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Frescos N, Stopher L, Jansen S, Kaminski MR. The financial burden of diabetes-related foot disease in Australia: a systematic review. J Foot Ankle Res 2023; 16:92. [PMID: 38151723 PMCID: PMC10751954 DOI: 10.1186/s13047-023-00688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. METHODS Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. RESULTS Three economic evaluations were included in the review. One study was rated as 'poor', one as 'very good' and one as 'excellent' when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. CONCLUSION There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. TRIAL REGISTRATION PROSPERO Registration No. CRD42022290910.
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Affiliation(s)
- Nicoletta Frescos
- Austin Health, Melbourne, VIC, Australia.
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - Lucy Stopher
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Shirley Jansen
- Sir Charles Gairdner Hospital, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Department of Podiatry, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied healthcare, Monash University, Melbourne, VIC, Australia
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Sadler S, Gerrard J, Searle A, Lanting S, West M, Wilson R, Ginige A, Fang KY, Chuter V. The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review. J Med Internet Res 2023; 25:e47608. [PMID: 37792467 PMCID: PMC10585435 DOI: 10.2196/47608] [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: 03/26/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. OBJECTIVE This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. METHODS PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. RESULTS No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33%) provided functionality for participants to enter health-related data; 1 (17%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. CONCLUSIONS The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. TRIAL REGISTRATION PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd.
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Affiliation(s)
- Sean Sadler
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
| | - James Gerrard
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
- Central Australian Aboriginal Congress, Mparntwe (Alice Springs), Australia
| | | | - Sean Lanting
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
| | - Matthew West
- Western Sydney University, Campbelltown, Australia
| | - Rhonda Wilson
- University of Newcastle, Gosford, Australia
- Massey University, Auckland, New Zealand
| | | | - Kerry Y Fang
- Western Sydney University, Campbelltown, Australia
| | - Vivienne Chuter
- Western Sydney University, Campbelltown, Australia
- University of Newcastle, Ourimbah, Australia
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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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McNeil S, Waller K, Poy Lorenzo YS, Mateevici OC, Telianidis S, Qi S, Churilov I, MacIsaac RJ, Galligan A. Detection, management, and prevention of diabetes-related foot disease in the Australian context. World J Diabetes 2023; 14:942-957. [PMID: 37547594 PMCID: PMC10401446 DOI: 10.4239/wjd.v14.i7.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023] Open
Abstract
Diabetes-related foot disease (DFD) is a widely feared complication among people who live with diabetes. In Australia and globally, rates of disability, cardio-vascular disease, lower extremity amputation, and mortality are significantly increased in patients with DFD. In order to understand and prevent these outcomes, we analyse the common pathogenetic processes of neuropathy, arterial disease, and infection. The review then summarises important management considerations through the interdisciplinary lens. Using Australian and international guidelines, we offer a stepwise, evidence-based practical approach to the care of patients with DFD.
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Affiliation(s)
- Scott McNeil
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Kate Waller
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Podiatry, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Yves S Poy Lorenzo
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Infectious Diseases Unit, Department of Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Pharmacy, St Vincent’s Hospital Melbourne, Fitzroy 3065, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
| | - Olimpia C Mateevici
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Infectious Diseases Unit, Department of Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Stacey Telianidis
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Vascular Surgery, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Sara Qi
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Vascular Surgery, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Irina Churilov
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Rehabilitation Medicine, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
| | - Richard J MacIsaac
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, University of Melbourne, Fitzroy 3065, Victoria, Australia
- the Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Anna Galligan
- High Risk Foot Service, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
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Sadler S, Gerrard J, West M, Lanting S, Charles J, Searle A, Chuter V. Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health: a systematic review. J Foot Ankle Res 2022; 15:55. [PMID: 35869536 PMCID: PMC9308327 DOI: 10.1186/s13047-022-00557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence, within the domain of lower limb health, foot disease has severe impacts for First Nations Peoples. Central to developing culturally safe healthcare and driving positive foot health change for First Nations Peoples, is the need for health professionals to develop understanding of First Nations perspectives of foot health. The aim of this systematic review was to evaluate studies investigating Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health.
Methods
PubMeD, Ovid (Embase, Emcare, Medline), CINAHL, Informit Indigenous collection, and grey literature sources were searched to 23rd July 2021. We included any published reports or studies that examined Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health, or meanings of, or attitudes to, foot and lower limb health.
Results
Four studies with a total of 1515 participants were included. Studies found that Aboriginal and Torres Strait Islander people self-assessed foot health with a demonstrated ability to perceive their feet as healthy relative to Western clinical measures of peripheral blood supply and neurological function. Footwear, including ill-fitting or lack of footwear was considered a contributing factor to reduced foot and lower limb health. Foot pain affected up to 60% of participants with up to 70% of foot pain untreated. Lack of access to culturally safe health care delivered by culturally capable health professionals was perceived to contribute to worse foot and lower limb health outcomes.
