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Solomou G, Bilyy A, Tadikonda P, Gurdas B, Pasapula C. Diagnostic accuracy of clinical, radiological and device-driven tests for the detection of First Ray Instability: A systematic review. Foot (Edinb) 2024; 59:102080. [PMID: 38484413 DOI: 10.1016/j.foot.2024.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/08/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION First Ray Instability (FRI) and especially hypermobility leads to the collapse of the medial longitudinal arch's structural framework, which reduces the foot's ability to become a rigid lever for propulsion, resulting in progressive foot deformities. Early detection of FRI with prompt intervention helps prevent degenerative foot deformities. Various manual, device-based and radiographic diagnostic tests for FRI quantification have been described in the literature. We aim to conduct an up-to-date, comprehensive, systematic review of the literature reporting on diagnostic tests to evaluate FRI. METHODOLOGY Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests. RESULTS 18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one. CONCLUSION Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.
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Affiliation(s)
- Georgios Solomou
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Andrey Bilyy
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Pranav Tadikonda
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Brian Gurdas
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Chandra Pasapula
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
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Rodriguez-Saldana J, Mijangos JHS, Hancock CN, Ramsey DL, Weiser LK. Prevalence and disease burden of peripheral neuropathy in the general population in Mexico city: a cross-sectional epidemiological study. Curr Med Res Opin 2024:1-11. [PMID: 38822450 DOI: 10.1080/03007995.2024.2352852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/05/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Peripheral neuropathy (PN) is one of the most common diseases of the peripheral nervous system. Symptoms range from mild sensory signs to severe neuropathic pain. Untreated PN is progressive and can lead to complications and impair quality of life (QoL). However, PN prevalence is underestimated in the general population and affected individuals often remain undiagnosed. This study aimed to contribute to the global generation of prevalence data and determine sociodemographic and disease-related characteristics of PN sufferers. METHODS This cross-sectional study collected information on PN prevalence and associated factors in the adult population (40-65 years) of the Mexico City area. Participants were recruited in public places and screened for PN using the Michigan Neuropathy Screening Instrument (MNSI). Subjects with PN answered the Neuropathy Total Symptom Score-6 (NTSS-6), the Short Form-36 Health Survey (SF-36), and the QoL Pharmacoeconomic Questionnaire. Statistical analysis included descriptive methods and calculation of PN prevalence with 95% confidence intervals. RESULTS Of 3066 participants, 448 had PN based on the MNSI physical examination. The overall PN prevalence was 14.6%, with the highest (18.9%) seen in subjects aged 61-65 years. PN was undiagnosed in 82.6%, and 62.9% had never heard of PN. Although half of all subjects had only mild PN symptoms, QoL was impacted in 91.8%. CONCLUSIONS The results confirm that PN prevalence in the general population is high. Despite the disease burden, most affected persons are undiagnosed and unaware of the disease. Almost all felt their QoL was impacted. The data highlight the need to raise awareness and identify undiagnosed individuals to prevent complications.
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Affiliation(s)
| | | | | | - David L Ramsey
- Procter & Gamble, Global Personal Health Care Division, Mason, OH, USA
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Njokweni M. Adjunctive topical oxygen therapy in the management of complex diabetes-related wounds: A South African case study series. Foot (Edinb) 2023; 57:101961. [PMID: 37866284 DOI: 10.1016/j.foot.2023.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus and are associated with significant morbidity and mortality. The essential role of oxygen in the treatment of DFUs is documented. Indicated for use on a variety of wound types, topical haemoglobin therapy (Granulox®) is a novel therapeutic technology that binds atmospheric oxygen and improves the availability of oxygen at the wound site. When used as part of the wound management strategy, this therapy helps to reduce inflammation, exudate and slough, and promotes wound healing. In South Africa, health resources, coordinated foot care and podiatry, and data on diabetic foot complications are limited. Twelve patient case studies assessing the impact of adding topical haemoglobin therapy to the management regimes for DFUs and surgical (post-amputation) wounds were undertaken in South Africa. Patients were aged 50-71 years, and all had diabetes mellitus. At baseline, the area of the wounds ranged from 10.2 to 149.6 cm2 with depths ranging from 0.2 to 0.9 cm. Clinical signs of wound infection and high levels of viscous exudate were recorded in all cases. Wound dressings were changed twice weekly and sharp debridement of the wound performed as necessary. The wounds were cleansed and then completely coated with a thin film of Granulox® and dressings applied. Treatment was monitored over periods ranging from 57 to 276 days, during which dressings were changed and Granulox® administered to the wounds, ranging from 16 to 79 times. During the period of evaluation, wound size steadily reduced (by 87.1-100%), the condition of the wound bed tissue and peri-wound skin improved, and clinical signs of wound infection steadily resolved. Wounds significantly improved in two patients, almost healed in six patients, and healed in four patients. All patients reported a reduction in malodour and pain; seven patients were pain-free at the final followup assessment. The overall impression of Granulox® was rated as 'very good' by the clinicians, who considered that Granulox® facilitated an increase in tissue viability, with the promotion of granulation tissue, and stimulated epithelialisation.
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Affiliation(s)
- Mazizi Njokweni
- Leratong Regional Hospital, Chamdor Krugersdorp, South Africa.
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Pasapula C, Solomou G, Al-Sukaini A, Liew I, Goetz J, Cutts S. Evaluation of first ray instability using the double dorsiflexion test: A prospective observational case-controlled study. Foot (Edinb) 2023; 56:102019. [PMID: 36966560 DOI: 10.1016/j.foot.2023.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND First-Ray (FR) stability allows for foot propulsion in-stance, taking 60% weight. First-ray instability (FRI) is associated with middle column overload, synovitis, deformity and osteoarthritis. Clinical detection can still be challenging. We propose to develop a clinical test that helps identify FRI using two simple manual manoeuvres. METHODS 10 patients with unilateral FRI were recruited. Unaffected contralateral feet were used as controls. Stringent exclusion criteria were applied including hallux MTP pain, laxity, inflammatory arthropathy and collagen disorders. A Klauemeter directly measured the sagittal plane dorsal first metatarsal head translation of affected vs unaffected feet. Maximum passive proximal phalanx 1st MTP joint dorsiflexion was measured using a video capture and Tracker motion software analysis with and without applying a dorsal force at the 1st metatarsal head using a Newton meter. Proximal phalanx motion was compared in affected vs unaffected feet with and without dorsal metatarsal head force application and compared to direct measurements using the Klaumeter. P value of < 0.05 was considered significant. RESULTS FRI feet had dorsal translation greater than 8 mm (median, 11.94; interquartile range [IQR], 10.23-13.81) vs 1.77 for unaffected control feet was (median, 1.77; interquartile range [IQR], 1.23-2.96) using the Klauemeter. The percentage reduction in 1st MTP joint dorsiflexion ROM when applying the double dorsiflexion test FRI (mean reduction of 67.98%) when compared to control feet (mean reduction of 28.44%)(P < 0.01). Receiver operating characteristic (ROC) analysis showed that a 50% reduction in dorsiflexion ROM of 1st MTPJ when performing the double dorsiflexion test achieved a specificity of 100% and sensitivity of 90% (AUC =0.990, 95%CI [0.958-1.000], P > 0.0001). CONCLUSION The double dorsiflexion (DDF) is easy to perform with two relatively simple manual manoeuvres that avoids the need for complex instrumented and radiation-based assessment. Greater than 50% decrease in proximal phalanx motion has an over 90% sensitivity in identifying feet with FRI. LEVEL OF EVIDENCE This was a prospective case-controlled study of consecutive cases of a level II evidence.
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Affiliation(s)
- Chandra Pasapula
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK.
| | - Georgios Solomou
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK.
| | - Ahmad Al-Sukaini
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK.
| | - Ignatius Liew
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK.
| | - James Goetz
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK.
| | - Steven Cutts
- James Paget University Hospital NHS Trust, Great Yarmouth, Norfolk, England NR31 6LA, UK.
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Alahakoon C, Singh TP, Galappaththy C, Charles J, Fernando M, Lazzarini P, Moxon JV, Golledge J. Risk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:221-228. [PMID: 37196911 DOI: 10.1016/j.ejvs.2023.05.016] [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: 08/10/2022] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Diabetes related foot disease (DFD) is a common reason for admission to hospital, but the predictive factors for repeat admission are poorly defined. The primary aim of this study was to identify rates and predictive factors for DFD related hospital re-admission. METHODS Patients admitted to hospital for treatment of DFD at a single regional centre were recruited prospectively between January 2020 and December 2020. Participants were followed for 12 months to evaluate the primary outcome of hospital re-admission. The relationship between predictive factors and re-admission were examined using non-parametric statistical tests and Cox proportional hazard analyses. RESULTS The median age of the 190 participants was 64.9 (standard deviation 13.3) years and 68.4% were male. Forty-one participants (21.6%) identified themselves as Aboriginal or Torres Strait Islander people. One hundred participants (52.6%) were re-admitted to hospital at least once over 12 months. The commonest reason for re-admission was for treatment of foot infection (84.0% of first re-admission). Absent pedal pulses (unadjusted hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.26 - 2.85), loss of protective sensation (LOPS) (unadjusted HR 1.98; 95% CI 1.08 - 3.62), and male sex (unadjusted HR 1.62; 95% CI 1.03 - 2.54) increased the risk of re-admission. After risk adjustment, only absence of pedal pulses (HR 1.92, 95% CI 1.27 - 2.91) and LOPS (HR 2.02, 95% CI 1.09 - 3.74) significantly increased the risk of re-admission. CONCLUSION Over 50% of patients admitted to hospital for treatment of DFD are re-admitted within one year. Patients with absent pedal pulses and those with LOPS are twice as likely to be re-admitted.
