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Montesi L, Ramírez-Rojas MG, Elizarrarás-Rivas J. Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico. Med Anthropol 2024:1-17. [PMID: 38865593 DOI: 10.1080/01459740.2024.2364241] [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: 06/14/2024]
Abstract
Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.
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Affiliation(s)
| | | | - Jesús Elizarrarás-Rivas
- Health Research Coordination, Mexican Institute of Social Security (IMSS), Oaxaca, Mexico
- Universidad Autónoma Benito Juárez de Oaxaca (UABJO), Oaxaca, Mexico
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2
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Jahan AM, Guitard P, Jutai JW. Psychosocial predictors of mobility assistive devices non-adherence among older adults. Disabil Rehabil Assist Technol 2024:1-9. [PMID: 38393746 DOI: 10.1080/17483107.2024.2320723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.
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Affiliation(s)
- Alhadi M Jahan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Paulette Guitard
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Jeffrey W Jutai
- School of Interdisciplinary Health Sciences and Life Research Institute, University of Ottawa, Ottawa, Canada
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Khan MS, Azam M, Khan MN, Syed F, Ali SHB, Malik TA, Alnasser SMA, Ahmad A, Karimulla S, Qamar R. Identification of contributing factors, microorganisms and antimicrobial resistance involved in the complication of diabetic foot ulcer treatment. Microb Pathog 2023; 184:106363. [PMID: 37730169 DOI: 10.1016/j.micpath.2023.106363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
Diabetic foot ulcer (DFU) is a neurological and peripherical complication of diabetes with unknown etiology that is often associated with polymicrobial infections. The present study was conducted to investigate the contributing factors in 285 DFU patients, which included 200 patients with diabetic foot infections (DFI). Identification and characterization of infecting bacterial isolates were done followed by assessment of their pattern of susceptibility to commonly used antibiotics. Among the studied subjects, type 2 diabetes mellitus (T2DM), ulcer type, depth, grade, loss of sensation, infection type, affected foot, recurrence, smoking status, Body Mass Index (BMI), and obesity levels revealed significant disease risk association. Ulcer grades 1 and 2 were more common in males while grade 3 in females. Recurrent infections were significantly higher in females (P = 0.03). Diabetic duration, hyperglycemia, ulcer type, infection type and BMI were positively correlated with delayed wound healing. In DFI samples, 40.2% consisted of gram-negative bacteria, with Pseudomonas aeruginosa (37.5%) being the most common, while in the 60% gram-positive isolates Staphylococcus aureus (40.5%) was the predominant species. Staphylococcus epidermidis was found more frequently in females (P = 0.05). The isolated bacterial strains presented higher resistance against the tested antibiotics; however, ceftriaxone was effective against most of the pathogens. In the current study T2DM along with diabetes duration, obesity, ulcer severity with polymicrobial infection was found to play a strong role in DFI development, where gender predisposition was also observed in ulcer grade and infection. DFI was correlated with loss of sensation, infection type, affected foot, smoking status, BMI and obesity levels.
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Affiliation(s)
- Muhammad Shakil Khan
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Maleeha Azam
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan.
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-I-Azam University Islamabad, Pakistan
| | - Foha Syed
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Syeda Hafiza Benish Ali
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | | | | | - Ashfaq Ahmad
- Department of Pharmacy Practice, College of Pharmacy, University of Hafr Al Batin, Hafr Al-Batin, 39524, Saudi Arabia
| | - Shaik Karimulla
- Department of Pharmacy Practice, College of Pharmacy, University of Hafr Al Batin, Hafr Al-Batin, 39524, Saudi Arabia
| | - Reheel Qamar
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan; Pakistan Academy of Sciences, Pakistan; Science and Technology Sector, Islamic World Educational, Scientific and Cultural Organization (ICESCO), Rabat, Morocco.
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Abstract
The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management.