Conclusions
Aboriginal and Torres Strait Islander Peoples’ perceptions of foot and lower limb health are influenced by multiple complex interrelated factors. The limited number of studies in this area indicates ongoing failings to consult First Nations Peoples regarding their own lower limb and foot health. It is therefore essential that healthcare service and cultural capability implementation is led by Aboriginal and Torres Strait Islander Peoples in co-design. Urgent need for further research that exemplifies design and delivery of culturally safe care is required.
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Abey S, Anil K, Hendy P, Demain S. The application, character, and effectiveness of person-centred care with service-users, and the community within the discipline of podiatry: a scoping review. J Foot Ankle Res 2022; 15:63. [PMID: 35986405 PMCID: PMC9389826 DOI: 10.1186/s13047-022-00566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background The concept of person-centred care is embedded within healthcare policy, focusing on long-term conditions and multimorbidity. The evidence that person-centred care is being operationalised effectively across all areas of healthcare is limited. The aim of this scoping review was to explore the application, features, and effectiveness of person-centred care with service-users, carers, and the community within podiatry. Methods The scoping review was based upon Arksey and Malley’s five stage framework. The following databases were searched between January 2010 and March 2021: AMED, CINAHL, Embase, Cochrane library, SocINDEX, British Education Index, Business Source Complete, MEDLINE (EBSCO), and the EThOS 'Global electronic thesis and dissertation' repository, Prospero, and reference lists of included papers. Primary research articles were included if they reported on a person-centred care focused intervention with podiatry. Research terms were developed, appropriate databases identified, and an initial search resulted in 622 papers which, following removal of duplicates and critical appraisal, resulted in 18 eligible papers. Data extracted involved the types of person-centred care utilised, intervention details, motivations for engaging in person-centred care interventions, and intervention barriers and challenges. Results Eighteen articles were included in the review. The main type of person-centred care utilised was patient/carer activities around self-management. None of the studies considered the role of the podiatrist as a person-centred care agent. The data on interventions generated the following themes ‘service facilitated person-centred care’ where a change has been made to service delivery, ‘direct clinician delivery’ where the intervention is delivered by the clinician with the patient present and ‘patient instigated participation’ where patient motivation is required to engage with an activity beyond the consultation. Outcome measures associated with quality of care and effectiveness were absent. Conclusion There is a lack of congruency between the concept of person-centred care and how it is operationalised. A whole system approach that considers commissioning, organisational leadership, the role of the practitioners and patients has not been considered. There is immense scope for the podiatrist to play an important part in the personalised-care agenda, but currently research that can evidence the effectiveness of person-centred care in podiatry is absent. Review registration Open Science Framework (osf.io/egjsd).
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Kuang B, Dean A, Frank G, Aitken SJ. Innovative and accessible multidisciplinary care is needed to improve diabetes-related foot disease outcomes in Australia and New Zealand. ANZ J Surg 2022; 92:644-645. [PMID: 35434956 DOI: 10.1111/ans.17582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anastasia Dean
- Auckland Regional Vascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Georgina Frank
- Sydney Local Health District Podiatry and High Risk Foot Services, Concord and Royal Prince Alfred Hospitals, Sydney, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Institute Academic Surgery, Vascular Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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West M, Sadler S, Charles J, Hawke F, Lanting S, Munteanu SE, Chuter V. Yarning about foot care: evaluation of a foot care service for Aboriginal and Torres Strait Islander Peoples. J Foot Ankle Res 2022; 15:25. [PMID: 35369890 PMCID: PMC8978452 DOI: 10.1186/s13047-022-00524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Peoples have high rates of diabetes-related foot disease including foot ulcer and amputation. There has been limited evaluation of foot care services for Aboriginal and Torres Strait Islander Peoples. This project aimed to evaluate an Aboriginal and Torres Strait Islander foot care service (the Buridja Clinic) for prevention and management of diabetes-related foot disease embedded in a university podiatry program from a Community perspective using culturally appropriate methods. Methods This mixed-methods study took place from March 2018 to April 2021 in the Buridja Clinic on the Central Coast of New South Wales, Australia, and included an audit of occasions of service (March 2018 to March 2020), and review of the Buridja Clinic via research yarns with Aboriginal and Torres Strait Islander clients of the clinic and a written 10-item customised clinic feedback survey. Research yarns were transcribed and analysed thematically. Descriptive analysis of quantitative occasions of use and survey data was undertaken, with the open-ended survey responses thematically analysed. Results Total occasions of service across the review period was 548, with a total of 199 individual clients treated. Most common service types were general treatments (nail and skin care) and diabetes assessments. Nine participants who attended the Buridja Clinic were recruited to the two research yarns. An additional 52 participants who attended the clinic completed the customised clinic feedback survey. Specific clinic design elements, including yarning circles and group booking as well as student placement, were identified as strengths of the clinic. Participants reported difficulty with transport and restricted opening hours and encouraged increased Community engagement by clinic staff. Conclusion Evaluation of a foot care service for Aboriginal and Torres Strait Islander Peoples embedded in a university-based podiatry program demonstrated that the incorporation of specific service design elements, including yarning circles and group appointments as well as student placements, encouraged ongoing Community engagement with the service. Participants reported improved foot health, greater foot and self-care knowledge, and overall better general health and management as a result of attendance to the clinic. Consideration needs to be given to addressing limited access to transport and flexible operating hours when establishing similar services. Graphical abstract ![]()
Artist Jenni McEwen (Bundjalung) lives on Darkinjung Country. The story of her art shows people sitting in yarning circles sharing knowledges but looking outwards to connect with Country too, the Ochre of Wiradjuri Country around Wellington, and the Blue of Darkinjung Country around Central Coast. These are locations where podiatry service provision takes place. These are locations where everyone is sharing and learning. Students, teachers, patients, non-Indigenous people, and First Nations people, learning from each other, and learning from Country. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00524-9.