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Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Charith Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - James Charles
- First Peoples Health Unit, Griffith University, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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Ferreira ACBH, Ferreira DD, Barbosa BHG, Aline de Oliveira U, Aparecida Padua E, Oliveira Chiarini F, Baena de Moraes Lopes MH. Neural network-based method to stratify people at risk for developing diabetic foot: A support system for health professionals. PLoS One 2023; 18:e0288466. [PMID: 37440514 DOI: 10.1371/journal.pone.0288466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Diabetes Mellitus (DM) is a chronic disease with a high worldwide prevalence. Diabetic foot is one of the DM complications and compromises health and quality of life, due to the risk of lower limb amputation. This work aimed to build a risk classification system for the evolution of diabetic foot, using Artificial Neural Networks (ANN). METHODS This methodological study used two databases, one for system design (training and validation) containing 250 participants with DM and another for testing, containing 141 participants. Each subject answered a questionnaire with 54 questions about foot care and sociodemographic information. Participants from both databases were classified by specialists as high or low risk for diabetic foot. Supervised ANN (multi-layer Perceptron-MLP) models were exploited and a smartphone app was built. The app returns a personalized report indicating self-care for each user. The System Usability Scale (SUS) was used for the usability evaluation. RESULTS MLP models were built and, based on the principle of parsimony, the simplest model was chosen to be implemented in the application. The model achieved accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 85%, 76%, 91%, 89%, and 79%, respectively, for the test data. The app presented good usability (93.33 points on a scale from 0 to 100). CONCLUSIONS The study showed that the proposed model has satisfactory performance and is simple, considering that it requires only 10 variables. This simplicity facilitates its use by health professionals and patients with diabetes.
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Affiliation(s)
- Ana Cláudia Barbosa Honório Ferreira
- School of Nursing, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
- University Center of Lavras, Unilavras, Lavras, Minas Gerais, Brazil
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Bhasin A, Krueger KM, Williams J, Gulati R, Sisler N, Galvin S. Management patterns and outcomes of patients hospitalized with diabetic foot ulcers at one tertiary care hospital. Intern Emerg Med 2023; 18:185-191. [PMID: 36474123 DOI: 10.1007/s11739-022-03166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
A diabetic foot ulcer is present in approximately 2.4% of hospitalized patients. Care for diabetic foot ulcers is highly variable. We sought to describe care practice patterns and risk factors for poor outcomes for patients hospitalized with a diabetic foot ulcer in our institution, an 894-bed tertiary care academic hospital located in downtown Chicago, IL. We conducted a retrospective cohort study of patients hospitalized with a diabetic foot ulcer between March 3rd, 2018 and December 31st, 2019. We categorized patients into having an uncomplicated ulcer or a complicated ulcer with cellulitis, wound infection, osteomyelitis, or gangrene. We evaluated rates of diagnostic resource utilization (imaging, cultures, biopsies, and antibiotics) and outcomes of osteomyelitis, amputation, and death. There were 305 patients of interest in the study cohort. A complicated lower extremity ulcer was found in 79% of patients. Amputation was required in 25% of patients, 21% were readmitted, and 13% died. Imaging was obtained in less than 50% of all patients, and in 60% or less of those with osteomyelitis. Bone biopsies were rarely acquired. Empiric antibiotics were prescribed in 77% of patients with osteomyelitis. Male, Black or African-American patients, and those with high Charlson score had the highest risk of poor outcomes. Care practices for patients hospitalized with diabetic foot ulcers were highly variable. Future interventions should target standardization to improve outcomes, with particular attention to health inequities as vulnerable populations have a higher risk of poor outcomes.
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Affiliation(s)
- Ajay Bhasin
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 E. Ontario, Suite 700, Chicago, IL, 60611, US.
- Division of Hospital Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, US.
| | - Karen Marie Krueger
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Janna Williams
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Reeti Gulati
- Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Nathan Sisler
- Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Shannon Galvin
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
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Alahakoon C, Fernando M, Galappaththy C, Lazzarini P, Moxon JV, Jones R, Golledge J. Repeatability, Completion Time, and Predictive Ability of Four Diabetes-Related Foot Ulcer Classification Systems. J Diabetes Sci Technol 2023; 17:35-41. [PMID: 33451251 PMCID: PMC9846411 DOI: 10.1177/1932296820986548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The inter and intra-observer reproducibility of measuring the Wound Ischemia foot Infection (WIfI) score is unknown. The aims of this study were to compare the reproducibility, completion times and ability to predict 30-day amputation of the WIfI, University of Texas Wound Classification System (UTWCS), Site, Ischemia, Neuropathy, Bacterial Infection and Depth (SINBAD) and Wagner classifications systems using photographs of diabetes-related foot ulcers. METHODS Three trained observers independently scored the diabetes-related foot ulcers of 45 participants on two separate occasions using photographs. The inter- and intra-observer reproducibility were calculated using Krippendorff's α. The completion times were compared with Kruskal-Wallis and Dunn's post-hoc tests. The ability of the scores to predict 30-day amputation rates were assessed using receiver operator characteristic curves and area under the curves. RESULTS There was excellent intra-observer agreement (α >0.900) and substantial agreement between observers (α=0.788) in WIfI scoring. There was moderate, substantial, or excellent agreement within the three observers (α>0.599 in all instances except one) and fair or moderate agreement between observers (α of UTWCS=0.306, α of SINBAD=0.516, α of Wagner=0.374) for the other three classification systems. The WIfI score took significantly longer (P<.001) to complete compared to the other three scores (medians and inter quartile ranges of the WIfI, UTWCS, SINBAD, and Wagner being 1.00 [0.88-1.00], 0.75 [0.50-0.75], 0.50 [0.50-0.50], and 0.25 [0.25-0.50] minutes). None of the classifications were predictive of 30-day amputation (P>.05 in all instances). CONCLUSION The WIfI score can be completed with substantial agreement between trained observers but was not predictive of 30-day amputation.
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Affiliation(s)
- Chanika Alahakoon
- Ulcer and Wound Healing Consortium
(UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of
Medicine and Dentistry, James Cook University, Townsville, Queensland,
Australia
- Faculty of Medicine, University of
Peradeniya, Peradeniya, Sri Lanka
| | - Malindu Fernando
- Ulcer and Wound Healing Consortium
(UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of
Medicine and Dentistry, James Cook University, Townsville, Queensland,
Australia
- School of Public Health and Social Work,
Queensland University of Technology, Brisbane, Queensland, Australia
| | - Charith Galappaththy
- Faculty of Medicine, University of
Peradeniya, Peradeniya, Sri Lanka
- The Department of Vascular and
Endovascular Surgery, Townsville University Hospital, Townsville, Queensland,
Australia
| | - Peter Lazzarini
- School of Public Health and Social Work,
Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative,
Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joseph V. Moxon
- Ulcer and Wound Healing Consortium
(UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of
Medicine and Dentistry, James Cook University, Townsville, Queensland,
Australia
- The Australian Institute of Tropical
Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Rhondda Jones
- The Australian Institute of Tropical
Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Ulcer and Wound Healing Consortium
(UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of
Medicine and Dentistry, James Cook University, Townsville, Queensland,
Australia
- The Department of Vascular and
Endovascular Surgery, Townsville University Hospital, Townsville, Queensland,
Australia
- The Australian Institute of Tropical
Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Jonathan Golledge, MChir, FRACS, Queensland
Research Centre for Peripheral Vascular Disease, College of Medicine and
Dentistry, James Cook University, 1 University Drive, Townsville, Queensland
4811, Australia.