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Affiliation(s)
| | | | - David V Coppini
- University Hospitals Dorset NHS Trust, Dorset, UK, and visiting fellow, Bournemouth University, Bournemouth, UK
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Ababneh A, Finlayson K, Edwards H, Armstrong DG, Najafi B, van Netten JJ, Lazzarini PA. The Validity and Reliability of Self-Reported Adherence to Using Offloading Treatment in People with Diabetes-Related Foot Ulcers. SENSORS (BASEL, SWITZERLAND) 2023; 23:4423. [PMID: 37177627 PMCID: PMC10181495 DOI: 10.3390/s23094423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
Adherence to using offloading treatment is crucial to healing diabetes-related foot ulcers (DFUs). Offloading adherence is recommended to be measured using objective monitors. However, self-reported adherence is commonly used and has unknown validity and reliability. This study aimed to assess the validity and reliability of self-reported adherence to using removable cast walker (RCW) offloading treatment among people with DFUs. Fifty-three participants with DFUs using RCWs were included. Each participant self-reported their percentage adherence to using their RCW of total daily steps. Participants also had adherence objectively measured using dual activity monitors. After one week, a subset of 19 participants again self-reported their percentage adherence to investigate test-retest reliability. Validity was tested using Pearson's r and Bland-Altman tests, and reliability using Cohen's kappa. Median (IQR) self-reported adherence was greater than objectively measured adherence (90% (60-100) vs. 35% (19-47), p < 0.01). There was fair agreement (r = 0.46; p < 0.01) and large 95% limits of agreement with significant proportional bias (β = 0.46, p < 0.01) for validity, and minimal agreement for test-retest reliability (K = 0.36; p < 0.01). The validity and reliability of self-reported offloading adherence in people with DFU are fair at best. People with DFU significantly overestimate their offloading adherence. Clinicians and researchers should instead use objective adherence measures.
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Affiliation(s)
- Anas Ababneh
- Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Kathleen Finlayson
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Helen Edwards
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jaap J. van Netten
- Department of Rehabilitation Medicine, 1105 AZ Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation and Development, 1105 AZ Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Peter A. Lazzarini
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
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Iacopi E, Pieruzzi L, Riitano N, Abbruzzese L, Goretti C, Piaggesi A. The Weakness of the Strong Sex: Differences Between Men and Women Affected by Diabetic Foot Disease. INT J LOW EXTR WOUND 2023; 22:19-26. [PMID: 33480296 DOI: 10.1177/1534734620984604] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m2; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P < .001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P = .02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P = .02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P = .03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men.
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Vanherwegen AS, Lauwers P, Lavens A, Doggen K, Dirinck E. Sex differences in diabetic foot ulcer severity and outcome in Belgium. PLoS One 2023; 18:e0281886. [PMID: 36795662 PMCID: PMC9934352 DOI: 10.1371/journal.pone.0281886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Sex differences are increasingly recognized to play an important role in the epidemiology, treatment and outcomes of many diseases. This study aims to describe differences between sexes in patient characteristics, ulcer severity and outcome after 6 months in individuals with a diabetic foot ulcer (DFU). METHODS A total of 1,771 patients with moderate to severe DFU participated in a national prospective, multicenter cohort study. Data were collected on demographics, medical history, current DFU and outcome. For data analysis, a Generalized Estimating Equation model and an adjusted Cox proportional hazards regression were used. RESULTS The vast majority of patients included were male (72%). Ulcers in men were deeper, more frequently displaying probe to bone, and more frequently deeply infected. Twice as many men presented with systemic infection as women. Men demonstrated a higher prevalence of previous lower limb revascularization, while women presented more frequently with renal insufficiency. Smoking was more common in men than in women. No differences in presentation delay were observed. In the Cox regression analysis, women had a 26% higher chance of healing without major amputation as a first event (hazard ratio 1.258 (95% confidence interval 1.048-1.509)). CONCLUSIONS Men presented with more severe DFU than women, although no increase in presentation delay was observed. Moreover, female sex was significantly associated with a higher probability of ulcer healing as a first event. Among many possible contributing factors, a worse vascular state associated with a higher rate of (previous) smoking in men stands out.