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Gerrard JM, Godwin S, Chuter V, Munteanu SE, West M, Hawke F. Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary. J Foot Ankle Res 2021; 14:38. [PMID: 33971934 PMCID: PMC8108329 DOI: 10.1186/s13047-021-00466-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Developing since colonisation, Australia's healthcare system has dismissed an ongoing and successful First Nations health paradigm in place for 60,000 years. From Captain James Cook documenting 'very old' First Nations Peoples being 'far more happier than we Europeans' and Governor Arthur Phillip naming Manly in admiration of the physical health of Gadigal men of the Eora Nation, to anthropologist Daisy Bates' observation of First Nations Peoples living 'into their eighties' and having a higher life expectancy than Europeans; our healthcare system's shameful cultural safety deficit has allowed for an Aboriginal and Torres Strait Islander child born in Australia today to expect to live 9 years less than a non-Indigenous child. Disproportionately negative healthcare outcomes including early onset diabetes-related foot disease and high rates of lower limb amputation in Aboriginal and Torres Strait Islander Peoples contribute to this gross inequity. MAIN BODY In 2020, the Australian Health Practitioner Regulation Authority released the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 - empowering all registered health practitioners within Australia to provide health care to Aboriginal and Torres Strait Islander Peoples that is inclusive, respectful and safe, as judged by the recipient of care. This recently released strategy is critically important to the podiatry profession in Australia. As clinicians, researchers and educators we have a collective responsibility to engage with this strategy of cultural safety. This commentary defines cultural safety for podiatry and outlines the components of the strategy in the context of our profession. Discussion considers the impact of the strategy on podiatry. It identifies mechanisms for podiatrists in all settings to facilitate safer practice, thereby advancing healthcare to produce more equitable outcomes. CONCLUSION Aboriginal and Torres Strait Islander Peoples access health services more frequently and have better health outcomes where provision of care is culturally safe. By engaging with the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy, all registered podiatrists in Australia can contribute to achieving equity in health outcomes for Aboriginal and Torres Strait Islander Peoples.
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Affiliation(s)
- James M. Gerrard
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
| | - Shirley Godwin
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, 3552 Australia
| | - Vivienne Chuter
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Shannon E. Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086 Australia
| | - Matthew West
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Fiona Hawke
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ourimbah, NSW 2258 Australia
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West M, Sadler S, Hawke F, Munteanu SE, Chuter V. Effect of a culturally safe student placement on students' understanding of, and confidence with, providing culturally safe podiatry care. J Foot Ankle Res 2021; 14:9. [PMID: 33499892 PMCID: PMC7836510 DOI: 10.1186/s13047-021-00450-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For university-based podiatry education there are little data available documenting the delivery method and impact of Aboriginal and Torres Strait Islander health curricula or the use of, and outcomes from, immersive clinical placements generally or specific to podiatry practice. Therefore, the primary aim of this study was to evaluate the effect of undertaking clinical placement in a culturally safe podiatry service for Aboriginal and Torres Strait Islander Peoples on podiatry students' understanding of, and confidence with, providing culturally safe podiatry care. METHODS Final year University of Newcastle undergraduate podiatry students attending a culturally safe Aboriginal and Torres Strait Islander student clinic at a local hospital were purposively recruited to participate. Students completed a custom-made and pilot-tested cultural awareness and capability survey before and after placement. Survey domains were determined from a principle component analysis. The Wilcoxon Signed Rank test was used to compare pre-placement scores on each domain of the survey to the post-placements scores. Effect sizes were calculated and interpreted as small (0.1-0.29), medium (0.3-0.49), and large (≥0.5). RESULTS This study recruited 58 final year University of Newcastle podiatry students to complete baseline and follow-up surveys. For survey domain 1 (level of understanding of power relationships), domain 2 (level of understanding of the interrelationship between culture and self-perceived health), domain 3 (level of understanding of the importance of culture in clinical practice and access to health care), and domain 4 (level of confidence with providing culturally safe care) a statistically significant (p < 0.05) increase in scores was recorded post-placement. The effect sizes were medium to large. CONCLUSION This study demonstrated that an immersive student placement at a culturally safe podiatry clinic significantly improved students' understanding of, and confidence with, providing culturally appropriate care to Aboriginal and Torres Strait Islander Peoples. This study provides foundation evidence of the role that such placements have on developing students' cultural capability in a tertiary health care setting, and will help inform future curricula development at both educational institutions and health services, as well as form the basis for ongoing research.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Sean Sadler