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Ravanbod HR. Analgesic efficacy of local versus proximal nerve blocks after hallux valgus surgery: a systematic review. J Foot Ankle Res 2022; 15:78. [PMID: 36273159 PMCID: PMC9588208 DOI: 10.1186/s13047-022-00581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hallux valgus (HV) surgery is an orthopaedic procedure that commonly causes mild to moderate postoperative pain. Effective management of this pain has become an important element of modern hallux valgus surgical treatment. A local anaesthetic (LA) with an antinociceptive effect can control this pain. However, relatively few papers have evaluated this strategy in depth. The objective of the current systematic review was to address this demand by comparing the efficacy of proximal and local blocks in controlling postoperative pain following hallux valgus surgery. Main text Ovid-MEDLINE, Cochrane Central, PubMed, Web of Science (WOS), Scopus, and Embase were searched from their inceptions through December 29, 2021. Observational and clinical trial publications in peer-reviewed English-language journals with a sample size of at least 20 were included. The trials involved adults over 18 who could describe their discomfort and had a bunionectomy. The included studies were evaluated using the Cochrane risk of bias 2 method. Descriptive analysis synthesised the results. Among the 439 articles identified, five studies compromising 459 participants were included. Ankle blocks were superior to control in two studies (P = 0.001, P < 0.001) and superior to local blocks in one study (P < 0.001). Additionally, one study showed that popliteal and ankle blocks administered with lidocaine or levobupivacaine were equivalent (P = 0.123 and P = 0.055, respectively). However, one of these five included studies indicated that ankle blocks were not effective (P = 0.123) in reducing postoperative pain. Conclusions The key findings presented herein suggest that regional blocks effectively reduce postoperative pain and that an ankle block has more supportive evidence for its effectiveness. However, an adequate assessment of the effectiveness of various administrative routes was challenging due to the lack of reliable evidence. This needs to be addressed in future studies. Trial registration PROSPERO registration: CRD42022307974. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00581-0.
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Affiliation(s)
- Hamid Reza Ravanbod
- Division of Podiatric Medicine and Surgery, University Western Australia, Park Avenue Building, Crawley Ave, WA, 6009, Crawley, Australia.
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Lee YJ, Han KD, Kim JH. Association among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study. Endocrinol Metab (Seoul) 2022; 37:770-780. [PMID: 36222086 PMCID: PMC9633221 DOI: 10.3803/enm.2022.1519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/29/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGRUOUND The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients. METHODS A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders. RESULTS The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors. CONCLUSION Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.
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Affiliation(s)
- Yoon Jae Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jun Hyeok Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Jun Hyeok Kim. Department of Plastic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: +82-2-3779-1198, Fax: +82-2-780-9114, E-mail:
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Kaminski MR, Golledge J, Lasschuit JWJ, Schott KH, Charles J, Cheney J, Raspovic A. Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:53. [PMID: 35791023 PMCID: PMC9258081 DOI: 10.1186/s13047-022-00534-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no current Australian guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples. METHODS The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This guideline underwent public consultation, further revision, and approval by national peak bodies. RESULTS Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered. CONCLUSIONS This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.
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Affiliation(s)
- Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia. .,Department of Podiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Joel W J Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, New South Wales, Australia.,Healthy Ageing, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Karl-Heinz Schott
- Southern Cross University School of Health and Human Sciences / Pedorthics, Gold Coast, Queensland, Australia
| | - James Charles
- First Peoples Health Unit, Health Group, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Cheney
- Diabetes Victoria, Melbourne, Victoria, Australia
| | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Pasangha E, George B, Bhuvana KB, Padmini D. Predictors of Pharmacotherapy and Quality of Life Among Patients With Diabetic Foot Syndrome: A Cross-Sectional Study from a Tertiary Care Hospital in India. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221080291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.
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Affiliation(s)
- E. Pasangha
- St. John’s Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - B. George
- Department of Endocrinology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - K. B. Bhuvana
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - D. Padmini
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
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DE’ LORENZI ROSSI C. Le medicazioni idrocolloidi nella cura delle lesioni croniche. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bundó M, Vlacho B, Llussà J, Puig-Treserra R, Mata-Cases M, Cos X, Jude EB, Franch-Nadal J, Mauricio D. Prevalence and risk factors of diabetic foot disease among the people with type 2 diabetes using real-world practice data from Catalonia during 2018. Front Endocrinol (Lausanne) 2022; 13:1024904. [PMID: 36353236 PMCID: PMC9637660 DOI: 10.3389/fendo.2022.1024904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain). METHODS We undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018. RESULTS During the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72). CONCLUSIONS In this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD.
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Affiliation(s)
- Magdalena Bundó
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center Ronda Prim, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain
| | - Bogdan Vlacho
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Department of Pharmacology, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Judit Llussà
- Primary Health Care Centre Sant Roc, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain Catalan Health Institute, Badalona, Spain
| | - Ramon Puig-Treserra
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manel Mata-Cases
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xavier Cos
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center Sant Martí de Provençals, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Innovation Office, Institut Català de la Salut, Barcelona, Spain
| | - Edward B. Jude
- Tameside and Glossop Integrated Care National Health Service (NHS) Foundation Trust, Tameside on Lyne, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - Josep Franch-Nadal
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
| | - Dídac Mauricio
- Diabetes des de Atención Primaria-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
- *Correspondence: Dídac Mauricio, ; Josep Franch-Nadal,
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Wang M, Yao S, He D, Qahar M, He J, Yin M, Wu J, Yang G. Type 2 Diabetic Mellitus Inhibits Skin Renewal through Inhibiting WNT-Dependent Lgr5+ Hair Follicle Stem Cell Activation in C57BL/6 Mice. J Diabetes Res 2022; 2022:8938276. [PMID: 35469170 PMCID: PMC9034921 DOI: 10.1155/2022/8938276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hair follicles are important accessory organs of the skin, and it is important for skin renewal and performs variety of important functions. Diabetes can cause several dermatoses; however, its effect on hair follicles is unclear. The purpose of this study was to investigate the effect of type II diabetes (T2DM) on the hair follicles of mice. METHODS Seven-week-old male C57BL/6 littermate mice were divided into two groups. The treatment group was injected with streptozotocin (STZ) to induce T2DM, and the control group was parallelly injected with the same dose of buffer. Seven days after injection, the back is depilated to observe the hair follicle regeneration. Hair follicle regeneration was observed by naked eyes and HE staining. The proliferation of the skin cells was observed by PCNA and K14 staining. The altered genes were screened by RNA sequencing and verified by qRT-PCR. In addition, Lgr5 + GFP/mTmG transgenic mice were used to observe the effect of T2DM on Lgr5 hair follicle stem cells (HFSC). And the expression of WNT4 and WNT8A were measured by Western Blot. RESULTS T2DM inhibited hair follicle regeneration. Compared to control mice, T2DM mice had smaller hair follicles, reduced skin thickness, and less expression of PCNA and K14. RNA sequencing showed that the two groups had significant differences in cell cycle and proliferation-related pathways. Compared with the control mice, the mRNA expression of Lgr4, Lgr5, Wnt4, and Wnt8a was decreased in the T2DM group. Moreover, T2DM inhibited the activation of Lgr5 HFSC and the expression of WNT4 and WNT8A. CONCLUSIONS T2DM inhibited hair follicle regeneration and skin cells proliferation by inhibiting WNT-dependent Lgr5 HFSC activation. This may be an important reason for the reduction of skin renewal ability and the formation of chronic wounds caused by diabetes. It is important for the treatment of chronic diabetic wounds and the development of tissue engineering.
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Affiliation(s)
- Minghui Wang
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Shangsheng Yao
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Dehua He
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Mulan Qahar
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Jinqing He
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Meifang Yin
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Jun Wu
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
- Human Histology & Embryology Section, Department of Surgery, Dentistry, Pediatrics & Gynecology, University of Verona Medical School, Verona 37134, Italy
| | - Guang Yang
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
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Singh G, Gupta S, Chanda A. Biomechanical modelling of diabetic foot ulcers: A computational study. J Biomech 2021; 127:110699. [PMID: 34425420 DOI: 10.1016/j.jbiomech.2021.110699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 01/13/2023]
Abstract
Diabetic foot problems are widespread globally, resulting in substantial medical, economic, and social challenges for patients and their families. Among diabetic complications, foot ulceration is the most frequent outcome and is more probable to be of neuropathic origin. To date, a plethora of studies has focused on diabetic foot and ulcer prevention. However, limited studies have investigated the biomechanics of diabetic foot post ulceration. In this work, extensive biomechanical modelling of diabetic foot ulcers was attempted. A full-scale foot model was developed using measurements from a human subject, and ulcers of differing sizes and depths were modelled at different plantar sites numerically. Also, the foot model was computationally modified to study the effect of flat foot conditions on the same diabetic ulcers. Standing condition was simulated, and the induced stresses were investigated at the plantar region. The maximum stresses were observed to be similar for all ulcer sizes and depths at the lateral midfoot region of the normal foot. However, the maximum stresses were reported in the lateral heel region for the flat foot, which varied significantly with size and depth. Such results present important information on the foot condition post ulceration and may help identify possibilities of further ulceration in the diabetic foot. These novel findings are anticipated to be indispensable for the development of suitable interventions (e.g., custom orthotics) for diabetic foot ulcer management.
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Affiliation(s)
- Gurpreet Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India.
| | - Shubham Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India.
| | - Arnab Chanda
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), Delhi, India.