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Affiliation(s)
| | - Patrick Lauwers
- Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Astrid Lavens
- Health Services Research, Sciensano, Brussels, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - Eveline Dirinck
- Endocrinology, Diabetology and Metabolism, University Hospital Antwerp, Edegem, Belgium
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McDermott K, Fang M, Boulton AJ, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care 2023; 46:209-221. [PMID: 36548709 PMCID: PMC9797649 DOI: 10.2337/dci22-0043] [Citation(s) in RCA: 119] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022]
Abstract
Diabetic foot ulcers (DFU) are a major source of preventable morbidity in adults with diabetes. Consequences of foot ulcers include decline in functional status, infection, hospitalization, lower-extremity amputation, and death. The lifetime risk of foot ulcer is 19% to 34%, and this number is rising with increased longevity and medical complexity of people with diabetes. Morbidity following incident ulceration is high, with recurrence rates of 65% at 3-5 years, lifetime lower-extremity amputation incidence of 20%, and 5-year mortality of 50-70%. New data suggest overall amputation incidence has increased by as much as 50% in some regions over the past several years after a long period of decline, especially in young and racial and ethnic minority populations. DFU are a common and highly morbid complication of diabetes. The pathway to ulceration, involving loss of sensation, ischemia, and minor trauma, is well established. Amputation and mortality after DFU represent late-stage complications and are strongly linked to poor diabetes management. Current efforts to improve care of patients with DFU have not resulted in consistently lower amputation rates, with evidence of widening disparities and implications for equity in diabetes care. Prevention and early detection of DFU through guideline-directed multidisciplinary care is critical to decrease the morbidity and disparities associated with DFU. This review describes the epidemiology, presentation, and sequelae of DFU, summarizes current evidence-based recommendations for screening and prevention, and highlights disparities in care and outcomes.
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Affiliation(s)
- Katherine McDermott
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew J.M. Boulton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Racaru S, Bolton Saghdaoui L, Roy Choudhury J, Wells M, Davies AH. Offloading treatment in people with diabetic foot disease: A systematic scoping review on adherence to foot offloading. Diabetes Metab Syndr 2022; 16:102493. [PMID: 35468484 DOI: 10.1016/j.dsx.2022.102493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS To identify measurement methods, proportions of adherent participants, factors affecting adherence, and concordance promoting interventions. METHODS A systematic scoping review was conducted by searching Medline, CINAHL, PubMed, EMBASE, and EMCARE databases. RESULTS Twenty-four trials were identified from 1001 citations. Only 25% of the included studies used objective methods to quantify adherence. The proportion of adherent participants (≥80% of daily steps/time) ranged from 28% to 60%. Psychosocial factors are the most common influencers of adherence. However, interventions for improving compliance are lacking. CONCLUSION There is a need to accurately quantify and optimize adherence to foot offloading in people with diabetes.
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Affiliation(s)
- Simona Racaru
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Diabetes Education Centre, 1st Floor, Mint Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Layla Bolton Saghdaoui
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Jaya Roy Choudhury
- Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Mary Wells
- Nursing Directorate, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK
| | - Alun H Davies
- Vascular Research Department, Charing Cross Hospital, Fulham Palace Road, Imperial College Healthcare NHS Trust, London, W6 7RF, UK; Section of Vascular Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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Abstract
Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM). Patients with DFU have increased mortality and morbidity as well as decreased quality of life (QoL). The present scoping review aims to study the social issues of diabetic foot. Following PRISMA guidelines, the review was conducted in two databases (Scopus and Pubmed) with the use of the following keywords: “social aspects and diabetic foot”, “social characteristics and diabetic foot”, “social issues and diabetic foot”, “demographic profiles and diabetic foot”, “social determinants and diabetic foot”, “social capital and diabetic foot”, “social characteristics and gender and diabetic foot”, “social profiles and diabetic foot”, “social relationships and diabetic foot” and “social risk and diabetic foot”, from July to August 2021. Predetermined exclusion and inclusion criteria were selected. Forty-five studies (quantitative and qualitative) were eligible for inclusion in this review. Gender problems, socioeconomic status, social capital, and medical problems were the most important negative variables for diabetic foot. All the included variables reveal that the social impact of diabetic foot is the most important factor for management and prevention, in terms of aggravation and more, of the diabetic foot.
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Zhang X, Wang H, Du C, Fan X, Cui L, Chen H, Deng F, Tong Q, He M, Yang M, Tan X, Li L, Liang Z, Chen Y, Chen D, Armstrong DG, Deng W. Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study. Diabetes Metab Syndr Obes 2022; 15:103-109. [PMID: 35046681 PMCID: PMC8759996 DOI: 10.2147/dmso.s341364] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy's clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions. METHODS A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy. RESULTS Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up. CONCLUSION Patients' adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.