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Fiona Hawke
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Shannon E. Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308 Australia
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West M, Sadler S, Hawke F, Munteanu SE, Chuter V. Foot health of Aboriginal and Torres Strait Islander Peoples in regional and rural NSW, Australia. J Foot Ankle Res 2020; 13:27. [PMID: 32466778 PMCID: PMC7254749 DOI: 10.1186/s13047-020-00397-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Foot health of Aboriginal and Torres Strait Islander Australians' has not been established. Additionally, studies have shown that there is a lack of engagement of this population with general preventive foot care services. The aim of this study was to establish foot health in Aboriginal and Torres Strait Islander people attending two recently developed, culturally safe podiatry services in rural and regional New South Wales (NSW), Australia. Secondarily the relationship between self-perceived foot health and some medical and demographic characteristics was investigated. METHODS This descriptive cross-sectional study included participants attending the culturally safe foot health care services managed by the University of Newcastle on the Central Coast or in Wellington, both located in NSW, Australia. At the consultation, participants completed the Foot Health Status Questionnaire (FHSQ) with the assistance of an Aboriginal health care worker, underwent basic vascular and neurological screening, and podiatric treatment. RESULTS A total of 111 Aboriginal and Torres Strait Islander Australians (48 from the Central Coast, and 63 from Wellington) were included. FHSQ scores for pain (75.7 ± 26.8), function (80.2 ± 25.2), footwear (53.9 ± 33.4), and general foot health (62.0 ± 30.9) were generally good, but below the optimal score of 100. The presence of diabetes (n = 39 of 111 participants or 35.1%) was associated with lower levels of self-perceived foot function (r = - 0.20, n = 107, p = 0.04). CONCLUSION We found that community-based foot health care services that are culturally safe are utilised by Aboriginal and Torres Strait Islander Peoples not currently at high risk of foot complications. This supports the use of culturally safe foot care services to improve engagement with preventative foot care. Future research should continue to be driven by Aboriginal and Torres Strait Islander Peoples and investigate ways to implement additional screening measures and undertake prospective evaluation of the impact of such services on health related outcomes in these communities.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Sean Sadler
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Fiona Hawke
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Shannon E. Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308 Australia
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Jiang X, Meng W, Li L, Meng Z, Wang D. Adjuvant Therapy With Mushroom Polysaccharides for Diabetic Complications. Front Pharmacol 2020; 11:168. [PMID: 32180724 PMCID: PMC7059129 DOI: 10.3389/fphar.2020.00168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Diabetic complications seriously endanger the health of most diabetic patients around the world. Most chemical hypoglycemic agents have adverse effects and are unable to improve the progression of diabetic complications. In recent years, a number of medicinal herbs have become increasingly popular for the treatment of diabetic complications due to their relative safety. Polysaccharides extracted from medicinal herbs with multiple pharmacological activities and low toxicity have been reported to be useful in the treatment of diabetic complications. Methods Primary studies with keywords including polysaccharide and diabetic complications were retrieved from the Web of Science and NCBI databases and were read and analyzed. Results Mushroom polysaccharides were proven to have positive effects on diabetic complications. Conclusions We studied the effects of mushroom polysaccharides on hyperglycemia and as adjuvant therapies for diabetic complications and summarized the applications and limitations of mushroom polysaccharides to better understand their application for the treatment of diabetic complications.
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Affiliation(s)
- Xue Jiang
- Department of Translational Medicine Research Institute, First Hospital, Jilin University, Changchun, China.,School of Life Sciences, Jilin University, Changchun, China
| | - Weiqi Meng
- School of Life Sciences, Jilin University, Changchun, China
| | - Lanzhou Li
- School of Life Sciences, Jilin University, Changchun, China
| | - Zhaoli Meng
- Department of Translational Medicine Research Institute, First Hospital, Jilin University, Changchun, China
| | - Di Wang
- School of Life Sciences, Jilin University, Changchun, China
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