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Gupta S, Singh G, Chanda A. Prediction of diabetic foot ulcer progression: a computational study. Biomed Phys Eng Express 2021; 7. [PMID: 34560679 DOI: 10.1088/2057-1976/ac29f3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/24/2021] [Indexed: 01/13/2023]
Abstract
The development of foot ulcers is a common consequence of severe diabetes. Due to vascular disorders and impeded healing caused by the disease, most foot ulcers have been reported to be affected by body weight and progress with time. Also, abnormal distribution of plantar pressures has been observed to cause the formation of additional ulcers, which may collectively lead to traumatic amputations. While a study of such pathophysiology is not possible through experiments, a few computational modelling works have investigated diabetic foot ulcers. To date, ulcers with a few sizes and locations have been studied, and their effect on the plantar stresses has been quantified. In this work, we have attempted to study the effect of all possible ulcer locations on the generated plantar peak stresses and peak stress locations where additional ulcers may form. Also, the effect of ulcer location on the possible ulcer growth was investigated. A full-scale foot model was developed and a total of 52 ulcer locations were simulated separately, with standing and walking loads. The generated stresses were normalised with the foot size and statistically analysed to develop novel formulations for predicting peak plantar stresses and their locations for any known ulcer location. The results from this study are anticipated to provide important guidelines to doctors and medical practitioners for predicting foot ulcer progression in diabetic patients with existing ulcers and allow the administration of timely preventive interventions.
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Affiliation(s)
- Shubham Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India
| | - Gurpreet Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India
| | - Arnab Chanda
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), Delhi, India
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Modulation of the Wound Healing through Noncoding RNA Interplay and GSK-3 β/NF- κB Signaling Interaction. Int J Genomics 2021; 2021:9709290. [PMID: 34485505 PMCID: PMC8413067 DOI: 10.1155/2021/9709290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot ulcers are seriously endangering the physical and mental health of patients. Due to the long duration of inflammation, the treatment of nonhealing wounds in diabetes is one of the most prominent healthcare problems in the world. The nuclear factor kappa B (NF-κB) signaling pathway, a classical pathway that triggers inflammatory response, is regulated by many regulators, such as glycogen synthase kinase 3 beta (GSK-3β). Noncoding RNAs, a large class of molecules that regulate gene expression at the posttranscriptional or posttranslational level, play an important role in various stages of wound healing, especially in the stage of inflammation. Herein, we summarized the roles of noncoding RNAs in the NF-κB/GSK-3β signaling, which might provide new ideas for the treatment of diabetic wound healing.
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Abstract
PURPOSE Determine the prevalence of foot problems in an inpatient population and to describe demographic data, comorbid conditions, and type of footwear worn. DESIGN Observational point-prevalence cross-sectional design. SUBJECTS AND SETTING The study setting was a 722-bed licensed hospital in Western Australia. A convenience sampling was used to include adults hospitalized in the study setting during the period of data collection. METHODS A subset of foot questions, guided by a literature review, and input from foot, wound, diabetes, and psychometric researchers and clinicians, was incorporated into the hospital point-prevalence survey conducted annually for nursing safety and quality. Trained nurses collected data during the 1-day survey. Data were analyzed using descriptive statistics and 2-tailed tests; associations between study variables were analyzed. RESULTS Two hundred twenty-one patients participated in the survey; a majority (n = 193, 87%) self-reported at least 1 foot problem. More than half (n = 124) reported 3 foot problems and nearly one-third (n = 67) had 5 or more foot problems. Thick nails, damaged nails, and calluses and corns were the most frequently occurring foot problems. Older participants were more likely to have certain foot problems such as calluses and thick nails. Eleven (5%) participants were admitted to the hospital for a foot-related condition. CONCLUSION The majority of foot problems in our study were found to be minor and not the primary admitting diagnosis. However, even minor foot problems can pose a risk of worsening, especially in high-risk populations such as those with diabetes. Thus, detection is critical in overall patient assessment, and nurses play a critical role in assessment and management of minor foot problems through the delivery of skin and nail care and through collaboration with other professionals who provide specialized foot care.
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Balduzzi G, De Giglio R, Masserini B, Formenti I, Lodigiani S, Mondello T, Mumoli N, Pintaudi B, Di Vieste G. Effectiveness, Safety, and Acceptance of an Interim Orthosis in Patients with Diabetes in the Immediate Postoperative Chopart Surgery. INT J LOW EXTR WOUND 2021:15347346211023041. [PMID: 34096795 DOI: 10.1177/15347346211023041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, P = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, P = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, P = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.
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Affiliation(s)
| | | | | | - Ilaria Formenti
- Abbiategrasso Hospital, 9338ASST Ovest Milanese, Milan, Italy
| | - Sara Lodigiani
- Abbiategrasso Hospital, 9338ASST Ovest Milanese, Milan, Italy
| | - Teresa Mondello
- Abbiategrasso Hospital, 9338ASST Ovest Milanese, Milan, Italy
| | - Nicola Mumoli
- Magenta Hospital, 472668ASST Ovest Milanese, Milan, Italy
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Iseli RK, Duncan G, Lee EK, Lewis E, Maier AB. Incorporating foot assessment in the comprehensive geriatric assessment. BMC Geriatr 2021; 21:223. [PMID: 33794805 PMCID: PMC8015740 DOI: 10.1186/s12877-021-02164-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults. Aims To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks. Methods Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA. Results Fifty-two patients (median age [inter-quartile range] 86.4 [79.2–90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a ‘high risk’ or ‘at risk’ foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 ‘at risk’ and 2 ‘low risk’ for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7–32.1] vs 15.2 [8–22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0–3] vs 0 [0–2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001). Conclusion Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02164-3.
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Affiliation(s)
- Rebecca K Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia. .,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.
| | - Gregory Duncan
- Eastern Health Clinical School, Monash University
- , Box Hill, Victoria, Australia
| | - Elton K Lee
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ellen Lewis
- Podiatry Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore, Singapore
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22
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Ramanathan B, Duraisamy R, Venkatramanasami BTD, Abbas MK, Balamurugan A. Association of glycaemic status and outcomes in diabetic foot problems: a retrospective evidence from South India. J Basic Clin Physiol Pharmacol 2021; 33:155-162. [PMID: 33618439 DOI: 10.1515/jbcpp-2020-0198] [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: 07/06/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Emerging shreds of evidence indicates that the risk of diabetic foot ulcer and associated morbidity can be reduced through the intensive glycemic control. There are very few studies which assessed the effects of glycemic control on diabetic foot problems among Indian patients. We aimed to assess the effect of glycemic control on the outcomes of diabetic foot problems among adult type 2 diabetes (T2DM) patients with foot ulcers. METHODS A cross sectional study was conducted among the T2DM patients from a tertiary care teaching hospital in South India. The demographic characters, risk factors, treatment characters, glycemic status were collected among the patients and analyzed against the outcomes of diabetic foot ulcers by reviewing their medical records. Descriptive statistics were used to present the data. The Chi-square test and ANOVA were used for was used for the categorical variables and continuous parameters to identify the factors affecting the outcomes, respectively. All analysis was performed in SPSS v21. RESULTS Out of the 100 participants included in the study, 70% were male. The majority (78%) were from an age group of 40 to 70 years, and the mean age was found to be 59.91 ± 10.6 years. The mean duration of diabetes was 9.66 years. Only ankle-brachial Index score (p=0.001) was significantly associated with the type of ulcers, whereas other factors not (p>0.05). A high level of average HbA1c, BMI, ABI index and poor glycemic status was associated with a significant debridement strategy and longer duration of hospitalization; however, it was not substantial. CONCLUSION Our study inferred that poor glycemic status is associated with a significant debridement strategy and longer duration of hospitalization. However, these findings need to be strengthened with adequately powered prospective studies.
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Affiliation(s)
- Balamurugan Ramanathan
- Department of General Medicine, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India
| | - Ramesh Duraisamy
- Department of General Medicine, Coimbatore Medical College & Hospital, Coimbatore, Tamilnadu, India
| | | | - Manoj Kumar Abbas
- Kovai Diabetes Speciality Centre & Hospital, Coimbatore, Tamilnadu, India
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23
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A. Hanna I. Tibial angioplasty in diabetics. JOURNAL OF MEDICINE IN SCIENTIFIC RESEARCH 2021. [DOI: 10.4103/jmisr.jmisr_91_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Iseli RK, Lee EK, Lewis E, Duncan G, Maier AB. Foot disease and physical function in older adults: A systematic review and meta-analysis. Australas J Ageing 2020; 40:35-47. [PMID: 33314652 DOI: 10.1111/ajag.12892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically assess the literature examining the association between foot disease (foot ulceration, infection, critical ischaemia and/or Charcot neuroarthropathy) and physical function in older adults. METHODS Literature search of MEDLINE, Embase and CINAHL was performed. Studies were included if foot disease and physical function were assessed in participants of mean or median age ≥ 65 years. RESULTS Of 2,574 abstracts screened, 19 studies (13 longitudinal, 6 cross-sectional) reporting on 5634 participants, 43% female, were included. Diabetes-related foot disease and critical ischaemia were most studied (n = 5017, 40% female). In 8 studies with control groups, foot disease was associated with poorer physical function. Meta-analysis of 5 studies (n = 1503, 45% female) found an association between foot disease and poorer physical function (SMD (95% CI): 1.00 (0.40, 1.62), P < 0.001). CONCLUSION Foot disease is associated with poorer physical function in older adults. Future research should include broader study populations and intervention strategies.