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Affiliation(s)
- Xi Zhang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Hongyan Wang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Xiaoyun Fan
- Department of Endocrinology, Hospital for Occupational Diseases of Chongqing, Chongqing, People’s Republic of China
| | - Long Cui
- Department of Endocrinology, Armed Police Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Heming Chen
- Department of Endocrinology, Ankang Central Hospital, Ankang, Shaanxi, People’s Republic of China
| | - Fang Deng
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, People’s Republic of China
| | - Qiang Tong
- Department of Endocrinology, Chongqing Xinqiao Hospital, Chongqing, People’s Republic of China
| | - Min He
- Department of Endocrinology, The People’s Hospital of Shapingba District, Chongqing, People’s Republic of China
| | - Mei Yang
- Department of Endocrinology, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, People’s Republic of China
| | - Xingrong Tan
- Department of Endocrinology, The 9th People’s Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Lin Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Zerong Liang
- Department of Endocrinology, Chongqing Red Cross Hospital, People’s Hospital of Jiangbei District, Chongqing, 400020, People’s Republic of China
| | - Yaqin Chen
- Department of Endocrinology, The People’s Hospital of Shizhu, Chongqing, People’s Republic of China
| | - Deqing Chen
- Department of Endocrinology, The People’s Hospital of Rongchang, Chongqing, People’s Republic of China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
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Diabetic Foot Ulcer Infections and Pseudomonas aeruginosa Biofilm Production During the COVID-19 Pandemic. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During the different waves of the coronavirus (COVID-19) pandemic, there has been an increased incidence of diabetes mellitus and diabetic foot infections. Among gram-negative bacteria, Pseudomonas aeruginosa is the predominant causative agent for diabetic foot ulcer infections in low-resource countries. P. aeruginosa possesses a variety of virulence factors, including biofilm formation. Biofilm formation is an important benchmark characteristic in the pathophysiology of diabetic foot ulceration. The main objective of the current study was to identify the most commonly isolated organisms and their antibiotic susceptibility patterns in diabetic foot patients during the COVID-19 pandemic. We also determined the genes associated with bacterial persistence and biofilm formation in the predominantly isolated organism. Accordingly, 100 wound swab samples were collected from diabetic foot patients from different hospitals in Alexandria, Egypt. Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers. Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and thus achieve better clinical outcomes in diabetic foot ulcer infections.
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13
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Sorber R, Abularrage CJ. Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. Semin Vasc Surg 2021; 34:47-53. [PMID: 33757635 DOI: 10.1053/j.semvascsurg.2021.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Diabetic foot ulcers (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. As the global incidence of diabetes has increased, along with the lifespan of the diabetic patient, the worldwide burden of DFUs has grown steadily. Outcomes in diabetes and DFUs are known to depend strongly on social determinants of health, with worse outcomes noted in minority and socioeconomically disadvantaged populations. Effective treatment of DFUs is complex, requiring considerable expenditure of resources and significant cost to the health care system. Comprehensive care models with multidisciplinary teams have proven effective in the treatment of DFUs by decreasing barriers to care and increasing access to the multiple specialists required to provide timely and effective DFU procedural intervention, surveillance, and preventative care. Vascular surgeons are an integral part throughout the cycle of care for DFUs and should be involved early in the course of such patients to maximize their contributions to a multidisciplinary care model.
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Affiliation(s)
- Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Halsted 671, 600 N Wolfe Street, Baltimore, MD 21287
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Halsted 671, 600 N Wolfe Street, Baltimore, MD 21287.
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Van Netten JJ, Jarl G, Postema K, Williams AE. A toolkit for prosthetists and orthotists to facilitate progress in professional communication over the next 50 years. Prosthet Orthot Int 2020; 44:408-415. [PMID: 33045902 PMCID: PMC7689560 DOI: 10.1177/0309364620962325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In this celebratory issue of Prosthetics and Orthotics International, we review professional communication skills in the field of prosthetics and orthotics. OBJECTIVE We aim to reflect on communication skills in the past 50 years, to discuss developments in the coming 50 years, and to create a toolkit and research agenda to facilitate progress in professional communication in the next 50 years. RESULTS Despite being a key area in prosthetics and orthotics training programmes, we found no studies on professional communication with an experimental design published in Prosthetics and Orthotics International. As an alternative, we provide clinical reflections on the changes in professional communication in the past 50 years, and we discuss questionnaire-based and qualitative studies that provide evidence for the importance of communication in pedorthic footwear provision. In the coming 50 years, professional communication in the field of prosthetics and orthotics may be impacted by aging populations, global mobility, information technology, technological advances and emphasis on prevention. We discuss each of these topics. To facilitate progress in professional communication, we have created a toolkit with resources for prosthetics and orthotics professionals, prosthetics and orthotics students and other interested professionals. CONCLUSIONS We hope this toolkit will inspire others to use, extend and implement it in their daily practice. As a research agenda, we strongly recommend undertaking research on interventions to improve professional communication and to study its effect on clinically meaningful outcomes.
