pandemic has impacted vulnerable populations with limb-threatening peripheral artery disease and diabetic foot infections.
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Affiliation(s)
- Laura Pride
- Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA
| | - Samantha D Minc
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, School of Medicine, Department of Occupational Health and Environmental Sciences, School of Public Health, West Virginia University, Morgantown, WV
| | | | - Lyssa N Ochoa
- San Antonio Vascular and Endovascular Clinic, San Antonio, TX
| | - A Sharee Wright
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
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