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Affiliation(s)
- Rebecca K Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Elton K Lee
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia
| | - Ellen Lewis
- Podiatry Department, The Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Gregory Duncan
- Eastern Health Clinical School, Monash University, Box Hill, Vic., Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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25
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Røikjer J, Jensen MH, Vestergaard P, Sørensen AM, Laursen HVB, Ejskjaer N. Twenty years with diabetes and amputations: a retrospective population-based cohort study. Diabet Med 2020; 37:2098-2108. [PMID: 31990417 DOI: 10.1111/dme.14251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/13/2023]
Abstract
AIM To investigate the trends in non-traumatic lower limb amputation in people with and without diabetes. METHODS From the Danish National Patient Register, all people with either type 1 or type 2 diabetes (n = 462 743) as well as a group of people without diabetes from the general population (n = 1 388 886) were identified and separated into three groups based on diabetes type. Among these, 17 265 amputations were identified between 1997 and 2017 and stratified into trans-femoral amputations, trans-tibial amputations and amputations below the ankle using surgical codes. Annual changes were described using least-squares linear regression. RESULTS The yearly mean decrease in incidence rate of amputation per 1000 person-years was -0.032 [95% CI: -0.062, -0.001], -0.022 [-0.032, -0.012] and -0.006 [-0.009, -0.003] for trans-femoral amputation, -0.072 [-0.093, -0.052], -0.090 [-0.102, -0.078] and -0.015 [-0.016, -0.013] for trans-tibial amputation, and -0.055 [-0.080, -0.020], -0.075 [-0.090, -0.060] and -0.011 [-0.014, -0.007] for amputation below the ankle in people with type 1 diabetes, people with type 2 diabetes and people without diabetes, respectively. CONCLUSIONS Over recent decades, the incidence of amputation has decreased significantly in people with diabetes and in the general population without diabetes.
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Affiliation(s)
- J Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M H Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - P Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine and Endocrinology, Aalborg University, Aalborg, Denmark
| | - A M Sørensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - H V B Laursen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - N Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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26
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Stoberock K, Kaschwich M, Nicolay SS, Mahmoud N, Heidemann F, Rieß HC, Debus ES, Behrendt CA. The interrelationship between diabetes mellitus and peripheral arterial disease - a systematic review. VASA 2020; 50:323-330. [PMID: 33175668 DOI: 10.1024/0301-1526/a000925] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This systematic review examined the interrelationship between concomitant diabetes mellitus (DM) and peripheral arterial disease (PAD). The objective was to determine differences in the prevalence as well as in the outcomes in diabetic vs. non-diabetic PAD patients. The current review followed a study protocol that was published online in German in 2017. The search included societal practice guidelines, consensus statements, systematic reviews, meta-analyses, and observational studies published from 2007 to 2020 reporting symptomatic PAD and concomitant DM in patients undergoing invasive open-surgical and endovascular revascularizations. German and English literature has been considered. Eligibility criteria were verified by three independent reviewers. Disagreement was resolved by discussion involving a fourth reviewer. 580 articles were identified. After exclusion of non-eligible studies, 61 papers from 30 countries remained, respectively 850,072 patients. The included studies showed that PAD prevalence differed between diabetic vs. non-diabetic populations (20-50% vs. 10-26%), and further by age, gender, ethnicity, duration of existing diabetes, and geographic region. The included studies revealed worse outcomes regarding perioperative complications, amputation rate, and mortality rate in diabetic patients when compared to non-diabetic patients. In both groups, the amputation rates decreased during the research period. This review emphasizes an interrelationship between PAD and DM. To improve the outcomes, early detection of PAD in diabetic patients, and vice versa, should be recommended. The results of this systematic review may help to update societal practice guidelines.
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Affiliation(s)
- Konstanze Stoberock
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Kaschwich
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shiva Sophia Nicolay
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nazeh Mahmoud
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik C Rieß
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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27
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Dygut J, Piwowar P, Detyna J, Popiela T, Kogut W, Boroń W, Dudek P, Piwowar M. Correction of foot deformities with hallux valgus by transversal arch restoration. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Yildiz S, Kirdi E, Bek N. Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia. Somatosens Mot Res 2020; 37:284-287. [PMID: 32996810 DOI: 10.1080/08990220.2020.1823362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The presence of kinesiophobia was identified in patients with foot problems. There was no finding of foot functionality according to the level of kinesiophobia in lower extremity problems. The aim of this study was to compare the lower extremity functional status in foot problems with a low or high level of kinesiophobia. MATERIALS AND METHODS Evaluated herein were 37 patients with foot problems (plantar fasciitis, hallux valgus, flat foot). Physical and demographic characteristics were recorded. Patients were divided into two groups based on if they had a high or low level of kinesiophobia using the Tampa kinesiophobia scale. Ankle plantar flexor and knee flexor muscles tightness were recorded. The foot posture was evaluated using the Foot Posture Index. Foot-related pain was measured using the Visual Analog Scale Foot & Ankle. The Foot Function Index and the American Orthopaedics Foot and Ankle Foundation Ankle-Hindfoot Scale and Hallux Metatarsophalangeal-Interphalangeal Scale were used to assess the foot function. The general functional status of the lower extremities was evaluated using the Lower Extremity Functional Scale. RESULTS Foot function was better in patients with a low level of kinesiophobia (p < 0.05). Pain was higher in patients with high level of kinesiophobia than in patients with a low level of kinesiophobia (p < 0.05). There was no difference between the groups in terms of foot posture index and muscle tightness (p > 0.05). The general lower extremity function was more negatively affected in patients with a high level of kinesiophobia (p < 0.05). CONCLUSIONS Patients with a high level of kinesiophobia presented with more functional problems in the foot and whole lower extremity; hence, function-based rehabilitation and pain coping strategies should be a crucial part of the rehabilitation program at the earliest opportunity.
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Affiliation(s)
- Sulenur Yildiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elif Kirdi
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nilgun Bek
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
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29
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Zografou I, Iliadis F, Sambanis C, Didangelos T. Validation of Neuropad in the Assessment of Peripheral Diabetic Neuropathy in Patients with Diabetes Mellitus Versus the Michigan Neuropathy Screening Instrument, 10g Monofilament Application and Biothesiometer Measurement. Curr Vasc Pharmacol 2020; 18:517-522. [DOI: 10.2174/1570161117666190723155324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/30/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Objective:
Sudomotor dysfunction is a feature of Diabetic Peripheral Neuropathy (DPN). The
indicator plaster Neuropad can provide an easy and accurate way to diagnose DPN. The aim of the present
study was to evaluate Neuropad’s specificity, sensitivity and accuracy in detecting DPN in patients
with Diabetes Mellitus (DM).
Methods:
A total of 174 patients with DM (79 with type 1 DM, 88 women), mean age 49.8 ± 16.1 years
and mean DM duration 17.3 ± 7.7 years were included in the present study. The following methods
were used to diagnose DPN: the Michigan Neuropathy Screening Instrument Questionnaire and Examination
(MNSIQ and MNSIE, respectively), application of 10 g monofilament (MONO) and measurement
of vibration perception threshold with biothesiometer (BIO). Neuropad was applied to both feet in
all patients and according to the presence or absence of color change of the sticker, patients were divided
in two groups: group A (n = 82, complete change in color from blue to pink, depicting normal
perspiration) and group B (n = 92, incomplete or no change, depicting abnormal perspiration).
Results:
MNSIQ and MNSIE were positive for DPN in 111 and 119 patients, respectively. BIO was
abnormal in 109 and MONO in 59 patients. Sensitivity of Neuropad testing was 95% vs. MONO, 73%
vs. BIO, 73% vs. MNSIE and 75% vs. ΜNSIQ. Specificity was 69, 81, 90 and 92%, respectively and
accuracy of the test was 78, 76, 78 and 83%, respectively.
Conclusion:
Neuropad has a high sensitivity and specificity in detecting DPN vs. MNSIQ, MNSIE and
BIO. Neuropad has a high sensitivity but moderate specificity vs. MONO. The accuracy of the test was
high in all measurements.