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Affiliation(s)
- Jaap J Van Netten
- Department of Rehabilitation Medicine and Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Jaap J Van Netten, Department of Rehabilitation Medicine and Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Klaas Postema
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Anita E Williams
- Directorate of Allied and Public Health, School of Health and Society, University of Salford, Salford, UK
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Jarl G, Tranberg R, Johansson U, Alnemo J, Lundqvist LO. Predictors of adherence to wearing therapeutic footwear among people with diabetes. J Foot Ankle Res 2020; 13:45. [PMID: 32660610 PMCID: PMC7359292 DOI: 10.1186/s13047-020-00413-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
Aims People at increased risk of developing diabetic foot ulcers often wear therapeutic footwear less frequently than is desirable. The aims were to identify patient groups prone to nonadherence to wearing therapeutic footwear and modifiable factors associated with adherence. Materials and methods A questionnaire was mailed to 1230 people with diabetes who had been fitted with therapeutic footwear. Independent variables were categorized into five domains. For each domain, variables that were associated with adherence in a univariate regression analysis were entered into a multiple regression analysis. Results A total of 429 (34.9%) questionnaires were analyzed. Multiple regression analyses showed significant associations (p < 0.05) between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear, and a belief that therapeutic footwear promotes ulcer healing. The five multivariate models explained 2–28% of the variance in adherence, with the strategies for footwear use domain explaining the most. Conclusions Patients without paid employment or without foot ulcer experience are more prone to nonadherence. To improve adherence, clinicians should advise patients to store therapeutic footwear in a visible place at home and put conventional footwear away and encourage patients’ self-efficacy and habitual use of therapeutic footwear. Future studies should investigate this topic further and explore ways to promote changes in habits. A study limitation was that all variables were self-reported.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ulf Johansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - John Alnemo
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Ahrary Z, Khosravan S, Alami A, Najafi Nesheli M. The effects of a supportive-educational intervention on women with type 2 diabetes and diabetic peripheral neuropathy: a randomized controlled trial. Clin Rehabil 2020; 34:794-802. [DOI: 10.1177/0269215520914067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To determine the effect of a supportive educational intervention based on the Orem self-care model on women with type 2 diabetes and diabetic peripheral neuropathy. Design: A randomized controlled trial. Setting: Hospital outpatient diabetes clinic. Subjects: Adult women with type 2 diabetes and mild-to-moderate diabetic peripheral neuropathy. Out of 410 patients, 120 diabetic patients were recruited and randomly assigned to trial group ( N = 60) and control group ( N = 60). Intervention: The trial group received a designed intervention consist of one-month supportive educational program with three months of follow-up (totally four months), based on self-care requisites according to the Orem self-care regarding diabetic peripheral neuropathy. The control group only received a routine care program in the diabetes clinic. Main measurements: The main outcomes were symptoms and severity of diabetic neuropathy. Further outcomes were fasting blood sugar and glycosylated hemoglobin. Results: By the end of the intervention, the number of participants reduced from 60 to 58 in the trial group and to 57 in the control group (totally 115). The intervention significantly decreased mean score of diabetic neuropathy symptoms (trial group: 3.26 vs. control group: 9.57, P = 0.001), severity (trial group: 5.86 vs. control group: 9.02, P = 0.001), fasting blood sugar (trial group: 151 vs. control group: 204, P = 0.001), and glycosylated hemoglobin (trial group: 7.85 vs. control group: 8.62, P = 0.004). Conclusion: Delivering a supportive-educational intervention based on the Orem self-care model on outpatient diabetes clinic can decrease the symptoms and severity of diabetic peripheral neuropathy. Trial registration: It was registered in the Iranian Registry of Clinical Trials (IRCT2015021521095N1).