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Affiliation(s)
- Ioanna Zografou
- Diabetes Center, 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Fotios Iliadis
- Diabetes Center, 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, ''AHEPA'' Hospital, Thessaloniki, Greece
| | - Christos Sambanis
- Diabetes Center, 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, ''AHEPA'' Hospital, Thessaloniki, Greece
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30
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Huynh P, Phie J, Krishna SM, Golledge J. Systematic review and meta-analysis of mouse models of diabetes-associated ulcers. BMJ Open Diabetes Res Care 2020; 8:8/1/e000982. [PMID: 32467222 PMCID: PMC7259859 DOI: 10.1136/bmjdrc-2019-000982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/29/2020] [Accepted: 04/18/2020] [Indexed: 12/14/2022] Open
Abstract
Mouse models are frequently used to study diabetes-associated ulcers, however, whether these models accurately simulate impaired wound healing has not been thoroughly investigated. This systematic review aimed to determine whether wound healing is impaired in mouse models of diabetes and assess the quality of the past research. A systematic literature search was performed of publicly available databases to identify original articles examining wound healing in mouse models of diabetes. A meta-analysis was performed to examine the effect of diabetes on wound healing rate using random effect models. A meta-regression was performed to examine the effect of diabetes duration on wound healing impairment. The quality of the included studies was also assessed using two newly developed tools. 77 studies using eight different models of diabetes within 678 non-diabetic and 720 diabetic mice were included. Meta-analysis showed that wound healing was impaired in all eight models. Meta-regression suggested that longer duration of diabetes prior to wound induction was correlated with greater degree of wound healing impairment. Pairwise comparisons suggested that non-obese diabetic mice exhibited more severe wound healing impairment compared with db/db mice, streptozotocin-induced diabetic mice or high-fat fed mice at an intermediate stage of wound healing (p<0.01). Quality assessment suggested that the prior research frequently lacked incorporation of key clinically relevant characteristics. This systematic review suggested that impaired wound healing can be simulated in many different mouse models of diabetes but these require further refinement to become more clinically relevant.
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Affiliation(s)
- Pacific Huynh
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
| | - James Phie
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
| | - Smriti Murali Krishna
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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31
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Goodall RJ, Langridge B, Lane T, Davies AH, Shalhoub J. A Narrative Review of the Use of Neuromuscular Electrical Stimulation in Individuals With Diabetic Foot Ulceration. INT J LOW EXTR WOUND 2020; 19:242-250. [DOI: 10.1177/1534734619898978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This review aims to summarize the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU). A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, 7 met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use; however, in each study, only 3 of the included participants had DFU and subgroup analyses based on ulcer etiology was omitted. The remaining 5 studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in nondiabetic wounds of a similar grade (healing rate: 70.0 ± 32.3% in DFU vs 38.4 ± 22.3% in nondiabetic ulcers [ P < .01]). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data support a potential role for NMES in individuals with DFU; however, the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
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Affiliation(s)
- Richard James Goodall
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Benjamin Langridge
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Tristan Lane
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Alun Huw Davies
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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32
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Singh S, Jajoo S, Shukla S, Acharya S. Educating patients of diabetes mellitus for diabetic foot care. J Family Med Prim Care 2020; 9:367-373. [PMID: 32110620 PMCID: PMC7014829 DOI: 10.4103/jfmpc.jfmpc_861_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose Diabetes mellitus (DM) is a global pandemic. Among the spectrum of diabetic complications, diabetic foot is a leading cause of morbidity and hence awareness and education regarding primary healthcare inclusive of self-care pertaining to diabetic foot care is of paramount importance. Aim The aim of the study was to educate patients of DM regarding the disease and its associated complications, specifically pertaining to diabetic foot care. Methodology The study was carried out in three phases, first was to assess the diabetic patients related to their awareness on disease complications and diabetic foot care, through pretest questionnaire, the second phase was to sensitize patients and educate them on the same, the third phase was to re assess the knowledge gained by the patients through posttest assessment. Results The study evaluated the absolute and relative learning gain regarding the awareness and knowledge of foot care among diabetic individuals. The absolute learning gain was 40.92% and the relative learning gain was 76.48% and normalized learning gain was 0. 88, the normalized gain was assessed to be high. Conclusion The study concluded that training and sensitizing individuals with diabetes will definitely help reduce morbidity of diabetic foot and hence the medical and paramedical staff need to spread awareness regards the same.
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Affiliation(s)
- Satyam Singh
- Department of Surgery, Jawaharlal Nehru Medical College, ABVR Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Suhas Jajoo
- Department of Surgery, Jawaharlal Nehru Medical College, ABVR Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, ABVR Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, ABVR Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
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Foundation doctor knowledge of wounds and dressings is improved by a simple intervention: An audit cycle-based quality improvement study. Ann Med Surg (Lond) 2020; 51:24-27. [PMID: 32021687 PMCID: PMC6994401 DOI: 10.1016/j.amsu.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Many foundation year 1 and 2 doctors (FYs) have limited knowledge experience in wound management. Wound dressing formularies exist in many NHS Trusts, though awareness of and adherence to them by FYs is not known. This quality improvement study described baseline FY knowledge of wound management, and investigated whether this could be improved through educational intervention. Methods A single-centre, prospective, baseline audit was conducted following local approval. This assessed knowledge of wound types and appropriate dressings alongside individual confidence providing wound care. The educational intervention involved the distribution of an ID-badge sized quick reference guide that could be attached to the FYs' lanyards, and an introduction to the formulary during routine teaching. The audit loop was closed by repeating the questionnaire. Results Pre- (n = 43) and post- (n = 35) intervention questions were completed by FYs. The mean score post-intervention was significantly higher than the pre-intervention score across all knowledge questions (from 32% correct to 71% correct, p < 0.0001). There was no change in participant confidence, which remained low. Conclusion FYs lack confidence and knowledge about wounds and dressings. The latter can be improved through a simple and practical educational intervention that could be deployed nationally. Junior doctors lack confidence and knowledge on wounds and wound care. Knowledge on appropriate wound care can be improved by a simple educational intervention. Junior doctor confidence managing wounds is not improved by educational interventions alone.
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34
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Dinoto E, Pecoraro F, Mirabella D, Ferlito F, Farina A, Lo Biundo N, Orlando-Conti P, Bajardi G. A Single-Center Experience on Below-The-Knee Endovascular Treatment in Diabetic Patients. Transl Med UniSa 2020; 21:21-23. [PMID: 32123676 PMCID: PMC7039268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic ulceration of the foot is a major global medical, social and economic problem and is the most frequent end-point of diabetic complications. A retrospective analysis from February 2017 to May 2019 of diabetic patients presenting below-the-knee artery disease (PAD) was carried out. Only patients treated with endovascular techniques as first choice treatment were evaluated. Outcome measured was perioperative mortality and morbidity. Freedom from occlusion, secondary patency and amputation rate were all registered. Additional maneuvers including stenting or angioplasty with drug eluting balloon (DEB) were reported. A total of 167 (101 male/66 female) patients with a mean age of 71 years were included in the study. A Rutherford 3, 4, 5 and 6 categories were reported in 5, 7, 110 and 45 patients, respectively. No perioperative mortality was reported. Morbidity occurred in 4 (4.4%) cases and consisted of pseudoaneurysm. Additional stenting during first procedure was required in 7 (4%) patients, drug eluting balloon was needed in 56 (33%) patients. At 1-year follow-up, estimated freedom from occlusion and secondary patency was 70% and 80% respectively. Major amputation rate was 2.4%, minor amputation rate was 41.9%. In our experience, extreme revascularization in search of distal direct flow reduce the rate of amputations with an increase in ulcer healing. New materials and techniques such as drug eluting technology, used properly, can improve outcome.
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Affiliation(s)
- E Dinoto
- Vascular Surgery Unit "P. Giaccone" Hospital
| | - F Pecoraro
- Vascular Surgery Unit "P. Giaccone" Hospital
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo; Palermo, Italy
| | - D Mirabella
- Vascular Surgery Unit "P. Giaccone" Hospital
| | - F Ferlito
- Vascular Surgery Unit "P. Giaccone" Hospital
| | - A Farina
- Vascular Surgery Unit "P. Giaccone" Hospital
| | - N Lo Biundo
- Vascular Surgery Unit "P. Giaccone" Hospital
| | | | - G Bajardi
- Vascular Surgery Unit "P. Giaccone" Hospital
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo; Palermo, Italy
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Chadwick P, Ousey K. Bacterial-binding dressings in the management of wound healing and infection prevention: a narrative review. J Wound Care 2019; 28:370-382. [DOI: 10.12968/jowc.2019.28.6.370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this review was to present the clinical data on the use of the family of bacterial-binding dressings (Sorbact; dialkylcarbamoyl chloride-coated) in the treatment of a variety of acute and chronic wounds. The findings are discussed in terms of the effectiveness of the bacterial-binding dressings on bacterial bioburden reduction, infection prevention, initiation/progression of wound healing and cost-effectiveness. The evidence in support of the bacterial-binding dressings is strongest in the area of infection prevention in surgical wounds, with several controlled trials showing the prophylactic benefit of the dressing in these wounds. Wound bioburden management in chronic wounds is supported by a number of clinical studies. In total, 29 published clinical studies (with a total of 4044 patients) were included in this review.
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Affiliation(s)
- Paul Chadwick
- Clinical Director, The College of Podiatry, Quartz House, 207 Providence Square, Mill Street, London, SE1 2EW
| | - Karen Ousey
- Professor of Skin Integrity, Professor and Director of the Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield
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Barwick AL, Hurn SE, van Netten JJ, Reed LF, Lazzarini PA. Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study. PLoS One 2019; 14:e0211140. [PMID: 30789920 PMCID: PMC6383933 DOI: 10.1371/journal.pone.0211140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/08/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population. METHODS This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups. RESULTS Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05). CONCLUSIONS Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.
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Affiliation(s)
- Alex L. Barwick
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jaap J. van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Footmotion Podiatry Brisbane, Queensland, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- * E-mail:
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Al-Ayed MY, Ababneh M, Robert AA, Salman A, Al Saeed A, Al Dawish MA. Evaluation of Risk Factors Associated with Diabetic Foot Ulcers in Saudi Arabia. Curr Diabetes Rev 2019; 15:224-232. [PMID: 30117397 DOI: 10.2174/1573399814666180816165848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 08/08/2018] [Accepted: 08/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers. The selected participants were interviewed and examined, and their medical records were reviewed for sensory, vibratory, and painful neuropathies; vascular insufficiency; retinopathy; and dermatological variations. The Wagner's classification system was employed to evaluate the stage of patients' foot ulcers. RESULTS Among the study participants [mean age range: 56.4 ± 6.72 years; 53 males (65.4%)], cases of loss of protective sensation, foot deformity, amputation history, and dermatological abnormalities were notable. The Wagner gradation value of ulcers were grade 0 for 16% study population, grade 1 for 35.8%, grade 2 for 45.7%, grade 3 for 2.5%, and grades 4 and 5 for 0%. Approximately 19% of the patients had a previous case of amputation and 29.6% had nail disease. The most common footwear reported to be used by the patients was sandals shoes (46%). CONCLUSION The issues of loss of protective sensation, vascular insufficiency, deformity, previous amputations, and dermatological abnormalities of the lower limbs were found to be most common among the foot ulceration patients. The study findings thus recommend regular foot examination, following basic hygiene habits, encouragement of the use of appropriate footwear, patient education about foot ulcers, and prompt treatment for minor injuries to prevent further ulceration in DM patients.
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Affiliation(s)
- Mousab Yousef Al-Ayed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mutasem Ababneh
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Salman
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulghani Al Saeed
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, Cheraghian B, Latifi SM. Prevalence and related risk factors of diabetic foot ulcer in Ahvaz, south west of Iran. Diabetes Metab Syndr 2018; 12:519-524. [PMID: 29602761 DOI: 10.1016/j.dsx.2018.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to evaluate the prevalence of diabetic foot ulcer and its related risk factors. MATERIALS AND METHODS In this descriptive cross-sectional study, 605 patients with diabetes were evaluated in July 2014. A checklist was used to obtain demographic data, diabetes related data, past medical history, and physical examination data. RESULTS The prevalence of diabetic foot ulcer was 6.4% (95% CI: 4.64-8.73). Seventeen cases of them were female (4.9%). In univariate analysis, the following variables had statistically significant relationship with DFU prevalence: diabetes duration, educational level, 10 g monofilament sensation, Ankle Brachial Index (ABI) and Body Mass Index (BMI). Patients' age, glycemic control and smoking did not show any significant relationship with DFU. After logistic regression analysis, the patients with decreased 10 g monofilament sensation had DFU more than patients with normal sensation (OR = 8.84, 95% CI: 3.5-22.3). Abnormal ABI increased the odds of DFU (OR = 5.6, 95% CI: 1.3-24.18). The DFU prevalence in patients with diabetes duration of 11-20 years, was more than patients with ≤5 years (OR = 3.8, 95% CI: 1.33-10.8).The odds of DFU development in educated patients compared with illiterate patients was 0.27(95% CI: 0.12-0.57). BMI had a significant relationship with DFU prevalence. The odds in overweight patients was 0.259(95% CI: 0.108-0.623) and in obese patients was 0.263 (95% CI: 0.1-0.687). CONCLUSION The prevalence of DFU was 6.4% in this study. Final associated risk factors of DFU were decreased 10 g monofilament sensation, abnormal ABI, diabetes duration, educational level and BMI.
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Affiliation(s)
- Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Iraj Nazari
- Department of Vascular Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Reza Arti
- Department of Orthopedic, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Ahmadi
- Infectious Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mahmoud Latifi
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Diabetic Foot Limb Salvage—A Series of 809 Attempts and Predictors for Endovascular Limb Salvage Failure. Ann Vasc Surg 2018; 49:9-16. [DOI: 10.1016/j.avsg.2018.01.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/16/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
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Commons RJ, Raby E, Athan E, Bhally H, Chen S, Guy S, Ingram PR, Lai K, Lemoh C, Lim LL, Manning L, Miyakis S, O'Reilly M, Roberts A, Sehu M, Torda A, Vicaretti M, Lazzarini PA. Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians. J Foot Ankle Res 2018; 11:13. [PMID: 29651304 PMCID: PMC5894166 DOI: 10.1186/s13047-018-0256-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand. Methods A cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians' management practices of patients with DFIs. Results Approximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely. Conclusions Patients with DFIs represent a significant proportion of an ID clinician's caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.
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Affiliation(s)
- Robert J Commons
- 1Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Tiwi, Casuarina, Northern Territory Australia
| | - Edward Raby
- 2Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA Australia
| | - Eugene Athan
- 3Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, VIC Australia
| | - Hasan Bhally
- 4Department of Infectious Diseases, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Sharon Chen
- 5Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, The University of Sydney, Westmead, NSW Australia
| | - Stephen Guy
- 6Department of Infectious Diseases, Western Health, 160 Gordon St, Footscray, VIC Australia.,7Department of Medicine, Melbourne Medical School - Western Precint, The University of Melbourne, St Albans, VIC Australia
| | - Paul R Ingram
- 2Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA Australia.,8School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA Australia
| | - Katy Lai
- 9Department of Infectious Diseases, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW Australia
| | - Chris Lemoh
- 10Monash Infectious Diseases, Dandenong Hospital, 135 David St, Dandenong, VIC Australia
| | - Lyn-Li Lim
- 11Department of Infectious Diseases, Eastern Health, 8 Arnold St, Box Hill, VIC Australia
| | - Laurens Manning
- 12School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, PO Box 404, Bull Creek, WA Australia
| | - Spiros Miyakis
- 13Department of Infectious Diseases, The Wollongong Hospital, Loftus St, Wollongong, NSW Australia
| | - Mary O'Reilly
- 11Department of Infectious Diseases, Eastern Health, 8 Arnold St, Box Hill, VIC Australia
| | - Adam Roberts
- 14Department of Endocrinology, University Hospital Geelong, Bellerine St, Geelong, VIC Australia
| | - Marjoree Sehu
- 15Infection Management Service, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD Australia.,16University of Queensland, St Lucia, QLD Australia
| | - Adrienne Torda
- 17Department of Infectious Diseases, Prince of Wales Hospital, Barker St, Randwick, NSW Australia
| | - Mauro Vicaretti
- 18Department of Vascular Surgery, Westmead Hospital, Hawkesbury Rd & Darcy Rd, Westmead, NSW Australia
| | - Peter A Lazzarini
- 19School of Clinical Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD Australia
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van Netten JJ, Lazzarini PA, Armstrong DG, Bus SA, Fitridge R, Harding K, Kinnear E, Malone M, Menz HB, Perrin BM, Postema K, Prentice J, Schott KH, Wraight PR. Diabetic Foot Australia guideline on footwear for people with diabetes. J Foot Ankle Res 2018; 11:2. [PMID: 29371890 PMCID: PMC5769299 DOI: 10.1186/s13047-017-0244-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. Methods We reviewed new footwear publications, (inter)national guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. Result We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate- or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate- or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate- or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. Conclusions This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes.