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Affiliation(s)
- Zohre Ahrary
- Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Shahla Khosravan
- Department of Community Health Nursing & Management Nursing, School of Nursing, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Alami
- Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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de Almeida Gonçalves Sachett J, da Silva Montenegro C. Epidemiological profi le of patients with chronic wounds treated by the “Better at
Home Program”. ESTIMA 2019. [DOI: 10.30886/estima.v17.737_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To define the epidemiological profile of patients with chronic wounds treated by the Multidisciplinary Home Care Team (EMAD) of Rio Branco, state of Acre. Methods: This is an exploratory, field study, in which users were enrolled in the Better at Home Program from January to May 2018. The sample of this study was composed of all active patients in the list attended by EMAD in the period comprised from the first visit of the researchers until the moment of exhaustion of the patients for the data collection. All patients of EMAD with wounds were included, totaling the sample of 100 patients. Results: One hundred patients answered a self-administered questionnaire. It was shown that 54% of the participants were men, with age greater than 51 years and mean age of 50 years [standard deviation (SD) = 19.81]. Sixty percent were brown, 36% singles, 52% had income between one and two minimum wages, 34% had incomplete elementary education, and 35% were retired. Of those selected, 80% live in their properties, 70% of which is masonry, water is piped in 74% of the places, and 100% has electricity. About 38% had hypertension, and 31% were diabetic, being the most prevalent diseases. Families were the main responsible for patients’ access to home care (45%). Lower limb injuries were the most prevalent (38%). It was possible to observe a low level of schooling and income in these patients, besides the majority presence of chronic noncommunicable diseases, as well as the importance of families in the search for specialized treatment. Conclusion: For the quicker rehabilitation of the patients, a holistic view is necessary, relating all areas of health and using the interdisciplinary knowledge so that greater treatment effectiveness occurs.
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de Almeida Gonçalves Sachett J, da Silva Montenegro C. Perfil epidemiológico dos pacientes com feridas crônicas atendidos pelo “Programa Melhor em Casa”. ESTIMA 2019. [DOI: 10.30886/estima.v17.737_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: definir o perfil epidemiológico dos pacientes com feridas crônicas atendidos pela Equipe Multidisciplinar de Atenção Domiciliar (EMAD) de Rio Branco, estado do Acre. Métodos: Trata-se de um estudo exploratório, de campo, no qual foram acompanhados usuários contemplados pelo programa Melhor em Casa de janeiro a maio de 2018. A amostra deste estudo foi composta por todos os pacientes ativos na lista de atendidos pela EMAD no período que compreendeu desde a primeira visita dos pesquisadores até o momento de esgotamento dos pacientes para a coleta de dados. Incluíram-se todos os pacientes da EMAD com feridas, totalizando a amostra de 100 pacientes. Resultados: Cem pacientes responderam a um questionário autoaplicado. Mostrou-se que 54% dos participantes eram do sexo masculino, com faixa etária maior que 51 anos e média de idade de 50 anos [desvio-padrão (DP) = 19,81]. Sessenta por cento eram pardos, 36% solteiros, 52% tinham renda entre um e dois salários mínimos, 34% apresentaram ensino fundamental incompleto e 35% eram aposentados. Dentre os selecionados, 80% vivem em imóveis próprios, sendo esses 70% de alvenaria, a água é encanada em 74% dos locais e 100% têm energia elétrica. Sobre sua saúde, 38% tinham hipertensão arterial e 31% eram diabéticos, sendo essas as doenças mais prevalentes. As famílias foram as maiores responsáveis pelo acesso dos pacientes à atenção domiciliar (45%). As lesões de membros inferiores foram as mais prevalentes (38%). Foi possível observar perfil de baixa escolaridade e renda nesses pacientes, além da presença majoritária de doenças crônicas não transmissíveis, bem como a importância das famílias na busca de tratamento especializado. Conclusão: Para a reabilitação mais rápida dos pacientes, é necessária uma visão holística, relacionando todas as áreas da saúde e utilizando o conhecimento interdisciplinar para que ocorra maior efetividade do tratamento.
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