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Affiliation(s)
- Jaap J van Netten
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
| | - Peter A Lazzarini
- 1School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia.,Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - David G Armstrong
- 5Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ USA
| | - Sicco A Bus
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Robert Fitridge
- Diabetic Foot Australia, Brisbane, QLD Australia.,7Vascular Surgery, The University of Adelaide, Adelaide, South Australia Australia
| | - Keith Harding
- 8University Dean of Clinical Innovation, Professor of Wound Healing Research, Cardiff University, Cardiff, UK
| | - Ewan Kinnear
- Diabetic Foot Australia, Brisbane, QLD Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD Australia
| | - Matthew Malone
- Diabetic Foot Australia, Brisbane, QLD Australia.,9High Risk Foot Service, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW Australia
| | - Hylton B Menz
- 10Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC Australia
| | - Byron M Perrin
- Diabetic Foot Australia, Brisbane, QLD Australia.,11La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC Australia
| | - Klaas Postema
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jenny Prentice
- Diabetic Foot Australia, Brisbane, QLD Australia.,Wound Consultant, Trojan Health, Perth, WA Australia
| | - Karl-Heinz Schott
- 14School of Health and Human Sciences (Pedorthics) Southern Cross University Gold Coast Campus, Bilinga, QLD Australia
| | - Paul R Wraight
- Diabetic Foot Australia, Brisbane, QLD Australia.,15Diabetic Foot Unit, Royal Melbourne Hospital, Melbourne, VIC Australia
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Toscano CM, Sugita TH, Rosa MQM, Pedrosa HC, Rosa RDS, Bahia LR. Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010089. [PMID: 29316689 PMCID: PMC5800188 DOI: 10.3390/ijerph15010089] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 12/30/2022]
Abstract
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
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Affiliation(s)
- Cristiana M Toscano
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Tatiana H Sugita
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Michelle Q M Rosa
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | | | - Roger Dos S Rosa
- Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Luciana R Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
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Affiliation(s)
| | | | - Aditi Kashikar
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Abha Mehndiratta
- Global Health and Development Group, Imperial College London, St Mary's Hospital, London, UK
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The validity and reliability of remote diabetic foot ulcer assessment using mobile phone images. Sci Rep 2017; 7:9480. [PMID: 28842686 PMCID: PMC5573347 DOI: 10.1038/s41598-017-09828-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/31/2017] [Indexed: 12/15/2022] Open
Abstract
Despite their potential for telemedicine in diabetic foot ulcer treatment, diagnostic accuracy of assessment of diabetic foot ulcers using mobile phone images is unknown. Our aim was to determine the validity and reliability of remote diabetic foot ulcer assessment using mobile phone images. Fifty diabetic foot ulcers were assessed live and photographed. Five independent observers remotely assessed the mobile phone images twice for presence of nine clinical characteristics and three treatment decisions. Positive likelihood (LLR+) and negative likelihood (LLR−) ratios were calculated for validity. Multirater Randolph’s and bi-rater Bennet kappa values were calculated for reliability. LLR+ ranged from 1.3–4.2; LLR− ranged from 0.13–0.88; the treatment decision ‘peri-wound debridement’ was the only item with ‘strong diagnostic evidence’. Inter-observer reliability kappa ranged from 0.09–0.71; test-retest reliability from 0.45–0.86; the treatment decision ‘peri-wound debridement’ was the only item with ‘adequate agreement’. In conclusion, mobile phone images had low validity and reliability for remote assessment of diabetic foot ulcers and should not be used as a stand-alone diagnostic instrument. Clinicians who use mobile phone images in clinical practice should obtain as much additional information as possible when making treatment decisions based on these images, and be cautious of the low diagnostic accuracy.
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van Netten JJ, Baba M, Lazzarini PA. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol. Syst Rev 2017; 6:101. [PMID: 28521817 PMCID: PMC5437559 DOI: 10.1186/s13643-017-0488-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/28/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person's quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia. METHODS-SEARCH The systematic review will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and EMBASE will be searched for publications in any language and without restrictions to date. Two independent investigators will screen publications for eligibility, with publications reporting Australian population-based incidence or prevalence of diabetic foot disease or diabetes-related lower-extremity amputation to be included. Additionally, a forward literature search will be performed in Google Scholar, and a grey literature search will be performed to identify government publications. METHODS-ASSESSMENT Quality assessment will be performed using customised checklists. The summary statistic used for each study will be an incidence or prevalence proportion of diabetic foot disease or diabetes-related lower-extremity amputation. The standard error for each proportion will be calculated. A meta-analysis will be performed when three or more publications of adequate quality, reporting on similar outcomes and in similar populations, are identified. DISCUSSION The results of this systematic review can be used to adequately inform stakeholders in the field of diabetic foot disease on the extent of the problem in incidence and prevalence of diabetic foot disease in Australia, and to help guide appropriate use of resources to reduce the burden of this disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016050740.
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Affiliation(s)
- Jaap J. van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia
- Diabetic Foot Australia, West End, QLD 4101 Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
| | | | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD Australia
- Diabetic Foot Australia, West End, QLD 4101 Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, QLD Australia
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Jia L, Parker CN, Parker TJ, Kinnear EM, Derhy PH, Alvarado AM, Huygens F, Lazzarini PA. Incidence and risk factors for developing infection in patients presenting with uninfected diabetic foot ulcers. PLoS One 2017; 12:e0177916. [PMID: 28545120 PMCID: PMC5435321 DOI: 10.1371/journal.pone.0177916] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/05/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE There is a paucity of research on patients presenting with uninfected diabetic foot ulcers (DFU) that go on to develop infection. We aimed to investigate the incidence and risk factors for developing infection in a large regional cohort of patients presenting with uninfected DFUs. METHODS We performed a secondary analysis of data collected from a validated prospective state-wide clinical diabetic foot database in Queensland (Australia). Patients presenting for their first visit with an uninfected DFU to a Diabetic Foot Service in one of thirteen Queensland regions between January 2012 and December 2013 were included. Socio-demographic, medical history, foot disease history, DFU characteristics and treatment variables were captured at the first visit. Patients were followed until their DFU healed, or if their DFU did not heal for 12-months, to determine if they developed a foot infection in that period. RESULTS Overall, 853 patients were included; mean(standard deviation) age 62.9(12.8) years, 68.0% male, 90.9% type 2 diabetes, 13.6% indigenous Australians. Foot infection developed in 342 patients for an overall incidence of 40.1%; 32.4% incidence in DFUs healed <3 months, 55.9% in DFUs healed between 3-12 months (p<0.05). Independent risk factors (Odds Ratio (95% confidence interval)) for developing infection were: DFUs healed between 3-12 months (2.3 (1.6-3.3)), deep DFUs (2.2 (1.2-3.9)), peripheral neuropathy (1.8 (1.1-2.9)), previous DFU history (1.7 (1.2-2.4)), foot deformity (1.4 (1.0-2.0)), female gender (1.5 (1.1-2.1)) and years of age (0.98 (0.97-0.99)) (all p<0.05). CONCLUSIONS A considerable proportion of patients presenting with an uninfected DFU will develop an infection prior to healing. To prevent infection clinicians treating patients with uninfected DFUs should be particularly vigilant with those presenting with deep DFUs, previous DFU history, peripheral neuropathy, foot deformity, younger age, female gender and DFUs that have not healed by 3 months after presentation.
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Affiliation(s)
- Limin Jia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Endocrinology, Ningxia People’s Hospital, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Christina N. Parker
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tony J. Parker
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ewan M. Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Patrick H. Derhy
- Clinical Access and Redesign Unit, Queensland Health, Brisbane, Queensland, Australia
| | - Ann M. Alvarado
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Flavia Huygens
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter A. Lazzarini
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. Foot Complications in a Representative Australian Inpatient Population. J Diabetes Res 2017; 2017:4138095. [PMID: 29164152 PMCID: PMC5661067 DOI: 10.1155/2017/4138095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
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Affiliation(s)
- Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Suzanne S. Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Faculty of Health Sciences, School of Physiotherapy, Australian Catholic University, Brisbane, QLD, Australia
| | - Maarten C. Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD, Australia
| | - Ewan M. Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Michael C. d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J 2016; 14:716-728. [PMID: 27696693 DOI: 10.1111/iwj.12683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self-reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) [95% confidence interval (CI):7·2-11·3%] had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes-related literature. The overall inpatient foot disease burden is similar in size to well-known medical conditions and should receive similar attention.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD,, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD,, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD,, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD,, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD,, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Michael C d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Gait parameters of people with diabetes-related neuropathic plantar foot ulcers. Clin Biomech (Bristol, Avon) 2016; 37:98-107. [PMID: 27389946 DOI: 10.1016/j.clinbiomech.2016.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot ulceration associated with diabetic peripheral neuropathy is a global concern. Biomechanical investigation allows the identification of gait abnormalities that may adversely affect ulcer healing. The objective of this case-control study was to compare the gait parameters of cases with diabetes-related foot ulcers to controls. METHODS Three-dimensional movement analyses were performed on 21 people with diabetes-related neuropathic plantar foot ulcers (cases), 69 people with diabetes without a foot ulcer history (diabetes controls) and 56 healthy controls. Outcome data were reported as mean differences, 95% confidence intervals and Cohen's d effect sizes. Binary logistic regressions were used to adjust for age, sex and body mass index. FINDINGS People with foot ulcers had a smaller plantar flexion (Cohen's d=-0.6 vs. diabetes controls and d=-0.8 vs. healthy controls), knee flexion (d=-0.6 vs. diabetes controls and d=-1.0 vs. healthy controls) and pelvic obliquity (d=-0.9 vs. diabetes controls and d=-0.7 vs. healthy controls) (all P<0.05). They also had a significantly greater range of anterior-posterior ground reaction force (d=1.0 vs. diabetes controls and d=1.7 vs. healthy controls) and total vertical ground reaction force (d=0.9 vs. diabetes controls and d=1.1 vs. healthy controls) and significantly slower walking speed and smaller step length compared to controls (all P<0.05). INTERPRETATION People with plantar foot ulcers have considerably different gait parameters to controls. Whether the observed gait parameters contributed to the ulcer development or are a response to the ulcer is currently unclear and needs further investigation.
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Kinnear EM, d'Emden MC, Reed L. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open 2016; 6:e010811. [PMID: 27324710 PMCID: PMC4916592 DOI: 10.1136/bmjopen-2015-010811] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. METHODS Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. RESULTS Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). CONCLUSIONS This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Ng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, Queensland, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Michael C d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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